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Jaideep H Mehta,1 Mary Elizabeth Gibson,2 David Amaro-Driedger,3 Mahammad N Hussain1 1Department of Anesthesiology, UT Health, McGovern Medical School, Houston, TX, 2Orlando Health, Orlando, FL, 3UT Health, McGovern Medical School, Houston, TX, USA Abstract: Management of nonobstetric pain in the pregnant patient presents unique challenges related to transplacental fetal exposure to opioids and the subsequent risk of neonatal withdrawal syndrome. We present the case of a pregnant patient suffering from the pain of a progressively enlarging thoracoabdominal sarcoma. Epidural analgesia (using local anesthetics with minimal opioid) was utilized over a span of weeks to manage oncologic pain, limiting fetal opioid exposure and culminating in the birth of a healthy infant. While nonobstetric abdominal pain during pregnancy is not that uncommon, neoplastic abdominal pain does appear to be rare. Combined local anesthetic and opioid continuous epidural infusion should be considered a viable option in the pain management approach to obstetric patients with nonobstetric pain associated with malignancy.Keywords: epidural, pregnancy, malignant, sarcoma

Integrating waste and industrial by-products into concrete is an alternative way to reduce global cement consumption, enhancing its eco-friendliness. In this context, residues with fly ash have been increasingly utilised. Considering the vulnerability of concrete with fly ash to carbonation and, at the same time, its high resistance to chlorides, it is important to investigate the behaviour of these concretes under their combined actions. For this purpose, an experimental investigation was conducted, studying mortar and concrete specimens with 40% replacement of cement with fly ash. These specimens were subjected to a combination of actions (Cl− and CO2) in two phases: initially through immersion and drying tests, and subsequently through a combination of accelerated tests. Concerning the chloride impact study, free and total chloride profiles were studied. Concerning the impact of carbonation, colourimetric and chemical tests were used. The results demonstrate a significant influence of combined action not only on chloride penetration in cement-based materials with fly ash but also on the development of a carbonation front. Exposure of cement-based materials with fly ash to environments with high Cl− and CO2 content sequentially may lead, on the one hand, to an increase in carbonation resistance. However, on the other hand, it may result in a substantial reduction in chloride penetration resistance.

Industrial clusters are highly concentrated professional environments, being a potential area for development of dynamic managerial capabilities and interorganizational learning. This study proposes to identify interorganizational learning mechanisms and their integration to the dynamic managerial capabilities in a technology cluster. This is an exploratory research and it uses a qualitative approach through a single-case study. The data analysis was based on content analysis techniques proposed by Bardin. It was identified formal and informal mechanisms that enable the learning between companies and the importance of the role of management core in fostering interorganizational learning, through the various projects that have integrator scope and cooperation between companies. The study revealed that the existence of a department for cluster management is essential to maintain relations between companies and their professionals. This research allowed expanding the knowledge related to the cluster perspective and interorganizational learning, providing the identification of mechanisms that favor the development and mobilization of dynamic managerial capabilities, which collaborate to fill theoretical gaps related to the constructs and reveal their complex nature that is determinant for the governance of a cluster.

Carbonation is one of the factors that can influence the chlorides transport. Despite the combined action of chlorides and carbonation being a reality, there is no consensus on the effect of this coupled deterioration on chloride transport. Accelerated tests were used to simulate this environment. Concrete specimens were cast using 0.60 water/cement ratio and CEM I 42.5R. After curing, half of specimens was submitted to accelerated carbonation test (20ºC, 55% RH and 4% CO2) during 1 and 7 months. The other half was protected with plastic film during the same period. Then, the specimens were submitted to the accelerated chlorides attack using: migration test and immersion test. Finished the immersion test, powder samples were extracted from surface to bulk and analysed to obtain free and total chloride profiles and pH profile. According to migration test results, the carbonation increases chloride transport regardless the test period. According to the immersion test results, there is a decrease in chloride ions transport when the specimens are carbonated for 1 month and a noticeable increase when carbonation period increases to 7 months. The redistribution of pores in carbonated concrete and the difficulty of chlorides binding in carbonated concrete are related to these results.

Este artigo tem como objetivo analisar como está sendo pesquisado, nos artigos publicados internacionalmente, o papel de gerentes no processo de desenvolvimento de Capacidades Dinâmicas. Foi realizada uma Revisão Sistemática da Literatura dos artigos disponíveis no maior repositório de trabalhos acadêmicos internacional na área de Administração, a Web of Science. Por meio de um processo de busca e filtragem, foram identificados diversos trabalhos científicos, os quais passaram por um procedimento de leitura e análise minuciosa, possibilitando a compreensão do propósito dos trabalhos, sua natureza, estratégias de pesquisa, métodos e outras informações relevantes. Foi possível constatar que existem poucos artigos que abordam o papel de gerente na literatura sobre Capacidades Dinâmicas. Após a proposição do conceito de Capacidade Gerencial Dinâmica e seus atributos, por Adner & Helfat (2003), novas pesquisas foram desenvolvidas, porém, até 2019 não foi possível observar estudos que aprofundassem de fato o construto em sua completude. Este trabalho contribui para o campo acadêmico com informações relevantes à pesquisa sobre Capacidades Dinâmicas e, de uma maneira mais ampla, sobre Estratégia Organizacional, além de permitir a criação de uma agenda de pesquisas futuras. Em nível prático, a identificação de trabalhos empíricos sobre a temática, pode auxiliar no desenvolvimento de estratégias organizacionais alinhadas as perspectivas das Capacidades Dinâmicas e suas aplicações em ambientes organizacionais e interorganizacionais.

This paper aims to analyze the dynamic of innovation in services for consumers at the bottom of the pyramid (BoP). For this purpose, a framework composed of innovation dimensions, capabilities and infrastructure was developed. To assess the framework behavior in the business practice, a case study was carried out in a retail firm operating in Brazil’s Northeast region whose target consumers are at the BoP. The results showed adherence of the proposed framework to the dynamics of innovation conducted by the studied firm. Considering the theoretical- academic perspective, the framework helps explain the interaction between dimensions, capabilities, and elements of the market infrastructure. As for its practical relevance, it explains how service innovations occur and how to adapt them to the BoP market. In addition, as the structure of the proposed framework includes both external and internal elements, innovation is then considered from different perspectives.

Hydrologic reconstructions from North America are largely unknown for the Middle Miocene. Examination of fungal palynomorph assemblages coupled with traditional plant-based palynology permits delineation of local, as opposed to regional, climate signals and provides a baseline for study of ancient fungas. Here, the Fungi in a Warmer World project presents paleoecology and paleoclimatology of 351 fungal morphotypes from 3 sites in the United States: the Clarkia Konservat-Lagerstätte site (Idaho), the Alum Bluff site (Florida), and the Bouie River site (Mississippi). Of these, 83 fungi are identified as extant taxa and 41 are newly reported from the Miocene. Combining new plant-based paleoclimatic reconstructions with funga-based paleoclimate reconstructions, we demonstrate cooling and hydrologic changes from the Miocene climate optimum to the Serravallian. In the southeastern United States, this is comparable to that reconstructed with pollen and paleobotany alone. In the northwestern United States, cooling is greater than indicated by other reconstructions and hydrology shifts seasonally, from no dry season to a dry summer season. Our results demonstrate the utility of fossil fungi as paleoecologic and paleoclimatic proxies and that warmer than modern geological time intervals do not match the "wet gets wetter, dry gets drier" paradigm. Instead, both plants and fungi show an invigorated hydrological cycle across mid-latitude North America., Competing Interests: Competing interests: The authors declare that they have no competing interests., (Copyright © 2024 Jennifer M. K. O’Keefe et al.)

Exposure to pediatric and adolescent gynecology (PAG) varies across residency programs in obstetrics and gynecology, family medicine, and pediatrics, as well as both adolescent medicine and PAG fellowship programs. Nevertheless, these programs are responsible for training residents and fellows and providing opportunities to fulfill PAG learning objectives. To that end, the North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG trainee education by creating and maintaining this Short Curriculum. The curriculum outlines specific learning objectives central to PAG education and lists high-yield, concise resources for learners. This updated curriculum replaces the previous 2021 publication with a new focus toward accessible online content and updated resources., (Copyright © 2024 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

Background: Perinatal mental health disorders affect up to 20% of all women. Women of refugee background are likely to be at increased risk, yet little research has explored this. This study aimed to assess if women of refugee background are more likely to screen risk positive for depression and anxiety than non-refugee women, using the Edinburgh Postnatal Depression Scale (EPDS); and if screening in pregnancy using the EPDS enables better detection of depression and anxiety symptoms in women of refugee background than routine care., Methods: This implementation study was conducted at an antenatal clinic in Melbourne, Australia. Women of refugee and non-refugee backgrounds were screened for depression using English or translated versions of the EPDS and a psychosocial assessment on a digital platform. The psychosocial assessment records of 34 women of refugee background receiving routine care (no screening) were audited., Results: Overall, 274 women completed the EPDS; 43% of refugee background. A similar proportion of women of refugee and non-refugee backgrounds had EPDS scores of ≥9 (39% vs. 40% p = 0.93). Women receiving the combined EPDS and psychosocial screening were more likely to receive a referral for further support than women receiving routine care (41% vs. 18%, p = 0.012)., Conclusion: Similarly, high proportions of women of refugee and non-refugee backgrounds were at increased risk of experiencing a current depressive disorder in early pregnancy, suggesting pregnancy care systems should acknowledge and respond to the mental health needs of these women. Screening appeared to facilitate the identification and referral of women compared to routine care., (© 2023 The Authors. Birth published by Wiley Periodicals LLC.)

Back pain is a common complaint, clinical finding and performance limiting factor in sport horses. This study sought to gather current veterinary trends in the diagnosis, treatment and management of primary equine back pain in the United States. A 22 question survey was distributed electronically to equine practitioners through AAEP and ACVSMR listservs and through closed social media groups. The survey was open from April 20, 2022 to July 5, 2022. Responses were analyzed using Microsoft excel pivot tables. Ninety-seven survey responses were obtained and analyzed. Respondents reported the clinical signs most frequently relayed to them by the owner/rider/trainer of horses diagnosed with primary back pain were behavioral issues and poor performance. Most common diagnostic tests reported were radiography of the spinous processes, thoraco-lumbar vertebral bodies, and transcutaneous ultrasound of the thoraco-lumbar region. Most common pathologies reported were impinging dorsal spinous processes, degenerative sacro-iliac joint disease, and osteoarthritis in lumbar or thoracic articular process joints. In regards to impinging spinous process ("kissing spine") treatments, 72.2% of respondents recommended surgery only after non-surgical treatments failed, and 14.6% of respondents never recommended surgery. The majority (82%) of respondents reported some level of improvement in clinical signs of primary back pain with rehabilitation alone. To date, there has been no consensus or discussion about common abnormalities, diagnostic tests, treatments or management options for primary equine back pain in the United States. Results of this survey are a starting point showing current trends in diagnosis, treatment and management of primary equine back pain among equine practitioners in the United States showing 82% of practitioners using rehabilitation as a component of treatment., Competing Interests: DF is employed by Summit Equine Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Marshall-Gibson, Durham, Seabaugh, Moorman and Ferris.)

A dramatic increase in firework-related blast injuries to the hand and upper extremity resulted in record-setting numbers at our institution over the July 4, 2018, holiday. This led our hand and upper extremity department to create a public service announcement (PSA) campaign regarding firework safety and injury prevention. This PSA was broadcast in advance of the next July 4 holiday via several media platforms including television, radio, and the internet. The following year only 4 patients required surgery for firework-related blast injuries to the hand and upper extremity over the same 10-day period, including the weekends before and after the July 4, 2019, holiday. This represented a considerable reduction compared with the 14 patients seen within the same time frame in 2018. The purpose of this article was to outline the process and report the impact of creating and disseminating a public service announcement for firework-related blast injury prevention., (Copyright © 2022 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

In 2015, the Resident Education Committee of the North American Society for Pediatric and Adolescent Gynecology published the Long Curriculum in Resident Education to provide educators with a comprehensive document to be used in postgraduate medical education. The original curriculum was designed to meet the resident learning objectives for the Council on Resident Education in Obstetrics and Gynecology, the American Board of Pediatrics, and the Royal College of Physicians and Surgeons of Canada and to provide a more intensive, broader learning experience. The curriculum was updated in 2018. This Committee Document is the third updated version (3.0) of the Long Curriculum in Resident Education., (Copyright © 2022 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

As a child matures so does the child's gait pattern. Gait changes in pediatric patients will be expected and sequential as developmental milestones. Gait changes may also represent normal variations along an appropriate spectrum. There are times when changes in gait are due to urgent orthopedic or medical conditions, and those should not be overlooked. A good understanding of pediatric gait development and a basic understanding of gait assessment are critical for the primary care physician who cares for children., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Pain relief during childbirth continues to stimulate controversy as new treatments emerge and continuing interventions in the birth process invoke concerns about safety, technologic imperatives, and informed consent. In this historical commentary, I identify a complex dissonance between scientific advances and women's needs and expectations regarding childbirth. Evidence-based practice became the standard during the last 50 years and has reinforced a more conservative and parsimonious use of technology to respond to women's needs for pain relief. In reviewing this history, it is apparent that pain relief during labor is inextricably linked to interventions. Nurses can advance evidence-based practice and facilitate robust informed consent as they support women during childbirth., Competing Interests: Conflict of Interest The author reports no conflicts of interest or relevant financial relationships., (Copyright © 2021 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Past studies have found poorer performance on vertical heading judgement accuracy compared to horizontal heading judgement accuracy. In everyday life, precise vertical heading judgements are used less often than horizontal heading judgements as we cannot usually control our vertical direction. However, pilots judging a landing approach need to consistently discriminate vertical heading angles to land safely. This study addresses the impact of training on participants' ability to judge their touchdown point relative to a target in a virtual environment with a clearly defined ground plane and horizon. Thirty-one participants completed a touchdown point estimation task twice, using three angles of descent (3°, 6° and 9°). In between the two testing tasks, half of the participants completed a flight simulator landing training task which provided feedback on their vertical heading performance; while, the other half completed a two-dimensional puzzle game as a control. Overall, participants were more precise in their responses in the second testing compared to the first (from a SD of ± 0.91° to ± 0.67°), but only the experimental group showed improvement in accuracy (from a mean error of - 2.1° to - 0.6°). Our results suggest that with training, vertical heading judgments can be as accurate as horizontal heading judgments. This study is the first to show the effectiveness of training in vertical heading judgement in naïve individuals. The results are applicable in the field of aviation, informing possible strategies for pilot training.

Study Objective: This was a prospective, pre-post, 13-year observational study documenting the multiyear implementation of an observation unit sickle cell pathway for patients with uncomplicated vaso-occlusive events., Methods: The sickle cell pathway begins with rapid triage to identify patients with uncomplicated vaso-occlusive events for immediate transfer to the observation unit and initiation of patient-controlled analgesia followed by repeated evaluations of pain and identification of other complications. Data were abstracted from the electronic medical record or observation unit database. The sickle cell pathway was initiated in April 2006. Major revisions of it were carried out in June 2009 (physician evaluation occurs in sickle cell pathway and only patient-controlled analgesia administration of medications) and October 2010 (multidisciplinary management and individual dosing)., Results: Annual ED visits ranged between 287 and 528. The preimplementation hospital admission rate was 33% (123/368), 3-day return rate 16% (60/368), and 30-day return rate 67% (248/368). Refinements to the sickle cell pathway have resulted in a decrease in admission rate to 20% (258/1276); 3-day return rate, to 3.6% (46/1,276); and 30-day return rate, to 41% (525/1,276) for the past 3 years., Conclusion: The use of a sickle cell pathway for the treatment of uncomplicated vaso-occlusive events has been effective in providing rapid treatment and reducing hospital admissions. However, it was not only the intervention and its refinement that made the sickle cell pathway successful. With the Consolidated Framework for Implementation Research, it was discerned that outer setting factors of organizational commitment to the care of patients with SCD, inner setting factors of learning climate and leadership engagement, individuals, and process contributed to the success of the sickle cell pathway., (Copyright © 2020 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Background: Limited data are available for long-term outcomes of pediatric patients with abdominal abscess or phlegmon at diagnosis of Crohn disease., Methods: We performed a retrospective chart review of such children over a recent 6-year period at 5 pediatric inflammatory bowel diseases., Results: Fifty-two patients (mean age 15.9 ± 1.8 years) were reviewed. Thirty-six had an abscess and 27 (75%) required resectional therapy compared to 16 with phlegmon which 10 (63%) requiring surgery. Overall (37/52) 71% had surgery which was performed within 6 months in 32 (86%)., Conclusions: A similar high surgical rate exists whether pediatric patients with Crohn disease present with abscess or phlegmon., (© The Author(s) 2020. Published by Oxford University Press on behalf of Crohn's & Colitis Foundation.)

Functional hypothalamic amenorrhea (FHA) is a common cause of amenorrhea in adolescent girls. It is often seen in the setting of stress, weight loss, or excessive exercise. FHA is a diagnosis of exclusion. Patients with primary or secondary amenorrhea should be evaluated for other causes of amenorrhea before a diagnosis of FHA can be made. The evaluation typically consists of a thorough history and physical examination as well as endocrinological and radiological investigations. FHA, if prolonged, can have significant impacts on metabolic, bone, cardiovascular, mental, and reproductive health. Management often involves a multidisciplinary approach, with a focus on lifestyle modification. Depending on the severity, pharmacologic therapy may also be considered. The aim of this paper is to present a review on the pathophysiology, clinical findings, diagnosis, and management approaches of FHA in adolescent girls.

Fear of pain often overshadows childbirth, and each woman must decide whether to receive anesthesia to combat labor pain. Historically, this choice resulted in unintended consequences and marked the beginnings of medical interventions in labor and birth. The purpose of this article is to trace the use of anesthesia in childbirth from the mid-19th to the mid-20th centuries and to explore its influence on childbearing women and nurses., (Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Background: Patients with pelvic ring displacement and instability can benefit from surgical reduction and instrumentation to stabilize the pelvis and improve functional outcomes. Current treatments include iliosacral screw or transsacral-transiliac screw, which provides greater biomechanical stability. However, controversy exists regarding the effects of placement of a screw across an uninjured sacroiliac joint for pelvis stabilization after trauma., Questions/purposes: Does transsacral-transiliac screw fixation of an uninjured sacroiliac joint increase pain and worsen functional outcomes at minimum 1-year followup compared with patients undergoing standard iliosacral screw fixation across the injured sacroiliac joint in patients who have sustained pelvic trauma?, Methods: All patients between ages 18 and 84 years who sustained injuries to the pelvic ring (AO/OTA 61 A, B, C) who were surgically treated between 2011 and 2013 at an academic Level I trauma center were identified for selection. We included patients with unilateral sacroiliac disruption or sacral fractures treated with standard iliosacral screws across an injured hemipelvis and/or transsacral-transiliac screws placed in the posterior ring. Transsacral-transiliac screws were generally more likely to be used in patients with vertically unstable sacral injuries of the posterior ring as a result of previous reports of failures or in osteopenic patients. We excluded patients with bilateral posterior pelvic ring injuries, fixation with a device other than a screw, previous pelvic or acetabular fractures, associated acetabular fractures, and ankylosing spondylitis. Of the 110 patients who met study criteria, 53 (44%) were available for followup at least 12 months postinjury. Sixty patients were unable to be contacted by phone or mail and seven declined to participate in the study. Outcomes were obtained by members of the research team using the visual analog scale (VAS) pain score for both posterior sacroiliac joints, Short Musculoskeletal Functional Assessment (SMFA), and Majeed scores. Patients completed the forms by themselves when able to return to the clinic. A phone interview was performed for others after they received the outcome forms by mail or email., Results: There were no differences between iliosacral and transsacral-transiliac in terms of VAS injured (2.9 ± 2.9 versus 3.0 ± 2.8, mean difference = 0.1 [95% confidence interval, -1.6 to 1.7], p = 0.91), VAS uninjured (1.8 ± 2.4 versus 2.0 ± 2.6, mean difference = 0.2 [-1.3 to 1.6], p = 0.82), Majeed (80.3 ± 19.9, 79.3 ± 17.5, mean difference = 1.0 [-11.6 to 9.6], p = 0.92), SMFA Function (22.8 ± 22.2, 21.0 ± 17.6, mean difference = 1.8 [-13.2 to 9.6], p = 0.29, and SMFA Bother (24.3 ± 23.8, 29.7 ± 23.4, mean difference = 5.4 [-7.8 to 18.6], p = 0.42)., Conclusions: Placement of fixation across a contralateral, uninjured sacroiliac joint resulted in no differences in pain and function when compared with standard iliosacral screw placement across an injured hemipelvis at least 1 year after instrumentation. When needed for biomechanical stability, transsacral-transiliac fixation across an uninjured sacroiliac joint can be used without expectation of positive or negative effects on pain or functional outcomes at minimum 1-year followup., Level of Evidence: Level III, therapeutic study.

Background: Left ventricular (LV) hypertrophy (LVH) plays an important role in hypertensive heart disease, and may be accompanied by myocardial autophagy. However, the pattern of autophagy during evolution of LVH is unclear. We hypothesized that autophagy activation indicates advancing cardiac LVH with tissue remodeling., Methods: Ten domestic pigs with a 10-week unilateral renovascular hypertension (HTN) were classified as mild or moderate HTN (n = 5 each group) based on the degree of renal artery stenosis (above or below 75%). Seven normal pigs served as controls. Left ventricular remodeling, function, and microvascular density were assessed using multi-detector- and micro-computed tomography and histology. Markers of myocardial autophagic and endoplasmic reticulum (ER) stress-related unfolded protein response (UPR), apoptosis, and fibrosis were examined ex vivo., Results: Both HTN groups had increased myocyte cross-sectional area, but it was greater in moderate HTN, accompanied by elevated LV muscle-mass. Moderate, but not mild HTN, also showed impaired microvascular density and impaired myocardial perfusion. Autophagy mediators were unaltered in mild HTN but UPR markers were increased, while in moderate HTN they were all upregulated, whereas UPR markers were suppressed. Myocardial apoptosis and fibrosis were also greater in moderate HTN. Autophagic proteins were correlated with LVH and fibrosis., Conclusions: Autophagic activity is stimulated during the exacerbation of LVH, following a transient early increase in ER stress, and may be involved in the progression of cardiac remodeling in renovascular hypertensive heart disease., (© American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

By shedding light on variation in time as well as in space, long-term biogeographic studies can help us define organisms' distribution patterns and understand their underlying drivers. Here we examine distributions of Pseudomonas in and around 15 human homes, focusing on the P. putida and P. fluorescens species groups. We describe recovery from 10,941 samples collected during up to 8 visits per home, occurring on average 2.6 times per year. We collected a mean of 141 samples per visit, from sites in most rooms of the house, from the surrounding yards, and from human and pet occupants. We recovered Pseudomonas in 9.7% of samples, with the majority of isolates being from the P. putida and P. fluorescens species groups (approximately 62% and 23% of Pseudomonas samples recovered respectively). Although representatives of both groups were recovered from every season, every house, and every type of environment sampled, recovery was highly variable across houses and samplings. Whereas recovery of P. putida group was higher in summer and fall than in winter and spring, P. fluorescens group isolates were most often recovered in spring. P. putida group recovery from soils was substantially higher than its recovery from all other environment types, while higher P. fluorescens group recovery from soils than from other sites was much less pronounced. Both species groups were recovered from skin and upper respiratory tract samples from healthy humans and pets, although this occurred infrequently. This study indicates that even species that are able to survive under a broad range of conditions can be rare and variable in their distributions in space and in time. For such groups, determining patterns and causes of stochastic and seasonal variability may be more important for understanding the processes driving their biogeography than the identity of the types of environments in which they can be found.

Recovery after a spinal cord injury often requires that axons restore synaptic connectivity with denervated targets several centimeters from the site of injury. Here we report that systemic artemin (ARTN) treatment promotes the regeneration of sensory axons to the brainstem after brachial dorsal root crush in adult rats. ARTN not only stimulates robust regeneration of large, myelinated sensory axons to the brainstem, but also promotes functional reinnervation of the appropriate target region, the cuneate nucleus. ARTN signals primarily through the RET tyrosine kinase, an interaction that requires the nonsignaling coreceptor GDNF family receptor (GFRα3). Previous studies reported limited GFRα3 expression on large sensory neurons, but our findings demonstrate that ARTN promotes robust regeneration of large, myelinated sensory afferents. Using a cell sorting technique, we demonstrate that GFRα3 expression is similar in myelinated and unmyelinated adult sensory neurons, suggesting that ARTN likely induces long-distance regeneration by binding GFRα3 and RET. Although ARTN is delivered for just 2 wk, regeneration to the brainstem requires more than 3 mo, suggesting that brief trophic support may initiate intrinsic growth programs that remain active until targets are reached. Given its ability to promote targeted functional regeneration to the brainstem, ARTN may represent a promising therapy for restoring sensory function after spinal cord injury.

Background: For patients with cystic fibrosis (CF) Pseudomonas aeruginosa infection is a major contributor to progressive lung disease. While colonizing strains are thought to be primarily environmental, which environments are important in lung colonization is unclear., Methods: We took 11,674 samples from a broad range of sites over 3-8 visits to homes with (7) and without (8) CF patients., Results: Twenty-eight percent of sampled drains yielded P. aeruginosa at least once, and a general mixed linear model estimated that 6.3% of samples from drains yield P. aeruginosa. This is more than eight times the estimated recovery from any other type of household environment., Conclusions: These findings implicate drains as important potential sources of P. aeruginosa infection. They suggest that maximizing P. aeruginosa control efforts for drains would reduce exposure with minimal extra burden to CF patients and families., (Copyright © 2014 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.)

Context: Attention deficit hyperactivity disorder (ADHD) is common in the general population, and many individuals with this condition participate in sports activity at all competition levels., Evidence Acquisition: Related studies were selected through literature searches of PubMed, MEDLINE, and Cochrane databases for the years 1991 to 2011. Key search terms were ADD, ADHD, sports, athletes, athletics, guidelines, NCAA, WADA, IOC, college, concussion, diagnosis, management, treatment, evaluation, return-to-play, pharmacotherapy, adult, adolescent, student, screening, injury, risk, neuropsychiatry, TBI, traumatic brain injury, and epidemiology., Study Design: Literature review., Level of Evidence: Level 4., Results: ADHD usually has an early onset, with delayed diagnosis in some patients due to heterogeneous presentations. Suspected cases can be evaluated with available diagnostic tools and confirmed clinically. Athletes with ADHD may participate at all competition levels., Conclusion: Athletes with ADHD are able to participate at all competition levels by following published guidelines and requirements. Exercise benefits many athletes with ADHD. The relationship between ADHD and concussion syndromes is currently under investigation.

Isolated traumatic subscapularis tendon tears are uncommon at any age. In adolescent patients, this type of injury is even more infrequent and usually presents as a bony avulsion of the lesser tuberosity. This report reviews a case of an adolescent American football player sustaining a posterior impact to an abducted, extended arm that resulted in an isolated subscapularis tendon tear. Magnetic resonance imaging of the shoulder revealed an isolated subscapularis tear retracted 1.6 cm without bony avulsion from the lesser tuberosity. Surgical repair was performed with 2 biocomposite absorbable anchors in the lesser tuberosity. The patient returned to basketball 12 weeks after surgery. This case illustrates that a high index of suspicion is required for an appropriate diagnosis in young athletes.

Drawing on a wealth of primary documents, this historical research describes nurses' efforts regarding early 20th century pediatric tuberculosis care in Virginia. Virginia nurses played a leadership role in designing a template for children's care. Ultimately, however, their legacy is a mixed one. They helped forge a system funded by a complicated, poorly coordinated, race- and class-based mix of public and private support that is now delivered through an idiosyncratic web of community, state, and federal programs. However, they also took courageous action, and their efforts improved the lives of many children. By so doing, they helped invent pediatric nursing., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Hypertension (HTN) may lead to left ventricular hypertrophy and vascular dysfunction, which are independent factors for adverse cardiovascular outcomes. We hypothesized that decreased blood pressure by percutaneous transluminal renal angioplasty (PTRA) would improve the function and architecture of coronary microvessels, in association with decreased inflammation and fibrosis., Methods: Three groups of pigs were studied: normal, HTN, and HTN+PTRA. After 6 weeks of renovascular HTN, induced by placing a local-irritant coil in the renal artery, pigs underwent PTRA or sham. Four weeks later multidetector-computed tomography (CT) was used to assess systolic, diastolic, and microvascular function, and responses to adenosine. Microvascular architecture, oxygen sensors, inflammation, and fibrosis were then explored in cardiac tissue., Results: PTRA successfully decreased blood pressure and left ventricular hypertrophy. Basal fractional vascular volume (FVV) was similar among the groups, but its response to adenosine was significantly attenuated in HTN, whereas microvascular permeability (MP) and response to adenosine were greater than normal. Both were restored by PTRA. These were accompanied by increased myocardial expression of hypoxia-inducible factor (HIF)-1α, inflammation, and microvascular remodeling, including increased density of epicardial microvessels (20-200 µm), as well as cardiac diastolic dysfunction, all of which improved by reversal of HTN. However, PTRA only partially decreased myocardial fibrosis., Conclusions: Reversal of early renovascular HTN improved coronary microvascular function and architecture and reversed myocardial hypertrophy and diastolic dysfunction, in association with decreased levels of myocardial ischemia and inflammation markers, underscoring the benefits of blood pressure normalization for preservation of cardiovascular function and structure.

Coronary artery disease is a leading cause of death. Hypertension (HT) increases the incidence of cardiac events, but its effect on cardiac adaptation to coexisting coronary artery stenosis (CAS) is unclear. We hypothesized that concurrent HT modulates microvascular function in chronic CAS and aggravates microvascular remodeling and myocardial injury. Four groups of pigs (n=6 each) were studied: normal, CAS, HT, and CAS+HT. CAS and HT were induced by placing local irritant coils in the left circumflex coronary artery and renal artery, respectively. Six weeks later multidetector computerized tomography (CT) was used to assess systolic and diastolic function, microvascular permeability, myocardial perfusion, and responses to adenosine in the "area at risk." Microvascular architecture, inflammation, and fibrosis were then explored in cardiac tissue. Basal myocardial perfusion was similarly decreased in CAS and CAS+HT, but its response to adenosine was significantly more attenuated in CAS. Microvascular permeability in CAS+HT was greater than in CAS and was accompanied by amplified myocardial inflammation, fibrosis, and microvascular remodeling, as well as cardiac systolic and diastolic dysfunction. On the other hand, compared with normal, micro-CT-derived microvascular (20-200 μm) transmural density decreased in CAS but not in HT or CAS+HT. We conclude that the coexistence of early renovascular HT exacerbated myocardial fibrosis and vascular remodeling distal to CAS. These changes were not mediated by loss of myocardial microvessels, which were relatively preserved, but possibly by exacerbated myocardial inflammation and fibrosis. HT modulates cardiac adaptive responses to CAS and bears cardiac functional consequences.

Background: Monocyte chemoattractant proteins (MCPs) play an important role in mediating inflammatory processes. Hypertension (HTN) is associated with inflammation as well as impaired cardiac microcirculatory function and structure, but the contribution of MCPs to these alterations remained unclear. This study tested the hypothesis that MCPs regulate cardiac microvascular function and structure in experimental HTN., Methods and Results: Pigs (n=6 per group) were studied after 10 weeks of normal, renovascular HTN, or renovascular HTN+ bindarit (MCPs inhibitor, 50 mg/kg/d PO). Left ventricular (LV) function, myocardial microvascular permeability, and fractional vascular volume were assessed by fast computed tomography before and after adenosine infusion (400 microg/kg/min). Myocardial fibrosis, inflammation, and microvascular remodeling were determined ex vivo. Hypertension was not altered by bindarit, but LV hypertrophy and diastolic function were improved. In response to adenosine, myocardial microvascular permeability increased in HTN (from 0.0083+/-0.0009 to 0.0103+/-0.0011 AU, P=0.038 versus baseline) and fractional vascular volume decreased, whereas both remained unchanged in normal and HTN+bindarit pigs. HTN upregulated endothelin-1 expression, myocardial inflammation, and microvascular wall thickening, which were inhibited by bindarit., Conclusions: MCPs partly mediate myocardial inflammation, fibrosis, vascular remodeling, and impaired vascular integrity induced by hypertension. Inhibition of MCPs could potentially be a therapeutic target in hypertensive cardiomyopathy.

The synthesis, cation binding and transmembrane conductive properties of a novel synthetic ion channel containing a redox-active ferrocene unit are described. Fluorescence spectroscopy was used to demonstrate that the channel supports multiple ion coordination and association constants for 1:1 and 1:2 (channel:cation) coordination for both Na(+) and K(+) were evaluated. Experiments using a black lipid membrane preparation revealed that this compound functioned effectively as an ion channel for both Na(+) and K(+). Concomitant (23)Na NMR spectroscopy studies supported this finding and revealed a Na(+) flux, at least 5 times higher than ion transport rates by monensin. Furthermore, oxidation of the redox-active centre (Fe(2+) to Fe(3+)) effectively inhibited ion transport.

An outline is given of the career of Alfred Fröhlich, and his correspondence with Sir Ronald Ross between 1901 and 1912 is described in detail.

Background: Hypoxic-ischemic (H-I) injury to the neonatal brain has been shown to result in rapid cell death with features of acute excitotoxicity/necrosis as well as prominent delayed cell death with features of apoptosis such as marked caspase-3 activation. BAX, a pro-apoptotic molecule, has been shown to be required for apoptotic neuronal cell death during normal development but the contribution of endogenous BAX in cell death pathways following H-I injury to the developing or adult brain has not been studied., Materials and Methods: Bax +/+, +/-, and -/- mice at post-natal day 7 were subjected to unilateral carotid ligation followed by exposure to 45 minutes of 8% oxygen. At different timepoints following H-I, brain tissue was studied by conventional histology, immunohistochemistry, immunofluorescence, Western blotting, and enzymatic assay to determine the extent and type of cell injury as well as the amount of caspase activation., Results: We found that bax -/- mice had significantly less (38%) hippocampal tissue loss than mice expressing bax. Some of the remaining cell death in bax -/- mice, however, still had features of apoptosis including evidence of nuclear shrinkage and caspase-3 activation. Though bax -/- mice had significantly decreased caspase-3 activation as compared to bax expressing mice following H-I, the density of cells with activated caspase-8 in the CA3 region of the hippocampus did not differ between bax +/- and bax -/- mice., Conclusions: These findings demonstrate that endogenous BAX plays a role in regulating cell death in the central nervous system (CNS) following neonatal H-I, a model of cerebral palsy. In addition, while BAX appears to modulate the caspase-3 activation following neonatal H-I, caspase-8 which is linked to death receptor activation, may contribute to apoptotic-like neuronal death in a BAX-independent manner.

Objective: To inventory maternal transport practices and develop regional transport guidelines., Study Design: A survey was administered to perinatal nursing directors of nine community hospitals in a rural region of Virginia. Items included personnel, training, equipment, vehicle, communication, and protocols. Following the survey, regional guidelines were developed using a collaborative process. Their use was promoted in the region. A post-intervention survey documented changes in transport practices., Results: The pre-intervention survey showed wide variability in training and number of personnel and in availability of emergency equipment. Communication was via radio to a dispatcher. No hospital had standing orders or protocols for transport. Guidelines were developed, which included recommendations for personnel, equipment, vehicle, communication methods, and care protocols. Eight of nine hospitals endorsed the guidelines. A follow-up survey revealed practice changes for standing orders/protocols, communication, and equipment., Conclusion: Regionwide practice changes can be successfully implemented. Guidelines may be helpful for other regions using primarily one-way maternal transports.

Brief mention is given of the early life of Sir Ronald Ross and an account of the events which led to his discovery of the method of transmission of malaria parasites. His later association with India is also referred to.