Deployment of the DosiKit System Under Operational Conditions: Experience From a French Defense National Nuclear Exercise.

Estimation of the dose received by accidentally irradiated victims is based on a tripod: clinical, biological, and physical dosimetry. The DosiKit system is an operational and mobile biodosimetry device allowing the measurement of external irradiation directly on the site of a radiological accident. This tool is based on capillary blood sample and hair follicle collection. The aim is to obtain a whole-body and local-surface dose assessment. This paper is about the technical evaluation of the DosiKit; the analytical process and scientific validation are briefly described. The Toulon exercise scenario was based on a major accident involving the reactor of a nuclear attack submarine. The design of the scenario made it impossible for several players (firefighters, medical team) to leave the area for a long time, and they were potentially exposed to high dose rates. The DosiKit system was fully integrated into a deployable radiological emergency laboratory, and the response to operational needs was very satisfactory.

Physicochemical characteristics and sensory attributes of meat from heavy-weight Iberian and F1 Large White × Landrace pigs finished intensively or in free-range conditions.

Iberian (IB, n = 60) and crossbred Large White × Landrace (F1, n = 58) pigs were slaughtered at 160 kg, after finishing under intensive conditions or on pasture and acorns. The study was carried out as a factorial arrangement of treatments, and physicochemical properties and sensory attributes of meat were assessed in Longissimus thoracis samples. Physical characteristics included the assessment of drip loss, cooking loss, shear force, and color coordinates in meat samples processed at 2 and 9 d postmortem. The interactions of genetic group and finishing system were significant (P < 0.05) for cooking loss in meat aged for 9 d and for sensorial tenderness and global acceptability of meat, but none of the other physicochemical, color coordinates, and sensory variables analyzed showed a significant interaction. Genetic group was the main factor influencing the variables analyzed, with a major (P < 0.01) influence on all meat physicochemical characteristics and sensory attributes. Relative to F1 pigs, the IB produced meat with higher intramuscular fat content and marbling score, more appealing color coordinates, lower shear force, and higher sensorial tenderness. The finishing systems affected (P < 0.05) most physical characteristics, but not chemical composition of meat and their impact on sensory properties was small. The tenderness, juiciness, and global acceptability of meat were much higher in IB pigs, and flavor was also more desirable, but the difference was smaller. The differences in sensory properties between meats originating from the two genetic groups were largely explained by the higher fat deposition in IB pigs, such that a higher level of marbling was positively associated with all the sensory attributes evaluated. Ageing meat for up to 9 d postmortem benefited pork quality, improving meat tenderness, and color, particularly in crossbred pigs and those finished intensively.

Carcass characteristics and fat depots in Iberian and F Large White × Landrace pigs intensively finished or raised outdoors in oak-tree forests.

A factorial experiment was performed with 117 barrows belonging to the Iberian (IB) and crossbred F Large White × Landrace (F) genetic groups, either intensively finished (IN) or finished outdoors on pasture in an oak and cork tree forest (EX). Information was collected on carcass weight, yield, and dimensions; weight of organs, carcass cuts, and abdominal fat depots; backfat depth; measurements of the longissimus thoracis (LT); and yield of different leg tissues. For the 41 slaughter and carcass traits analyzed, the interaction between genetic group and finishing system was significant ( < 0.05) in 18 traits, and overall, there was a more pronounced influence of genetic group than of finishing system. In most variables, particularly those related with fat deposition, the interaction reflected mostly changes in mean differences among genetic groups rather than in their ranking, where IB pigs consistently produced fatter carcasses, regardless of the finishing system. Liver weight in IB-EX pigs was lower by nearly 8% when compared with F-EX or IB-IN pigs, but the opposite pattern was found in F pigs, where liver weight in F-EX pigs was higher by 16% relative to IB-EX pigs or to F-IN pigs. The deposition of adipose tissue was much larger ( < 0.05) in IB pigs compared with F pigs, with means for fat depots in IB pigs that were higher by about 25% in total abdominal fat, 94% in dorsal fat depth, 72% in intermuscular plus subcutaneous fat in the leg, and over 300% in intramuscular fat (IMF). The deposition of lean tissue was much lower in IB pigs ( < 0.05), with means for trimmed loin weight corresponding to about one-half of the means obtained in F pigs, whereas lean percentage in the leg of IB pigs was about two-thirds of the mean in F pigs and the mean area of the LT was nearly one-half of that observed in F pigs in the same finishing system ( < 0.05). A strong correlation was observed between the various fat depots when the full data set was considered (correlations of IMF with abdominal fat and backfat depth of 0.65 and 0.83, respectively; < 0.05), but the correlations were much smaller when they were estimated within breed, particularly for IB pigs (-0.10 and 0.20 for the correlations of IMF with abdominal fat and backfat depth, respectively; > 0.05), indicating that it is feasible to reduce subcutaneous and abdominal fat without compromising IMF and meat quality.

Ultrastructural Characterization of Fresh and Vitrified In Vitro- and In Vivo-Produced Sheep Embryos.

The lower results in cryopreservation of in vitro-produced (IVP) sheep embryos, when compared to the in vivo derived, limits its use. Four groups of blastocyst (BL) were evaluated: fresh IVP (n = 3), fresh in vivo derived (n = 3), warmed IVP cryopreserved in open pulled straws (OPS, n = 3) and warmed in vivo derived cryopreserved in OPS (n = 3). Ultrastructural observation of processed fresh embryos showed a reduced number of microvilli and mitochondria in the IVP ones, as well as a lower number of mature mitochondria, that can be associated with deficient metabolism in IVP embryos, possibly involved in the lower resistance to cryopreservation. Both in vivo-derived and IVP embryos had a large number of vesicles, with light and dense content. In embryos vitrified by OPS, major changes were observed mainly in IVP embryos with small changes in grade 2 (fair) and high changes in grade 3 (bad) semithin scoring. The main changes associated with cryopreservation included disruption of cellular membranes and poor intracellular preservation, with loss of microvilli and the presence of cellular debris. In conclusion, ultrastructural evaluation of IVP blastocysts cryopreserved in OPS was herein described for the first time, reporting more severe cellular damage in these embryos when compared to those produced in vivo. This is probably associated with a lower cryotolerance that can be related to their lipid content and metabolism.

Brain iron accumulation affects myelin-related molecular systems implicated in a rare neurogenetic disease family with neuropsychiatric features.

The 'neurodegeneration with brain iron accumulation' (NBIA) disease family entails movement or cognitive impairment, often with psychiatric features. To understand how iron loading affects the brain, we studied mice with disruption of two iron regulatory genes, hemochromatosis (Hfe) and transferrin receptor 2 (Tfr2). Inductively coupled plasma atomic emission spectroscopy demonstrated increased iron in the Hfe-/- × Tfr2mut brain (P=0.002, n ≥5/group), primarily localized by Perls' staining to myelinated structures. Western immunoblotting showed increases of the iron storage protein ferritin light polypeptide and microarray and real-time reverse transcription-PCR revealed decreased transcript levels (P<0.04, n ≥5/group) for five other NBIA genes, phospholipase A2 group VI, fatty acid 2-hydroxylase, ceruloplasmin, chromosome 19 open reading frame 12 and ATPase type 13A2. Apart from the ferroxidase ceruloplasmin, all are involved in myelin homeostasis; 16 other myelin-related genes also showed reduced expression (P<0.05), although gross myelin structure and integrity appear unaffected (P>0.05). Overlap (P<0.0001) of differentially expressed genes in Hfe-/- × Tfr2mut brain with human gene co-expression networks suggests iron loading influences expression of NBIA-related and myelin-related genes co-expressed in normal human basal ganglia. There was overlap (P<0.0001) of genes differentially expressed in Hfe-/- × Tfr2mut brain and post-mortem NBIA basal ganglia. Hfe-/- × Tfr2mut mice were hyperactive (P<0.0112) without apparent cognitive impairment by IntelliCage testing (P>0.05). These results implicate myelin-related systems involved in NBIA neuropathogenesis in early responses to iron loading. This may contribute to behavioral symptoms in NBIA and hemochromatosis and is relevant to patients with abnormal iron status and psychiatric disorders involving myelin abnormalities or resistant to conventional treatments.

Ultrastructural characterization of in vivo-produced ovine morulae and blastocysts.

The ultrastructure of in vivo-produced ovine embryos, at the morula, early blastocyst and late blastocyst stages, was evaluated using transmission electron microscopy. Embryonic cells were characterized by the presence of intact intercellular junctions, numerous mitochondria, smooth endoplasmic reticulum cisternae and light vesicles. Polyribosomes, rough endoplasmic reticulum cisternae, secondary lysosomes, Golgi complexes and lipid droplets were also observed in the cytoplasm. The nucleus was well defined and organized, with an intact envelope rich in nuclear pore complexes, and one or more reticular nucleoli. Microvilli were present in external blastomeres of morulae and became more abundant in trophectoderm cells of early and late blastocysts. Light vesicles seemed to be associated with small cisternae of Golgi and endoplasmic reticulum origin. These cisternae fused and created light vesicles with engulfed heterogeneous cytosolic structures, small cisternae and vesicles. Their labile membrane enabled them to rapidly coalesce into medium-sized vesicles that began to engulf mitochondria and lipid droplets, forming giant vacuoles mostly filled with fat. Incomplete matured secretory vesicles were observed to exocytose into the perivitelline space of morulae, whereas fully matured secretory vesicles appeared only in trophectoderm cells, being exocytosed into the blastocoelic cavity. These observations suggested that these endoplasmic-/Golgi-derived vesicles behave as active autophagic organelles presenting probably a maturation process from compact morulae to blastocyst.

Exome sequencing is a useful diagnostic tool for complicated forms of hereditary spastic paraplegia.

Hereditary spastic paraplegias constitute a heterogeneous group of neurodegenerative diseases encompassing pure and complicated forms, for which at least 52 loci and 31 causative genes have been identified. Although mutations in the SPAST gene explain approximately 40% of the pure autosomal dominant forms, molecular diagnosis can be challenging for the sporadic and recessive forms, which are often complicated and clinically overlap with a broad number of movement disorders. The validity of exome sequencing as a routine diagnostic approach in the movement disorder clinic needs to be assessed. The main goal of this study was to explore the usefulness of an exome analysis for the diagnosis of a complicated form of spastic paraplegia. Whole-exome sequencing was performed in two Spanish siblings with a neurodegenerative syndrome including upper and lower motor neuron, ocular and cerebellar signs. Exome sequencing revealed that both patients carry a novel homozygous nonsense mutation in exon 15 of the SPG11 gene (c.2678G>A; p.W893X), which was not found in 584 Spanish control chromosomes. After many years of follow-up and multiple time-consuming genetic testing, we were able to diagnose these patients by making use of whole-exome sequencing, showing that this is a cost-efficient diagnostic tool for the movement disorder specialist.

Glucocerebrosidase gene variants in parkinsonian patients with Machado Joseph/spinocerebellar ataxia 3.

UNLABELLED: Machado-Joseph disease/spinocerebellar ataxia type 3 (MJD/SCA3) may rarely presents a parkinsonian phenotype. Considering that mutations in the glucocerebrosidase (GBA) gene have been associated with Parkinson disease, we investigated whether these would be more prevalent in MJD/SCA3 patients with parkinsonian manifestations than in those without them. METHODS: MJD/SCA3 patients with parkinsonian features were identified and compared to relatives and to a MJD/SCA3 control group with no such features. The GBA gene was sequenced and, in a subset of patients and in normal volunteers, GBA enzyme activity was measured. RESULTS: We have identified nine index MJD/SCA3 patients with parkinsonian manifestations. Overall, GBA sequence variations were found in 3/9 MJD/SCA3 index cases with parkinsonian manifestations (33%) and in 0/40 MJD/SCA3 controls without parkinsonism (p=0.03, Fisher exact test). The GBA sequence variations found were p.K(-27)R, p.E326K, and p.T369M. The latter two sequence variations were also found in two symptomatic relatives with no parkinsonian manifestations. A MJD/SCA3 relative belonging to the first positive pedigree and carrier of the p.K(-27)R mutation also presented parkinsonian manifestations. GBA activity in MJD/SCA3 patients was similar to those found in the normal control group. CONCLUSION: Sequence variations at the GBA gene may play a role as a minor, modifying gene of MJD/SCA3 phenotype. This hypothetical role was not related to changes in GBA activity in peripheral leukocytes.

Ultrastructural characterization of fresh and cryopreserved in vivo produced ovine embryos.

Controlled slow freezing and vitrification have been successfully used for ovine embryo cryopreservation. Selection of embryos for transfer is based on stereomicroscopical embryo scoring after thawing, but the subjectivity inherent to this selection step has been demonstrated by ultrastructural studies of controlled slow frozen, in vivo produced ovine morulae and blastocysts. These studies have shown that certain abnormalities remain undetected by stereomicroscopy only. In the present study, using ovine in vivo produced morulae and blastocysts, we have studied the ultrastructural alterations induced by open pulled straw vitrification (OPS) and controlled slow freezing, compared stereomicroscopical embryo scoring with light microscopy evaluation of embryo's semithin sections, and related the ultrastructural cellular damage with the embryo classification by stereomicroscopical embryo scoring of embryos' and semithin section evaluation by light microscopy. The ultrastructural lesions found for OPS-vitrified and controlled slow frozen embryos were similar, independently of embryo stage. A significant higher number of grade 3 embryos was found at stereomicroscopical scoring after controlled slow freezing (P=0.02), and a significant higher number of grade 3 blastocysts was found at semithin sectioning after OPS vitrification (P=0.037). The extension of ultrastructural damage, especially of mitochondria and cytoskeleton, was related to the semithin classification but not to stereomicroscopical scoring at thawing. This suggests that semithin scoring is a useful tool for predicting ultrastructural lesions and new improvements in cryopreservation and thawing methods of ovine embryos are still warranted, including in the case of blastocysts cryopreserved by OPS vitrification.

Population genetics of wild-type CAG repeats in the Machado-Joseph disease gene in Portugal.

OBJECTIVE: To gain insights on the molecular mechanisms of mutation that led to the emergence of expanded alleles in the MJD gene, by studying the behavior of wild-type alleles and testing the association of its distribution with the representation of the disease. METHODS: The number of CAG motifs in the MJD gene was determined in a representative sample of 1000 unrelated individuals. Associations between the repeat size and the epidemiological representation of MJD were tested. RESULTS: The allelic profile of the total sample was in the normal range (13-41 repeats), with mode (CAG)23. No intermediate alleles were present. Allelic size distribution showed a negative skew. The correlation between the epidemiological representation of MJD in each district and the frequency of small, medium and large normal alleles was not significant. Further correlations performed grouping the districts also failed to produce significant results. CONCLUSIONS: The absence of association between the size of the repeats and the representation of MJD demonstrates that prevalence is not an indirect reflection of the frequency of large normal alleles. Globally the results obtained are in accordance with a model that postulates the occurrence of a few mutations on the basis of most of the MJD cases worldwide.

Analysis of Y-chromosome variability and its comparison with mtDNA variability reveals different demographic histories between islands in the Azores Archipelago (Portugal).

We determined the Y-chromosomal composition of the population of the Azores Islands (Portugal), by analyzing 20 binary polymorphisms located in the non-recombining portion of the Y-chromosome (NRY), in 185 unrelated individuals from the three groups of islands forming the Archipelago (Eastern, Central and Western). Similar to that described for other Portuguese samples, the most frequent haplogroups were R1(xR1b3f) (55.1%), E(xE3a) (13%) and J (8.6%). Principal components analysis revealed a Western European profile for the Azorean population. No significant differences between Azores and mainland Portugal were observed. However, the haplogroup distribution across the three groups of islands was not similar (P<0.003). The Western group presented differences in the frequencies of haplogroups R1, E(xE3a) and I1b2 (27.3%, 22.7% and 13.6%, respectively) when compared to the other two groups. An assessment of the NRY variability, and its comparison with mitochondrial DNA (mtDNA) variability, was further evidence of the differential composition of males during the settlement of the three groups of islands, contrary to what has been previously deduced for the female settlers using mtDNA data.

Work hardening: past, present, and future--the work programs special interest section national work-hardening outcome study.

OBJECTIVES: A review of outcome research conducted between 1982 and 1992 revealed return-to-work rates for industrial rehabilitation programs that ranged from 50% to 88%. Variations in outcome statistics appeared to reflect discrepancies in factors such as type of research design, initial characteristics of the client sample, and clients excluded from the study group. METHOD: A work-hardening outcome study involving 36 programs was conducted by the Work Programs Special Interest Section to address questions left unanswered by existing studies regarding (a) rates of program nonacceptance or noncompletion, (b) basic client characteristics and outcome, (c) length of disability and outcome, (d) breakdown of client disposition after program completion, and (e) program characteristics and return to work. RESULTS: Findings included the following: (a) 11.5% of clients were not accepted into work hardening and 24.6% did not complete the program; (b) outcome was not related to client age, gender, area of injury, or physical demand level of job before injury; (c) as duration of disability increased, return to work decreased significantly; (d) at discharge, 48.2% of clients returned to the usual and customary job and 30.5% to alternate or modified work, whereas 13.6% were referred to a vocational counselor; and (e) there was no relationship between number of visits or number of professionals seen and return to work. CONCLUSION: The authors suggest a need for uniform standards in collection of outcome data to establish a basis for comparison of efficacy among programs. Recommendations include tracking comparison or control groups, grouping clients in terms of length of disability, computing success rate on the basis of number of clients who completed their program, using relevant subcategories when reporting return to work, and consistency of the postdischarge interval for follow-up.

Effects of ivermectin on reproductive functions in ewes.

In response to producers' concerns about possible detrimental effects of ivermectin on ewes during the breeding season, an evaluation of its effects on endocrinological, physiological, and behavioral measures of reproductive performance was made. Twenty cycling ewes were randomly assigned on d 10 (d 0 = estrus) to receive a single recommended oral dose of 200 micrograms/kg of BW of ivermectin or a control volume of water. Twelve hours after treatment, ewes received a luteolytic injection of 5 mg of PGF2 alpha and were introduced to fertile rams. On d 10 after mating, laparoscopies were performed to assess ovulation rate, and on d 18 conceptuses were surgically recovered. Blood samples were collected during the 92-h interval beginning immediately before ivermectin and control treatments and were assayed for LH. It was determined that 1) interval from PGF2 alpha-induced luteal regression to a) onset of estrus (36.1 +/- 1.4 vs 36.3 +/- 1.4 h) and b) onset of the preovulatory surge of LH (38.2 +/- 2.6 vs 44.2 +/- 2.6 h), 2) magnitude of the surge of LH (275.6 +/- 38.9 vs 199.8 +/- 38.9 ng/mL), 3) duration of the surge of LH (9.4 +/- .4 vs 9.0 +/- .4 h), 4) area under the curve of the surge of LH (54,321 +/- 7,419 vs 38,138 +/- 7,419 arbitrary units), 5) ovulation rate (2.1 +/- .4 vs 2.0 +/- .3 ovulations/ewe), 6) pregnancy rate (8/10 vs 5/10 ewes pregnant), and 7) conceptuses per ewe (1.75 +/- .37 vs 1.60 +/- .33) did not differ (all P > .1) between ivermectin- and control-treated ewes, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Endocrine and endometrial secretory protein changes associated with uterine receptivity in sheep.

Crossbred ovariectomized ewes were treated with steroid therapies determined previously to be adequate (progesterone-primed) or inadequate (unprimed) for embryonic development in order to determine actual serum concentrations of replaced steroid hormones achieved by such treatments and to identify secreted endometrial proteins that might mediate uterine receptivity. Ewes received estradiol-17 beta on day 0, and on days 1-4, either vehicle (unprimed; N = 16) or progesterone (primed; N = 16) daily. All ewes then received "estrus estradiol" (at 8 hr-intervals), followed by "maintenance progesterone" (at 12 hr-intervals), to mimic endocrine profiles of intact ewes at and following estrus. Jugular blood samples were obtained at 4-hr intervals from 6 ewes/treatment on day 0-15 to determine serum progesterone, estradiol, and PGFM concentrations. Endometrium from two ewes/treatment on days 11-15 was cultured in vitro with [3H]leucine and radiolabeled proteins in media were analyzed electrophoretically. Results demonstrated that 1) treatments generated transient serum estradiol levels slightly greater than those reported in intact animals at estrus, 2) serum progesterone concentrations due to treatments were similar to those reported in the luteal phase of intact ewes, 3) progesterone-priming was specifically associated with a small, sustained (24-36 hr) elevation in serum PGFM, and that 4) priming was not associated with the presence or absence of major, secreted endometrial proteins that might act either as factors required for development or as embryotoxins. These results suggest that positive effects of progesterone-priming on embryo survival are not due to pharmacological doses of exogenously administered hormones, nor are due to changes in secretion of hormonally-regulated, major endometrial proteins.

Active immunization of ewes against prostaglandin F2 alpha to control ovarian function.

The hypothesis that pregnancy success could be improved in early postpartum ewes by prolonging the lifespan of the corpus luteum via active immunization against prostaglandin F2 alpha (PGF2 alpha) was tested. Further experiments in ewes immunized against PGF2 alpha investigated the effects of exogenous PGF2 alpha on the preovulatory follicle and the effects of PGF2 alpha and oestradiol benzoate on corpus luteum function. Four weeks pre-partum, 39 ewes bred to lamb during seasonal anoestrus received either 5 mg PGF2 alpha-ovalbumin conjugate (n = 20; immunized) or ovalbumin (n = 19; control) in Freund's complete adjuvant. Treatments were repeated on day 5 post-partum with reagents emulsified in Freund's incomplete adjuvant. On day 17 post-partum, ewes received 500 iu pregnant mares' serum gonadotrophin (PMSG) and 48 h later 50 micrograms gonadotrophin-releasing hormone (GnRH). Laparoscopy was performed 36 h after GnRH to assess ovarian activity and ewes with recent ovulations were inseminated into the uterus. No immunized ewes had ovulated, but ten had follicles that luteinized and secreted progesterone during the 8 weeks studied. Eighteen of 19 control ewes ovulated and 15 of 18 had increased progesterone concentration for at least 21 days. By day 70 post partum, progesterone had returned to basal values in all control ewes. In a second study, 24 immunized ewes bearing persistent corpora lutea, and for which the interval from the previous parturition was greater than 90 days, received 15 mg PGF2 alpha and 500 iu PMSG followed 48 h later by 50 micrograms GnRH. PGF2 alpha induced corpus luteum regression in all ewes.(ABSTRACT TRUNCATED AT 250 WORDS)

Lack of effects of indomethacin on estradiol feedback control of luteinizing hormone in ovariectomized ewes.

We tested the hypothesis that indomethacin, a potent inhibitor of prostaglandin synthesis, would modify estradiol's effects on tonic and surge concentrations of LH in chronically ovariectomized ewes during the anestrous season. Ewes (n = 21) were assigned randomly to one of four treatments: Vehicle+Blank (n = 5); Indomethacin+Blank (n = 6); Vehicle+Estradiol (n = 5); or Indomethacin+Estradiol (n = 5). On d=0 (hr = 0), ewes began to receive i.m. injections of either indomethacin (4 mg/kg body weight) or corn oil every 8 hr for 9 d. Blood samples were collected every 12 min for 6 hr beginning at -6 hr, +18 hr, and on day 8 (relative to initial injections of indomethacin or vehicle) to assess tonic patterns of secretion of LH. At +24 hr, ewes received blank- or estradiol-containing Silastic implants and were bled hourly for 48 hr. On day 9, ewes received 50 micrograms of GnRH i.v. and were bled hourly for 8 hr. Serum samples were assayed for LH. Indomethacin had no effect on the following parameters of LH secretion: 1) mean concentrations (ng/ml; 8.4 +/- .7 vs 8.9 +/- .8; P > .1), 2) pulse frequency/6 hr (4.5 +/- .4 vs 4.1 +/- .4; P > .1) or 3) pulse amplitude (ng/ml; 15.3 +/- 1.1 vs 14.9 +/- 1.2; P > 1). Estradiol elicited a surge of LH which began 18.9 +/- 1.7 hr after implant insertion, reached a mean peak concentration of 95.3 +/- 20.1 ng/ml, and did not differ with respect to indomethacin treatment (P > .1).(ABSTRACT TRUNCATED AT 250 WORDS)

Statement: occupational therapy services in work practice.

Occupational therapy practitioners focus on the individual's ability to participate in productive occupations throughout their life span. Through prevention, assessment, and intervention strategies, occupational therapy practitioners often collaborate with other members of the health care team and assist persons to optimize their ability to engage in purposeful occupation while facilitating a safe and successful entry into or return to work.

Using work simulation to treat adults with back injuries.

Occupational therapy at the Liberty Mutual Medical Service Center, Boston, Massachusetts, offers a diverse variety of modalities for the treatment of patients with low back pain. Treatment may include the use of a balance monitor, a multiwork station, a pneumatic lifting-lowering device, a computerized upper extremity work simulator, and a truck-driving simulator. The primary objective of occupational therapy in this setting is to provide a supportive environment where patients can practice and improve the execution of the work-related activities they need to perform their jobs while they are learning to live with or control their symptoms.