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United States of America demographic profiles illustrate a nation rich in cultural and racial diversity. Approximately 29% of the population are minorities and demographic projections indicate an increase to 50% by the year 2050. This creates a highly mobile and constantly changing environment, revealing the need for new levels of cultural awareness and sensitivity. These issues are particularly critical in the medical community where medical professionals must understand the impact cultural differences and barriers can have on evaluation, treatment, and rehabilitation. During times of stress, such as when injury strikes, problems associated with lack of cultural sensitivity are intensified. Cultural diversity is of particular concern when standard measures for diagnosis and prognosis are derived from established norms for responding, because culture defines norms. This paper details a ten point checklist designed to facilitate cultural awareness and sensitivity in medical settings to ensure maximum successful recovery and outcomes for all patients.

A 20-year-old female, alias Sara, was an aspiring professional oboist who studied music performance at college level. While wading across a river she lost her balance, was swept down river, and suffered profound injuries including severe hypothermia, cardiac arrest, and hypoxic brain injury. While recovering, her family and friends surrounded Sara with music. Her oboe teacher placed Sara's oboe in her hand and played tapes of Sara's past performances. Her mother played recordings of her favourite music in hopes that the music would remind her of her life's passion and, thus, stimulate her mind and soul while she recovered. Two years post-injury, Sara continues to strive to improve her quality of life. In this case study, Sara's musical and medical recovery is detailed using quantitative and qualitative data. This data gathered allows one to provide an analysis of the powerful role of music in Sara's fight to recover.

It is widely recognized that sleep disorders (SD) are highly prevalent, despite being under diagnosed and under treated in practice. SDs occurs at all ages, although presentation and subsequent consequences for an individual's health varies throughout the lifespan. Currently, evaluation of SDs are inadequate across all age ranges, and for both sexes, as they are compromised by under reporting and relying on self-report, rather than professional sleep studies (i.e., nocturnal polysomnography (NPS) and multiple sleep latency tests (MSLT)). Moreover, there is a paucity of data specific to the elderly; many older individuals report dissatisfaction with quality of sleep. Indeed, literature has shown that geriatric populations spend less time in slow-wave sleep and rapid eye movement (REM) sleep and have more difficulties maintaining sleep. Their dissatisfaction may occur from changes in sleep architecture associated with the aging process; however, it has been suggested that it largely stems from comorbid illness, social problems, hormonal effects, altered circadian rhythms, or side effects of medications that are common in the elderly. Further, geriatric sleep is related to depression, impaired health and functioning, and weaker/ less synchronized circadian rhythms. In response, we utilized a 111-item questionnaire in conjunction with NPS, MSLT, the Epworth Sleepiness Scale (ESS) and medical chart reviews of individuals referred for SD evaluation to compare sleep in geriatrics with adults. Analysis revealed numerous differences between adult and geriatric groups, with the elderly experiencing more SDs, longer sleep latencies, and fewer sleep complaints. Based on the outcomes of this investigation, we posit further consideration to SDs across the age groups to achieve the best health care and quality of life for all.

The effects of emotional mood states on remembering scenes along a route of travel were examined in two experiments. For Experiment 1, 48 participants were exposed to a route of travel following a sad, happy, or neutral mood-induction procedure. Process dissociation (Jacoby, 1991) was used to derive separate estimates of the relative roles of conscious recollection and sense of familiarity (unconscious retrieval) in recognizing scenes. Conscious recollection, but not familiarity, was adversely affected by being in an emotional mood state during exposure. For Experiment 2, 24 participants given neutral mood induction were divided according to self-reports of induced mood. Participants in the sad mood group selected more old frames such as "looking sad" in a later test of implicit memory (unconscious retrieval) than did those in the happy mood group. These results reinforced that researchers must address diverse memory processes to understand the role of emotional mood states in spatial cognition.

Individually, sleep disturbances and type 2 diabetes pose pervasive challenges to health. In addition, the negative symptomology associated with each condition is exacerbated further when presenting concomitantly. This relationship formulates a destructive loop wherein those with diabetes experience decreased sleep quality, which, in turn, worsens a wide range of health threats experienced by those with diabetes, including obesity and glucose intolerance. Because major lifestyle changes and daily care are needed to effectively manage both diabetes and sleep disturbances, an efficient and timely modality of treatment is essential. Advanced technology incorporating telemedicine and telehealth has the potential to enhance treatment by delivering accepted standard of care, medical monitoring, and education quickly and seamlessly—even in rural locations. This type of intervention has the added potential benefit of fostering patient empowerment.

The training available to perioperative nurses in rural areas is often inefficient and can be difficult to access. We designed a distance training programme using educational material from the Association of Perioperative Registered Nurses (AORN). Over a six-year period, we compared the performance of 22 nurses undertaking the programme via telemedicine with that of 13 nurses undertaking it conventionally, in person. The telemedicine nurses were based at six rural hospitals and interacted with their preceptors via remotely controlled videoconferencing systems. There was no significant difference in the time taken to complete the programme: 118 days in the telemedicine group and 84 days in the in-person group. There were no significant differences between groups in the AORN module scores. The average AORN final examination score was 88% for the telemedicine group and 91% for the in-person group. The scores from skills assessed were not significantly different between groups. The majority of students in the in-person and telemedicine groups considered that the programme was a success (92% and 91% respectively). The study suggests that telemedicine merits serious consideration for training in perioperative nursing specifically, and probably more generally in the nursing field.

We conducted three experiments to explore distinct memory processes involved in remembering places in spatial environments. The results of all three experiments demonstrated the viability of the process-dissociation procedure for studying spatial cognition ; that procedure yielded separate measures of the role of familiarity (implicit memory) and conscious recollection (explicit memory) in recognizing scenes along a previously viewed route of travel. Those measures were not affected by whether the participants viewed videotapes or also physically walked the route of travel. Increasing the delay between encoding and retrieval led to comparable effects for familiarity and conscious recollection (Experiment 1). In contrast, the adverse consequences of dividing attention during encoding were specific to conscious recollection ; familiarity estimates were unaffected (Experiments 2 and 3). Overall, the results reinforced the viability of process dissociation as a vehicle for exploring diverse memory processes underlying place recognition.

The authors explored gender differences by examining 2 distinct memory processes involved in recognizing pictures that were scenes captured from videotapes. For Study 1, the authors used a process dissociation procedure ( L. J. Anooshian & P. S. Seibert, 1995; L. L. Jacoby, 1991) to obtain separate estimates of the contributions of recollection ( conscious retrieval ) and sense of familiarity ( unconscious retrieval) in recognizing scenes along previously viewed routes of travel. Women obtained higher familiarity scores than did men, whereas no gender difference emerged for conscious recollection. In Study 2, the authors tested both preschool children and adults and found results similar to those in Study I for a task with pictures captured from children's cartoons, regardless of age. The results from these studies illustrate the need for greater attention to diverse memory processes when investigating individual differences, including gender differences, in diverse task domains.

Two experiments based upon the Reicher task were conducted to investigate the influence of happy, sad, and neutral moods on the processing of positive, negative, and neutral words. In Experiment 1 participants showed least advantage in determining which of two one-letter-different words, in comparison with nonword controls, had been presented for words that were valenced in congruence with the induced mood. In Experiment 2 mood acted as a prime that produced a detrimental effect of presenting nontarget mood-congruent preview words on participants' performance on the valenced targets. The authors contend that these effects are related to mood's altering of the baseline activation levels of congruently valenced word nodes in the mental lexicon as well as to mood's narrowing of the spatial focus of attention.

Spasticity is characterized by velocity-dependent increase in tonic stretch reflexes and tendon jerks. Many people affected by spasticity receive late treatment, or no treatment, which greatly reduces the potential to regain full motor control and restore function. There is much to consider before determining treatment for people with spasticity. Treatment of pedi- atric patients increases the complexity, because of the substantial difference between adult and pediatric spasticity. Proper patient evaluation, utilization of scales and measures, and obtaining patient and caregiver history is vital in determining optimal spasticity treatment. Further, taking into consideration the limitations and desires of individuals serve as a guide to best management. We have grouped contributing factors into the IDAHO Criteria to elucidate a multidisciplinary approach, which considers a person's complete field of experience. This model is applied to goal setting, and recognizes the importance of a spasticity management team, comprising the treatment subject, his/her family, the environment, and a supportive, well-informed medical staff. The criteria take into account the complexity associated with diagnosing and treating spasticity, with the ultimate goal of improved function.

First graders, fifth graders, university students, and older adults drew sketch maps of familiar environments. Not until after the sketch maps were collected did subjects have any idea that the study had anything to do with expression of preferences. At that time, subjects were asked to identify (recall) objects located in the environment drawn that they liked most, disliked most, and about which they felt neutral These items were compared with other items on the sketch maps to determine whether they were drawn on the same scale, were emphasized, or were absent. A similar pattern of results was found across age groups; most of the subjects did not draw items they disliked on their sketch maps. These results suggested a dissociation between indirect (map drawing) and direct (specific recall) approaches to expressing preferences.

In two experiments, we investigated the relationship shared by irrelevant thoughts, emotional mood states, and cognitive task performance. At an empirical level, irrelevant thoughts were defined as thoughts that did not facilitate successful task performance. We used the same general procedure for both experiments: three groups of college students received happy-, neutral-(control), or sad-mood inductions and performed a memory task. The procedure for obtaining thoughts varied between experiments. The subjects in Experiment 1 listed their thoughts after the memory recall task. In Experiment 2, the subjects were tape-recorded while performing a memory task and producing concurrent verbal protocols. The subjects in both experiments then judged their thoughts in terms of frequency, intensity, and irrelevance. We found a similar pattern of results in both experiments: (1) The proportions of irrelevant thoughts and recall performance were negatively related, and (2) happy and sad students produced reliably greater proportions of irrelevant thoughts than did neutral (control) students.

We describe a brief, convenient, and effective procedure for experimentally inducing mood states in the laboratory that are especially useful in the study of cognition and emotion. The procedure is like that of Velten’s (1968) in that a verbal self-instructional procedure is used to induce a temporary mood state. It differs from Velten’s in that the mood induction items contain current language usage familiar to typical college undergraduates, contain no reference to potential cognitive processing deficits or strategies that may either interfere with or facilitate performance on some criterion cognitive task, contain no reference to suicidal or somatic states, and is briefer than Velten’s procedure in that only 25, rather than 60, items are employed. Validation of the mood induction procedure demonstrated that the induction procedures were effective, as assessed by a depression adjective checklist (DACL), and that the induction of both sad and happy moods produced poorer recall than did a neutral mood control.

Using a thought-listing procedure, we investigated the kinds of thoughts experienced by individuals who have undergone experimental mood induction. The results of Experiment 1, in which neutral- and depressed-mood-induction groups were compared, showed that individuals who had received a depressed-mood induction rated significantly more of their thoughts as unfavorable. In Experiment 2, subjects were required to engage in a cognitive task before the thought-listing procedure; the experiment included an elated-mood-induction group, as well as neutral and depressed groups. Although effects were in the expected direction, no reliable differences were found among the three groups in the proportion of unfavorable thoughts listed.

An estimated 5 million Americans have congestive heart failure (CHF) and one in five over the age of 40 will develop CHF. There are numerous examples of CHF patients living beyond the years normally expected for people with the disease, usually attributed to taking an active role in disease management. A relatively new alternative for CHF outpatient care is telemedicine and e-health. We investigated the effects of a 6-week in-home telemedicine education and monitoring program for those with systolic dysfunction on the utilization of health care resources. We also measured the effects of the unit 4.5 months after its removal (a total of 6 months post introduction of the unit into the home). Concurrently, we assessed participants' perceptions of the value of having a telemedicine unit. Participants in the telemedicine group reported weighing more times a week with less variability than did the control group. Telemedicine led to a reduction in physician and emergency department visits and those in the experimental group reported the unit facilitating self-care, though this was not significantly different from the control group (possibly due to small sample size). These findings suggest a possibility for improvement in control of CHF when telemedicine is implemented. Our review of the literature also supports the role of telemedicine in facilitating home health care and self-management for CHF patients. There are many challenges still to be addressed before this potential can be reached and further research is needed to identify opportunities in telemedicine.

Over one-third of adults are at risk of developing sleep disorders. Telemedicine is emerging as an effective tool in sleep medicine by allowing people to undergo sleep studies without overnight hospital stays (e.g. monitoring at home). Telemedicine has the potential to overcome several obstacles in the diagnosis and treatment of sleep disorders by offering increased access to sleep specialists, enhancing health-care support for patients in their homes and providing cost-effective professional education. The initial costs for telemedicine equipment and training are not insignificant; however, the benefits may outweigh the expense over time. However, recapturing the initial costs cannot be assumed.

Our purpose is to describe a case of atlanto-occipital dislocation and discuss treatment approaches to minimize subsequent neurological deficits. Traumatic atlanto-occipital dislocation, has traditionally been considered rare and lethal, due to resulting high levels of spinal cord injury. Outcomes are generally expected to be poor. However, recent case reports indicate that survival is increasing. Of patients who survive cranio-cervical dislocation, many endure resulting neurological deficits. We present a rare case of a 23-year-old male, who sustained an atlanto-occipital dislocation in a motor vehicle accident. The patient presented with a Glasgow Coma Scale (GCS) of 11T. Lateral C-spine x-ray and thin-section slices CT delineated a C1 ring fracture on the left side with approximately 1 cm anterior and superior subluxation of the occipital condyles of the cranium in reference to C1. The patient was completely awake, alert, and was following commands. The patient underwent a cranio-cervical stabilization from occiput to C3, using lateral mas screws (C1–C3) and transarticular screws (C2–C3). The Vertex (Medtronics) system used included longitudinal bars connected to the lateral mas plating system, which was subsequently used to place screws within the keel of the occipital bone. Motor strength and sensation remained intact following surgery. One-week post-operation, the patient was ambulating 140 feet, conversationally appropriate, and had a GCS of 15. This case illustrates the possibility for neurosurgical intervention of cranio-cervical dislocations to achieve optimal outcome and demonstrates that survival from this injury is not only conceivable, but recovery of function is also possible.

The objectives of this investigation were to (1) identify elements that comprise an acceptable quality of life (Q-L) post-traumatic brain injury (TBI) from the perspectives of patients and families, and (2) explore patient and family satisfaction with treatment decisions relevant to QoL. The authors created, tested, and administered two forms (patient; family) of a 35-question interview to 33 participants in a longitudinal TBI study (14 women, 19 men) and 33 associated family members. Men associated ratings of QoL with numerous variables, while women's responses revealed no significant relationships shared by QoL and other variables. Women reported a poorer QoL than did men. Older patients reported a better QoL than did younger patients. Families emphasized the family relationship, emotional control, and ability to concentrate when considering overall QoL. Patients did not. The majority of patients and families expressed satisfaction with decisions made about acute treatment. QoL research is essential to illuminate best practice models.