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Understandings of sexual and gender identity have expanded beyond traditional binaries, yet we know little about adolescents’ appropriation of identity labels across diverse communities. In a mixed-methods study of adolescents recruited from lesbian, gay, bisexual, transgender, and queer (LGBTQ+) spaces in communities differing in support of sexual and gender diversity, seven patterns emerged: (a) frequent use of nonbinary gender identity labels (23.9% of survey sample), especially in high-support communities; (b) greater comfort among adolescents assigned female at birth (AFAB) with diverse gender expression, which informants attributed to pressures to conform to compulsive masculinity for boys; (c) frequent use of plurisexual (60.8%) and asexual (9.9%) labels, especially among those AFAB, and discussion of online settings as a resource; (d) intersectional patterning of “queer” to describe sexual identity (12.4% of survey sample), with White youth in high-support communities signifying an intellectual/political stance and non-White youth in low-support communities using queer as an umbrella term; (e) resistance to labeling and ambivalence about labels due to intra-community dynamics; (f) labeling challenges among boys of color; and (g) challenges with stigma, sexualization, and violence for transgender and nonbinary youth. Findings highlight how contemporary adolescents engage with and challenge received conceptions of gender and sexuality and how this process is shaped by intersectional identities.

This study identified custodial grandparents’ perception of sources of stress that may affect their health and better understand their needs. Findings from this qualitative study are based on thematic analysis of interviews with 10 custodial grandparents. The following themes emerged: 1) grandparents’ stress from perceived lack of readiness to care for grandchildren; 2) need for effective communication between and among family members; 3) sufficiency of financial and legal resources; 4) access to community resources, and 5) raising grandchildren reenergizes and revitalizes grandparents’ physical and mental health. These findings provide insight into the stressful aspects of the role of raising grandchildren. Understanding stressors affecting custodial grandparents and their grandchildren will help school nurses, social workers, teachers, school administrators and other professionals collaborate to address their challenges.

Background: Anterior cruciate ligament (ACL) rupture is a common knee injury among athletes and physically active adults. Despite surgical reconstruction and extensive rehabilitation, reinjuries are common and disability levels are high, even years after therapy and return to activity. Prolonged knee dysfunction may result in part from unresolved neuromuscular deficits of the surrounding joint musculature in response to injury. Indeed, “upstream” neurological adaptations occurring after injury may explain these persistent functional deficits. Despite evidence for injury consequences extending beyond the joint to the nervous system, the link between neurophysiological impairments and patient-reported measures of knee function remains unclear. Hypothesis: Patterns of brain activation for knee control are related to measures of patient-reported knee function in individuals after ACL reconstruction (ACL-R). Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: In this multicenter, cross-sectional study, participants with unilateral ACL-R (n = 25; 10 men, 15 women) underwent task-based functional magnetic resonance imaging testing. Participants performed repeated cycles of open-chain knee flexion/extension. Neural activation patterns during the movement task were quantified using blood oxygen level–dependent (BOLD) signals. Regions of interest were generated using the Juelich Histological Brain Atlas. Pearson product-moment correlations were used to determine the relationship between mean BOLD signal within each brain region and self-reported knee function level, as measured by the International Knee Documentation Committee index. Partial correlations were also calculated after controlling for time from surgery and sex. Results: Patient-reported knee function was positively and moderately correlated with the ipsilateral secondary somatosensory cortex ( r = 0.57, P = 0.005) and the ipsilateral supplementary motor area ( r = 0.51, P = 0.01). Conclusion: Increased ipsilateral secondary sensorimotor cortical activity is related to higher perceived knee function. Clinical Relevance: Central nervous system mechanisms for knee control are related to subjective levels of knee function after ACL-R. Increased neural activity may reflect central neuroplastic strategies to preserve knee functionality after traumatic injury.

Like all warfare, drone warfare is deeply gendered. This article explores how this military technology sediments or disrupts existing conceptualizations of women who kill in war. The article using the concept of motherhood as a narrative organizing trope and introduces a ‘fictional’ account of motherhood and drone warfare and data from a ‘real life’ account of a pregnant British Reaper operator. The article considers the way trauma experienced by Reaper drone crews is reported in a highly gendered manner, reflecting the way women’s violence is generally constructed as resulting from personal failures, lost love and irrational emotionality. This irrational emotionality is tied to a long history of medicalizing women’s bodies and psychologies because of their reproductive capacities and, specifically, their wombs – explored in this article under the historico-medical term of ‘hysteria’. The article argues that where barriers to women’s participation in warfare have, in the past, hinged upon their (argued) physical weakness, and where technology renders these barriers obsolete, there remains the tenacious myth that women are emotionally incapable of conducting lethal operations – a myth based on (mis)conceptions of the ‘naturalness’ of motherhood and the feminine capacity to give life.

Context: After anterior cruciate ligament (ACL) reconstruction (ACLR), athletes commonly undergo prolonged rehabilitation (eg, 9-12 months), but few actually return to preinjury sports activities. The nature (composition, configuration) of an ACL rehabilitation program (ACL-RP) is an important factor in determining rehabilitation outcomes; however, details about the nature of ACL-RPs are reported inconsistently in research studies. To guide future research reporting to support clinical translation and implementation of ACL-RPs, it is necessary to describe the nature, reporting, and outcomes of ACL-RPs in the current literature. Objective: The purpose of this scoping review was to understand the nature and reporting of various ACL-RPs that address musculoskeletal, biomechanical, functional, or patient-reported outcome measures in adult and pediatric athletes with ACLR. Data Sources: Articles were selected from searches in 5 electronic databases (PubMed, EbscoHost [MEDLINE, SportDiscus, CINAHL Plus], PROQuest, Cochrane, and Embase). Study Selection: Studies were included if they evaluated a post-ACL-RP that implemented strength, balance, plyometric, change of direction running, and/or agility running and included self-reported physical function, quality of life, or pain outcomes. Study Design: Scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Level of Evidence: Level 4. Data Extraction: Data were extracted and synthesized to evaluate the reporting of acute program variables (APVs) and exercise descriptors (EDs); 17 studies were included in the final synthesis. Results: Studies reported between 0% and 67% of the APVs and EDs combined. Only 2 studies were considered to have adequate reporting of both APVs and EDs. Conclusion: Inadequate reporting of APVs and EDs in past studies restricts the translation and implementation of existing research-based ACL-RPs to present-day clinical contexts.

Sleep quality amongst caregivers with disability may have been compounded by the COVID-19 pandemic. We evaluated differences in sleep quality amongst custodial grandparents from a southern state that were identified through state-based Kinship Care support groups coordinators and online. Participants ( N = 102) completed the Pittsburgh Sleep Quality Index and self-reported disability statuses. Gamma tests showed a strong negative relationship between disability and sleep duration indicating fewer hours of sleep, higher use of sleep medication and greater sleep disturbances. Disability is not significantly related to sleep latency, sleep efficiency, and daytime dysfunction. T-tests showed no strength of relationship between disability and overall sleep quality. During the first year of the COVID-19 pandemic, custodial grandparents with disability had greater issues with their sleep quality than those without disability. Sleep, as it pertains to its overall preponderant role in maintaining good health, should be examined amongst custodial grandparent caregivers and those with disability.

Objectives: Anterior cruciate ligament (ACL) rupture is a common knee injury among athletes and physically active adults. Despite surgical reconstruction and extensive rehabilitation, reinjury rates remain high and patient-reported disability continues even years after therapy and return to activity. Prolonged knee dysfunction has been attributed, in part, to unresolved neuromuscular deficits of the surrounding joint musculature in response to injury. Recent reports have identified widespread cortical and spinal cord changes to engage the quadriceps following injury, which may explain why a considerable proportion of patients exhibit persistent levels of knee disability. While these reports have provided evidence for consequences of injury that extend beyond the joint, there is a paucity of studies exploring the link between nervous system functioning and patient-reported measures of disability. The objective of this study was to determine the relationship between patient-reported knee disability and neural activity for knee control in patients with ACL reconstruction (ACL-R). Methods: In this multicenter cross-sectional study, twenty-five participants with unilateral ACL-R (18 left, 7 right; 10 males, 15 females; age, 21.8 ± 2.6 years; height, 169.7 ± 19.2 cm; weight, 69.6 ± 14.8 kg; Tegner activity level scale, 8.4 ± 1.2; IKDC, 84.9 ± 10.8; graft type, 15 quadrupled hamstring tendon / 10 bone-patellar-tendon-bone; time from surgery, 51.6 ± 32.0 months) underwent functional magnetic resonance imaging (fMRI) testing. fMRI testing consisted of repeated cycles of open-chain knee flexion/extension movement (Figure 1A). Neural activation patterns were quantified using blood-oxygen-level-dependent (BOLD) signals for all participants during the movement task at a cluster corrected z-threshold >2.3, pResults: ACL-R self-reported IKDC scores were positively related with neural activity within the ipsilateral secondary somatosensory cortex, S2 ( r=0.57, p=.005), and premotor cortex, PMC ( r=0.48, p=.02), after controlling for sex and time from surgery (Table 1, Figure 2-3). Conclusions: These data suggest increases in secondary sensorimotor activity (premotor, secondary somatosensory cortices) report greater levels of perceived knee function in patients following ACL-R. The S2 largely functions as a center for processing varied levels of somatosensory information. The PMC, on the other hand, receives a considerable number of sensory inputs but operates to guide voluntary movements. Therefore, increased recruitment of these regions may improve functionality to the knee or provide a neurologic mechanism to compensate for joint instability or the loss of afferent fibers within the ACL, in turn reducing levels of self-reported knee disability. Future investigations should determine if ACL-R patients with low self-reported disability would benefit from rehabilitation approaches that target these brain regions across the therapeutic window.

Category: Ankle; Other Introduction/Purpose: Recurrent ankle injuries can lead to chronic ankle instability requiring surgical stabilization. Since the anterior talofibular ligament (ATFL) is the weakest of the lateral ankle ligaments, repair is often required in cases of chronic lateral ankle instability. Damage to the calcaneofibular ligament (CFL) is less common than the ATFL, but additional repair of it in these cases may be necessary to avoid this recurrent instability. A modified Brostrom procedure has been a widely accepted surgical approach to chronic lateral ankle instability if conservative measures fail. However, cases of recurrent instability even after initial stabilization surgery can present. The purpose was to examine reasoning for and rate of revision surgeries attempting to fix chronic lateral ankle instability as it relates to the ATFL and CFL integrity. Methods: A retrospective chart review was conducted to assess outcomes of a modified Brostrom procedure to determine underlying reasoning of the need for revision surgery by utilizing results of the anterior drawer and varus tilt tests. The files of these patients were examined via electronic health records to determine the reasoning for surgery. The preoperative and postoperative results of the anterior drawer test (ADT) and varus tilt test were used to examine ATFL and CFL integrity, respectively, in addition to operative notes. Results: 172 patients met criteria having undergone a modified Brostrom dual ligament repair procedure for lateral ankle instability by a single orthopedic foot and ankle surgeon. With a 3.49% revision rate in the patient population, the only similarity found in all of the patients was the presence of a positive varus tilt test indicating the CFL was a major contributor of failed correction via the modified Brostrom procedure. One patient had a positive ADT, and one had a mildly positive ADT. These ADT and varus tests were performed at various time points in the care of the patients. The average length between surgeries was calculated to be 624.2 days. This revision rate is higher than past studies but was limited to a few years under examination. Conclusion: In conclusion, the anterior drawer and varus tilt tests are utilized to determine the integrity of the ATFL and CFL in the lateral ankle ligament complex. In failed modified Brostrom procedures examined, the positive result was consistently in the varus tilt test, indicating that the CFL is the ligament most affected in these patients requiring additional surgery. However, these physical exam tests are only one way to examine the ankle and do not take additional pathologies of the lateral ankle into account. Additional studies are needed to examine long-term outcomes of the modified Brostrom procedure and reasoning for failure.

Category: Ankle; Arthroscopy; Hindfoot; Lesser Toes; Midfoot/Forefoot; Other Introduction/Purpose: Popliteal nerve blocks are a common procedure employed by anesthesiologists to augment intraoperative anesthesia as well as provide postoperative pain control. Unfortunately, these can be associated with unintended complications. These complications may be sensory or motor including pain, numbness, and foot drop, sometimes without clear resolution. Studies suggest complications higher than previously reported, Lauf (2020). Our study looked to address the complication rates from an alternative anesthetic procedure, a distal ankle nerve block which involves anesthesia to the five nerve(s) more intimately involved in the surgical procedure. This alternative technique may provide equivalent anesthetic properties and pain relief as the popliteal blocks, with less motor and sensory complications for many patients across various demographics. Methods: We retrospectively reviewed patient charts and messaging from 2019 to 2021 that received a distal ankle field block for various surgical procedures including ankle arthroscopy, ankle fractures, and lateral ankle stabilizations. The five nerves anesthetized in the distal ankle nerve block included the tibial, superficial and deep peroneal, sural, and saphenous. Thus far, 90 surgeries have been reviewed and analyzed for neuropathic complications and confirmed via EMG. Results: Of the 90 patients analyzed, 3 patients were found to have a superficial peroneal neuropathy that included dorsal numbness as a result of the distal ankle block, resulting in a 3.33% complication rate. 1 patient required a rescue block to be performed post-operatively for pain. The remaining 87 patients recovered appropriately and without complications. No motor complications have been found from patients receiving distal ankle nerve blocks, as performed by the senior author. Conclusion: With the absence of motor complications and markedly reduced incidence of sensory complications, distal ankle nerve blocks may be a beneficial alternative to popliteal nerve blocks for various foot and ankle orthopedic surgeries. As motor complications can result in life altering disability, an anesthetic procedure with reduced negative motor outcomes can improve surgery and recovery prognosis. Future directions for this study include adding more patients to increase the sample size, as well as continuing to follow current patients, monitoring symptoms or complications.

Background: One in 4 children globally is stunted. Stunting is associated with reduced cognitive development, reduced productivity, and chronic disease in later life. Objective: To explore the association between maternal diet during pregnancy and low birth weight, which increases the risk of stunting. Methods: Current literature pertaining to maternal diet and low birth weight was reviewed. Results: Low birth weight and small for gestational age are risk factors for stunting. Dietary pattern studies show an association between moderate dairy protein intake and increased birth weight and reduced risk of low birth weight. Protein-to-carbohydrate ratios are important factors in relation to gestational weight gain and fetal programming. There is evidence suggesting that whey protein could play a role in fetal lean body mass and reduced risk of low birth weight. Conclusions: Maternal diet is associated with birth weight.

Heart failure is a chronic and terminal disease that affects a significant portion of the U.S. population. It is marked by considerable suffering, for which palliative care has been recommended. Palliative care standards require the inclusion of spiritual care, but there is a paucity of literature supporting effective spiritual interventions for the heart failure population. A literature search resulted in 30 articles meeting the criteria for review of spirituality and spiritual coping in the heart failure population. Findings within this body of literature include descriptive evidence of the uniqueness of spirituality in this population, quantitative and qualitative approaches to inquiry, theoretical models of spiritual coping, and proposed interventions. The article concludes with implications for future research and practice.

Category: Ankle; Arthroscopy; Bunion; Hindfoot; Midfoot/Forefoot; Other Introduction/Purpose: Popliteal nerve blocks are a common procedure employed by anesthesiologists to augment intraoperative anesthesia and provide postoperative pain control. Unfortunately, these can be associated with unintended complications including pain, numbness, and foot drop, sometimes without clear resolution. Studies from Kahn (2017), Anderson (2015), Park (2018), Lauf (2020) suggest complications higher than previously reported with Lauf (2020) finding short-term complication rates of 10.1% and 4.1% long-term as confirmed by EMG. Our study looked to address the complication rates from an alternative anesthetic procedure, a distal ankle nerve block involving anesthesia to the five nerve(s) more intimately involved in the surgical procedure. This alternative technique may provide equivalent anesthetic properties and pain relief as popliteal blocks, with fewer complications for many patients across various demographics. Methods: We retrospectively reviewed patient charts and messaging from 2019 to 2021 that received a distal ankle field block for various surgical procedures including ankle arthroscopy, ankle fractures, and lateral ankle stabilizations. The five nerves anesthetized in the distal ankle nerve block included the tibial, superficial and deep peroneal, sural, and saphenous. Thus far, 61 surgeries have been reviewed and analyzed for neuropathic complications and confirmed via EMG. Results: Of the 61 patients analyzed, 3 patients were found to have a superficial peroneal neuropathy that included dorsal numbness as a result of the distal ankle block, resulting in a 4.92% complication rate. 1 patient required a rescue block to be performed postoperatively for pain. The remaining 57 patients recovered appropriately and without complications. No motor complications have been found from patients receiving distal ankle nerve blocks, as performed by the senior author. Conclusion: With the absence of motor complications and markedly reduced incidence of sensory complications, distal ankle nerve blocks may be a beneficial alternative to popliteal nerve blocks for various foot and ankle orthopedic surgeries. As motor complications can result in life-altering disability, an anesthetic procedure with reduced negative motor outcomes can improve surgery and recovery prognosis. Future directions for this study include adding more patients to increase the sample size, as well as continuing to follow current patients, monitoring symptoms or complications.

Stroke continues to be a public health problem, and risk perceptions are key to understanding people’s thoughts about stroke risk and their preventive health behaviors. This review identifies how the perceived risk of stroke has been measured and outcomes in terms of levels, predictors, accuracy, and intervention results. Sixteen studies were included. The perceived risk of stroke has primarily been assessed with single-item measures; no multi-item surveys were found. In general, people tend to perceive a low-moderate risk of stroke; the most common predictors of higher stroke risk perceptions were having risk factors for stroke (hypertension, diabetes) and a higher number of risk factors. However, inaccuracies were common; at least half of respondents underestimated/overestimated their risk. Few studies have examined whether interventions can improve the perceived risk of stroke. Strategies to improve stroke risk perceptions should be explored to determine whether accuracy can promote healthy lifestyles to reduce stroke risk.

Highly organized project management facilitates rigorous study implementation. Research involves gathering large amounts of information that can be overwhelming when organizational strategies are not used. We describe a variety of project management and organizational tools used in different studies that may be particularly useful for novice researchers. The studies were a multisite study of caregivers of stroke survivors, an Internet-based diary study of women with migraines, and a pilot study testing a sleep intervention in mothers of low-birth-weight infants. Project management tools were used to facilitate enrollment, data collection, and access to results. The tools included protocol and eligibility checklists, event calendars, screening and enrollment logs, instrument scoring tables, and data summary sheets. These tools created efficiency, promoted a positive image, minimized errors, and provided researchers with a sense of control. For the studies described, there were no protocol violations, there were minimal missing data, and the integrity of data collection was maintained.

Category: Other Introduction/Purpose: Chronic exertional compartment syndrome (CECS) is defined as reversible, insufficient blood supply to a fascial compartment’s contents. Patients with this condition have abnormally elevated pressures within specific fascial compartments, causing decreased blood flow to that area. This temporary loss of blood supply produces a feeling of tightness in the affected muscles, pain, and possibly local paresthesia. Surgical treatment involves a fasciotomy, which releases the implicated compartment’s fascia. This procedure creates additional space for muscle expansion and more adequate blood supply to the appropriate tissues.The purpose of this study is to review the surgical outcomes of patients diagnosed with lower extremity CECS whom received a fasciotomy, assessing correlations between resting intramuscular compartment pressures and surgical outcomes. Methods: A retrospective chart analysis was performed of the senior author’s patients between January 1st, 2013 and June 30th, 2019. Patients included in this study presented with symptoms consistent with lower extremity CECS and had the diagnosis confirmed, either unilaterally or bilaterally, via the resting intramuscular pressure cutoff (>=15 mmHg) outlined by the Pedowitz criteria. These patients subsequently received fasciotomies for the syndrome. Results: Out of the 37 patients included in this study, 30 (81.1%) reported improvement in their post-operative pain scores. There was a trend (P > 0.1523) between resting intra-compartment pressures and post-operative pain improvement. Conclusion: Our study suggests a positive trend between higher resting intra-compartment pressures and post-operative pain improvement. Due to the limited number of study participants, no correlations could be determined. However, this data is significant because it demonstrates the importance of the Pedowitz diagnostic criteria, as it is the first study showing a relationship between the resting pressure criteria and surgical outcomes. Further research is necessary to determine if there is a correlation between higher intramuscular pressures and positive surgical outcomes.

Francisella tularensis is a Gram-negative intracellular bacterium that can cause acute disease in mouse models of infection when administered via the inhalational route. The immune response to a pulmonary infection is typified by an initial lack of pro-inflammatory cytokines, followed by hypercytokinemia prior to host death. It remains unclear what causes this delay in the host immune response. In this study we determine the presence of FoxP3 regulatory T cells in the lung, liver and spleen following intranasal infection with F. tularensis SCHU S4. In the lung, the site of initial infection, there is an increase in FoxP3+ cells during the first few days of infection and a notable absence of these cells at the point of cytokine storm and death (day 4 post-infection). This coincides with a decrease in the anti-inflammatory cytokine TGF-β and increases of chemokines MIP-1α, MIP-1β and RANTES. In our model, we also observed an overall decrease in the number of regulatory T cells in the spleen, which was not as evident in the liver. Overall, this data suggests that early on in an acute F. tularensis SCHUS4 infection regulatory T cells contribute to a dampening of the pro-inflammatory response, allowing for bacterial replication and spread.

One challenge in using multilevel models is determining how to report the amount of explained variance. In multilevel models, explained variance can be reported for each level or for the total model. Existing measures have been based primarily on the reduction of variance components across models. However, these measures have not been reported consistently because they have some undesirable properties. The present study is one of the first to evaluate the accuracy of these measures using Monte Carlo simulations. In addition, a measure based on the full partitioning of variance in multilevel models was examined. With the exception of the Level 2 explained variance measure, all other measures performed well across our simulated conditions.

Does the bureaucracy represent the interests of the public or react to the partisan and ideological demands of political principals? This study uses data from the federal workforce reports and the U.S. Office of Personnel Management’s Central Personnel Data File to demonstrate that partisanship and ideology influence the demographic composition of the federal senior executives. The analysis indicates that fluctuation between administrations is largely attributed to presidents nominating and appointing individuals who share similar ideological views. The analysis also suggests that political control by ideologically driven principals has the potential to perpetuate divisiveness over polarizing issues. The partisan and ideological influences that continue to influence access to policy-making positions contribute to the perpetuation of patterned disparities in the representation of interests and undermine government performance.

Using a list provided by the American Board of Pathology, the names of all board certified forensic pathologists (BCFPs) were entered into an electronic database, along with the year in which each was certified. The names of BCFPs were searched in PubMed/Medline against authors of journal articles. We limited study to 836 BCFPs who were certified in the years 1985 through 2010. We documented that at least 33% of BCFPs had been published authors, and that up to 66% could have been published authors. The total number of articles found and verified by authors was 2128. The average number of articles was 7.7 per published BCFP. Eleven journals accounted for 52% of the articles, and the remaining 48% of articles were published in 415 other journals of diverse subject scope. BCFPs were the lead author or solo author on 986 (45%) of the articles. The majority of articles were case reports. Two hundred and sixty-one articles (12%) included a categorization of “Research Support” which means that at least one author was supported with funds from the National Institutes of Health (NIH) or other government sources such as the Public Health Service. For this group of 261 articles with research support, a BCFP was the lead author, last author, or solo author on 80 (31%) of them. Using extrapolations based on our data, we estimate that BCFPs since 1959 have collectively published as many as 164 journal articles per year and possibly more than 8000 articles over the past 50 years.

This study examined two methods for detecting differential item functioning (DIF): Raju, van der Linden, and Fleer’s 1995 differential functioning of items and tests (DFIT) procedure and Thissen, Steinberg, and Wainer’s 1988 likelihood ratio test (LRT). The major research questions concerned which test provides the best balance of Type I errors and power and if the tests differ in terms of detecting different types of DIF. Monte Carlo simulations were conducted to address these questions. Equal and unequal sample size conditions were fully crossed with test lengths of 10 and 20 items. In addition, α and β parameters were manipulated in order to simulate DIF. Findings indicate that DFIT and LRT both had acceptable Type I error rates when sample sizes were equal but that DFIT produced too many Type I errors when sample sizes were unequal. Overall, the LRT exhibited greater power to detect both α and β parameter DIF than did DFIT. However, DFIT was more powerful than LRT when the last two β parameters had DI...

The current study examined the Type I error rates and power of several item response theory (IRT) item fit indices used in conjunction with the graded response model (GRM). Specifically, S — χ2, χ2*, and adjusted χ 2 degrees of freedom ratios (χ2/dfs) were examined. Model misfit was introduced by manipulating item parameters and by using a different IRT model to generate item data. Results indicated lower than expected Type I error rates for S — χ2 and χ 2*. Adjusted χ2/dfs resulted in large Type I error rates when used with cross validation and very low Type I error rates when used without cross validation. χ2* and adjusted χ 2/dfs without cross validation were the most powerful overall.

The initial Point of View: Directions for Research ( Neurorehabilitation and Neural Repair, 2007;21:3-13) identified confounders that might limit the impact that rehabilitation multicenter clinical trials may have upon altering practice patterns. Part of that viewpoint addressed the Extremity Constraint Induced Therapy Evaluation (EXCITE) Trial and highlighted some of its perceived strengths and limitations. The present Point of View expands upon factors worthy of consideration in planning and executing clinical trials in neurorehabilitation based upon experiences encountered by the EXCITE team. Cost factors and patient attributes, both of which profoundly influence the ability of clinical researchers to execute the ideal study, are among these factors. In particular, the costs associated with large trials necessitate compromise in study design or implementation, resulting in a dichotomy between what should be undertaken and what can be accomplished.

BackgroundMusculoskeletal injuries are a significant burden to United States Army Special Operations Forces. The advanced tactical skill level and physical training required of Army Special Operators highlights the need to optimize musculoskeletal characteristics to reduce the likelihood of suffering a recurrent injury.PurposeTo identify the residual impact of previous injury on musculoskeletal characteristics.Study DesignCross-sectional study; Level of evidence, 3.MethodsIsokinetic strength of the knee, shoulder, and back and flexibility of the shoulder and hamstrings were assessed as part of a comprehensive human performance protocol, and self-reported musculoskeletal injury history was obtained. Subjects were stratified based on previous history of low back, knee, or shoulder injury, and within-group and between-group comparisons were made for musculoskeletal variables.ResultsKnee injury analysis showed no significant strength or flexibility differences. Shoulder injury analysis found internal rotation strength of the healthy subjects (H) was significantly higher compared with injured (I) and uninjured (U) limbs of the injured group (H, 60.8 ± 11.5 percent body weight [%BW]; I, 54.5 ± 10.5 %BW; U, 55.5 ± 11.3 %BW) ( P = .014 [H vs I] and P = .05 [H vs U]). The external rotation/internal rotation strength ratio was significantly lower in the healthy subjects compared with injured and uninjured limbs of the injured group (H, 0.653 ± 0.122; I, 0.724 ± 0.121; U, 0.724 ± 0.124) ( P = .026 [H vs I] and P = .018 [H vs U]). Posterior shoulder tightness was significantly different between the injured and uninjured limb of the injured group (I, 111.6° ± 9.4°; U, 114.4° ± 9.3°; P = .008). The back injury analysis found no significant strength differences between the healthy and injured groups.ConclusionFew physical differences existed between operators with prior knee or back injury. However, operators with a previous history of shoulder injury demonstrated significantly less shoulder strength than uninjured operators as well as decreased shoulder flexibility on the injured side. All operators, regardless of prior injury, must perform the same tasks; therefore, a targeted injury rehabilitation/human performance training specifically focused on internal rotation strength and tightness of the posterior capsule may help reduce the risk for recurrence of injury. Operators presenting with musculoskeletal asymmetries and/or insufficient strength ratios may be predisposed to musculoskeletal injury.Clinical RelevanceSpecific fitness programs to compensate for deficiencies in strength and flexibility need to be designed that may reduce the risk of injuries in Special Forces Operators.

In acute stroke, the target of therapy is the severely hypoxic but salvageable tissue. Previous human studies using 18F-fluoromisonidazole and positron emission tomography (18F-FMISO PET) have shown high tracer retention indicative of tissue hypoxia, which had normalized at repeat scan >48 h later. In the only validation study of 18F-FMISO, using ex vivo autoradiography in thread middle cerebral artery occluded (MCAo) rats, there was unexpected high uptake as late as 22 h after reperfusion, raising questions about the use of 18F-FMISO as a hypoxia tracer. Here we report a pilot study of 18F-FMISO PET in experimental stroke. Spontaneous hypertensive rats were subjected to distal clip MCAo. Three-hour dynamic PET was performed in 7 rats: 3 normals, 1 with permanent MCAo (two sessions: 30 mins and 48 h after clip), and 3 with temporary MCAo (45 mins, n = 1; 120 mins, n = 2; scanning started 30 mins after clip removal). Experiments were terminated by perfusion—fixation for standard histopathology. Late tracer retention was assessed by both compartmental modelling and simple side-to-side ratios. In the initial PET session of the permanent MCAo rat, striking trapping of 18F-FMISO was observed in the affected cortex, which had normalized 48 h later; histopathology revealed pannecrosis. In contrast, there was no demonstrable tracer retention in either temporary MCAo models, and histopathology showed ischemic changes only. These results document elevated 18F-FMISO uptake in the stroke area only in the early phase of MCAo, but not after early reperfusion nor when tissue necrosis has developed. These findings strongly support the validity of 18F-FMISO as a marker of viable hypoxic tissue/penumbra after stroke.

A modelling tool has been developed, which has enabled significant new findings in relation to rapid dynamic response measurements of time-dependent flows using Coriolis meters. The tool comprises a finite element modelling capability that simulates the meter flow tube in motion and allows the generation of pseudo-data at points on the tube corresponding to sensor locations. Combined with this, a suite of signal processing algorithms then enables the representation of an indicated flow time history output by a Coriolis meter in response to a prescribed input flow. The aims were then to investigate meter response to flow steps, ramps, and pulsations. Methods of increasing speed of response are of particular importance, for example, in fast batch-filling applications. Flow steps introduce one or more inevitable noise components in the meter sensor signals, and modelling results suggest that for a given meter geometry, the corresponding noise amplitude in the meter-indicated flow is a constant fraction of the step height. The virtual Coriolis meter has also demonstrated the potential for a substantial contribution to meter design by enabling the development of new meters with specifications matched to selected requirements to meet a wide range of applications.

We recently found that four peptide hormones synthesized by the same gene completely inhibit the growth of human pancreatic adenocarcinomas in athymic mice. The present immunocytochemical investigation was designed to determine where in the adenocarcinomas these peptide hormones localize. Atrial natriuretic peptide, vessel dilator, long-acting natriuretic peptide, and kaliuretic peptide localized to the cytoplasm and nucleus of the human pancreatic adenocarcinomas, which is consistent with their ability to decrease DNA synthesis in the nucleus of this cancer. In this first investigation of where these peptide hormones with anticancer effects localize in any cancer, these peptide hormones also localized to the endothelium of capillaries and fibroblasts within these cancers. This is the first demonstration of growth-inhibiting peptide hormones localizing to the nucleus, where they inhibit DNA synthesis and may interact with growth-promoting hormones that localize there as the etiology of their ability to inhibit the growth of adenocarcinomas both in vitro and in vivo.

Oxygen-15 positron emission tomography (15O PET) can provide important data regarding patients with head injury. We provide reference data on intersubject variability and reproducibility of cerebral blood flow (CBF), cerebral blood volume (CBV), cerebral metabolism (CMRO2) and oxygen extraction fraction (OEF) in patients and healthy controls, and explored alternative ways of assessing reproducibility within the context of a single PET study. In addition, we used independent measurements of CBF and CMRO2 to investigate the effect of mathematical correlation on the relationship between flow and metabolism. In patients, intersubject coefficients of variation (CoV) for CBF, CMRO2 and OEF were larger than in controls (32.9% ± 2.2%, 23.2% ± 2.0% and 22.5% ± 3.4% versus 13.5% ± 1.4%, 12.8% ± 1.1% and 7.3% ± 1.2%), while CoV for CBV were lower (15.2% ± 2.1% versus 22.5%±2.8%) ( P>0.001). The CoV for the test—retest reproducibility of CBF, CBV, CMRO2 and OEF in patients were 2.1% ± 1.5%, 3.8% ± 3.0%, 3.7% ± 3.0% and 4.6% ± 3.5%, respectively. These were much lower than the intersubject CoV figures, and were similar to alternative measures of reproducibility obtained by fractionating data from a single study. The physiological relationship between flow and metabolism was preserved even when mathematically independent measures were used for analysis. These data provide a context for the design and interpretation of interventional PET studies. While ideally each centre should develop its own bank of such data, the figures provided will allow initial generic approximations of sample size for such studies.

The worldwide incidence of tuberculosis is increasing, largely as a consequence of both the increasing prevalence of human immunodeficiency virus and the emergence of drug-resistant strains. The pulmonary system is typically the primary site of involvement by this infectious disease; however, extrapulmonary disease does occasionally occur. Although uncommon, neck involvement can occur. The usual presentation is bilateral adenopathy from pulmonary dissemination. Tuberculous cervical adenitis in the absence of pulmonary findings is rare. A concurrent diagnosis of pregnancy complicates the treatment of the infected patient. We present a case of isolated, unilateral tuberculous cervical adenitis in a pregnant patient and discuss the multidisciplinary approach necessary for the appropriate management of this unique situation.

Introduction: A portion of patients undergoing cardiac surgery may develop focal and/or subtle brain injuries secondary to cardiac surgery. There is evidence that, in some cases, these injuries may be related to cardiopulmonary bypass (CPB). Embolism and hypoperfusion are the dominant mechanisms for focal neurologic injuries among coronary artery bypass graft (CABG) surgery patients. Recent studies suggest that these mechanisms may also produce the more prevalent subtle neurological deficits. The aim of our current work is to obtain a thorough understanding of the processes of care associated with the production of embolic activity, cerebral hypoperfusion, and hemodynamic aberrations that often occur during CPB. Methods: We developed a system for simultaneous recording of physiologic parameters, embolic activity in the CPB circuit and in the cerebral arteries, and near infrared regional cerebral oxyhemoglobin saturation (NIRS) during cardiac surgery. All data were synchronized with a video recording of the surgical procedure. Periods of embolic activity and NIRS were subsequently related to surgical and CPB processes of care through a systematic review of the patient’s surgical case video. Results: To date, we have enrolled 47 patients undergoing coronary and/or valvular procedures. We have observed wide variation across patients in detected cerebral embolic counts, NIRS and physiologic parameters. We have identified increased embolic counts in the CPB circuit related to specific processes and events such as the method of venous drainage, the entrainment of air in the venous line, the injection of medications into the CPB circuit and blood sampling from the CPB circuit. A portion of detected changes in NIRS were related to periods of hypotension and positioning of the heart during the construction of distal coronary artery grafts on the posterior coronary artery vessels. Summary: Use of this model provides the surgical team with detailed information regarding the contribution of CPB to the creation of precursors of neurological injury. This system provides meaningful data to guide the surgical team in the redesign of the CPB system and associated techniques.

Whereas postmortem ischemic damage is common in head injury, antemortem demonstration of ischemia has proven to be elusive. Although 15O positron emission tomography may be useful in this area, the technique has traditionally analyzed data within regions of interest (ROIs) to improve statistical accuracy. In head injury, such techniques are limited because of the lack of a priori knowledge regarding the location of ischemia, coexistence of hyperaemia, and difficulty in defining ischemic cerebral blood flow (CBF) and cerebral oxygen metabolism (CMRO2) levels. We report a novel method for defining disease pathophysiology following head injury. Voxel-based approaches are used to define the distribution of oxygen extraction fraction (OEF) across the entire brain; the standard deviation of this distribution provides a measure of the variability of OEF. These data are also used to integrate voxels above a threshold OEF value to produce an ROI based upon coherent physiology rather than spatial contiguity (the ischemic brain volume; IBV). However, such approaches may suffer from poor statistical accuracy, particularly in regions with low blood flow. The magnitude of these errors has been assessed in modeling experiments using the Hoffman brain phantom and modified control datasets. We conclude that this technique is a valid and useful tool for quantifying ischemic burden after traumatic brain injury.

Antemortem demonstration of ischemia has proved elusive in head injury because regional CBF reductions may represent hypoperfusion appropriately coupled to hypometabolism. Fifteen patients underwent positron emission tomography within 24 hours of head injury to map cerebral blood flow (CBF), cerebral oxygen metabolism (CMRO2), and oxygen extraction fraction (OEF). We estimated the volume of ischemic brain (IBV) and used the standard deviation of the OEF distribution to estimate the efficiency of coupling between CBF and CMRO2. The IBV in patients was significantly higher than controls (67 ± 69 vs. 2 ± 3 mL; P < 0.01). The coexistence of relative ischemia and hyperemia in some patients implies mismatching of perfusion to oxygen use. Whereas the saturation of jugular bulb blood (SjO2) correlated with the IBV ( r = 0.8, P < 0.01), SjO2 values of 50% were only achieved at an IBV of 170 ± 63 mL (mean ± 95% CI), which equates to 13 ± 5% of the brain. Increases in IBV correlated with a poor Glasgow Outcome Score 6 months after injury (ρ = −0.6, P < 0.05). These results suggest significant ischemia within the first day after head injury. The ischemic burden represented by this “traumatic penumbra” is poorly detected by bedside clinical monitors and has significant associations with outcome.

A pit feature containing human remains was originally interpreted as a trash pit based on its shape, the presence of ceramic sherds, flakes, and fire-cracked rocks, and the absence of items traditionally viewed as “grave goods.” However, a cooperative reconsideration of the feature, incorporating the insights of a representative of the Nanticoke Indian Tribe, developed a new interpretation. Ethnohistoric data clearly indicate that local Indian people would not be likely to bury a body in a trash pit. Therefore, the presence of human remains signified a burial and artifacts usually viewed as “trash” could still have symbolic and ritual significance. Upon careful study, many of the feature's artifacts showed attributes which seem to distinguish them from superficially similar items found in non-grave settings. Data gathered from ethnohistoric sources, ethnographies, and linguistic analysis fit together to create a consistent cultural context for the artifacts' ritual and symbolic meaning.

This article reports trends and implications of interdisciplinary teaming practices in middle level schools, based on findingsfrom a national survey. Noting that nearly 80% of schools currently implement teaming the authors challenge principals and teachers to move beyond the simple formation of teams to the creation of an infrastructure that supports highperforming teams and thereby promotes improved student achievement.

An online survey of more than 1,400 middle level leaders (grades 5-9) was conducted as part of a national study. This article reports the findings; compares the results with previous studies conducted in 1965, 1980, and 1992; and discusses the implications and recommendations for recruiting initial training, and continuing professional development offuture middle level principals.

The axon initial segment (AIS), the domain responsible for action potential initiation and maintenance of neuronal polarity, is targeted for disruption in a variety of central nervous system pathological insults. Previous work in our laboratory implicates oxidative stress as a potential mediator of structural AIS alterations in two separate mouse models of central nervous system inflammation, as these effects were attenuated following reactive oxygen species scavenging and NADPH oxidase-2 ablation. While these studies suggest a role for oxidative stress in modulation of the AIS, the direct effects of reactive oxygen and nitrogen species (ROS/RNS) on the stability of this domain remain unclear. Here, we demonstrate that oxidative stress, as induced through treatment with 3-morpholinosydnonimine (SIN-1), a spontaneous ROS/RNS generator, drives a reversible loss of AIS protein clustering in primary cortical neurons in vitro. Pharmacological inhibition of both voltage-dependent and intracellular calcium (Ca2+) channels suggests that this mechanism of AIS disruption involves Ca2+ entry specifically through L-type voltage-dependent Ca2+ channels and its release from IP3-gated intracellular stores. Furthermore, ROS/RNS-induced AIS disruption is dependent upon activation of calpain, a Ca2+-activated protease previously shown to drive AIS modulation. Overall, we demonstrate for the first time that oxidative stress, as induced through exogenously applied ROS/RNS, is capable of driving structural alterations in the AIS complex.

The current design criterion for laterally loaded drilled shafts embedded in weathered Piedmont rock profiles requires a challenging effort on the part of the engineer. A substantial cost saving could be realized, while maintaining an acceptable and safe performance, if a rational method were developed for the analysis and design of drilled shafts in such a profile. In a current research project, the primary objective is to develop and validate a procedure for design and analysis of laterally loaded drilled shafts embedded in the Piedmont weathered rock profiles. A major component of this research is a field-testing program. Presented are the results of the first in a series of several lateral load tests performed on two drilled shafts 0.762 m (30 in.) in diameter embedded in Piedmont weathered rock. These shafts were instrumented with inclinometers and strain gauges. Field data obtained from the instrumented shafts were used to develop P-y curves. Field testing also encompassed the use of a borehole dilatometer to establish correlations between the rock strength and deformation parameters and potential P-y curves. A comparison is made between backcalculated P-y curves, P-y curves predicted by using Reese’s method, and P-y curves from the rock dilatometer. Loaddeformation results are presented and discussed for all methods used.

Caregivers for dependent, elderly community dwellers are frequently themselves at risk for illnesses exacerbated by stress. This study evaluates a videotape scenario intervention designed to increase self-care behaviors in three groups of caregivers randomly assigned to a control or to one of two experimental groups. Within the 6- to 8-week trial, attitudes toward self-care became more positive in the experimental groups, and all groups reported endorsement of behavioral changes related to self-care.

The need for middle level principals skilled in curricular and instruc tional reform and school restructuring has never been more important. The hope for highly implemented and fully functioning programs lies in the principal's ability to facilitate comprehensive restructuring, restructuring that has broad-based involvement in establishing new visions of teaching and learning and collaborative decision making.

A novel technique employing shear stress sensitive microcapsules (MC) was utilized to investigate the shear stresses that were experienced by a single polymer and the components of a polymer blend during melting, in both a lab scale single screw extruder (SSE) and internal batch mixer. It was found that the MC could sense differing melting environments when process variables such as temperature and shear rate, as well as blend constituents were manipulated.

Background: Digoxin improves baroreflex function and reduces neurohumoral activation in severe heart failure, but it is uncertain how digoxin affects ventricular remodeling and progression to left ventricular dysfunction. In addition, the effect of digoxin in in vitro β- adrenoceptor density and function, and contractile reserve in vivo is not well understood. Methods and Results: To study this, we compared digoxin with placebo treatment in rats with chronic volume overload induced by aortocaval fistula and in sham-operated control animals. Left ventricular end-diastolic cavity dimensions (LVDd) and wall thickness were measured weekly by in vivo transthoracic echocardiography, and left ventricular mass (LVM) and percent fractional shortening (%FS) were calculated. Six weeks after fistula cre ation, simultaneous echocardiographic and invasive hemodynamic evaluation at rest and in response to incremental dobutamine (1-10 μg/kg/min intravenously) were measured. Myo cardial plasma membrane β-adrenoceptor density and maximal adenylate cyclase responses (Vmax) to isoproterenol, 5'-guanylylimi dodiphosphate, and forskolin were measured in vitro. Volume overload induced progressive increases in LVDd and LVM over the 6-week study period. Percent fractional shortening at rest. and the change in %FS in response to dobutamine stress were dramatically reduced 6 weeks after fistula creation. Although 6- week fistula animals had unchanged β-adrenoceptor density (Bmax) and binding affinity (Kd) as compared with controls, maximal adenylate cyclase responses to stimulation in vitro (V max) were markedly reduced. Digoxin treatment prevented this loss of responsiveness of adenylate cyclase but did not affect β-adrenoceptor density or affinity in vitro. Digoxin had no effect on LVDd, LVM, %FS, or the response to dobutamine infusion in vivo. Conclusions: Although digoxin prevented β-adrenoceptor desensitization and improved in vitro myocardial adenylate cyclase response, the cardiac response to adrenergic stimulation in vivo was not significantly improved. These results suggest that the role of β-adrenoceptor desensitization in the progression from volume overload hypertrophy to left ventricular dysfunction and heart failure may be less important than previously thought. Furthermore, although digoxin treatment did produce modest hemodynamic benefits, it did not prevent progressive remodeling in this model.

The existing analysis of the response of small turbine flowmeters in liquid flows to step changes in flow shows a strong influence of the requirements of conservation of angular momentum. An apparatus is described for the experimental measurement of the step response. The results show that the existing analysis is not an adequate description of the response. An explanation of the experimental response is given. Stop (step to zero) tests are also described and are used to assist in the explanation of the meter response.

An analysis is presented of the influence of forces due to an electromagnetic pick-up on the calibration of small turbine flowmeters. The analysis shows how the forces can produce high starting flows. A comparison between the theory and the experimental results of calibrating a meter both with and without the electromagnetic pick-up suggests that the dominant effect of the pick-up is to produce an additional resisting torque which is almost independent of the rotational speed of the meter.

Administrators, teachers, parents, and community members can be involved in collaborative efforts in many ways. Whether the collaboration is direct involvement in decision making or participation as an influencer, leadership plays an important role in its success. Principals, by valuing and recognizing the contributions of each teacher, staff member, student, and parent, give high visibility to the collaborative process.

Mesenchymal stem cells (MSCs) derived from bone marrow (BM), adipose tissue (AT), umbilical cord blood (CB), and umbilical cord tissue (CT) are increasingly being used to treat equine inflammatory and degenerative lesions. MSCs modulate the immune system in part through mediator secretion. Animal species and MSC tissue of origin are both important determinants of MSC function. In spite of widespread clinical use, how equine MSCs function to heal tissues is fully unknown. In this study, MSCs derived from BM, AT, CB, and CT were compared for their ability to inhibit lymphocyte proliferation and secrete mediators in response to activation. Five MSC lines from each tissue were isolated. Lymphocyte proliferation was assessed in a mixed leukocyte reaction, and mediator secretion was determined by ELISA. Regardless of tissue of origin, quiescent MSCs did not alter lymphocyte proliferation or secrete mediators, except for transforming growth factor-β (TGF-β1). When stimulated, MSCs of all tissue types decreased lymphocyte proliferation, increased prostaglandin (PGE2) and interleukin-6 (IL-6) secretion, and decreased production of tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ). BM-MSCs and CB-MSCs also produced nitric oxide (NO), while AT-MSCs and CT-MSCs did not. Equine MSCs did not produce indoleamine 2,3-dioxygenase (IDO). These data suggest that activated equine MSCs derived from BM, AT, CT, and CB secrete high concentration of mediators and are similar to MSCs from rodents and humans in their immunomodulatory profiles. These findings have implication for the treatment of inflammatory lesions dominated by activated lymphocytes and TNF-α and IFN-γ in vivo.

In virtually all advanced capitalist industrial societies, transitions from compulsory education into employment have been prolonged since the 1970s. The basic reasons are the same everywhere, but there have been contrasting interpretations of youth's new social condition by different countries' social scientists. Here a particularly sharp contrast is between Britain and Germany. In the former country most researchers have taken a negative view of the trends, whereas German scholars have stressed the spread of flexibility, individualisation, and opportunities for self-directed growth. This paper discusses the similarities and differences between transitions into employment in Britain and Germany using evidence from matched samples of 16-22 year olds. It is argued that there are fundamental, systemic differences between the organisation of entering the labour forces in Britain and Germany. In Germany transitions take longer, are more structured, and are rooted in a training culture. However, each country's young people are made to feel that they themselves make significant choices, and their transitions have become individualised. Simultaneously, individuals' opportunities in each country continue to be governed by the familiar predictors - family background, sex, place of residence, and attainments in secondary education. It is argued that in each country young people are prototypical cases of broader trends towards structured individualisation and the fragmentation of formerly more homogeneous social groups.

Positron emission tomography regional CBF (rCBF) studies of cognitive processes have traditionally required 30–60 mCi of H215O per scan and intersubject averaging to achieve statistical significance. However, intersubject anatomical, functional, and disease variability can make such an approach problematic. A new method that produces significant results in single subjects is presented. It is based upon high-sensitivity three-dimensional imaging and a “slow” bolus administration of >15 mCi of H215O per scan. The method is validated in four normal volunteers using control and auditory-language activation tasks with four scans per condition and statistical parametric mapping analysis. It is demonstrated that the rCBF distribution associated with the cognitive state is detected during the arrival of radiotracer in the brain. This occurs over 30 s and constitutes a critical temporal window during which stimulation should be performed. A 90-s acquisition time is found to produce results of greater significance than a 60-s acquisition time. The implications of the results and the functional neuroanatomical findings are discussed. This method is suitable for the study of individual functional neuroanatomy in many neuropsychological, pharmacologic, and symptom states in normal subjects and in patients with psychiatric and neurologic disorders.

South Carolina native Robert Henry Best, son of a Protestant minister, obtained journalism credentials at the Columbia University School of Journalism and ended up in Vienna, as did others such as William L. Shirer and Dorothy Thompson in the years between the wars. Working as a stringer, Best became captivated by Vienna, although he never achieved the same fame as a reporter as did others. When World War II broke out, he decided to remain, by then engaged to an Austrian journalist whom he later married. He volunteered to broadcast for the German government, and did, although he denied ever being a Nazi. By shortwave, his broadcasts reached perhaps 150,000 Americans during twice-an-evening broadcasts. Best coined such phrases as “Jewnited States,” and even the Nazis found him extreme. Convicted in the United States of treason after the war, Best died in prison in 1952.

Flow visualisation and velocity measurement studies have been carried out on the liquid side of a sac-type VAD. The objectives have been to identify both good (e.g. short residence times) and bad (e.g. high turbulence levels) flow characteristics. The flow was visualised using polystyrene micro-spheres illuminated with white light on selected transverse planes across the pumping chamber and its inlet and outlet connections. These results then served as a guide for velocity measurements using laser-Doppler anemometry. Flow tests were run using water or a water/glycerol mixture. Operating conditions were determined from the appropriate fluid mechanics modelling laws to ensure dynamical similarity. Initially, steady flow behaviour was investigated including the effects of removal and insertion of the tilting-disc inlet and outlet valves. In subsequent full pumping tests, using a pneumatic driver, regions of high shear, separation, and high turbulence intensity have been identified.