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Purpose: Cognitive impairment is highly prevalent after stroke but can be difficult to identify acutely. We aimed to study if a large difference between two common, routine physical therapy assessments (Timed Up and Go [TUG] test and 10-Meter Walk Test [10MWT]) could identify patients with subtle cognitive difficulties post-stroke. Method: An observational study was conducted in 141 individuals admitted to acute inpatient rehabilitation after stroke. We computed the percent difference between TUG and 10MWT performance. Cognitive outcome measures were the Trail Making Test A and B (TMT-A and -B) and the Functional Independence Measure (FIM)-Cognition subscale. Linear and logistic regression analyses were conducted to evaluate if the difference between TUG and 10MWT was associated with cognitive functioning. Results: After adjusting for covariates, there was no significant linear association between TUG-10MWT discrepancy and cognition; however, stroke patients with the largest difference between TUG and 10MWT (highest quartile of scores) exhibited significantly worse attention on the TMT-A (adjusted odds ratio = 2.46, p = 0.04). Conclusions: A large difference between TUG and 10MWT may reflect deficits in complex sustained attention in individuals with stroke. Physical therapy staff may use this difference score to identify patients with potential cognitive deficits and refer them for comprehensive neuropsychological evaluation.

This paper identifies barriers that prevent corporations in the United States from advocating for climate policy so that companies can break them down and embrace climate advocacy. We find companies face seven key barriers to comprehensively adopting a science-based climate policy agenda. None of these barriers are an excuse for inaction. The purpose of this paper is to help individuals within a company anticipate and overcome these obstacles. In the conclusion, we offer a checklist of specific actions and strategies to clear multiple barriers (e.g., conducting a risk analysis) and to help advance essential public policies that address climate change. The audience for this paper is C-suite and other key staff members within large (Fortune 500) companies that strive to be climate leaders. Though the United States grants companies of all sizes the right to engage in political lobbying and campaign financing, those that have larger operations and revenue have a greater capacity, empowered by greater resources, to directly participate in the federal policymaking process. Similarly, this paper focuses on political influence at the federal level.

ObjectivesWe examined stillbirths in relation to disinfection by-product (DBP) exposures including chloroform, bromodichloromethane (BDCM), dibromochloromethane, bromoform, trichloroacetic acid, dichloroacetic acid (DCAA), monobromoacetic acid and summary DBP measures (trihalomethanes (THM4), haloacetic acids (HAA5), THMBr (brominated trihalomethanes) and DBP9 (sum of THM4 and HAA5)).MethodsWe randomly selected 10 controls for each of the 2460 stillbirth cases with complete quarterly 1997–2004 THM4 and HAA5 town-level drinking water data. Adjusted (aORs) were calculated based on weight-averaged second-trimester DBP exposures.ResultsWe detected statistically significant associations for stillbirths and the upper DCAA quartiles (aOR range: 1.50–1.71). We also found positive associations for the upper four HAA5 quintiles and different stillbirth cause of death categories that were examined including unexplained stillbirth (aOR range: 1.24–1.72), compression of umbilical cord (aOR range: 1.08–1.94), prematurity (aOR range: 1.37–2.88), placental separation and haemorrhage (aOR range: 1.44–2.01) and asphyxia/hypoxia (aOR range: 1.52–1.97). Additionally, we found positive associations between stillbirths and chloroform exposure (aOR range: 1.29 – 1.36) and unexplained stillbirths and BDCM exposure (aOR range: 1.51 – 1.78). We saw no evidence of exposure–response relationships for any categorical DBP metrics.ConclusionsConsistent with some previous studies, we found associations between stillbirths and chloroform and unexplained stillbirth and BDCM exposures. These findings strengthen existing evidence of prenatal THM exposures increasing the risk of stillbirth. Additionally, we saw statistically significant associations between DCAA and stillbirth. Future research should examine cause-specific stillbirths in relation to narrower critical windows and additional DBP exposure metrics beyond trihalomethanes and haloacetic acids.

Replacing sponge and tub bathing with swaddled bathing can reduce stress and heat loss during the procedure of bathing. After completing this article, readers should be able to: 1. Identify everyday NICU care that can cause stress in preterm infants. 2. Define sponge, tub, and swaddled bathing. 3. Compare the effects of swaddled bathing and other bathing methods on infant stress and heat loss. Preterm infants in the NICU are subject to many stressors that can affect their development and may have a negative impact on long-term outcomes. (1)(2) Routine handling and typical care in the NICU can be stressful for infants. (3) Sponge bathing in the NICU is one stressor that can cause physiologic and behavioral stress, manifested by signs and behaviors such as hypothermia and crying (1). Hypothermia in infants can lead to negative effects such as hypoxemia and hypoglycemia. (1) Although bathing is a nursing procedure, physicians need to be aware that different types of bathing are available for preterm infants. Three main types of bathing are available for infants. Sponge bathing is the act of bathing with a cloth or sponge without being immersed in a tub of water. Tub bathing is the act of bathing with the infant immersed in a tub of water. …

Background Epidemiological studies suggest that exposure to water disinfection by-products (DBPs) may increase the risk of certain birth defects. However, evidence for musculoskeletal defects (MSDs) is limited. Previous MSD studies have not examined DBPs beyond trihalomethanes (THMs) and have not separately examined limb or diaphragm defects which may have distinct developmental etiologies. Methods We calculated adjusted odds ratios (aORs) in a registry-based case-control study of birth defects in Massachusetts with complete quarterly 1999-2004 data on four THMs and five haloacetic acids (HAAs). We matched 10 controls each to 187 MSD cases based on week of conception. Weight-averaged town-level first-trimester DBP exposures were individually assigned based on residence at birth. We adjusted THM models for exposure to the sum of five HAAs (HAA5), and HAA models for the sum of four THMs (THM4). Results We detected positive exposure-response associations for all grouped MSDs with THM4 quintiles (aOR range: 1.90-3.18) and chloroform quartiles (aOR range: 1.30-2.21), and for reduction of upper or lower limbs with chloroform quartiles (aOR range: 2.39-3.52). We detected elevated aORs for diaphragmatic hernia with DBP9 (sum of THM4 and HAA5), and chloroform and bromodichloromethane tertiles and an exposure-response relationship for THM4 tertiles (aOR range: 1.67-1.80). Conclusions This is the first epidemiological study to examine HAAs in relation to MSDs. Given the indirect nature of our exposure assessment data and small case numbers, the exposure-response relationships that we detected for THM4 and chloroform warrant further investigation.

The aim of this study was to examine associations between craniofacial birth defects (CFDs) and disinfection by-product (DBP) exposures, including the sum of four trihalomethanes (THM4) and five haloacetic acids (HAA5) (ie, DBP9).We calculated first trimester adjusted odds ratios (aORs) for different DBPs in a matched case-control study of 366 CFD cases in Massachusetts towns with complete 1999 to 2004 THM and HAA data.We detected elevated aORs for cleft palate with DBP9 (highest quintile aOR = 3.52; 95% CI: 1.07, 11.60), HAA5, trichloroacetic acid (TCAA), and dichloroacetic acid. We detected elevated aORs for eye defects with TCAA and chloroform.This is the first epidemiological study of DBPs to examine eye and ear defects, as well as HAAs and CFDs. The associations for cleft palate and eye defects highlight the importance of examining specific defects and DBPs beyond THM4.

Previous epidemiological studies in Massachusetts have reported a risk of adverse health outcomes in relation to disinfection by-product (DBP) exposures. Measurement error due to the use of indirect exposure surrogates can lead to misclassification bias in epidemiological studies; therefore, it is important to characterize exposure variability in these populations to assess the potential for exposure misclassification. We used 19,944 trihalomethane (THM) samples and 9291 haloacetic acid (HAA) samples collected in 201 public water systems (PWSs) in Massachusetts to examine temporal variability under different drinking water sources and disinfection types. Annual and seasonal variability was also examined in 46 PWSs with complete quarterly THM4 (i.e., the sum of 4 individual THMs) data from 1995 to 2004 and 19 PWSs with complete HAA5 (i.e., the sum of 5 individual HAAs) data from 2001 to 2004. The quarterly ratio of THM4 and HAA5 and correlations between THM4, HAA5 and individual DBP species were examined to determine the adequacy of using different exposure surrogates in epidemiological studies. Individual PWSs were used to examine monthly variability in relation to quarterly averages. Based on all available matched samples (n=9003) from 1995 to 2004 data, we found a correlation of 0.52 for THM4 and HAA5. The correlation was stronger among the 62 ground water systems (r(s)=0.62) compared to the 81 surface water (r(s)=0.45) and 40 mixed water (r(s)=0.39) systems. Mean THM4 levels were fairly stable over the 10-year study period for 46 PWSs including 39 PWSs that did not change disinfection. Large reductions (∼40 μg/L) in mean THM4 data were found among seven systems that switched from chlorination to alternative disinfectants. As expected, the highest mean THM4 values were detected for Quarter 3, while the lowest values were found in Quarter 1. The highest HAA5 values were detected in Quarters 2 and 3 and the lowest was found in Quarter 4. Data from four systems showed mean differences up to 66 μg/L (67% change) in successive months and by 46 μg/L compared to quarterly mean concentrations. Although longer-term disinfection by-product temporality may be minimal in this study population, the use of monthly average concentrations for exposure assessment may be needed for some PWSs to minimize misclassification of narrow critical periods of exposure in epidemiological studies.

GTP cyclohydrolase I (GTPCH) gene expression was investigated in the human monoamine-containing neuroblastoma cell line SK-N-BE(2)M17. Northern blot analysis revealed a single GTPCH mRNA transcript that was confirmed by RNase protection assay to encode for Type 1 GTPCH; no alternatively spliced forms of GTPCH mRNA were detected with this assay. Incubation with 8Br-cAMP, but not nerve growth factor or leukemia inhibitory factor, produced a rapid increase in GTPCH mRNA and protein levels; protein levels remained elevated during the entire treatment period while mRNA content declined rapidly between 10 and 24 h. Treatment with 8Br-cAMP did not significantly modify the stability of GTPCH mRNA but did increase GTPCH transcription as determined by transient transfection assays of a luciferase reporter construct containing 1171 bp of human GTPCH 5'-flanking sequence. Cis-acting elements required for maximal basal and cAMP-dependent transcription were localized by deletion analysis to the 146 bp proximal promoter. DNase I footprint analysis of the proximal promoter using SK-N-BE(2)M17 nuclear extracts identified two protein binding domains: one an upstream Sp1-like site and the other a combined CRE-Sp1-CCAAT-box element. EMSA and supershift assays demonstrated that the combined CRE-Sp1-CCAAT-box element recruits ATF-2 and NF-Y but not Sp1-4 or Egr-1-3. NF-Y binding was confirmed using pure recombinant human NF-Y protein. Transcription of the human GTPCH gene in human SK-N-BE(2)M17 cells is thus enhanced by cAMP acting through regulatory elements located in the proximal promoter and may involve the transcription factors NF-Y and ATF-2.

Integrin-linked kinase (ILK) and caveolin-1 (cav-1) are implicated in the pathogenesis of cancer. Overexpression of ILK leads to altered expression of cell cycle regulators, a decreased level of cell adhesion to the extracellular matrix, a decreased level of apoptosis, in vitro phosphorylation of Akt, and tumor formation in nude mice. Conversely, cav-1 expression is frequently downregulated in many forms of cancer. We examined whether ILK and cav-1 interact in SHEP human neuroblastoma cells because ILK is present in caveolae-enriched membranes and contains a putative cav-binding domain. SHEP cells were stably transfected with vector, wild-type ILK (ILK-wt), kinase-deficient ILK (ILK-kd), or mutant cav-binding domain ILK (ILK-mutCavbd). Control SHEP cells and ILK transfectants express high levels of ILK and cav-1. Immunoprecipitation with anti-cav-1 co-immunoprecipitates a 59 kDa protein that is immunoreactive with the anti-ILK antibody, and this interaction is partially prevented in cells expressing ILK-mutCavbd. Cav-1 and ILK partially colocalize in SHEP cells, also supporting these data. Last, affinity chromatography with a biotinylated cav-scaffolding domain peptide precipitates ILK-wt but not ILK-mutCavbd. These data suggest that the cav-binding domain of ILK and the cav-scaffolding domain of cav-1 mediate complex formation in human neuroblastoma cells.

Neuroblastoma (NBL) is the most common malignant disease of infancy, and children with bone metastasis have a mortality rate greater than 90%. Two major classes of proteins, integrins and growth factors, regulate the metastatic process. We have previously shown that tumorigenic NBL cells express higher levels of the type I insulin-like growth factor receptor (IGF-IR) and that beta1 integrin expression is inversely proportional to tumorigenic potential in NBL. In the current study, we analyze the effect of beta1 integrin and IGF-IR on NBL cell attachment and migration. Nontumorigenic S-cells express high levels of beta1 integrin, whereas tumorigenic N-cells express little beta1 integrin. Alterations in beta1 integrin are due to regulation at the protein level, as translation is decreased in N-type cells. Moreover, inhibition of protein synthesis shows that beta1 integrin is degraded more slowly in S-type cells (SHEP) than in N-type cells (SH-SY5Y and IMR32). Inhibition of alpha5beta1 integrin prevents SHEP (but not SH-SY5Y or IMR32) cell attachment to fibronectin and increases SHEP cell migration. Increases in IGF-IR decrease beta1 integrin expression, and enhance SHEP cell migration, potentially through increased expression of alphavbeta3. These data suggest that specific classes of integrins in concert with IGF-IR regulate NBL attachment and migration.

Patients with Duchenne muscular dystrophy (DMD) lose ambulation by age 12. Long-term steroids have lengthened ambulation by 2-5 years. Ischial weight-bearing knee ankle foot orthoses prolong ambulation for 2-3 years. We report the outcome of the ambulatory status of a patient with DMD treated with daily steroid therapy and orthoses. This male patient was diagnosed with DMD at age of 2. He has been treated with daily steroids since age 7 years. He lost the ability to arise from the floor and walk up steps at age 14 and lost ambulation by age 16. He was fitted with orthoses at age 16 following surgical correction of his lower extremity contractures and regained independent ambulation. At age 20, he was able to stand independently in his orthoses and take steps with moderate support. We conclude that a combination of daily steroids and orthoses prolongs ambulation beyond that of the natural history DMD.

Although future orbital facilities will have immense scale, details will require intricate operations in restrictive, confined quarters. LEMUR is a small, agile and capable six-legged walking robot that has been built at the Jet Propulsion Laboratory to perform dexterous small-scale assembly, inspection and maintenance. It is intended to expand the operational envelope of robots in its size class (sub-5 kg) through the flexible use of its limbs and effectors, as well as through the modular changeout of those effectors. In short, LEMUR is intended as a robotic instantiation of a six-limbed primate with Swiss Army knife tendencies. LEMUR's layout consists of six independently operated limbs arranged in two rows of three. The front two limbs have four active degrees of freedom while the rear four limbs have three each. Each limb is reconfigurable to allow the integration of a variety of mechanical tools.

This report is an overview of effluent monitoring and environmental surveillance activities conducted on and in the vicinity of SRS from January 1 through December 31, 2012 - including the Site�s performance against applicable standards and requirements. Details are provided on major programs such as the Environmental Management System (EMS) and permit compliance.

The use of public water system (PWS) average trihalomethane (THM) and haloacetic acid (HAA) concentrations as surrogates of “personal” exposures in epidemiological studies of disinfection by-products (DBPs) may result in exposure misclassification bias from various sources of measurement error including intra-system variation of DBPs. Using 2000–2004 data from 107 PWSs in Massachusetts, we assessed two approaches for characterizing DBP spatial variability by identifying PWSs with low spatial variability (LSV) and examining differences in LSV across DBP groups and by type of source water and primary disinfectant. We also used spatial differences to examine the association between THM concentrations and indices of social disadvantage; however, we found no correlations or statistically significant differences based on the available data. We observed similar patterns for the percentage of quarterly sampling dates with LSV across different types of source water for all DBPs but not across disinfectants. We found there was little overlap between sites classified as having LSV across different DBP groups. In the main analysis, we found moderate correlations between both approaches ( φ THM4 = 0.55; φ BrTHM = 0.64; φ HAA5 = 0.67); although Method 1 (based on concentration differences between samples) may be better suited for identifying PWSs for inclusion in epidemiological studies because it is more easily adapted to study-specific exposure gradients than Method 2 (based on categorical exposure percentiles). These data reinforce the need to consider different exposure assessment approaches when examining the spatial variation of multiple DBP surrogates as they can represent different DBP mixtures.

Poster Presentation Purpose for the Program An opportunity existed to reduce or eliminate the risk of retained surgical items (RSIs) in response to the Joint Commission's October Sentinel Event Alert regarding RSIs. Within perinatal nursing there is a keen awareness that a discrepancy exists between the approaches to surgical counts in the perioperative suite versus the vaginal delivery room. It is very likely that during vaginal births, the surgical count error rate is greater than the overall 10% to 15% error rate noted by The Joint Commission. Proposed Change To implement a highly reliable and standardized count process during all vaginal births that was more in line with structured counts of the perioperative suites. Implementation, Outcomes, and Evaluation Although limited, the literature demonstrated the need to first revise the facility wide count policy and specifically address the count process for vaginal births. Next, informal staff surveys indicated that the existing process lacked clear expectations, identified significant gaps in the process, and confirmed breaks in communication between nursing and provider staff. These surveys also revealed that the team approached the counts for vaginal births in a less formal manner than the surgical counts in the perioperative suite. Based on this information we implemented a standardized counting system that included a defined interdisciplinary communication requisite, streamlined the documentation, and provided global team education. Within 2 months of the completion of phase one training (hands on training) and the policy revision, the count sheet audits demonstrated greater than 95% adherence. After Phase 2 training, which included video demonstration and eLearning, greater than 98% adherence was demonstrated using 100% count sheet and random observed audits. In the 3rd and 4th month of observed audits, 100% adherence was noted, demonstrating normalization of the new process. Implications for Nursing Practice Primary outcomes included improved communication between health care providers and nurses, count diligence, and standardization of the count culture within the vaginal delivery room. In addition, the process change enhanced patient safety by minimizing the risk of the RSI in the vaginal delivery room. Finally, although not utilized in this process change, there is clearly a need to evaluate the effect of assistive safe count technology during vaginal births.

GTP cyclohydrolase I (GTPCH) gene expression was investigated in the human monoamine-containing neuroblastoma cell line SK-N-BE(2)M17. Northern blot analysis revealed a single GTPCH mRNA transcript that was confirmed by RNase protection assay to encode for Type 1 GTPCH; no alternatively spliced forms of GTPCH mRNA were detected with this assay. Incubation with 8Br-cAMP, but not nerve growth factor or leukemia inhibitory factor, produced a rapid increase in GTPCH mRNA and protein levels; protein levels remained elevated during the entire treatment period while mRNA content declined rapidly between 10 and 24 h. Treatment with 8Br-cAMP did not significantly modify the stability of GTPCH mRNA but did increase GTPCH transcription as determined by transient transfection assays of a luciferase reporter construct containing 1171 bp of human GTPCH 5'-flanking sequence. Cis-acting elements required for maximal basal and cAMP-dependent transcription were localized by deletion analysis to the 146 bp proximal promoter. DNase I footprint analysis of the proximal promoter using SK-N-BE(2)M17 nuclear extracts identified two protein binding domains: one an upstream Sp1-like site and the other a combined CRE-Sp1-CCAAT-box element. EMSA and supershift assays demonstrated that the combined CRE-Sp1-CCAAT-box element recruits ATF-2 and NF-Y but not Sp1-4 or Egr-1-3. NF-Y binding was confirmed using pure recombinant human NF-Y protein. Transcription of the human GTPCH gene in human SK-N-BE(2)M17 cells is thus enhanced by cAMP acting through regulatory elements located in the proximal promoter and may involve the transcription factors NF-Y and ATF-2.