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Study Design Systematic Review Introduction 3D printed orthoses are emerging as a possible option in the field of hand therapy to fabricate conventional casts and orthoses. It is unknown how this technology is currently being used to treat upper extremity musculoskeletal conditions, and if 3D orthoses are comparable to custom- made low temperature thermoplastic orthoses fabricated by hand therapists. Purpose of the Study The primary aim of this review was to investigate the utilization, effectiveness and feasibility of 3D printed technology to manufacture custom orthoses for musculoskeletal conditions of the upper extremity. Methods Studies describing 3D printed orthoses or casts used in treatment with patients were included following a comprehensive literature search using CINAHL, PubMed, Medline, ProQuest, and EBSCO databases. The selected studies had to address musculoskeletal conditions of the elbow, wrist, hand and/or digits that would typically be immobilized with a cast or brace or orthotic or orthosis. Results Ten studies met the inclusion criteria. Study designs included case studies, case series, and 1 randomized clinical trial. 3D printed orthoses/casts appear to be comfortable, provide adequate immobilization, and have pleasing aesthetics. However, expensive equipment, lack of appropriate software and scanning tools and lack of highly skilled clinicians are all factors preventing the implementation of 3D printed orthoses into current clinical practice. Discussion 3D printed orthoses appear to be effective at immobilization of a limb, aesthetically pleasing, and utilize lightweight and well -ventilated materials. However, the feasibility of implementing 3D printing technology in hand therapy settings remains challenging in part due to the resources required. Conclusions While 3D printing shows promise, the high cost of equipment, lack of training and skill of clinicians and the long time required for production are all factors that need to be improved to make 3D printing a viable option in the hand therapy setting.

Visual Abstract, Alzheimer’s disease (AD) starts decades before clinical symptoms appear. Low-glucose utilization in regions of the cerebral cortex marks early AD. To identify these regions, we conducted a voxel-wise meta-analysis of previous studies conducted with positron emission tomography that compared AD patients with healthy controls. The resulting map marks hypometabolism in the posterior cingulate, middle frontal, angular gyrus, and middle and inferior temporal regions. Using the Allen Human Brain Atlas, we identified genes that show spatial correlation across the cerebral cortex between their expression and this hypometabolism. Of the six brains in the Atlas, one demonstrated a strong spatial correlation between gene expression and hypometabolism. Previous neuropathological assessment of this brain from a 39-year-old male noted a neurofibrillary tangle in the entorhinal cortex. Using the transcriptomic data, we estimate lower proportions of neurons and more microglia in the hypometabolic regions when comparing this donor’s brain with the other five donors. Within this single brain, signal recognition particle (SRP)-dependent cotranslational protein targeting genes, which encode primarily cytosolic ribosome proteins, are highly expressed in the hypometabolic regions. Analyses of human and mouse data show that expression of these genes increases progressively across AD-associated states of microglial activation. In addition, genes involved in cell killing, chronic inflammation, ubiquitination, tRNA aminoacylation, and vacuole sorting are associated with the hypometabolism map. These genes suggest disruption of the protein life cycle and neuroimmune activation. Taken together, our molecular characterization reveals a link to AD-associated hypometabolism that may be relevant to preclinical stages of AD.

Alzheimer’s disease (AD) starts decades before clinical symptoms appear. Low glucose utilization in regions of the cerebral cortex marks early AD and is clinically useful. To identify these regions, we conducted a voxel-wise meta-analysis of positron emission tomography studies that compared AD patients with healthy controls. This meta-analysis included 27 studies that assayed glucose utilization in 915 AD patients and 715 healthy controls. The resulting map marks hypometabolism in the posterior cingulate, middle frontal, angular gyrus, middle and inferior temporal regions. Using the Allen Human Brain Atlas, we identified genes with expression patterns associated with this hypometabolism pattern in the cerebral cortex. Of the six brains in the Atlas, one demonstrated a strong spatial association with the hypometabolism pattern. Previous neuropathological assessment of this brain from a 39-year-old male noted a neurofibrillary tangle in the entorhinal cortex. Using the transcriptomic data, we estimate lower proportions of neurons and more microglia in the hypometabolic regions when compared with the other five brains. Within this single brain, signal recognition particle (SRP)-dependent cotranslational protein targeting genes, which primarily encode cytosolic ribosome proteins, are highly expressed in the hypometabolic regions. Analyses of human and mouse data show that expression of these genes progressively increases across AD-associated states of microglial activation. In addition, genes involved in cell killing, chronic inflammation, ubiquitination, tRNA aminoacylation, and vacuole sorting are associated with the hypometabolism map. These genes suggest disruption of the protein life cycle and neuroimmune activation. Taken together, our molecular characterization of cortical hypometabolism reveals a molecular link to AD associated hypometabolism that may be relevant to preclinical stages.

Oophorectomy prior to menopause is associated with late-life dementia. Memory decline may start within 6 months after oophorectomy in middle-aged women, suggested by lower verbal and working memory performance. Unknown is whether such changes persist beyond 6 months, and whether they are reversed by estradiol. Short-term benefits of estradiol on verbal memory following oophorectomy were observed in one study, but longer term effects remain unknown. In the present study, middle-aged BRCA1/2 mutation carriers with early oophorectomy at least 1 year prior to study onset were tested on verbal and working memory with results stratified by (1) current estradiol use (n = 22) or (2) no history of estradiol use (n = 24), and compared to age-matched premenopausal controls (n = 25). Both memory abilities were adversely affected by oophorectomy, but only working memory was maintained by estradiol. Estrogen metabolite levels correlated with working memory, suggesting a role for estradiol in preserving this ability. Memory decline appears to persist after early oophorectomy, particularly for women who do not take estradiol.

Study Design Cross-sectional survey study. Introduction Occupational therapy (OT) programs must provide students with the skills necessary to fabricate orthoses. Input from OT educators can provide valuable insight into how these skills are taught and the resources used. Purpose of the Study Explore how instruction in orthotic fabrication is addressed in OT education programs. Methods Surveys were distributed to all accredited OT programs in the United States. Quantitative data were analyzed using descriptive statistics, and content analysis was done on qualitative data to identify themes. Results Overall response rate was 25%. Most programs teach orthotic fabrication with demonstration and hands-on laboratory time. Almost half add digital videos in their orthotic course content. The average number of orthoses made ranged from 2 to 5, and the resting hand, wrist, and short opponens immobilization orthoses are the most commonly taught. Discussion This study examined the orthotic fabrication curricula in OT programs in the United States, including the time devoted to this topic, types of orthoses covered, course structure and pedagogical strategies used, and whether faculty anticipated changes in their orthotic content. The majority of programs offer this content within other existing courses within the curriculum, including coursework in physical dysfunction, OT interventions, orthopedics, and biomechanics. Only 15% of participants in the current study reported teaching orthotic content as a separate course in their curricula. Interestingly, some participants reported that they plan to offer a full separate orthotics course in their future curricula, whereas others reported combining orthotics content with other coursework or reducing the time spent making custom orthoses in the classroom. It would appear that there is still considerable variability in course structure and content in current OT programs. Conclusion Participants feel that orthotic fabrication is an essential and integral component of their curricula and that the importance of hands-on learning experiences contributes to students' preparedness and ability to use this knowledge. Student feedback indicated that more time and instruction is desired. Sharing teaching experiences can enhance emerging OT curricula and can impact future practice. Educators must strive to improve and refine curricular content to ensure that graduates have the skills necessary to meet the orthotic needs of their clients.

Objective To describe patterns in sweetened beverage consumption by race/ethnicity and sex, documenting both the amount and types of sweetened beverages consumed; and to examine the association of sweetened beverage consumption with hyperactivity/inattention symptoms among middle school students in a single urban school district. Methods Middle school students (n = 1649; 47% Hispanic and 38% black, non-Hispanic) from 12 schools, randomly selected out of 27 district schools, completed health behavior surveys in fall 2011. Students reported quantity and types of sweetened beverages consumed in the past 24 hours and completed the 5-item Hyperactivity/Inattention subscale of the Strengths and Difficulties Questionnaire to measure symptoms. Results Amount and variety of reported sweetened beverage consumption (including energy drinks) were greater among boys versus girls and among black and Hispanic versus white students. Risk of hyperactivity/inattention increased by 14% for each additional sweetened beverage consumed, adjusting for age, race/ethnicity, sex, school lunch eligibility, family structure, and sugary food consumption. Students reporting consumption of energy drinks were 66% more likely to be at risk for hyperactivity/inattention after adjusting for number of drinks, other types of drinks consumed, and other potential confounders. Conclusions Results support recommendations to limit consumption of sweetened beverages and to avoid consumption of energy drinks among children. Interventions to reduce sweetened beverage consumption should explicitly focus on energy drinks and other emerging sweetened beverages such as sports and sweetened coffee drinks. More research is needed to understand the direction of effects and the mechanisms behind the association between sweetened beverages and hyperactivity/inattention symptoms.

Background: Conservative treatment for carpometacarpal (CMC) joint osteoarthritis (OA) may include orthotic fabrication to decrease pain. Different types of orthoses have been used as conservative interventions to improve symptoms, but there are no guidelines specifying if inclusion of the thumb metacarpophalangeal (MCP) in an orthosis is required in the treatment of thumb CMC joint OA. The main objective of this study is to determine the effectiveness of 2 different thumb CMC joint orthotic designs on pain reduction and improved hand function: one design immobilizes both the MCP joint and the CMC joint and the other design immobilizes only the CMC joint. Methods: A total of 66 patients were included in the study. One group of 33 patients received a short thumb orthosis with the MCP joint excluded, and the other group of 33 patients received a short thumb orthosis with the MCP joint included. Outcomes measures included the visual analog scale for pain and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH; Spanish version) for function. Results: In both patient groups, the orthoses contributed to decreased pain levels and improved functional abilities ( F1.0 = 315.467 and F1.0 = 72.419; both, P < .001). There was no significant difference between the 2 groups regarding pain or improvement in daily activities ( F1.0 = 0.553 and F1.0 = 2.539; both, P > .05). Conclusion: There are benefits of either thumb orthotic design on pain reduction and functional improvement even after 1 week of using the orthoses as the sole conservative treatment.

Background Obesity, a major risk factor for cardiometabolic disease, is associated with lower cognitive performance from childhood to senescence, especially on tasks of executive function. In the cardiovascular domain, fat stored viscerally rather than elsewhere in the body carries particularly high risk. It is unknown whether this is also true in case of obesity-cognition relationships. The aim of this study is to assess the cross-sectional relationship between visceral fat (VF) and cognitive performance in a community sample of healthy adolescents. Methods In a community-based sample of 983 adolescents (12–18 years old, 480 males), VF was quantified using magnetic resonance imaging, total body fat was measured using a multifrequency bioimpedance and cognitive performance was assessed using a battery of cognitive tests measuring executive function and memory. Results We found that larger volumes of VF were associated with lower performance on six measures of executive function (p=0.0001 to 0.02). We also found that the association of VF with executive function was moderated by sex for a subset of measures, such that relationship was present mainly in females and not in males (sex-by-VF interaction: p=0.001 to 0.04). These relationships were independent of the quantity of total body fat and a number of potential confounders, including age, puberty stage and household income. Conclusions Our results suggest that the adverse association between obesity and executive function may be attributed to fat stored viscerally and not to fat stored elsewhere in the body. They also suggest that females compared with males may be more sensitive to the potentially detrimental effects of VF on cognition.

Fluctuations in ovarian hormones across the menstrual cycle have long been considered a determinant of mood in women. The majority of studies, however, use menstrual cycle phase as proxy for hormone levels. We measured ovarian hormone levels directly in order to examine the relationship between daily hormone levels and mood in non-help-seeking women. Participants (n = 19) provided daily information about their positive and negative moods, and collected their first morning-voided urine for 42 days, which was analyzed for estrogen and progesterone metabolites (E1G and PdG). The independent contributions of daily E1G, PdG, stress, physical health, and weekly social support, were calculated for 12 daily mood items, and composite measures of positive and negative mood items, using linear mixed models. E1G or PdG contributed to few mood items: E1G measured 2 days prior contributed negatively to the model for Motivation, while E1G measured 3 days prior contributed negatively to Getting Along with Others, and E1G measured 4 days prior contributed negatively to Anxiety. PdG, measured the same day and 1 day prior, contributed positively to the models of Irritability, and PdG measured 5 days prior contributed positively to Difficulty Coping. By contrast, the variables stress and physical health contributed significantly to all the mood items, as well as both composite positive and negative mood measures. These findings demonstrate that, compared to stress and physical health, ovarian hormones make only a small contribution to daily mood. Thus, fluctuations in ovarian hormones do not contribute significantly to daily mood in healthy women.

Simplifying orthotic fabrication in the clinic is of value to both therapists and patients. This author describes a technique of using thermoplastic material to create a hinge, thus eliminating the task of lining up hinges with the joint axis of motion. Three different orthotic designs using this technique are described in this article.—Victoria Priganc, PhD, OTR, CHT, CLT, Practice Forum Editor

Background Static progressive orthoses are commonly used in the treatment of stiff joints or joint contractures of the upper extremity, but there are few high-quality studies to support this intervention. In addition, there has not been a recently published review of the current literature describing this treatment technique and the outcomes achieved. The specific purpose of this comprehensive literature review is to investigate the current levels of evidence supporting the use of static progressive orthoses in the treatment of joint stiffness or contracture in clients with orthopedic conditions of the upper extremity. This review will also discuss common diagnoses of patients and outcomes achieved, as well as provide recommendations for future hand therapy practice. Methods A computerized database search of publications incorporating the use of static progressive orthoses for the upper extremity was conducted, dating from January 1979 through January of 2011. The search was limited to studies in English of adults with orthopedic conditions. Results A total of 65 publications were located. However, only 16 of these studies met this review's inclusion criteria of level 4 evidence or above. Each of the articles was critically appraised using the Structured Effectiveness for Quality Evaluation of Study (SEQES) and the Oxford Center for Evidence-Based Medicine 2011 Level of Evidence. Total SEQES scores ranged from 17 to 39. The majority of the studies are level 4 evidence. Conclusions Although the overall level of evidence is low, the inclusion of static progressive orthoses as an intervention appears to result in positive outcomes, including increased active range of motion, increased grip strength, improved DASH scores, and improved patient satisfaction as well as reduced pain medications during orthotic intervention. The current evidence supports static progressive orthoses as an intervention for patients with upper extremity joint stiffness or contractures due to orthopedic conditions.

In the normal course of practice, rehabilitation professionals are not typically provided with x-rays or radiology reports. Hand therapists who obtain x-rays or reports will glean valuable information about the patient that might otherwise go unidentified. Unique details discovered from an x-ray can contribute to improved clinical treatment plans and functional outcomes. Radiography is the general term used to describe the commonly known imaging procedures of x-ray and fluoroscopy. The purposes of this article are to provide the reader with an overview of basic radiography terminology and provide information to help better understand the typical positions and views used in upper extremity radiography. With this knowledge, guidelines for reviewing x-rays will be presented and several examples of bony pathology revealed by x-rays will be presented along with several case studies.

To allow safe early wrist motion after wrist injury, this author has modified an earlier version of a dart thrower's motion orthotic device using material that is currently available on the market and an inexpensive paper fastener as the rivet. - KristinValdes, OTD, OT, CHT, Practice Forum Editor.

Importance Early adversity is an important risk factor that relates to internalizing symptoms and altered brain structure. Objective To assess the direct effects of early adversity and child internalizing symptoms (ie, depression, anxiety) on cortical gray matter (GM) volume, as well as the extent to which early adversity associates with variation in cortical GM volume indirectly via increased levels of internalizing symptoms. Design, Setting, and Participants A prospective investigation of associations between adversity within the first 6 years of life, internalizing symptoms during childhood and early adolescence, and altered brain structure in late adolescence (age, 18-21 years) was conducted in a community-based birth cohort in England (Avon Longitudinal Study of Parents and Children). Participants from the cohort included 494 mother-son pairs monitored since the mothers were pregnant (estimated date of delivery between April 1, 1991, and December 31, 1992). Data collection for the present study was conducted between April 1, 1991, and November 30, 2010; the neuroimaging data were collected between September 1, 2010, and November 30, 2012, and data analyses for the present study occurred between January 25, 2013, and February 15, 2015. Risk factors were adversity within the first 6 years of the child's life (including prenatal exposure) and the child's internalizing symptoms between age 7 and 13 years. Exposures Early childhood adversity. Main Outcomes and Measures The main outcomewas GMvolume of cortical regions previously associated with major depression measured through T1-weighted magnetic resonance images collected in late adolescence. Results Among 494 young men included in this analysis, early adversity was directly associated with lower GMvolumes in the anterior cingulate cortex (β = ..18; P = .01) and higher GM volume in the precuneus (β = .18; P = .009). Childhood internalizing symptoms were associated with lower GMvolume in the right superior frontal gyrus (β = ..20; P = .002). Early adversity was also associated with higher levels of internalizing symptoms (β = .37; P

Obesity has proven difficult to treat. Many approaches neglect to address the deep-rooted underlying psychological issues. This paper describes a psychodynamically oriented approach to treating compulsive overeating as an addiction. Common to all addictions is a compulsion to consume a substance or engage in a behavior, a preoccupation with using behavior and rituals, and a lifestyle marked by an inability to manage the behavior and its harmful consequences. The approach represents a shift away from primarily medical models of intervention to integrated models focusing on the psychological underpinnings of obesity. Long-term psychodynamic group psychotherapy is recommended as a primary treatment.

Strategies for facilitation of tendon transfers following surgery for enhanced wrist extension in a patient with cerebral palsy are described. The therapeutic process began prior to surgery with a thorough pre-operative assessment and evaluation. This case report emphasises the effectiveness of a closely monitored therapeutic programme following surgery, and promotes the comprehensive utilisation and supervision of facilitation techniques during subsequent rehabilitation.

Analysis of text from open-ended interviews has become an important research tool in numerous fields, including business, education, and health research. Coding is an essential part of such analysis, but questions of quality control in the coding process have generally received little attention. This article examines the text coding process applied to three HIV-related studies conducted with the Centers for Disease Control and Prevention considering populations in the United States and Zimbabwe. Based on experience coding data from these studies, we conclude that (1) a team of coders will initially produce very different codings, but (2) it is possible, through a process of codebook revision and recoding, to establish strong levels of intercoder reliability (e.g., most codes with kappa 0.8). Furthermore, steps can be taken to improve initially poor intercoder reliability and to reduce the number of iterations required to generate stronger intercoder reliability.

Strategic alliances, one component of a total quality management program, break down linkages of a supply chain and help alliance partners to address new markets that could not be economically satisfied by a single firm. In recent years, through numerous press releases and anecdotal references, there have been an increased number of reported strategic alliances. However, there have been no systematic studies of the prevalence and impact of strategic alliances in specific industries and no way to obtain information on the costs and benefits of these formal relationships. This current research addresses these gaps. As part of a long‐term longitudinal research program covering diverse industries, two different industries, one in products (food and beverages) and the other in services (executive recruiting) were studied to determine the extent of penetration and effectiveness of strategic alliances. This paper presents examples of strategic alliances and the survey results describing penetration, types of alliances, business benefits, and expected costs.

Distinct differences in the human voice emerge during adolescence, with males producing deeper and more resonant voices than females by the end of sexual maturation. Using magnetic resonance images of heads and voice recordings obtained in 532 typically developing adolescents, we investigate what might be the drivers of this change in voice, and the subjective judgment of the voice "maleness" and "femaleness". We show clear sex differences in the morphology of voice-related structures during adolescence, with males displaying strong associations between age (and puberty) and both vocal-fold and vocal-tract length; this was not the case in female adolescents. At the same time, males (compared with females) display stronger associations between age (and puberty) with both fundamental frequency and formant position. In males, vocal morphology was a mediator in the relationship between bioavailable testosterone and acoustic indices. Subjective judgment of the voice sex could be predicted by the morphological and acoustic parameters in males only: the length of vocal folds and its acoustic counterpart, fundamental frequency, is a larger predictor of subjective "maleness" of a voice than vocal-tract length and formant position.

Degenerative joint disease commonly affects the distal interphalangeal (DIP) joints, causing articular destruction and marginal bone formation. Treatment for pain relief and function is most often done through arthrodesis. The case of a 70-year-old concert violinist with left index finger DIP joint osteoarthritis is presented. Arthritis in the involved joint caused pain and deformity and interfered with the patient's ability to play music. Trial arthrodesis with K-wires proved impossible because of the patient's need for continued mobility. Swanson hinge implant arthroplasty was performed on the affected DIP joint. The patient eventually achieved an excellent result and was able to return to playing the violin professionally. Treatment and therapy guidelines are presented.

Frequently when one sustains an injury to a digit, multiple soft tissue structures can be involved. As a result, the MCP, PIP, and DIP joints can be affected, thus limiting the ability to fully flex the finger. As hand therapists, one of our primary goals is to improve functional grasp/grip. These authors have designed a single-digit, composite flexion splint to help achieve this goal.

Introduction: Carpometacarpal (CMC) joint osteoarthritis critically impacts activities of daily living. Pain is the main reason for a consultation to the hand therapy clinic as described in the literature, and conservative treatment, typically an orthosis, is the first intervention of choice. A thumb orthosis is a specific nonoperative palliative treatment for CMC joint osteoarthritis for improving function and comfort. A variety of thumb orthoses are described in the literature, but there is no supporting evidence highlighting the use of a specific orthotic design for short-time effect on pain and function. Purpose of the Study: The study was conducted to compare the short-term effect of 2 different thumb CMC orthoses on pain reduction as a primary outcome and improved hand function as a secondary outcome. Methods: A total of 66 patients were included in the study. One group of 33 patients received a Hybrid orthosis, immobilizing only the CMC joint, and the other group of 33 patients received a thumb orthosis called the “whale,” which immobilizes the CMC and metacarpophalangeal (MP) joints. Both orthotic designs were custom fabricated for each patient. Outcomes measures included the visual analogue scale (VAS) for pain and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH, Spanish version) for function. Results: Differences in pain scores and functional scores were found in both groups after the one-week washout period compared with baseline, but did not differ significantly between the two groups. Outcome for functional score demonstrated both clinically and statistically significant differences between the baseline and 1 week for outcome score for the both groups (p = .001). With respect to pain intensity, the mean pain score decreased from 7.69 to 5.51 for the CMC orthosis (p = .001) and from 7.78 to 5.45 for the CMC/MP “whale orthosis” (p = .001). Conclusion: The present study adds to our therapeutic knowledge base regarding the benefits of 2 different thumb orthotic designs on pain reduction and functional improvement in the first week using orthoses as an exclusive conservative treatment.

Purpose: The purpose of this research is to increase understanding of the current levels of evidence supporting the use of static progressive orthoses, and to provide clarity on appropriate diagnoses, outcome measures, and duration of use for this intervention. Rationale: Static progressive orthoses are an intervention commonly provided for clients with stiffness and/or limited range of motion (ROM) of upper extremity joints, due to trauma or injury. This type of orthosis incorporates nonelastic components to apply force to the stiff joint or tissue, holding it at end-range position to improve passive motion. There are only a limited number of studies on the use of static progressive orthoses for the upper extremity with a small number of clients enrolled. Design: A literature search of the current evidence supporting static progressive orthoses for treatment of stiff upper extremity joints was performed to identify information regarding common diagnoses of clients treated with this type of orthotic intervention, outcomes achieved, wearing schedules, and duration of orthotic use. Participants: This research examined the current levels of evidence supporting the use of static progressive orthoses for clients with limitations in ROM of the upper extremity following surgery or trauma (orthopedic pathologies). Analytic Methods: The current evidence supporting the use of static progressive orthoses is found in 11 studies on the elbow, 2 studies on the forearm, 3 studies on the wrist, 2 studies on stiff fingers, and 2 systematic reviews. The data provided in these 20 studies on client diagnoses, type of orthotic design, outcome measures, and duration of use are analyzed and described. Conclusions: Clients benefit from the use of static progressive orthoses by demonstrating increased ROM, increased function and grip strength, and decreased pain. The current evidence includes 20 studies that present information on appropriate client diagnoses, outcome measures, protocols of use, and average duration of wear.

An important question for exobiology is, did life evolve on Mars? To answer this question, experiments must be conducted on the martian surface. Given current mission constraints on mass, power, and volume, these experiments can only be performed using proposed analytical techniques such as: electron microscopy, X-ray fluorescence, X-ray diffraction, alpha-proton backscatter, gamma-ray spectrometry, differential thermal analysis, differential scanning calorimetry, pyrolysis gas chromatography, mass spectrometry, and specific element detectors. Using prepared test samples consisting of 1% organic matter (bovine serum albumin) in palagonite and a mixture of palagonite, clays, iron oxides, and evaporites, it was determined that a combination of X-ray diffraction and differential thermal analysis coupled with gas chromatography provides the best insight into the chemistry, mineralogy, and geological history of the samples.

Study design Systematic review. Introduction Joint mobilizations are used as an intervention for improving range of motion, decreasing pain and ultimately improving function in patients with a wide variety of upper extremity diagnoses. However, there are only a limited number of studies describing this treatment for conditions affecting the elbow, wrist, and hand. Furthermore, it is unclear as to the most effective joint mobilization technique utilized and the most beneficial functional outcomes gained. Purpose Examine the current evidence describing joint mobilizations for treatment of conditions of the elbow, wrist and hand, and offer informative practical clinical guidance. Methods Twenty-two studies dated between 1980 and 2011 were included in the systematic review for analysis. Results The current evidence provides moderate support for the inclusion of joint mobilizations in the treatment of lateral epicondylalgia (LE). In particular, mobilization with movement as described by Mulligan is supported with evidence from nine randomized clinical trials as an effective technique for the treatment of pain. Other described techniques include those known as Kaltenborn, Cyriax physical therapy, and Maitland, but the evidence for these techniques is limited. There is also limited evidence for the joint mobilizations in the treatment of wrist and hand conditions. Conclusions The current literature offers limited support for joint mobilizations of the wrist and hand, and moderate support for joint mobilizations of the elbow for LE. There is moderate support for mobilization with movement. Level of evidence 2A.

Study Design Randomized clinical trial. Introduction: Contrast baths are a treatment modality commonly used in hand clinics. Yet the benefits of contrast baths have been poorly substantiated. Contrast baths have been suggested for the purposes of reducing hand volume, alleviating pain, and decreasing stiffness in affected extremities. Purpose of the Study To determine the effects of specific contrast bath protocols on hand volume in patients diagnosed with Carpal Tunnel Syndrome. Methods Study participants were randomly assigned to one of three treatment group protocols—contrast baths with exercise, contrast baths without exercise, and an exercise-only control treatment group. Study participants were evaluated with hand volumetry, before and after treatment at two different data collection periods—pre- and postoperatively. Results Data were gathered on 58 participants before Carpal Tunnel Release surgery and on 56 participants after Carpal Tunnel Release surgery, for a total of 114 treatments. The changes in hand volume (the after treatment volume minus the before treatment volume) were analyzed using one-way and multi-way analysis of variance (ANOVA). Although all three treatments resulted in a slight increase in hand volume both pre- and postsurgery, the increase was not clinically significant with regard to hand volumes. Also no significant differences were noted among the three treatments. Specifically, the ANOVA for presurgery differences among treatments had F = 0.155 (2 and 55 df), p = 0.857. The ANOVA for postsurgery difference among treatments had F = 0.544 (2 and 53 df), p = 0.584. Conclusions The use of contrast bath treatment has no significant effect on increase or decrease of hand volume in Carpal Tunnel Syndrome patients, pre- and/or postoperatively. Level of evidence 1B.

Continuous passive motion (CPM) is a common adjunct to the postoperative therapy program. Use of CPM has been advocated for a variety of diagnoses in hand rehabilitation. This retrospective study compares two groups of patients who underwent digital tenolysis (and/or capsulectomy) and evaluates the use of CPM in their postoperative therapeutic management. Both groups had initial injuries of fractures, tendon lacerations, and/or crush injuries resulting in surgical intervention. After therapeutic rehabilitation, the patients failed to gain satisfactory active ROM and elected to proceed with a secondary surgical procedure. Fifteen patients (19 digits) who used CPM machines in addition to their home exercise program were compared to 21 patients (24 digits) who did not use CPM. Primary outcome comparisons for this study were change in total active motion (TAM) over time (preoperative to discharge from therapy), duration of therapy, and total number of therapy visits. There was no significant difference (F=1.16, p=0.29) in the change in TAM for patients using CPM (39.89 degrees ) compared to those not using CPM treatment (31.83 degrees ). Furthermore, CPM users were seen for significantly more therapy sessions than non-CPM users (25.7 therapy visits compared to 18.54 therapy visits). Rehabilitation lasted approximately the same amount of weeks for both groups (CPM users 10.21 weeks vs. non-CPM users 11.42 weeks).

The Evelyn Mackin Traveling Hand Therapist Award is a new award established in 2004 by the American Hand Therapy Foundation. This award was named in honor of Evelyn Mackin, a distinguished leader in hand therapy rehabilitation. Ms. Mackin enthusiastically endorses worldwide networking among hand therapists. She strongly believes in the value of sharing knowledge and technical skills. This award enables members of the ASHT to travel, learn new concepts or skills, and share them with the American hand therapy community. Visits to clinics in Great Britain and Norway revealed similarities and differences between European and American hand therapy practice. Clinical observations explore tendon transfer rehabilitation, cold sensitivity, sensory desensitization and re-education, Dupuytren's contracture, and clinic design. Other highlighted topics include delivery of health care services, hand therapist certification, and the unique contributions of Occupational Therapy and Physiotherapy to the practice of hand therapy. A hand therapy practice survey focuses on treatment and practice issues, continuing education, and challenges facing hand therapist colleagues abroad.

The importance and need for full compliant implementation of NIMS nationwide was clearly demonstrated during the Hurricane Katrina event, which was clearly expressed in Secretary Chertoff's October 4, 2005 letter addressed to the State's governors. It states, ''Hurricane Katrina was a stark reminder of how critical it is for our nation to approach incident management in a coordinated, consistent, and efficient manner. We must be able to come together, at all levels of government, to prevent, prepare for, respond to, and recover from any emergency or disaster. Our operations must be seamless and based on common incident management doctrine, because the challenges we face as a nation are far greater than capabilities of any one jurisdiction.'' The NIMS is a system/architecture for organizing response on a ''national'' level. It incorporations ICS as a main component of that structure (i.e., it institutionalizes ICS in NIMS). In a paper published on the NIMS Website, the following statements were made: ''NIMS represents a core set of doctrine, principles, terminology, and organizational processes to enable effective, efficient and collaborative incident management at all levels. To provide the framework for interoperability and compatibility, the NIMS is based on a balance between flexibility and standardization.'' Thus the NIC is challenged with the need to adopt quality SDO generated standards to support NIMS compliance, but in doing so maintain the flexibility necessary so that response operations can be tailored for the specific jurisdictional and geographical needs across the nation. In support of this large and complex challenge facing the NIC, the Pacific Northwest National Laboratory (PNNL) was asked to provide technical support to the NIC, through their DHS Science and Technology ? Standards Portfolio Contract, to help identify, review, and develop key standards for NIMS compliance. Upon examining the challenge, the following general process appears to be a reasonable approach for identifying and establishing existing standards that would be applicable to NIMS compliance. The suggested generalized steps to establishing existing SDO generated standards for NIMS compliance are: (1) establish search criteria from the NIMS and its support documents, (2) search SDO databases to identify key existing nationally and/or internationally recognized standards that have potential application to NIMS compliance needs, (3) review the identified standards against the specific component needs of the NIMS, (4) identify the pertinent aspects/components of those identified standards that clearly address specific NIMS compliance needs, (5) establish a process to adopt the pertinent standards, which includes the generation of formalized FEMA Guidance that identifies the specific NIMS component compliance needs addressed in the respective standard, (6) develop performance criteria for which to measure compliance with the identified NIMS components addressed by the respective adopted standard, and (7) adopt the standard, publish the guidance and performance criteria, and incorporate it into routine FEMA/NIC NIMS management operations. This review process will also help identify real gaps in standards for which new NIMS specific standards should be developed. To jump start this process and hopefully identify some key ''low hanging fruit'' standards the NIC could use to begin such a process, a panel of first-responder experts (familiar with the current standards of common use in the first-responder community) from various response disciplines was formed and a workshop held. The workshop included a pre-workshop information gathering process. This report discusses the workshop and its findings in detail.