Passive Range of Motion for Conservative Management of Brachial Plexus Birth Injury: A Survey of Expert Therapists.

Brachial plexus birth injury (BPBI) occurs in almost 1/1000 live births potentially resulting in lifelong upper extremity weakness and joint contracture. Early referral and initiation of passive range of motion (PROM) are recommended but there is no standard of care to guide treatment. A descriptive survey study design was used to target occupational and physical therapists who work in brachial plexus clinics to identify current practices for early therapeutic intervention. With 26 respondents, therapists recommend initiating PROM by 4 wks of life performed at every diaper change. Seventy-four percent of therapists report differences in outcomes for children whose caregivers are more adherent, however, there was no significant relationship between frequency of PROM and outcomes. More outcome research is needed to identify an optimal frequency and duration, examine the efficacy of methods for parent education, and identify training methods to facilitate adherence.

Engaging military couples in marital research: does requesting referrals from service members to recruit their spouses introduce sample bias?

BACKGROUND: While enrolling dyads in research studies is not uncommon, there is limited literature on the utility of different recruitment strategies and the resulting selection biases. This paper examined two recruitment strategies used to enroll military couples in a longitudinal study, assessing the impact of both strategies on the representativeness of the final study sample. METHOD: Descriptive and bivariate analyses were conducted to 1) identify characteristics associated with spouse referral, 2) compare response rates based on recruitment strategy and assess whether recruitment strategy modified correlates of response propensity among spouses, and 3) assess whether referred spouse characteristics differed from non-referred spouses in the final sample. The study sample consisted of married US service members with 2-5 years of military service as of October 2011 and their spouses. RESULTS: Service members who referred their spouses to participate in the Millennium Cohort Family Study were more likely to be male, have children, serve in the Army, and have combat deployment experience than those who did not refer their spouse. Nearly two-thirds (n = 5331, 64.9%) of referred spouses participated in the Family Study, compared with less than one-third (n = 3458, 29.5%) of directly contacted spouses. Spouse characteristics also differed significantly between recruitment groups. CONCLUSIONS: Overall results suggest that minimal bias was introduced by using a referral recruitment methodology. Service members appeared to be more likely to refer their spouses if they perceived the research topic as relevant to their spouse, such that male service members with combat deployment experience were more likely to refer female spouses caring for multiple children. Referred spouses were significantly more likely to respond to the Millennium Cohort Family Study survey than those who were directly contacted; however, the overall success rate of using a referral strategy was less than recruiting spouses through direct contact. Differences between referred spouses and spouses contacted directly mirrored service member referring characteristics.

Reliability of Hip Rotation Range of Motion in Supine and Seated Positions.

CONTEXT: Hip rotation range of motion (ROM) is commonly assessed in individuals with lower extremity or spine pathology. It remains unknown which hip rotation ROM testing position is most reliable. OBJECTIVE: To compare interrater and intrarater reliabilities between hip internal rotation (IR) and external rotation (ER) ROM in supine and seated positions. STUDY DESIGN: Controlled laboratory study. SETTING: University research laboratory. PARTICIPANTS: A total of 19 participants (11 females and 8 males; age = 23.5 [1.2] y; height = 173.2 [8.6] cm; and mass = 69.2 [13.4] kg) without hip, knee, low back, or sacroiliac pain within the preceding 3 months or history of hip or low back surgery were recruited. INTERVENTIONS: Three testers obtained measures during 2 testing sessions. Passive supine and seated hip IR and ER ROM were performed with the hip and knee flexed to 90°. MAIN OUTCOME MEASURES: The primary outcome measures were hip IR and ER ROM in supine and seated positions (in degrees). Interrater and intrarater reliabilities were calculated using intraclass correlation coefficients (ICCs). Minimal detectable change was calculated. Differences between supine and seated hip IR and ER ROM values were assessed using paired t tests (significance level was .05). RESULTS: Supine hip IR and ER ROM interrater and intrarater reliabilities were excellent (ICC = .75-.91). Seated hip IR ROM interrater and intrarater reliabilities were good (ICC = .64-.71). Seated hip ER ROM interrater reliability was good (ICC = .65), and intrarater reliabilities were good to excellent (ICC = .65-.82). Minimal detectable change values for supine and seated hip IR and ER ROM ranged from 6.1° to 8.6°. There were significant differences between supine and seated positions for hip IR and ER ROM (41.6° vs 44.5°; P < .01 and 53.0° vs 44.2°; P < .01, respectively). CONCLUSION: Supine hip rotation had higher interrater and intrarater reliabilities. Hip IR and ER ROM values differed significantly between supine and seated positions and should not be used interchangeably.

¡Venga Y Relájese! Pilot Stress Reduction Program for Migrant Latina Women Living in Low-Resource Settings From Milwaukee to Lima.

Latina women living in low-income communities frequently report a high prevalence of feeling physically and/or emotionally "unwell." Formative focus groups were used to design a 3-session stress reduction curriculum called ¡Venga y Relájese! (Come and relax yourself!). Survey data from 5 Milwaukee cohorts and 1 Peruvian cohort revealed statistically significant improvements in general health status, perceived stress status, and confidence to manage future stress among women who completed all sessions (n=54). The pilot ¡Venga y Relájese! stress reduction curriculum yielded benefits for Latina women living in low-income neighborhoods in Milwaukee, Wisconsin and Lima, Peru.

Factors Associated with Cigarette Smoking in Homeless Adults: Findings From an Outpatient Counseling Clinic.

BACKGROUND: Those who are homeless are 4 times more likely to smoke cigarettes than the general population in the United States. Though research has investigated smoking risk factors among homeless individuals, further investigation is needed to understand factors that can be addressed by smoking cessation programs. This study seeks to understand characteristics associated with cigarette use in clients of the counseling clinic at a Midwest homeless shelter, including whether homeless individuals who smoke demonstrate lower self-efficacy, greater social isolation, poorer perception of therapy, and greater levels of chronic homelessness than nonsmokers. METHODS: From 2014 through 2019, clients of the counseling clinic were invited to contribute to a data bank. Logistic regression was performed to determine predictors of smoking status. RESULTS: No association was identified between smoking status and self-efficacy, social isolation, perception of therapy, or chronic homelessness. Compared to those without a high school degree, odds of being a smoker were 95% lower for those with a high school degree or equivalent and 93% lower for those with more than a high school education. Those with 3 or more episodes of prior substance abuse treatment were more likely to be smokers. CONCLUSION: This study demonstrates that cigarette use among the homeless population is associated with low education level and prior substance abuse treatment. Smoking cessation programs would benefit from tailoring information to the education level of their audience. Further study could determine whether use of other substances may contribute to cigarette use in the homeless population and how this may be addressed by smoking cessation programs.

Reactive Astrocytes Derived From Human Induced Pluripotent Stem Cells Suppress Oligodendrocyte Precursor Cell Differentiation.

Astrocytes are instrumental in maintaining central nervous system (CNS) homeostasis and responding to injury. A major limitation of studying neurodegenerative diseases like multiple sclerosis (MS) is lack of human pathological specimens obtained during the acute stages, thereby relegating research to post-mortem specimens obtained years after the initiation of pathology. Rodent reactive astrocytes have been shown to be cytotoxic to neurons and oligodendrocytes but may differ from human cells, especially in diseases with genetic susceptibility. Herein, we purified human CD49f+ astrocytes from induced pluripotent stem cells derived from individual patient and control peripheral leukocytes. We compared TNF and IL1α stimulated human reactive astrocytes from seven persons with MS and six non-MS controls and show their transcriptomes are remarkably similar to those described in rodents. The functional effect of astrocyte conditioned media (ACM) was examined in a human oligodendrocyte precursor cell (OPC) line differentiation assay. ACM was not cytotoxic to the OPCs but robustly inhibited the myelin basic protein (MBP) reporter. No differences were seen between MS and control stimulated astrocytes at either the transcript level or in ACM mediated OPC suppression assays. We next used RNAseq to interrogate differentially expressed genes in the OPC lines that had suppressed differentiation from the human ACM. Remarkably, not only was OPC differentiation and myelin gene expression suppressed, but we observed induction of several immune pathways in OPCs exposed to the ACM. These data support the notion that reactive astrocytes can inhibit OPC differentiation thereby limiting their remyelination capacity, and that OPCs take on an immune profile in the context of inflammatory cues.

Integrating deep learning and unbiased automated high-content screening to identify complex disease signatures in human fibroblasts.

Drug discovery for diseases such as Parkinson's disease are impeded by the lack of screenable cellular phenotypes. We present an unbiased phenotypic profiling platform that combines automated cell culture, high-content imaging, Cell Painting, and deep learning. We applied this platform to primary fibroblasts from 91 Parkinson's disease patients and matched healthy controls, creating the largest publicly available Cell Painting image dataset to date at 48 terabytes. We use fixed weights from a convolutional deep neural network trained on ImageNet to generate deep embeddings from each image and train machine learning models to detect morphological disease phenotypes. Our platform's robustness and sensitivity allow the detection of individual-specific variation with high fidelity across batches and plate layouts. Lastly, our models confidently separate LRRK2 and sporadic Parkinson's disease lines from healthy controls (receiver operating characteristic area under curve 0.79 (0.08 standard deviation)), supporting the capacity of this platform for complex disease modeling and drug screening applications.

Wnt regulation: exploring Axin-Disheveled interactions and defining mechanisms by which the SCF E3 ubiquitin ligase is recruited to the destruction complex.

Wnt signaling plays key roles in embryonic development and adult stem cell homeostasis and is altered in human cancer. Signaling is turned on and off by regulating stability of the effector ß-catenin (ß-cat). The multiprotein destruction complex binds and phosphorylates ß-cat and transfers it to the SCF-TrCP E3-ubiquitin ligase for ubiquitination and destruction. Wnt signals act though Dishevelled to turn down the destruction complex, stabilizing ß-cat. Recent work clarified underlying mechanisms, but important questions remain. We explore ß-cat transfer from the destruction complex to the E3 ligase, and test models suggesting Dishevelled and APC2 compete for association with Axin. We find that Slimb/TrCP is a dynamic component of the destruction complex biomolecular condensate, while other E3 proteins are not. Recruitment requires Axin and not APC, and Axin's RGS domain plays an important role. We find that elevating Dishevelled levels in Drosophila embryos has paradoxical effects, promoting the ability of limiting levels of Axin to turn off Wnt signaling. When we elevate Dishevelled levels, it forms its own cytoplasmic puncta, but these do not recruit Axin. Superresolution imaging in mammalian cells raises the possibility that this may result by promoting Dishevelled:Dishevelled interactions at the expense of Dishevelled: Axin interactions when Dishevelled levels are high.

Smoking and drinking behaviors of military spouses: Findings from the Millennium Cohort Family Study.

INTRODUCTION: The associations between stressful military experiences and tobacco use and alcohol misuse among Service members are well documented. However, little is known about whether stressful military experiences are associated with tobacco use and alcohol misuse among military spouses. METHODS: Using 9872 Service member-spouse dyads enrolled in the Millennium Cohort Family Study, we employed logistic regression to estimate the odds of self-reported cigarette smoking, risky drinking, and problem drinking among spouses by Service member deployment status, communication regarding deployment, and stress associated with military-related experiences, while adjusting for demographic, mental health, military experiences, and Service member military characteristics. RESULTS: Current cigarette smoking, risky drinking, and problem drinking were reported by 17.2%, 36.3%, and 7.3% of military spouses, respectively. Current deployment was not found to be associated with spousal smoking or drinking behaviors. Communication about deployment experiences with spouses was associated with lower odds of smoking, but not with risky or problem drinking. Spouses bothered by communicated deployment experiences and those who reported feeling very stressed by a combat-related deployment or duty assignment had consistently higher odds of both risky and problem drinking. CONCLUSIONS: Our findings suggest that contextual characteristics about the deployment experience, as well as the perceived stress of those experiences, may be more impactful than the simple fact of Service member deployment itself. These results suggest that considering the impact of deployment experiences on military spouses reveals important dimensions of military community adaptation and risk.

THE RELIABILITY OF FABER TEST HIP RANGE OF MOTION MEASUREMENTS.

BACKGROUND: The Flexion ABduction External Rotation (FABER) test is typically used as a provocation special test, but has also been used as a measurement of combined hip range of motion (ROM). It is thought that limited ROM with this measurement may be indicative of hip pathology. To date, normative data, reliability, and minimal detectable change (MDC) of such measurements have not been established. PURPOSE: To determine normative FABER height, assess inter- and intra-rater reliability and MDC for FABER, and compare traditional FABER measurements to methods which account for differences in thigh length. STUDY DESIGN: Descriptive laboratory reliability study. METHODS: Nineteen healthy participants without low back, hip, or knee pain in the preceding three months were recruited. Measurements were performed during two sessions (three to seven days between sessions) by three clinicians. FABER height and thigh length measurements were performed. Thigh length normalized FABER range of motion (ROM) and side-to-side FABER ROM symmetry were calculated. One tester also measured FABER with a digital inclinometer. Inter- and intra-rater reliability were calculated using interclass correlation coefficients (ICC) and mean MDC values were calculated. RESULTS: Mean values for FABER height and normalized FABER ROM were 12.4 ± 2.8 cm and 0.30 ± 0.07, respectively. Inter-rater reliability for FABER and normalized FABER were good (ICC 0.67-0.68) and between session intra-rater reliability were good to excellent (ICC 0.76-0.86). Mean FABER and normalized FABER ROM MDC were 3.7 cm and 0.04, respectively. Mean FABER ROM symmetry was 2.0 ± 0.9 cm with poor inter-rater reliability (ICC 0.20), poor to good intra-rater reliability (ICC 0.38-0.66), and mean MDC of 4.0 cm. FABER measured with a ruler, normalized FABER ROM, and inclinometry all resulted in excellent intra-rater reliability, with the highest ICC being demonstrated for inclinometry (ICC 0.86, 0.86, and 0.91). CONCLUSIONS: Overall, FABER measurements were reliable, whether normalized to thigh length or not. Furthermore, use of inclinometry may increase reliability. Reliability was poor to good when assessing symmetry between limbs. LEVEL OF EVIDENCE: Level 3.

Demographic and Psychosocial Predictors of Early Attrition for Drug Use in U.S. Marines.

OBJECTIVE: The objective of this study was to determine demographic and psychosocial predictors of early attrition for drug use in a cohort of U.S. Marines and the resulting lost person-days. METHOD: The study included data from 35,193 male Marines who completed a life history questionnaire during their first week of basic training. Associations between demographic and psychosocial variables with subsequent discharge for drug use were analyzed using logistic regression. RESULTS: The strongest predictors of early attrition because of drug use were being a smoker, African American race, moving around often as a child, not having a high school diploma, joining the military to leave problems behind, and having a prior arrest record. The results also indicate that approximately 3.1 million person-days were lost in this cohort because of early discharge for drug abuse. CONCLUSIONS: Despite effective policies that prohibit drug use, these findings suggest that a significant loss in manpower and training costs still occurs because of early attrition for drug use. Postenlistment interventions for those recruits at higher risk for drug abuse may help to reduce this attrition.