Upper Limb Function of Children with Unilateral Cerebral Palsy After a Magic-Themed HABIT: A Pre-Post-Study with 3- and 6-Month Follow-Up.

Aims: To examine changes in upper limb function, and performance in everyday tasks, for children with unilateral cerebral palsy who participated in a magic-themed hand-arm bimanual intensive therapy (HABIT). Methods: Twenty-eight children participated; mean age 10 y 6 mo (SD 2 y 2 mo), n = 15 male and n = 13 female. Using a single group, pre-and post-test design, the magic-themed HABIT was delivered for 60 hours over 10 days. Bimanual and unimanual hand function were measured using the Assisting Hand Assessment (AHA) and Box and Blocks Test (BBT). Occupational performance was rated using the Canadian Occupational Performance Measure (COPM). Two parent questionnaires explored change in bimanual hand use in everyday activities; ABILHAND-Kids and Children's Hand-use Experience Questionnaire (CHEQ). Assessments were completed pre-, immediately post, 3 months and 6 months after the intervention. Results: Friedman's ANOVA revealed a significant improvement for COPM and CHEQ grasp subscale. Repeated measures ANOVA revealed a significant improvement in BBT, and ABILHAND-Kids, and no significant change for AHA. Conclusions: Children who participated in the magic-themed HABIT experienced improved occupational performance, unimanual skills, and parent ratings of performance in challenging everyday tasks.

A magic-themed upper limb intervention for children with unilateral cerebral palsy: The perspectives of parents.

AIM: To explore parent's perspective of their child's participation in a magic-themed intervention called Amazing Magic Club (AMC), and to further our understanding of motivated engagement and the impact of themed group-based interventions for children with unilateral cerebral palsy (CP). METHODS: Twenty-nine parents of children with unilateral CP completed semi-structured interviews. The child participants (n = 28) attended one of three AMCs; average age of the children was 10y 6mo (SD 2y 2mo). The parent interviews were analysed using thematic analysis. RESULTS: The three themes are: "It's okay to be me", the magic effect and "I can do it". Parents observed their children to belong and learn about their abilities. The importance of the magicians and the performance is described. Parents observed their children to have increased self-belief and a new willingness to attempt difficult tasks. DISCUSSION: AMC appears to capture intrinsic motivation for children with unilateral CP to complete challenging tasks.

An observational study of glucocorticoid-induced osteoporosis prophylaxis in a national cohort of male veterans with rheumatoid arthritis.

UNLABELLED: We applied regression techniques to a large cohort of patients to understand why certain patients are prescribed medications to prevent glucocorticoid-induced osteoporosis (GIO). Rates of prescriptions to prevent osteoporosis were low. The presence of drugs and disorders associated with osteoporosis and gastrointestinal conditions actually are associated with a decreased likelihood of receiving osteoporosis-preventing medications. INTRODUCTION: To understand why some patients are prescribed medications to prevent GIO while other patients are not, we examined whether there is an association among osteoporosis-inducing medical conditions or medications and prescriptions for osteoporosis prophylaxis in a large cohort of rheumatoid arthritis patients on chronic glucocorticoids. METHODS: Department of Veterans' Affairs national administrative databases were used to construct a cohort (n = 9,605) and provide the data for this study. Multivariate logistic regression was performed to determine medical conditions and medications associated with dispensing of GIO-preventive medications, controlling for sociodemographic variables, comorbidities, glucocorticoid dosage, prior fractures, and rheumatoid arthritis severity. A subanalysis examined predictors of early GIO prevention. RESULTS: Subjects were more likely to receive GIO prophylaxis if they were older, African American, treated with multiple antirheumatic disease-modifying drugs, or received greater glucocorticoid exposure. The prescription of certain drug classes (loop diuretics and anticonvulsants) and conditions (malignancy, renal insufficiency, alcohol abuse, and hepatic disease) were associated with lower likelihood of GIO prophylaxis, despite putative links between these agents/conditions and osteoporosis. The presence of gastrointestinal disorders dramatically decreased likelihood of GIO prophylaxis. Few characteristics predicted the dispensing of GIO-preventing medications within 7 days of the initial glucocorticoid start date. CONCLUSIONS: Rates of prescriptions to prevent osteoporosis in a cohort of older men with rheumatoid arthritis on chronic glucocorticoids were low. Gastrointestinal disorders and drugs and disorders potentially linked to osteoporosis are associated with diminished odds of being prescribed GIO-preventing medications.

Metabolomic fingerprint of cryo-stress in a freeze tolerant insect.

This study employed H-NMR spectroscopy to assay the metabolome of the high Arctic freeze-tolerant dipteran larvae, Heleomyza borealis, after recovery from exposure to a range of sub-zero temperature treatments. Our data demonstrate the resilience of freeze tolerance in individuals of this permanently freeze-tolerant species that were acclimated to summer temperatures (5 degree C): recovery of homeostasis after 48 h was not significantly disturbed by 2h exposures to -3, -12, or -20 degree C. Evidence of homeostatic perturbation to cryo-stress - both in terms of changes in specific metabolite concentrations as well as systemic changes in metabolism determined using multivariate pattern recognition techniques - was expressed almost entirely at a temperature coincident with the significant onset of mortality (-25 degree C) and considerably below the minimum winter temperatures of its over-wintering habitat (c.-12 degree C).

Occupancy estimation and modeling with multiple states and state uncertainty.

The distribution of a species over space is of central interest in ecology, but species occurrence does not provide all of the information needed to characterize either the well-being of a population or the suitability of occupied habitat. Recent methodological development has focused on drawing inferences about species occurrence in the face of imperfect detection. Here we extend those methods by characterizing occupied locations by some additional state variable (e.g., as producing young or not). Our modeling approach deals with both detection probabilities <1 and uncertainty in state classification. We then use the approach with occupancy and reproductive rate data from California Spotted Owls (Strix occidentalis occidentalis) collected in the central Sierra Nevada during the breeding season of 2004 to illustrate the utility of the modeling approach. Estimates of owl reproductive rate were larger than naïve estimates, indicating the importance of appropriately accounting for uncertainty in detection and state classification.

Converging indicators for assessing individual differences in adaptation to extreme environments.

It is well known that microgravity results in various physiological alterations, for example, head-ward fluid shifts which can impede physiological adaptation. Other factors that may affect crew operational efficiency include disruption of sleep-wake cycles, high workload, isolation, confinement, stress, and fatigue. From an operational perspective, it is difficult to predict which individuals will be most or least affected in this unique environment given that most astronauts are first-time flyers. During future lunar and Mars missions space crews will include both men and women of multi-national origins, different professional backgrounds, and various states of physical condition. Therefore, new methods or technologies are needed to monitor and predict astronaut performance and health, and to evaluate the effects of various countermeasures on crew during long-duration missions. Herein we describe the development and validation of a new methodology for assessing the deleterious effects of spaceflight on crew health and performance. We reviewed several studies conducted in both laboratory and operational environments with men and women ranging in age between 18 to 50 yr. The studies included the following: soldiers performing command and control functions during mobile operations in enclosed armored vehicles; subjects participating in laboratory tests of an anti-motion sickness medication; subjects exposed to chronic hypergravity aboard a centrifuge; and subject responses to 36-h of sleep deprivation. Physiological measurements, performance metrics, and subjective self-reports were collected in each study. The results demonstrate that multivariate converging indicators provide a significantly more reliable method for assessing environmental effects on performance and health than any single indicator.

Use of bioindicators and passive sampling devices to evaluate ambient ozone concentrations in north central Pennsylvania.

Ambient concentrations of tropospheric ozone and ozone-induced injury to black cherry (Prunus serotina) and common milkweed (Asclepias syriaca) were determined in north central Pennsylvania from 29 May to 5 September 2000 and from 28 May to 18 September 2001. Ogawa passive ozone samplers were utilized within openings at 15 forested sites of which six were co-located with TECO model 49 continuous ozone monitors. A significant positive correlation was observed between the Ogawa passive samplers and the TECO model 49 continuous ozone monitors for the 2000 (r=0.959) and 2001 (r=0.979) seasons. In addition, a significant positive correlation existed in 2000 and 2001 between ozone concentration and elevation (r=0.720) and (r=0.802), respectively. Classic ozone-induced symptoms were observed on black cherry and common milkweed. In 2000, initial injury was observed in early June, whereas for the 2001 season, initial injury was initially observed in late June. During both seasons, injury was noted at most sites by mid- to late-July. Soil moisture potential was measured for the 2001 season and a significant positive relationship (P<0.001) showed that injury to black cherry was a function of cumulative ozone concentrations and available soil moisture.

Use of Ulva lactuca to identify ammonia toxicity in marine and estuarine sediments.

Toxicity identification evaluation (TIE) methods are being developed for use with whole sediments. Although a phase I TIE method has been developed to characterize ammonia toxicity in aqueous samples using the marine macroalga Ulva lactuca, the relationship between amphipod and mysid mortality and uptake by U. lactuca of bedded sediment ammonia had not been explored. Additionally, it was not known how interactions in whole sediments between metal and organic contaminants with U. lactuca and ammonia would affect TIE interpretation. The current study showed that ammonia toxicity to amphipods and mysids was reduced significantly in marine sediments in the presence of U. lactuca. The alga slightly affected metal concentrations but did not alter the concentration of organic contaminants in either overlying or interstitial waters. Conversely, ammonia uptake by U. lactuca was not affected by the presence of metal or organic contaminants in the sediments. When used with other TIE manipulations, U. lactuca can be utilized in a whole-sediment, phase I TIE to remove toxicity due to ammonia.

Transformation of Rickettsia prowazekii to erythromycin resistance encoded by the Escherichia coli ereB gene.

Rickettsia prowazekii, the etiologic agent of epidemic typhus, is an obligate, intracytoplasmic, parasitic bacterium. Recently, the transformation of this bacterium via electroporation has been reported. However, in these studies identification of transformants was dependent upon either selection of an R. prowazekii rpoB chromosomal mutation imparting rifampin resistance or expression of the green fluorescent protein and flow cytometric analysis. In this paper we describe the expression in R. prowazekii of the Escherichia coli ereB gene. This gene codes for an erythromycin esterase that cleaves erythromycin. To the best of our knowledge, this is the first report of the expression of a nonrickettsial, antibiotic-selectable gene in R. prowazekii. The availability of a positive selection for rickettsial transformants is an important step in the characterization of genetic analysis systems in the rickettsiae.

Dual agency, dual relationships, boundary crossings, and associated boundary violations: a survey of military and civilian psychiatrists.

We hypothesized that psychiatrists with high dual-agency potential (military and health maintenance organization [HMO] psychiatrists) were more likely than non-HMO civilian psychiatrists to engage in dual relationships, report pressures to do so, participate in other general boundary-crossing activities, and report associated counter-therapeutic outcomes (boundary violations). Ninety military and 191 demographically matched civilian psychiatrists reported the number of boundary-crossing activities (including dual relationships) and associated counter-therapeutic outcomes in the preceding year with adult patients. Military and HMO psychiatrists reported greater external pressures than non-HMO civilian psychiatrists to engage in dual relationships; however, all three groups were similar in their reported numbers of dual relationships. The reported boundary-crossing activities and dual relationships studied here are not necessarily associated with reported boundary violations. The relative risk of a particular boundary crossing associating with harm to a patient likely depends on the therapeutic context and should be determined on a case-by-case basis.

Self-reports of alcohol use, drug use and sexual behavior: expanding the Timeline Follow-back technique.

OBJECTIVE: The purpose of this study is to compare reports of alcohol use, drug use and sexual behavior from 30-day Summary measures with an expanded version of a Timeline Follow-back (Timeline) interview technique among gay/bisexual men entering outpatient substance abuse treatment at a gay-identified agency. METHOD: Respondents (N = 418) first completed self-administered questionnaires covering the 30-day period prior to their last use of alcohol or drugs. Summary measures included alcohol use, number of days of use for five categories of drugs and number of episodes of anal intercourse (with and without condoms) by partner type (primary or secondary). Participants then completed the Timeline interview procedure to recall their daily drinking, drug use and sexual behavior during the same 30-day period. RESULTS: The findings indicate that the Timeline method yielded significantly lower estimates of mean number of drinks consumed when heavier than usual drinking days is included in the Summary measure (124.0 vs 147.0 drinks), mean number of days drugs were used (9.3 vs 10.7) and mean number of episodes of anal intercourse with a primary partner (1.2 vs 2.2). Differences generally remained significant when assessed by length of time between the study interview and last use of alcohol or drugs, with the exception of number of anal sex episodes with primary partners. CONCLUSIONS: These findings indicate that Timeline estimates are lower than estimates using a more standard method (Summary measures). Discrepancies between these findings and those reported by other researchers indicate a need for further exploration of the effects of the mode of administration on various populations.

Acculturation, alcohol consumption and AIDS-related risky sexual behavior among African American women.

The present study examined the relationship between acculturation, alcohol consumption and AIDS-related risky sexual behavior in a national probability sample of 533 African American women. Results indicated that women who were the heaviest drinkers were also the least acculturated. However, women most likely to engage in risky sexual behavior, including having multiple partners, being nonmonogamous or in a nonmonogamous relationship, and being nonmonogamous or in a nonmonogamous relationship and not using a condom consistently, were high in acculturation rather than low. Alcohol use proved related to risky sexual behavior when considered in conjunction with respondents' level of acculturation. Women at risk for contracting AIDS were not low acculturated African American women who drank heavily, but high acculturated African American women. Findings from this study extend our understanding of risk and contain implications for research and prevention efforts in the area of alcohol use and AIDS-related sexual behavior among African American women.

PIP: The relationship between acculturation, alcohol consumption, and AIDS-related risky sexual practices was investigated in a national probability sample of 533 African American women. Data were collected in 1991-92 as part of a follow-up survey to the 1984 US National Alcohol Survey. Acculturation--the extent of adaptation to US mainstream society--was measured through use of a 10-item questionnaire related to preference for African American mass media and reliance on an African American social network. Scores on this scale ranged from 1.00 (low acculturation) to 3.78 (high acculturation). Most respondents were 18-29 years of age and lived in urban areas. Among the 306 respondents (74%) who were sexually active in the preceding year, 60 (21%) had had multiple sex partners, 130 (43%) were in a nonmonogamous relationship, and 266 (91%) had not used condoms consistently. 109 women (41%) abstained from alcohol consumption, 107 (36%) were moderate drinkers, and 90 (22%) consumed 5 or more drinks per day. When sociodemographic factors, religiosity, and attitudes toward sex were controlled, it was found that high-risk sexual practices were most prevalent among respondents with high levels of both acculturation and alcohol consumption. Heavy drinking alone was not a risk factor. Multivariate analysis indicated that women in the high acculturation/heavy drinking group were 13 times more likely to have multiple sex partners than their low acculturation/alcohol abstinent counterparts. These findings suggest the need for AIDS prevention programs for African American women that address alcohol treatment and assertiveness training.

AIDS protection and contraception among African American, Hispanic, and white women.

The goal of this study was to examine behaviors related to AIDS protection and contraception among African American, Hispanic, and white women. Data were collected in 1991 and 1992 as part of a large-scale National Alcohol Survey in which respondents were asked questions about AIDS-related sexual behavior and attitudes in face-to-face interviews. Results indicated that a significant proportion of women and their partners in each ethnic group did not use any form of protection during their most recent sexual encounter. The findings suggest that it may be useful to combine efforts to reduce unintended pregnancies with efforts for AIDS protection.

Sexual dysfunction induced by serotonin reuptake antidepressants.

Serotonin reuptake inhibitor (SRI) antidepressants have been associated with sexual dysfunction, though there have been few prospective reports specifically examining this problem. The purpose of this study was to determine if three SRIs affected sexual function in patients with an anxiety disorder or major depressive disorder over a 3-month period. Sixty-one patients were evaluated for at least 2 months in a prospective study of the effects of fluoxetine, sertraline, and paroxetine on five aspects of sexual function: libido, erection/lubrication, orgasm quality, orgasm delay, and sexual frequency. Measurements were made at baseline and at each month on visual analog scales. For men and women, orgasm quality was lower and orgasm delay longer at Months 1, 2, and 3 compared with baseline (p < .001). Erection scores were lower over time (p < .02) but this change was less dramatic. Lubrication, libido, and sexual frequency were not appreciably changed over 3 months. Anorgasmia was significantly more common in women than men at Months 1 and 2. Orgasm appears to be a primary sexual function affected by SRIs.

Alcohol and AIDS-related sexual behavior among Hispanics: acculturation and gender differences.

We examined the relationship of acculturation to alcohol use and risky sexual behavior among Hispanic men (N = 269) and women (N = 294). Data were obtained from a 1991/1992 general population survey on alcohol that included questions on sexual behavior. Guided by a conceptual/theoretical framework, we focused on gender and acculturation differences as we examined the relationship between sociodemographic characteristics, perception of AIDS-related risk, drinking and AIDS-related sexual behavior. Logistic regression analyses were performed separately for men and women to evaluate the predictive strength of acculturation, demographic factors, and alcohol consumption on risky sexual behavior. Results indicated that less acculturated Hispanic men drank more heavily and were more likely to engage in risky sexual behavior than those who were more acculturated. Although acculturated Hispanic women drank more than those who were less acculturated, less acculturated Hispanic women engaged in more risky sexual behavior. The data indicate the need for culturally sensitive AIDS-prevention programs that are linked with alcohol treatment services for men and that are targeted to different acculturation levels for men and women.

PIP: Most at risk for heterosexually transmitted HIV infection are those engaged in multiple sexual partners and those not using condoms. This follow up survey examined the relationship of acculturation to alcohol use and risky sexual behavior among Hispanic men (269) and women (294). Data was collected from a 1991-92 general population survey on alcohol that included questions on sexual behavior. Examination of the relationship between sociodemographic characteristics, perception of AIDS-related risk, drinking and AIDS-related sexual behavior focused on gender and acculturation differences. Results indicated that less acculturated Hispanic men drank more heavily and were more likely to engage in risky sexual behavior than those who were more acculturated. Although acculturated Hispanic women drank more than those who were less acculturated, less acculturated Hispanic women engaged in more risky sexual behavior. This study suggests a need for culturally sensitive AIDS-prevention programs that are linked with alcohol treatment services for men and that are targeted to different acculturation levels for men and women.

Ethnic differences in the association between behavior with a new partner: an event-based analysis.

The relationship of alcohol consumption to risky sexual behavior at the most recent encounter with a new sexual partner in representative samples of white, Hispanic, and black adults was examined. Drinking at the new partner event was more prevalent among whites than either blacks or Hispanics. Multivariate analyses indicated that drinking in the event was an important predictor on having a casual partner and using condoms with a casual partner for men but not for women. For women, drinking during the event predicted failure to use a condom. Some of these associations were dependent on ethnicity. Hispanics who consumed alcohol at the encounter were more likely to engage in protected sex than whites or blacks. These findings suggest that alcohol is but one of many influences regulating the riskiness of a particular encounter with a new partner and that the interplay of personal, situational, and behavioral factors with risky sex are culturally dependent.

Quadriceps femoris function during knee extension following total knee arthroplasty.

Electromyographic signals (EMG) from surface electrodes over the vastus medialis, rectus femoris and vastus lateralis were monitored during isometric knee extension for 10 TKA patients and 6 control subjects. No significant side-to-side differences in normalized EMG signals from any of the monitored muscles were found when the left and right legs of the control group were compared or when the operative and the non-operative legs of the patient group were compared. However, both the operative and the non-operative legs in the patient group differed significantly (p < 0.01) in normalized EMG from the control group. This study has shown that a muscle imbalance, possibly leading to patellar tracking problems, does not routinely exist following TKA through a medial parapatellar incision.

Bupropion treatment of serotonin reuptake antidepressant-associated sexual dysfunction.

Serotonin reuptake inhibitor (SRI)-induced sexual dysfunction is common, and a number of pharmacologic adjunctive strategies have been employed to treat this vexing problem. This open label study tested the efficacy of adjunctive bupropion across several measures of sexual function. Patients taking SRIs for various mood or anxiety disorders who reported prospective decline in sexual function after at least 2 months on SRIs were offered treatment with bupropion, 75 mg/day. Eight patients were treated, and sexual function was measured by use of a visual analog scale at 1 month of treatment. Four of eight patients experienced marked improvement in sexual dysfunction following adjunctive bupropion treatment. Bupropion may be a pharmacologic option for treating SRI-associated sexual dysfunction, though controlled clinical trials are needed.