Implementation of a mentored professional development programme in laboratory leadership and management in the Middle East and North Africa.

Laboratories need leaders who can effectively utilize the laboratories' resources, maximize the laboratories'capacity to detect disease, and advocate for laboratories in a fluctuating health care environment. To address this need, the University of Washington, USA, created the Certificate Program in Laboratory Leadership and Management in partnership with WHO Regional Office for the Eastern Mediterranean, and implemented it with 17 participants and 11 mentors from clinical and public health laboratories in 10 countries (Egypt, Iraq, Jordan, Lebanon, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, and Yemen) in 2014. Designed to teach leadership and management skills to laboratory supervisors, the programme enabled participants to improve laboratory testing quality and operations. The programme was successful overall, with 80% of participants completing it and making impactful changes in their laboratories. This success is encouraging and could serve as a model to further strengthen laboratory capacity in the Region.

Implementation of a mentored professional development programme in laboratory leadership and management in the Middle East and North Africa

Laboratories need leaders who can effectively utilize the laboratories' resources, maximize the laboratories'capacity to detect disease, and advocate for laboratories in a fluctuating health care environment. To address this need, the University of Washington, USA, created the Certificate Program in Laboratory Leadership and Management in partnership with WHO Regional Office for the Eastern Mediterranean, and implemented it with 17 participants and 11 mentors from clinical and public health laboratories in 10 countries [Egypt, Iraq, Jordan, Lebanon, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, and Yemen] in 2014. Designed to teach leadership and management skills to laboratory supervisors, the programme enabled participants to improve laboratory testing quality and operations. The programme was successful overall, with 80% of participants completing it and making impactful changes in their laboratories. This success is encouraging and could serve as a model to further strengthen laboratory capacity in the Region

Les laboratoires ont besoin de directeurs à même d'utiliser les ressources internes de façon efficace, de maximiser leurs capacités à dépister les maladies, et d'oeuvrer pour le bien de ces établissements dans un environment de soins de santé en perpétuel changement. Pour répondre à ces besoins, l'Université de Washington [Etats-Unis], en partenariat avec le Bureau régional de l'OMS pour la Méditerranée orientale, a mis au point le Programme de certification en direction et gestion de laboratoire qui a été suivi par 17 participants et 11 mentors issus de laboratoires de santé clinique et publique dans 10 pays [Arabie saoudite, Egypte, Iraq, Jordanie, Liban, Maroc, Oman, Pakistan, Qatar et Yémen] au cours de l'année 2014. Conçu pour former les responsables de laboratoire aux compétences de direction et de gestion, le programme a permis aux participants de renforcer la qualité du dépistage et des opérations de leurs laboratoires. Le programme a été une réussite dans l'ensemble puisqu'il a été suivi jusqu'à son terme par 80% des participants et que ceux-ci ont ensuite pu mettre en place des changements réels dans leurs laboratoires. Ce succès est encourageant et pourrait servir de modèle afin de renforcer davantage encore les capacités des laboratoires dans la Région

The MoCA: well-suited screen for cognitive impairment in Parkinson disease.

OBJECTIVE: To establish the diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) when screening externally validated cognition in Parkinson disease (PD), by comparison with a PD-focused test (Scales for Outcomes in Parkinson disease-Cognition [SCOPA-COG]) and the standardized Mini-Mental State Examination (S-MMSE) as benchmarks. METHODS: A convenience sample of 114 patients with idiopathic PD and 47 healthy controls was examined in a movement disorders center. The 21 patients with dementia (PD-D) were diagnosed using Movement Disorders Society criteria, externally validated by detailed independent functional and neuropsychological tests. The 21 patients with mild cognitive impairment (PD-MCI) scored 1.5 SD or more below normative data in at least 2 measures in 1 of 4 cognitive domains. Other patients had normal cognition (PD-N). RESULTS: Primary outcomes using receiver operating characteristic (ROC) curve analyses showed that all 3 mental status tests produced excellent discrimination of PD-D from patients without dementia (area under the curve [AUC], 87%-91%) and PD-MCI from PD-N patients (AUC, 78%-90%), but the MoCA was generally better suited across both assessments. The optimal MoCA screening cutoffs were <21/30 for PD-D (sensitivity 81%; specificity 95%; negative predictive value [NPV] 92%) and <26/30 for PD-MCI (sensitivity 90%; specificity 75%; NPV 95%). Further support that the MoCA is at least equivalent to the SCOPA-COG, and superior to the S-MMSE, came from the simultaneous classification of the 3 PD patient groups (volumes under a 3-dimensional ROC surface, chance = 17%: MoCA 79%, confidence interval [CI] 70%-89%; SCOPA-COG 74%, CI 62%-86%; MMSE-Sevens item 56%, CI 44%-68%; MMSE-World item 62%, CI 50%-73%). CONCLUSIONS: The MoCA is a suitably accurate, brief test when screening all levels of cognition in PD.

Recent crosse designs increase ball velocity: implications for injury in women's lacrosse.

The aim of this preliminary investigation was to describe the kinematics of ball release from 24 different lacrosse stick models during the performance of an overhand pass. Multiple trials (N=120) of an overhand lacrosse pass, performed by an elite female lacrosse athlete, were captured in the sagittal plane using two-dimensional videography and analysed using motion analysis software. On average, there was a tendency for balls to release earlier from wood crosses (180.8+/-16.0 degrees ) than from synthetic crosses (183.6+/-6.0 degrees ) (p>0.15) and earlier from non-planar linear (179.7+/-6.7 degrees ) and non-planar curvilinear (182.5+/-9.5 degrees ) crosse heads than from traditional, planar-headed sticks (185.6+/-11.7 degrees ). Peak angular velocities of the stick shaft were lower for the wood as compared to the synthetic crosses (p<0.001) with mean values of 15.4+/-0.6rads(-1) and 16.6+/-0.7rads(-1), respectively. Similarly, the resultant velocity of the ball at release was significantly lower (p<0.001) for the wood crosses (13.9+/-0.8ms(-1)) as compared to the synthetic crosses (14.8+/-0.6ms(-1)). These results indicate that changes in the material composition and design of lacrosse sticks are changing the timing and rate at which balls release from the crosse pocket. Strict rule enforcement, good coaching, the mandatory use of protective equipment and continuous monitoring of changes in stick technology will be required if the frequency and severity of ocular, head and facial injuries are to be controlled.

Lacrosse stick entrapment injury to the thumb.

A case of injury to the left thumb following an errant stick check, and subsequent entrapment of the digit in the open sidewall of a lacrosse stick, is presented. A circumferential laceration, severe swelling, and bruising to the proximal phalanx resulted. This case report emphasises the need to limit the dimensions of openings in the sidewalls of lacrosse sticks to prevent the occurrence of this and other preventable injuries.

The influence of external orthotic support on the adaptive gait characteristics of individuals with chronically unstable ankles.

External orthotic supports or braces are used clinically to treat individuals with chronically unstable ankles. Braces have efficacious effects on dynamic strength, passive tissue tension, and proprioception, but their effects on gait remains undetermined. The purpose of this study was to determine if overground locomotion, including walking up a step and a curb are influenced by orthotic device use. Twenty subjects, 10 with no previous injury and 10 with chronically unstable ankles, performed with no brace, a flexible brace and a semi-rigid brace while walking on a level surface, up a step and on a ramp. Differences were noted in kinematic and kinetic gait parameters between groups and between step and ramp conditions, suggesting that gait patterns vary between individuals who have had ankle sprain and those who have not. Few differences were noted between the brace and no brace conditions for both groups. Adding to the previously described efficacious benefits, we conclude that bracing does not alter selected gait parameters in individuals who have chronic ankle instability.

Seminal vesicle cyst with ipsilateral renal agenesis.

OBJECTIVE: The purpose of this study was to review the clinical symptoms and imaging features of a seminal vesicle cyst associated with renal agenesis. CONCLUSION: Patients with seminal vesicle cysts associated with renal agenesis may present with symptoms of bladder irritation or obstruction and with an abdominal or pelvic mass revealed on physical examination. Differentiation of a seminal vesicle cyst from other pelvic cystic masses may be determined with a spectrum of imaging techniques including excretory urography, sonography, CT, and MR imaging.

Decision training: the effects of complex instruction, variable practice and reduced delayed feedback on the acquisition and transfer of a motor skill.

Novice, intermediate and advanced baseball hitters followed a 7-week training programme, in which they received either behavioural training or decision training. Participants in the behavioural training group received simple-to-complex instruction, variable practice and an abundance of feedback throughout the acquisition period; the decision training group received complex instruction, variable practice and reduced delayed feedback. As predicted, the intermediate and advanced hitters who received decision training hit at a lower level (%) during acquisition but at a higher level during a transfer test in week 7. Novices in the behavioural training group were better than novices in the decision training group over both acquisition and transfer trials.

Bilateral Q angle asymmetry and anterior knee pain syndrome.

OBJECTIVE: To determine whether quadriceps (Q) angles were bilaterally symmetric in individuals asymptomatic vs symptomatic for anterior knee pain. DESIGN: Cross-sectional study. BACKGROUND: Previous attempts to link excessive Q angles to the occurrence of knee pain have yielded equivocal results. Deriving unilateral rather than bilateral measures of the Q angle and thereafter analysing data using traditional between-group analysis-of-variance structural models may, however, play a role in obscuring the true nature of the Q angle-knee pain relationship. METHODS: Left and right Q angles were goniometrically measured in 75 subjects (37 males, 38 females) while they adopted a static, standing position with quadriceps relaxed. The majority (n = 50) were asymptomatic, while the remainder were unilaterally (n = 11) or bilaterally (n = 14) symptomatic for anterior knee pain. A questionnaire was used to determine the extent and magnitude of pain experienced in each of the symptomatic subjects. RESULTS: Significant right vs left lower limb differences in Q angles were observed by group (p < 0.001) and group by gender (p < 0.05). Mean values, however, did not always reflect the true variation of data within the sample. Forty-seven percent of the subjects studied demonstrated a minimum 4 degrees bilateral Q angle difference, while in 13 of 75 subjects, this difference ranged from 8 degrees to 12 degrees. Only a weak yet significant relationship between right and left Q angles (r = 0.53, p < 0.001) was noted. While there were no correlations between Q angle measures and the magnitude of discomfort experienced in unilateral knee pain sufferers, these relationships were weak yet significant in bilateral knee pain sufferers. CONCLUSION: Q angles are not bilaterally symmetric, with the magnitude and direction of the observed asymmetry varying according to whether an individual is asymptomatic, unilaterally symptomatic, or bilaterally symptomatic for anterior knee pain. RELEVANCE: Future investigations of the Q angle must ensure that measures are derived bilaterally and analysed appropriately. Data from unilateral vs bilateral symptomatic subjects should be evaluated separately, and the shortcomings of standard ANOVA structural models must be recognized.

Genital mycoplasmas stimulate tumor necrosis factor-alpha and inducible nitric oxide synthase production from a murine macrophage cell line.

Ureaplasma urealyticum and Mycoplasma hominis, two genital mycoplasmas, are the most common organisms isolated in the perinatal period and both either cause or are associated with poor perinatal outcomes. We speculate that these microbes could increase inflammation by stimulating macrophages to produce tumor necrosis factor-alpha (TNF-alpha) and inducible nitric oxide synthase because of their propensity to interact with the host's immune system. To test this hypothesis, RAW 264.7 cells, a murine macrophage cell line, were coincubated for 16 h with either U. urealyticum or M. hominis, and LPS and sterile broth were used as controls. Lipopolysaccharide (LPS) and both mycoplasmas induced TNF-alpha production, which was concentration-dependent, whereas sterile broth had little effect. TNF-alpha production was not inhibited by the addition of polymyxin B, excluding the possibility of contaminating endotoxin in this effect. Inducible nitric oxide synthase was produced only in the presence of recombinant inteferon-gamma. We conclude that both viable and nonviable U. urealyticum and M. hominis are capable of TNF-alpha induction from murine macrophages and that LPS is not involved in this event. Also, the genital mycoplasmas are capable of stimulating inducible nitric oxide synthase production from murine macrophages. We speculate that the genital mycoplasmas produce perinatal disease by producing proinflammatory mediators by their interaction with inflammatory cells and either induce or act as a catalyst and augment inflammation which in turn leads to a poor pregnancy outcome.

Exogenous bovine surfactant suppresses tumor necrosis factor-alpha release by murine macrophages stimulated by genital mycoplasmas.

Tumor necrosis factor-alpha (TNF-alpha) is a proinflammatory cytokine that appears to play a significant role in the development of neonatal chronic lung disease (CLD). Inflammation and CLD are also associated with respiratory tract colonization with genital mycoplasmas. The possible protective roles of surfactant in mitigating the inflammatory response to these microbes were investigated. Murine RAW 264.7 macrophages were preincubated with an exogenous surfactant and exposed overnight to sterile media, lipopolysaccharide (LPS), Mycoplasma hominis, or Ureaplasma urealyticum. Macrophages released TNF-alpha in response to challenge with LPS, U. urealyticum, and M. hominis in a concentration-dependent fashion. Surfactant suppressed LPS and M. hominis induced TNF-alpha production in a dose-dependent manner but suppressed U. urealyticum-mediated TNF-alpha production only at the higher dose tested. Similar effects were seen in hyperoxia (95% O2). Thus, exogenous bovine surfactant significantly inhibits the production of TNF-alpha by murine macrophages stimulated with genital mycoplasmas and bacterial LPS.

The quadriceps angle: a review of the literature.

Previous investigations of the quadriceps (Q) angle and its relationship to knee disorders have yielded equivocal results. The purpose of this paper is to present a review of the current literature on the Q angle and to examine the differences in Q angles when measured: 1) under differing measurement protocols; 2) between asymptomatic and symptomatic populations; 3) between male and female samples; and 4) from side to side within subjects. Little scientific evidence exists to support the commonly held assumptions that Q angles are larger in symptomatic vs. asymptomatic or that they are equal in the right vs. left lower limb. However, larger mean values are consistently observed in groups of young adult females vs. young adult males.

Conflict and aggression in group psychotherapy: a self psychological vantage point.

Self psychology's emphasis on listening and understanding from a patient's vantage point has led to a commonly held misconception that it ignores conflict and aggression; this is not the case. On the contrary, an understanding of rage is central to Kohut's views. Some basic self psychological concepts and their application to dealing with conflict and aggression in group psychotherapy are presented along with a clinical illustration. In the approach presented, it is not the rage and conflict itself that becomes the focus of the therapeutic endeavor. It is the underlying vulnerability that must be expressed, explored, and worked through in order to facilitate a curative process.

Bilateral within-subject Q angle asymmetry in young adult females and males.

Previous investigations of the quadriceps angle (or Q angle) and its relationship to knee disorders have yielded equivocal results. Methodological differences may account for some of the observed discrepancies, but so too may the tendency for investigators to rely on between-group rather than within-subject research designs. The purpose of this investigation was to study the between-group (male versus female) and within-subject (right versus left lower limb) differences in Q angle measures in subjects with no history of knee disorders. The right and left Q angles of fifty young men and women were measured goniometrically with subjects standing in an erect, weight-bearing position. In males, there was little disparity in the magnitude of the Q angle between the right (9.5 degrees +/- 4.6) and left (10.4 degrees +/- 5.7) lower limb. Similarly, in females, the mean value for the right Q angle (10.5 degrees +/- 4.2) was only slightly smaller in magnitude than that of the left (12.2 degrees +/- 5.2). A 2 x 2 ANOVA revealed no significant gender (p < 0.17) or right to left lower limb (p < 0.19) differences. However, when the data for each subject was examined on an individual basis, the magnitude of the right and left Q angles differed by 4 degrees or more in 24 subjects. In 10 subjects, this difference ranged from 8.0 degrees to 10.3 degrees. For the majority of subjects the left Q angle was greater in magnitude than the right Q angle. These results suggest that (I) the assumption of symmetry in right versus left lower limb Q angle measures may be erroneous, (II) statistical comparisons of mean values may not be the best method by which to analyze Q angle data, and (III) further investigation of bilateral within-subject Q angle asymmetry is warranted.

Segmental inertial parameters of the human trunk as determined from computed tomography.

This study used computed tomography (CT) imaging to determine in vivo mass, center of mass (CM), and moments of inertia (Icm) about the CM of discrete segments of the human torso. Four subjects, two males and two females, underwent serial transverse CT scans that were collected at 1-cm intervals for the full length of the trunk. The pixel intensity values of transverse images were correlated to tissue densities, thereby allowing trunk section mass properties to be calculated. The percentage of body mass observed by vertebral levels ranged from 1.1% at T1 to 2.6% at L5. The masses of the upper, middle, and lower trunk segments as percentages of body mass were estimated to be 18.5, 12.2, and 10.7%, respectively. The whole trunk mass was estimated to comprise 41.6% of the total body mass. Transverse vertebral CM values were found to lie anterior to their respective vertebral centroids by up to 5.0 cm in the lower thoracic region. For the upper, middle, and lower trunk segments, the average CM positions were found to be 25.9, 62.5, and 86.9% of the distance from the superior to inferior ends of the trunk. The upper and middle trunk CMs corresponded to approximately 4.0 cm anterior to T7/T8 vertebral centroid levels and 1.0 cm anterior to L3/L4 vertebral centroid levels, respectively. For the whole trunk, the CM was 52.7% of the distance from the xiphoid process and approximately 2.0 cm anterior to L1/L2 vertebral centroid levels. Variations in CM and Icm values were observed between subject, but these were within the range of previous reports of body segment parameters. Differences from previous studies were attributable to variations in boundary definitions, measurement techniques, population groups, and body states (live versus cadaver) examined. The disparity between previous findings and findings of this study emphasizes the need to better define the segmental properties of the trunk so that improved biomechanical representation of the body can be achieved.

Eye injuries in women's lacrosse: strict rule enforcement and mandatory eyewear required.

OBJECTIVE: To inform practitioners of the risk of ocular injury in women's lacrosse and to advocate the mandatory use of protective eyewear. DESIGN, MATERIALS AND METHODS: Athletes reported retrospectively, via a questionnaire, on the nature and circumstances leading to their injuries. MEASUREMENTS AND MAIN RESULTS: Four case reports of injury to ocular and adjacent nasal structures are presented. None of the athletes was wearing protective equipment at the time that her injuries were incurred. CONCLUSIONS: Mandatory eye protection should be introduced into the game of women's field lacrosse. Eyewear may have prevented the injuries reported in this article.

Hockey helmets, face masks, and injurious behavior.

OBJECTIVE: To educate physicians about factors that contribute to injurious behaviors in ice hockey and to propose that the medical community play a role in advocating change within the sport. METHODS: A review of relevant literature on the topic was conducted, with information drawn from scientific journal publications, conference proceeding, theses, and newspaper publications. RESULTS: The introduction of mandatory head and facial protection has been effective in virtually eliminating ocular, facial, and dental injuries in youth hockey, but it has also been problematically linked with an increase in catastrophic spinal injuries. Players adopt a false sense of security when donning the equipment, leading them to take excessive and unwarranted risks because of the protection they are supposedly afforded. The addition of these protective devices has also altered how officials perceive game situations, leading them to be more lenient in administering penalties. The net result has been an increase in illegal and injurious behaviors, such as checking from behind. CONCLUSION: Physician advocacy may play an important role in effecting change within the sport.

The geometry of the psoas muscle as determined by magnetic resonance imaging.

Magnetic resonance images from fifteen physically active and asymptomatic male volunteers were collected to present morphometric parameters on the psoas and its moment arms, which are important in the study of spinal mechanics and models for the investigation of low back pain. The mean age of the subjects was 21.5 +/- 1.8 years. Data were obtained from nine vertebral and/or intervertebral levels (L2, L2/L3, L3, L3/L4, L4, L4/L5, L5, L5/S1, S1). In general, the psoas increased in size as it descended the trunk, moving anteriorly and slightly laterally in relation to the vertebral column. Maximum cross-sectional areas for the psoas (M = 16.3cm2) were observed at the L4/L5 level. Right-left symmetry was apparent in the aforementioned dimension, but not with respect to the mediolateral (X) diameter of the muscle. The length of the X moment arm was significantly (p < .05) greater for the right versus the left psoas from L3 to S1, with the length increasing as the psoas descended the trunk. However, this trend was not noted for the anteroposterior (Y) moment arm where observed values remained relatively small throughout the course of the muscle. These results will contribute to the study of low back pain onset and the design of appropriate rehabilitation interventions by providing accurate morphometric parameters for biomechanical models to predict of the loading conditions of the spine in vivo.

Developmental requirements for the ecdysoneless (ecd) locus in Drosophila melanogaster.

The ecdysoneless locus in Drosophila melanogaster has been defined previously by a single conditional mutation, I(3)ecd1, that causes an ecdysteroid deficit and larval death at the restrictive temperature, 29 degrees C, although the primary role of the mutation in developmental processes has been unclear. Gene dosage and complementation studies reported here for ecd1 and five nonconditional lethal alleles indicate that the ecd locus plays prezygotic and postzygotic roles essential for normal embryonic development, the successful completion of each larval molt, adult eclosion, and female fertility. The ecd locus is also required for normal macrochaete differentiation. For each observed phenotype, the severity of mutational effects was correlated with ecd mutant genotypes. In all cases, ecd1 homozygotes were least affected. Mutants heteroallelic for ecd1 and any one of four nonconditional recessive mutations were more severely affected than ecd1 homozygotes, revealing these as hypomorphic alleles. For all phenotypic effects, mutants heteroallelic for ecd1 and a dominant mutation (ecd3D) were most severely affected. These individuals died during embryogenesis at 29 degrees C and developed no macrochaetes on the dorsal thorax when transferred to 29 degrees C during the white prepupal stage. The ecd3D mutation also caused female semisterility in heterozygotes. Ecdysteroid regulation has been implicated previously in all the developmental processes disrupted by these ecd mutations except for macrochaete differentiation.