THE DISABLED SOLDIER: A CASE FOR DISABLED AMERICANS IN THE U.S. ARMED SERVICES

Despite the rising demands and functions of non-kinetic warfare, the military bars most disabled Americans from entry. Artificial intelligence, complex decision-making, and fifth-generation-warfare elements stress a multidimensional force and cognitive skills over dominant kinetic traits. This thesis investigates the feasibility requirements, national security implications, and benefits to the Department of Defense of expanding active military service to disabled Americans. After reviewing U.S. and international integration of disabled persons, the defined needs and skills for emerging warfare, academic studies of disabled talents, and military policy, this thesis reveals the feasibility of inclusion. Recommendations include mainstreaming persons with disabilities within the existing military model, making changes to defense policy, establishing a pilot program or corps, and undertaking future research.Civilian, Department of Homeland SecurityApproved for public release. Distribution is unlimited

Comparing Methods of Quantifying Tibial Acceleration Slope

Considerable variability in tibial acceleration slope (AS) values, and different interpretations of injury risk based on these values, have been reported. Acceleration slope variability may be due in part to variations in the quantification methods used. Therefore, the purpose of this study was to quantify differences in tibial AS values determined using end points at various percentage ranges between impact and peak tibial acceleration, as a function of either amplitude or time. Tibial accelerations were recorded from 20 participants (21.8 ± 2.9 years, 1.7 m ± 0.1 m, 75.1 kg ± 17.0 kg) during 24 unshod heel impacts using a human pendulum apparatus. Nine ranges were tested from 5–95% (widest range) to 45–55% (narrowest range) at 5% increments. ASAmplitude values increased consistently from the widest to narrowest ranges, whereas the ASTime values remained essentially the same. The magnitudes of ASAmplitude values were significantly higher and more sensitive to changes in percentage range than ASTime values derived from the same impact data. This study shows that tibial AS magnitudes are highly dependent on the method used to calculate them. Researchers are encouraged to carefully consider the method they use to calculate AS so that equivalent comparisons and assessments of injury risk across studies can be made

The Development of Wingate Normative-Reference Values for a Healthy Canadian Adult Population

Introduction. The Wingate anaerobic test is a tool used to evaluate anaerobic power and capacity. While it is commonly utilized to assess performance, specifically among athletic populations, its evaluative capacity for non-athletic populations is limited by the lack of published data and normative-reference standards in the literature. Therefore, the purpose of this study was to develop Wingate normative-reference values that are representative of the general young and healthy Canadian adult population. Methods. A convenience sample of 873 (396 males and 477 females) university students, ranging in age from 20 to 29 years, was examined. Data were collected in a Kinesiology laboratory-based course from 2010 to 2019. Participants completed a Wingate exercise protocol, which consisted of two 30-second bouts of pedalling that were separated by a 30-second rest period. During the testing bouts, participants pedalled against a resistance equivalent to 7.5% of their body mass in kilograms. Results.An overall trend of higher peak power (PP) and mean power (MP) values among male participants in comparison to female participants was observed, while females displayed lower fatigue index (FI) scores. Independent samples t-test results revealed statistically significant differences (p Conclusion. The collected data allowed for normative-reference values, including percentile rankings and seven performance classifications, to be generated. The development of these Wingate norms, specific to the target population, will allow for significant practical applications, including an effective method in assessing anaerobic performance and health

A Child\u27s Journey Through the Child Welfare System.

Once a child is known to the government child welfare agency, the child and his or her family become subject to a series of decisions made by judges, caseworkers, legal representatives, and others-all of whom have an important role to play. A child may encounter dozens of other new adults, including foster parents, counselors, and doctors. Most children enter foster care when removed from their homes by a child protective agency because of abuse or neglect, or both. Others enter care because of the absence of their parents, resulting from illness, death, disability, or other problems. Some children enter care because of delinquent behavior or because they have committed a juvenile status offense, such as running away or truancy. A small percentage of children enter care because of a disability. For many, foster care represents their only access to disability services, such as mental health care for a child with severe emotional disturbance. In these rare instances, in states that allow such placements, a child is placed in foster care voluntarily at the request of the child\u27s parents

Thrombospondin-1 Silencing Down-Regulates Integrin Expression Levels in Human Anaplastic Thyroid Cancer Cells with BRAFV600E: New Insights in the Host Tissue Adaptation and Homeostasis of Tumor Microenvironment

Background and Rationale: Anaplastic thyroid cancer (ATC) is characterized by pleomorphic cells, has a poor prognosis, is highly devastating disease, and is not curable. No reliable biomarkers of metastatic potential, helpful for early diagnosis of ATC and therapeutic response have been found yet. Thrombospondin-1 (TSP-1) plays a fundamental role in cancer progression by regulating cell stromal cross-talk in the tumor microenvironment. Goals: Our goal was to understand whether TSP-1 could affect protein levels of its integrin receptors (e.g., ITGα3, α6, and β1) and cell morphology in BRAFV600E-ATC cells in vitro and in vivo. Experimental Design: Anaplastic thyroid cancer-derived cell cultures and western blotting were used to assess integrin protein expression upon TSP-1 silencing. Immunohistochemistry was performed on orthotopic primary human ATC and metastatic ATC in lung tissue to compare TSP-1 and integrin protein expression levels. Results:: TSP-1 knock-down down-regulates ITGα3, α6, and β1 in BRAFV600E-human ATC cells. BRAFV600E-ATC cells with TSP-1 knock-down were rounded compared to control cells, which displayed a spread morphology. TSP-1 knock-down also reduced TSP-1, ITGα3, α6, and β1 protein expression levels in vivo in the ATC microenvironment, which is enriched in stromal and inflammatory cells. Conclusion:: TSP-1 silencing causes changes in ITG levels and ATC cell morphology. The assessment of TSP-1 and ITG levels might contribute to earlier metastatic potential of BRAFV600E-positive aggressive thyroid cancers, and allow improved patient selection for clinical trials

Combined Carpal Tunnel Release and Palmar Fasciectomy for Dupuytren’s Contracture Does Not Increase the Risk for Complex Regional Pain Syndrome

Background: Hand surgery dogma suggests that simultaneous surgical treatment of carpal tunnel syndrome (CTS) and Dupuytren’s contracture (DC) results in an increased incidence of Complex Regional Pain Syndrome (CRPS). As a result, many surgeons do not perform surgery for the two conditions concurrently. Our goal was to determine the extent of this association. Methods: We identified all patients undergoing surgical treatment for CTS, DC, or both between April 1982 and March 2017 using the Indiana Network for Patient Care (INPC), a large, multi-institutional, statewide information exchange. Demographics, comorbidities, and 1-year post-operative incidence of CRPS were recorded. Results: A total of 51,739 (95.6%) patients underwent carpal tunnel release (CTR) only, 2,103 (3.9%) underwent palmar fasciectomy (PF) only, and 305 (0.6%) underwent concurrent CTR and PF. There was no difference in the likelihood of developing CRPS (p=0.163) between groups. Independent risk factors for developing CRPS were younger age, anxiety, depression, epilepsy, gout, and history of fracture of the radius, ulna, or the carpus. Conclusions: Concurrent CTR and PF is not associated with an increased risk for developing CRPS. Patient demographics, medical comorbidities, and a history of upper extremity trauma are associated with the development of CRPS after surgery and should be discussed preoperatively as potential risk factors

Large, Prospective Analysis of the Reasons Patients Do Not Pursue BRCA Genetic Testing Following Genetic Counseling

Genetic counseling (GC) and genetic testing (GT) identifies high‐risk individuals who benefit from enhanced medical management. Not all individuals undergo GT following GC and understanding the reasons why can impact clinical efficiency, reduce GT costs through appropriate identification of high‐risk individuals, and demonstrate the value of pre‐GT GC. A collaborative project sponsored by the Michigan Department of Health and Human Services prospectively collects anonymous data on BRCA‐related GC visits performed by providers in Michigan, including demographics, patient/family cancer history, GT results, and reasons for declining GT. From 2008 to 2012, 10,726 patients underwent GC; 3476 (32.4%) did not pursue GT. Primary reasons included: not the best test candidate (28.1%), not clinically indicated (23.3%), and insurance/out of pocket cost concerns (13.6%). Patient disinterest was the primary reason for declining in 17.1%. Insurance/out of pocket cost concerns were the primary reason for not testing in 13.4% of untested individuals with private insurance. Among untested individuals with breast and/or ovarian cancer, 22.5% reported insurance/out of pocket cost concerns as the primary reason for not testing and 6.6% failed to meet Medicare criteria. In a five‐year time period, nearly one‐third of patients who underwent BRCA GC did not pursue GT. GT was not indicated in almost half of patients. Insurance/out of pocket cost concerns continue to be barriers.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146968/1/jgc40859.pd

We Know Better Than We Do: A Policy Framework for Child Welfare Reform

The need for comprehensive reform of child welfare policies and systems has long been evident. This Article reports observations from the WK Kellogg Foundation-sponsored Families for Kids Initiative that seeks to expand services and support to families and reduce the time children spend in temporary care. The authors first provide an overview of the need for reforms such as those proposed by this initiative, suggesting that many child welfare studies, critiques, and proposed reforms have had similar objectives. The authors highlight lessons learned from how these reform goals are being developed, implemented, and practiced in ongoing programs across the nation and argue that change at multiple levels must occur for reform of this system to succeed. They identify nine methods being used to varying degrees by some of these initiatives to institutionalize reform goals and improve the quality and outcomes of child welfare legal and social service practice. By highlighting these evolving models of state law, agency administrative procedure and professional practice, the authors identify areas of reform for other jurisdictions. Child welfare reform rests upon new legislation mandates; more specific reasonable efforts requirements, adoption of flexible funding mechanisms, capitated foster care contracts, timely court processes better trained professional or cross-system data capability to monitor children in care. All of these policy and system reforms must be designed and implemented collectively for child welfare ideals to become operational

Enantioselective Construction of Acyclic Quaternary Carbon Stereocenters: Palladium-Catalyzed Decarboxylative Allylic Alkylation of Fully-Substituted Amide Enolates

We report a divergent and modular protocol for the preparation of acyclic molecular frameworks containing newly created quaternary carbon stereocenters. Central to this approach is a sequence composed of a (1) regioselective and -retentive preparation of allyloxycarbonyl-trapped fully substituted stereodefined amide enolates and of a (2) enantioselective palladium-catalyzed decarboxylative allylic alkylation reaction using a novel bisphosphine ligand