Assessment of techniques for measuring hand pressures in mock deliveries on a mannequin

Shoulder dystocia is a serious obstetric emergency. Brachial plexus injuries can be caused by hyperextension of the neck or misalignment of the fetal head during traction. To address knowledge gaps relating to clinician applied forces associated with deliveries, this study analyzed hand pressures applied by obstetricians in mock deliveries and suggests improvements for pressure-sensing gloves. The subjects were obstetricians, both residents and staff, recruited from the University of Kansas Hospital. A Laerdal PROMPT Birthing Simulator was used for the mock deliveries. The experimental design involved two pressure measurement strategies. Force Sensitive Applications (FSA) pressure sensitive gloves (Vista Medical) with twelve pressure sensors for each hand provided pressure measurements with time. Fujifilm Pressure Measurement Film Prescale [Two-Sheet Type for Extreme Low Pressure (4LW)] recorded areas where pressure was applied. The two measurement techniques compared well in capturing the spatial distribution of pressures across the hands. Both indicated pressure was exerted primarily with the middle, index, and ring fingers. Pressures due to the thumb and the palm were significantly smaller. Nonzero average pressures produced by the left hand were higher than the right but not significantly so. The pressure-film data indicated that pressures applied by resident and staff subgroups were comparable, except for the left hand where staff members applied significantly higher pressure with the little finger. With the glove sensors, there were three conditions: downward traction only, excessive force, which simulated conditions where damage could occur, and full delivery. The downward traction only, excessive force, and full delivery conditions had similar results with few significant differences. The residents and staff had few significant differences for these conditions between each other and between the conditions. The staff may have been more adept at using all the regions of their hands efficiently to apply balanced pressures. The glove sensors covered a range from 0 to 20 psi (0 to 0.14 MPa). If pressures exceeded the maximum of the range, the accuracy of the data decreased. This suggested that perhaps the sensor range should be improved in newer designs. Other important design changes could include increasing the numbers of sensors

Art therapy, opening doors : Master's thesis video and organizational manual

Explains how the author created a 16-minute video which an art therapist could use as a resume when seeking employment. The video included interviews with other art therapists who talked about their profession

Rationale and design of a prospective study: Cervical Dystonia Patient Registry for Observation of OnaBotulinumtoxinA Efficacy (CD PROBE)

<p>Abstract</p> <p>Background</p> <p>A registry of patients with cervical dystonia (Cervical Dystonia Patient Registry for Observation of onaBotulinumtoxinA Efficacy [CD PROBE]) was initiated to capture data regarding physician practices and patient outcomes with onabotulinumtoxinA (BOTOX^®, Allergan, Inc., Irvine, CA, USA). Methods and baseline demographics from an interim analysis are provided.</p> <p>Methods/Design</p> <p>This is a prospective, multicenter, clinical registry in the United States enrolling subjects with cervical dystonia (CD) who are toxin naïve and/or new to the physicians' practices, or who had been in a clinical trial but received their last injection ≥ 16 weeks prior to enrollment. Subjects are followed over 3 injection cycles of onabotulinumtoxinA, with assessments at time of injection and 4-6 weeks later. Information on physician's practice, patient demographics, CD disease history, duration of treatment intervals and neurotoxin dose, dilution, use of electromyography, and muscles injected are collected. Outcomes are assessed by physicians and subjects using various questionnaires.</p> <p>Discussion</p> <p>This ongoing registry includes 609 subjects with the following baseline data: 75.9% female, 93.6% Caucasian, mean age 57.6 ± 14.3, age at symptom onset 48.3 ± 16.2, and time to diagnosis 5.4 ± 8.6 years, with an additional 1.0 ± 3.5 years before treatment. Of those employed at the time of diagnosis, 36.6% stopped working as a result of CD. CD PROBE, the largest clinical registry of CD treatment, will provide useful data on current treatment practices with onabotulinumtoxinA, potentially leading to refinements for optimization of outcomes.</p> <p>Trial registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT00836017">NCT00836017</a></p

Securing By Design

This article investigates how modern neo-liberal states are 'securing by design' harnessing design to new technologies in order to produce security, safety, and protection. We take a critical view toward 'securing by design' and the policy agendas it produces of 'designing out insecurity' and 'designing in protection' because securing by design strategies rely upon inadequate conceptualisations of security, technology, and design and inadequate understandings of their relationships to produce inadequate 'security solutions' to readymade 'security problems'. This critique leads us to propose a new research agenda we call Redesigning Security. A Redesigning Security Approach begins from a recognition that the achievement of security is more often than not illusive, which means that the desire for security is itself problematic. Rather than encouraging the design of 'security solutions' a securing by design a Redesigning Security Approach explores how we might insecure securing by design. By acknowledging and then moving beyond the new security studies insight that security often produces insecurity, our approach uses design as a vehicle through which to raise questions about security problems and security solutions by collaborating with political and critical design practitioners to design concrete material objects that themselves embody questions about traditional security and about traditional design practices that use technology to depoliticise how technology is deployed by states and corporations to make us 'safe'

Urinary TWEAK as a biomarker of lupus nephritis: a multicenter cohort study

Introduction: TNF-like weak inducer of apoptosis (TWEAK) has been implicated as a mediator of chronic inflammatory processes via prolonged activation of the NF-κB pathway in several tissues, including the kidney. Evidence for the importance of TWEAK in the pathogenesis of lupus nephritis (LN) has been recently introduced. Thus, TWEAK levels may serve as an indication of LN presence and activity. Methods: Multicenter cohorts of systemic lupus erythematosus (SLE) patients and controls were recruited for cross-sectional and longitudinal analysis of urinary TWEAK (uTWEAK) and/or serum TWEAK (sTWEAK) levels as potential biomarkers of LN. The performance of TWEAK as a biomarker for nephritis was compared with routinely used laboratory tests in lupus patients, including anti-double stranded DNA antibodies and levels of C3 and C4. Results: uTWEAK levels were significantly higher in LN patients than in non-LN SLE patients and other disease control groups (P = 0.039). Furthermore, uTWEAK was better at distinguishing between LN and non-LN SLE patients than anti-DNA antibodies and complement levels, while high uTWEAK levels predicted LN in SLE patients with an odds ratio of 7.36 (95% confidence interval = 2.25 to 24.07; P = 0.001). uTWEAK levels peaked during LN flares, and were significantly higher during the flare than at 4 and 6 months prior to or following the flare event. A linear mixed-effects model showed a significant association between uTWEAK levels in SLE patients and their disease activity over time (P = 0.008). sTWEAK levels, however, were not found to correlate with the presence of LN or the degree of nephritis activity. Conclusions: High uTWEAK levels are indicative of LN, as opposed to non-LN SLE and other healthy and disease control populations, and reflect renal disease activity in longitudinal follow-up. Thus, our study further supports a role for TWEAK in the pathogenesis of LN, and provides strong evidence for uTWEAK as a candidate clinical biomarker for LN

Orthotopic liver transplantation in glycogen storage disease type la: Perioperative glucose and lactate homeostasis

Abstract Glycogen storage disease type 1a (GSD 1a) is a rare inborn error of metabolism. It causes severe fasting intolerance and lactic acidosis due to the deficiency of glucose-6-phosphatase enzyme. Blood glucose and lactate concentrations from 2 patients with GSD 1a were retrospectively compared to a control group of patients with familial amyloid polyneuropathy. Carbohydrate intake and infusions were compared to experimental data based on stable isotope studies. Perioperative lactate concentrations were significantly higher in our 2 patients with GSD 1a (median 15.0 mmol/L; range 9.9-22.0 mmol/L) versus 8 controls. In one patient, despite normal blood glucose concentrations, lactate acidosis was probably caused by a combination of the disease itself, insufficient (par)enteral carbohydrate intake, Ringer lactate infusions, and circulatory insufficiency. Patients with GSD 1a carry an increased risk of lactic acidosis during orthotopic liver transplantation compared to non-GSD patients. Multidisciplinary perioperative care is essential to prevent significant complications

Sub-lethal glyphosate exposure alters flowering phenology and causes transient male-sterility in Brassica spp

BACKGROUND: Herbicide resistance in weedy plant populations can develop through different mechanisms such as gene flow of herbicide resistance transgenes from crop species into compatible weedy species or by natural evolution of herbicide resistance or tolerance following selection pressure. Results from our previous studies suggest that sub-lethal levels of the herbicide glyphosate can alter the pattern of gene flow between glyphosate resistant Canola®, Brassica napus, and glyphosate sensitive varieties of B. napus and B. rapa. The objectives of this study were to examine the phenological and developmental changes that occur in Brassica crop and weed species following sub-lethal doses of the herbicides glyphosate and glufosinate. We examined several vegetative and reproductive traits of potted plants under greenhouse conditions, treated with sub-lethal herbicide sprays. RESULTS: Our results indicate that exposure of Brassica spp. to a sub-lethal dose of glyphosate results in altering flowering phenology and reproductive function. Flowering of all sensitive species was significantly delayed and reproductive function, specifically male fertility, was suppressed. Higher dosage levels typically contributed to an increase in the magnitude of phenotypic changes. CONCLUSIONS: These results demonstrate that Brassica spp. plants that are exposed to sub-lethal doses of glyphosate could be subject to very different pollination patterns and an altered pattern of gene flow that would result from changes in the overlap of flowering phenology between species. Implications include the potential for increased glyphosate resistance evolution and spread in weedy communities exposed to sub-lethal glyphosate.Keywords: Glyphosate, Herbicide drift, Brassica, Canola®, Glufosinate, Transgene escapeKeywords: Glyphosate, Herbicide drift, Brassica, Canola®, Glufosinate, Transgene escap

Identity centrality and psychosocial functioning : a person-centered approach

There has been increased recognition that identity operates within several “components” and that not every component is likely to be equally central to one’s sense of self. The aim of the current study was to determine the extent to which identity components (i.e., personal, relational, collective, and public) are differentially central to emerging adults’ identity. We used a two-step cluster analytic procedure to identify distinct clusters and determine how these configurations might differ in relation to psychosocial functioning (i.e., well-being, externalizing and internalizing symptoms, illicit drug use, risky sex, and impaired driving). The sample consisted of 8,309 college students (72.8% female; M age = 19.94 years, 18–29, SD = 2.01) from 30 U.S. colleges and universities. Analyses identified six unique clusters based on the centrality of the four identity components. The findings indicated that a more well-rounded identity was associated with the most favorable psychosocial functioning. Results are discussed in terms of important directions for identity research and practical implications

Finding Water Scarcity Amid Abundance Using Human–Natural System Models

Water scarcity afflicts societies worldwide. Anticipating water shortages is vital because of water’s indispensable role in social-ecological systems. But the challenge is daunting due to heterogeneity, feedbacks, and water’s spatial-temporal sequencing throughout such systems. Regional system models with sufficient detail can help address this challenge. In our study, a detailed coupled human–natural system model of one such region identifies how climate change and socioeconomic growth will alter the availability and use of water in coming decades. Results demonstrate how water scarcity varies greatly across small distances and brief time periods, even in basins where water may be relatively abundant overall. Some of these results were unexpected and may appear counterintuitive to some observers. Key determinants of water scarcity are found to be the cost of transporting and storing water, society’s institutions that circumscribe human choices, and the opportunity cost of water when alternative uses compete

Single Gene Deletions of Orexin, Leptin, Neuropeptide Y, and Ghrelin Do Not Appreciably Alter Food Anticipatory Activity in Mice

Timing activity to match resource availability is a widely conserved ability in nature. Scheduled feeding of a limited amount of food induces increased activity prior to feeding time in animals as diverse as fish and rodents. Typically, food anticipatory activity (FAA) involves temporally restricting unlimited food access (RF) to several hours in the middle of the light cycle, which is a time of day when rodents are not normally active. We compared this model to calorie restriction (CR), giving the mice 60% of their normal daily calorie intake at the same time each day. Measurement of body temperature and home cage behaviors suggests that the RF and CR models are very similar but CR has the advantage of a clearly defined food intake and more stable mean body temperature. Using the CR model, we then attempted to verify the published result that orexin deletion diminishes food anticipatory activity (FAA) but observed little to no diminution in the response to CR and, surprisingly, that orexin KO mice are refractory to body weight loss on a CR diet. Next we tested the orexigenic neuropeptide Y (NPY) and ghrelin and the anorexigenic hormone, leptin, using mouse mutants. NPY deletion did not alter the behavior or physiological response to CR. Leptin deletion impaired FAA in terms of some activity measures, such as walking and rearing, but did not substantially diminish hanging behavior preceding feeding time, suggesting that leptin knockout mice do anticipate daily meal time but do not manifest the full spectrum of activities that typify FAA. Ghrelin knockout mice do not have impaired FAA on a CR diet. Collectively, these results suggest that the individual hormones and neuropepetides tested do not regulate FAA by acting individually but this does not rule out the possibility of their concerted action in mediating FAA