What happens post-pilot testing? A model for revising a disability awareness and competency training program.

Disability awareness and competency trainings are an important component of addressing ableism and health equity in the health promotion context. This commentary describes our process of developing, implementing, and refining a disability competency training, the Inclusive Community Exercise Training, for community-based group exercise instructors. The training originated from a partnership between academic researchers, community organizations, and individuals with disabilities. After initial pilot testing, we used feedback from participants to enhance the training. To optimize successful dissemination of this training, we utilized the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, which is widely used in public health. The revision process focused on generalizing content to suit a wider audience, utilizing an eLearning platform for dissemination, and optimizing interactivity to improve learning effectiveness. The commentary emphasizes the lessons learned and the significance of systematic program revision, considering diverse expertise, content tailoring, and the benefits of accessible eLearning platforms.

Melatonin improves the motility and DNA integrity of frozen-thawed ram spermatozoa likely via suppression of mitochondrial superoxide production.

The ability of the neurohormone melatonin to ameliorate cryopreservation-induced damage to spermatozoa has been demonstrated in several domestic species. However, it is unclear how these protective effects are conferred, with improvements in sperm quality ambiguously attributed to the general antioxidant activity of melatonin. To further investigate this phenomenon, ram spermatozoa were diluted in cryomedia with and without melatonin (0 [control], 0.1, 1, 10, and 100 µM) and assessed for motility, viability, DNA integrity, mitochondrial superoxide production, lipid peroxidation, and intracellular reactive oxygen species before freezing and after thawing (0, 3, and 6 h post-thaw). Before freezing, supplementation with melatonin at any concentration had no effect on any measure of sperm quality. However, post-thaw, spermatozoa frozen in the presence of any level of melatonin reduced mitochondrial superoxide production of spermatozoa (P < 0.001), decreased the level of sperm DNA fragmentation (P < 0.001), and increased the percentage of motile spermatozoa (P = 0.035). Melatonin supplementation did not influence the relative levels of lipid peroxidation in the sperm membrane, the levels of intracellular reactive oxygen species, or sperm membrane lipid disorder (P > 0.05). There was no difference in the percentage of viable spermatozoa between treatment groups pre- or post-freeze (P > 0.05). These results suggest that, in the ram, melatonin does not protect the quality of cryopreserved spermatozoa through a nondiscerning scavenging of reactive oxygen species as previously suggested. Rather, melatonin appears to specifically reduce mitochondrial superoxide production, altering sperm functionality, as opposed to merely increasing the percentage of live sperm.

Treatment of rams with melatonin implants in the non-breeding season improves post-thaw sperm progressive motility and DNA integrity.

In the Merino ram, it is unclear whether cryopreserved sperm function and fertility is compromised when collected during the non-breeding season, when Merino ewes are seasonally anestrus. It was therefore investigated whether treatment with melatonin could improve sperm function or fertility when semen was collected during the period Merino ewes were seasonally anestrus. There were 16 Merino rams treated or not treated with melatonin implants during the non-breeding season of ewes (September). Ejaculates were collected before melatonin treatment (Week 0), during the period of melatonin release (Week 7) and subsequent breeding season (Week 23). In vitro sperm function was assessed before freezing, and at 0- and 3 -hs post-thaw. Fertility was determined through intrauterine insemination of ewes (n = 966) with frozen-thawed samples, during the breeding season. Compared to Week 0 values, spermatozoa from melatonin-treated rams had greater progressive motility at Week 7 (P = 0.019) and less DNA fragmentation (P = 0.003) at Weeks 7 and 23, whilst spermatozoa from non-treated rams were unchanged during these time-periods. There were no other treatment effects on sperm function or fertility (P > 0.05). In ejaculates collected during Week 23, there were no effects of treatment either before freezing or post-thawing. Sperm from ejaculates collected at Week 23, however, had lesser pre-freezing/post-thawing total motility and resulted in lower pregnancy rates (P < 0.05). It is concluded there are no effects of season on sperm quality or fertility of Merino rams and that melatonin treatment subtly improves quality of spermatozoa following cryopreservation.

Exogenous melatonin advances the ram breeding season and increases testicular function.

Governed by melatonin, ovine reproductive seasonality limits production outcomes due to periods of decreased reproductive efficiency. Though it is established that slow-release melatonin implants improve out of season reproductive performance in the ewe, the comprehensive effects of exogenous melatonin in the ram remain inconclusive. This study aimed to ultimately clarify the ability of exogenous melatonin to alter ram reproductive function during the non-breeding season and the subsequent breeding season. Hence, we investigated the effect of exogenous melatonin on reproductive endocrinology, semen quality and production, testicular size and libido in Merino and Poll Dorset rams (n = 31, using a subset of 18 rams for analysis of semen production and quality). Melatonin treatment resulted in elevation of melatonin in seminal plasma from 1-8 weeks post-implantation and in blood plasma at 6 weeks post-implantation. The blood plasma testosterone of implanted rams was greater than controls at both 6 weeks post-implantation and during the following breeding season. Implanted rams exhibited increased testicular size and number of sperm per ejaculate from 3-12 weeks post-implantation but did not demonstrate any change in sperm motility or morphology in response to treatment. Compared to their control counterparts, melatonin-treated Poll Dorset rams exhibited a lower percentage of sperm DNA fragmentation during several weeks of the non-breeding season. Though melatonin increased the likelihood of ejaculate collection in Poll Dorset rams (P < 0.05), libido was otherwise unaffected by treatment. Melatonin did not alter seminal plasma concentrations of inhibin A or Anti-Mullerian hormone, however, for the first time in the ram we have shown Anti-Mullerian hormone to be positively correlated with the number of sperm per ejaculate and sperm motility (r = 0.464 and 0.3242 respectively, P < 0.001), and inhibin A to be correlated to the number of sperm per ejaculate (r = 0.1786, P = 0.0135). These results indicate that melatonin is able to both systemically upregulate reproduction and act directly upon testicular function in the ram.

Overcoming neuroendocrine and metabolic barriers to puberty: the role of melatonin in advancing puberty in ewe lambs.

Pubertal onset in the ewe is subject to a multitude of physiological and environmental constraints. As seasonal breeders, sheep rely on decreasing photoperiod to enter puberty and the subsequent breeding periods, hindering production. The initiation of puberty defines the reproductive yield of the ewe, and as such is a critical factor influencing production outcomes. Currently, the misconception that ovine puberty is reliant on age results in ewes being bred at over a year old, leading to a substantial unproductive period between birth and first conception. As such, transcending pubertal barriers to allow for earlier initiation of reproductive competency has significant commercial merit. The primary candidate to achieve this is the neurohormone melatonin, a key factor that naturally signals photoperiodic change that facilitates seasonal remodeling of the ovine hypothalamic-hypophyseal-gonadal axis. Despite being known to modulate reproductive seasonality in both the mature ewe and ram, the ability of melatonin to advance ewe puberty remains underutilized in industry. To optimize melatonin application and shape perceptions of breeding ewe lambs, a greater understanding of pubertal impediments and the natural role of melatonin is warranted. This review examines the physiological role and applications of melatonin to advance ewe puberty, and how this may act in conjunction with other physiological and metabolic cues.

The Attitudes of Pulmonologists Regarding Smoking Behavior of Their Patients with Advanced COPD: A Qualitative Research.

Background: Patients with diseases linked with smoking, such as COPD, report a health-related stigma on their smoking behavior, which is related to a poorer quality of life and psychological distress. According to patients with COPD, health-care professionals sometimes reinforce the sense of stigma. However, little is known about the physicians' attitudes on this topic towards the patient with COPD. Purpose: To explore attitudes of pulmonologists regarding the smoking behavior of their patients with COPD and if (and to what extent) a stigma is present in their attitudes towards their smoking patients. Patients and methods: Eighteen pulmonologists were interviewed using a semi-structured guide with prespecified topics. The interview transcripts were coded using Atlas.ti. Analysis of data from these interviews was performed using conventional content analysis. Results: We identified three themes: attitudes towards smoking in general, the interaction between patient and physician, and smoking cessation. All participants said patients are not fully responsible for their smoking behavior. Contrarily, smoking was also seen as a free choice by most physicians. Moreover, smoking cessation was mostly seen as the responsibility of the patient. Feelings of powerlessness, frustration and compassion were reported in the guidance of patients with COPD. Conclusion: The results of this study show an ambivalent attitude of pulmonologists regarding the smoking behavior of their patients with COPD. The outcomes of this study can form a base for further research and can be used as insights for interventions that aim to raise awareness of physicians' own attitudes and increase the quality of physician-patient communication.

The fate of spermatozoa in the female reproductive tract: A comparative review.

The journey that spermatozoa take following deposition in the female tract is a long and perilous one. The barriers they face within the female tract differ depending on whether they are deposited in the vagina or uterus, like spermatozoa of the ram or boar respectively. Comparative studies on the transit of spermatozoa through the ewe and sow tracts serves to highlight similarities, or differences, in the way their sperm-surface properties enable them to overcome these barriers, progress through the tract and fertilise the oocyte. The female environment contributes towards this successful transit by providing a vehicle for sperm transport, aiding the removal of dead spermatozoa and other pathogens and applying strict selection pressures to ensure only those cells with the highest quality reach the site of fertilisation. Understanding the criteria behind these natural barriers helps an understanding of the limitations to fertility associated with preserved spermatozoa, and how in vitro manipulation can alter this complex interaction between spermatozoa and the female environment. Similar mechanisms or surface coat interactions exist in both species, but each has evolved to be used for physiologically disparate functions. Here we briefly describe the sperm surface characteristics of both fresh and frozen-thawed boar and ram spermatozoa and compare how these properties equip them to survive the physical, biochemical and immune interactions within the female reproductive tract.

Radiographic imaging features of thoracic complications after pneumonectomy in oncologic patients.

PURPOSE: The morbidity and mortality for pneumonectomy in patients has been reported to be as high as 24%. To determine if a subset of patients undergoing pneumonectomy for a malignancy would have similar complication rates and appearances, we performed a review of the radiographic findings of patients at our institution. METHOD: A retrospective review of a thoracic surgery database was performed at our institution for patients who underwent pneumonectomy between January 2001 and April 2004. All images were reviewed on the institutional patient archive communication system, by two experienced, fellowship trained, thoracic radiologists. RESULTS: There were 144 patients (112 men and 32 women) with a mean age of 52 years (range 21-83 years). Of the 144 patients, thoracic complications were present in 52 (36%) patients consisting of pneumonia in 19 (13%), empyema/pleural space infection in 9 (6%), adult respiratory distress syndrome (ARDS) in 8 (6%), bronchopleural fistula in 7 (5%), gortex graft failure/organ herniation in 4 (3%), chylothorax/chyle leak in 2 (1%), pulmonary embolus in 2 (1%), pulmonary hemorrhage in 1 (<1%). CONCLUSION: In oncologic patients, post-pneumonectomy complications occur in over a third of patients and can be life threatening. The presentations are similar to other pneumonectomy patients and are often radiographically detectable. Therefore it is important for radiologist to be aware of the radiographic manifestations of these complications so that appropriate immediate treatment is instituted.

Effects of tutoring in phonological and early reading skills on students at risk for reading disabilities.

This study examined the effectiveness of nonprofessional tutors in a phonologically based reading treatment similar to those in which successful reading outcomes have been demonstrated. Participants were 23 first graders at risk for learning disability who received intensive one-to-one tutoring from noncertified tutors for 30 minutes, 4 days a week, for one school year. Tutoring included instruction in phonological skills, letter-sound correspondence, explicit decoding, rime analysis, writing, spelling, and reading phonetically controlled text. At year end, tutored students significantly outperformed untutored control students on measures of reading, spelling, and decoding. Effect sizes ranged from .42 to 1.24. Treatment effects diminished at follow-up at the end of second grade, although tutored students continued to significantly outperform untutored students in decoding and spelling. Findings suggest that phonologically based reading instruction for first graders at risk for learning disability can be delivered by nonteacher tutors. Our discussion addresses the character of reading outcomes associated with tutoring, individual differences in response to treatment, and the infrastructure required for nonprofessional tutoring programs.

Hemisphere preference and EEG.

This study examined the association of scores on a paper-and-pencil test of hemispheric preference and EEG measures. No significant relationships between these two measures were found.

Linguistic performance and regional cerebral blood flow in persons who stutter.

In a series of studies regarding CNS dysfunction in stuttering, we have examined linguistic and motoric performance in the context of measures of brain function. Previous studies of adults with developmental stuttering identified alterations in brain function (metabolic and electrophysiologic) in cortical regions implicated in models of speech motor control and language processing. We also identified a sub-group of these subjects who exhibited linguistic performance deficits related to speech performance deficits. The present study examined the hypothesis that adults who stutter and who show linguistic performance deficits will also show metabolic alterations in cortical regions classically related to language processing, whereas adults who stutter but who do not show linguistic performance deficits will not show these cortical metabolic alterations. Significant relative blood flow asymmetry (left < right) was observed in middle temporal and inferior frontal cortical regions only for adults who both stuttered and showed linguistic performance deficits. Results support models that explicitly recognize that efficient integration of linguistic, motoric, and cognitive processes is critical to the production of oral/verbal fluency and to understanding sources of fluency failure.

Brain blood flow related to acoustic laryngeal reaction time in adult developmental stutterers.

The 1980s witnessed renewed interest in the relation between developmental stuttering and central nervous system (CNS) abnormalities. We have reported differences between nonstutterers and developmental stutterers on electrophysiologic (QTE) and metabolic (rCBF) measures of brain function. A critical step in the interpretation of results of functional brain imaging studies is to determine the relation, if any, of identified CNS abnormalities to speech motor control in persons who stutter. In this study we addressed the interpretation of rCBF findings by asking whether we could identify patterns of impaired acoustic laryngeal reaction time (LRT) as a function of response complexity parallel to rCBF findings. Stutterer subgroups determined by clinical severity ratings were not differentiated by LRT values as a function of response complexity. Stutterers with relative blood flow asymmetry below the normal median value involving both left superior and middle temporal regions of interest (ROIs) showed significantly longer LRT for the complex response than did normal speakers and stutterers with above-normal median relative flow values to at least one of these temporal ROIs. Stutterer subgroups based on reduced cingulate flow alone were not differentiated by LRT values. Findings are consistent with Goldberg's (1985) model of CNS premotor processing. Findings also suggest that stutterer subgroups might be distinguished by the presence, loci, and relative magnitude of cortical and/or subcortical rCBF abnormality in regions that subserve a fluency-generating system.

Regional cerebral blood flow in developmental stutterers.

Stuttering is a poorly understood communication disorder with a 1% global prevalence. Recently, there has been a resurgence of interest in a neurogenic origin for the disorder, although no research has established clear neurological differences between "developmental" (stuttering onset in childhood) stutterers and nonstutterers. We have used xenon 133 single-photon emission computed tomography to study regional cerebral blood flow (rCBF) in 20 stutterers. Analysis revealed global, absolute flow reductions. Relative flow asymmetries (left less than right) were identified in three hemispheric regions: anterior cingulate and superior and middle temporal gyri. Milder changes were found in the left inferior frontal gyrus. Stutterers had rCBF values below median for either anterior cingulate or middle temporal gyri. With one exception, severe stutterers had rCBF values below median for the anterior cingulate gyrus. All stutterers with rCBF values above median in the cingulate gyrus had rCBF values below median in the middle temporal gyrus, and severity of their disorder was either mild or moderate. Our findings suggest that stuttering is a neurogenic disorder involving recognized cortical regions of speech-motor control.

Laryngeal reaction time profiles in spasmodic dysphonia: relationship to cortical electrophysiologic abnormality.

This study combines measures of linguistic and vocal performance and long-latency auditory electrophysiology to investigate task-dependent variability in spasmodic dysphonia (SD). Linguistic performance was evaluated using several measures of relatively complex linguistic ability (i.e., discourse analysis). Vocal performance was evaluated by measuring acoustic laryngeal reaction time (LRT) for tasks that differ in complexity. Normal structure of the cortex and subcortex was confirmed by magnetic resonance imaging. Cortical function was measured using multichannel quantitative auditory evoked potentials (AEPs). As a group, SD subjects who demonstrated subtle linguistic deficits also demonstrated prolonged LRT for the complex task and repeated and persistent auditory electrophysiologic abnormalities over the anterior quadrant of the left hemisphere. As a group, linguistically normal SD subjects demonstrated no significant increase in LRT for the complex task and no recurrent electrophysiologic abnormalities over the left anterior cortex relative to normal controls. Results support a neurogenic origin of SD and suggest that some aspects of inter- and intrasubject variability may be related to differences in loci and magnitude of cortical abnormalities.

Heterogeneity in spasmodic dysphonia. Neurologic and voice findings.

Spasmodic dysphonia is a disturbance of phonation with laryngeal spasms. We report voice and neurologic examination findings in 45 subjects. Neurologic abnormalities were found in 32 subjects (71.1%). Rapid alternating movement abnormalities, weakness, and tremor were common. Incoordination and spasticity were rare. Lower extremity findings were frequent. Abnormalities were bilateral. Spasmodic dysphonia severity was related to age. Type, severity, and duration of vocal symptoms were not different for subjects with or without neurologic abnormalities. Vocal tremor was more frequent in neurologically abnormal subjects. Involvement of a pallidothalamic-supplementary motor area system could account for neurologic findings, brain imaging findings, and clinical heterogeneity. The view emerging is that spasmodic dysphonia is a manifestation of disordered motor control involving systems of neurons rather than single anatomical sites.

Quantitative electroencephalography and anatomoclinical principles of aphasia. A validation study.

No single technology in isolation can provide a full view of the anatomoclinical principles evident in the clinical populations we study. The dynamic nature of quantitative electrophysiology makes it an ideal complement to anatomic and metabolic imaging. The statistical conundrum it has presented may be resolved by the approach incorporated in CART. The intent of this study was to examine QEEG and CART in the evaluation of the neurologic bases of a well-defined behavioral disorder like aphasia. The combined power of QEEG and CART yielded objective electrophysiologic methods to predict aphasia that rival the reliability of the language examination. Such success is unprecedented. This success allows us to incorporate QEEG and CART into our technological armamentarium and to return to the evaluation of less well-understood disorders with confidence in both our findings and anatomoclinical principles we derive from them.

A health investment that may save your life.

Breast cancer need not continue to be the devastating, deadly disease it has been in the past. With early detection, there is a higher rate of cure. There are three components to good breast health. These include (a) annual physical exam by a physician, (b) mammography according to the prescribed guidelines, and (c) monthly breast self-examination (BSE). When a woman does all three of these things, she's doing everything she can to insure early detection of breast cancer. This article discusses location, description, and characteristics of tumors. It also includes a teaching protocol developed for Midwest Breast Care Center in St. Louis, Missouri by the writer that includes risk factors, signs, and symptoms of breast cancer. It also includes new, comprehensive examination techniques set forth by the University of Texas System Cancer Center M. D. Anderson Cancer Center. The protocol is set up in a step-by-step format for easier teaching and learning. New, more thorough examination techniques have also been established at M. D. Anderson for the woman who has had a mastectomy and needs to examine the surgical site each month as well as her remaining breast. The article encourages women to take responsibility for their breast health and wellness.

Evidence for cortical dysfunction in spasmodic dysphonia: regional cerebral blood flow and quantitative electrophysiology.

Cortical function was evaluated in 26 subjects with spasmodic dysphonia. Quantitative topographic electrophysiologic mapping (QTE) was employed to provide quantitative analyses of EEG spectra and auditory and visual long-latency evoked potentials. Single-photon emission computed tomography (SPECT) of the cerebral transit of Xenon-133 was used to evaluate regional cerebral blood flow. Left hemispheric abnormalities in cortical function were found by both techniques in 10 subjects and by at least one technique in 18 subjects. Right hemispheric abnormalities were observed by both techniques in 8 subjects and by at least one technique in 18 subjects. Most patients with cortical dysfunction in one hemisphere had cortical dysfunction in the other, while only 4 subjects had unilateral lesions as found by one of the two techniques. Eight subjects were normal by all measurements. Underlying structural abnormalities were detected by magnetic resonance imaging in 5/24 subjects. However, functional abnormalities (SPECT or QTE) were not observed at sites of structural abnormalities. SPECT and QTE were significantly related in identification of left hemispheric dysfunction (p = .037) with a trend in the right hemisphere (p = .070), and a significant congruence of SPECT and QTE findings occurred in the left anterior cortical quadrant (p = .011). These findings indicate that dysfunction of cortical perfusion and/or cortical electrophysiology is associated with spasmodic dysphonia in the majority of subjects studied.

Quantitative topographic electrophysiology and functional neurologic status in right middle cerebral artery infarction.

Thirteen patients with clinically and radiographically defined right middle cerebral artery infarction were studied using EEG, quantitative electroencephalographic (QEEG) spectra, and multi-channel evoked potentials. The purpose of this effort was to develop QEEG rules that related to the patient's neurologic status. Three QEEG relative delta spectral patterns were identified in the right hemisphere which related to neurologic residua. These include limited perisylvian involvement, mixed involvement of perisylvian and extrasylvian regions, and extrasylvian involvement only. While there were parallels between QEEG spectral patterns and auditory, visual and somatosensory evoked potentials, there were modality specific features consistent with functional differences.