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Evidence-based practice has had a growing impact on chiropractic education and the delivery of chiropractic care. For evidence-based practice to penetrate and transform a profession, the penetration must occur at 2 levels. One level is the degree to which individual practitioners possess the willingness and basic skills to search and assess the literature. Chiropractic education received a significant boost in this realm in 2005 when the National Center for Complementary and Alternative Medicine awarded 4 chiropractic institutions R25 education grants to strengthen their research/evidence-based practice curricula. The second level relates to whether the therapeutic interventions commonly employed by a particular health care discipline are supported by clinical research. A growing body of randomized controlled trials provides evidence of the effectiveness and safety of manual therapies.

Low cost, durable, and selective membranes with high ionic conductivity are a priority need for wide-spread adoption of polymer electrolyte membrane fuel cells (PEMFCs) and direct methanol fuel cells (DMFCs). Electrolyte membranes are a major cost component of PEMFC stacks at low production volumes. PEMFC membranes also impose limitations on fuel cell system operating conditions that add system complexity and cost. Reactant gas and fuel permeation through the membrane leads to decreased fuel cell performance, loss of efficiency, and reduced durability in both PEMFCs and DMFCs. To address these challenges, the U.S. Department of Energy (DOE) Fuel Cell Technologies Program, in the Office of Energy Efficiency and Renewable Energy, supports research and development aimed at improving ion exchange membranes for fuel cells. For PEMFCs, efforts are primarily focused on developing materials for higher temperature operation (up to 120 °C) in automotive applications. For DMFCs, efforts are focused on developing membranes with reduced methanol permeability. In this paper, the recently revised DOE membrane targets, strategies, and highlights of DOE-funded projects to develop new, inexpensive membranes that have good performance in hot and dry conditions (PEMFC) and that reduce methanol crossover (DMFC) will be discussed.

Breast cancer has been redefined into three clinically relevant subclasses: (i) estrogen/progesterone receptor positive (ER+/PR+), (ii) HER2/ERRB2 positive, and (iii) those lacking expression of all three markers (triple negative or basal-like). While targeted therapies for ER+/PR+ and HER2+ tumors have revolutionized patient treatment and increased lifespan, an urgent need exists for identifying novel targets for triple-negative breast cancers. Here, we used integrative genomic analysis to identify candidate oncogenes in triple-negative breast tumors and assess their function through loss of function screening. Using this approach, we identify lactate dehydrogenase B (LDHB), a component of glycolytic metabolism, as an essential gene in triple-negative breast cancer. Loss of LDHB abrogated cell proliferation in vitro and arrested tumor growth in fully formed tumors in vivo. We find that LDHB and other related glycolysis genes are specifically upregulated in basal-like/triple-negative breast cancers as compared with other subtypes, suggesting that these tumors are distinctly glycolytic. Consistent with this, triple-negative breast cancer cell lines were more dependent on glycolysis for growth than luminal cell lines. Finally, we find that patients with breast cancer and high LDHB expression in their tumors had a poor clinical outcome. While previous studies have focused on the ubiquitous role of LDHA in tumor metabolism and growth, our data reveal that LDHB is upregulated and required only in certain cancer genotypes. These findings suggest that targeting LDHB or other components of lactate metabolism would be of clinical benefit in triple-negative breast cancer., (©2012 AACR.)

Objective: The purpose of this study was to evaluate the effects of an evidence-based practice (EBP) curriculum incorporated throughout a chiropractic doctoral program on EBP knowledge, attitudes, and self-assessed skills and behaviors in chiropractic students., Methods: In a prospective cohort design, students from the last entering class under an old curriculum were compared with students in the first 2 entering classes under a new EBP curriculum during the 9th and 11th quarters of the 12-quarter doctoral program at the University of Western States in Portland, OR (n = 370 students at matriculation). Analysis of variance (ANOVA) was performed using a 3-cohort × 2-quarter repeated cross-sectional factorial design to assess the effect of successive entering classes and stage of the students' education., Results: For the knowledge exam (primary outcome), there was a statistically significant cohort effect with each succeeding cohort showing better performance (P < .001); students also performed slightly better in the 11th quarter than in the 9th quarter (P < .05). A similar pattern in cohort and quarter effects was found with behavior self-appraisal for greater time accessing databases such as PubMed. Student self-appraisal of their skills was higher in the 11th than the 9th quarter. All cohorts rejected a set of sentinel misconceptions about application of scientific literature (practice attitudes)., Conclusions: The implementation of the EBP curriculum at this institution resulted in acquisition of knowledge necessary to access and interpret scientific literature, the retention and improvement of skills over time, and the enhancement of self-reported behaviors favoring use of quality online resources., (Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.)

Objective: The primary goal of this study was to determine whether exposure to endovascular simulator training increases interest in vascular surgery among medical students. Secondary goals were to determine whether interest in vascular surgery is inversely related to the time after exposure, to identify factors associated with interest, and to identify students' characteristics that positively influence performance metrics., Methods: This was a prospective, randomized, crossover study comprising 80 medical students who were randomized into group A (n = 40) and group B (n = 40). Participants completed a survey of their interest in vascular surgery and attitudinal factors using Vascular Surgery Interest Form (VSIF) before exposure to the simulator (pretest). At 1 month after exposure of group A to the simulator, both groups were tested using VSIF (test). Upon completion of testing, group B was exposed to simulator training, whereas group A received no further training. At 2 months after exposure of group B to the simulator, both groups were posttested using VSIF, which asked the students' level of interest in vascular surgery using a 1 to 10 scale. Performance metrics were recorded during each exposure. Differences among cohort demographics were determined using Pearson χ(2) analysis. Differences in interest were determined with paired sample correlations. Linear regression and analysis of variance were used to correlate VSIF responses with interest and the performance metrics., Results: Both student cohorts had significant increases in interest after exposure to simulation. In group A, test interest (mean ± standard deviation) was significantly higher than pretest and posttest interests (5.51 ± 1.73 vs 4.00 ± 1.88 vs 4.18 ± 1.82; P < .05). In group B, posttest interest was significantly higher than pretest and test interests (5.62 ± 2.03 vs 3.96 ± 1.61 vs 4.08 ± 1.64; P < .05). The increase in interest was reciprocally related to the time passed since the initial exposure. Resident and attending lifestyle, length of training, radiation concerns, gender identification of a mentor, and personality fit with occupation were not correlated with interest. Sex, medical school year, comfort with endovascular procedures, willingness to work long hours, interest in performing percutaneous procedures, and commitment to surgical career did not affect impact performance metrics., Conclusions: One exposure of students to endovascular simulator training is associated with an increase in vascular surgery interest. Acquired interest is reciprocally related to the time demonstrating the temporal importance of the exposure., (Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

During cell division, cells form the microtubule-based mitotic spindle, a highly specialized and dynamic structure that mediates proper chromosome transmission to daughter cells. Cancer cells can show perturbed mitotic spindles and an approach in cancer treatment has been to trigger cell killing by targeting microtubule dynamics or spindle assembly. To identify and characterize proteins necessary for spindle assembly, and potential antimitotic targets, we performed a proteomic and genetic analysis of 592 mitotic microtubule copurifying proteins (MMCPs). Screening for regulators that affect both mitosis and apoptosis, we report the identification and characterization of STARD9, a kinesin-3 family member, which localizes to centrosomes and stabilizes the pericentriolar material (PCM). STARD9-depleted cells have fragmented PCM, form multipolar spindles, activate the spindle assembly checkpoint (SAC), arrest in mitosis, and undergo apoptosis. Interestingly, STARD9-depletion synergizes with the chemotherapeutic agent taxol to increase mitotic death, demonstrating that STARD9 is a mitotic kinesin and a potential antimitotic target., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Carotid aneurysms are rare, accounting for less than 4% of all aneurysms, and repair of this entity comprises only 0.9% of all carotid procedures at major referral centers. Stroke is the most frequent complication and the possibility of rupture is only rarely considered. Rupture of a nontraumatic, uninfected carotid aneurysm is an exceedingly rare event, with only a handful of cases documented in the world literature, most of which presented as an acute, life-threatening emergency. This report documents the highly unusual circumstance of subacute presentation of a ruptured carotid aneurysm.

In this article, I examine the relationship between homophobic language use and its broader social context, focusing on how a U.S.-based, conservative Christian organization's institutionalized homophobic text-making practices seek to derive legitimacy from the broader political economic discourses associated with the neoliberal moment. Using the Family Research Council's statement on marriage and the family as the basis for analysis, I demonstrate how the organization seeks to represent lesbian and gay subjects and their kinship formations as a threat to human capital development because they are based on affectional relationships that neither reflect nor respond to the kinds of self-governance and marketization that neoliberalism requires of all citizen-subjects and their families. Linguistic strategies for creating such representations include lexical choices that avoid overtly identifying lesbian and gay subjects as the object of discussion, the creation of a taxonomy for what constitutes "proper" families-based on neoliberal principles--that implicitly excludes lesbian and gay kinship formations, and the use of neoliberal discourses of self-governance and marketization as the basis for that exclusion.

This case report highlights an acute deterioration in a previously myelopathic patient who had an almost instantaneous post-operative improvement. It also highlights an unchanged MRI appearance after acute neurological deterioration. The classification of spinal arteriovenous malformations, pathology and clinical presentation, and clinical course post-treatment are also reviewed.

Potent and efficacious inhibitors of the hedgehog pathway for the treatment of cancer have been prepared using the 2-pyridyl biphenyl amide scaffold common to the clinical lead GDC-0449. Analogs with polar groups in the para-position of the aryl amide ring optimized potency, had minimal CYP inhibition, and possessed good exposure in rats. Compounds 9d and 14f potently inhibited hedgehog signaling as measured by Gli1 mRNA and were found to be equivalent or more potent than GDC-0449, respectively, when studied in a Ptch(+/-) medulloblastoma allograft model, that is, highly dependent on hedgehog signaling., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Taxanes are very effective at causing mitotic arrest; however, there is variability among cancer cells in the apoptotic response to mitotic arrest. The variability in clinical efficacy of taxane-based therapy is likely a reflection of this variability in apoptotic response, thus elucidation of the molecular mechanism of the apoptotic response to mitotic stress could lead to improved clinical strategies. To identify genes whose expression influences the rate and extent of apoptosis after mitotic arrest, we screened a kinase-enriched small interfering RNA library for effects on caspase activation in response to maximally effective doses of paclitaxel, a PLK1 inhibitor, or cisplatin. Small interfering RNA oligonucleotides directed against an atypical protein kinase, TP53RK, caused the greatest increase in caspase-3/7 activation in response to antimitotic agents. Time-lapse microscopy revealed that cells entered mitosis with normal kinetics, but died after entry into mitosis in the presence of paclitaxel more rapidly when TP53RK was depleted. Because expression levels of TP53RK vary in cancers, TP53RK levels could provide a molecular marker to predict response to antimitotic agents. TP53RK inhibition may also sensitize cancers to taxanes.

Efforts to identify potent small molecule inhibitors of PI3 kinase and mTOR led to the discovery of the exceptionally potent 6-aryl morpholino thienopyrimidine 6. In an effort to reduce the melting point in analogs of 6, the thienopyrimidine was modified by the addition of a methyl group to disrupt planarity. This modification resulted in a general improvement in in vivo clearance. This discovery led to the identification of GNE-477 (8), a potent and efficacious dual PI3K/mTOR inhibitor., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Payments for ecosystem services (PES) are an increasingly promoted approach to conservation. These approaches seek to develop financial mechanisms that create economic incentives for the maintenance of ecosystems and associated biodiversity by rewarding those who are responsible for provision of ecological services. There are, however, few cases in which such schemes have been used as a strategy for conserving wildlife in developing countries and very few operational examples of such schemes of any sort in sub-Saharan Africa. In savannah ecosystems, large mammal populations generally depend on seasonal use of extensive areas and are widely declining as a result of habitat loss, overexploitation, and policies that limit local benefits from wildlife. Community-based conservation strategies seek to create local incentives for conserving wildlife, but often have limited impact as a result of persistent institutional barriers that limit local rights and economic benefits. In northern Tanzania, a consortium of tourism operators is attempting to address these challenges through an agreement with a village that possesses part of a key wildlife dispersal area outside Tarangire National Park. The operators pay the community to enforce voluntary restrictions on agricultural cultivation and permanent settlement in a defined area of land. The initiative represents a potentially cost-effective framework for community-based conservation in an ecologically important area and is helping to reconcile historically conflicting local and national interests relative to land tenure, pastoralist livelihoods, and conservation. Wider adaptation of payments for ecosystem services approaches to settings where sustaining wildlife populations depends on local stewardship may help address current challenges facing conservation outside state-protected areas in savannah ecosystems in sub-Saharan Africa and other parts of the world.

Background Context: Systematic reviews of randomized controlled trials suggest that spinal manipulative therapy (SMT) is efficacious for care of cervicogenic headache (CGH). The effect of SMT dose on outcomes has not been studied., Purpose: To compare the efficacy of two doses of SMT and two doses of light massage (LM) for CGH., Patient Sample: Eighty patients with chronic CGH., Main Outcome Measures: Modified Von Korff pain and disability scales for CGH and neck pain (minimum clinically important difference=10 on 100-point scale), number of headaches in the last 4 weeks, and medication use. Data were collected every 4 weeks for 24 weeks. The primary outcome was the CGH pain scale., Methods: Participants were randomized to either 8 or 16 treatment sessions with either SMT or a minimal LM control. Patients were treated once or twice per week for 8 weeks. Adjusted mean differences (AMD) between groups were computed using generalized estimating equations for the longitudinal outcomes over all follow-up time points (profile) and using regression modeling for individual time points with baseline characteristics as covariates and with imputed missing data., Results: For the CGH pain scale, comparisons of 8 and 16 treatment sessions yielded small dose effects: |AMD|

Objective: A baseline microbial survey was conducted to identify the microbes present on the headpieces of chiropractic adjusting tables from across the Western States Chiropractic College, Portland, Ore, facilities. This included the instructional adjustive technique laboratories, the student health center, the campus outpatient clinic, and an off-site clinic. The objective of this study was to evaluate the effect of disinfection protocols over time at a chiropractic college., Methods: Four samplings were done for a 12-month period. A total of 69 treatment tables were tested. Sampling was done directly to blood agar (5% sheep blood) plates. Data obtained from the clinic locations were analyzed using linear regression models., Results: Identification of microbes by differential staining and biochemical analysis yielded a variety of gram-positive bacteria in all 4 surveys. The numbers of bacterial colonies decreased in the second survey after changes to disinfection protocols. The number of colonies continued to remain below baseline in the third and fourth surveys. Methicillin-resistant Staphylococcus aureus was found in the clinics in 3 of 4 surveys. Methicillin-resistant S aureus was not detected in the technique laboratories., Conclusions: Various microbes were identified on the headpieces of adjusting tables in the college instructional technique laboratories and college clinics. Changing the disinfection protocols reduced the number of bacteria found in the second survey. In addition, the third and fourth surveys showed fewer bacterial colonies than baseline, suggesting that compliance with disinfection protocols continued over time.

Venous thromboembolism (VTE) continues to be a major source of morbidity and mortality in the United States with an estimated incidence of greater than 600 000 clinically evident cases each year. It results in more than 200 000 deaths per year and is thought to be the number one cause of preventable in-hospital deaths. This review presents the history, pathophysiology, diagnostic considerations, and treatment options for VTE.

Clinical Report: We report the case of a 56 year-old woman who presented with worsening speech and poor seizure control eleven years after undergoing wrapping of a middle cerebral artery aneurysm. Radiological and histological findings were consistent with a muslin granuloma with a large cystic component. The cyst was drained endoscopically and an Omaya reservoir placed. The patient's speech improved and so did their seizure control., Discussion: This is the first case in which this rare complication of aneurysm surgery has caused speech deterioration. This is also the first case in which neuroendoscopy has been successfully employed to obtain tissue for diagnosis and to treat such a lesion.

Background: This study aimed to evaluate the outcomes for consecutive patients with diverticular disease who underwent elective laparoscopic sigmoid colectomy., Methods: Data for this patient population were collected by chart review and analyzed retrospectively., Results: Between December 2001 and March 2007, 200 consecutive patients (93 men and 107 women) with an average age of 55 years were identified. All cases were managed by one of two colorectal surgeons. Of the 200 patients, 158 had recurrent diverticulitis, 20 had fistulas, 12 had abscesses, 8 had strictures, 1 had a mass, and 1 had a bleed. The mean operative time was 159 min, and the conversion rate was 8%. A total of 30 early postoperative complications occurred for 26 patients including wound infection (n = 9), ileus (n = 8), Clostridium difficile colitis (n = 3), urinary retention (n = 3), pelvic abscess (n = 2), deep vein thrombosis and pulmonary embolism (n = 1), pneumonia (n = 1) urinary tract infection (n = 1), anastomotic leak (n = 1), and small bowel obstruction (n = 1). Late complications experienced by 11 patients included Clostridium difficile colitis (n = 3), incisional hernia (n = 3), wound infection (n = 3), wound hematoma (n = 1), and intraabdominal hemorrhage (n = 1)., Conclusions: The authors believe it is feasible to offer elective laparoscopic sigmoid colectomy to all patients with symptomatic diverticular disease despite preoperative risk factors.

Intraoperative gamma probe guidance has become widely utilized for sentinel lymph node dissection in patients with breast cancer and melanoma, using (99m)Tc sulfur colloid. However, new indications are possible and need to continue to be investigated. We report the use during a wedge liver biopsy of a new hand-held gamma probe designed for (123)I intraoperative guidance. The patient studied is a 5-year-old boy with history of stage 4 high-risk neuroblastoma. Anatomic imaging (CT, MRI), (99m)Tc bone scintigraphy and 2-deoxy-2-[F-18]fluoro-d-glucose-positron emission tomography/computed tomography (FDG-PET/CT) were negative, but the (123)I MIBG scintigraphy suggested recurrent liver disease. A decision was made to biopsy these lesions to obtain histopathological confirmation. Intraoperative gamma probe mapping of the liver identified areas with signal above the background, but these were prove to be hemosiderin deposits on histo-pathology examination.

Background: A paper entitled "Core Competencies in Integrative Medicine for Medical School Curricula: A proposal," published in Academic Medicine, stimulated a broad discussion among complementary and alternative medicine (CAM) educators. This discussion led to a formal process for responding to the issues raised by the paper., Methods: Representatives from the Academic Consortium for Complementary and Alternative Health Care (ACCAHC) and the Oregon Collaborative for Complementary and Integrative Medicine (OCCIM) formed the ACCAHC/OCCIM Task Force to participate in a Delphi process of consultation and deliberation. This process led to a broad, cross-discipline agreement on important points to include in a response to the integrative medicine (IM) curriculum proposal., Results: Five key areas of concern emerged: (1) the definition of IM as presented in the paper; (2) lack of clarity about the goals of the proposed IM curriculum; (3) lack of recognition of the breadth of whole systems of health care; (4) omission of competencies related to collaboration between MDs and CAM professionals in patient care; and (5) omission of potential areas of partnership in IM education., Conclusions: A major overall theme emerging from the Delphi process was a desire for closer collaboration between conventional medical schools and CAM academic institutions in developing IM curricula. Several cross-disciplinary venues for addressing the Delphi Task Force themes include the National Center for Complementary and Alternative Medicine's R-25 Initiatives, and the National Education Dialogue. OCCIM is presented as an example of a successful lateral integration approach.

Cuthbert and Goodheart recently published a narrative review on the reliability and validity of manual muscle testing (MMT) in the Journal. The authors should be recognized for their effort to synthesize this vast body of literature. However, the review contains critical errors in the search methods, inclusion criteria, quality assessment, validity definitions, study interpretation, literature synthesis, generalizability of study findings, and conclusion formulation that merit a reconsideration of the authors' findings. Most importantly, a misunderstanding of the review could easily arise because the authors did not distinguish the general use of muscle strength testing from the specific applications that distinguish the Applied Kinesiology (AK) chiropractic technique. The article makes the fundamental error of implying that the reliability and validity of manual muscle testing lends some degree of credibility to the unique diagnostic procedures of AK. The purpose of this commentary is to provide a critical appraisal of the review, suggest conclusions consistent with the literature both reviewed and omitted, and extricate conclusions that can be made about AK in particular from those that can be made about MMT. When AK is disentangled from standard orthopedic muscle testing, the few studies evaluating unique AK procedures either refute or cannot support the validity of AK procedures as diagnostic tests. The evidence to date does not support the use of MMT for the diagnosis of organic disease or pre/subclinical conditions.

Objective.  When using spinal cord stimulation (SCS) for chronic pain management, precise longitudinal positioning of the cathode is crucial to generate an electrical field capable of targeting the neural elements involved in pain relief. Presently used methods have a poor spatial resolution and lack postoperative flexibility needed for fine tuning and reprogramming the stimulation field after lead displacement or changes in pain pattern. We describe in this article a new method, "electrical field steering," to control paresthesia in SCS. The method takes advantage of newer stimulator design and a programming technique allowing for "continuous" adjustment of contact combination while controlling stimulation current for each contact separately. Method.  Using computer modeling we examined how stimulation of dorsal column (DC) and dorsal root (DR) fibers was influenced by changing the current ratio of the cathodes of a dual (--) and a guarded dual cathode (+--+) configuration programmed on a percutaneous lead with 9 and 4 mm center-to-center contact spacing. Results.  A cathodal current ratio could be found for which DC or DR fiber recruitment and thus, most likely, paresthesia coverage was maximized. The DR threshold profiles shifted longitudinally, thus following the shift in the electrical field during steering. The profiles had a constant shape when the contact spacing was small and a varying shape for wider contact separation. Generally, the wider contact separation provided less DC and more DR fiber recruitment. Conclusions.  By means of cathodal steering on a longitudinal contact array, the group of excited DC and DR fibers, and thus paresthesia coverage, can be controlled when using SCS. With widely spaced contacts, superposition of the electrical field from each steering contact is limited. To precisely control segmental paresthesia (DR stimulation), a small contact spacing is necessary.

We report a 79-year-old man whose third burr hole craniotomy evacuation for recurrent chronic subdural haematoma (CSDH) was complicated by cerebellar haemorrhage. The patient died 9 days later. Two previously documented cases in which this complication arose after evacuation of extra-axial collections also resulted in death. Remote cerebellar haemorrhage is a rare complication of neurosurgery but is associated with high mortality. This complication should be considered among the differential diagnoses after neurological deterioration following CSDH evacuation.

Previously, we reported that avenanthramide-c (Avn-c), one of the major avenanthramides, polyphenols of oats, inhibited the serum-induced proliferation of vascular smooth muscle cells (SMC), which is an important process in the initiation and development of atherosclerosis. In the present study, we further investigated its cell cycle inhibitory mechanism. Rat embryonic aortic smooth muscle cell line A10 was used in this study. Flow cytometry analysis revealed that treatment of A10 cells with 80 muM Avn-c arrested the cell cycle in G1 phase as indicated by an increase in the number of cells in G1 phase and a decrease in the number of cells in S phase. This cell cycle arrest was associated with a decrease in the phosphorylation of retinoblastoma protein (pRb), whose hyperphosphorylation is a hallmark of the G1 to S transition in the cell cycle. The inhibition of pRb phosphorylation with Avn-c was accompanied by a decrease in cyclin D1 expression and an increase in cyclin-dependent kinase inhibitor p21cip1 expression, without significant changes in p27kip1 expression. Furthermore, Avn-c treatment increased the expression level and stability of p53 protein, which could account for the increase of p21cip1 expression. Our results demonstrate for the first time that Avn-c, which is a unique polyphenol found in oats, arrests SMC proliferation at G1 phase by upregulating the p53-p21cip1 pathway and inhibiting pRB phosphorylation. This inhibitory effect of Avn-c on SMC proliferation is an additional indication for the potential health benefit of oat consumption in the prevention of coronary heart disease beyond its known effect through lowering blood cholesterol.

In 2006, the U.S. Food and Drug Administration approved the first vaccine for the prevention of acute herpes zoster neuralgia (shingles). This vaccine has important implications in reducing the incidence and severity of the common neuropathic pain condition postherpetic neuralgia. The new vaccine is described.

Objective: To identify patient history intake questions common to four fields of medicine--allopathic, naturopathic, chiropractic, and Traditional Chinese Medicine for potential development of an Integrative Patient History Intake Tool., Design: A two-round modified Delphi technique was utilized to generate expert consensus among Oregon healthcare practitioners on the importance of specific patient history intake questions. A panel of faculty members from Oregon Health & Sciences University (OHSU), the National College of Naturopathic Medicine (NCNM), the Oregon College of Oriental Medicine (OCOM), and Western States Chiropractic College (WSCC) identified 321 patient history intake questions, which then were distributed to 106 Oregon healthcare practitioners. The healthcare practitioners were asked to rate the importance of each question through a series of two surveys over the period of 11 weeks. Suggestions for additional intake questions also were invited., Results: The Delphi process resulted in the original 321 initial questions plus 150 additional suggested questions being reduced to 52 intake questions (11% total similarity) for the potential development of the Integrative Patient History Intake Tool. There was a 63% response rate to SURVEY I, and a 73% response rate for SURVEY II., Conclusion: The concept of attempting to develop an integrative patient history intake tool is important to improve communication between practitioners of allopathic, naturopathic, chiropractic, and Traditional Chinese Medicine. This study revealed insight into the difficulties faced with such a tool due to the lack of similarity in priorities of questions between these different disciplines. This may also reveal a component of why communication remains difficult between these fields, but should not deter efforts to increase communication in the interest of optimal patient care.

Objective: Preliminary studies have suggested that prolonged retraction of the paraspinal muscle during spinal surgery may produce ischemic damage. We report the continuous measurement of intramuscular pressure (IMP) during decompressive lumbar laminectomy and its relationship to subsequent back pain and disability., Methods: Twenty patients undergoing two-level decompressive lumbar laminectomy for lumbar canal stenosis were recruited. Back pain and disability were assessed by use of the Visual Analog Score (VAS), Oswestry Disability Index (ODI), and Short-Form 36 (SF-36) Health Survey. During surgery, IMP was recorded continuously from the multifidus muscle by use of a pressure transducer. The intramuscular perfusion pressure (IPP) was estimated as the difference between the patient's mean arterial pressure and IMP., Results: Two muscle retractors were used: the Norfolk and Norwich (n = 10) and the McCulloch (n = 10). The mean duration of deep muscle retraction was 62.7 +/- 8 minutes (range, 19-133 min). On application of deep muscle retraction, there was a rapid and sustained increase in IMP (P < 0.001), and overall, the calculated mean IPP approached 0 mm Hg or less during this period (P < 0.001). On release of deep muscle retraction, there was a rapid decrease in IMP to preoperative levels. The IPP was greater with the Norfolk and Norwich than the McCulloch retractor (P < 0.001). Compared with preoperative values, there was a decrease in ODI (P < 0.001) and VAS for back pain (P < 0.001) at discharge and 4 to 6 weeks and 6 months after surgery. In addition, there was a decrease in SF-36 scores at 6 months compared with preoperative values (P < 0.001). Total duration of muscle retraction greater than 60 minutes was associated with worse VAS scores for back pain and ODI and SF-36 scores for disability at 6 months after surgery (P < 0.05). There was no relationship between the VAS, ODI, and SF-36 scores and other parameters measured, including the mean IPP, retractor type, operating surgeon, and wound length., Conclusion: The McCulloch retractor generates a higher IMP than the Norfolk and Norwich retractor. However, postoperative improvement in VAS, ODI, and SF-36 scores in these patients was associated with a shorter duration of muscle retraction and not the degree of IMP or IPP generated. In this respect, periodic relaxation of the paraspinal muscle retractors during surgery to allow muscle perfusion may help to reduce postoperative back pain and disability.

The proper orthogonal decomposition (POD) technique (also known as the Karhunen-Loeve transform) has been used as a model reduction tool for many applications in engineering and science. In principle, one begins with an ensemble of data, called snapshots, collected from an experiment or laboratory results. The POD technique is then used to produce a set of basis elements that can span the original snapshot collection using the fewest possible degrees of freedom. It is such capability that allows us to extract the representative characteristics of a cancer from a collection of DNA microarray samples known to be cancerous. The resulting few POD elements can be regarded as dominant cancerous patterns, which can be used to determine whether an arbitrary DNA microarray sample is cancerous. In our study, we consider two types of cancers, liver and bladder. DNA microarray data are downloaded from the Stanford Microarray Database. Our findings indicate that the POD method can successfully detect both cancer types, although our approach can be applied to other types of disease or cancer.

Voltage-gated potassium channels are formed by the tetramerization of their alpha subunits, in a process that is controlled by their conserved N-terminal T1 domains. The crystal structures of Shaker and Shaw T1 domains reveal interesting differences in structures that are contained within a highly conserved BTB/POZ domain fold. The most surprising difference is that the Shaw T1 domain contains an intersubunit Zn2+ ion that is lacking in the Shaker T1 domain. The Zn2+ coordination motif is conserved in other non-Shaker channels making this the most distinctive difference between these channels and Shaker. In this study we show that Zn2+ is an important co-factor for the tetramerization of isolated Shaw and Shal T1 domains. Addition of Zn2+ increases the amount of tetramer formed, whereas chelation of Zn2+ with phenanthroline blocks tetramerization and causes assembled tetramers to disassemble. Within an intact cell, full-length Shal subunits containing Zn2+ site mutations also fail to form functional channels, with the majority of the protein found to remain monomeric by size exclusion chromatography. Therefore, zinc-mediated tetramerization also is a physiologically important event for full-length functional channel formation.