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Daylight is a key component of green building; however, no prevailing metric has emerged to help identify buildings that are well-daylit buildings. This paper proposes a ‘daylighting dashboard’; a visual representation of a design’s potential to meet eight design goals: average illuminance, coverage, diffuse daylight, daylight autonomy, circadian stimulus, glazing area, view and solar heat gain. This metric allows for informed decisions to be made early in the conceptual phase of design, and highlights aspects of design that may need further development, while there is still the opportunity to make modifications. These eight goals should be prioritized as appropriate for individual projects, rating systems or code requirements. This early indication of performance of conceptual design alternatives is likely to guide architects to better daylit buildings. [ABSTRACT FROM AUTHOR]

Objective: Our study examines the association between suicidal ideation and and self-reported symptoms of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), and alcohol use disorder (AUD) in a sample of treatment-seeking Canadian combat and peacekeeping veterans; and identifies potential predictors of suicidal ideation.Methods: Actively serving Canadian Forces and Royal Canadian Mounted Police members and veterans seeking treatment at the Parkwood Hospital Operational Stress Injury Clinic (n = 250) completed measures including the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, the Alcohol Use Disorder Identification Test, and the PTSD Checklist-Military Version (PCL-M) between January 2002 and December 2010. Regression analyses were used to determine the respective impact of PTSD, and self-reported symptoms of MDD, GAD, AUD, and anxiety on suicidal ideation.Results: Most people met PCL-M screening criteria for PTSD (73.6%, n = 184), while 70.8% (n = 177) screened positively for a probable major depressive episode. PTSD symptom was significantly associated with suicidal ideation (β = 0.412, P < 0.001). After controlling for self-reported depressive symptom severity, AUD severity, and generalized anxiety, PTSD severity was no longer significantly associated with suicidal ideation (β = 0.043, P = 0.58).Conclusions: Although PTSD alone is associated with suicidal ideation, after controlling for common comorbid psychiatric illnesses, self-reported depressive symptom severity emerged as the most significant predictor of suicidal ideation. These findings support the importance of screening for comorbidities, particularly an MDD, as potentially modifiable conditions that are strongly related to suicidal ideation in military personnel's endorsing criteria for PTSD. [ABSTRACT FROM AUTHOR]

To determine the origin of >4,000 suspected diarrheagenic Escherichia coli strains isolated during 2004-2011 in South Africa, we identified 7 isolates as serotype O104; 5 as enteroaggregative E. coli O104:H4, and 2 as enteropathogenic E. coli O104:non-H4. Pulsed-field gel electrophoresis showed that these isolates were unrelated to the 2011 E. coli O104:H4 outbreak strain from Germany. [ABSTRACT FROM AUTHOR]

Cholera was absent from the island of Hispaniola at least a century before an outbreak that began in Haiti in the fall of 2010. Pulsed-field gel electrophoresis (PFGE) analysis of clinical isolates from the Haiti outbreak and recent global travelers returning to the United States showed indistinguishable PFGE fingerprints. To better explore the genetic ancestry of the Haiti outbreak strain, we acquired 23 whole-genome Vibrio cholerae sequences: 9 isolates obtained in Haiti or the Dominican Republic, 12 PFGE pattern-matched isolates linked to Asia or Africa, and 2 nonmatched outliers from the Western Hemisphere. Phylogenies for whole-genome sequences and core genome single-nucleotide polymorphisms showed that the Haiti outbreak strain is genetically related to strains originating in India and Cameroon. However, because no identical genetic match was found among sequenced contemporary isolates, a definitive genetic origin for the outbreak in Haiti remains speculative. [ABSTRACT FROM AUTHOR]

In October 2006, much of the wine-growing area in Tasmania was affected by a series of some of the worst frost events in more than 30 years. Widespread damage left vineyards with blackened shoots and the prospect of a considerably smaller crop, with later maturing bunches from secondary buds contributing to poorer quality wine. In a commercial, spur-pruned Pinot Noir planting, treatments intended to encourage and manipulate secondary bud-burst are imposed and effects on yield recorded. Treatments are imposed 10 days after the frost and include: (i) an untreated control (control) with all damaged tissue left in place; (ii) frost-damaged tissue removed (light pruning); (iii) frost-damaged tissue removed and original spur trimmed back to one bud (medium pruning); and (iv) original (damaged) shoot removed back to compound bud on the spur (heavy pruning). Pruning treatment responses for season 2006-07 show that heavy pruning reduces the current crop with no useful gain in uniformity of ripening. The medium and heavy pruning treatments also reduce pruning weights at the end of the season and all post-frost pruning treatments result in a smaller inflorescence primordia size in dormant buds dissected at the beginning of commercial pruning. In the 2007-08 vintage, the untreated control and the medium pruning treatment have significantly lower bunch numbers than the other treatments. There is also a significant effect of terrain elevation on total yield and the number of bunches in the frost year, with increasing damage lower in the inversion. This gradation in damage does not have carry-over effects into the second season. The results indicate that none of the pruning treatments tested have clear benefits for current or subsequent season production, and that a prescriptive approach to pruning should be avoided when the level of frost damage is inconsistent across vines. [ABSTRACT FROM AUTHOR]

This paper reports on a health needs assessment that set out to elicit the perceived and expressed health and wellbeing needs of the residents of a former mining village in Kent. Data was principally collected from residents, professionals and stakeholders through focus groups and interviews. Open days enabled key themes to emerge and provided verification of the research findings. A wide range of services and improvements that would have an impact on wellbeing were identified, requiring a multi-agency approach to delivery, but primary health care services were regarded as the priority. The outcome of the study has been a commitment from the primary care trust to provide a part-time nurse practitioner/prescriber in the village and to employ a community centre manager to support health promotion activities and thereby address the concerns raised by the residents and stakeholders. [ABSTRACT FROM AUTHOR]

School health policies and programs provide the framework for a safe and supportive environment for students with asthma. School Health Policies and Programs Study 2006 data were examined to assess whether schools nationwide have policies and programs consistent with the 'How Asthma-Friendly Is Your School?' checklist from the National Asthma Education and Prevention Program. Adherence to some of the recommendations on the checklist was high. For example, 80% or more of schools allowed students to carry and self-administer asthma medications, and obtained and kept asthma action plans. For other recommendations, however, far fewer schools had the recommended polices or programs; most notably, less than one third of schools had a full-time Registered Nurse. Improvements in many school policies and programs are needed so that students have a safe and supportive school environment to help them control their asthma while away from home. [ABSTRACT FROM AUTHOR]

Background: We found no information in the literature regarding the relationship between patient and physician-derived outcome assessments with a shoulder questionnaire. In this study, we examined a group of patients who were assessed with patient and physician-administered questionnaires following shoulder arthroplasty.Methods: From August 2003 to February 2004, sixty-seven consecutive patients who had been followed for a minimum of six months after shoulder arthroplasty were evaluated with a self-administered and an identical physician-directed shoulder questionnaire that assessed clinical and functional outcomes at the time of routine follow-up. An assessment of the agreement between physicians and patients as well as the factors that affected agreement was performed.Results: The intraclass correlation indicated almost perfect physician-patient agreement (>0.80) on items related to overall pain, pain at night, pain with activity, stability, and active elevation and substantial agreement (intraclass correlation, 0.66 and 0.69) between the physician and patient assessments of pain without activity and strength. While the differences were small, on the average physician ratings for pain were lower (indicating less pain) than patient ratings for pain, physicians rated stability and strength as being closer to normal, and they reported less active elevation. There was substantial agreement between the physician and patient assessments of outcome with the modified Neer system (intraclass correlation = 0.75), with 87% agreement if excellent and satisfactory outcomes were combined.Conclusions: A patient-derived questionnaire can provide a high level of agreement with surgeon assessments of outcome following shoulder surgery. Patient-administered methods should continue to be evaluated as a means of assessment of these patients. [ABSTRACT FROM AUTHOR]

Background: Currently, there is very little information available regarding the results of rotator cuff repair in patients with rheumatoid arthritis. Therefore, we reviewed our experience to determine the results, the risk factors for an unsatisfactory outcome, and the rates of failure of this procedure.Methods: We retrospectively reviewed the records of all patients with rheumatoid arthritis who had undergone repair of a rotator cuff tear at our institution from 1988 to 2002. Twenty-three shoulders in twenty-one patients were identified. The median duration of follow-up for the twenty shoulders that did not require revision surgery was 9.7 years. Nine shoulders had a partial-thickness tear, and fourteen had a full-thickness tear. The shoulders were assessed with regard to pain, functional outcome, and overall patient satisfaction.Results: Patients with both partial and full-thickness rotator cuff tears had significant improvements in terms of overall pain (p < 0.05) and satisfaction (p < 0.05). Patients who had undergone repair of a partial-thickness tear had improved active elevation (from 155 degrees to 180 degrees; p = 0.03), whereas patients who had undergone repair of a full-thickness tear did not have improved elevation. Six of the fourteen shoulders with a full-thickness tear had an unsatisfactory result, whereas only two of the nine shoulders with a partial-thickness tear had an unsatisfactory result.Conclusions: Rotator cuff repair in patients with rheumatoid arthritis can be challenging. However, durable pain relief and patient satisfaction can be achieved. Functional gains should not be expected in patients with full-thickness rotator cuff tears. Repair of the rotator cuff in patients with rheumatoid arthritis can be undertaken when nonoperative measures for pain relief have failed. [ABSTRACT FROM AUTHOR]

Background: Repetitive trauma to the hand is a concern for baseball players. The present study investigated the effects of repetitive trauma and the prevalence of microvascular pathological changes in the hands of minor league professional baseball players. In contrast to previous investigators, we documented the presence of abnormalities in younger, asymptomatic individuals.Methods: Thirty-six baseball players on active minor league rosters underwent a history and physical examination of both hands as well as additional specialized tests, including Doppler ultrasound, a timed Allen test, determination of digital brachial pressure indices, and ring sizing of fingers. Data were compared between gloved hands and throwing hands, hitters and nonhitters, and players at four different positions (catcher [nine subjects], outfielder [seven subjects], infielder [five subjects], and pitcher [fifteen subjects]).Results: Digital brachial indices in the ring fingers of the gloved (p < 0.05) and throwing hands (p < 0.02) of catchers were significantly diminished compared with those in all other players. Doppler testing showed a significantly greater prevalence of abnormal flow in the ulnar artery at Guyon's canal when catchers were compared with other position players (p < 0.01). Doppler abnormalities were significantly more common in the gloved hand compared with the throwing hand (p < 0.05). Seven of nine catchers (and only catchers) were found to have index finger hypertrophy (average change, two ring sizes; p < 0.01); the hypertrophy occurred at the proximal phalanx and the proximal interphalangeal joint of the gloved hand. Catchers had a significantly higher prevalence of subjective hand symptoms (specifically, weakness in the gloved hand) compared with pitchers and infielders/outfielders (44% compared with 7% and 17%, respectively; p < 0.05).Conclusions: Microvascular changes are present in the hands of otherwise healthy professional baseball players in all positions, with a significantly higher prevalence in catchers, prior to the development of clinically important ischemia. Repetitive trauma resulting from the impact of the baseball also leads to digital hypertrophy in the index finger of the gloved hand of catchers. Gloves currently used by professional catchers do not adequately protect the hand from repetitive trauma. [ABSTRACT FROM AUTHOR]

BACKGROUND: The diagnosis of a painful partial tear of the medial collateral ligament in overhead-throwing athletes is challenging, even for experienced elbow surgeons and despite the use of sophisticated imaging techniques. HYPOTHESIS: The 'moving valgus stress test' is an accurate physical examination technique for diagnosis of medial collateral ligament attenuation in the elbow. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Twenty-one patients underwent surgical intervention for medial elbow pain due to medial collateral ligament insufficiency or other abnormality of chronic valgus overload, and they were assessed preoperatively with an examination called the moving valgus stress test. To perform the moving valgus stress test, the examiner applies and maintains a constant moderate valgus torque to the fully flexed elbow and then quickly extends the elbow. The test is positive if the medial elbow pain is reproduced at the medial collateral ligament and is at maximum between 120 degrees and 70 degrees. RESULTS: The moving valgus stress test was highly sensitive (100%, 17 of 17 patients) and specific (75%, 3 of 4 patients) when compared to assessment of the medial collateral ligament by surgical exploration or arthroscopic valgus stress testing. The mean shear range (ie, the arc within which pain was produced with the moving valgus stress test) was 120 degrees to 70 degrees. The mean angle at which pain was at a maximum was 90 degrees of elbow flexion. CONCLUSIONS: The moving valgus stress test is an accurate physical examination technique that, when performed and interpreted correctly, is highly sensitive for medial elbow pain arising from the medial collateral ligament. [ABSTRACT FROM AUTHOR]

Background. In a recent longitudinal study of first-episode schizophrenia patients, we found that while dysfunction of the right dorsolateral prefrontal cortex (DLPFC), right thalamus, left cerebellum and cingulate gyrus normalized with antipsychotic treatment and significant reduction in symptomatology, the left DLPFC, left thalamus, and right cerebellum remained disturbed. In the present study we investigated whether these abnormalities are also present in clinically stable, relatively well-functioning schizophrenia patients in comparison to control subjects during performance of the N-back working-memory task.Method. Twelve schizophrenia and 12 control subjects completed the study. The functional images collected during scanning were analyzed using a random-effects model in a restricted set of six regions of interest (ROIs). In addition, the exploratory search in the entire brain volume was performed.Results. The ROI analyses revealed relative underactivation in the region of the left DLPFC and the right cerebellum, as well as overactivation in the left cerebellum. The exploratory whole-brain search exposed additional overactivation in the medial frontal, anterior cingulate, and left parietal cortices.Conclusions. The present study provides evidence of significant underactivations in stable schizophrenia patients in regions that we have previously observed to be dysfunctional in acutely psychotic and partially remitted patients, together with extensive overactivations in several regions that potentially reflect some compensatory mechanism or increased effort on the working-memory task. [ABSTRACT FROM AUTHOR]

The definition of the 'yips' has evolved over time. It is defined as a motor phenomenon of involuntary movements affecting golfers. In this paper, we have extended the definition to encompass a continuum from the neurologic disorder of dystonia to the psychologic disorder of choking. In many golfers, the pathophysiology of the 'yips' is believed to be an acquired deterioration in the function of motor pathways (e.g. those involving the basal ganglia) which are exacerbated when a threshold of high stress and physiologic arousal is exceeded. In other golfers, the 'yips' seems to result from severe performance anxiety. Physically, the 'yips' is manifested by symptoms of jerks, tremors or freezing in the hands and forearms. These symptoms can result in: (i) a poor quality of golf performance (adds 4.9 strokes per 18 holes); (ii) prompt use of alcohol and beta-blockers; and (iii) contribute to attrition in golf. Golfers with the 'yips' average 75 rounds per year, although many 'yips'-affected golfers decrease their playing time or quit to avoid exposure to this embarrassing problem. While more investigation is needed to determine the cause of the 'yips', this review article summarises and organises the available research. A small study included in this paper describes the 'yips' phenomenon from the subjective experience of 'yips'-affected golfers. The subjective experience (n = 72) provides preliminary support for the hypothesis suggesting that the 'yips' is on a continuum. Based on the subjective definitions of 72 'yips'-affected golfers, the 'yips' was differentiated into type I (dystonia) and type II (choking). A theoretical model provides a guide for future research on golfers with either type I or type II 'yips'. [ABSTRACT FROM AUTHOR]

A cohort of 282 elite amateur ice hockey players were analyzed to 1) record the number, type, location, and severity of head, neck, and facial injuries sustained during games; 2) examine the relationship between injuries and the type of facial protection (none, partial, or full) according to individual playing time; and 3) determine whether full or partial facial protection is associated with an increased incidence of concussions, eye injuries, and neck injuries. Fifty-two injuries (158.9 per 1000 player-game hours) occurred in players wearing no facial protection, 45 (73.5 per 1000 player-game hours) in players wearing partial facial protection (half shield), and 16 (23.2 per 1000 player-game hours) in players wearing full facial protection (full cage or shield). Players wearing no protection were injured at a rate more than twice that of players wearing partial protection and almost seven times higher than those wearing full protection. Concussions occurred in four players wearing no protection, five players wearing partial protection, and two players wearing full protection; these differences were not significant. The risk of eye injury was 4.7 times greater for players wearing no protection compared with those wearing partial protection. No eye or neck injuries occurred in players wearing full protection. This study demonstrates that both full and partial facial protection significantly reduce injuries to the eye and face without increasing neck injuries and concussions. [ABSTRACT FROM AUTHOR]

Purpose. To determine the impact on sonographers of converting an ultrasound facility from one that uses film to one that uses a picture archiving and communication system (PACS). Method. This study was conducted in two parts, part I to assess sonographer acceptance of PACS and part 2 to measure how much time was spent dealing with film before and after PACS installation. Results. PACS was well received by the sonographers prior to turning off film, and even better received after cessation of printing film. Significant time savings were gained. Four weeks after conversion, the results of the questionnaire were similar to that after cessation of film printing, indicating that the gains as a result of PACS were realized immediately at the time film printing was stopped. Conclusion. Transition to a filmless PACS was well received by sonographers and improved department efficiency. Significant time savings are realized once film printing stopped. [ABSTRACT FROM AUTHOR]

BACKGROUND: The 'yips' is a psychoneuromuscular impediment affecting execution of the putting stroke in golf. Yips symptoms of jerks, tremors and freezing often occur during tournament golf and may cause performance problems. Yips-affected golfers add approximately 4.7 strokes to their scores for 18 holes of golf, and have more forearm electromyogram activity and higher competitive anxiety than nonaffected golfers in both high and low anxiety putting conditions. The aetiology of the yips is not clear. OBJECTIVE: To determine whether the yips is a neurological problem exacerbated by anxiety, or whether the behaviour is initiated by anxiety and results in a permanent neuromuscular impediment. METHODS: In phase I, golf professionals assisted investigators in developing a yips questionnaire that was sent to tournament players (<12 handicap) to establish the prevalence and characteristics of the yips. Phase II measured putting behaviour in scenarios that contribute to the yips response. Four self-reported yips and 3 nonaffected golfers putted 3 scenarios using an uncorrected grip and a standard length putter. Heart rate was superimposed on the videotape and the putter grip was instrumented with strain gauges to measure grip force. Electromyograms and relative putting performance were also measured. RESULTS: The questionnaire was sent to 2,630 tournament players, of whom 1,031 (39%) responded (986 men and 45 women). Of these, 541 (52%) perceived they experienced the yips compared with 490 (48%) who did not. Yips-affected golfers reported that the most troublesome putts were 3, 4 and 2 feet (0.9, 1.2 and 0.6 metres) from the hole. Fast, downhill, left-to-right breaking putts and tournament play also elicited the yips response. Golfers affected by the yips had a faster mean heart rate, increased electromyogram activity patterns and exerted more grip force than nonrffected golfers and had a poorer putting performance. CONCLUSIONS: For <10 handicap male golfers and <12 handicap female golfers, the prevalence of the yips is between 32.5% and 47.7%, a high proportion of serious golfers. This high prevalence suggests that medical practitioners need to understand the aetiology of the yips phenomenon so that interventions can be identified and tested for effectiveness in alleviating symptoms. Although previous investigators concluded that the yips is a neuromuscular impediment aggravated but not caused by anxiety, we believe the yips represents a continuum on which 'choking' (anxiety-related) and dystonia symptoms anchor the extremes. The aetiology may well be an interaction of psychoneuromuscular influences. Future research to test the effect of medications such as beta-blockers should assist in better identifying the contributions these factors make to the yips phenomenon. [ABSTRACT FROM AUTHOR]

Introduction: Simultaneous treatment of HW and MTB can be complicated by drug interactions. Induction of the cytochrome P450 system by rifampicin (RIF) could lower plasma concentration leveis (PCL) of NNRTIs and possibly result in subtherapeutic levels. Aim: To measure real-time trough PCL of nevirapine (NVP) and efavirenz (EFV) in 12 patients taking both combination antiretroviral therapy (ARV) and twice-weekly RIF-containing Directly Observed Therapy (DOT). Methods: Nine patients on NVP 200mg bd and three on EFV 600mg od were studied. All patients received RIF 600mg DOT. NNRTI trough PCL were taken immediately prior to DOT, 24 hours post-DOT and on completion of DOT (controls). The PCL were taken 12 hours after last NVP dose and > 19 hours after last EFV dose. Results: Mean PCL of NVP (n=9) pr- and post-DOT were 3.91 µg/ mL and 4.4 µg/mL, respectively. The mean PCL of EFV (n = 3) preand post-DOT were 5.7 µtg/mL and 4.7 µg/mL, respectively. Five patients completed DOT and the mean PCL of NVP (n = 4) and EFV (n = 1) were 5.6 µg/mL and 2.2 µg/mL, respectively. Conclusion: In this small study all trough PCL of NNRTIs pre- and post-DOT and off DOT were within the normal range of historical controls, although significant interpatient variation did occur with EFV and RIF DOT. All patients had good surrogate marker response. Further NNRTI PCL monitoring of patients is needed to determine whether these drugs can be used concurrently. [ABSTRACT FROM AUTHOR]

Eighty-six male high school ice hockey players participated in this prospective study to determine both the incidence of injury in high school ice hockey and the influence of physical, situational, and psychosocial factors. Physical factors included height, weight, vision, previous injuries, musculoskeletal abnormalities, and injuries present at the time of screening evaluations. Situational factors examined were level of participation, playing time, player position, and games versus practices. Psychosocial factors such as confidence, stress, social support, positive states of mind, and mood states were also examined to determine their influences on injury. Twenty-seven injuries occurred during the 1994 to 1995 season. As hypothesized, the overall incidence of injury in high school hockey games (34.4 per 1000 player-game hours) was less than the incidence of injury in Junior A hockey (96.1 per 1000 player-game hours) and was more than previously reported for Bantam youth hockey (10.9 per 1000 player-game hours). Injuries occurred more often in games than in practices, usually as a result of collisions. Physical factors such as player position and previous injuries did not significantly predict injuries, but players in the high playing time group were more likely to be injured. Psychosocial factors of low vigor and high fatigue as measured by the Incredibly Short Profile of Mood States (ISPOMS) significantly predicted high school ice hockey injuries. [ABSTRACT FROM AUTHOR]

We report on the first recorded outbreak of cholera in Namibia. From December 2006 to February 2007, more than 250 cases of cholera were reported from the Omusati and Kunene provinces of Namibia. However, only nine bacterial isolates were obtainable for analysis. Isolates were all identified as Vibrio cholerae O1 serotype Inaba biotype El Tor. All isolates were susceptible to ampicillin, augmentin, chloramphenicol, nalidixic acid, ciprofloxacin, tetracycline, kanamycin, imipenem, ceftriaxone and ceftazidime; and they all showed resistance to trimethoprim, sulfamethoxazole and streptomycin. Pulsed-field gel electrophoresis analysis of bacteria incorporating either SfiI or NotI digestion revealed an identical fingerprint pattern for all isolates. These data together with results indicating identical antimicrobial susceptibility profiles for all isolates determined that the outbreak was caused by a single strain of V. cholerae. [ABSTRACT FROM AUTHOR]

Extended abstract of a paper presented at Microscopy and Microanalysis 2009 in Richmond, Virginia, USA, July 26 – July 30, 2009 [ABSTRACT FROM PUBLISHER]

We report the first case of appendicitis within a recurrent inguinal hernia, more unique in its presentation as epididymo-orchitis. A 61-year old male presented with right testicular pain, erythematous scrotum and raised inflammatory markers. He previously had recurrent left epididymo-orchitis and right inguinal hernia repair. A diagnosis of epididymo-orchitis was made but CT was performed which diagnosed acute appendicitis within a recurrent inguinal hernia entering the scrotum. This was confirmed intra-operatively with a distal inflamed appendix segment passing beyond the medial border of the exposed mesh. Correct pre-operative CT diagnosis requires high index of suspicion even with innocuous testicular symptoms. CT reduces misdiagnosis which is associated with significant morbidity, and also aids in planning surgical approach. The only other case of acute appendicitis presenting with testicular symptoms was diagnosed only during scrotal exploration necessitating further laparotomy. The appendix entrapment beyond the mesh could suggest an alternative aetiology of mesh-related appendicitis. [ABSTRACT FROM PUBLISHER]