Effect of drug load and lipid-wax blends on drug release and stability from spray-congealed microparticles.

This study was designed to evaluate paraffin wax as a potential controlled release matrix for spray congealing and its impact on drug release and stability of the microparticles. Paraffin wax can form a hydrophobic barrier to moisture and reduce drug degradation besides retarding drug release in the gastrointestinal tract. More hydrophilic lipid-based additives can be incorporated to modulate the drug release through the paraffin wax barrier. This study reports the findings of lipid-wax formulations at preserving the stability of moisture-sensitive drugs in spray-congealed microparticles. Aspirin-loaded microparticles formulated with different drug loads, lipid additives, and lipid:wax ratios were produced by spray congealing. Stearic acid (SA), cetyl alcohol (CA), and cetyl ester (CE) were the lipid additives studied. The microparticles were evaluated for yield, encapsulation efficiency, particle size, drug stability, and release. CE exhibited the greatest effect on increasing drug release, followed by CA and SA. Dissolution profiles showed the best fit to Weibull kinetic model. The degree of drug degradation was low, with CA imparting the least protective effect, followed by SA and CE. Paraffin wax is useful for preserving the stability of moisture-sensitive aspirin and retarding its release from spray-congealed microparticles. The addition of lipid additives modulated drug release without compromising drug stability.

Epidemiology of scoliosis in cerebral palsy: A population-based study at skeletal maturity.

AIM: This study investigated the prevalence of scoliosis in a large, population-based cohort of individuals with cerebral palsy (CP) at skeletal maturity to identify associated risk factors that may inform scoliosis surveillance. METHODS: Young people with CP born between 1990 and 1992 were reviewed through routine orthopaedic review or a transition clinic. Classification of CP was recorded by movement disorder, distribution, gross and fine motor function. Clinical examination was undertaken and those with clinical evidence of scoliosis or risk factors had radiographs of the spine. Scoliosis severity was measured and categorised by Cobb angle. RESULTS: Two hundred and ninety-two individuals were evaluated (78% of the birth cohort) at a mean age of 21 years, 4 months (range 16-29 years). Scoliosis (Cobb angle >10°) was found in 41%, with strong associations to the Gross Motor Function Classification System (GMFCS), Manual Abilities Classification System (MACS) and dystonic/mixed movement disorders. Those at GMFCS V were 23.4 times (95%CI 9.9-55.6) more likely to develop scoliosis than those at GMFCS I. Severe curves (Cobb >40°, 13% of the cohort) were found almost exclusively in those functioning at GMFCS IV and V, and were 18.2 times (95%CI 6.9-48.5) more likely to occur in those with dystonia than those with spasticity. CONCLUSIONS: Scoliosis was very common in young people with CP, with prevalence and severity strongly associated with GMFCS and MACS level and dystonic movement disorder. Severe curves were almost exclusively found in non-ambulant children. Clinical screening for scoliosis should occur for all children with CP, with radiographic surveillance focusing on those functioning at GMFCS IV and V.

Hip health at skeletal maturity: a population-based study of young adults with cerebral palsy.

AIM: We studied 'hip health' in a population-based cohort of adolescents and young adults with cerebral palsy to investigate associations between hip morphology, pain, and gross motor function. METHOD: Ninety-eight young adults (65 males, 33 females) from the birth cohort were identified as having developed hip displacement (migration percentage >30) and were reviewed at a mean age of 18 years 10 months (range 15-24y). Hip morphology was classified using the Melbourne Cerebral Palsy Hip Classification Scale (MCPHCS). Severity and frequency of pain were recorded using Likert scales. Gross motor function was classified by the Gross Motor Function Classification System (GMFCS). RESULTS: Hip pain was reported in 72% of participants. Associations were found between pain scores and both hip morphology and GMFCS. Median pain severity score for MCPHCS grades 1 to 4 was 2 (interquartile range [IQR] 1.0-3.0) compared to 7 (IQR 6.0-8.0) for grades 5 and 6 (severe subluxation or dislocation). Hip surveillance and access to surgery were associated with improved hip morphology and less pain. INTERPRETATION: Poor hip morphology at skeletal maturity was associated with high levels of pain. Limited hip surveillance and access to surgery, rather than GMFCS, was associated with poor hip morphology. The majority of young adults who had access to hip surveillance, and preventive and reconstructive surgery, had satisfactory hip morphology at skeletal maturity and less pain.

Putting judging situations into situational judgment tests: evidence from intercultural multimedia SJTs.

Although the term situational judgment test (SJT) implies judging situations, existing SJTs focus more on judging the effectiveness of different response options (i.e., response judgment) and less on how people perceive and interpret situations (i.e., situational judgment). We expand the traditional SJT paradigm and propose that adding explicit assessments of situational judgment to SJTs will provide incremental information beyond that provided by response judgment. We test this hypothesis across 4 studies using intercultural multimedia SJTs. Study 1 uses verbal protocol analysis to discover the situational judgments people make when responding to SJT items. Study 2 shows situational judgment predicts time-lagged, peer-rated task performance and interpersonal citizenship among undergraduate seniors over and above response judgment and other established predictors. Study 3 shows providing situational judgment did not affect the predictive validity of response judgment. Study 4 replicates Study 2 in a working adult sample. We discuss implications for SJT theory as well as the practical implications of putting judging situations back into SJTs.

The impact of complementary and alternative medicine on hip development in children with cerebral palsy.

AIM: This study aimed to evaluate the effect of complementary and alternative medicine (CAM) approaches on long-term surgical requirements, and clinical and radiographic outcomes for children with cerebral palsy and hip displacement. METHOD: Twenty-three children with cerebral palsy and early hip displacement who were offered preventive hip surgery and whose parents declined in favour of CAM approaches were followed (13 males, 10 females; mean age 13 y 9 mo [SD 3 y 1 mo]; mean length of follow-up 10 y 2 mo [SD 2 y 11 mo]; 17 with spastic quadriplegia, two with spastic triplegia, and four with spastic diplegia; three with gross motor function classified at Gross Motor Function Classification System [GMFCS] level II, four at level III, six at level IV, and 10 at level V). Principal outcome measures were progression of hip displacement (measured by migration percentage: the percentage of the femoral head sitting outside of the acetabulum), eventual need for reconstructive or salvage surgery, and long-term hip morphology (classified by the Melbourne Cerebral Palsy Hip Classification Scale). The results were compared with a previously reported cohort of 46 children who had surgery when recommended (31 males, 15 females; mean age 13 y 11 mo [SD 1 y 6 mo]; mean length of follow-up 10 y 10 mo; 10 with diplegia and 36 with quadriplegia; three at GMFCS level II, 11 at level III, 20 at level IV, and 12 at level V). RESULTS: Outcomes for 23 children who had pursued CAM were analysed (mean length of follow-up 10 y 2 mo). Hip displacement progressed in one or both hips in all non-ambulant children (GMFCS level IV or V). Of the 20 children with documented progressive hip displacement, eight developed pain and deformity requiring salvage surgery. An additional 11 children with progressive hip displacement had late reconstructive surgery when symptoms first started. There was strong evidence of a relationship between GMFCS and both progressive hip displacement (χ(2) =17.78; p=0.001) and final Melbourne Cerebral Palsy Hip Classification Scale grade (odds ratio 12.5; p=0.012; 95% confidence interval 1.7-90.4). There was also evidence of those children who pursued CAM requiring more complex surgery than the group who had surgery when recommended (odds ratio 2.5; p=0.002; 95% confidence interval 1.4-4.5). INTERPRETATION: CAM therapy did not appear to influence the progression of hip displacement in children with cerebral palsy. Most children required major reconstructive surgery or salvage surgery despite pursuing CAM.

Leader-member exchange (LMX) and culture: a meta-analysis of correlates of LMX across 23 countries.

This study extends leader-member exchange (LMX) research by meta-analyzing the role of national culture in moderating relationships between LMX and its correlates. Results based on 282 independent samples (N = 68,587) from 23 countries and controlling for extreme response style differences indicate that (a) relationships of LMX with organizational citizenship behavior, justice perceptions, job satisfaction, turnover intentions, and leader trust are stronger in horizontal-individualistic (e.g., Western) contexts than in vertical-collectivistic (e.g., Asian) contexts; and (b) national culture does not affect relationships of LMX with task performance, organizational commitment, and transformational leadership. These findings highlight that although members are universally sensitive to how their leaders treat them, members' responses in Asian contexts may also be influenced by collective interests and role-based obligations.

The impact of botulinum toxin A and abduction bracing on long-term hip development in children with cerebral palsy.

AIM: To study the long-term impact of 3 years of botulinum toxin A (BoNT-A) injections and abduction bracing on hip development in children with bilateral spastic cerebral palsy (CP). We wanted to know if early treatment improved hip development and reduced the need for surgery. METHOD: A long-term review of hip morphology and surgery requirements in children who participated in a multicentre, randomized controlled trial. The trial investigated short-term effects of BoNT-A injections combined with an abduction brace, compared with usual care, on hip displacement in children with bilateral spastic CP. RESULTS: Forty-six children with bilateral spastic CP (31 males, 15 females; 10 with diplegia, 36 with quadriplegia; mean age at enrolment of 3 y 2 mo, mean age at most recent clinical review 13 y 11 mo [range 10 y 6 mo-16 y 8 mo]; three children in Gross Motor Function Classification System level II, 11 in level III, 20 in level IV, 12 in level V) were followed for a mean of 10 years 10 months from recruitment to the trial. Mean migration percentage was 15.9% in the BoNT-A group and 15.2% in the comparison group (t = 0.26, p = 0.79). Eighty-nine percent of hips in the treatment group and 91% hips in the comparison group had satisfactory development, using a valid scale (Mann-Whitney U test = 867.50, z = -1.59, p = 0.11). Forty children had preventive surgery (21 treatment group, 19 comparison group) and 18 children had reconstructive surgery (10 treatment, 8 comparison). INTERPRETATION: In children with bilateral spastic CP, early treatment with BoNT-A and hip abduction bracing does not reduce the need for surgery or improve hip development at skeletal maturity.

Differences between tight and loose cultures: a 33-nation study.

With data from 33 nations, we illustrate the differences between cultures that are tight (have many strong norms and a low tolerance of deviant behavior) versus loose (have weak social norms and a high tolerance of deviant behavior). Tightness-looseness is part of a complex, loosely integrated multilevel system that comprises distal ecological and historical threats (e.g., high population density, resource scarcity, a history of territorial conflict, and disease and environmental threats), broad versus narrow socialization in societal institutions (e.g., autocracy, media regulations), the strength of everyday recurring situations, and micro-level psychological affordances (e.g., prevention self-guides, high regulatory strength, need for structure). This research advances knowledge that can foster cross-cultural understanding in a world of increasing global interdependence and has implications for modeling cultural change.

Rating leniency and halo in multisource feedback ratings: testing cultural assumptions of power distance and individualism-collectivism.

This study extends multisource feedback research by assessing the effects of rater source and raters' cultural value orientations on rating bias (leniency and halo). Using a motivational perspective of performance appraisal, the authors posit that subordinate raters followed by peers will exhibit more rating bias than superiors. More important, given that multisource feedback systems were premised on low power distance and individualistic cultural assumptions, the authors expect raters' power distance and individualism-collectivism orientations to moderate the effects of rater source on rating bias. Hierarchical linear modeling on data collected from 1,447 superiors, peers, and subordinates who provided developmental feedback to 172 military officers show that (a) subordinates exhibit the most rating leniency, followed by peers and superiors; (b) subordinates demonstrate more halo than superiors and peers, whereas superiors and peers do not differ; (c) the effects of power distance on leniency and halo are strongest for subordinates than for peers and superiors; (d) the effects of collectivism on leniency were stronger for subordinates and peers than for superiors; effects on halo were stronger for subordinates than superiors, but these effects did not differ for subordinates and peers. The present findings highlight the role of raters' cultural values in multisource feedback ratings.

Personality and leader effectiveness: a moderated mediation model of leadership self-efficacy, job demands, and job autonomy.

The trait theory of leadership is advanced by a joint investigation of the mediating role of (a) leadership self-efficacy (LSE = leader's perceived capabilities to perform leader roles) in linking neuroticism, extraversion, and conscientiousness with leader effectiveness and (b) the moderating role of job demands and job autonomy in influencing the mediation. Using K. J. Preacher, D. D. Rucker, and A. F. Hayes' (2007) moderated mediation framework, the authors tested the model (over a 2-year period) with matched data from 394 military leaders and their supervisors. Results showed that LSE mediated the relationships for neuroticism, extraversion, and conscientiousness with leader effectiveness. Moderated mediation analyses further revealed that LSE mediated the relationships for (a) all 3 personality variables for only those leaders with low job demands; (b) neuroticism and conscientiousness for only those leaders with high job autonomy; and (c) extraversion, regardless of a leader's level of job autonomy. Results underscore the importance of accounting for leaders' situational contexts when examining the relationships between personality, LSE, and effectiveness.

Personality, biographical characteristics, and job interview success: a longitudinal study of the mediating effects of interviewing self-efficacy and the moderating effects of internal locus of causality.

In this study, the authors developed and tested a model of performance in job interviews that examines the mediating role of interviewing self-efficacy (I-SE; job applicants' beliefs about their interviewing capabilities) in linking personality and biographical background with interview success and the moderating role of locus of causality attributions in influencing the relationship between interview success and subsequent I-SE. The authors tested their model (over 5 months' duration) with matched data from 229 graduating seniors, firms, and university records. Hierarchical regression analyses demonstrated I-SE mediated the effects of Extraversion, Conscientiousness, and leadership experience on interview success. Locus of causality attributions for interview outcomes moderated the relationship between interview success and subsequent I-SE. Theoretical and practical implications are discussed.

Comparative anatomical study of the gracilis and coracobrachialis muscles: implications for facial reanimation.

Since the introduction of cross-facial nerve grafting and free vascularized muscle transfer for the treatment of longstanding facial paralysis, substantial progress has been made toward restoration of facial expression that is as normal as possible. Much of the focus has remained on the gracilis as a donor muscle. However, its inherent anatomical characteristics may preclude it from ever being more than simply a mass of contractile tissue in the face. The coracobrachialis muscle, which is the analogue in the arm of the lower limb adductor mass, was proposed as an alternative donor muscle because it was thought that certain features would allow it to improve on the overall results that are currently possible with the gracilis. A comparative anatomical study was conducted to gauge this potential. A total of 133 muscles were analyzed, including 96 dissected specimens, 16 arterial and 14 venous study specimens, and seven neurovascular study specimens. Anatomical parameters were recorded for each muscle and later tabulated. Histological analysis of the nerves to 10 gracilis and 10 coracobrachialis muscles was performed, and the findings were confirmed with intraneural dissection of an additional 20 nerves under an operating microscope. The coracobrachialis was observed to be a practical alternative to the gracilis. Indeed, it has many of the attributes that initially drew attention to the gracilis as a possible donor muscle, including a reliable neurovascular supply, minimal donor-site morbidity, and the option of having two teams operate simultaneously. In addition, it has a size, shape, and form that make it an excellent choice for transfer to the face. It could be easily attached in the face to provide static support as well as animation, because of its long proximal tendon, the thick intermuscular septum along its lateral surface, and, when present, the ligament of Struthers.