In vitro biomechanical testing of anterior cruciate ligament reconstruction: traditional versus physiologically relevant load analysis.

Various anterior cruciate ligament (ACL) graft-fixation devices exist. In this in vitro study a comparison of biomechanical characteristics of the cross-pin and button type fixation devices under practical rehabilitation loads was done. Forty bovine knees and hoof extensor tendons were harvested. After disarticulation, the femoral end of an ACL was prepared with either fixation, using the extensor tendon as graft. The mechanical test was either a single load to failure or load to failure after cycling loads. Twenty specimens were loaded to failure at a rate of 1mm/s, remaining specimens were cycled between 50 and 250 N for 1000 cycles then failure tested in a similar manner. Results show that both forms of fixation are able to withstand loads that exceed those observed in performing functional activities. Activity-specific stiffness (loads comparable to walking, jogging and stair descent) was lower than linear stiffness for both endobutton and cross-pin, without prior cycling. After cycling, activity-specific stiffness increased to linear stiffness values for the cross-pin for all activities. Thus, suggesting that the cross-pin provides a more rigid fixation after initial implantation over a wider range of activities, which would theoretically permit a more aggressive rehabilitation protocol and possibly an earlier return to regular activity. In contrast, activity-specific stiffness increased above linear stiffness values for the endobutton only under heavier loads (jogging and stair descent). Dynamic stiffness was higher and displacement lower for cross-pin throughout the cycle test. These results indicate, in ACL reconstruction, that graft complex stiffness should be considered at relevant loads only.

Effect of the adapted Virtual Reality cognitive training program among Chinese older adults with chronic schizophrenia: a pilot study.

OBJECTIVE: To examine the effect of the adapted virtual reality cognitive training program in older adults with chronic schizophrenia. METHODS: Older adults with chronic schizophrenia were recruited from a long-stay care setting and were randomly assigned into intervention (n = 12) and control group (n = 15). The intervention group received 10-session of VR program that consisted of 2 VR activities using IREX. The control group attended the usual programs in the setting. RESULTS: After the 10-session intervention, older adults with chronic schizophrenia preformed significantly better than control in overall cognitive function (p .000), and in two cognitive subscales: repetition (p .001) and memory (p .040). These participants engaged in the VR activities volitionally. No problem of cybersickness was observed. CONCLUSIONS: The results of the current study indicate that engaging in the adapted virtual reality cognitive training program offers the potential for significant gains in cognitive function of the older adults with chronic schizophrenia.

Cross-cultural psychiatric residency training: the Oregon experience.

OBJECTIVE: The purpose of this article is to describe the goals and structure of cross-cultural psychiatric training at Oregon Health and Science University (OHSU). This training in core knowledge, skills, and attitudes of cultural psychiatry over the past three decades has included medical students, residents, and fellows, along with allied mental health personnel. The curriculum includes both didactic sessions devoted to core topics in the field and varied clinical experiences in community settings and the Intercultural Psychiatric Program under the supervision of experienced academic faculty. METHODS: The authors review the central elements of the training experiences and include a detailed description of the core clinical settings and experiences. RESULTS: At the conclusion of their clinical experiences, trainees have specialized cross-cultural psychiatric knowledge and skills, including treatment of refugees and immigrants, sociocultural variables that influence the assessment and treatment of a wide range of psychiatric conditions, and comfort with cultural dynamics that influence both the doctor/patient relationship and collaboration with a wide range of mental health professionals. CONCLUSION: Because of rapid demographic changes in the U.S. population, providing cross-cultural training for students, residents, and fellows is an essential foundation for the education of the next generation of clinicians and health care leaders. OHSU has provided a long-term model for this training in a busy clinical and academic setting that places an emphasis on multidisciplinary and multicultural collaboration.

High prevalence rates of diabetes and hypertension among refugee psychiatric patients.

There is increasing evidence that immigrants and traumatized individuals have elevated prevalence of medical disease. This study focuses on 459 Vietnamese, Cambodian, Somali, and Bosnian refugee psychiatric patients to determine the prevalence of hypertension and diabetes. The prevalence of hypertension was 42% and of diabetes was 15.5%. This was significantly higher than the US norms, especially in the groups younger than 65. Diabetes and hypertension were higher in the high-trauma versus low-trauma groups. However, in the subsample with body mass index (BMI) measurements subjected to logistic regression, only BMI was related to diabetes, and BMI and age were related to hypertension. Immigrant status, presence of psychiatric disorder, history of psychological trauma, and obesity probably all contributed to the high prevalence rate. With 2.5 million refugees in the country, there is a strong public health concern for cardiovascular disease in this group.

The Chinese Diaspora and Diaspora and Disability/Rehabilitation in the United States / 中国康复理论与实践

In this article, I will discuss disability issues as a second and a half generation American of Chinese descent who has worked with persons with disabilities, has taught rehabilitation counseling as well as having been a rehabilitation psychologist for more than 35 years in the U.S. and Australia. I am pleased to be able to share some of my thoughts and experiences in this article that is a bit less formal than what you may expect in a professional journal. Though I hope that what I share will provoke some thinking and action from those who read these words.