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The purpose of this study was to examine the features that foster the academic and social integration of students enrolled in blended synchronous courses (BSC). Many studies and models have considered academic and social integration to be important determinants of student persistence and success in higher education programs and courses. In keeping with current research on blended courses that builds on models and theories developed for both online courses and face-to-face courses, we draw on Tinto’s model (Tinto, Review of Educational Research 45:89–125, 1975; Tinto, Leaving college: Rethinking the causes and cures of student attrition, 1993) and those of Rovai (The Internet & Higher Education 6:1–16, 2003) and Park (Proceedings of the 2007 Academy of Human Resource Development Annual Conference, 2007) to better define the academic and social integration of students in blended synchronous courses. To meet the study objective, a qualitative methodology was adopted. A convenience sampling technique was used in the study. The study participants were students (n = 8) enrolled in a graduate program in education offering only blended synchronous courses, as well as their instructors (n = 5). Semi-structured interviews (60–120 min in length) were selected as the data collection method. All qualitative data were analyzed using a general inductive approach (Thomas, American Journal of Evaluation 27:237–246, 2006). The results show that many features appear to promote academic and social integration, including the pedagogical strategies used. Moreover, this integration depends on the attitudes of both instructors and face-to-face students towards online students. This study highlights some challenges associated with blended synchronous courses. Further, it appears to suggest that instructors will need to work more on the inclusion of online students, and that training should be provided to assist them in this regard.

Background When necessary, radial head integrity after a fracture can be re-created by the use of a radial head arthroplasty if the radial head is judged irreparable. The purpose of this study was to compare the clinical and radiographic outcomes of metal modular radial head replacements with a smooth vs. a porous stem. Methods A retrospective cohort study of radial head replacements performed in the first 4 weeks after a trauma in an adult patient at our institution between 2000 and 2014 was completed. Patients were divided into 2 groups: a porous stem group (ExploR; Biomet Orthopedics, Warsaw, IN, USA) and a smooth stem group (EVOLVE; Wright Medical Group, Memphis, TN, USA). Primary outcomes were the Disabilities of the Arm, Shoulder, and Hand and Mayo Elbow Performance Index scores. Secondary outcomes were the visual analog scale score for pain, range of motion, grip strength, and radiographic evaluations. Results Of the 80 eligible patients, 57 agreed to participate (porous stem group, 36; smooth stem group, 21). Demographic data were similar between the 2 groups. Average follow-up was 6.3 years. Average Disabilities of the Arm, Shoulder, and Hand and Mayo Elbow Performance Index scores were similar between the 2 groups. Porous implants were more prone to osteolysis (64.3% vs. 23.5%; P = .01) and were associated with a greater loss of elbow flexion (6° vs. 1°; P = .02). The porous stem group showed a tendency toward more overstuffing (24.0% vs. 5.9%; P = .21). Conclusion Our results reveal that outcomes between smooth and porous stem metal modular radial head implants are equivalent. However, the smooth stem implant may represent the preferred option as it is associated with a lower rate of complications.

Long-term exposure to antipsychotics like haloperidol can increase sensitivity to dopamine agonist stimulation. This could contribute to treatment failure and increase relapse to psychosis. Chronic antipsychotic treatment elevates neurotensin levels in the nucleus accumbens (NAc), where the neuropeptide modulates dopamine function by signalling through NTS1 receptors. We hypothesized that increasing neurotensin activity in the NAc attenuates the expression of antipsychotic-induced dopamine supersensitivity, which is indicated by a potentiated psychomotor response to amphetamine. Rats received either continuous (CONT-HAL; achieved via subcutaneous osmotic minipump) or intermittent (INT-HAL; achieved via daily subcutaneous injection) haloperidol treatment for 16-17 days. Three to 5 days later, we injected neurotensin into the NAc and measured amphetamine-induced locomotion. Only CONT-HAL rats showed potentiated amphetamine-induced locomotion, indicating dopamine supersensitivity. Compared to intra-NAc saline, intra-NAc neurotensin suppressed amphetamine-induced locomotion in CONT-HAL rats, but not in INT-HAL or control rats. In a new cohort of CONT-HAL and INT-HAL rats, we measured striatal levels of proneurotensin mRNA and NTS1 receptors. The two treatments led to overlapping but also distinct neurochemical profiles. Neither treatment altered NTS1 receptor levels in the NAc, but both increased proneurotensin mRNA levels in the NAc core. In the caudate-putamen, only INT-HAL increased NTS1 receptor levels, while only CONT-HAL increased proneurotensin mRNA expression. Thus, antipsychotic-induced dopamine supersensitivity enhances the ability of neurotensin in the NAc to regulate dopamine-mediated behaviours, and this likely does not involve changes in local levels of NTS1 receptors or proneurotensin mRNA. We conclude that increasing neurotensin activity could be considered to attenuate antipsychotic-induced dopamine supersensitivity.

Drug abuse and addiction are excessively common in schizophrenia. Chronic antipsychotic treatment might contribute to this comorbidity by inducing supersensitivity within the brain's dopamine system. Dopamine supersensitivity can enhance the incentive motivational properties of reward cues, and reward cues contribute to the maintenance and severity of drug addiction. We have shown previously that rats withdrawn from continuous haloperidol (HAL) treatment (via subcutaneous minipump) develop dopamine supersensitivity and pursue reward cues more vigorously than HAL-naive rats following an amphetamine (AMPH) challenge. Atypical antipsychotic drugs are thought to be less likely than typicals to produce dopamine supersensitivity. Thus, we compared the effects of HAL and the atypical antipsychotic olanzapine (OLZ) on the pursuit of reward cues. Rats were trained to associate a light-tone cue with water then treated with HAL or OLZ. Following antipsychotic withdrawal, we assessed AMPH-induced enhancement of lever pressing for the cue. Withdrawal from HAL, but not from OLZ, enhanced this effect. HAL, but not OLZ, also enhanced AMPH-induced psychomotor activation and c-fos mRNA expression in the caudate-putamen. Thus, prior HAL, but not OLZ, enhanced conditioned reward following an AMPH challenge, and this was potentially linked to enhanced behavioral sensitivity to AMPH and AMPH-induced engagement of the caudate-putamen. These findings suggest that HAL, but not an atypical like OLZ, modifies reward circuitry in ways that increase responsiveness to reward cues. Because enhanced responsiveness to reward cues can promote drug-seeking behavior, it should be investigated whether atypical antipsychotics might be a preferential option in schizophrenic patients at risk for drug abuse or addiction.

Purpose: The objective of this non-randomized controlled study of 40 patients was to compare the positioning time required between the beach chair (20 patients) and the lateral decubitus position (20 patients) for a shoulder arthroscopy. Methods: A single evaluator measured the speed of setup and the time was divided in four periods. All surgeries were performed at a single hospital by two fellowship-trained upper extremity orthopaedic surgeons using the SPIDER Limb positioner (Smith Nephew, Memphis, TN, USA) and under regional and general anaesthesia. The anaesthesia period was performed with the patient’s supine before the positioning. Results: The time required from positioning to the first incision is faster in lateral decubitus than in beach chair position (18:28 min vs 22:44 min, p < 0.0001). The setup time by the beneficiary attendant (10:13 min vs 14:12 min, p < 0.0001) and the time to set up the operative fields (7:42 min vs 8:39 min, p = 0.006) also indicate the same tendency. The duration of the anaesthetic period, excluding the time required for the regional block, is also faster in the lateral decubitus position (13:40 min vs 17:09 min, p = 0.17). Moreover, the correlation between weight and time positioning is inversely proportional in lateral decubitus position and proportional in beach chair position.

Chronic exposure to some antipsychotic medications can induce supersensitivity to dopamine receptor stimulation. This is linked to a worsening of clinical outcome and to antipsychotic treatment failure. Here we investigated the role of striatal subregions [nucleus accumbens (NAc) and caudate-putamen (CPu)] in the expression of antipsychotic-induced dopamine supersensitivity. We treated rats with haloperidol (HAL) or olanzapine (OLZ), using regimens that achieve clinically relevant kinetics of striatal D2 receptor occupancy. Under these conditions, HAL produces dopamine supersensitivity whereas OLZ does not. We then assessed behaviors evoked by the dopamine agonist amphetamine (AMPH). We either injected AMPH into the striatum or inhibited striatal function with microinjections of GABA receptor agonists prior to injecting AMPH systemically. HAL-treated rats were dopamine supersensitive, as indicated by sensitization to systemic AMPH-induced potentiation of both locomotor activity and operant responding for a conditioned reward (CR). Intra-CPu injections of AMPH had no effect on these behaviors, in any group. Intra-NAc injections of AMPH enhanced operant responding for CR in OLZ-treated and control rats, but not in HAL-treated rats. In HAL-treated rats, inhibition of the NAc also failed to disrupt systemic AMPH-induced potentiation of operant responding for CR. Furthermore, while intra-NAc AMPH enhanced locomotion in both HAL-treated and control animals, inhibition of the NAc disrupted systemic AMPH-induced locomotion only in control rats. Thus, antipsychotic-induced dopamine supersensitivity persistently disrupts NAc function, such that some behaviors that normally depend upon NAc dopamine no longer do so. This has implications for understanding dysfunctions in dopamine-mediated behaviors in patients undergoing chronic antipsychotic treatment.

We report the case of a 49-year-old woman with severe elbow ankylosis 10 weeks after a trochlea fracture treated with open reduction and internal fixation. Imaging confirmed failure of open reduction and internal fixation with a displaced and severely damaged trochlea. We treated the nascent malunited trochlea and associated elbow ankylosis with a distal humeral hemiarthroplasty and circumferential elbow arthrolysis. The patient regained functional range of motion of the elbow and had minimal pain. Distal humeral hemiarthroplasty, which has been indicated for acute fractures involving the capitellum or the entire distal humerus, may also be indicated for certain isolated complex fractures of the trochlea.

Chronic exposure to antipsychotic medications can persistently change brain dopamine systems. Most studies on the functional significance of these neural changes have focused on motor behavior and few have addressed how long-term antipsychotic treatment might influence dopamine-mediated reward function. We asked, therefore, whether a clinically relevant antipsychotic treatment regimen would alter the incentive motivational properties of a reward cue. We assessed the ability of a Pavlovian-conditioned stimulus to function as a conditioned reward, as well as to elicit approach behavior in rats treated with haloperidol, either continuously (achieved via subcutaneous osmotic minipump) or intermittently (achieved via daily subcutaneous injections). Continuous, but not intermittent, treatment enhanced the ability of amphetamine to potentiate the conditioned reinforcing effects of a cue associated with water. This effect was not related to differences in the ability to attribute predictive value to a conditioned stimulus (as measured by conditioned approach behavior), but was potentially linked to the development of behavioral supersensitivity to amphetamine and to augmented amphetamine-induced immediate early-gene expression (c-fos and Nur77) in dorsal striatopallidal and striatonigral cells. By enhancing the ability of reward cues to control behavior and by intensifying dopamine-mediated striatopallidal and striatonigral cell activity, standard (ie, continuous) antipsychotic treatment regimens might exacerbate drug-seeking and drug-taking behavior in schizophrenia. Achieving regular but transiently high antipsychotic levels in the brain (as modeled in the intermittent condition) might be a viable option to prevent these changes. This possibility should be explored in the clinic.

Cystic fibrosis (CF) is characterized by a dramatic neutrophil recruitment and repeated Pseudomonas infections in the lungs. To evaluate cytokine releasibility by airway epithelial cells in the context of CF, we studied primary nasal epithelial cells isolated from the upper airways and continuous epithelial cell lines from normal and CF subjects. Relatively low levels of interleukin (IL)-8, IL-6, and granulocyte/macrophage colony-stimulating factor (GM-CSF) were produced spontaneously by primary epithelial cells (50 pg/10(6) cells) and higher levels of colony-stimulating factor-1 (CSF-1) (1 to 2 ng/10(6) cells). Cells were stimulated with substances that are likely to be present in the inflamed lungs of CF patients-namely, the proinflammatory monokines IL-1 and tumor necrosis factor-alpha (TNF alpha) as well as neutrophil elastase and bacterial products from Pseudomonas (mucoid exopolysaccharide [MEP] and rhamnolipids). Both IL-1 and TNF alpha induced a dose-dependent release of IL-6 (5 to 10 ng/10(6) cells) and GM-CSF (2 to 3 ng/10(6) cells) by primary epithelial cells from eight normal volunteers. The TNF alpha/IL-1-stimulated GM-CSF release was blocked by the addition of 1 microM dexamethasone, whereas basal CSF-1 release was unaffected. Neutrophil elastase was a potent inducer of IL-8 and GM-CSF both in primary epithelial cells and in cell lines. Dexamethasone (1 microM) did not inhibit elastase-induced IL-8 release in either normal or CF epithelial cells. Rhamnolipids and MEP were found to stimulate the copious release of IL-8, GM-CSF, and IL-6 from epithelial cells, in a steroid-sensitive fashion.(ABSTRACT TRUNCATED AT 250 WORDS)

We examined the interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF alpha) releasability of alveolar macrophages and the natural killer (NK) cell activity in the bronchoalveolar lavage (BAL) cells of 11 patients with Farmer's lung at different stages of the disease. Although there were some variations in the levels of monokine release, macrophages of patients with acute disease secreted significantly higher spontaneous levels of TNF alpha than did a nonfarming control group (p = 0.0002). Conversely, TNF alpha release stimulated by bacterial lipopolysaccharide (LPS) was similar in patients with acute disease when compared with that in normal control subjects. IL-1 was also spontaneously secreted in significantly greater amounts by patients with acute Farmer's lung than by subjects in a control group (p = 0.0001). However, LPS-induced IL-1 release was significantly diminished in BAL macrophages from patients with acute manifestations of the disease when compared with that in control subjects (p = 0.001). Treating hypersensitivity pneumonitis with corticosteroids or by contact avoidance resulted in very significant decrease in spontaneous and LPS-stimulated IL-1 production by BAL macrophages (p = 0.0001 and p = 0.03, respectively), as well as in a decrease in spontaneous TNF alpha release that was also significant (p = 0.01). In addition, BAL cells of patients in the acute phase had a significant NK cell activity (mean +/- SEM of 18.33 +/- 2.65%). Treatment of these patients resulted in an increase in NK cell activity (mean of 40.17 +/- 7.86%), which was significantly different from values of patients with acute disease (p = 0.037).(ABSTRACT TRUNCATED AT 250 WORDS)

C57BL/6 inbred strain mice were instilled intranasally with 150 μg/day of the actinomycete Faeni rectivirgula three days a week as a model of farmer's lung disease. Instilled mice developed a strong alveolitis manifested by a large increase in the number of cells in the bronchoalveolar lavage (BAL) (4.1 x 104cells in saline controls versus 5.28x 105cells in F rectivirgula-instilled mice). This influx was associated with a substantial release of pro-inflanm1atory cytokine in the BAL; 170 U/mL of interleukin (IL)-1 in instilled mice whereas saline instilled mice had undetectable levels of cytokines in the BAL. In addition, pulmonary fibrosis was evident in challenged mice at three weeks (twofold increase in lung hydroxyproline levels). Infusion of a rabbit antimouse tumour necrosis factor-alpha was associated with an almost complete abrogation of all markers of the disease. Also, administration of cyclosporine A (50 mg/kg/day) partially prevented the alveolitis (P