Acceptability of the Cognition Test Battery in Astronaut and Astronaut-Surrogate Populations.

BACKGROUND: Sustained high levels of astronaut cognitive performance are a prerequisite for mission success. A neuropsychological battery of 10 brief cognitive tests (Cognition) covering a range of cognitive domains was specifically developed for high performing astronauts to objectively assess cognitive performance. Extended mission durations require repeated cognitive testing and thus high acceptability of the Cognition software to the astronaut population. The aim of this qualitative study was to evaluate acceptability of Cognition to astronauts and astronaut surrogate populations. METHODS: Cognition was administered repeatedly to N=87 subjects (mean age ±SD 35.1 ±8.7 years, 52.8% male) on a laptop or iPad across five individual studies on the International Space Station or in space analog environments on Earth. Following completion of each study, participants were interviewed regarding their experience using Cognition in a semi-structured debrief. Participant comments were analyzed using a qualitative conventional content analysis approach. RESULTS: The majority of participants' comments (86.1%) were coded as positive or neutral in valence, with most positive comments relating to software usability, engagement, and overall design. Among the 10 Cognition tests, subjects liked the Visual Object Learning Test most (28 likes, 32.2% of participants), while the Emotion Recognition Test was liked least (44 dislikes, 50.6% of participants). Some subjects (36.8%) were frustrated with the level of difficulty of some of the 10 Cognition tests, especially during early administrations, which was by design to avoid ceiling effects in repeated administrations of high-performers. Technical difficulties were rare (20.7% of participants), and most often observed in environments with restricted internet access. Most participants (82.3% of those who commented) liked the feedback provided by Cognition after each test, which includes a graph showing performance history. CONCLUSION: Cognition was found to be acceptable to astronaut and astronaut-surrogate populations across a variety of settings and mission durations. Participant feedback provided was used to further improve Cognition and increase its acceptability during sustained space missions.

Mapping of the second locus for the Van der Woude syndrome to chromosome 1p34.

The Van der Woude syndrome (VWS) is a dominantly inherited developmental disorder characterized by pits and/or sinuses of the lower lip, cleft lip and/or cleft palate. It is the most common cleft syndrome. VWS has shown remarkable genetic homogeneity in all populations, and so far, all families reported have been linked to 1q32-q41. A large Finnish pedigree with VWS was recently found to be unlinked to 1q32-q41. In order to map the disease locus in this family, a genome wide linkage scan was performed. A maximum lod score of 3.18 was obtained with the marker D1S2797, thus assigning the disease locus to chromosomal region 1p34. By analyses of meiotic recombinants an approximately 30 cM region of shared haplotypes was identified. The results confirm the heterogeneity of the VWS syndrome, and they place the second disease locus in 1p34. This finding has a special interest because the phenotype in VWS closely resembles the phenotype in non-syndromic forms of cleft lip and palate.

Time to B. cereus about hot chocolate.

OBJECTIVE: To determine the cause of illnesses experienced by employees of a Minneapolis manufacturing plant after drinking hot chocolate bought from a vending machine and to explore the prevalence of similar vending machine-related illnesses. METHODS: The authors inspected the vending machines at the manufacturing plant where employees reported illnesses and at other locations in the city where hot chocolate beverages were sold in machines. Tests were performed on dry mix, water, and beverage samples and on machine parts. RESULTS: Laboratory analyses confirmed the presence of B. cereus in dispensed beverages at a concentration capable of causing illness (170,000 count/gm). In citywide testing of vending machines dispensing hot chocolate, 7 of the 39 licensed machines were found to be contaminated, with two contaminated machines having B. cereus levels capable of causing illness. CONCLUSIONS: Hot chocolate sold in vending machines may contain organisms capable of producing toxins that under favorable conditions, can induce illness. Such illnesses are likely to be underreported. Even low concentrations of B. cereus may be dangerous for vulnerable populations such as the aged or immunosuppressed. Periodic testing of vending machines is thus warranted. The relationship between cleaning practices and B. cereus contamination is an issue for further study.

Renal transplantation in insulin-treated diabetics.

In our view, renal transplantation in the uremic diabetic patient is justified. Recipients should be selected with caution. Patients with both loss of vision and heart disease will only rarely benefit from renal transplantation. Living related donor should be preferred if possible.

Cultivation of Clinostomum marginatum (Digenea: Clinostomatidae) metacercariae in vitro, in chick embryo and in mouse coelom.

Metacercariae of Clinostomum marginatum obtained from naturally infected Perca flavescens were cultured by 5 methods. In vitro cultivation at 37 C in twice daily changes of Tyrode's, Na-poor Tyrode's, and Eagle's media failed to produce ovigerous adults after 4-5 days. Metacercariae placed on the chorioallantois of week-old chick embryos at 37 C migrated to the albumen. Only 8 of 123 worms recovered were ovigerous after 4-7 days in ovo. Best success occurred with metacercariae injected in groups of 4 or 6 into the abdominal cavities of male A/J mice. Despite liver lesions and strong inflammatory responses in the host, all 174 worms recovered were ovigerous after 4-8 days. None of 41 mice died prematurely from the procedure or the parasites.

Fine structure and sugar transport functions of the tegument in Clinostomum marginatum (Digenea: Clinostomatidae): environmental effects on the adult phenotype.

Digenean flukes can be classified into 3 groups according to their location in the host: the lumen of the alimentary canal or associated organ, body cavity or tissue, and external surfaces. We obtained adults of Clinostomum marginatum that had matured in these 3 habitats and compared the fine structure and glucose transporting capacity of their teguments. Adults from the esophagus of herons, Ardea herodias, had thick, smooth teguments and took up glucose by facilitated diffusion, the type of transport that is Na(+)-independent and insensitive to phlorizin. By contrast, the surfaces of adults cultured from metacercariae in body cavities of laboratory mice were amplified 3-5-fold due to numerous irregular projections of the tegument. Glucose transport by these worms was largely Na(+)-dependent and inhibited by phlorizin, indicating active transport. Ectoparasites from herons' mouths had relatively thick, smooth teguments, but these worms always were encrusted with bacteria and yeast that are known to absorb and metabolize glucose. Most of the attached bacteria, and the apparent glucose uptake associated with their presence, were removed by treating the worms with antibiotics prior to transport assays. As facilitated diffusion and active transport are operational simultaneously in metacercariae, the type of transport function, if any, expressed in the adult is determined by environmental conditions associated with the worm's habitat.

Bacteria associated with tegument of Clinostomum marginatum (Digenea).

Adults of Clinostomum marginatum freshly collected from a heron, Ardea herodias, were examined using transmission electron microscopy. Specimens from the mouth of the bird were encrusted with bacteria that were not removed by washing unless the saline contained antibiotics. There was no evidence that the attached bacteria were damaging to the trematode tegument. Three species of Gram-negative bacteria were isolated from the worm surfaces and identified; Achromobacter sp. was present in pure culture on 4 of 6 original cultures and in mixed culture with Edwardsiella tarda and Enterobacter agglomerans in 2 cultures. These species and 3 unidentified species of bacteria were isolated from the oral epithelium of the heron. Microorganisms were not seen attached to the surfaces of worms recovered from the esophagus. Because E. tarda and E. agglomerans were the only species isolated from the heron esophagus, the intimate bacterial-worm association in the heron mouth may be due specifically to Achromobacter sp.

Middle ear disease in cleft palate children at three years of age.

Fourty-four cleft palate children consecutively referred to a plastic surgery unit were treated with palate repair at one year of age by one surgeon. The children were not routinely treated with ventilating tubes for middle ear disease. At 3 years of age they were investigated for aural pathology. Also specific antipneumococcal antibody activity was measured and was found to be compatible with the activity found in healthy age-matched control children. In the cleft palate children with no immaturity of the immune system only a slight increase in frequency of acute otitis media was evident. One third of the children had however suffered from long-standing secretory otitis media which can be regarded to be more common than what has been found in the normal population in several epidemiologic studies. At 3-4 years of age 82% of the children had a normal hearing indicating an improvement of the condition.

Child maltreatment among U.S. East Coast migrant farm workers.

This paper reports findings from a study that was conducted in 1983 to determine the incidence and patterns of child maltreatment among migrant farm worker families who reside in or travel through the Atlantic coastal region known as the Eastern Stream. These results are based on responses to a multipurpose mailed questionnaire that was administered to a sample of 2,207 migrant educators. Educational personnel from 14 of the 22 Eastern Stream states participated in this survey, which was designed to elicit information on the incidence of maltreatment in this population. The survey considered 13 different indicators of child abuse and neglect and six maltreatment forms. Another segment of the instrumentation secured information on the migrant population with which the respondents had direct contact so that an incidence rate could be formulated. The study conclusively established that the incidence of child maltreatment rate among migrant farm worker families, as perceived by migrant educators, was substantially higher than the rate observed for the population as a whole or even for families with approximately the same socioeconomic status. Comparative data are presented to place this primary research result in perspective and a more precise overall incidence estimate is derived. Differential rates of abuse and neglect within the migrant population and the factors that contribute to them are also considered.

Migrants and maltreatment: comparative evidence from central register data.

This paper reports the results of a series of studies on the abuse and neglect of migrant farmworker children. These investigations were conducted between 1983 and 1985 in the states of New York, New Jersey, Pennsylvania, Florida, and Texas. Names of approximately 24,000 migrant children obtained from annual migrant education censuses were individually cross-referenced with the appropriate state data bases to determine if they had been involved in a confirmed incident of maltreatment. The information acquired was converted to incidence estimates that were contrasted with the rates for all children in the respective states and were decomposed to identify high-risk cohorts within the migrant population. One finding common to all five assessments was that migrant children were significantly more likely to be maltreated than other children, although these incidence rates varied appreciably from one state to another. The emphasis of this paper is on the unique methodology employed in the research, issues pertaining to provisions for accessing central registers and protecting confidentiality of subjects, the generalizability of the findings, and cross-state incidence differentials for both migrants and children from nonmigrant families.

Career aspirations to higher leadership positions of nurse faculty middle managers.

The purpose of this study was to determine the attitudes of nurse faculty who worked full time in midlevel management positions in baccalaureate degree schools of nursing in order to identify those factors related to career aspirations to higher leadership positions such as deanship. Thirty-seven nurse midmanagers from 30 of the 40 baccalaureate degree schools of nursing in the Midwest completed the three-part questionnaire composed of a demographic profile, Johnson's Faculty Satisfaction Instrument, and Guilbert's Health Care Work Powerlessness Scale (revised). Selected results of this study indicated that the majority of nurse faculty middle managers did not view their current position as a career step to deanship (56.76 per cent) nor did they have career aspirations to a higher leadership position (62.16 per cent). The primary reason reported for this lack of career aspiration was family responsibilities. They did not perceive powerlessness or job satisfaction (P < .05) as an issue in their decision. Career aspirations to a higher leadership position was reported greater when the salary was higher and the perception was stronger that the current position was a career step to deanship (P < .05). They reported the lowest degrees of job satisfaction in reference to parking (SD = 1.79) and leadership of the dean (SD = 1.61).

Tubed free flap combined with split-rib-graft for reconstruction of multiple oral cavity defects. A case report.

The successful use of a conventional bone graft for mandibular reconstruction in combination with a free forearm flap is described. Two separate intraoral mucosal defects, one in the mandible and one in the palate, were covered, using the same flap and partial tubing of the flap. Three weeks post-flap-transfer the flap was successfully divided. A safe reliable and versatile technique combining nonvascularized bone graft and free flap for simultaneous reconstruction of mandibular and intraoral mucosal defects is described. Simultaneous coverage of multiple intraoral defects with tubing of the flap is found to be possible.

Oronasal fistulas in cleft palate patients and their influence on speech.

The size, site, and influence on speech of oronasal fistulas were studied in 12 patients with unilateral and 32 with bilateral cleft lip and palate. There were more and larger fistulas in the bilateral group. The series was divided into: those with fistulas that affected speech (group A, n = 18) and those with fistulas that did not affect their speech (group B, n = 26). Group A had significantly larger fistulas than group B, but there were no differences in the sites of the fistulas, either between the bilateral and unilateral groups or between groups A and B. Most fistulas were located in the region of the incisive foramen or in the hard palate. Judgements by listeners and analyses by the NORAM instrument were made of the speech of 12 of the patients in group A before and after temporary covering of the fistulas. Significant differences in hypernasality, according to both listener's judgments and instrumental analyses were found. This finding is further evidence that an oronasal fistula can influence and contribute to velopharyngeal dysfunction.

The effect of palatoplasty on airway patency and growth in infants with clefts and failure to thrive.

We monitored respiratory patterns, transcutaneous PO2 (tcPO2) and transcutaneous PCO2 (tcPO2) in three infants with clefts and severe failure to thrive. Unexplained dysphagia, muscular weakness and cardiac enlargement were other prominent symptoms. During sleep, repeated obstructive apneas accompanied by significant hypoxemia (tcPO2 less than 6 kPa) were recorded in all infants. Relief of the respiratory obstructions by means of nasopharyngeal intubation led to rapid growth catch-up and disappearance of the cardiac and gastrointestinal symptoms. This improvement in clinical condition was paralleled by an increase in transcutaneous PO2. Palatal closure according to Veau-Wardill-Killner led to a marked decrease in the number of airway obstructions and a significant improvement in blood gas homeostasis. The clinical condition of the infants was equally improved. We suggest that a respiratory investigation should be performed in infants with clefts and poor growth in spite of adequate caloric intake. Early closure of the palate should be considered in infants with signs of a respiratory failure.

Craniofacial development in children with unilateral clefts of the lip, alveolus, and palate treated according to four different regimes. I. Maxillary development.

Lateral skull radiographs of 85 patients with unilateral clefts of the lip, alveolus, and palate treated according to four different regimes were compared at three different ages regarding maxillary development. Regimes that included primary bone grafting to the alveolus at six months of age resulted in inhibited anterior maxillary growth and reduced maxillary inclination. Regimes that included secondary bone grafting after eruption of the incisors but before the eruption of the canines, resulted in better maxillary development, but were not as good as regimes that omitted bone grafting altogether.

Craniofacial development in children with unilateral clefts of the lip, alveolus, and palate treated according to three different regimes. Assessment of nasolabial appearance.

From extraoral photographs taken from the front and in profile of 61 16-year old children with unilateral cleft lip, alveolus, and palate (UCLAP) who had been treated by three different treatment regimes, the nasolabial appearances were assessed by a panel. The photographs were masked, leaving only the mid face including the nose and lips. The following features were assessed using a five point scale: nasal form, symmetry of the nose, vermilion of the upper lip, shape of the vermilion border, total symmetry of upper lip, and nasal profile including the upper lip. The number and type of secondary operations required were recorded. Intraobserver reliability was good but interobserver agreement was poor, some observers systematically scoring more severely than others. A panel of six was therefore set up to establish an acceptable mean assessment. The treatment regime that included secondary bone grafting, and the one that included primary bone grafting and presurgical orthopaedic-T-traction, scored better on all features assessed compared with the group that underwent primary bone grafting but no T-traction. The latter group required fewer secondary revisionary procedures, however, which could explain these results.

Craniofacial development in children with unilateral clefts of the lip, alveolus, and palate treated according to four different regimes. II. Mandibular and vertical development.

Lateral skull radiographs of 85 patients with unilateral clefts of the lip, alveolus and palate treated according to four different regimes were compared longitudinally, at three different ages, regarding mandibular and vertical facial development. It was found that there were no lasting differences in mandibular morphology resulting from regimes including primary or early secondary bone grafting. The non grafted group, however, showed increased mandibular length and anterior height. The jaw angle was increased and there was a more favourable sagittal jaw relationship. Regimes that included primary bone grafting were associated with reduced upper anterior facial height, which resulted in less harmonious facial proportions compared with treatment regimes including early secondary bone grafting done during the mixed dentition, or no bone grafting at all. Vertical development was greatest where bone grafting was excluded.

Craniofacial development in children with unilateral clefts of the lip, alveolus, and palate treated according to four different regimes. III. The soft tissue profile at 16-18 years of age.

The soft tissue profiles of 85 16-18 year old children with unilateral clefts of the lip, alveolus, and palate treated according to four different regimes were studied using lateral skull radiographs. Regimes that included secondary bone grafting to the alveolus in the mixed dentition gave better convexity of the soft tissue profile (excluding the nose) and better soft tissue sagittal jaw relationships compared with treatment regimens that included primary bone grafting. The soft tissue profile in regimes that excluded bone grafting was almost as favourable as those in regimes in which bone grafting was done during the mixed dentition.

Tongue posture in cleft palate patients with a pharyngeal flap.

Position of the tongue was studied in lateral cineradiographic pictures of 15 patients with cleft palate and velopharyngeal incompetence, and from ten unaffected reference subjects. The patients were examined before and after pharyngoplasty. Before operation there was no difference in the degree of tongue/velum contact between the patients and the reference subjects, but after the operation, contact was lost in 13 of the 15 patients because the tongue was lowered and the velum raised by the pharyngeal flap. This contradicts the previous theory that the position of the tongue should be expected to be higher to maintain the posterior oral seal. The tongue was in a more posterior position in the patients than in the reference subjects both before and after operation. After operation the tip of the tongue retracted into the anterior oral cavity. The posterior and downward change in position of the tongue may account for part of the posterior and downward growth pattern of the lower third of the face which occurs in children after pharyngoplasty. A loss of tongue-lip balance around the premaxilla may be one of the factors that causes the maxillary retrusion that has been reported after pharyngoplasty in patients with cleft palates.

Treatment of keloids with surgical excision and postoperative X-ray radiation.

124 patients with keloids were treated with surgical excision followed by postoperative X-ray radiation, begun within 24 hours after surgery. Only patients with a two-year keloid history were included in this study. The treatment results were evaluated 6 and 24 months after treatment. There was good correlation agreement between subjective and objective evaluations. Good or excellent results were observed in 92% of the patients. Side effects were moderate. Slight hyperpigmentation was found in 31% of the patients and telangiectasis in 15%. It was concluded that excision and early postoperative irradiation constitute effective keloid treatment.