An Innovative Faculty Travel Award Program to Support Child, Elder, or Dependent Care.

This study observes how a travel award program that supports child, elder, or dependent care affected university faculty members.

Mechanical compression augments venous flow equal to intermittent pneumatic compression.

Intermittent pneumatic compression is part of the current standard of care model for preventing venous thromboembolic events (VTE) after total joint arthroplasty. Pneumatic motors limit the rate of inflation resulting in bulky devices with uncomfortable sleeves that inhibited patient compliance and mobility. Nonpneumatic mechanical devices are an alternative for providing mobile, graded, intermittent, sequential, rapid, and monitorable compression posthospitalization. Fifteen healthy volunteers underwent mechanical compression using the Cirvo (Radial Medical, Mountain View, CA) as well as pneumatic compression with four commercially available systems (VenaFlow Elite, Kendall SCD Compression System, ActiveCare DVT, Vasculaire Compression System) and manual calf compression. Peak flow velocity (PFV) was measured by ultrasound of the femoral vein during compression and at baseline. Mechanical compression for 1 second resulted in a significant increase in femoral venous PFV to 107.8 ± 38.2 cm/s from 17.1 ± 4.7 cm/s at baseline (P < .001). The change in femoral venous PFV with mechanical compression for 1 second (90.7 ± 34.9 cm/s) was not statistically different from pneumatic compression from VenaFlow system (106.0 ± 35.6 cm/s, P = .124) and statistically lower than manual calf compression (115.5 ± 26.8 cm/s, P = .015). Pneumatic compression from the VenaFlow system produced the largest change in femoral venous PFV of all commercial pneumatic systems tested. Mechanical compression replicates or exceeds femoral venous PFV available from currently available intermittent pneumatic compression.

A pilot study of venous flow augmentation using a novel mechanical graded intermittent sequential compression device for venous insufficiency.

BACKGROUND: Guidelines as well as multiple RTCs support the use of intermittent pneumatic compression (IPC) for the treatment of venous leg ulcers when conservative measures fail. Unfortunately, the clinical usefulness of IPC is significantly limited by the physical limitations of pneumatic motors, which leads to bulky devices with slow inflation cycles, uncomfortable sleeves, lack of patient mobility, and ultimately poor patient compliance with therapy. A novel mechanical device for lower leg graded intermittent sequential compression was designed to address these limitations of IPC therapy for venous leg ulcer treatment by providing rapid compression cycles in a truly wearable device that offers the additional benefit of monitoring compression dose and patient compliance. The wearable intermittent compression (WIC) device was hypothesized to provide improved augmentation of venous flow compared with both baseline and standard IPC therapy. METHODS: Ten patients with Clinical, Etiologic, Anatomic and Pathophysiologic class 3 to 6 venous insufficiency were recruited under institutional review board approval. The primary end point for the study was augmentation of venous blood flow as measured by peak venous velocity. Patients underwent measurement of peak venous velocity in centimeters per second at the popliteal and femoral veins for the following conditions: (1) baseline, (2) WIC device on a low setting, and (3) WIC device on a high setting. In five patients, an additional measurement of peak venous velocity in centimeters per second at the popliteal and femoral veins was completed while wearing a commercially available IPC device. RESULTS: Both low and high settings of the WIC device resulted in higher average peak venous velocities when compared with both baseline and the IPC device (P < .05). No patients reported discomfort with either the WIC device or the IPC device during therapy. CONCLUSIONS: The WIC device significantly increases the augmentation of venous flow as measured by peak venous velocity in both the popliteal and femoral veins in patients with Clinical, Etiologic, Anatomic and Pathophysiologic class 3 to 6 venous insufficiency. In addition, the WIC device was found to be easy to use and comfortable during therapy. Future studies are planned to determine if the WIC improvements in venous flow augmentation and patient compliance will lead to higher rates of venous ulcer healing.

Sexual Harassment in Medical Schools: The Challenge of Covert Retaliation as a Barrier to Reporting.

Although Title IX, the federal law prohibiting sexual harassment in educational institutions, was enacted in 1972, sexual harassment continues to be distressingly common in medical training. In addition, many women who experience sexual harassment do not report their experiences to authorities within the medical school.In this article, the authors review the literature on the prevalence of sexual harassment in medical schools since Title IX was enacted and on the cultural and legal changes that have occurred during that period that have affected behaviors. These changes include decreased tolerance for harassing behavior; increased legal responsibility assigned to institutions; and a significant increase in the number of female medical students, residents, and faculty. The authors then discuss persisting barriers to reporting sexual harassment, including fears of reprisals and retaliation, especially covert retaliation. They define covert retaliation as vindictive comments made by a person accused of sexual harassment about his or her accuser in a confidential setting, such as a grant review, award selection, or search committee.The authors conclude by highlighting institutional and organizational approaches to decreasing sexual harassment and overt retaliation, and they propose other approaches to decreasing covert retaliation. These initiatives include encouraging senior faculty members to intervene and file bystander complaints when they witness inappropriate comments or behaviors as well as group reporting when multiple women are harassed by the same person.

Increased extra-pair paternity in broods of aging males and enhanced recruitment of extra-pair young in a migratory bird.

Despite keen interest in extra-pair mating in birds, its adaptive significance remains unresolved. Here, we use a multi-year dataset to test whether traits of a female's social mate influence her propensity to produce extra-pair offspring in a population of house wrens, and whether producing extra-pair young has consequences for a female's fitness through effects on offspring survival. Females were most likely to produce extra-pair offspring when paired with old males and when paired with males on poor-quality territories, although this latter effect was marginally nonsignificant. Among offspring, the cutaneous immunity of within-pair young decreased as the age of their sires increased, but cutaneous immunity of extra-pair young was not affected by the age of their extra-pair sires or by the age of the males rearing them. Extra-pair offspring were more likely than within-pair offspring to return as breeding adults to the local population, with extra-pair sons being more likely to return as a breeder for multiple years. Our findings support the hypothesis that females produce extra-pair offspring to enhance their inclusive fitness beyond what they are capable of given the male with which they are socially paired.

Neonatal body condition, immune responsiveness, and hematocrit predict longevity in a wild bird population.

Measures of body condition, immune function, and hematological health are widely used in ecological studies of vertebrate populations, predicated on the assumption that these traits are linked to fitness. However, compelling evidence that these traits actually predict long-term survival and reproductive success among individuals in the wild is lacking. Here, we show that body condition (i.e., size-adjusted body mass) and cutaneous immune responsiveness to phytohaemagglutinin (PHA) injection among neonates positively predict recruitment and subsequent longevity in a wild, migratory population of house wrens (Troglodytes aedon). However, neonates with intermediate hematocrit had the highest recruitment and longevity. Neonates with the highest PHA responsiveness and intermediate hematocrit prior to independence eventually produced the most offspring during their lifetime breeding on the study site. Importantly, the effects of PHA responsiveness and hematocrit were revealed while controlling for variation in body condition, sex, and environmental variation. Thus, our data demonstrate that body condition, cutaneous immune responsiveness, and hematocrit as a neonate are associated with individual fitness. Although hematocrit's effect is more complex than traditionally thought, our results suggest a previously underappreciated role for this trait in influencing survival in the wild.

Genetic and environmental variation in condition, cutaneous immunity, and haematocrit in house wrens.

BACKGROUND: Life-history studies of wild bird populations often focus on the relationship between an individual's condition and its capacity to mount an immune response, as measured by a commonly-employed assay of cutaneous immunity, the PHA skin test. In addition, haematocrit, the packed cell volume in relation to total blood volume, is often measured as an indicator of physiological performance. A multi-year study of a wild population of house wrens has recently revealed that those exhibiting the highest condition and strongest PHA responses as nestlings are most likely to be recruited to the breeding population and to breed through two years of age; in contrast, intermediate haematocrit values result in the highest recruitment to the population. Selection theory would predict, therefore, that most of the underlying genetic variation in these traits should be exhausted resulting in low heritability, although such traits may also exhibit low heritability because of increased residual variance. Here, we examine the genetic and environmental variation in condition, cutaneous immunity, and haematocrit using an animal model based on a pedigree of approximately 2,800 house wrens. RESULTS: Environmental effects played a paramount role in shaping the expression of the fitness-related traits measured in this wild population, but two of them, condition and haematocrit, retained significant heritable variation. Condition was also positively correlated with both the PHA response and haematocrit, but in the absence of any significant genetic correlations, it appears that this covariance arises through parallel effects of the environment acting on this suite of traits. CONCLUSIONS: The maintenance of genetic variation in different measures of condition appears to be a pervasive feature of wild bird populations, in contradiction of conventional selection theory. A major challenge in future studies will be to explain how such variation persists in the face of the directional selection acting on condition in house wrens and other species.

Localized control of exsanguinating arterial hemorrhage: an experimental model.

UNLABELLED: To develop an arterial injury model for testing hemostatic devices at well-defined high and low bleeding rates. MATERIAL AND METHOD: A side-hole arterial injury was created in the carotid artery of sheep. Shed blood was collected in a jugular venous reservoir and bleeding rate at the site of arterial injury was controlled by regulating outflow resistance from the venous reservoir. Two models were studied: uncontrolled exsanguinating hemorrhage and bleeding at controlled rates with blood return to maintain hemodynamic stability. Transcutaneous Duplex ultrasound was used to characterize ultrasound signatures at various bleeding rates. RESULTS: A 2.5 mm arterial side-hole resulted in exsanguinating hemorrhage with an initial bleeding rate of 400 ml/min which, without resuscitation, decreased to below 100 ml/min in 5 minutes. After 17 minutes, bleeding from the injury site stopped and the animal had lost 60% of total blood volume. Reinfusion of shed blood maintained normal hemodynamics and both high and low bleeding rates could be maintained without hemorrhagic shock. Bleeding rate at the arterial injury site was held at 395±78 ml/min for 8 minutes, 110±11 ml/min for 15 minutes, and 12±1 ml/min for 12 minutes. Doppler flow signatures at the site of injury were characterized by high peak and end-diastolic flow velocities at the bleeding site which varied with the rate of hemorrhage. CONCLUSION: We have developed a hemodynamically stable model of acute arterial injury which can be used to evaluate diagnostic and treatment methods focused on control of the arterial injury site.

Evidence for heterozygote instability in microsatellite loci in house wrens.

Microsatellite loci have high mutation rates and high levels of allelic variation, but the factors influencing their mutation rate are not well understood. The proposal that heterozygosity may increase mutation rates has profound implications for understanding the evolution of microsatellite loci, but currently has limited empirical support. We examined 20 microsatellite mutations identified in an analysis of 12 260 meiotic events across three loci in two populations of a songbird, the house wren (Troglodytes aedon). We found that for an allele of a given length, mutation was significantly more likely when there was a relatively large difference in size between the allele and its homologue (i.e. a large 'allele span'). Our results support the proposal of heterozygote instability at microsatellite loci.

Language and theory of mind in preschool children with specific language impairment.

UNLABELLED: Language plays a critical role in the development of theory of mind (ToM). There is limited research, however, examining the role of specific components of language in ToM development for typical and clinical populations. The purpose of the current study is to examine the relative contributions of general grammar, grammatical tense markers, syntactic complementation, and receptive vocabulary on understanding standard ToM tasks in preschool children with specific language impairment (SLI). Thirty-four children with language disorders, ages 42-65 months, were administered a series of language and ToM measures. Hierarchical regression analyses were conducted to examine the relative contributions of language subcomponents to ToM task performance. The results indicated that general grammatical development and vocabulary contributed uniquely to ToM reasoning. Sentential complementation abilities did not make an independent contribution. Theoretical and clinical implications of the findings for different accounts of the role of language in ToM reasoning will be discussed. LEARNING OUTCOMES: Readers of the current study will be able to: (1) understand the relationship between language and ToM development in both typical and clinical populations; (2) understand the different ways in which various language components are related to false belief reasoning; and (3) consider the implications for intervening with children with language disorders.

Extra-pair young in house wren broods are more likely to be male than female.

Sex-allocation theory predicts that females should preferentially produce offspring of the sex with greater fitness potential. In socially monogamous animal species, extra-pair mating often increases the variance in fitness of sons relative to daughters. Thus, in situations where offspring sired by a female's extra-pair mate(s) will typically have greater fitness potential than offspring sired by the within-pair mate, sex-allocation theory predicts that females will bias the sex of offspring sired by extra-pair mates towards male. We examined the relationship between offspring sex and paternity over six breeding seasons in an Illinois population of the house wren (Troglodytes aedon), a cavity-nesting songbird. Out of the 2345 nestlings that had both sex and paternity assigned, 350 (15%) were sired by extra-pair males. The sex ratio of extra-pair offspring, 0.534, was significantly greater than the sex ratio of within-pair offspring, 0.492, representing an increase of 8.5 per cent in the proportion of sons produced. To our knowledge, this is the first confirmed report of female birds increasing their production of sons in association with extra-pair fertilization. Our results are consistent with the oft-mentioned hypothesis that females engage in extra-pair mating to increase offspring quality.

Female house wrens (Troglodytes aedon) increase the size, but not immunocompetence, of their offspring through extra-pair mating.

House wrens are typically socially monogamous, but frequently engage in extra-pair matings leading to multisired broods. Because females do not appear to acquire direct material benefits from their extra-pair mates, we tested the hypothesis that female house wrens derive indirect genetic benefits, such as enhanced immunocompetence (cutaneous immune activity, humoral immunity, and plasma bactericidal activity) and condition (size and haematoserological traits) for their offspring, by mating polyandrously. We predicted that extra-pair young (EPY) should show greater immune responsiveness and better body condition than their within-pair maternal half-siblings (WPY). Contrary to our prediction, WPY had higher cutaneous immune activity than their EPY brood-mates in two of three years, and EPY and WPY did not differ in measures of innate and humoral immunity. WPY also had higher albumin to gamma-globulin ratios than EPY; however, they were not in better condition based on other measures. EPY had consistently longer tarsi (a measure of long-bone size) than their WPY half-siblings, suggesting that females engage in extra-pair copulations with larger males. The benefits of large structural size in the study population is unknown, but based on evidence from other passerines, we suggest that structural size may be an important fitness-related trait in house wrens. We conclude that our results are not consistent with the hypothesis that females gain immune-related benefits for their offspring by engaging in extra-pair matings. Further study of the fitness consequences of differences in tarsus length is needed to determine whether females acquire size-related benefits for their offspring from extra-pair mates.

Cytochrome P450 testing for better psychiatric care.

Genotyping for CYP2D6 and CYP2C19 variations is emerging as a potentially useful clinical tool to help mental health professionals prescribe psychiatric medications for their patients. Cytochrome P450 testing uses a blood sample to determine an individual's required dosage of identified drugs that are metabolized by the two enzymes. To provide care for patients and families, nurses should be able to demonstrate identified essential nursing competencies related to genetics and genomics, which include an understanding of cytochrome P450 testing. As patient advocates, nurses are expected to understand how to identify patients most likely to benefit from CYP2D6 and CYP2C19 testing, how to ensure informed consent for such testing, and how to educate patients about testing and test results.

Increased anterior abdominal aortic wall motion: possible role in aneurysm pathogenesis and design of endovascular devices.

PURPOSE: To determine whether variations in aortic wall motion exist in mammalian species other than humans and to consider the potential implications of such variations. METHODS: M-mode ultrasound was used to measure abdominal aortic wall motion in 4 animal species [mice (n=10), rats (n=8), rabbits (n=7), and pigs (n=5)], and humans (n=6). Anterior wall displacement, posterior wall displacement, and diastolic diameter were measured. The ratio of displacement to diameter and cyclic strain were calculated. RESULTS: Body mass varied from 24.1+/-2.4 g (mouse) to 61.8+/-13.4 kg (human); aortic diameter varied from 0.53+/-0.07 mm (mouse) to 1.2+/-1 mm (human). Anterior wall displacement was 2.5 to 4.0 times greater than posterior among the species studied. The ratios of wall displacement to diastolic diameter were similar for the anterior (range 9.40%-11.80%) and posterior (range 2.49%-3.91%) walls among species. The ratio of anterior to posterior displacement (range 2.47-4.03) and aortic wall circumferential cyclic strain (range 12.1%-15.7%) were also similar. An allometric scaling exponent was experimentally derived relating anterior wall (0.377+/-0.032, R2=0.94) and posterior wall (0.378+/-0.037, R2=0.93) displacement to body mass. CONCLUSION: Abdominal aortic wall dynamics are similar in animals and humans regardless of aortic size, wih more anterior than posterior wall motion. Wall displacement increases linearly with diameter, but allometrically with body mass. These data suggest increased dynamic strain of the anterior wall. Increased strain, corresponding to increased elastin fatigue, may help explain why human abdominal aortic aneurysms initially develop anteriorly. Aortic wall motion should be considered when developing endovascular devices, since asymmetric motion may affect device migration, fixation, and sealing.

Interaction of lexical and grammatical aspect in toddlers' language.

This study examined the effect of lexical aspect on children's imitation accuracy of English tense-aspect morphology. Thirty-five typically developing children, ages 2;4 to 3;1, imitated sentence-pairs in which the same regular verb was used once in an activity (skip on the rug) and once in an accomplishment (skip out the door). Children imitated past-imperfective morphology equally well in accomplishments and activities, but they imitated past-perfective morphology with higher accuracy in accomplishments than activities. These findings suggest that children's early morphology development is influenced by lexical aspect conveyed at the sentence level, as predicted by the PROTOTYPE HYPOTHESIS.

A closer look at MLU: what does it really measure?

Despite the common use of mean length of utterance (MLU) as a diagnostic measure, what it actually reflects in terms of linguistic knowledge is relatively unclear. This study explored the extent to which variance in MLU could be accounted for by a measure of expressive vocabulary and a measure of morphosyntax in a group of 44 typically-developing children, ages 28-37 months. Regression techniques were employed to predict MLU from number of different words (NDW) and a tense accuracy composite (TAC). Depending on whether the variable was acting alone or in concert with the other, TAC accounted for 23% or none of the variance in MLU, while NDW accounted for 51% or 28%. We offer three potential explanations for the observed association between MLU and NDW, none of which necessarily precludes the others.

Duplex scanning after endovascular aneurysm repair: an alternative to computed tomography.

Late complications following endovascular aneurysm repair indicate the need for long-term surveillance. Clinical trials involving endoluminal stent grafts have typically used computed tomography angiography as the main imaging modality for surveillance. However, computed tomography angiography exposes the patient to higher levels of ionizing radiation, nephrotoxic agents, and increased cost compared to duplex ultrasound. Duplex ultrasound scanning has been widely used for surveillance of abdominal aortic aneurysms for many years. It is well established and the procedure of choice for noninvasive imaging of the aorta. It offers the advantages of easy access, decreased cost, no radiation exposure, and no nephrotoxicity. There is little controversy about duplex scanning for preoperative patient evaluation or surveillance of patients with small aneurysms. However, the use and reliability of duplex scanning in the evaluation and surveillance of patients following endovascular repair is controversial. This article will discuss the benefits, techniques, and limitation of duplex ultrasound in the long-term surveillance of endografts following endovascular abdominal aortic aneurysm repair.

Language abilities in children who stutter: toward improved research and clinical applications.

The nature of the association between language and stuttering in young children has been the focus of debate for many years. One aspect of this ongoing discussion is the status of language abilities in children who stutter (CWS). Available research findings and associated interpretations of these findings are equivocal. This article asserts that an important contributor to the ambiguous nature of this literature may be differences in research traditions and methods that typically have been employed n the study of language development and in the study of stuttering. Cross-disciplinary investigations are inherently complex and, in designing and intterpreting research of this nature, a larger set of issues must be considered and more diverse variables must be aressed and/or controlled. This article presents five prinples that can be used to guide future research in the area language and stuttering. These principles also assist in interpreting and applyng the current research literature to clinical concerns.