Arterial stiffness and carotid distensibility following acute formaldehyde exposure in female adults.

Formaldehyde (FA) is a ubiquitous organic preservative used in several industries and represents an occupational health hazard. Short-term exposure to FA can increase oxidative stress and cause a decrease in conduit vessel function. These decrements in vascular function may extend to the arterial architecture, predisposing individuals to increased risk of cardiovascular disease. The purpose of this study was to investigate the impact of an acute 90-minute FA exposure period (259 ± 95 ppb) on indices of arterial architecture. Arterial stiffness and carotid distensibility as determined by central pressures, augmentation index (AIx), and carotid-femoral pulse wave velocity (cfPWV) (n=13F, 24 ± 1 year) as well as carotid stiffness and intima media thickness (IMT) (n = 9F, 23 ± 1 year) were assessed prior to (Pre-FA) and immediately following (Post-FA) exposure to FA in human cadaver dissection laboratories. Central pressures and cfPWV (Pre-FA: 5.2 ± 0.8 m.s-1, Post-FA: 5.2 ± 1.1 m s-1) were unchanged by acute FA exposure (p > 0.05). Carotid stiffness parameters and distension were unchanged by acute FA exposure (p > 0.05), although distensibility (Pre-FA: 33.9 ± 10.5[10-3*kPa-1], Post-FA: 25.9 ± 5.5[10-3*kPa-1], p < 0.05), and IMT (Pre-FA: 0.42 ± 0.05 mm, Post-FA: 0.51 ± 0.11 mm, p < 0.05) decreased and increased, respectively. Individual Pre- to Post-FA changes in these markers of arterial architecture did not correlate with levels of FA exposure ([FA]: 20-473 ppb) (p > 0.05). Our group previously found vascular function decrements following acute FA exposure in human cadaver laboratories; here we found that carotid distensibility and intima media thickness are altered following FA exposure.

Regarding the Dead: A Model for Anatomical Gifting Outside the Traditional Medical School Setting.

In 2017, Elon University became one of very few universities in the United States without a medical school to have an in-house Anatomical Gift Program (AGP). The program accepts first-person-consenting individuals only and within 2.5 years has become self-sufficient, supporting anatomy curricular needs of its physical therapy, physician assistant, and undergraduate biology and anthropology programs (n = 21 donors annually). This paper describes the timeline, costs, and benefits of developing an in-house AGP at a university without a medical school. Policy development, public outreach, equipment needs, and cost benefits are discussed. Within 2.5 years of program opening, the AGP Director delivered 161 educational outreach presentations at 86 different venues across the state providing information on anatomical gifting. The program registered 320 individuals (60% female, 40% male) and enrolled 41 deceased donors (69% female, 31% male; average age of 74.6 at time of registration and 74.8 at donation). During the first seven months of the program, donor preparation costs (with outsourcing for transport/donor preparation/document filing/serology testing/cremation) averaged US$ 2,100 per donor. Over the past 23 months, donor preparation has been completed on site, lowering the cost per donor to US$ 1,260. Other costs include personnel salaries, legal fees, and outfitting of the anatomy laboratory and preparatory room. Program benefits include support of anatomy education on campus, assurance that all donors have given first-person consent, and faculty/student access to donor-determined health, social, and occupational information. Faculty, staff, and students contribute to the daily operations of the AGP.

Vascular dysfunction and oxidative stress caused by acute formaldehyde exposure in female adults.

Formaldehyde (FA) is a common, volatile organic compound used in organic preservation with known health effects of eye, nose, and throat irritation linked to oxidative stress and inflammation. Indeed, long-term FA exposure may provoke skin disorders, cancer, and cardiovascular disease. However, the effects of short-term FA exposure on the vasculature have yet to be investigated. We sought to investigate the impact of an acute FA exposure on 1) macrovascular function in the arm (brachial artery flow-mediated dilation, FMD), 2) microvascular function in the arm (brachial artery reactive hyperemia, RH) and leg (common femoral artery, supine passive limb movement, PLM), and 3) circulating markers of oxidative stress (xanthine oxidase, XO; protein carbonyl, PC; and malondialdehyde, MDA) and inflammation (C-reactive protein, CRP). Ten (n = 10) healthy females (23 ± 1 yr) were studied before and immediately after a 90-min FA exposure [(FA): 197 ± 79 ppb] in cadaver dissection laboratories. Brachial artery FMD% decreased following FA exposure (Pre-FA Exp: 9.41 ± 4.21%, Post-FA Exp: 6.74 ± 2.57%; P = 0.043), and FMD/shear decreased following FA exposure (Pre-FA Exp: 0.13 ± 0.07 AU, Post-FA Exp: 0.07 ± 0.03 AU; P = 0.016). The area under the curve for brachial artery RH (Pre-FA Exp: 481 ± 191 ml, Post-FA Exp: 499 ± 165 ml) and common femoral artery PLM (Pre-FA Exp: 139 ± 95 ml, Post-FA Exp: 129 ± 64 ml) were unchanged by FA exposure (P > 0.05). Circulating MDA increased (Pre-FA Exp: 4.8 ± 1.3 µM, Post-FA Exp: 6.3 ± 2.2 µM; P = 0.047) while XO, PC, and CRP were unchanged by FA exposure (P > 0.05). These initial data suggest a short FA exposure can adversely alter vascular function and oxidative stress, influencing cardiovascular health.NEW & NOTEWORTHY This study was the first to investigate the implications of acute formaldehyde (FA) exposure on adult female vascular function in the arms and legs. The main findings of this study were a decrease in conduit vessel function without any alteration to microvascular function following a 90-min FA exposure. Additionally, the oxidative stress marker malondialdehyde increased after FA exposure. Taken together, these results suggest acute FA exposure have deleterious implications for the vasculature and redox balance.Listen to this article's corresponding podcast at https://ajpheart.podbean.com/e/formaldehyde-exposure-decreases-vascular-function/.

Perceptions of ability among adults with upper limb absence: impacts of learning, identity, and community.

Aims: The purpose of this research was to examine the lived experiences of adults with upper limb absence, specifically the interplay of device use, ability, and quality of life through semi-structured interviews. We sought to draw insight from these experiences to improve the practice and perceptions of adults with upper limb absence, prosthetists, and technology designers.Methods: Semi-structured interviews were conducted and interpreted with phenomenological analysis for fourteen individuals with acquired or congenital limb absence. Through an interpretive phenomenological analysis approach, researchers employed an inductive approach to coding and identification of central themes.Results: Participants shared high perceptions of ability and function, regardless of prosthesis or assistive technology use. Life experiences related to three dimensions strongly influenced perceptions of ability: (1) learning to live with upper limb absence, (2) developing their identity, and (3) connecting with their community. The diversity of experiences across participants highlighted the limitations of identifying "normative" pathways of recovery or device use, emphasizing the need for flexible and adaptable systems that can creatively support personal goals and needs.Conclusions: Integration of novel platforms for professional practice, supportive communities, and technology innovation can support the evolving needs and care of individuals with upper limb absence.Implications for rehabilitationIn this study, perceptions of ability were largely independent of prosthetic use and each individual developed a unique toolkit of devices and strategies to support function in daily life.Clinicians can support perceptions of ability by promoting opportunities for community development and life-long learning.Informal communities, such as online networks, can provide novel device designs, resources for learning, and societal awareness to empower individuals with limb absence.

Naming the Dead: What information do Physical Therapy and Physician Assistant Anatomy Faculty Share With Students?

In this novel study, the researchers quantify cadaver information provided to Physical Therapy (PT) and Physician Assistant (PA) anatomy faculty and ask what portion of that information is then shared with students. Descriptive statistics were used to the describe demographics of the study respondents and to report survey responses. The majority (60% or greater) of faculty who teach anatomy to PT and PA students have clinical degrees matching the student groups they teach. Chi-square analysis showed no appreciable difference (P < 0.001) between PT and PA anatomy faculty in the amount of cadaver information they receive or then share with students. There was a difference in the type of cadaver information (identifying vs. non-identifying) that is received and then shared by these faculty. Faculty are more likely to receive non-identifying cadaver information (93%) than identifying information (40%) (P < 0.0001) and share non-identifying information (83%) than identifying information (26%) with students (P < 0.0003). Interestingly, there is no consensus as to whether sharing cadaver information is respectful or disrespectful to those who donate their bodies for anatomy education and research. Further research is warranted into the reasons anatomy faculty withhold cadaver information from students and in the value, if any, for students knowing more about the cadavers they are learning from.

Positive airway pressure for sleep-disordered breathing in acute quadriplegia: a randomised controlled trial.

RATIONALE: Highly prevalent and severe sleep-disordered breathing caused by acute cervical spinal cord injury (quadriplegia) is associated with neurocognitive dysfunction and sleepiness and is likely to impair rehabilitation. OBJECTIVE: To determine whether 3 months of autotitrating CPAP would improve neurocognitive function, sleepiness, quality of life, anxiety and depression more than usual care in acute quadriplegia. METHODS AND MEASUREMENTS: Multinational, randomised controlled trial (11 centres) from July 2009 to October 2015. The primary outcome was neurocognitive (attention and information processing as measure with the Paced Auditory Serial Addition Task). Daytime sleepiness (Karolinska Sleepiness Scale) was a priori identified as the most important secondary outcome. MAIN RESULTS: 1810 incident cases were screened. 332 underwent full, portable polysomnography, 273 of whom had an apnoea hypopnoea index greater than 10. 160 tolerated at least 4 hours of CPAP during a 3-day run-in and were randomised. 149 participants (134 men, age 46±34 years, 81±57 days postinjury) completed the trial. CPAP use averaged 2.9±2.3 hours per night with 21% fully 'adherent' (at least 4 hours use on 5 days per week). Intention-to-treat analyses revealed no significant differences between groups in the Paced Auditory Serial Addition Task (mean improvement of 2.28, 95% CI -7.09 to 11.6; p=0.63). Controlling for premorbid intelligence, age and obstructive sleep apnoea severity (group effect -1.15, 95% CI -10 to 7.7) did not alter this finding. Sleepiness was significantly improved by CPAP on intention-to-treat analysis (mean difference -1.26, 95% CI -2.2 to -0.32; p=0.01). CONCLUSION: CPAP did not improve Paced Auditory Serial Addition Task scores but significantly reduced sleepiness after acute quadriplegia. TRIAL REGISTRATION NUMBER: ACTRN12605000799651.

Quantifying Cadaver Use in Physician Assistant Anatomy Education.

PURPOSE: To quantify the number of cadavers used in physician assistant (PA) anatomy education and to ascertain the origins of those cadavers. METHODS: An electronic survey was generated and distributed to all schools that had been accredited by the Accreditation Review Commission on Education for the Physician Assistant. Responses were reported using descriptive statistics. RESULTS: The survey had a 49% response rate. Among the responding programs, 79% reported working with 655 cadavers, with an average of one cadaver per 5.72 students. Programs reported that 21% receive cadavers from multiple sources. Of all programs using cadavers, 62% receive cadavers from medical schools, 23% from in-house anatomical gift programs, 19% from state anatomy boards, 9% from private organizations, and 8% from other sources. Anatomy educators reported that 55% know the origins of the cadavers in their programs, 18% do not, and 27% are uncertain. In categorizing cadavers at their programs, 56% were reported as registered donors, 4% as next-of-kin donations, 1% as unclaimed dead, 17% as uncertain origin, and 22% as unaccounted for by respondents. CONCLUSIONS: Among educators who teach anatomy to PA students, 45% do not know or are uncertain of the origins of the cadavers in their programs. Of the reported 655 cadavers used in PA education, 289 were not categorized as registered donors. Facing the expansion of PA programs, educators need to be aware of cadavers' origins to ensure that all aspects of PA education are consistent with the ethics that the students are being taught. Those ethics include the need for informed consent for all cadavers involved in PA education.

Design and Real-World Evaluation of Eyes-Free Yoga: An Exergame for Blind and Low-Vision Exercise.

People who are blind or low vision may have a harder time participating in exercise due to inaccessibility or lack of encouragement. To address this, we developed Eyes-Free Yoga using the Microsoft Kinect that acts as a yoga instructor and has personalized auditory feedback based on skeletal tracking. We conducted two different studies on two different versions of Eyes-Free Yoga: (1) a controlled study with 16 people who are blind or low vision to evaluate the feasibility of a proof-of-concept and (2) an 8-week in-home deployment study with 4 people who are blind or low vision, with a fully functioning exergame containing four full workouts and motivational techniques. We found that participants preferred the personalized feedback for yoga postures during the laboratory study. Therefore, the personalized feedback was used as a means to build the core components of the system used in the deployment study and was included in both study conditions. From the deployment study, we found that the participants practiced Yoga consistently throughout the 8-week period (Average hours = 17; Average days of practice = 24), almost reaching the American Heart Association recommended exercise guidelines. On average, motivational techniques increased participant's user experience and their frequency and exercise time. The findings of this work have implications for eyes-free exergame design, including engaging domain experts, piloting with inexperienced users, using musical metaphors, and designing for in-home use cases.

A Multi-Institutional Assessment of Factors Influencing Locomotion and Pacing in Captive Okapis (Okapia johnstoni).

The okapi (Okapia johnstoni), native to the Democratic Republic of Congo, is a large, solitary, and diurnal forest-dwelling ungulate highly sensitive to captive conditions. The captive population demonstrates persistent health problems, reproductive abnormalities, and several potentially abnormal repetitive behaviors. This study reports on locomotion and pacing in adult male and female okapis. Commonly, data on repetitive behavior have been derived from surveys. Although insightful, the results are often highly generalized and provide little information about the true preponderance and nature of such behavior in a population. In this study, direct observations determining how often and when a behavior of interest occurs are paired with information on factors (intrinsic and extrinsic) that can impact a nonhuman animal's propensity to perform repetitive behavior. More than half of the North American okapi population comprised the study population. Each animal was studied for 2 summer and winter seasons. Factors predictive of pacing in both males and females included 3 housing and habitat factors and 4 management factors. Patterns of locomotion and the rate and pattern of pacing in males when compared with females suggested different mechanisms may be driving these behaviors in the different sexes and that a sex-specific management strategy would benefit this species.

Nutritional composition and digestibility by ocelots (Leopardus pardalis) of whole animals and a commercial diet.

Felids are adapted to eat whole prey, but in North American zoos are usually fed processed diets based on muscle meat. We analyzed proximate nutrient composition and digestibility by ocelots of a commercial processed diet and whole animals of five species. The processed diet did not differ significantly from the whole animals in proximate composition, although it was at one end of the range of results for all nutrients. Domestic chicks were significantly lower than all other dietary items tested in digestibility of energy and fat, and lower than rabbits and quail in digestibility of dry matter. There were no other significant differences. These results suggest that the commercial diet tested provides an appropriate nutritional environment for ocelots with respect to proximate constituents. Studies of vitamin and mineral composition and digestibility and comparisons to wild prey species should be conducted to permit a full evaluation.

Improving knowledge about mental illness through family-led education: the journey of hope.

OBJECTIVE: Families often do not receive the information that they need to care for their adult relatives with mental illness. This study examined the effectiveness of a family-led education intervention, the Journey of Hope, in improving participants' knowledge about mental illness and its treatment and decreasing their information needs. METHODS: A total of 462 family members of adults with mental illness in Louisiana participated in the study; 231 were randomly assigned to immediate receipt of the Journey of Hope course (intervention group), and 231 were randomly assigned to a nine-month waiting list for the course (control group). Participants completed in-person, structured interviews assessing their knowledge of mental illness and problem-solving skills and their information needs at study enrollment (baseline), three months postbaseline, and eight months postbaseline. RESULTS: Random regression analyses indicate that at three and eight months postbaseline, compared with participants assigned to the control group, those in the intervention group reported greater knowledge gains (beta=.84, p< or =.01) and fewer needs for information on coping with positive symptoms (beta=-.63, p< or =.05), coping with negative symptoms (beta=-.80, p< or =.001), problem management (beta=-1.00, p< or =.001), basic facts about mental illness and its treatment (beta=-.73, p< or =.01), and community resources (beta=-.07, p< or =.05). These significant differences in knowledge and information needs were maintained over time and were significant even when controlling for participants' demographic characteristics and their relatives' clinical characteristics. CONCLUSIONS: Participation in family-led education interventions, such as the Journey of Hope, may provide families with the information they need to better cope with their relative's mental illness.

Urinary corticosteroid excretion patterns in the okapi (Okapia johnstoni).

Stress is known to alter a variety of biological processes, including behavior and reproduction. It is therefore important to understand the stress levels of animals in captivity, especially those for whom captive breeding is a priority, such as the okapi. Levels of stress hormones can be measured from samples collected noninvasively, such as urine or feces, which are preferable with nondomestic species for whom drawing blood might in itself be a considerable stressor. To understand the excretion of cortisol in urine in the okapi, four (1.3) animals were subject to three injections: saline, 200 IU of an adrenocorticotropic hormone (ACTH) analogue, and 300 IU of the analogue. Their 24-hr urinary corticosteroid levels were compared with 4 baseline days. Injection with the ACTH analogue significantly increased the urinary corticosteroid levels compared with saline injections and baseline. Eight (3.5) okapi were then observed for 24 hr per day for 5 days to determine their normal patterns of corticosteroid production. The mean corticosteroid levels varied significantly by individual. A significant circadian pattern in urinary corticosteroid was apparent independent of individual or gender, with cortisol rising during the daylight hours and decreasing again at night. Zoo Biol 27:381-393, 2008. (c) 2008 Wiley-Liss, Inc.

Psychological well-being and relationship outcomes in a randomized study of family-led education.

CONTEXT: Family members of adults with mental illness often experience emotional distress and strained relationships. OBJECTIVE: To test the effectiveness of a family-led educational intervention, the Journey of Hope, in improving participants' psychological well-being and relationships with their ill relatives. DESIGN AND SETTING: A randomized controlled trial using a waiting list design was conducted in the community in 3 southeastern Louisiana cities. PARTICIPANTS: A total of 462 family members of adults with mental illness participated in the study, with 231 randomly assigned to immediate receipt of the Journey of Hope course and 231 assigned to a 9-month course waiting list. Intervention The Journey of Hope intervention consisted of 8 modules of education on the etiology and treatment of mental illness, problem-solving and communication skills training, and family support. MAIN OUTCOME MEASURES: Participants' psychological well-being and relationships with their ill relatives were assessed at study enrollment, 3 months after enrollment (at course termination), and 8 months after enrollment (6 months after course termination). Mixed-effects random regression analysis was used to predict the likelihood of decreased depressive symptoms, increased vitality, and overall mental health, and improved relationship ratings. RESULTS: Intervention group participants reported fewer depressive symptoms, greater emotional role functioning and vitality, and fewer negative views of their relationships with their ill relatives compared with control group participants. These improved outcomes were maintained over time and were significant (P<.05 for all) even when controlling for participant demographic and relative clinical characteristics. CONCLUSION: Results show that family-led educational interventions are effective in improving participants' psychological well-being and views of their relationships with ill relatives.

Changes in caregiving satisfaction and information needs among relatives of adults with mental illness: results of a randomized evaluation of a family-led education intervention.

The authors examined changes in caregiving satisfaction and information needs among 462 relatives of individuals with mental illness who participated in a study of a family-led education course, the Journey of Hope (JOH). Participants were randomly assigned to receive JOH or to a control group waiting list and followed for 9 months. General linear model repeated measures analysis of variance found that, compared with the control group, the intervention group showed significant improvement in caregiving satisfaction and information needs following course completion and maintained these gains for another 6 months. Education and support from other family members in the form of a structured course is effective in meeting the caregiving needs of relatives of persons with mental illness.

Awareness of genital health in young male athletes.

OBJECTIVE: To assess young male athletes' understanding of the need for a genital examination during the sports physical, their knowledge of signs and symptoms of serious testicular pathology, and the type of genital protection they wear for specific sports. Additionally, to identify common sport-specific genital injuries requiring emergency department treatment. DESIGN: Descriptive survey. SETTING: Station-based mass screening preparticipation physical exams performed in northeastern Ohio. PARTICIPANTS: A total of 755 male athletes at the junior high school, high school, and collegiate levels (age 12-25 years). MAIN OUTCOME MEASUREMENTS: Participants' answers to a 5-question survey. Male genital injury occurring in common contact and collision sports identified from the National Electronic Injury Surveillance System. RESULTS: Fifty percent did not understand why the genital examination is done. Forty-seven percent did not wear genital protection during sports. Most were unaware of the risk of testicular cancer and did not appreciate the difference in urgency of seeking medical treatment of painless versus painful testicular swelling. Approximately 20% of emergency department visits for sports-related genital trauma had a risk of permanent injury, and up to 7% resulted in hospitalization or transfer. CONCLUSIONS: Young male athletes are unaware of testicular pathology that affects their age group, and many do not wear genital protection during sports. Better education of young males regarding genital health and protection is necessary.