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Deceleration and crushing injuries of the chest may traumatize the thoracic aorta or its branches. Traumatic aortic rupture has received significant attention over the past 40 years, whereas the aortic arch branch injuries remain under-recognized. Despite the development of new imaging modalities, angiography remains the gold standard for evaluation of a patient with suspected thoracic arterial injury. Recently, computed tomography and transesophageal echocardiography have been used for serial examination of minimal aortic injuries that are treated conservatively. Medical treatment of the ruptured aorta, delayed surgical repair, and endoluminal deployment of stent-grafts are new developments that provide new options and pose new questions in the management of thoracic arterial injuries.

Summary: Purpose: Although vagus nerve stimulation (VNS) is now marketed throughout most of the world as a treatment for drug-resistant epilepsy, the therapeutic mechanism of action of VNS-induced seizure suppression has not yet been established. Elucidation of this mechanism is an important first step in the development of strategies to improve VNS efficacy. Because the locus coeruleus (LC) has been implicated in the antinociceptive effects of VNS, we chemically lesioned the LC in the present study to determine if it is a critical structure involved in the anticonvulsant mechanisms of VNS. Methods: Rats were chronically depleted of norepinephrine (NE) by a bilateral infusion of 6-hydroxydopamine (6-OHDA) into the LC. Two weeks later, they were tested with maximal electroshock (MES) to assess VNS-induced seizure suppression. In another experiment, the LC was acutely inactivated with lidocaine, and seizure suppression was tested in a similar fashion. Results: VNS significantly reduced seizure severities of control rats. However, in animals with chronic or acute LC lesions, VNS-induced seizure suppression was attenuated. Conclusions: Our data indicate that the LC is involved in the circuitry necessary for the anticonvulsant effects of VNS. Seizure suppression by VNS may therefore depend on the release of NE, a neuromodulator that has anticonvulsant effects. These data suggest that noradrenergic agonists might enhance VNS-induced seizure suppression.

Drawing upon research which conceptualizes anger as a multidimensional construct including three associated components—anger experience (affective anger), hostility (anger cognitions), and anger expression (aggression, assertion, and withdrawal)—the preliminary development of a Multidimensional School Anger Inventory (MSAI) for adolescents is described. This scale is a modification and extension of the School Anger Inventory and was developed to assess the affective, cognitive, and expressive aspects of anger using items having school-relevant content. Data were collected through personal interviews of 202 males from three different schools: School 1 included general education students in a parochial school in grades 6 through 12; School 2 included students attending general education or mainstreamed special education classes at a public intermediate school; and School 3 included students participating in a public day treatment program for youths with serious emotional disturbance. Scale development is discussed focusing on item development and scale refinement through item and factor analyses. Four factors were identified that accounted for 43.3% of the common variance. Anger Experience, Cynical Attitudes, and Anger Expression were identified as major clusters with the anger expression items bifurcating into Destructive Expression and Positive Coping components. The resulting 31-item scale has strong psychometric qualities and appears to have promise for use in research, treatment planning, and outcome evaluations. © 1998 John Wiley & Sons, Inc.

Provides a rationale for utilizing a litany in the context of ministering to a dying person. Offer an example of such a litany and suggests ways of evaluating its effectiveness.

Pseudoaneurysm formation and infection at the site of iliac artery stenting are uncommon complications that occur soon after stent placement. We describe a case in which an infected pseudoaneurysm developed 22 months following stent implantation. Stent infection, although rare, has potentially disastrous implications, as made evident by a review of the literature. Prophylactic antibiotic therapy at the time of stent placement is recommended.

This investigation provides a descriptive framework for Hispanic adolescents' preference for social support on salient concerns in their daily lives. Participants were 698 Hispanic adolescents attending a junior high school (grades 7–8), 138 of whom were identified by the school as “migratory” students. Participants identified who they would most likely talk to given specific concerns. Parents and teachers were major sources of support and information, in particular for matters of school-work and relationships with peers and teachers at school Peers were the preferred sources for nonacademic issues such as “looks” and getting along with other students. The patterns described above varied according to gender and migrant status. Possible explanations were considered and related to likely variations in the subcultures of gender and migrant status.

Purpose: Recent studies have suggested that transesophageal echocardiography (TEE) can be used as the primary imaging method in patients suspected of traumatic rupture of the thoracic aorta. A segment of the aorta and the aortic arch branches cannot be adequately evaluated in all patients by TEE. To assess the impact of these limitations of TEE, this retrospective study examined the aortographic features of traumatic aortic or great vessel injuries in a large number of patients. Materials and Methods: We retrospectively reviewed clinical and imaging features of 89 patients with a history of blunt chest trauma and angiographic evidence of traumatic injury to the thoracic aorta or to its branches. Results: Of these 89 patients, 72 had aortic rupture alone. One (1%) of these ruptures occurred at the distal ascending aorta, a potential blind spot for TEE. Seventeen patients (19%) had 24 injuries to the aortic arch branches: in 14 of these 17 patients, the aorta was intact, whereas three patients also had aortic rupture. Seventy percent of the injuries to the aortic arch branches were not suspected on physical examination. Conclusion: Twenty percent of patients in our retrospective series had traumatic involvement of aortic arch branches or the distal ascending aorta. These vascular injuries may be suboptimally assessed or overlooked if TEE is used as the sole imaging modality in the evaluation of patients with blunt chest trauma.

In prior research by Witkiewitz and colleagues, African American adults receiving refusal skills training (RST) had fewer heavy drinking days and were categorized as having more successful outcomes. This study extends findings to adolescents receiving the Adolescent Community Reinforcement Approach (A-CRA). Propensity score matching was used to create three groups equivalent on baseline characteristics, including: African Americans receiving refusal skills training (AA+RST; n=214), African Americans not receiving RST (AA-RST; n=212), and Caucasians receiving RST (CA+RST; n=214). In propensity weighted regression models that controlled for overall A-CRA exposure, racial group by RST status was not a significant predictor of substance use frequency or abstinence/early remission outcomes. Higher exposure to A-CRA, however, was a significant predictor of both outcomes. Universal receipt of RST may not improve the outcomes of African American adolescents with substance use problems, and outcomes may be driven more by the overall number of A-CRA procedures received.

article i nfo At a time when there is increasing attention being given to systematically integrating the well-being of chil- dren with the goals of safety and permanence in child welfare, little is known about the psychosocial function- ing of foster youth transitioning to adulthood from substitute care. This article systematically reviews 16 peer-reviewed articles and/or research reports to identify lifetime and past year prevalence rates of mental health disorders and service utilization. At ages 17 or 18, foster youth are 2 to 4 times more likely to suffer from lifetime and/or past year mental health disorders compared to transition aged youth in the general pop- ulation. Findings show that mental health service use declines at ages when the prevalence rate of mental health disorders is peaking. The findings of this review suggest the need to focus future efforts in three main areas: 1) setting a common research agenda for the study of mental health and service use; 2) routine screening and empirically supported treatments; and 3) integration and planning between child and adult mental health service systems.

A study of the two-dimensional crystallization of rhodizonic acid on the crystalline surfaces of gold and copper is presented. Rhodizonic acid, a cyclic oxocarbon related to the ferroelectric croconic acid and the antiferroelectric squaric acid, has not been synthesized in bulk crystalline form yet. Capitalizing on surface-assisted molecular self- assembly, a two-dimensional analogue to the well-known solution-based coordination chemistry, two-dimensional structures of rhodizonic acid were stabilized under ultrahigh vacuum on Au(111) and Cu(111) surfaces. Scanning tunneling microscopy, coupled with fi rst-principles calculations, reveals that on the less reactive Au surface, extended two- dimensional islands of rhodizonic acid are formed, in which the molecules interact via hydrogen bonding and dispersion forces. However, the rhodizonic acid deprotonates into rhodizonate on Cu substrates upon annealing, forming magic clusters and metal − organic coordination networks with substrate adatoms. The networks show a 2:1 distribution of rhodizonate coordinated with 3 and 6 Cu atoms, respectively. The stabilization of crystalline structures of rhodizonic acid, structures not reported before, and their transition into metal − organic networks demonstrate the potential of surface chemistry to synthesize new and potential useful organic nanomaterials.

Experienced CPAs were surveyed to examine the perception of the written lan guage skills of entry-level accountants. The results suggest that written lan guage fundamentals in word selection and usage, sentence and paragraph construction, and other grammar and mechanics remain a problem for entry- level accountants.

Purpose: This study was performed to determine the primary patency, foot salvage, and complication rates associated with iliac artery stent deployment. Methods: From March 1992 to May 1995, 147 iliac artery stents were deployed in 98 limbs of 72 patients for disabling claudication or limb-threatening ischemia. Procedure-related and late (>30 days) complications, as well as adjunctive maneuvers required to correct a complication, were tabulated. Stented iliac artery cumulative primary patency and foot salvage rates were calculated with life-table analysis. Factors that impacted early complications, late complications, foot salvage rates, and stented iliac artery primary patency rates were identified with stepwise logistic regression analysis. Results: A procedure-related complication occurred in 19 (19.4%) limbs. Initial technical success, however, was achieved in all but three of 98 limbs (96.9%). Stented iliac artery cumulative primary patency rates were 87.6%, 61.9%, 55.3%, and foot salvage rates were 97.7%, 85.1%, 76.1%, at 12, 18, and 24 months, respectively. External iliac artery stent deployment, superficial femoral artery occlusion before treatment, and single-vessel tibial runoff before treatment negatively affected stented iliac artery cumulative primary patency rates. Stented iliac artery primary patency rates were not significantly affected by age, smoking, coronary artery disease, diabetes, hypercholesterolemia, hypertension, presenting symptom, early complication, number of stents deployed, type of stent deployed, or stent deployment for stenosis versus occlusion. Conclusions: Limb-threatening and life-threatening complications can be associated with iliac artery stent deployment. Stented iliac artery primary patency rates are affected by distal atherosclerotic occlusive disease and the position of the deployed stent within the iliac system. Stent reconstruction of severe iliac artery occlusive disease is feasible but should be thoughtfully selected. (J Vasc Surg 1996;24:545-55.)

The purpose of this study was to analyze outcomes of two different treatment strategies in patients treated for renal artery (RA) stenosis and a coincidental abdominal aortic aneurysm (AAA). A total of 50 patients were encountered who required treatment for concomitant RA stenosis and an AAA from 1980 to 1994. Simultaneous operative aortic and RA reconstruction was done in 32 patients, whereas 18 patients where treated with preoperative percutaneous transluminal renal artery angioplasty (PTRA). The two groups were well matched with respect to age, AAA size, incidence of hypertension, preoperative creatinine level, and creatinine clearance (all p values > 0.07). Aortorenal bypass (18 RAs), reimplantation (18 RAs), or endarterectomy (2 RAs) was performed to correct a mean RA stenosis of 88%, whereas 23 RAs (91% mean stenosis) were treated with preoperative PTRA. PTRA failed in four patients with RA stenosis, and they were successfully treated with surgery (3 bypasses and 1 reimplantation). Statistical analysis did not demonstrate a significant difference between these four failed PTRA patients, the 14 successful PTRA patients, and the 32 RA reconstruction patients in terms of operating time (p = 0.15), operative blood loss (p = 0.20), intensive care unit days (p = 0.71), or total hospital days (p = 0.94). Among the 40 patients available for follow-up, hypertension was cured in seven, improved in 10, unchanged in 15, and worse in eight with no difference demonstrated between the groups (p = 0.73). These data suggest that preoperative PTRA has no specific advantage over surgical RA reconstruction in patients with concomitant RA stenosis and AAA. Failed PTRA did not preclude or complicate subsequent operative RA revascularization.

Open operative balloon angioplasty is a treatment alternative for certain nonatherosclerotic lesions of the internal carotid artery (ICA) including fibromuscular dysplasia (FMD). Standard operative exposure of the carotid bifurcation is performed with atraumatic passage of a guidewire and balloon through a carotid bulb arteriotomy. Under direct fluoroscopic guidance, precise dilatation of the involved area is possible with minimal risk of intimal tear/flap or distal embolization as compared with graduated intraluminal dilatation or percutaneous balloon angioplasty. Vascular control of the common and external carotid arteries lessens the risk of embolization resulting from the constant backflow of blood through the ICA before, during, and after balloon angioplasty, adding to the overall safety and efficacy of the procedure. We report a case of asymptomatic critical carotid artery stenosis associated with FMD successfully treated with open operative balloon angioplasty and review the current literature regarding treatment options for FMD of the ICA.

The counseling process of psycho-palliation is presented as a type of spiritual journey that leads to enlightenment. First, the theory of psycho-palliation is defined. Then, a step-by-step outline is given on how a psycho-palliative attitude produces enlightenment for the counselor. Throughout the exposition, the theory of psycho-palliative counseling is expanded upon through the use of parables and spiritual references from the world's religions. Wosong had learned much and thought that he was ready to enter Heaven. So he went to the doors of Heaven and knocked. A voice said, “Who is there?” “It is Wosong, and I am ready to enter.” The voice replied, “I am sorry Wosong, but there is not room for me and thee.” Dejected, Wosong returned to his place, studied all the prophets and gave all he had to the poor. Once again he returned to the doors of Heaven and knocked. A voice said, “Who is there?” “It is Wosong.” The voice replied, “I am sorry Wosong, but there is not room for me and thee.” In complete confusion, Wosong returned to his place. For 7 years, he meditated on the voice of Heaven. Then, in complete humility, he knocked on the doors of Heaven. A voice said, “Who is there?” Wosong replied, “It is thyself.” So the voice said, “Enter. I always have room for myself.”

α-Chloro carboxylic acid dianions condense with propanal to form β-lactones which, upon treatment with magnesium bromide, form 3,5-disubstituted butenolides.

Saturated and unsaturated aldehydes and ketones, when treated with trimethylsilylketene and BF3 for 16 hours, form β-lactones which spontaneously rearrange to α,β-unsaturated TMS esters; these hydrolyze during workup to form the corresponding carboxylic acids.

Professional social workers are compelled by social work educators, state funding agencies, and their employers to use empirically supported treatments (ESTs). Here an EST refers to a treatment that has met some minimum evidentiary threshold criteria for establishing efficacy (Chambless & Hollon, 1998). Such treatments, however, are only one important part of evidence-based practice (EBP), which refers to an iterative process of selecting the most appropriate interventions that are personalized to diverse social work clients (Gambrill, 2006). Thus, EBP as a process moves well beyond specific evidentiary classification schemes used to deem specific practices to be ESTs. There is a lack of agreement on how to teach ESTs to students (Adams, LeCroy, & Matto, 2009) and implement them with fidelity in today's social services environment in which organizations may lack the capacity, willingness, or resources to do so. As part of this continuing dialogue on how to define EBP, Cameron and Keenan (2010) proposed that social workers perpetuate a transtheoretical common factors approach. Common .factors were defined as the conditions and processes, such as developing empathy or increasing social support, that are known to cut across a "range of practice approaches that have been associated with positive client outcomes" (Cameron & Keenan, 2010, p. 64). Such an approach was argued to have numerous benefits, including the following: allowing social workers to use evidence-based principles while integrating the dizzying amount of practice models available to them, remaining applicable no matter what the population or clinical problem may be, guiding clinical assessments, and moving beyond conceptualizations that place the clinician as the central figure in the helping process. Cameron and Keenan (2010) offered some interesting and useful recommendations for social work educators, practitioners, and researchers. For example, their article reminded us to not become overzealous about any one particular treatment approach, as meta-analytic findings show that change often occurs regardless of what specific treatment techniques are applied (Ahn & Wampold, 2001; Imel, Wampold, Miller, & Fleming, 2008; Wampold et al., 1997). However, not all meta-analyses fail to find differences when comparing distinct active treatments (S. Miller, Wampold, & Varhely, 2008), and when active treatments are compared with carefully constructed control groups including only common factors (that is, attention and rapport development), the former are more effective (Stevens, Hynan, & Allen, 2000). For this and other technical methodological reasons (Carroll & Rounsaville, 2010; Crits-Cristoph, 1997; Shadish & Sweeney, 1991), it remains difficult to conclude that specific treatment components do not matter, and it may be premature to suggest that the widespread adoption of a common factors approach is desirable in social work. This column outlines some potentially negative consequences associated with adopting a common factors model to facilitate additional debate in the profession about defining, teaching, and conducting research on ESTs. COMMON FACTORS APPROACH: EBP ALTERNATIVE OR BUSINESS AS USUAL? Cameron and Keenan (2010) argued that regardless of the specific techniques or specific practice model used, several common factors have empirical support. By extension, no matter what techniques are used to activate these common factors, they should be considered empirically supported because of the literature support for the underlying processes of change that are activated. Although there is merit to Cameron and Keenan's argument that numerous techniques can activate healing processes, caution must be exercised so that using a common factors approach does not become a rationalization for not engaging in the EBP process. For example, many practitioners say they are competent at using effective treatments, but their interventions may not resemble empirically supported or efficient treatment strategies to activate these common factors. …

Mobile phones using Time Division Multiple Access (TDMA) technology generate audio noise on audio systems using speakers, specially if long cables are used. In general, any RF amplitude modulated signal can interfere other electronic systems when entering the circuits and being rectified (“audio rectification”). In this paper a simple setup for troubleshooting a system for that audio rectification problem is described. An RF power amplifier and a coaxial antenna are described as key elements of the setup and the general ideas about the use of the system are included.

Hypertext, an electronic communication medium in which information is structured and accessed according to the audience's needs and interests, is increasingly used in business and technical communication. That use may justify curricula expansion in the development of the ability to communicate in hypertext from specialty courses to a variety of business and technical courses, including the foundation course. This article provides a concise overview of hypertext for instructors who may be considering this expansion but who need to become more familiar with the medium. The basic information that is provided includes the definition, uses, and advantages of hypertext. In addition, the terminology, theoretical bases, and essential structure of hypertext are discussed. Of particular concern to business and technical communication instructors who may be considering adding hypertext to their courses are the problems that the medium presents. Discussion includes considerations of linguistic design, computer capabilities, and human performance. Finally, behaviors that business and technical communicators should exhibit to encourage the use of hypertext are presented.

Based upon the growing research connected with a “good death, a six-session group is suggested for people with Acquired Immune Deficiency Syndrome (AIDS). Each session is described by giving a theoretical basis for the theme of the session, followed by an activity that can be used in the session to explore that theme. The six sessions are intended to meet six key psychological needs of the dying.

The purpose of this study was to evaluate the impact of an assessment training and certification program on the quality of data collected from clients entering substance abuse treatment. Data were obtained from 15,858 adult and adolescent clients entering 122 treatment sites across the United States using the Global Appraisal of Individual Needs-Initial (GAIN-I). GAIN Administration and Fidelity Index (GAFI) scores were predicted from interviewer certification status, interviewer experience, and their interactions. We controlled for client characteristics expected to lengthen or otherwise complicate interviews. Initial bivariate analyses revealed effects for certification status and experience. A significant interaction between certification and experience indicates interviewers attaining certification and having more experience far outperformed certified interviewers with low experience. Although some client characteristics negatively impacted fidelity, interviewer certification and experience remained salient predictors of fidelity in the multivariate model. The results are discussed with regard to the importance of ongoing monitoring of interviewer skill.

Contrary to much literature on death and dying addressing the necessity for people's openness in facing death, an argument is presented in favor of being supportive of a terminally-ill person's choice to deny death's inevitability. After presenting an illustrative case study on the choice of denial, the author draws upon the supportive work of some of the foremost experts in the field of death and dying. Finally, the author addresses the implications for the dying person's counselor and the consequences for the dying person's social milieu.

This study addressed the question of whether there are attitudes that may be psychologically beneficial to the dying, their families, and their caregivers. The Omega Attitudes Inventory was distributed to 467 systematically selected hospice coordinators nationwide. The responses of 327 (70%) indicated high concordance with patient attitudes contributing to a "healthy" death. The identified attitudes were qualitatively enhanced through anecdote and the literature. The study concluded with implications for clinical practice and further research.

After presenting evidence for the heightened need among the dying to explore religious-spiritual issues, the article explains how counselors might best approach this need. The approach that is explicated centers on nonjudgmental openness toward all of the client's religious-spiritual explorations. The last, and largest, portion of the article presents psycho-social tools that can be used to assess, examine, and amplify a client's religious-spiritual strengths.

This commentary compares Smith's work to classic value clarification, addresses issues of counselor judgement and informed consent, and outlines further exercises based on near-death experiences.

A novel technique for insertion of the Ash Split-Cath without a peel-away sheath to decrease the potential for air embolism is described. A retrospective review of 62 attempted Ash Split-Cath insertions at three hospitals was made. Conversion to the usual technique using a sheath was necessary in four cases, mostly because of extensive scarring from previous catheters. There was no air embolus, hematoma, or immediate catheter malfunction. The authors believe that the occurrence of air embolism during placement of Ash Split-Cath may be lessened by eliminating the use of a peel-away sheath.

This pilot study investigated the validity of the functional ambulatory profile (FAP) score from the GAITRite™ electronic pathway in persons with multiple sclerosis (PwMS) who had onset of walking impairment. Thirteen PwMS who had Expanded Disability Status Scale (EDSS) scores of 4.0–6.0 performed four trials on GAITRite™ pathway, and completed a multidimensional walking assessment including performance tests (timed 25 foot walk; T25FW, timed up and go; TUG), self reports of walking ability (Multiple Sclerosis Walking Scale-12; MSWS-12) and function (Late Life Function and Disability Inventory; LL-FDI), and free-living walking behavior (accelerometry). The FAP score correlated strongly with neurological disability (EDSS, ρ = −0.81), walking performance (T25FW, ρ = −0.82; TUG, ρ = −0.88) and self-reported walking function (LL-FDI, ρ = 0.81), and moderately with self-reported walking impairment (MSWS-12, ρ = 0.49) and free-living walking behavior (accelerometry, ρ = 0.52). This suggests that the FAP score is a valid marker of gait impairment in PwMS who have onset of walking impairment.

One fifth of all public treatment admissions are emerging adults, and few studies have considered whether treatments are developmentally appropriate. This study compares outcomes between adolescents and emerging adults with substance use disorders who received the Adolescent Community Reinforcement Approach (A-CRA). Propensity score matching was used to create a weighted comparison group of adolescents (n = 151) who had similar demographic characteristics, clinical severity, and treatment retention as the group of emerging adults (n = 152). We examined age differences in abstinence and other psychosocial outcomes at the last available follow-up. Emerging adults and adolescents both reduced their substance use at follow-up. However, emerging adults were less likely to be abstinent and in remission and had more days of alcohol use when compared with adolescents. This study's findings are consistent with prior work on emerging adults. Additional research should examine features of interventions that are most effective in addressing the developmental needs of emerging adults.

cis-Fused bicyclic γ-lactones were prepared in a three step sequence, featuring the stereospecific rearrangement of spiro bicyclic β-lactones; the dependence of the β- to γ-lactone ring expansion on the relative stabilities of the intermediate carbocations was also investigated.

Although the St. Louis Financial Stress Index suggests the level of financial stress in the markets has declined significantly since September 2008, the stress level remains modestly higher than average.

A static column of contrast agent or saline in an angiographic catheter will passively exchange with blood during angiography. The authors investigated the time course of this exchange in 5.5- and 7-F polyethylene catheters inclined at various angles. Passive blood exchange occurred 2 cm into the catheters within 7-15 seconds at most catheter tip angles, except for those catheters oriented so that their tips were nearly horizontal. In a separate series of experiments, the effect of contrast agent on platelet function and blood clotting was analyzed. The agent was sufficiently diluted in blood so as to simulate an angiographic procedure. The studies were performed in 60 cylindrical polyethylene containers with both unheparinized and heparinized blood. Use of an ionic contrast agent, more than a nonionic agent, lengthened the time for platelet aggregation (mean increases for ionic vs nonionic agents were 46.4 and 37.1 seconds, for unheparinized and heparinized blood, respectively), platelet adhesion to polyethylene surfaces (mean increases, 46.0 and 64.2 seconds), and platelet-stimulated coagulation (mean increases, 38.5 and 43.9 seconds). Conventional, intermittent flushing with saline or filling the catheter with contrast agent may be insufficient to prevent blood from rapidly back-filling the catheter tips. Contrast agents (ionic more than nonionic) distributed in the patient's blood volume inhibit platelet coating of catheter lumens and/or blood clotting under such circumstances.

Anatomic anomalies involving the inferior vena cava (IVC) can present both diagnostic and therapeutic challenges when percutaneous placement of a filter is considered. A patient with a duplicated IVC was treated with placement of a filter in the right-sided IVC and steel coil embolization of a smaller left-sided IVC.

Prior studies have found that VNS is effective in accelerating and enhancing recovery of function following traumatic brain injury (TBI). The main limitation to these earlier results is that VNS treatment was initiated at either 2 hr or 24 hr after TBI. Present findings indicate that VNS treatment is effective for recovery of function after TBI even when the initiation of VNS treatment is delayed until two weeks after injury. In addition, present evidence demonstrates that, in general, practice, or a rehabilitation regimen, that is conducted across consecutive days is more effective when done in conjunction with VNS treatment. In conjunction with VNS, a regimen of delayed practice (every two days) was found to be less effective than consecutive practice for functional recovery. These results provide heretofore unknown answers regarding the potential utility of VNS as a clinical treatment for human TBI.

Background and Aims: Increased levels of nitric oxide (NO) are hypothesized to contribute to renal dysfunction in patients with decompensated cirrhosis. In this study, we examined whether splanchnic and/or peripheral NO levels and L-arginine (L-Arg) correlate with progressive renal dysfunction in cirrhotics. Methods: Serum NO metabolites (NOx) and L-Arg were measured in: controls (n = 10); organ donors (n = 12); compensated cirrhotics (n = 17), cirrhotics with ascites (n = 25), refractory ascites (n = 11) or hepatorenal syndrome type II (HRS) (n = 11) and chronic renal failure patients (n = 18). Results: Plasma NOx and L-Arg levels rose progressively with worsening renal function in decompensated cirrhotics. Both NOx and L-Arg levels were highest in patients with HRS (P < 0.001 and P < 0.025, respectively). While there were no differences in NOx levels related to the site of sampling, L-Arg levels were lowest in hepatic venous blood. There were significant relationships of NOx and L-Arg with Model for End-Stage Liver Disease score and Child-Pugh scores (P < 0.04 and P < 0.01, respectively). Multivariate analysis showed a significant relationship between NOx, L-Arg and HRS. Conclusion: Worsening renal function in decompensated cirrhosis is accompanied by progressive elevation in plasma NOx and L-Arg. These findings support the hypothesis that NO-mediated vasodilation is probably linked with the mechanism of progressive renal failure in decompensated cirrhotics.

The selected strain of rodent used in experimental models of traumatic brain injury is typically dependent upon the experimental questions asked and the familiarity of the investigator with a specific rodent strain. This archival study compares the injury responsiveness and recovery profiles of two popular outbred strains, the Long-Evans (LE) and the Sprague-Dawley (SD), after brain injury induced by lateral fluid percussion injury (LFPI). General findings include a significantly longer duration of unconsciousness in LE rats, but similar durations of apnea. Both strains displayed the same level of initial FPI-induced behavioral deficits, followed by a more rapid rate of functional recovery in SD rats. Cortical volume loss was not significantly different, but close inspection of the data suggests the possibility that LE rats may be more susceptible to damage in the hemisphere contralateral to the injury site than are SD rats. It is hoped that the information provided here encourages greater attention to the subtle differences and similarities between strains in future pre-clinical efficacy studies of traumatic brain injury.

In an effort to address the stressors accompanying work with the dying, a special “Phoenix” group for caregivers is introduced. Planning considerations, group format, and accompanying structured activities are presented.