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Background Denervation atrophy is one factor contributing to suboptimal motor recovery following major nerve repair. The hypertrophic effects of anabolic steroids may have a potential role in improving reinnervated muscle strength after delayed repair. Methods Forty-five immature female Sprague–Dawley rats underwent three surgeries and final testing. The tibial nerve was transected in the hind limb of the experimental ( n=13) and control ( n=14) animals and exposed, but not transected in the sham ( n=15) group animals. Three months later, once denervation atrophy was established, all transected nerves underwent repair using an autograft from the contralateral limb. After waiting an additional month to allow axonal regeneration to the gastrocnemius muscles, the rodents were implanted with a subcutaneous infusion pump. For the experimental group, nandrolone was administered over the next 30 days via this pump, while the control and sham group pumps were filled with carrier only. Results Final testing, 6 weeks later, showed improved muscle contraction strength in the steroid-treated animals (72% of sham group strength) compared to control animals (57% of sham group strength, pConclusions These findings support the potential role of anabolic steroids in improving recovery of atrophic muscle after delayed reinnervation.

The paper describes an approach for evaluating operational benefits of technologies proposed under the Next Generation Air Transportation System (NextGen) program. Our approach, led by the Federal Aviation Administration (FAA) Office of Aviation Safety, extends traditional flight-based assessment methodologies to include passenger-based metrics. Studies performed over the past several years to quantify the potential benefits of selected NextGen operational improvements typically focus on evaluating per-flight benefits, measuring the potential reduction in delay per flight, fuel burn per flight, or assessing safety risk per flight. Our process for predicting NextGen operational benefits incorporates measures related to passenger itineraries, such as missed passenger connections. The initial phase of the work focuses on demonstrating the process using Boeing-developed models to predict the operational benefits of a single NextGen technology improvement. The paper outlines the approach, describes the models, and documents initial results.

Narration in psychotherapy has become a key area of theoretical and empiri-cal concern. Rationales for this new concern are provided in the context of introducing a three-dimensional model of narrative structure. Numerous measures corresponding to each dimension are operationally defined and used in an illustrative study of 16 pairs of temporally contiguous child-thera-pist stories sampled from Gardner's (1971)Therapeutic Communication with Children. As predicted, the therapist's narratives were more structurally con-nected, more often concerned with protagonists' internal psychological pro-cesses, and more elaborate/complex than the children's narratives. The therapist's narrative measures, however, did not seem adapted to the chil-dren's varying narrative competence, indicated by the absence of significant covariation with the children's narrative measures or with their age. These and additional analyses illustrate how to assess narrative processes in psycho-therapy and suggest future research on and training in the use of narratives in psychotherapy.(Psychology)

Purpose A retrospective study was done to evaluate the use of transalveolar implant placement in the mandible posterior to the mental nerve. Materials and Methods Ten patient charts were reviewed of twenty implants placed transalveolarly with evaluation of function, osseointegration, and bone level for 1 year by unregistered periapical x-rays. Results Ten patients which received twenty transalveolar implants were followed for 1 year. One implant failed. There were no significant complications encountered from the procedure. Conclusion All On Four treatment of mandibles with relatively anterior mental nerve locations may be successfully treated with transalveolar implant placement posterior to the foramen.

The objective of this study was to compare the community-based, long-term care program called Aging in Place (AIP) and nursing home care, in terms of cost to the Medicare and Medicaid programs. A retrospective cohort design was used in this study of 39 nursing home residents in the Midwest who were matched with 39 AIP participants. The AIP program consisted of a combination of Medicare home health, Medicaid home and community-based services (HCBS), and intensive nurse care coordination. Controlling for high inpatient Medicare cost in the 6 months prior and the 10 most frequently occurring chronic conditions, multiple regression was used to estimate the relationship of the AIP program on Medicare and Medicaid costs. Total Medicare and Medicaid costs were $1,591.61 lower per month in the AIP group ( p < 0.01) when compared with the nursing home group over a 12-month period. The findings suggest that the provision of nurse-coordinated HCBS and Medicare home health services has potential to provide savings in the total cost of health care to the Medicaid program while not increasing the cost of the Medicare program.

Graft choice is one of the few variables over which the surgeon has control when reconstructing nerve gaps. Because repair of chronically denervated nerves generally yields inferior recovery, we hypothesized that the use of chronically denervated nerve tissue as a graft source may compromise axonal regeneration and clinical results.A total of 45 immature female Sprague-Dawley rats underwent transection of one peroneal nerve before being divided into 3 experimental groups: group A (n = 15) had acutely denervated nerve graft, group B (n = 15) had 2-month denervated nerve graft, and group C (n = 15) had 4-month denervated nerve graft. We included 10 additional rats as a sham group. After 2 months, groups A and B underwent removal of 1 cm of the contralateral peroneal nerve. For group A, this section of nerve was immediately sutured back in place to serve as a model for acute denervation. For group B, the defect was repaired with a 1-cm graft from the distal stump of the previously transected (denervated) peroneal nerve. Group C underwent the same procedure as group B, but after an additional 2 months. After 8 weeks of regeneration time, the 3 experimental groups and the sham group underwent testing. We assessed twitch contraction forces of the reinnervated extensor digitorum longus before we harvested the muscle belly for morphologic measurements. Histological nerve tissue evaluation assessed axonal regeneration.We detected no statistical differences for mean muscle contraction strengths between the experimental groups; nevertheless, the reinnervated extensor digitorum longus muscle bellies from the 4-month denervated nerve graft group were statistically smaller than muscles from the other 2 experimental groups (p.05). Axon counts decreased, whereas axon diameters increased in direct correlation with the length of time of graft denervation (p.05). No difference in axon myelination was found between experimental groups.Prolonged denervation of nerve graft material compromised both axon and reinnervated muscle recovery in this rodent model.

The purpose of this evaluation was to study the relationship of nurse care coordination (NCC) to the costs of Medicare and Medicaid in a community-based care program called Missouri Care Options (MCO). A retrospective cohort design was used comparing 57 MCO clients with NCC to 80 MCO clients without NCC. Total cost was measured using Medicare and Medicaid claims databases. Fixed effects analysis was used to estimate the relationship of the NCC intervention to costs. Controlling for high resource use on admission, monthly Medicare costs were lower ($686) in the 12 months of NCC intervention (p = .04) while Medicaid costs were higher ($203; p = .03) for the NCC group when compared to the costs of MCO group.

Several task demands were examined in a battery of praxis tests: the movement system (limb versus axial), input modality (command versus imitation), movement complexity (single gestures versus a sequence of gestures), type of limb gesture (transitive versus intransitive), and the representational nature of the gestures. Performance accuracy for a group of left hemisphere patients was significantly lower than for two other groups of patients with either right hemisphere damage or no brain damage on all gestures. The right hemisphere patients were significantly different from the normals only for the most complex gestures involving a three movement sequence. Within the left hemisphere group performance to command was not different from imitation. Representational and nonrepresentational gestures were not different, and axial gestures was not different from the limb gestures. The transitive and complex gestures were not different but were both performed less accurately than the intransitive gestures. The implications of these findings for understanding apraxia were discussed.

Infection of the heifer mammary gland with common mastitis pathogens, particularly staphylococci, prior to calving is well documented. Efforts to eliminate pre-partum intramammary infections (IMI) in heifers have focused primarily on intramammary antibiotic therapy shortly before or at the time of calving. Few studies have evaluated vaccination of heifers against staphylococcal mastitis. The objectives of the present study were to evaluate the efficacy of a commercially available Staphylococcus aureus bacterin in protecting against staphylococcal IMI (S. aureus and coagulase-negative staphylococci (CNS)), to study the effect of vaccination on milk SCC, and to evaluate the milk antibody isotype response to vaccination using a lactating cow model. Ninety Holstein-Friesian lactating dairy cows of various parities were systematically assigned to a vaccinated (n=44) or control (n=46) group. Vaccinates received two 5 ml doses of the bacterin 14 days apart starting on day 0. Quarter milk samples for bacterial culture were collected prior to each vaccination and approximately monthly thereafter for 6 months. Composite milk samples were collected on days 0, 14, 28, 49 and 70 for IgA, IgG(1), IgG(2), and IgM determinations and somatic cell count. No animals in either group developed a new S. aureus IMI after vaccination. The numbers of mammary quarters that developed a new CNS IMI, time to new CNS IMI, milk somatic cell count, and milk antibody isotype sample-to-positive ratio did not significantly differ between groups (P>0.05). In a herd with a 3% prevalence of S. aureus IMI and a 30% prevalence of CNS IMI, the vaccine did not reduce the new staphylococcal IMI rate. There may be insufficient vaccine-induced opsonizing antibody in milk to facilitate phagocytosis and clearance of staphylococci from the mammary gland.

Purpose To examine if the gene encoding C-reactive protein (CRP), a biomarker of inflammation, confers risk for neovascular age-related macular degeneration (AMD) in the presence of other modifiers of inflammation, including body mass index (BMI), diabetes, smoking, and complement factor H (CFH) Y402 genotype. Additionally we examined the degree to which CRP common variation was in linkage disequilibrium (LD) within our cohort. Methods We ascertained 244 individuals from 104 families where at least one member had neovascular AMD, and a sibling had normal maculae and was past the age of the index patient’s diagnosis of neovascular AMD. We employed a direct sequencing approach to analyze the 5′-promoter region as well as the entire coding region and the 3′-untranslated region of the CRP gene. CFH Y402 genotype data was available for all participants. Lifestyle and medical factors were obtained via administration of a standardized questionnaire. The family-based association test, haplotype analysis, McNemar’s test, and conditional logistic regression were used to determine significant associations and interactions. Haploview was used to calculate the degree of LD (r2) between all CRP variants identified. Results Six single nucleotide polymorphisms (SNPs; rs3091244, rs1417938, rs1800947, rs1130864, rs1205, and rs3093068) comprised one haplotype block of which only rs1130864 and rs1417938 were in high LD (r2=0.94). SNP rs3093068 was in LD but less so with rs3093059 (r2=0.83), which is not part of the haplotype block. Six SNPs made up six different haplotypes with ≥ 5% frequency, none of which were significantly associated with AMD risk. No statistically significant association was detected between any of the nine common variants in CRP and neovascular AMD when considering disease status alone or when controlling for smoking exposure, BMI, diabetes, or CFH genotype. Significant interactions were not found between CRP genotypes and any of the risk factors studied. No novel CRP variation was identified. Conclusions We provide evidence that if elevated serum/plasma levels of CRP are associated with neovascular AMD, it is likely not due to genetic variation within CRP, but likely due to variations in some other genetic as well as epidemiological factors.

A variety of different approaches have been employed to enable implantation of electronic medical microdevices. A novel method of producing low-cost, rapidly fabricated implantable enclosures from biocompatible silicone is presented in this paper. This method utilises 3D computer-aided design software to design and model the enclosures prior to fabrication. The enclosures are then fabricated through additive manufacturing from biocompatible silicone using a 3D bioprinter. In this paper, four different implantable enclosure designs are presented. A prototyping stage with three different prototypes is described, these prototype enclosures are then evaluated through submersion and operation tests. A final design is developed in response to the obtained results, and then evaluated in a long term temperature controlled submersion test. The evaluation results are presented and discussed. Several areas of future works are identified and discussed.

This study investigated the isometric force and static position control of the upper lip, lower lip, tongue, jaw, and finger in four subject groups (normal control, apraxia of speech, conduction aphasia, and ataxic dysarthria) at two force and displacement levels. Results from both the force and position tasks suggested that the apraxic and dysarthric groups tended to produce significantly greater instability than the normal group, although the pattern of instability across articulators was not systematic within or across the force and position experiments for subjects within or between groups. The conduction aphasic group produced force and position stability that typically was not significantly different from any of the remaining three groups, suggesting that their force and position stability as indexed in the present study fell somewhere between that of the normal group and the apraxic and dysarthric groups. It is suggested that other analyses of force and position control, such as descriptive accounts of the trial-by-trial time histories, might shed additional light on the speech and orofacial sensorimotor control deficits in persons with apraxia, dysarthria, and conduction aphasia.

Many communities and several states prohibit smoking in bars or restaurants. Using county-level data on employment from across the US, we find that communities where smoking is banned experience reductions in bar employment compared with counties that allow smoking. Smoking bans have a larger detrimental impact on bars in geographic areas with a high prevalence of smokers. The relative effect on restaurant employment is neutral or mildly positive. The positive effects are concentrated in areas with fewer smokers. We also find that bans have a positive effect on restaurant employment in warmer regions of the country, especially during the cooler winter months, and in the summer in colder regions. This suggests the prevalence of outdoor seating might influence the policy's effect.

We review the existing evidence on age discrimination and its effects in U.S. labor markets. First, we look at attempts to describe the attitudes in the workplace toward older individuals and how these may affect managerial decision making. Second, we review the types of cases filed with the Equal Employment Opportunity Commission (EEOC) and assess whether this tells us anything about the nature and effect of age discrimination. Third, we document the disadvantageous positions of older individuals in the labor force in terms of certain labor market barometers, including hiring, unemployment duration, re-employment wages, and promotion. Finally, we look at attempts to assess whether the disadvantageous position is the result of discrimination on the part of employers. Despite many conflicting results and alternative interpretations of those results, we are able to draw several conclusions about age discrimination in the United States. First, the industrial gerontology literature and the industrial psychology literature have produced more than a handful studies showing that age is considered when making decisions about the relative worth of job applicants. Attitudes about older workers are considered in promotion decisions as well. Second, the thousands of ADEA cases that are resolved and deemed worthy of merit by the EEOC indicate that age discrimination - at least as defined and recognized by the law - is an ongoing phenomenon in U.S. labor markets. Third, while older workers perform relatively well in the labor market in terms of wages and employment, they perform poorly in terms of unemployment duration, the probability of getting hired, their incidence of displacement, and the consequences of displacement in terms of re-employment earnings. Fourth, studies that estimate the link between age discrimination and adverse outcomes tend to find evidence of such a link. However, some of these studies have difficulty ruling out alternative explanations.

Background: Fracture of the thoracolumbar (TL) spine is reported in 8 to 15% of victims of blunt trauma. Current screening of these patients is done with conventional radiography. This may require repeated sets of films and take hours to days. It is imperative that these patients get timely, accurate evaluation to allow for treatment planning and early mobilization; alternatives to plain films would aid in this. The objective of this study is to determine whether the data obtained from admission chest/abdomen/pelvis (CAP) computed tomography (CT) scans after blunt trauma has utility in thoracolumbar spine evaluation Methods: The records of all patients admitted to a Level I trauma center over a 2-month period who underwent CAP CT were reviewed for the presence of TL spine fracture, time to completion of plain film evaluation, and clinical course. Admission CT scans were reviewed by an attending radiologist who was blinded to any previously diagnosed spine fractures. The two tests were compared for diagnostic accuracy and their discriminatory ability was compared using receiver operating characteristic (ROC) curves. Significance was defined as p < 0.05. Results: In all, 103 patients were admitted from January 1, 2003 to February 28, 2003 and underwent CAP CT scan as part of their initial trauma evaluation. Of these, 26 (25%) had thoracolumbar fractures. Seven (27%) thoracolumbar fractures were not seen on plain radiographs taken during the trauma evaluation. Average time until plain film completion in this group was 8 hours (range, 44 minutes to 38 hours). All 26 (100%) patients with fractures, however, were diagnosed on CT scan performed shortly after admission. Of the remaining 77 patients, two (2.6%) were falsely read as positive for fracture on CT. Sensitivity and specificity of CT scan for thoracolumbar fracture were excellent at 100% and 97%, respectively, with a negative predictive value of 100%. Plain radiographs were 73% sensitive, 100% specific, and had a negative predictive value of 92%. Area under the ROC curve for CT was 0.98, but for plain film was 0.86 (p < 0.02). Conclusion: Admission CAP CT obtained as part of the routine trauma evaluation in these high-risk patients is more sensitive than plain radiographs for evaluation of the TL spine after blunt trauma. In addition, CAP CT can be performed faster. Omission of plain radiographs will expedite accurate evaluation allowing earlier treatment and mobilization.

Many features of living wage laws may influence the strength of their effects on wages and employment of low-skill individuals. Echoing past research, business assistance living wage laws generate stronger wage increases and employment reductions than contractor-only laws. But broader enforcement or implementation and geographic concentration of living wage laws also appear to strengthen their effects. Finally, geographic concentration may be more significant than the distinction between business assistance and contractor-only living wage laws.

Nearly 100 cities and local governments in the United States passed living wage laws since the mid-1990s. The central goal of living wages is to reduce poverty, yet they may fail to do so because of disemployment effects. We summarize and critique the existing research on the effects of living wages on wages, employment, and family income, emphasizing common findings, points of disagreement, and important questions for future research. The evidence thus far points to wage increases as well as employment losses for the least skilled—although thereis disagreement about the employment effects—but, on net, some beneficial distributional effects. The evidence also points to efficiency wage–type effects of living wage laws that may offset some of the adverse impacts on employers.

In the current study we generated murine bone marrow stromal cells that constitutively express human VCAM-1. These stromal cell lines allow investigation of the contribution of VCAM-1 initiated signaling to tumor cell survival. Co-culture of ALL cell lines with stromal cells engineered to over express VCAM-1 enhanced survival of leukemic cells in a PI-3 kinase-dependent manner, compared to co-culture with parental stromal cells expressing only endogenous VCAM-1. These observations suggest that modulation of stromal cell VCAM-1 by specific chemotherapeutic drugs may have utility in decreasing residual disease. In addition, these novel lines provide an in vitro model in which other tumor types that interact with stromal cells in the bone marrow microenvironment may be evaluated to determine the contribution of VCAM-1 initiated signaling to modulation of treatment response.

The authors of this chapter include emergency physicians, surgical specialists and anaesthetists with experience of working in a wide variety of hostile environments. As with earlier chapters, the aim is not to “teach grandmothers to suck eggs”. Senior surgeons with deployment experience will have their own tried and trusted methods for managing patients under austere circumstances, and some will belong to that dying breed the “general surgeon”. This chapter is not aimed at the senior and experienced old hands. Rather, the purpose is to illustrate the range and complexity of conditions covered by our chapter headings for the more junior and often specialised health professional with a surgical interest in the widest sense

A previously described monoclonal antibody (MAb)-based competitive-inhibition enzyme-linked immunosorbent assay (cELISA) was modified to optimize performance, and the assay was validated in various defined cattle populations for detection of serum antibody to Neospora caninum , a major cause of bovine abortion. Modifications to the cELISA included capturing native N. caninum antigen with a parasite-specific MAb (MAb 5B6-25) and directly conjugating the competitor MAb (MAb 4A4-2), with both MAbs binding different epitopes of a conserved, immunodominant 65-kDa tachyzoite surface antigen. The assay was validated using three serum sets, a “gold standard” set of 184 cow sera defined by fetal histopathology and N. caninum immunohistochemistry and by maternal N. caninum indirect fluorescence assay (IFA) at a 1:200 serum dilution, a relative standard set of 330 cow sera defined by IFA alone, and a set of 4,323 cow sera of unknown N. caninum status. A test cutoff of 30% inhibition was identified. The diagnostic sensitivity was 97.6%, and diagnostic specificity was 98.6% for the gold standard abortion-defined sera. The diagnostic sensitivity was 96.4%, and diagnostic specificity was 96.8% for the relative standard IFA-defined sera. Testing of the 4,323 bovine sera of unknown N. caninum status revealed a distinct bimodal distribution and steep sigmoid frequency curve with only 1.8% of samples within 5% of the test cutoff, indicating a sharp discrimination between test-positive and test-negative samples. In summary, the modified N. caninum cELISA provided a simple, rapid, and versatile method to accurately identify N. caninum infection status in cattle using a single cutoff value.

Living wage ordinances typically mandate that businesses under contract with a city or, in some cases, receiving assistance from a city, must pay their workers a wage sufficient to support a family financially. We estimate the effects of these ordinances on wages, hours, and employment in cities that have adopted such legislation. We then examine the effects of these laws on poverty. Our findings indicate that living wage ordinances boost wages of low-wage workers. Moreover, we find a moderate negative employment effect. Finally, some of the evidence suggests that living wages achieve modest reductions in urban poverty.

Gelled liquid hydrogen was experimentally formulated using sol-gel technology. As a follow-on to work with cryogenic simulants, hydrogen was gelled with an alkoxide material: BTMSE. Initial results demonstrated that gellants with a specific surface area of 1000 m(exp 2)/g could be repeatably fabricated. Gelled hexane and metallized gelled hexane (with 13.8-wt% Al) were produced. Propellant settling testing was conducted for acceleration levels of 2 to 10 times normal gravity and a minimum gellant percentage was determined for stable gelled hexane and metalized gelled hexane. A cryogenic capillary rheometer was also designed, constructed, and used to determine the viscosity of gelled hydrogen. Small volumes of liquid hydrogen were gelled with a 7- to 8-wt% gellant level. The gelled H2 viscosity was 1.5 to 3.7 times that of liquid hydrogen: 0.048 to 0.116 mPa-s versus 0.03 mPa-s for liquid H2 (at 16 K and approximately 1 atm pressure).

Background & Aims Although the zinc-finger transcription factor GATA4 has been implicated in regulating jejunal gene expression, the contribution of GATA4 in controlling jejunal physiology has not been addressed. Methods We generated mice in which the Gata4 gene was specifically deleted in the small intestinal epithelium. Measurements of plasma cholesterol and phospholipids, intestinal absorption of dietary fat and cholesterol, and gene expression were performed on these animals. Results Mice lacking GATA4 in the intestine displayed a dramatic block in their ability to absorb cholesterol and dietary fat. Comparison of the global gene expression profiles of control jejunum, control ileum, and GATA4 null jejunum by gene array analysis revealed that GATA4 null jejunum lost expression of 53% of the jejunal-specific gene set and gained expression of 47% of the set of genes unique to the ileum. These alterations in gene expression included a decrease in messenger RNAs (mRNAs) encoding lipid and cholesterol transporters as well as an increase in mRNAs encoding proteins involved in bile acid absorption. Conclusions Our data demonstrate that GATA4 is essential for jejunal function including fat and cholesterol absorption and confirm that GATA4 plays a pivotal role in determining jejunal vs ileal identity.

An implicit assumption of many studies of articulatory kinematics is that all normal speakers are equivalent, at least in a statistical sense. The present report investigated this assumption by performing post hoc analyses on random groups of 8 normal, geriatric males. Results of these analyses suggest that, at least for the geriatric population, small numbers of subjects may not represent the parent population adequately, especially when the unit of statistical analysis is the individual trial. These findings have implications for the types of generalizations that can be made from studies with small samples and suggest the need for more comprehensive investigations of speech kinematics.

Peptides bind to MHC class II molecules with a defined periodicity such that the peptide-flanking residues (PFRs) P-1 and P11, which lie outside the core binding sequence (P1–P9), are solvent exposed and accessible to the TCR. Using a novel MHC class II:peptide binding assay, we defined the binding register for nine immunogenic epitopes to formally identify the flanking residues. Seven of the nine epitopes, restricted by H-2Ak, H-2Ag7, or H-2Ek, were found to generate T cells that were completely dependent on either P-1 or P11, with dependency on P-1 favored over P11. Such PFR dependency appears to be influenced by the type of amino acid exposed, in that residues that can form salt bridges or hydrogen bonds are favored over small or hydrophobic residues. Peptides containing alanine substitutions at P-1 or P11 in place of PFRs that mediate dependency were considerably less immunogenic and mediated a substantially reduced in vitro recall response to the native protein, inferring that PFR recognition increases immunogenicity. Our data suggest that PFR recognition is a common event characteristic of all MHC class II-restricted T cell responses. This key feature, which is not shared by MHC class I-restricted responses, may underlie the broad functional diversity displayed by MHC class II-restricted T cells.