Treatment of severe vertebral body compression fractures with percutaneous vertebroplasty.

OBJECTIVE: Evaluate the efficacy of percutaneous vertebroplasty for severe vertebral body compression fractures. METHODS: Over a period of 6 years and 8 months, 661 vertebroplasties were performed in 292 patients at our institution. Of these, 69 patients met our criteria for a severe vertebral body compression fracture defined as vertebral body collapse to less than one-third of the original height. Of the 69, 25 underwent single level vertebroplasty. Imaging features were then analyzed including location, extent of collapse, pattern of compression, pre- and post-kyphotic angle and adjacent disc height. Complications and clinical outcomes were then evaluated. RESULTS: Involved vertebra ranged from T6 to L5 with 60% at the thoracolumbar junction. Vertebral body collapse ranged from 30 to 14% (mean 22%) of original height. Pattern of collapse included 11/ 25 (44%) plana, 8/25 (32%) gibbus, and 6/25 (24%) H-shaped. Kyphotic angle before vertebroplasty ranged from 33-0° (mean 16°) with an average correction of 1.2° after vertebroplasty. Mean disc height before vertebroplasty was 7.3 mm above and 7.7 mm below. Complications included cement leak to the adjacent disc in 16 (64%) and the paravertebral soft tissues in 3 (12%). Cement leak into the proximal azygous vein was documented in one case. International Quality of Life Questionnaire VAS was completed before and after (6 weeks) the procedure by all but six patients. Mean pre-intervention VAS was reported as 7.00 (range 5-10, SD 1.73) and mean post-intervention VAS was reported as 5.11 (range 0-9, SD 2.56), demonstrating a statistically significant improvement in pain (P < 0.015, 95% CI = 0.83-2.96) with 84% or 16/19 patients reporting some degree of improvement. CONCLUSION: Percutaneous vertebroplasty is safe and effective in the treatment of single level severe vertebral body compression fractures.

A generative co-design framework for healthcare innovation: development and application of an end-user engagement framework.

Background Continual improvements to health systems, products, and services are necessary for improvements in health. However, many of these improvements are not incorporated into everyday practice. When designing new health systems, products, and services, involving members of the healthcare community and the public with personal healthcare experience can help to make sure that improvements will be useful and relevant to others like them. Methods Together with healthcare workers and family members with healthcare experience, we developed and applied a step-by-step guide to involving those with personal experience in the design of health system improvements. Results Our guide has three phases- 'Pre-Design', 'Co-Design', and 'Post-Design'. This paper describes each of these phases and illustrates how we applied them to our own project, which is to use virtual healthcare methods to improve care for children with chronic healthcare conditions and their families. In our own work, we found that healthcare workers and family members with personal healthcare experiences were able to use their knowledge and creativity to help us imagine how to improve care for children with chronic healthcare conditions and their families. We have created action items from these family member- and healthcare worker-identified needs, which we will use to shape our virtual healthcare system. Conclusions This paper may be useful for those seeking to involve members of the healthcare community and the public in the creation of better healthcare systems, products, and services. Background Challenges with the adoption, scale, and spread of health innovations represent significant gaps in the evidence-to-practice cycle. In the health innovation design process, a lack of attention paid to the needs of end-users, and subsequent tailoring of innovations to meet these needs, is a possible reason for this deficit. In the creative field of health innovation, which includes the design of healthcare products, systems (governance and organization mechanisms), and services (delivery mechanisms), a framework for both soliciting the needs of end-users and translating these needs into the design of health innovations is needed. Methods To address this gap, our team developed and applied a seven-step methodological framework, called A Generative Co-Design Framework for Healthcare Innovation. This framework was developed by an interdisciplinary team that included patient partners. Results This manuscript contributes a framework and applied exemplar for those seeking to engage end-users in the creative process of healthcare innovation. Through the stages of 'Pre-Design', 'Co-Design', and 'Post-Design', we were able to harness the creative insights of end-users, drawing on their experiences to shape a future state of care. Using an expository example of our own work, the DigiComp Kids project, we illustrate the application of each stage of the Framework. Conclusions A Generative Co-Design Framework for Healthcare Innovation provides healthcare innovators, applied health science researchers, clinicians, and quality improvement specialists with a guide to eliciting and incorporating the viewpoints of end-users while distilling practical considerations for healthcare innovation and design.

Sjögren syndrome: advances in the pathogenesis from animal models.

Sjögren syndrome is an autoimmune disease characterized by hyposecretion of the lacrimal and salivary glands, resulting in dryness of the eyes and mouth. Individuals may experience primary Sjögren syndrome or a secondary form accompanying another rheumatic autoimmune disease, such as rheumatoid arthritis or systemic lupus erythematosus. The pathogenic mechanisms of Sjögren syndrome remain largely unknown, in part a consequence of the heterogeneity of the disease. Animal models have shed light on the connections between specific pathways and symptoms, but an ideal system is wanting. Improved disease models will enable a better understanding of Sjögren syndrome, including how immune tolerance is lost and potential therapeutic interventions. Most importantly, an optimal model will enable detection of disease biomarkers, since injury to the salivary glands may precede lymphocytic infiltration. This review aims to characterize available mice models of Sjögren syndrome, including advantages and disadvantages, from the researcher's perspective.

Gametogony of eimeria tenella (coccidia) in cell cultures.

Mature male and female gametocytes of Eimeria tenella, a coccidium of the chicken ceca, developed in primary cultures of chick embryonic kidney cells inoculated with sporozoites. Immature gametocytes appeared in the cultures after approximately 144 hours of incubation at 41 degrees C. Mature micro-and macrogametes were present from 160 to 190 hours after inoculation.

Energy partitioning by broiler breeder pullets in skip-a-day and precision feeding systems.

An empirical nonlinear mixed model was derived to describe metabolizable energy (ME) partitioning in Ross 308 broiler breeder pullets. Its coefficients described ME used for total heat production (HP) and growth. A total of 630 pullets were randomly and equally assigned to 2 treatments: precision feeding (PF) and conventional skip-a-day feeding (CON) from 10 to 23 wk of age. The PF system allowed birds to enter voluntarily at any time, weighed them, and provided access to feed for 60 s if their BW was less than the target BW. Birds in the CON treatment were fed as a group on alternate days. Energetic efficiency of pullets was evaluated using residual total heat production (RHP), defined as the difference between observed and predicted total HP. Additionally, ME intake (MEI), ADG, HP, and cumulative feed conversion ratio (FCR) were calculated for the entire experimental period. The energy partitioning model (P < 0.05) predicted MEI = (120+u)BW0.68 + 1.52(ADG) + ε. Total HP was (120 kcal/kg0.68 + u); the energy requirement for each g of BW gain was 1.52 kcal/d. The random variable u ∼ N (0, σu2) indicated a pen level HP standard deviation σu = 12.1 kcal/kg0.68. Over the experimental period, for CON and PF treatments, respectively, MEI was 194 and 174 kcal/d (P < 0.001); ADG was 15.3 and 15.4 g/d (P = 0.94); HP was 129 and 111 kcal/kg0.68 (P < 0.001); FCR was 4.888 and 4.057 (P < 0.001); and RHP was 0.12 and -0.12 kcal/kg0.68 (P = 0.73). The CON pullets had similar ADG, but higher MEI relative to PF, consistent with levels of heat production predicted by RHP. The PF pullets had lower cumulative FCR compared to CON pullets. The PF pullets lost less energy as heat, likely because they were fed continuously, reducing the need to store and mobilize nutrients compared to CON pullets. Thus, increased feeding frequency likely increased PF pullet efficiency.

The effect of broiler breeder genetic strain and parent flock age on eggshell conductance and embryonic metabolism.

The effect of genetic strain (Ross 308; Cobb 500) and parent flock age [young (29 wk), peak (Ross = 34 wk; Cobb = 36 wk), postpeak (40 wk), mature (45 wk), old (55 wk), and very old (59 wk)] on eggshell conductance and embryonic metabolism were examined. At each flock age, eggs from each strain were incubated for 21.5 d in individual metabolic chambers to measure embryonic O(2) intake and CO(2) output. From these data, the respiratory quotient (RQ) and metabolic heat production were calculated. Data were analyzed by the GLM procedure of SAS at P < or = 0.05. Neither strain nor flock age influenced conductance. Total embryonic O(2) consumption, CO(2) output, RQ, and metabolic heat production over the entire incubation period were not affected by strain. Daily differences existed between strains for embryonic O(2) intake (1, 7, 16, 17, 19, 20 d of incubation), CO(2) output (1 to 4, 16 to 20 d of incubation), and heat production (4, 7, 16 to 19 d of incubation). Embryos from young, mature, old, and very old flocks produced significantly more total embryonic heat over the entire 21 d (1,712, 1,677, 1,808, and 1,832, respectively) than embryos from peak (1,601) and postpeak (1,693) flocks. Average RQ for the entire incubation period was higher in embryos from mature flocks compared with all other flock ages. Daily differences among embryos from different flock ages were shown for O(2) consumption (all but d 8 of incubation), CO(2) production (all but d 7 and 9 of incubation), and heat output. The results showed that genetic strain and parent flock age influence daily embryonic metabolism, especially during the early and latter days of incubation. These daily differences coincide with the days of incubation having a higher incidence of embryonic mortality; these 2 factors may be related. Further investigation into the relationship between embryonic metabolic heat production and mortality during incubation may lead to the development of specific incubation conditions for different genetic strains and flock ages.

Precision feeding: Innovative management of broiler breeder feed intake and flock uniformity.

Achieving high lifetime productivity with broiler breeder flocks is challenging because feed restriction intensity continues to increase due to selection for efficient, fast growing, and high yielding broilers. Flock uniformity is compromised by intense competition for limited feed. Equitable feed allocation and stable metabolic rates are likely to increase reproductive efficiency. A prototype precision feeding (PF) station was developed to sequentially feed birds according to their individual needs. If pullets were under target BW, the station provided small amounts of feed during short feeding bouts. The objectives of the current study were to determine whether a sequential PF system could control BW of individual group-housed pullets by matching real-time BW to BW targets, and to quantify fluctuations in metabolic rate using continuous or stepwise increases in target BW. Two treatments were used in a completely randomized design: CON, the Ross 708 target BW curve interpolated hourly; and STEP, the Ross 708 BW curve updated every 21 days. Twenty Ross 708 broiler breeder pullets were assigned to the treatments (n = 10 per treatment). All pullets were fed by one PF station in a single pen from 35 to 140 d of age. Feed intake and BW records were used to evaluate BW and BW variation to estimate maintenance ME requirements, and to evaluate feeding patterns. Differences were reported as significant where P < 0.05. Precision feeding allowed different feeding programs to be evaluated in the same pen. In both treatments, BW CV decreased to less than 2% by wk 20. Complex temporal differences in feed intake and BW reflected treatment-specific target growth trajectories. Metabolic rate in the STEP treatment increased 70 to 100% during wk in which rapid growth was permitted, compared with wk in which BW targets were held constant. Precision feeding shows promise both as a data acquisition system for poultry researchers and breeders, and as a means of increasing broiler breeder flock uniformity.

A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders.

BACKGROUND: Previous cross-sectional data showed that children and adolescents with attention-deficit hyperactivity disorder (ADHD) are at increased risk of comorbid conduct, mood, and anxiety disorders as well as impairments in cognitive, social, family, and school functioning. However, longitudinal data were needed to confirm these initial impressions. METHODS: Using DSM-III-R structured diagnostic interviews and raters blinded as to diagnosis, we reexamined psychiatric diagnoses at 1- and 4-year follow-ups in children with ADHD and controls. In addition, subjects were evaluated for cognitive, achievement, social, school and family functioning. RESULTS: Analyses of follow-up findings revealed significant differences between children with ADHD and controls in rates of behavioral, mood, and anxiety disorders, with these disorders increasing markedly from baseline to follow-up assessments. In addition, children with ADHD had significantly more impaired cognitive, family, school, and psychosocial functioning than did controls. Baseline diagnosis of conduct disorder predicted major depression and bipolar disorder at follow-up, and anxiety disorders at baseline predicted anxiety disorders at follow-up. CONCLUSION: These results confirm and extend previous retrospective results indicating that children with ADHD are at high risk of developing a wide range of impairments affecting multiple domains of psychopathology such as cognition, interpersonal, school, and family functioning. These findings provide further support for the value of considering psychiatric comorbidity in both clinical assessment and research protocols involving children with ADHD.

Toward a new psychometric definition of social disability in children with attention-deficit hyperactivity disorder.

OBJECTIVE: To investigate a new mechanism for identifying social disability in children with attention-deficit hyperactivity disorder (ADHD), employing psychometric methodology used in defining learning disabilities. METHOD: Two groups of index children were examined: 140 children with ADHD (referred from both psychiatric and pediatric sources) and 120 non-ADHD comparison children. Subjects were defined as socially disabled if they had a value greater than 1.65 on a standardized discrepancy score between observed and expected scores on a measure of social functioning (with expected scores derived as a function of the child's estimated Full Scale IQ). Children identified as socially disabled were compared with non-socially disabled probands on psychopathology, familiality, cognitive functioning, school history, and treatment history. RESULTS: Using this psychometric approach, 22% of the ADHD probands qualified as socially disabled, whereas none of the comparison probands qualified (p < or = .001). Socially disabled ADHD probands were significantly more impaired than were non-socially disabled ADHD probands in global and specific measures of social functioning and patterns of psychiatric comorbidity. CONCLUSIONS: The psychometrically defined construct of social disability may identify children with ADHD who are at very high risk for severe social dysfunction and whose course and prognosis may vary from those of other children with ADHD. This subgroup of children with ADHD may be at heightened risk for poor outcome, and their identification may facilitate the development of clinical interventions aimed at ameliorating their specific difficulties.

Attention-deficit hyperactivity disorder and juvenile mania: an overlooked comorbidity?

OBJECTIVE: To evaluate the psychiatric, cognitive, and functional correlates of attention-deficit hyperactivity disorder (ADHD) children with and without comorbid bipolar disorder (BPD). METHOD: DSM-III-R structured diagnostic interviews and blind raters were used to examine psychiatric diagnoses at baseline and 4-year follow-up in ADHD and control children. In addition, subjects were evaluated for cognitive, academic, social, school, and family functioning. RESULTS: BPD was diagnosed in 11% of ADHD children at baseline and in an additional 12% at 4-year follow-up. These rates were significantly higher than those of controls at each assessment. ADHD children with comorbid BPD at either baseline or follow-up assessment had significantly higher rates of additional psychopathology, psychiatric hospitalization, and severely impaired psychosocial functioning than other ADHD children. The clinical picture of bipolarity was mostly irritable and mixed. ADHD children with comorbid BPD also had a very severe symptomatic picture of ADHD as well as prototypical correlates of the disorder. Comorbidity between ADHD and BPD was not due to symptom overlap. ADHD children who developed BPD at the 4-year follow-up had higher initial rates of comorbidity, more symptoms of ADHD, worse scores on the CBCL, and a greater family history of mood disorder compared with non-BPD, ADHD children. CONCLUSIONS: The results extend previous results documenting that children with ADHD are at increased risk of developing BPD with its associated severe morbidity, dysfunction, and incapacitation.

Predictors of persistence and remission of ADHD into adolescence: results from a four-year prospective follow-up study.

OBJECTIVE: To evaluate the predictors of persistence and the timing of remission of attention-deficit hyperactivity disorder (ADHD). METHOD: Subjects were 6- to 17-year old Caucasian, non-Hispanic boys with and without ADHD. DSM-III-R structured diagnostic interviews and blind raters were used to examine psychiatric diagnoses, cognitive achievement, social, school, and family functioning at a 4-year follow-up assessment. RESULTS: At the 4-year follow-up assessment, 85% of children with ADHD continued to have the disorder and 15% remitted. Of those who remitted, half did so in childhood and the other half in adolescence. Predictors of persistence were familiality of ADHD, psychosocial adversity, and comorbidity with conduct, mood, and anxiety disorders. CONCLUSIONS: The findings prospectively confirm that the majority of children with ADHD will continue to express the disorder 4 years later. For a minority of children, ADHD was a transient disorder that remits early in development. In addition, we have shown that persistence of ADHD is predictable. Familiality, adversity, and psychiatric comorbidity may be clinically useful predictors of which children with ADHD are at risk for a persistent disorder.

Anterior transposition of the inferior oblique for dissociated vertical deviation with inferior oblique overaction.

We reviewed the charts of 17 children (27 eyes) who underwent anterior transposition of the inferior oblique muscle for dissociated vertical deviation coexistent with inferior oblique overaction. All the eyes showed an improvement in the inferior oblique overaction. Twenty-one eyes had reduction in the dissociated vertical deviation, five eyes showed no change in the degree of dissociated vertical deviation, and in one case the hyperdeviation increased after surgery. No intraoperative or late postoperative complications were noted. Anterior transposition is an effective procedure for weakening inferior oblique overaction coexistent with dissociated vertical deviation.

Investigating the eggshell conductance and embryonic metabolism of modern and unselected domestic avian genetic strains at two flock ages.

The objective of this study was to determine if broiler strain and breeder flock age affect eggshell conductance, fertility, and hatchability parameters; heart and hepatic glycogen concentrations at hatch; and embryonic metabolism throughout incubation. The 3 broiler strains investigated were HBY, a modern commercial broiler strain selected for high breast yield; WBM, a modern commercial broiler strain selected for the whole bird market; and UN78, a female broiler parent strain unselected since 1978. Fertility and hatchability parameters for each of the 3 strains were determined when the flocks were 32, 34, 37, and 38 wk of age. Eggshell conductance was measured on separate eggs produced from flocks at 37, 45, and 53 wk of age. Concurrently, fertile hatching eggs from the 3 broiler strains at 2 flock ages (33 and 38 wk) were incubated in individual metabolic chambers. Total daily CO2 production of each embryo was measured. Strain and flock age did not influence any of the fertility or hatchability parameters. Strain had no effect on conductance, but eggs from the 37-wk-old flocks had higher conductance than eggs from the 45- or 53-wk-old flocks, which did not differ from one another. Strain had no significant effect on average total CO2 production over the entire 21.5 d of incubation. However, embryos from the 38-wk-old flock produced more total CO2 than did embryos from the 33-wk-old flocks. Also, there was an interaction between strain and flock age for total CO2 production; UN78 embryos from the 33-wk flocks had higher CO2 production than WBM embryos, and the CO2 production of HBY did not differ from either strain. When embryos from the 38-wk flocks were compared, WBM embryos had higher CO2 production than did UN78 embryos, and HBY embryos did not differ from either strain. The data showed that in the 3 strains examined in this study, genetic differences in embryonic metabolic rate were dependent upon breeder flock age.

Coroners' records on suicide mortality in Montréal: limitations and implications in suicide prevention strategies.

INTRODUCTION: In Montréal, the characteristics of suicide cases may vary between different areas. The information collected by coroners during their investigations of suicides could be used to support local suicide-prevention planning actions. METHODS: This study analyzes all coroners' records on suicide in Montréal from 2007 to 2009 to (1) determine the usefulness of the data available; (2) develop a profile of cases; (3) examine local differences by comparing two areas, one with the highest suicide rate and the other with the lowest. RESULTS: The data collected revealed the lack of a systematic, standardized procedure for recording information about deaths by suicide. The rates of missing data varied, but were very high for antecedents of suicide attempts and recent events that could have precipitated the suicide. We observed differences in the characteristics of suicide cases according to area of residence. CONCLUSION: By adopting a standardized procedure for collecting information on cases of suicide, coroners could provide local decision makers with a more accurate portrait of the people who die by suicide in their area. Local adjustments may improve suicide prevention strategies.

TITRE: Dossiers des coroners sur la mortalité par suicide à Montréal : limites et incidences sur les stratégies de prévention du suicide. INTRODUCTION: À Montréal, les caractéristiques des cas de suicide sont susceptibles de varier d'un territoire à l'autre. Les données recueillies par les coroners dans le cadre de leurs investigations sur les suicides pourraient servir à appuyer la planification en matière de prévention du suicide à l'échelle locale. MÉTHODOLOGIE: Dans cette étude, nous avons analysé tous les dossiers des coroners relatifs aux décès par suicide survenus à Montréal entre 2007 et 2009 afin de déterminer l'utilité des données disponibles, d'établir un profil des cas de suicide et d'examiner les différences à l'échelle locale en comparant deux territoires, celui ayant le taux de suicide le plus élevé et celui ayant le taux le plus faible. RÉSULTATS: Les données recueillies ont révélé qu'il n'existait pas de procédure uniforme et systématique pour la consignation des données sur les décès par suicide. Quoique les taux de données manquantes aient été variables, ils étaient très élevés en ce qui concerne les antécédents de tentative de suicide et les événements récents qui pourraient avoir provoqué le suicide. Nous avons observé des différences dans les caractéristiques des personnes qui s'enlèvent la vie en fonction du territoire de résidence. CONCLUSION: L'adoption par les coroners d'une procédure uniforme de collecte de données sur les cas de suicide permettrait aux décideurs d'avoir un portrait plus juste des personnes décédées par suicide au sein de leur territoire. S'adapter à la situation locale pourrait améliorer les stratégies de prévention du suicide.

The design and use of the Personal Environmental Sampling Backpack (PESB II) for activity-specific exposure monitoring of career pig barn workers.

Career pig barn workers in large confinement barns are exposed to airborne contaminants that need to be quantified. Monitoring instrumentation had to be sanitized to satisfy the biosecurity entrance requirements for pig barns. We satisfied this requirement with the development of a portable Personal Environmental Sampling Backpack (PESB). A pilot study was conducted with the original PESB after which modifications were made to construct the PESB II. The objective of the present study was to modify the PESB to create a monitoring system that is acceptable to workers, accurate, able to collect and store data reliably, and transferable from one animal confinement operation to another. A CO2 sensor with a higher detection range was incorporated into the new instrumentation, H2S monitoring capability was added, and improvements were made to the amount of data the new PESB II instrumentation could store. Compared to the original PESB, the PESB II has a lower mass and volume (reduced by 46% and 70%, respectively), a wider range of CO2 measurement capability, an H2S sensor, a data logger with more data capacity for 11.5 h of real-time monitoring, and a high level of worker acceptability. Apart from revealing a problem with H2S cross-reacting with the NH3 sensor, the PESB II system measured all other parameters reliably and accurately while allowing disinfection to meet stringent biosecurity protocols.

Sensory effects on judgments of short time-intervals.

Two experiments were conducted to test the effect of nontemporal factors on duration discrimination. In Exp. 1, a forced-choice adaptive procedure with a standard duration of 400 or 800 ms was employed. It was shown that, for both auditory and visual modes, the discrimination is better with empty intervals (a silent period between two brief signals) than with filled intervals (a continuous signal), but only with shorter durations. In a second experiment, where intervals of the same duration range were employed but were presented with a single-stimulus method, discrimination was better with empty than with filled intervals, and this effect applied to both ranges of duration and both sensory modes. In both experiments, discrimination was better in the auditory than in the visual mode. These data are discussed in the context of current models of timing mechanisms.