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Background Medical school curricula are constantly evolving and change has potential positive and negative effects. At East Tennessee State University Quillen College of Medicine, a broader understanding of the effects of a curriculum change (reduction in clerkship length for one transitional year) was explored. Methods A broad, system-wide evaluation was used to evaluate impacts on all stakeholders. Curriculum management data, including qualitative and quantitative data and short-term and follow-up perspectives of stakeholders, were used for evaluation. Results Students evaluated the change positively. Academic performance in the transitional year was similar to the prior year. Differences in students’ clerkship evaluations were not statistically significant. Clerkship directors were concerned that students’ clinical experience suffered and noted that implementing changes was time consuming but recognized the benefits for students. Administrators dedicated a significant amount of time to planning the transitional year; however, the additional weeks at the beginning of fourth year made the scheduling process easier. Conclusion This article demonstrates an overall positive result with this tool for curriculum change but also indicates the impacts differed across stakeholders. Knowledge gained from this experience can help other schools successfully anticipate challenges and prepare for a variety of outcomes in implementing necessary curriculum change.

SHEEP pox in two northern states of Nigeria is reported. The disease produced nodules which became popular, vesicular and ulcerated on the skin. Lesions also developed in the respiratory, urogenital and alimentary organs The importance of the disease in animal production and its control are discussed. Viral isolation was not done but the disease was experimentally reproduced. Diagnosis was based on clinical history, experimental transmission and morphological examination

Some captive breeding colonies of rhesus macaques live in large outdoor multimale, multifemale social groups. These groups are composed of several matrilineal families, governed by a clear female dominance hierarchy. Aggression within the same or between different matrilineal families due to social instability can result in trauma and mortality. Therefore, a primary management goal is to detect emerging social unrest before the onset of significant fighting and wounding. Accordingly, groups are monitored routinely for changes in dominance and alliance relations as well as for increases in trauma frequency and severity. Decreased food intake is a normal physiologic response to acute stress; therefore, inappetence in key animals or groups of monkeys might be used as an indicator of increased social stress and emerging instability. An incident of intrafamily aggression occurred recently in a breeding group at our facility and resulted in considerable fighting. Because this compound was equipped with an automated feeding system that tracks the caloric intake of individual animals, we retrospectively analyzed feeding data to determine whether significant reduction in caloric consumption occurred prior to the onset of aggression, compared with baseline values. Neither the entire group nor individual families showed any significant differences in total caloric intake between baseline and previous 24 h values; however, the affected family exhibited a 20% reduction in total caloric during the 24 h prior to the aggression. Most notably, the deposed subfamily showed a marked 58% reduction in caloric intake during the prior 24 h, whereas remaining subfamilies showed no significant changes in intake. High-ranking animals of the group, including the α female, β female, and α male, similarly exhibited marked decreases in caloric intake during that period. These findings indicate that automated feeders can assist management staff with monitoring social stability in breeding colonies of rhesus macaque.

Background Ulnar collateral ligament injuries are rampant in the sport of baseball where kinetic chain impacts, stemming from misappropriation of stride length or changes that occur in competition due to fatigue, have not been evaluated for dynamic elbow stability effects. Hypothesis/Purpose To examine the relationship between clinical measures of grip strength and altered stride length in baseball pitchers. It is believed that shorter stride lengths would reduce grip strength in baseball pitchers. Study Design Crossover Study Design Methods A total of 19 uninjured pitchers (15 collegiate and 4 high school) (age 18.63 ± 1.67 years, height 1.84 ± 0.054 m, mass 82.14 ± 0.054 kg) threw two simulated 80-pitch games at ±25% of their desired stride length recorded by motion capture with two force plates and a radar gun to track each throw. A handheld grip dynamometer was used to record the mean change in grip strength after games from baseline measures. Pairwise comparisons at baseline and post-game denoted grip strength changes and dominant grip strength offsets for stride length conditions. Results Subjects with shorter stride lengths revealed a significant decline in grip strength in the dominant arm from baseline (pre-game; 45.1 kg vs. post-game; 43.2 kg, p=0.017, ES=0.28), however all other tests involving dominant grip strength changes and offset analyses were not statistically different for under-stride and over-stride length conditions. Conclusions Clinical evaluation of grip strength has the potential to identify altered lower body mechanics and may be considered as a safe and effective monitoring strategy to integrate with motion capture in determining optimal stride lengths for baseball pitchers. Level of Evidence Level 3

Salmonella and E. coli O157:H7 are two of the most important problems for the beef industry. Cattle can develop salmonellosis and persistently harbor Salmonella, or they can asymptomatically shed Salmonella and/or E. coli O157:H7 resulting in contamination of the hide and carcass surfaces during processing. Additionally, Salmonella infiltrates lymph nodes that get incorporated into ground beef. In this study, we investigated the possibility of identifying cattle with reduced susceptibility to one or both of these infections. Empirical observations from previous studies suggested that a diminished susceptibility was possible in amelanotic cattle, i.e., cattle bearing the mcr1/mcr1 genotype and lacking overt black pigmentation. By searching for single nucleotide polymorphisms (SNP) present in the 34 genes encoding the Salmonella interactome, we identified a SNP that was consistently present in amelanotic cattle with diminished susceptibility to Salmonella. Specifically, we used an ex vivo assay to screen 500 cattle blood samples for the diminished ability of Salmonella to penetrate peripheral leukocytes. Diminished Salmonella penetration was observed in 150 of these blood samples and 147 of these samples harbored two alleles bearing a SNP that introduces a miRNA cleavage site (bta-let-7b) in the 3’UTR of the bsynJ1 gene, which we designate as the SYNJ1/SNYJ1 genotype. Further ex vivo studies revealed a decreased expression of SYNJ1 in leukocytes bearing the SYNJ1/SNYJ1 genotype. In vivo experimental challenge studies revealed a diminished susceptibility to salmonellosis in cattle with the SYNJ1/SNYJ1::mcr1/mcr1 genotype. Additional in vivo challenge studies revealed that SYNJ1/SNYJ1::mcr1/mcr1 cattle have a decreased susceptibility to lymph node infiltration by two Salmonella serotypes (S. Anatum and S. Montevideo) implicated in this lymph node problem, and a decreased susceptibility to E. coli O157:H7 colonization of the recto-anal junction. A field study revealed that the SYNJ1/SNYJ1::mcr1/mcr1 genotype was five times more prevalent, when compared to the SYNJ1/synj1::mcr1/mcr1 and synj1/ synj1::mcr1/mcr1 genotypes, in Salmonella-free lymph nodes. Small-scale genetic surveys revealed that the SYNJ1/SNYJ1 genotype was present in the following mcr1/mcr1 breeds: Akaushi, Barzona, Braunvieh, Hereford, Piedmontese, Red and White Holsteins, Red Angus, Red Poll, Shorthorn, Simmental (Red), and Tarentaise. Studies using the aforementioned ex vivo penetration assay, which putatively predicts the diminished susceptibility phenotype, revealed that the penetrance of the diminished susceptibility is >99% in SYNJ1/SNYJ1::mcr1/mcr1 cattle but only ∼1% in SYNJ1/SNYJ1 cattle with at least one MCR1 allele. Further studies with the ex vivo assay revealed that three additional SNPs are part of a genotype conferring diminished susceptibility to a broad array of Salmonella serotypes commonly associated with cattle. In summary, the studies presented herein reveal a bovine genotype associated with decreased susceptibility to Salmonella and E. coli O157:H7. PSR Genetics LLC holds a U.S. patent on testing for the SYNJ1/SNYJ1 genotype (patent number 9,049,848) while the three complementary SNPs are under further investigation.

Coordinated lower extremity biomechanics are altered in response to changes in stride length, influencing the kinetic chain that potentially induces compensatory throwing mechanics throughout the baseball pitching cycle. The respective sagittal knee dynamic profiles, for both the stride (lead) and drive (trail) leg, were analyzed during flat ground baseball pitching to determine whether the stride length variation elicits compensatory drive and stride leg knee joint kinematics, kinetics, and joint powers. Using a randomized cross-over design, a cohort of 19 healthy skilled competitive pitchers from collegiate and high school travel programs from across Western New York were assigned to throw 2 simulated 80 pitch games at ±25% of their desired stride length. An integrated motion capture system with two force plates and a radar gun tracked each throw. Pairwise comparisons at hallmark events and phases identified significantly different sagittal knee dynamics for both the drive and stride leg between the stride length conditions. During the acceleration phase, the drive knee moments between the stride length conditions demonstrated differences in power generation and absorption. Longer strides allowed for greater knee propulsion dynamics, exemplified by eccentric drive knee extensor moments with a concomitant power absorption that slowed the rate of drive knee flexion (p ≤ 0.001). Conversely, shorter strides generated power through concentric knee flexor moments that increased the rate of drive knee flexion (p ≤ 0.001). Stride knee extensor moments and power generation during the acceleration phase were also significantly higher with shorter strides (p ≤ 0.05). Adapted knee joint dynamics may offer insights into stride length optimization, training, and injury prevention strategies.

The ichthyoses are rare skin disorders with immune and barrier aberrations. Identifying blood phenotypes may advance targeted therapeutics. We aimed to compare frequencies of skin homing/cutaneous lymphocyte antigen (+) versus systemic/cutaneous lymphocyte antigen (–) "polar" CD4 + /CD8 + and activated T-cell subsets in ichthyosis versus atopic dermatitis, psoriasis, and control blood, with appropriate clinical correlations. Flow cytometry was used to measure IFN-γ, IL-13, IL-9, IL-17, and IL-22 cytokines in CD4 + /CD8 + T cells, with inducible co-stimulator molecule and HLA-DR defining mid- and long-term T-cell activation, respectively. We compared peripheral blood from 47 patients with ichthyosis (congenital ichthyosiform erythroderma, lamellar ichthyosis, epidermolytic ichthyosis, and Netherton syndrome) with 43 patients with atopic dermatitis and 24 patients with psoriasis and 59 age-matched controls. Clinical measures included the ichthyosis severity score, with subsets for erythema and scaling, transepidermal water loss, and pruritus. All ichthyoses had excessive inducible co-stimulator molecule activation ( P P P P P P > 0.1) versus controls were also noted. IL-17/IL-22-producing cells clustered with clinical measures, whereas IFN-γ clustered with age. Our data show peripheral blood IL-17/IL-22 activation across the ichthyoses, correlating with clinical measures. Targeted therapies should dissect the relative contribution of polar cytokines to disease pathogenesis.

Research on sex differences in autism spectrum disorder (ASD) suggests both higher prevalence and a more easily observable presentation of core ASD symptomology in males, which may lead to sex differences in parental concerns. The current study examined whether sex and diagnosis relate to the timing, number, and types of pre-diagnosis concerns for 669 (Nmale = 468) toddlers who screened at risk for ASD. No sex differences in parents’ concerns emerged for toddlers diagnosed with ASD; however, in the overall at-risk sample, parents of boys endorsed ASD symptoms, including restricted and repetitive behaviors, more than parents of girls. Future research should examine why sex differences in pre-diagnosis concerns emerge and how they might impact early diagnosis for at-risk boys versus girls.

Propulsion and bracing ground reaction force (GRF) in overhand throwing are integral in propagating joint reaction kinetics and ball velocity, yet how stride length effects drive (hind) and stride (lead) leg GRF profiles remain unknown. Using a randomised crossover design, 19 pitchers (15 collegiate and 4 high school) were assigned to throw 2 simulated 80-pitch games at ±25% of their desired stride length. An integrated motion capture system with two force plates and radar gun tracked each throw. Vertical and anterior-posterior GRF was normalised then impulse was derived. Paired t-tests identified whether differences between conditions were significant. Late in single leg support, peak propulsion GRF was statistically greater for the drive leg with increased stride. Stride leg peak vertical GRF in braking occurred before acceleration with longer strides, but near ball release with shorter strides. Greater posterior shear GRF involving both legs demonstrated increased braking with longer strides. Conversely, decreased drive leg propulsion reduced both legs' braking effects with shorter strides. Results suggest an interconnection between normalised stride length and GRF application in propulsion and bracing. This work has shown stride length to be an important kinematic factor affecting the magnitude and timing of external forces acting upon the body.

Background The shoulder mobility screen of the Functional Movement Screen™ (FMS™) and the upper extremity patterns of the Selective Functional Movement Assessment (SFMA) assess global, multi-joint movement capabilities in the upper-extremities. Identifying which assessment can most accurately determine if baseball players are at an increased risk of experiencing overuse symptoms in the shoulder or elbow throughout a competitive season may reduce throwing-related injuries requiring medical attention. Purpose The purpose of this study was to determine if preseason FMS™ or SFMA scores were related to overuse severity scores in the shoulder or elbow during the preseason and competitive season. Study design Cohort study. Methods Sixty healthy, male, Division III collegiate baseball players (mean age = 20.1 ± 2.0 years) underwent preseason testing using the FMS™ shoulder mobility screen, and SFMA upper extremity patterns. Their scores were dichotomized into good and bad movement scores, and were compared to weekly questionnaires registering overuse symptoms and pain severity in the shoulder or elbow during the season. Results Poor FMS™ performance was associated with an increased likelihood of experiencing at least one overuse symptom during the preseason independent of grade and position (adjusted odds ratio [OR] = 5.14, p = 0.03). Poor SFMA performance was associated with an increased likelihood of experiencing at least one overuse symptom during the preseason (adjusted OR = 6.10, p = 0.03) and during the competitive season (adjusted OR = 17.07, p = 0.03) independent of grade and position. Conclusion FMS™ shoulder mobility and SFMA upper extremity pattern performance were related to the likelihood of experiencing overuse symptoms during a baseball season. Participants with poor FMSTM performances may be more likely to experience at least one overuse symptom in their shoulder or elbow during the preseason. Additionally, individuals with poor SFMA performances may be more likely to report overuse symptoms during the preseason or competitive season. Level of evidence Level 3.

Some captive breeding colonies of rhesus macaques live in large outdoor multimale, multifemale social groups. These groups are composed of several matrilineal families, governed by a clear female dominance hierarchy. Aggression within the same or between different matrilineal families due to social instability can result in trauma and mortality. Therefore, a primary management goal is to detect emerging social unrest before the onset of significant fighting and wounding. Accordingly, groups are monitored routinely for changes in dominance and alliance relations as well as for increases in trauma frequency and severity. Decreased food intake is a normal physiologic response to acute stress; therefore, inappetence in key animals or groups of monkeys might be used as an indicator of increased social stress and emerging instability. An incident of intrafamily aggression occurred recently in a breeding group at our facility and resulted in considerable fighting. Because this compound was equipped with an automated feeding system that tracks the caloric intake of individual animals, we retrospectively analyzed feeding data to determine whether significant reduction in caloric consumption occurred prior to the onset of aggression, compared with baseline values. Neither the entire group nor individual families showed any significant differences in total caloric intake between baseline and previous 24 h values; however, the affected family exhibited a 20% reduction in total caloric during the 24 h prior to the aggression. Most notably, the deposed subfamily showed a marked 58% reduction in caloric intake during the prior 24 h, whereas remaining subfamilies showed no significant changes in intake. High-ranking animals of the group, including the α female, β female, and α male, similarly exhibited marked decreases in caloric intake during that period. These findings indicate that automated feeders can assist management staff with monitoring social stability in breeding colonies of rhesus macaque.

Intraocular foreign bodies (IOFBs) can present in an insidious manner. A 20-year-old male presented with gradual visual loss in the right eye over a six-month period. He was found to have a dense cataract. During examination he was noted to have a small, healed corneal scar and subtle iris heterochromia. Further questioning revealed a previously undisclosed metal-on-metal hammering injury concerning for an IOFB. B-scan ultrasonography was inconclusive and CT studies confirmed the presence of IOFB. The patient underwent a combined cataract extraction with intraocular lens implantation with a pars plan vitrectomy, removal of IOFB, and endolaser. He had an excellent visual outcome, despite developing siderosis. A high index of suspicion should be raised for any asymmetric cataract formation, especially in younger patients. Careful examination for findings such as healed corneal scars or iris heterochromia may aid in diagnosing previously undisclosed injuries.

AIMS: The aim of the study was to determine whether increased physical activities (PA) affect frailty for old women, 75 years and older (OO), compared to 60–74 years old (YO). METHODS: This crosssectional study measured 19 frailty indicators (muscle strength and endurance, balance, gait characteristics, and function), using 46 community-dwelling women. PA were divided into three levels by caloric expenditure per week (4,000 kcal/week). RESULTS: As PA level increased, a gap (=difference) between OO and YO narrowed for step length and function, but for quadriceps strength and endurance, a gap widened. CONCLUSIONS: Frailty progresses with aging but older women who engage in a high level of physical activity (>4,000 kcal/week) can increase mobility and functional capacity, but not for muscle strength and endurance. Starting regular resistance training activities early in the aging process is critical to improve or maintain muscle quality to offset age-related frailty.

The objective was to determine associations between response to superovulation and body condition, subclinical endometritis and circulating metabolic biomarkers [adiponectin, leptin, insulin, IGF1, tumor necrosis factor (TNF) α, interleukin (IL) 1β, IL6, and urea] in lactating dairy cows. Ten multiparous lactating Holstein cows in each body condition score (1-5; 1 emaciated; 5 obese) category (BCSC) 2.00 to 2.50 (BCSC1), 2.50 to 3.00 (BCSC2), 3.00 to3.50 (BCSC3), 3.50 to4.00 (BCSC4) and 4.00 to 5.00 (BCSC5) groups (total n = 50) were randomly selected and superovulated, timed artificially inseminated with frozen-thawed semen from three sires and embryos collected (n = 50 collections). At embryo collection, blood samples and embryo recovery fluid were collected for determination of metabolic markers and presence of subclinical endometritis (lavage technique;6% PMN). In total, 379 embryos were collected (average of 7.6 embryos per superovulation). Mean numbers of total ova and embryos was greater for cows in BCSC2, BCSC3 and BCSC4 groups compared with cows in BCSC1 and BCSC5 groups (P 0.01). Total number of transferrable embryos were greater for cows in BCSC 2 and BCSC3 groups compared with cows in BCSC1, BCSC4 and BCSC5 groups (P 0.01). Mean number of total ova and embryos and of transferrable embryos was higher for cows with 0 or 1-6% PMN compared to cows with6% PMN (P 0.01). In addition, there was a quadratic association between blood urea nitrogen concentrations and % transferrable embryos (r

BACKGROUND: Use of biological or synthetic mesh might improve outcomes of immediate implant-based breast reconstruction-breast reconstruction with implants or expanders at the time of mastectomy-but there is a lack of high-quality evidence to support the safety or effectiveness of the technique. We aimed to establish the short-term safety of immediate implant-based breast reconstruction performed with and without mesh, to inform the feasibility of undertaking a future randomised clinical trial comparing different breast reconstruction techniques.METHODS: In this prospective, multicentre cohort study, we consecutively recruited women aged 16 years or older who had any type of immediate implant-based breast reconstruction for malignancy or risk reduction, with any technique, at 81 participating breast and plastic surgical units in the UK. Data about patient demographics and operative, oncological, and complication details were collected before and after surgery. Outcomes of interest were implant loss (defined as unplanned removal of the expander or implant), infection requiring treatment with antibiotics or surgery, unplanned return to theatre, and unplanned re-admission to hospital for complications of reconstructive surgery, up to 3 months after reconstruction and assessed by clinical review or patient self-report. Follow-up is complete. The study is registered with the ISRCTN Registry, number ISRCTN37664281.FINDINGS: Between Feb 1, 2014, and June 30, 2016, 2108 patients had 2655 mastectomies with immediate implant-based breast reconstruction at 81 units across the UK. 1650 (78%) patients had planned single-stage reconstructions (including 12 patients who had a different technique per breast). 1376 (65%) patients had reconstruction with biological (1133 [54%]) or synthetic (243 [12%]) mesh, 181 (9%) had non-mesh submuscular or subfascial implants, 440 (21%) had dermal sling implants, 42 (2%) had pre-pectoral implants, and 79 (4%) had other or a combination of implants. 3-month outcome data were available for 2081 (99%) patients. Of these patients, 182 (9%, 95% CI 8-10) experienced implant loss, 372 (18%, 16-20) required re-admission to hospital, and 370 (18%, 16-20) required return to theatre for complications within 3 months of their initial surgery. 522 (25%, 95% CI 23-27) patients required treatment for an infection. The rates of all of these complications are higher than those in the National Quality Standards (INTERPRETATION: Complications after immediate implant-based breast reconstruction are higher than recommended by national standards. A randomised clinical trial is needed to establish the optimal approach to immediate implant-based breast reconstruction.FUNDING: National Institute for Health Research, Association of Breast Surgery, and British Association of Plastic, Reconstructive and Aesthetic Surgeons.

The use of functional knee braces for returning to sports or during demanding activities following anterior cruciate ligament rupture is common; yet despite being commonly prescribed, its mechanism of action remains unknown.To examine the effect of functional knee braces on mean muscle activity when performing lunge exercises.Pre-/post-test (within-subject research design).A total of 10 male participants with unilateral isolated anterior cruciate ligament deficiency participated. Electromyographic activities of six muscles around the knee were recorded during lunge exercises, with and without wearing a custom functional knee brace. The lunge cycle movement was subdivided into three phases: eccentric, isometric, and concentric.The quadriceps and hamstrings were no different in the braced and unbraced conditions. When braced, the mean amplitude of the medial gastrocnemius was significantly lower throughout the whole movement (p = 0.01) and during the concentric (p = 0.006) and eccentric (p = 0.028) phases, but not within the isometric phase. The lateral gastrocnemius was found to have lower mean amplitude in the isometric phase (p = 0.044).With its origin on the medial femoral condyle, perhaps reduced medial gastrocnemius activity may better guide knee rotation and assist the joint achieving a healthier kinematic pattern.Lower medial gastrocnemius activity may facilitate lower medial compartment contact pressure, for which greater loading is known to increase the risk of osteoarthritis in anterior cruciate ligament-deficient (ACLD) knees. However, further research is needed.

This is the second component of a two-part series investigating 3D momentum profiles specific to overhand throwing, where altering stride reportedly influences throwing mechanics resulting in significantly different physiologic outcomes and linear momentum profiles. Using a randomized cross-over design, nineteen pitchers (15 collegiate and 4 high school) were assigned to pitch two simulated 80-pitch games at ±25% of their desired stride length. An 8-camera motion capture system (240Hz) integrated with two force plates (960Hz) and radar gun tracked each overhand throw. Segmental angular momentums were summed yielding throwing arm and total body momentums, from which compensation ratio's (relative contribution between the two) were derived. Pairwise comparisons at hallmark events and phases identified significantly different angular momentum profiles, in particular total body, throwing arm, and momentum compensation ratios (P⩽0.05) as a result of manipulating stride length. Sagittal, frontal, and transverse angular momentums were affected by stride length changes. Transverse magnitudes showed greatest effects for total body, throwing arm, and momentum compensation ratios. Since the trunk is the main contributor to linear and angular momentum, longer strides appear to better regulate transverse trunk momentum in double support, whereas shorter strides show increased momentum prior to throwing arm acceleration.

Undifferentiated pleomorphic sarcoma is a malignancy of mesenchymal origin, which was previously known as malignant fibrous histiocytoma. It is known to occur on rare occasion as a primary orbital tumor, but no known cases of metastatic orbital involvement have been reported since 2002, when the reclassification of these tumors took place. The authors report a patient who presented with a metastasis to the left orbit 2 years after undergoing treatment of a high-grade undifferentiated pleomorphic sarcoma of the right thigh. Histopathology of the orbital mass was similar to the primary tumor biopsy prior to neoadjuvant chemotherapy and radiation. The appearance was markedly altered in the subsequent excisional tissue, which showed treatment changes. Immunohistochemistry and genetic testing also supported the metastatic nature of the orbital lesion. The patient's tumor progressed rapidly despite systemic targeted therapy and orbital exenteration was performed. At 2 years follow up, the patient remained without evidence of tumor recurrence in the socket.

Objective: Elevated aggression and poor intelligence scores occur in children with BLLs (Blood Lead Levels) lower than 10 μg/dL while Pb-exposed cats show increased aggressive behavior with BLLs of 10 μg/dL. This increased aggression in cats may be associated with the development of hyper-spiny neurons observed in the motor cortex, hippocampus and cerebellum of kittens with BLLs

The purpose of this study was to examine the infuence of trunk lean and contralateral hip abductor strength on the peak knee adduction moment (KAM) and rate of loading in persons with moderate medial knee osteoarthritis. Tirty-one males (17 with osteoarthritis, 14 controls) underwent 3-dimensional motion analysis, strength testing of hip abductors, and knee range of motion (ROM) measures, as well as completing the knee osteoarthritis outcome score (KOOS). No diferences were found between groups or limbs for gait cycle duration, but the osteoarthritis group had longer double-limb support during weight acceptance (p < 0.001) and delayed frontal plane trunk motion towards the stance limb (p < 0.01). Tis was refected by a lower rate of loading for the osteoarthritis group compared to controls (p < 0.001), whereas no diferences were found for peak KAM. Trunk angle, contralateral hip abductor strength, and BMI explained the rate of loading at the involved knee (p < 0.001), an association not found for the contralateral knee or control knees. Prolonged trunk lean over the stance limb may help lower peak KAM values. Rate of frontal plane knee joint loading may partly be mediated by the contralateral limb’s abductor strength, accentuating the importance of bilateral lower limb strength for persons with knee osteoarthritis., Financial support was received from the Icelandic Physiotherapy Association.

This study assessed pitching performance by examining variability in ball velocities among skilled pitchers over two simulated games, where stride lengths were altered while monitoring the effect o...

The Progressive MS Alliance Industry Forum describes a new approach to address barriers to developing treatments for progressive multiple sclerosis (MS). This innovative model promises to facilitate robust collaboration between industry, academia, and patient organizations and accelerate research towards the overarching goal of developing safe and effective treatments for progressive MS.

Martha Sajatovic,1,2 Angela L Ridgel,3 Ellen M Walter,1,4 Curtis M Tatsuoka,1,2 Kari Colón-Zimmermann,2 Riane K Ramsey,2 Elisabeth Welter,2 Steven A Gunzler,1,4 Christina M Whitney,1,4 Benjamin L Walter1,4 1Department of Neurology, Case Western Reserve University School of Medicine, 2Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, 3Department of Exercise Physiology, Kent State University, Kent, 4Movement Disorders Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA Background: Depression is common in people with Parkinson’s disease (PD), and exercise is known to improve depression and PD. However, lack of motivation and low self-efficacy can make exercise difficult for people with PD and comorbid depression (PD-Dep). A combined group exercise and chronic disease self-management (CDSM) program may improve the likelihood that individuals will engage in exercise and will show a reduction in depression symptoms. The purpose of this study was to compare changes in depression in PD-Dep between individual versus group exercise plus CDSM and to examine participant adherence and perception of the interventions.Methods: Participants (N=30) were randomized to either Enhanced EXerCisE thErapy for PD (EXCEED; group CDSM and exercise) or self-guided CDSM plus exercise. Outcomes were change in depression assessed with the Montgomery–Asberg Depression Rating Scale (MADRS), cognition, apathy, anxiety, sleep, quality of life, motor function, self-efficacy, and patient satisfaction.Results: Both groups showed significant improvement in MADRS (P

The principle of lower limb support, and the contribution of hip, knee and ankle moments to an overall limb support strategy for an impact-like, rapid deceleration movement may help explain individual moment magnitude changes, thereby providing insight into how injury might occur or be avoided. Twenty subjects performed single limb, impact-like, deceleration landings at three different knee flexion angles in the range of 0–25, 25–50 and 50–75°. Kinematic and kinetic measures identified hip, knee and ankle moment contribution to limb support moments (LSMs) in three planes. Repeated measures ANOVA compared LSMs and the contribution of individual joint moments at initial contact (IC) and 50 ms after. There were no significant differences in the overall LSMs at IC in any plane when the deeper knee flexion landings (25–50° and 50–75°) were compared to the 0–25° landing position but there were significant changes in the 50 ms period after IC. There were greater overall extensor LSMs, less resistance to medial opening of the knee and decreased support against internal tibia rotation when landing in greater knee flexion. The role of individual joint moments changed rapidly in the 50 ms period after initial landing; and, the relative contribution of the hip and ankle moments depended on the degree of limb flexion at landing. Analyses of individual joint moments emphasized the critical role that the hip joint moments have in balancing potentially injurious knee moments in all three planes for all three landing conditions.

Changing stride length during overhand throwing delivery is thought to alter total body and throwing arm linear momentums, thereby altering the proportion of throwing arm momentum relative to the total body. Using a randomized cross-over design, nineteen pitchers (15 collegiate and 4 high school) were assigned to pitch two simulated 80-pitch games at ±25% of their desired stride length. An 8-camera motion capture system (240Hz) integrated with two force plates (960Hz) and radar gun tracked each throw. Segmental linear momentums in each plane of motion were summed yielding throwing arm and total body momentums, from which compensation ratio's (relative contribution between the two) were derived. Pairwise comparisons at hallmark events and phases identified significantly different linear momentum profiles, in particular, anteriorly directed total body, throwing arm, and momentum compensation ratios (P⩽.05) as a result of manipulating stride length. Pitchers with shorter strides generated lower forward (anterior) momentum before stride foot contact, whereas greater upward and lateral momentum (toward third base) were evident during the acceleration phase. The evidence suggests insufficient total body momentum in the intended throwing direction may potentially influence performance (velocity and accuracy) and perhaps precipitate throwing arm injuries.

Atopic dermatitis (AD) predominantly affects young children, but our understanding of AD pathogenesis is based on skin and blood samples from long-standing adult AD. Genomic biopsy profiling from early pediatric AD showed significant Th2 and Th17/Th22-skewing, without the characteristic adult Th1 up-regulation. Because obtaining pediatric biopsies is difficult, blood gene expression profiling may provide a surrogate for the pediatric skin signature.To define the blood profile and associated biomarkers of early moderate-to-severe pediatric AD.We compared microarrays and reverse transcription polymerase chain reaction (RT-PCR) of blood cells from 28 AD children (5 years and within 6 months of disease onset) to healthy control blood cells. Differentially expressed genes (DEGs) in blood (fold change [FCH]1.2 and false discovery rate [FDR]0.05) were then compared with skin DEGs.Eosinophil and Th2 markers (IL5RA, IL1RL1/ST2, HRH4, CCR3, SIGLEC8, PRSS33, CLC from gene arrays; IL13/IL4/CCL22 from RT-PCR) were up-regulated in early pediatric AD blood, whereas IFNG/Th1 was decreased. Th1 markers were negatively correlated with clinical severity (EASI, pruritus, transepidermal water loss [TEWL]), whereas Th2/Th17-induced interleukin (IL)-19 was positively correlated with SCORAD. Although a few RT-PCR-defined immune markers (IL-13/CCL22) were increased in blood, as previously also reported for skin, minimal overlap based on gene array DEGs was seen.The whole blood signature of early moderate-to-severe pediatric AD blood cells show predominantly a Th2/eosinophil profile; however, markers largely differ from the skin profile. Given their complementarity, pooling of biomarkers from blood and skin may improve profiling and predictions, providing insight regarding disease course, allergic comorbidity development, and response to systemic medications.

Enhanced external counterpulsation (EECP) has been approved by the United States Food and Drug Administration (FDA) for management of refractory angina (Class IIb). EECP uses three sets of pneumatic cuffs that sequentially contract during diastole, increasing aortic diastolic pressure, augmenting coronary blood flow and central venous return. EECP improves anginal symptoms and exercise tolerance, and reduces nitroglycerin use in patients with chronic, stable angina. EECP has also been shown to be safe and beneficial in patients with symptomatic stable congestive heart failure. It has been postulated that cardiac benefits of EECP are mediated though vascular endothelial growth factor (VEGF) and nitric oxide mediated vasodilatation and angiogenesis. In June 2002, the FDA also approved EECP therapy for heart failure patients.