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Patients with Parkinson's Disease (PD) often exhibit difficulties with visual search that may impede their ability to recognize landmarks and cars while driving. The main objective of this study was to investigate visual search performances of both billboards and cars in patients with PD using a driving simulator. A second objective was to examine the role of cognitive functions in performing the visual search task while driving. Nineteen patients with PD (age: 68 ± 8yo, sex (Men/Women): 15/4) and 14 controls (age: 60 ± 11yo, sex: 7/7) first performed a battery of cognitive tests. They then drove in a simulator and were instructed to follow a lead vehicle while searching for billboards with the letter A (stationary target) or red cars (moving target) among other distractors. Accuracy and response times of visual search were the main outcome variables. Standard deviation of lateral position (SDLP) was the secondary outcome. During driving, patients were less accurate in identifying the targets, particularly for the stationary billboards located in the outer periphery. Within the group of patients, significant correlations were found between several measures of cognitive tests and simulator-based visual search accuracy. By contrast, only the score on the MOCA test correlated significantly with visual search accuracy in controls. Findings suggest that patients with PD have impaired visual search for more eccentric stationary targets while driving a simulator, which is likely due to cognitive deficits. Difficulties identifying objects in the outer periphery may have implications for driving safety. Decreased functional field of view under increased cognitive load may have attributed to the difficulties identifying these landmarks. This may impact the ability to identify, anticipate, and respond to important information (e.g., pedestrians, navigation signs, landmarks), especially in complex driving situations (e.g. urban driving or intersections).Future studies should be conducted in a larger sample size to determine whether a visual search task on a driving simulator may predict on-road driving performances., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: Examine the correlates of Health Related Quality of Life (HRQL) in a large cohort of Parkinson's disease (PD) patients from National Parkinson Foundation (NPF) Centers of Excellence (COEs)., Background: Improving outcomes for PD will depend upon uncovering disease features impacting HRQL to identify targets for intervention and variables for risk-adjustment models. Differences in HRQL outcomes between COEs could uncover modifiable aspects of care delivery., Methods: This cross-sectional study examined the relative contribution of demographic, social, clinical and treatment features potentially related to HRQL, as measured by the PDQ-39, in 4601 consecutive subjects from 18 COEs. Stepwise linear regression was utilized to identify correlates of HRQL., Results: The variability in the PDQ-39 summary index score correlated with H&Y stage (R(2) = 22%), Timed up and Go (TUG) (17%), disease duration (11%), comorbidities (8%), cognitive status (8%), antidepressant use (6%) and center at which a patient received care (5%). Stepwise regression reordered the importance of the variables, with the H&Y first and TUG and the center becoming equal and the second most important variables determining the PDQ-39 total score. All independent variables together accounted for 44% of the variability in HRQL., Conclusions: We confirmed many but not all HRQL associations found in smaller studies. A novel observation was that the site of care was an important contributor to HRQL, suggesting that comparison of outcomes and processes among centers may identify best practices., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: The objective of this study was to identify clinicopathologic features that are associated with an increased risk of recurrence for borderline ovarian tumors (BOT)., Methods: We performed a retrospective review of all patients treated for BOT at our institution from 1979 to 2008. Progression-free survival (PFS) was defined as the time of diagnosis to time of recurrence/death or last follow-up. The Kaplan-Meier method was used to calculate the PFS rate and the Wilcoxon-Gehan test was performed to identify prognostic factors., Results: A total of 266 patients were identified. The median age was 43 years (range, 15-94 years). The majority of patients (68.4%) had FIGO stage I disease and serous histology (73.7%). Only 23 (8.6%) patients developed recurrent disease. The median PFS was 19 years and the median follow-up was 4 years. Abnormal baseline CA-125 (>35 U/ml), advanced stage, age at diagnosis, and invasive implants were associated with decreased PFS. Of the 196 patients with serous BOT, those with a micropapillary pattern had a 3-year PFS of 75.9% (95%CI, 55.6-87.8) compared with 94.3% (95% CI, 88.4-97.3) for patients without micropapillary pattern (P<0.001)., Conclusion: Age at diagnosis, an elevated preoperative CA-125, invasive implants, and micropapillary histology were clinical factors associated with increased risk of recurrence in women with BOT. Including these clinicopathologic features will likely identify patients at higher risk for recurrence, for whom development of new treatment strategies would be appropriate., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Ropinirole, which is a non-ergot dopamine agonist derivative, exerts therapeutic benefits in Parkinson's disease (PD). Based on recent studies implicating dopamine receptors 2 and 3 (D2R and D3R) as possible targets of ropinirole, we over-expressed these dopamine receptor genes in the dopamine-denervated striatum of rodents to reveal whether their over-expression modulated ropinirole activity. Adult Sprague-Dawley rats initially received unilateral 6-hydroxydopamine lesion of the medial forebrain bundle. At 1 month after surgery, successfully lesioned animals (3 or less forelimb akinesia score, and 8 or more apomorphine-induced rotations/min over 1 h) were randomly assigned to intrastriatal injection (ipsilateral to the lesion) of blank lentiviral vector, D2R, D3R or both genes. At about 5 months post-lesion, ropinirole (0.2 mg/kg, i.p.) was administered daily for 9 consecutive days. The subtherapeutic dose of ropinirole improved the use of previously akinetic forelimb and produced robust circling behavior in lesioned animals with striatal over-expression of both D2R and D3R compared to lesioned animals that received blank vector. In contrast, the subtherapeutic dose of ropinirole generated only modest motor effects in lesioned animals with sole over-expression of D2R or D3R. Western immunoblot and autoradiographic assays showed enhanced D2R and D3R protein levels coupled with normalized D2R and D3R binding in the ventral striatum of lesioned animals with lentiviral over-expression of both D2R and D3R relative to vehicle-treated lesioned animals. Immunohistochemical analyses showed that D2R and D3R GFP fluorescent cells colocalized with enkephalin and substance P immunoreactive medium spiny neurons. These data support the use of the subtherapeutic dose of ropinirole in a chronic model of PD.

Understanding contaminant distribution is critical to selection and implementation of effective and affordable containment and remediation efforts. This article describes the characterization of soil containing thorium at a training site on Kirtland Air Force Base, Albuquerque, NM. The site has been used by the Defense Nuclear Weapons School since the early 1960's to train personnel in emergency response to nuclear weapons accidents and for characterization and containment of radioactive contamination. The purpose of work reported herein is to describe the primary location and migration pattern of 232Thorium (232Th) and 232Th progeny (decay products) at the site. Soil containing thorium oxide (ThO2) was applied to the site for approximately 30 years (early 1960-1990) and was used to simulate a plutonium release from a nuclear weapons accident. Data presented indicate that surface 232Th and 232Th progeny at approximately 5 times background levels are approaching test site boundaries. However, the data also indicate that vertical migration has not exceeded 0.9 m because of the insoluble nature of ThO2. The major mechanisms of 232Th mobility appear to be surface migration mediated by precipitation runoff and wind-blown soil.

The effects of three different forms of v-src on brain cell development were determined in vivo. Recombinant retroviral vectors encoding the marker lacZ (control) and either wild-type v-src or SH2 or SH3 domain-deleted forms of v-src (deltaSH2 or deltaSH3, respectively) were used to infect neuronal progenitor cells in the embryonic chicken midbrain (optic tectum; OT). Embryos were injected in the OT with retroviral concentrates on embryonic day (E) 3 and sacrificed at E6, E9, and later in development. Patterns of cell proliferation, migration, and differentiation of lacZ-marked clonal cell progeny were then analyzed. Relative to lacZ-only controls, cell clone size at E6 was significantly increased for v-src-, unchanged for deltaSH2-, and smaller for deltaSH3-injected embryos. At E9, deltaSH2 cell clones were significantly larger than controls, suggesting increased survival from normal programmed cell death. Radial neuronal migration was impaired for v-src and deltaSH3 clones, whereas tangential neuronal migration was enhanced along fiber tracts in v-src and deltaSH2 clones. Moreover, radial glial cell development and differentiation was hindered in v-src and deltaSH3 clones. These experiments demonstrate that ectopic v-src signaling alters proliferation, migration, survival, and differentiation of developing brain cells and suggest that src signaling pathways are involved in these developmental processes. Furthermore, certain effects of v-src on brain cells require specific src homology domains.

A study of 1,800 Kentucky high school students revealed that working students demonstrate a remarkable diversity of work experience and uses of earnings while not differing markedly from nonworking students in school experience. The data, both quantitative and qualitative, suggest that conventional wisdom is not sufficient to capture fully the current realities of students who work; however, unresolved theoretical issues remain.

There are five major haplotypes associated with sickle cell anemia (SS). Individuals homozygous for haplotypes 3 (Senegal) and 31 (Saudi Arabian) have high fetal hemoglobin (HbF) levels (15 to 30% of total hemoglobin) whereas individuals homozygous for haplotypes 17 (Cameroon), 19 (Benin), and 20 (Bantu) have low HbF levels (1 to 10%). We previously identified several point mutations in the LCR 5'HS-2 that were specific for haplotype 19 beta s chromosomes (compared to the GenBank HUMHBB reference sequence, T-->G at position 8580, A-->G at position 8598, and A-->T at position 9114). We postulated that one or more of these mutations may alter the binding of specific trans-acting factors and ultimately affect the expression of HbF in these sickle cell patients. We performed gel mobility shift assays using 32P-end-labeled double-stranded 19mers corresponding to each of the LCR 5'HS-2 normal (GenBank) and mutant sequences. Nuclear extracts prepared from HeLa and HEL cells were used in our experiments and neither the normal nor mutant sequence at position 8580 bound trans-acting factors in either nuclear extract. The 8598 mutant increased binding of Sp1; using purified protein and both nuclear extracts. HEL extracts were used to quantify the increase in Sp1 binding to the 8598 mutation and we found an increase in binding of 66 and 47%, respectively, in two shifted bands. The 9114 mutation sharply decreased binding of an unknown trans-acting factor by 74%. This factor was present in both HeLa and HEL nuclear extracts.

A continuous line of human kidney epithelial cells was cultured to confluency on porous membranes, and the formation of intercellular tight junctions was monitored by measuring increases in the trans-monolayer electrical resistance. Typical monolayers developed functioning tight junctions within 4 days of culture and showed an increase in resistance of 1840 +/- 440 ohms (mean +/- SD; n = 5) at this time. Conventional 51Cr release assays showed that suspended kidney cells were lysed by specific antibody and complement but were relatively resistant to lysis mediated by lymphokine-activated killer cells. However, when antibody and complement or LAK cells were added to functioning kidney cell monolayers the electrical resistance of the monolayers was rapidly reduced in both cases. In the absence of trans-monolayer resistance the ion gradients essential for renal tubular function will not be supported. These results indicate that the ability of a cytotoxic effector cell to liberate 51Cr from suspended kidney cells may not be a sensitive assay for the ability of these effector cells to impair the function of structured kidney cell monolayers. It is possible that significant kidney dysfunction may occur during renal allograft rejection by failure of trans-epithelium resistance in the absence of widespread epithelial cell lysis.

Although (diagnostic related groups) DRGs were originally devised as a research instrument for the evaluation of medical resource allocation, no studies have been reported that compare the actual physiologic status of patients with DRG classification. At the Westchester Medical Center, a University tertiary referral center, 100 consecutive high-risk elective surgical patients entered a preoperative intensive care unit for a prospective analysis of physiologic assessment, resource utilization, DRG classification, and outcome. Swan-Ganz catheters inserted 1 or 2 days before surgery were used to compute physiologic profiles and stage according to previously published criteria. Risk was determined by age, associated conditions, and magnitude of the proposed operation. There were no patients in stage 1; 55% in stage 2; 41% in stage 3; and 4% in stage 4, which accounted for three of the four total deaths. The 41% of patients over age 70 all had DRG comorbidity factors, but none died. All in stages 3 and 4 had comorbidity factors, as did 87% in stage 2. In 53% of the patients, the physiologic profile provided data necessary for preoperative "fine tuning"; in 37%, for volume expansion; in 23%, for inotropic therapy; and in 17%, for pulmonary therapy. Reoperation was required in 17% and contributed to the long average length of stay (LOS) of 24.5 days. In spite of case severity and comorbidity factors, LOS in the postoperative ICU was only 3 days. There were no significant differences in patients with cancer DRGs. Significant differences between stages 2 and 3 were found for pulmonary wedge pressure, right ventricular stroke work, pulmonary vascular resistance, and pulmonary shunt fraction. The 4% who died all had advanced liver disease. Although the DRG system as set up by the Health Care Financing Administration (HCFA) correctly predicts that age and comorbidity factors lead to increased utilization of resources, the extent to which they underestimate the increased needs of these patients will lead to financial disaster. Compensation for comorbidity factors and advanced age are not cumulative, but patients over 70 had an average of 2.5 comorbidity factors and required an average 26.5 days hospitalization. DRGs allowed only 15% extra reimbursement for these complex cases. High-risk, referred surgical patients are much sicker than they appear to the DRG system, and in all 100 cases compensation was grossly inadequate.

From July 18, 1978 to Sept 15, 1982, four boys were treated for air gun injuries of the abdomen at the North Carolina Baptist Hospital, Winston-Salem. Three patients had wounds of one or more of the hollow viscera, and one patient had an injury only of the liver. There was no morbidity or mortality following repair. Some present-day air (pneumatic) weapons have muzzle velocities that equal or exceed those of common civilian handguns, and they are frequently used by unsupervised children. These weapons are not restricted and regulated as are other firearms, and are believed to be incapable of serious injury other than to the eye. These cases and others in the literature dispute that belief.

Aggressive intervention in the medical and psychosocial problems of the subacute phase of alcoholism allows the physician to assume a holistic approach to the alcohol-addicted individual and provides a basis for eventual arrest of the chronic disease. A variety of metabolic abnormalities and physiologic disorders require attention. Management of psychologic problems requires the use of rational authority, early psychotherapy, judicious short-term psychopharmacology and use of available community resources.