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To foster teamwork, improve clinical excellence, and promote a culture of safety, perioperative leaders should have a clear understanding of the dynamics that affect clinician communication in the OR. We used social network analysis to characterize the typical OR clinician communication patterns at a military surgery center and determine how clinician relationships influenced individual behavior. We surveyed 50 surgical teams and used the data to develop six relational networks and a clinician communication effectiveness index. The study results showed that communication effectiveness increased in networks in which clinicians reported interacting frequently, having close working relationships, socializing, and seeking advice and providing advice to others. Increases in individual clinician centrality were associated with increased communication effectiveness. Participants rated anesthesia professionals as the most effective communicators, followed by perioperative nurses, surgeons, and surgical technologists. Perioperative leaders should consider surgical team familiarity as a potential option to optimize surgical care and improve communication effectiveness.

Malignant hyperthermia (MH) crises may induce morbidity or death in MH-susceptible (MHS) individuals. The only sensitive method of determining susceptibility is the caffeine-halothane contracture test, requiring muscle biopsy. Early research on MH demonstrated an abnormal response to catecholamines in MHS individuals. The purpose of this study was to determine whether MHS B lymphocytes would demonstrate an increased sensitivity to norepinephrine as indicated by an adrenergic augmentation of intracellular calcium ion (Ca

Background Nurses lack genome literacy, skill, and self-confidence in applying genomics to health care. Standardized curricula and evaluation tools are needed for wide spread uptake and application of genome science in nursing education, practice, and research. Aim To determine whether psychometrically robust survey instruments exist to assess knowledge, skills, attitudes, and self-confidence in applying genomic nursing competency among students and registered nurses. Design Psychometric systematic review. Data Sources Medline, CINAHL, Academic Search Elite, Web of Science, and ProQuest Dissertations were searched from 1995 to 2014, with an English language restriction. Procedures Critical analysis of the study elements and psychometric attributes was conducted after data were abstracted into analysis and synthesis tables. The synthesis assessed the design, methods, and measurement properties with a focus on reliability and validity using 16 criteria on a 4-point grading scale. Findings Twelve studies were included in a detailed review that focused on assessment of genomic nursing core competencies. Six studies met the inclusion criteria. In terms of psychometric quality of the instruments, one study scored high, two moderate, two low, and one very low. Linking Evidence to Action Most instruments assess self-perceived rather than objectively assessed competency. The highest quality instrument lacks clinical application. Knowledge-focused test questions based on up-to-date genome science that are relevant to practice need to be developed.

Traumatic brain injury (TBI) in all of its forms—blast, concussive, and penetrating—has been an unfortunate sequela of warfare since ancient times. The continued evolution of military munitions and armor on the battlefield, as well as the insurgent use of improvised explosive devices, has led to blast-related TBI whose long-term effects on behavior and cognition are not yet known. Advances in medical care have greatly increased survival from these types of injuries. Therefore, an understanding of the potential health effects of TBI is essential. This review focuses on specific aspects of military-related TBI. There exists a large body of literature reporting the environmental conditions, forces, and staging of injury. Many of these studies are focused on the neuropathology of TBI, due to blast overpressure waves, and the emergence of large numbers of mild blast-related TBI cases.

As professional psychology becomes increasingly involved in providing healthcare services beyond traditional mental healthcare, the enactment of President Obama’s Patient Protection and Affordable Care Act provides a unique opportunity to shape the nation’s rapidly evolving healthcare environment. The study of health policy should be incorporated into accreditation requirements for graduate psychology training, using the experience of nursing as an informative model. It is also critical to foster interdisciplinary team-based skills throughout clinical and research training. It is important that our next generation appreciate the unique language, culture, and history of the public policy process, as well as that of other disciplines. Engagement in public policy will ultimately improve patient care and expand psychology’s role in promoting and serving the healthcare of the nation.

The continued evolution of military munitions and armor on the battlefield, as well as the insurgent use of improvised explosive devices, has led to embedded fragment wounds containing metal and metal mixtures whose long-term toxicologic and carcinogenic properties are not as yet known. Advances in medical care have greatly increased the survival from these types of injuries. Standard surgical guidelines suggest leaving embedded fragments in place, thus individuals may carry these retained metal fragments for the rest of their lives. Nursing professionals will be at the forefront in caring for these wounded individuals, both immediately after the trauma and during the healing and rehabilitation process. Therefore, an understanding of the potential health effects of embedded metal fragment wounds is essential. This review will explore the history of embedded fragment wounds, current research in the field, and Department of Defense and Department of Veterans Affairs guidelines for the identification and long-term monitoring of individuals with embedded fragments.

Metal translocation to the brain is strictly controlled and often prevented by the blood-brain barrier. For the most part, only those metals required to maintain normal function are transported into the brain where they are under tight metabolic control. From the literature, there are reports that traumatic brain injury disrupts the blood-brain barrier. This could allow the influx of metals that would normally have been excluded from the brain. We also have preliminary data showing that metal pellets, surgically-implanted into the leg muscle of a rat to simulate a shrapnel wound, solubilize and the metals comprising the pellet can enter the brain. Surprisingly, rats implanted with a military-grade tungsten alloy composed of tungsten, nickel, and cobalt also showed significantly elevated uranium levels in their brains as early as 1month after pellet implantation. The only source of uranium was low levels that are naturally found in food and water. Conversely, rats implanted with depleted uranium pellets demonstrated elevated uranium levels in brain resulting from degradation of the implanted pellets. However, when cobalt levels were measured, there were no significant increases in the brain until the rats had reached old age. The only source of cobalt for these rats was the low levels found in their food and water. These data suggest that some metals or metal mixtures (i.e., tungsten alloy), when embedded into muscle, can enhance the translocation of other, endogenous metals (e.g., uranium) across the blood-brain barrier. For other embedded metals (i.e., depleted uranium), this effect is not observed until the animal is of advanced age. This raises the possibility that metal body-burdens can affect blood-brain barrier permeability in a metal-specific and age-dependent manner. This possibility is disconcerting when traumatic brain injury is considered. Traumatic brain injury has been called the "signature" wound of the conflicts in Iraq and Afghanistan, often, an embedded metal fragment wound occurs simultaneously. Since the blood-brain barrier can be disrupted by traumatic brain injury, this raises the possibility of free access to the brain for any metals found in the body. Therefore, we hypothesize that this influx of metals overwhelms normal brain homeostasis, depletes the brain's antioxidant defense systems, and activates microglial cells resulting in the release of inflammatory mediators that can potentially exacerbate the adverse effects of traumatic brain injury. Language: en

Tungsten-based materials have been proposed as replacements for depleted uranium in armor-penetrating munitions and for lead in small-arms ammunition. A recent report demonstrated that a military-grade composition of tungsten, nickel, and cobalt induced a highly-aggressive, metastatic rhabdomyosarcoma when implanted into the leg muscle of laboratory rats to simulate a shrapnel wound. The early genetic changes occurring in response to embedded metal fragments are not known. In this study, we utilized two cultured rodent myoblast cell lines, exposed to soluble tungsten alloys and the individual metals comprising the alloys, to study the genotoxic effects. By profiling cell transcriptomes using microarray, we found slight, yet distinct and unique, gene expression changes in rat myoblast cells after 24 h metal exposure, and several genes were identified that correlate with impending adverse consequences of ongoing exposure to weapons-grade tungsten alloy. These changes were not as apparent in the mouse myoblast cell line. This indicates a potential species difference in the cellular response to tungsten alloy, a hypothesis supported by current findings with in vivo model systems. Studies examining genotoxic-associated gene expression changes in cells from longer exposure times are warranted.

The infrastructure in healthcare to advance nursing practice and Veteran care includes doctorally prepared nurses: the Doctor of Philosophy (PhD) and the Doctor of Nursing Practice (DNP). Including doctorally prepared nurses in clinical nursing departments is a focus for nurse executives as they strive to reach the Institute of Medicine (IOM) Future of Nursing goal.1 This goal directs nurses to achieve higher levels of education and training to meet increasingly complex patient care needs. With the surge in returning Veterans, expanding the number of doctorally prepared nurses is a priority for Veterans Health Administration (VHA) as well as for non-VA healthcare providers responding to the Joining Forces Campaign2 to care for returning Veterans in the private sector. The authors sought to understand how VA and non-VA PhD and DNP nurses on different career trajectories respond to this challenge.

Nurses must have appropriate knowledge and skills to provide safe and effective nursing care in recognition of evolving science. Knowledge of genomics is required to ensure appropriate referral and education of patients who would benefit from genetic services. This article describes the process the Veterans Healthcare Administration's (VHA's) Office of Nursing Services used to determine the nursing genomic competencies appropriate for VHA nurses and identify available resources for educating nurses on these nursing competencies and a strategic plan for long-term implementation.

The regulation of hypertrophy or atrophy of skeletal muscle is highly regulated by genetic signals closely tied to function. This chapter focuses on the genetic alteration of structural and cytoskeletal proteins that influence exercise capacity, self-care, and activities of daily living by modulation of the physiologic cross-sectional area of skeletal muscle. In addition to a discussion of genetic mechanisms of atrophy and sarcopenia, the muscular dystrophies along with the laminopathies, both diseases of cytoskeletal proteins will be reviewed.

The use of novel materials on the modern battlefield, both in military munitions as well as in Improvised Explosive Devices, opens the possibility of wounds with embedded fragments whose health effects and toxicity characteristics have not been fully investigated, if at all. The costly and time-consuming nature of standard two-year lifespan studies prohibits the testing of many materials. In this report, we describe an in vitro system for rapidly assessing potential toxicity of metals and metal mixtures. Using rat L6 and mouse C2C12 skeletal muscle cells and tests for cellular viability, we have shown that two militarily relevant tungsten alloy mixtures (W/Ni/Co and W/Ni/Fe) significantly decreased the metabolic viability of rat L6 cells, whereas the viability of mouse C2C12 cells was not affected by W/Ni/Co and only slightly affected by W/Ni/Fe. In addition, viability assessed through lysosomal uptake of neutral red dye was not affected by either mixture in either cell line indicating that the mitochondria may be the target organelle of these unique metal mixtures. Development of this in vitro screening system may provide a procedure by which the potential toxicities of embedded metal fragments can be rapidly assessed.

Subject matter experts (SMEs) can be valuable resources, but there are no standards or criteria for their selection. The temptation to assert one's self as an SME in the absence of actual expertise is great. As a consumer, where does one turn, how does one know who to believe, and where does one place trust? What constitutes an SME is explored using two methods of how SMEs are developed. The reader is guided through finding, selecting, and validating an SME. The identification of some obstacles in using SMEs is also addressed. The question, "Is your subject matter expert really an expert?" is answered.

The purpose of this article is to integrate the physiology of the male reproductive system and the role of hormones in the pathophysiology and treatment of prostate cancer. The primary focus is to review hormonal changes associated with androgen ablation treatment and to integrate the available hormonal data into a hypothesis. This review used a systematic search of Medline references from 1990 to 2006. All sources were critically evaluated to arrive at an understanding of androgen deprivation symptoms, such as hot flushes/flashes, and to identify research needed in this area. Research is needed to explore the physiological mechanisms of hot flashes to develop better therapeutic treatment options to ameliorate side effects of hormonal treatment. Studies are needed to investigate all aspects of hot flashes in populations other than those with breast cancer, such as men with prostate cancer, carcinoid tumors, medullary thyroid tumors, pancreatic islet-cell tumors, renal cell carcinoma, and phenochromocytoma.

This chapter describes common genomic and proteomic methods and their application to the study of vulnerable population groups. The International HapMap project is discussed in relation to unique Haplotype single nucleotide polymorphisms (htSNPs) in population groups. In addition, studies, which have used these methods to investigate aging, ethnic, and racial specific conditions, as well as psychiatric diseases, are reviewed. Advantages and limitations of various genomic and proteomic approaches are discussed in relation to population admixture and sample selection.

Traumatic brain injury (TBI) in all of its forms--blast, concussive, and penetrating--has been an unfortunate sequela of warfare since ancient times. The continued evolution of military munitions and armor on the battlefield, as well as the insurgent use of improvised explosive devices, has led to blast-related TBI whose long-term effects on behavior and cognition are not yet known. Advances in medical care have greatly increased survival from these types of injuries. Therefore, an understanding of the potential health effects of TBI is essential. This review focuses on specific aspects of military-related TBI. There exists a large body of literature reporting the environmental conditions, forces, and staging of injury. Many of these studies are focused on the neuropathology of TBI, due to blast overpressure waves, and the emergence of large numbers of mild blast-related TBI cases.

Passive stiffness (Nm/ ◦ ) of the plantar flexors was measured during a passive stretch into dorsiflexion (DF) in 18 healthy female subjects (range 18-60 years old) using an isokinetic dynamometer. Passive stiffness of the ankle joint was measured at a short range of motion (from 10 ◦ of plantar flexion (PF) to 10 ◦ of DF), and at a full range of motion (from 10 ◦ PF to maximal DF for each individual) with a neutral EMG from a subset of four legs. The purpose of the study was to assess the variances in the measurements of passive stiffness of the calf muscle and to correlate passive stiffness to age and jumping ability. There was a significant correlation (r = 0.76) between the FRS and FRS test-retest. The methodological error for duplicate determinations was 7.7% for the SRS and 5.5% for the FRS. There was a significant correlation between age and the (FRS) full-range stiffness (r = 0.83). There was a significant negative correlation between age and jumping (r = �0.54). We conclude that the test model of passive stiffness used in the present study is a useful method with good reliability. The passive elastic properties of muscles and tendons might explain part of the muscle performance in functional tests with ageing. However, other qualities may influence performance as well.

• APPROXIMATELY 500,000 surgical site infections (SSIs) occur each year in the United States. The purpose of this study was to determine if the bacteria most frequently involved in SSIs could be found on telephones in the OR. • TWENTY-SIX CULTURES were taken from telephones in 14 ORs and two substerile rooms at a large teaching medical center. • USING STANDARD LABORATORY procedures, the researchers identified coagulase-negative staphylococci in the cultures. The study found that telephones in the OR can serve as reservoirs for SSI-causing bacteria. AORN J 83 (March 2006) 607–626.

Nurses lack genome literacy, skill, and self-confidence in applying genomics to health care. Standardized curricula and evaluation tools are needed for wide spread uptake and application of genome science in nursing education, practice, and research.To determine whether psychometrically robust survey instruments exist to assess knowledge, skills, attitudes, and self-confidence in applying genomic nursing competency among students and registered nurses.Psychometric systematic review.Medline, CINAHL, Academic Search Elite, Web of Science, and ProQuest Dissertations were searched from 1995 to 2014, with an English language restriction.Critical analysis of the study elements and psychometric attributes was conducted after data were abstracted into analysis and synthesis tables. The synthesis assessed the design, methods, and measurement properties with a focus on reliability and validity using 16 criteria on a 4-point grading scale.Twelve studies were included in a detailed review that focused on assessment of genomic nursing core competencies. Six studies met the inclusion criteria. In terms of psychometric quality of the instruments, one study scored high, two moderate, two low, and one very low.Most instruments assess self-perceived rather than objectively assessed competency. The highest quality instrument lacks clinical application. Knowledge-focused test questions based on up-to-date genome science that are relevant to practice need to be developed.

The continued evolution of military munitions and armor on the battlefield, as well as the insurgent use of improvised explosive devices, has led to embedded fragment wounds containing metal and metal mixtures whose long-term toxicologic and carcinogenic properties are not as yet known. Advances in medical care have greatly increased the survival from these types of injuries. Standard surgical guidelines suggest leaving embedded fragments in place, thus individuals may carry these retained metal fragments for the rest of their lives. Nursing professionals will be at the forefront in caring for these wounded individuals, both immediately after the trauma and during the healing and rehabilitation process. Therefore, an understanding of the potential health effects of embedded metal fragment wounds is essential. This review will explore the history of embedded fragment wounds, current research in the field, and Department of Defense and Department of Veterans Affairs guidelines for the identification and long-term monitoring of individuals with embedded fragments.

Animal models have been invaluable in the conduct of nursing research for the past 40 years. This review will focus on specific animal models that can be used in nursing research to study the physiologic phenomena of exercise and obesity when the use of human subjects is either scientifically premature or inappropriate because of the need for sampling tissue or the conduct of longitudinal studies of aging. There exists an extensive body of literature reporting the experimental use of various animal models, in both exercise science and the study of the mechanisms of obesity. Many of these studies are focused on the molecular and genetic mechanisms of organ system adaptation and plasticity in response to exercise, obesity, or both. However, this review will narrowly focus on the models useful to nursing research in the study of exercise in the clinical context of increasing performance and mobility, atrophy and bedrest, fatigue, and aging. Animal models of obesity focus on those that best approximate clinical pathology.

The effects of prolonged hind-limb unloading on titin antibody localization and expression of titin isozymes of single fibers from the synergistic slow-twitch soleus (SOL) and fast-twitch plantaris (PLN) of adult rats were studied after 14 and 28 days of hind-limb unloading (HU). Titin antibody localization and expression was not altered at 14 days of HU. However, there was a 4% loss in antibody to Z-band distance (Ab-Z) in the SOL and an increase of 8% in PLN Ab-Z after 28 days of HU. The titin and myosin heavy chain composition of single fibers and small bundles of fibers from control and unloaded muscles were examined using 2% to 12% sodium dodecyl sulfate-polyacrylamide gel electrophoresis. There was a marked loss of relative amounts of titin in both SOL and PLN following 28 days of HU. As the protein loads for these measures were identical, the authors conclude that these findings represent an actual loss of titin density rather than a decreased value due to a loss of total muscle mass. Laser scanning densitometry of the titin bands show a marked decrease in density and molecular weight in unloaded SOL. In the PLN, marked losses of titin density were accompanied by decreased electrophoretic motility. The results demonstrate that the titin isoform composition and titin antibody localization of skeletal muscle is altered during hind-limb unloading. Furthermore, as titin is responsible for positional stability of the sarcomere and the fiber during contraction, change in isoforms during HU may predispose atrophied muscle to injury during reuse and recovery.

The purpose of this article is to evaluate a free-breathing pulse sequence to quantify myocardial T1 changes in a swine model of tachycardia-induced heart failure.Yorkshire swine were implanted with pacemakers and were ventricularly paced at 200 beats/min to induce heart failure. Animals were scanned twice with a 1.5-T MRI scanner, once at baseline and once at heart failure. A T1-mapping sequence was performed during tidal respiration before and 5 minutes after the administration of a gadolinium-chelate contrast agent. T1-mapping values were compared between the baseline and heart failure scans. The percentage of fibrosis of heart failure myocardial tissue was compared with similar left ventricular tissue from control animals using trichrome blue histologic analysis.In the study cohort, differences were found between the baseline and heart failure T1-mapping values before the administration of contrast agent (960 ± 96 and 726 ± 94 ms, respectively; p = 0.02) and after contrast agent administration (546 ± 180 and 300 ± 171 ms, respectively; p = 0.005). The animals with heart failure also had a difference histologically in the percentage of myocardial collagen compared with tissue from healthy control animals (control, 5.4% ± 1.0%; heart failure, 9.4% ± 1.6%; p0.001).The proposed T1-mapping technique can quantify diffuse myocardial changes associated with heart failure without the use of a contrast agent and without breath-holding. These T1 changes appear to be associated with increases in the percentage of myocardial collagen that in this study were not detected by traditional myocardial delayed enhancement imaging. T1 mapping may be a useful technique for detecting early but clinically significant myocardial fibrosis.

The cytoplasmic volume-to-myonucleus ratio in the tibialis anterior and gastrocnemius muscles of juvenile rats after 5.4 days of microgravity was studied. Three groups of rats (n = 8 each) were used. The experimental group (space rats) was flown aboard the space shuttle Discovery (NASA, STS-48), while two ground-based groups, one hindlimb suspended (suspended rats), one non-suspended (control), served as controls. Single fibre analysis revealed a significant decrease in cross-sectional area (microns2) in the gastrocnemius for both the space and the suspended rats; in the tibialis anterior only the suspended rats showed a significant decrease. Myonuclei counts (myonuclei per mm) in both the tibialis anterior and gastrocnemius were significantly increased in the space rats but not in the suspended rats. The mean myonuclear volume (individual nuclei: microns3) in tibialis anterior fibres from the space rats, and in gastrocnemius fibres from both the space and the suspended rats, was significantly lower than that in the respective control group. Estimation of the total myonuclear volume (microns3 per.mm), however, revealed no significant differences between the three groups in either the tibialis anterior or gastrocnemius. The described changes in the cross-sectional area and myonuclei numbers resulted in significant decreases in the cytoplasmic volume-to-myonucleus ratio (microns3 x 10(3)) in both muscles and for both space and suspended rats (tibialis anterior; 15.6 +/- 0.6 (space), 17.2 +/- 1.0 (suspended), 20.8 +/- 0.9 (control): gastrocnemius; 13.4 +/- 0.4 (space) and 14.9 +/- 1.1 (suspended) versus 18.1 +/- 1.1 (control)). These results indicate that even short periods of unweighting due to microgravity or limb suspension result in changes in skeletal muscle fibres which lead to significant decreases in the cytoplasmic volume-to-myonucleus ratio.

The purpose of this investigation was to describe and compare two methods of recovery of atrophied skeletal muscle following short-term impaired physical mobility. An animal model was used to study morphologic adaptations of atrophied soleus and plantaris muscles to the effects of 7 days of hind-limb suspension (HS) followed by either sedentary recovery or run training during a 28-day recovery period. Significant atrophy, demonstrated by decreased mean fiber area (MFA, in square micrometers), occurred during the 7-day period of HS. During recovery, MFA returned to control values 14 days earlier in the sedentary compared with the trained groups. Run training following short-term atrophy induced by HS did not result in the high levels of frank muscle damage and type IIC fibers previously reported following long-term (28-day) atrophy. © 1996 John Wiley & Sons, Inc.

The purpose of this study was to determine whether reloading of atrophied skeletal muscle after 28 days of hind-limb unloading (HU) would produce significant sarcolemmal membrane disruption before frank necrosis. Soleus and plantaris muscles were atrophied by HU. Adult female Wistar rats (N = 13) were killed at 28 days of unloading and 4 and 7 days of reloading after HU. Rat serum albumin was used as a marker for muscle fiber disruption. Dark intracellular staining with horseradish peroxidase-conjugated anti-rat serum albumin antibody was interpreted as evidence of membrane rupture. There was a significantly different time course of disruption between plantaris and soleus muscles, with a negative correlation between cell size and occurrence of disruption. Fourteen percent of plantaris fibers were wounded after HU, peaking at day 4 of reloading (20% of cross-sectional area). Soleus demonstrated disruption only on reloading peaking in severity at day 7 (14% of fibers). It was demonstrated that sarcolemmal disruption due to atrophy and reloading does not always progress to necrosis and degeneration by the 7th day of recovery.

This article takes the position that the current ethic of nursing is inadequate. It is limited to an ethic of process. This ethic limits the discipline of nursing to process-oriented activities, including research and the clinical nursing process. These processes are not, however, unique to nursing but are shared by all professional disciplines. Nursing will continue to be insufficient without the development of structure or expert clinical knowledge accompanied by an ethic of accountability.

The purpose of this research was to describe the contractile response of pelvic muscle to exercise (PME). Pelvic muscle pressure curves from ten randomly selected records from a larger study of 65 women with urodynamically demonstrated stress urinary incontinence (SUI) were analyzed. The subjects completed a PME protocol that lasted 16 weeks. Five pressure curves before and after 16 weeks of exercise were analyzed and classified according to pressure-time profile types. Descriptive statistics revealed decreases in urine loss variables and increases in pelvic muscle pressure curve variables. Changes in profile characteristics suggested an increase in type II muscle fiber recruitment; recruitment of type I fibers that appeared less fatigable; and increased contractile force of both type I and type II fibers. Changes were analyzed by descriptive statistics and by reference to putative types. Reference to profile types may be useful to PME prescription to enhance fiber type-specific performance.

This study examined the spatial distributions of different fiber types in the soleus muscle of control rats and in rats subjected to hindlimb unloadingfor 28 days. The frequencies with which musclefibers of one type were adjacent to each other and tofibers of other types were tabulated and compared to expectations generatedfrom Monte Carlo simulations. In the normal rat, there is a tendency for Type Ifibers to avoid adjacency with each other, a tendency that persisted in the hindlimb-suspended group, despite the substantial shrinkage in size of Type I fibers. We conclude that this treatment, unlike neurogenic pathologies, does not cause any remodeling of the adjacency relations of fibers.

Instrumentation capable of handling 12 continuous hours of nine-channel real-time physiologic data sampled at 10Hz was needed to test within and between subject variability and preterm infant responses to skin-to-skin contact with the mother. A review of basic electrical components, electrical principles related to physiologic monitoring, and electrophysiology concepts generic to physiologic monitoring is presented. The development, specifications and applications of a new instrument to monitor premature infant cardiorespiratory adaptations are discussed.

Mild traumatic brain injury (mTBI) represents a significant challenge for the civilian and military health care systems due to its high prevalence and overall complexity. Our earlier works showed evidence of neuroinflammation, a late onset of neurobehavioral changes, and lasting memory impairment in a rat model of mild blast-induced TBI (mbTBI). The aim of our present study was to determine whether acute treatment with the non-steroidal anti-inflammatory drug minocycline (Minocin(®)) can mitigate the neurobehavioral abnormalities associated with mbTBI, Furthermore, we aimed to assess the effects of the treatment on select inflammatory, vascular, neuronal, and glial markers in sera and in brain regions associated with anxiety and memory (amygdala, prefrontal cortex, ventral, and dorsal hippocampus) following the termination (51 days post-injury) of the experiment. Four hours after a single exposure to mild blast overpressure or sham conditions, we treated animals with a daily dose of minocycline (50 mg/kg) or physiological saline (vehicle) for four consecutive days. At 8 and 45 days post-injury, we tested animals for locomotion, anxiety, and spatial memory. Injured animals exhibited significantly impaired memory and increased anxiety especially at the later testing time point. Conversely, injured and minocycline treated rats' performance was practically identical to control (sham) animals in the open field, elevated plus maze, and Barnes maze. Protein analyses of sera and brain regions showed significantly elevated levels of all of the measured biomarkers (except VEGF) in injured and untreated rats. Importantly, minocycline treatment normalized serum and tissue levels of the majority of the selected inflammatory, vascular, neuronal, and glial markers. In summary, acute minocycline treatment appears to prevent the development of neurobehavioral abnormalities likely through mitigating the molecular pathologies of the injury in an experimental model of mbTBI.

De novo hippocampal neurogenesis contributes to functional recovery following traumatic brain injury (TBI). Enriched environment (EEN) can improve the outcome of TBI by positively affecting neurogenesis. Blast induced traumatic brain injury (bTBI) characterized by memory impairment and increased anxiety levels, is a leading cause of chronic disability among soldiers. Using a rodent model of bTBI we asked: (a) whether long-term exposure to EEN after injury can ameliorate behavioral abnormalities and (b) what the effects of EEN are at the molecular and cellular levels and on de novo neurogenesis. We found that housing injured animals in EEN resulted in significantly improved spatial memory while animals in normal housing (NH) showed persistent memory impairment. VEGF and Tau protein but not Interleukin-6 (IL-6) levels were normalized in the dorsal hippocampus (DHC) of EEN rats while all three markers remained elevated in NH rats. Interestingly, after peaking at 6 weeks post-injury, anxiety returned to normal levels at 2 months independent of housing conditions. Housing animals in EEN had no significant effect on VEGF and Tau protein levels in the ventral hippocampus (VHC) and the amygdala (AD). We also found that EEN reduced IL-6 and IFNγ levels in the VHC; these markers remained elevated following NH. We observed an increase in GFAP and DCX immunoreactivities in the VHC of NH animals at 2 months post-injury. Conversely, injured animals housed in EEN showed no increase in GFAP or DCX immunoreactivity in their VHC. In summary, long-term exposure of injured animals to EEN appears to play a positive role in the restoration of memory functions but not on anxiety, which returned to normal levels after a significant period of time. Cellular and molecular changes in response to EEN appear to be a part of neurogenesis-independent as well as dependent recovery processes triggered by bTBI.

The objective of this investigation was to study impaired physical mobility and the resulting skeletal muscle atrophy. An animal model was used to study morphological adaptations of the soleus and plantaris muscles to decreased loading induced by hindlimb suspension of an adult rat for 7, 14, and 28 consecutive days. Alterations in weight, skeletal muscle growth, and changes in fiber type composition were studied in synergistic plantar flexors of the rat hindlimb. Body weight and the soleus muscle mass to body mass ratio demonstrated significant progressive atrophy over th 28-day experimental period with the most significant changes occurring in the first 7 days of hindlimb suspension. Hindlimb suspension produced atrophy of Type I and Type IIa muscle fibers as demonstrated by significant decreases in fiber cross-sectional area (micron 2). These latter changes account for the loss of contractile force production reported in the rat following hindlimb unloading. When compared to traditional models of hindlimb suspension and immobilization, the ISC model produces a less severe atrophy while maintaining animal mobility and health. We conclude that it is the preferred animal model to address nursing questions of impaired physical mobility.

Potential health issues arising from embedded metal fragment injuries are an operational health issue in the military medical community. Embedded fragment injuries can occur not only from standard-use munitions, but also from improvised explosive devices (IEDs). With few exceptions, the behavior of metal fragments, when embedded in the body, is not known. Herein, we propose a multitiered assessment protocol that can be used to both determine future health issues associated with newly developed munitions and, once the composition has been identified, determine potential toxicity of embedded fragments as a result of an IED event. The main premise of this assessment protocol is to view the embedded fragment as an implanted medical device and to utilize the guidelines already in place for testing the safety of such materials. Use of this structured, tiered approach will yield information critical for informed medical decisions.

The objectives were to study morphological adaptations of soleus muscle to decreased loading induced by hindlimb suspension and the effect of run training during the subsequent recovery period. Adult female Wistar rats were kept for 28 days with hindlimbs suspended. For the next 28 days, rats were assigned to a cage-sedentary or daily running group. Compared with control soleus muscles, 28 days of hindlimb suspension reduced the mass and fiber cross-sectional area to 58 and 53% of control values, respectively, and decreased type I fibers from 92 +/- 2 to 81 +/- 2%. During recovery, clusters of damaged fibers were observed in the soleus muscle, and this observation was more pronounced in trained animals. Type IIc fibers appeared transiently during recovery, and their presence was exacerbated with training, as IIc fibers increased to approximately 20% of the total by day 14 of recovery and were no longer evident at day 28. Although muscle wet mass does not differ as a result of mode of recovery at day 14, training transiently decreased the overall fiber area compared with sedentary recovery at this point. By day 28 of recovery the morphological characteristics of soleus muscle in the trained group did not differ from control muscle, whereas in the sedentary group muscle mass and overall fiber cross-sectional area were approximately 14% less than control values.

This investigation determined whether inflammatory mediators 1) have diurnal variations, 2) respond to high-force eccentric exercise, and 3) associate with markers of muscle damage after high-force eccentric exercise. College-aged men and women ( n = 51) completed exercise (3 × 15 maximal eccentric elbow flexor actions using 1 arm) and control conditions in random order. Blood was collected preexercise and 4, 8, 12, 24, 48, and 96 h postexercise. Additional measures included maximal isometric force and midbiceps arm circumference (to detect swelling). Serum and plasma were analyzed for soluble tumor necrosis factor receptor-1 (sTNFR1), IL-6, C-reactive protein, cortisol, and creatine kinase (CK) activity. Relative to the 7:00 AM point in the control condition, diurnal decreases were measured at 12:00 PM and 4:00 PM for IL-6 and at 12:00 PM, 4:00 PM, and 8:00 PM for sTNFR1 and cortisol. sTNFR1, IL-6, CK, swelling, and soreness were higher in the exercise compared with the control condition. The largest of the inflammatory mediator responses was measured for IL-6 8 h postexercise in the exercise (3.00 ± 3.59 pg/ml) relative to the control condition (1.15 ± 0.99 pg/ml). The IL-6 response (time-matched exercise − control concentration) at 8 h associated ( r > 0.282) with muscle soreness at 24 and 96 h, and the cortisol response at 8 h associated ( r > 0.285) with swelling at 8, 24, and 96 h. Thus soreness and swelling, but not CK and strength loss, had a low association with the inflammatory response following eccentric exercise.

There are approximately 500,000 surgical site infections per year in the United States. The purpose of this study was to determine if the bacteria most frequently involved in Surgical Site Infections (SSI) could be found on telephones in the Operating Room (OR). A total of 26 cultures were taken from telephones within 14 operating rooms and two sub-sterile rooms at a large, teaching, medical center. Bacteria were identified using standard laboratory procedures and the Vitek system version 7.02. Of the 52 isolates discovered, the following bacteria were identified: Acinetobacter calcoaceticus-baumannii complex 1.9%, Pseudomonas aeruginosa 1.9%, Agrobacterium radiobacter/tumefaciens 1.9%, Coagulase-negative Staphylococcus 82.7%, Micrococcus 3.8 %, Streptococcus non-group D 5.8%, and one unidentified gram-negative rod 1.9%.

Objective: The aim of the study was to evaluate the reliability of two clinical tests of mobility for stroke patients. Design: The study took place in a university hospital with a case control design. Subjects: A sample of convenience including 31 subjects: a group of patients with prior stroke (n = 19); a control group (n = 12). Methods: The time(s) for sitting up from a supine position and transferring from an examination table to a chair were measured and inter- and intra-rater reliability were assessed. The source of variation in the test results as well as intra-class correlations were estimated. Results: The largest source of variation in the supine position was between subjects, and the between-tester variability was very low, with similar results for the transfer from table to chair. The intra-class correlations are all high (range 0.77– 0.98). This indicates that it is of little importance which tester is performing the tests. Conclusion: Sitting up on an examination table and transferring from an examination table to a chair seem to be reliable timed clinical tests of mobility in stroke research.