Capsular lesions with glenohumeral ligament injuries in patients with primary shoulder dislocation: magnetic resonance imaging and magnetic resonance arthrography evaluation

The glenohumeral ligaments are important structures for the stability of the shoulder. They are integrated parts of the capsule and are at risk to be injured in a traumatic shoulder dislocation. The aim was to examine the prevalence of capsular ligament lesions in the acute phase and at minimum 3 weeks' follow-up after first-time traumatic shoulder dislocation. Forty-two patients aged 16–40 years were included. All patients underwent computed tomography and magnetic resonance imaging (MRI) scans shortly after the injury and MR-arthrography (MRA) at follow-up. The median time from dislocation to MRI was 7 (range 2–14) days and to MRA 30 (range 21–54) days. We found capsular ligament lesions in 22 patients (52.4%) in the acute stage and in five patients (11.9%) at follow up. Nine patients (21.4%) had a humeral avulsion of the anterior glenohumeral ligament (HAGL lesion) on MRI. Three patients (7.1%) had this lesion at follow-up. The rate of HAGL lesions in the acute stage was higher than reported previously, but the prevalence at follow-up was in keeping with earlier published studies

Exon Exchange Approach to Repair Duchenne Dystrophin Transcripts

Background: Trans-splicing strategies for mRNA repair involve engineered transcripts designed to anneal target mRNAs in order to interfere with their natural splicing, giving rise to mRNA chimeras where endogenous mutated exons have been replaced by exogenous replacement sequences. A number of trans-splicing molecules have already been proposed for replacing either the 59 or the 39 part of transcripts to be repaired. Here, we show the feasibility of RNA surgery by using a double trans-splicing approach allowing the specific substitution of a given mutated exon. Methodology/Principal Findings: As a target we used a minigene encoding a fragment of the mdx dystrophin gene enclosing the mutated exon (exon 23). This minigene was cotransfected with a variety of exon exchange constructions, differing in their annealing domains. We obtained accurate and efficient replacement of exon 23 in the mRNA target. Adding up a downstream intronic splice enhancer DISE in the exon exchange molecule enhanced drastically its efficiency up to 25–45 % of repair depending on the construction in use. Conclusions/Significance: These results demonstrate the possibility to fix up mutated exons, refurbish deleted exons and introduce protein motifs, while keeping natural untranslated sequences, which are essential for mRNA stability and translation regulation. Conversely to the well-known exon skipping, exon exchange has the advantage to be compatible with almost any type of mutations and more generally to a wide range of genetic conditions. In particular, it allows addressing disorders caused by dominant mutations

Life-Span Perspective of Personality in Dementia

To propose an alternative view of personality change in dementia by presenting existing evidence for the continuity of personality. Significance : As the population continues to age, dementing illnesses will account for a greater proportion of morbidity and mortality; the care of these people will have a significant effect on the health care system. Organizing Framework : Life-span perspective of personality continuity. Scope, Method : Review of current literature on personality in dementia using Medline, 1980–1994; CINAHL, 1990–1994; and Psych Lit, 1980–1994. Findings : Although there are systematic shifts in personality with dementia, individuals tend to maintain their unique pattern of premorbid personality traits. Conclusions : The personalities of dementia patients seem to reflect adaptive patterns that served them in the past. Implications : Use of a life-span perspective can enhance individualized care for demented patients and advance theory development.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73653/1/j.1547-5069.1996.tb00380.x.pd

Political strategies of external support for democratization

Political strategies of external support to democratization are contrasted and critically examined in respect of the United States and European Union. The analysis begins by defining its terms of reference and addresses the question of what it means to have a strategy. The account briefly notes the goals lying behind democratization support and their relationship with the wider foreign policy process, before considering what a successful strategy would look like and how that relates to the selection of candidates. The literature's attempts to identify strategy and its recommendations for better strategies are compared and assessed. Overall, the article argues that the question of political strategies of external support for democratization raises several distinct but related issues including the who?, what?, why?, and how? On one level, strategic choices can be expected to echo the comparative advantage of the "supporter." On a different level, the strategies cannot be divorced from the larger foreign policy framework. While it is correct to say that any sound strategy for support should be grounded in a theoretical understanding of democratization, the literature on strategies reveals something even more fundamental: divergent views about the nature of politics itself. The recommendations there certainly pinpoint weaknesses in the actual strategies of the United States and Europe but they have their own limitations too. In particular, in a world of increasing multi-level governance strategies for supporting democratization should go beyond preoccupation with just an "outside-in" approach

Longitudinal investigation of wandering behavior in department of veterans affairs nursing home care units

Objectives To explore the extent of and factors associated with male residents who change wandering status post nursing home admission. Design Longitudinal design with secondary data analyses. Admissions over a 4-year period were examined using repeat assessments with the Minimum Data Set (MDS) to formulate a model understanding the development of wandering behavior. Setting One hundred thirty-four Veterans Administration (VA) nursing homes throughout the United States. Participants Included 6673 residents admitted to VA nursing homes between October 2000 and October 2004. Measurements MDS variables (cognitive impairment, mood, behavior problems, activities of daily living and wandering) included ratings recorded at residents' admission to the nursing home and a minimum of two other time points at quarterly intervals. Results The majority (86%) of the sample were classified as non-wanderers at admission and most of these (94%) remained non-wanderers until discharge or the end of the study. Fifty-one per cent of the wanderers changed status to non-wanderers with 6% of these residents fluctuating in status more than two times. Admission variables associated with an increased risk of changing status from non-wandering to wandering included older age, greater cognitive impairment, more socially inappropriate behavior, resisting care, easier distractibility, and needing less help with personal hygiene. Requiring assistance with locomotion and having three or more medical comorbidities were associated with a decreased chance of changing from non-wandering to wandering status. Conclusion A resident's change from non-wandering to wandering status may reflect an undetected medical event that affects cognition, but spares mobility. Copyright © 2009 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/64919/1/2316_ftp.pd

Hobbes and the Congo: Frames, Local Violence, and International Intervention

Why do international peacebuilders fail to address the local causes of peace process failures? The existing explanations of peacebuilding failures, which focus on constraints and vested interests, do not explain the international neglect of local conflict. In this article, I show how discursive frames shape international intervention and preclude international action on local violence. Drawing on more than 330 interviews, multi-sited ethnography, and document analysis, I develop a case study of the Democratic Republic of Congo's transition from war to peace and democracy (2003-2006). I demonstrate that local agendas played a decisive role in sustaining local, national, and regional violence. However, a postconflict peacebuilding frame shaped the international understanding of violence and intervention in such a way that local conflict resolution appeared irrelevant and illegitimate. This frame included four key elements: international actors labeled the Congo a "postconflict" situation; they believed that violence there was innate and therefore acceptable even in peacetime; they conceptualized international intervention as exclusively concerned with the national and international realms; and they saw holding elections, as opposed to local conflict resolution, as a workable, appropriate, and effective tool for state- and peacebuilding. This frame authorized and justified specific practices and policies while precluding others, notably local conflict resolution, ultimately dooming the peacebuilding efforts. In conclusion, I contend that analyzing discursive frames is a fruitful approach to the puzzle of international peacebuilding failures beyond the Congo

Need-driven dementia-compromised behavior: An alternative view of disruptive behavior

The disruptive behavior of persons with dementia is a problem of considerable clinical interest and growing scientific concern. This paper offers a view of these behaviors as expressions of unmet needs or goals and provides a comprehensive conceptual framework to guide further research and clinical practice. Empiricalfindings and clinical impressions related to wandering, vocalizations and aggression to support and illustrate the framework are presentedPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66887/2/10.1177_153331759601100603.pd

The Evolution of Trade and Scientific Collaboration Networks in the Global Wine Sector: A Longitudinal Study Using Network Analysis

Throughout the past three decades, the global pattern of wine production has undergone fundamental changes, most notably the emergence of New World producers. This article presents a detailed account of the sector’s changing global organization from 1974 to 2004 by applying network analysis methods to the evolution of international trade and scientific collaboration networks. We argue that there is a strong mutual interdependence of trade and scientific knowledge production, as a result of which we expect the geographic configuration of global knowledge and trade networks to coevolve. Our results showthat, over time, only a few New World wine producers developed trade and scientific collaboration networks that resemble those of traditional Old World producers. They also show that structures of trade and scientific collaboration networks are more alike for Old World than for New World producers, which suggests that, contrary to our expectations, it is particularly Old World producers who may have mainly benefited from participation in international scientific collaboration

MR imaging in sports-related glenohumeral instability

Sports-related shoulder pain and injuries represent a common problem. In this context, glenohumeral instability is currently believed to play a central role either as a recognized or as an unrecognized condition. Shoulder instabilities can roughly be divided into traumatic, atraumatic, and microtraumatic glenohumeral instabilities. In athletes, atraumatic and microtraumatic instabilities can lead to secondary impingement syndromes and chronic damage to intraarticular structures. Magnetic resonance (MR) arthrography is superior to conventional MR imaging in the diagnosis of labro-ligamentous injuries, intrinsic impingement, and SLAP (superior labral anteroposterior) lesions, and thus represents the most informative imaging modality in the overall assessment of glenohumeral instability. This article reviews the imaging criteria for the detection and classification of instability-related injuries in athletes with special emphasis on the influence of MR findings on therapeutic decisions