Nerve Conduction Studies of the Larynx: Porcine Model and Human Application.

OBJECTIVE: There is a paucity of information in the literature about how electromyography (EMG) with nerve conduction studies (NCS) can be utilized in the field of neurolaryngology. The goal of this study was two-part: (1) to identify the NCS test parameters that best reflect underlying neurolaryngeal pathophysiology in a porcine model, and (2) to determine if comparable NCS parameters can be used to assess clinical laryngeal denervation injuries in patients. METHODS: Yukatan minipigs underwent general anesthesia with EMG and recurrent laryngeal NCS assessment. Recurrent laryngeal nerve (RLN) transection injury and uninjured RLN cases were included to determine NCS neuropathologic and normative findings, respectively. Our porcine analytic model was then applied to a clinical scenario of seven patients with RLN injury. RESULTS: The porcine model was able to differentiate and characterize normative and neuropathologic NCS changes. Clinical outcomes suggest that RLN NCS can be performed clinically and is overall well tolerated by in patients. Findings may serve as a useful tool to differentiate normal nerve function, neuropraxia, axonotmesis, and irreversible RLN injuries. CONCLUSION: This novel study is the first to demonstrate the feasibility and applicability of EMG with NCS in the evaluation of vocal fold function in a porcine model in addition to the clinical setting. Further studies are needed to better understand the clinical utility and predictive value in recovery of vocal fold paralysis.

Interactive effect of adverse child experiences and suicidal thoughts and behaviors on adolescent alcohol and cannabis use frequency.

OBJECTIVE: Adolescents with adverse childhood experiences (ACEs) and suicidality may engage in high levels of substance use to alleviate distress. Most studies of associations among ACEs, suicidality, and substance use rely on retrospective reports by adults. Comparatively less is known about concurrent relationships between ACEs, suicide risk, and substance use in adolescents, which is important for prevention. This study tested if the associations between ACEs and drinking and between ACEs and cannabis use would be even stronger among youth with suicidal ideation or attempt, relative to youth without suicidal ideation or attempt. METHOD: High schoolers (N = 1,625; 50.8% male; 47.1% female; 2% nonbinary) from western New York completed the Youth Risk Behavior Survey. Ordinal regressions tested main effects and interactions of the number of ACEs and suicidal ideation/behavior (i.e., none, ideation/plan, attempt) on categories of past-month drinking and cannabis days of use, controlling for age, gender, and race/ethnicity. RESULTS: Significant ACEs by suicide interactions on adolescent drinking indicate that the association between ACEs and drinking was stronger for adolescents with suicide attempt adjusted odds ratio (AOR = 2.63) compared to youth with no ideation or attempt (AOR = 1.56) and suicidal ideation/planning only (AOR = 1.58). Main effects of ACEs (AORs = 1.95-2.08) and suicide attempt (vs. no suicidal ideation/attempt [AOR = 2.11] and suicidal ideation/plan [AOR = 2.11]) were associated with greater cannabis use; interactions were not significant. CONCLUSIONS: Associations between ACEs and drinking were particularly strong for adolescents with suicide attempt. Conversely, ACEs and suicide attempt were independently associated with cannabis use. Mitigating against ACEs may reduce both adolescent alcohol and cannabis use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Allostatic load in opioid use disorder: a scoping review protocol.

INTRODUCTION: Opioid use disorder affects 2.1 million individuals in the USA, causing more than 100 000 overdose-related deaths annually. While the neurobiological model of addiction is well described and accepted, there is a lack of morbidity and mortality prognosticators for patients struggling with opioid use disorder. Allostatic load index is a promising candidate for the basis of a prognostication tool. Previous studies show that allostatic load predicts both morbidity and mortality in a variety of cohorts. This scoping review protocol provides the rationale and steps for summarising and presenting existing evidence surrounding allostatic load in the context of opioid use disorder. Identification of current knowledge gaps will pave the way for subsequent prospective studies. METHODS AND ANALYSIS: This scoping review protocol will follow the five-step method designed by Arksey and O'Malley. All studies written in English on allostatic load in the context of opioid use disorder, as defined in our inclusion criteria, will be included. There will be no limit on the year of publication. We will search PubMed, Embase, CINAHL, PsycINFO and Google Scholar. We will hand-review reference lists of included articles, and we will hand search grey literature. We will then group, analyse and present the data in narrative, tabular and diagrammatic format according to themes identified in the scoping review. ETHICS AND DISSEMINATION: Ethics approval is not necessary, as data are gathered from publicly accessible sources. The results will be disseminated through a peer-reviewed journal and reported at conferences related to addiction medicine. TRIAL REGISTRATION NUMBER: 10.17605/OSF.IO/4J6DQ.

Statistical Shape Modelling the In Vivo Location of Acetabular Wear in Retrieved Hip Implants.

Edge-wear in acetabular cups is known to be correlated with greater volumes of material loss; the location of this wear pattern in vivo is less understood. Statistical shape modelling (SSM) may provide further insight into this. This study aimed to identify the most common locations of wear in vivo, by combining CT imaging, retrieval analysis and SMM. Shape variance was described in 20 retrieved metal-on-metal acetabular surfaces. These were revised after a mean of 90 months, from 13 female and seven male patients. They were positioned with a mean inclination and anteversion of 53° and 30°, respectively. Their orientation, in vivo, was established using their stabilising fins, visible in pre-revision CT imaging. The impact of wear volume, positioning, time, gender and size on the in vivo location of wear was investigated. These surfaces had a mean wear volume of 49.63 mm3. The mean acetabular surface displayed superior edge-wear centred 7° within the posterosuperior quadrant, while more of the volumetric wear occurred in the anterosuperior quadrant. Components with higher inclination had greater superior edge-wear scars, while a relationship was observed between greater anteversion angles and more posterosuperior edge-wear. This SSM method can further our understanding of hip implant function, informing future design and may help to refine the safe zone for implant positioning.

Nerve Conduction Studies: Basic Concepts and Patterns of Abnormalities.

Nerve conduction studies are a key component of the electrophysiologic evaluation of the peripheral nerve system, and provide important information about the integrity of the large, myelinated axons, neuromuscular junctions, and muscle. Nerve conduction studies involve eliciting nerve action potentials at sites along a peripheral nerve and recording the response from another site along the nerve or from a muscle innervated by that nerve. Attention to details of test performance, use of well-established normative values, and knowledge of the patterns of abnormality produced by disorders that affect neuronal, axonal, and myelin sheath function are fundamental for proper interpretation of results.

Critical Connections Among Embedding of Childhood Adversity and Adult Chronic Gastrointestinal and Genitourinary Disorders: A Review of the Literature.

BACKGROUND: A gap in the literature exists demonstrating associations between adverse child experiences (ACEs) as potential a priori contributing factors and gastrointestinal (GI)/genitourinary (GU) disorders. PURPOSE: A narrative review of the literature was conducted to explore critical connections between ACEs and GI/GU disorders with a working hypothesis of a dose-responsive relationship existing among them. METHODS: A literature search was conducted using MEDLINE, Cumulative Index of Nursing and Allied Health Literature, PubMed, and Web of Science using search terms adverse childhood experiences, childhood adversity, obesity, gastrointestinal disorders, and genitourinary disorders, and secondary searches of obesity and specific GI/GU disorders (eg, irritable bowel syndrome, pelvic pain). Duplicates and articles with inappropriate focus were discarded after review. RESULTS: A total of 58 articles were included. Research identified showed that ACEs do play a role in adult GI and GU morbidities in a dose-response manner, and selected factors such as socioeconomic status, race, gender identity, and physiologic state (eg, obesity) confer higher risk. Research also suggested that genetic/epigenetic mechanisms are at play in disease occurrence, and the impact of ACEs may be mitigated with positive life experiences. CONCLUSION: Research on the relationship between ACEs and GI/GU disorders is heterogeneous, notably due to wide variations in how types of ACEs are defined and screening methods used. Despite this limitation, associations are demonstrated. Awareness of a possible correlation between ACEs and risk of GI/GU disorders has the potential to improve patient care, especially through trauma-informed strategies.

Non-Invasive Characterization of Single-, Double- and Triple-Viral Diseases of Wheat With a Hand-Held Raman Spectrometer.

Plant diseases can reduce crop yield by up to 100%. Therefore, timely and confirmatory diagnosis of plant diseases is strongly desired. Typical pathogen assaying methods include polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA). These approaches are quite useful but are also time-consuming and destructive to the sample. Raman spectroscopy (RS) is a modern analytical technique that enables non-invasive plant disease detection. In this study, we report on Raman-based detection of wheat diseases caused by wheat streak mosaic virus (WSMV) and barley yellow dwarf virus (BYDV). Our results show that RS can be used to differentiate between healthy wheat and wheat infected by these two viruses. We also show that RS can be used to identify whether wheat is infected by these individual viruses or by a combination of WSMV and BYDV, as well as WSMV, BYDV, and Triticum mosaic virus (TriMV). We found that wheat spectra showed non-linear spectroscopic responses to coinfection by different viruses. These results suggest that RS can be used to probe pathogen-specific changes in plant metabolism. The portable nature of this approach opens the possibility of RS directly in the field for confirmatory diagnostics of viral diseases.

Connections Among Biologic Embedding of Childhood Adversity, Adult Chronic Illness, and Wound Care: A Review of the Literature.

Adverse childhood experiences (ACEs) biologically embed by altering brain development and influencing epigenetic mechanisms. These experiences may generate health risk factors. PURPOSE: A literature review was conducted to compare ACE-generated health risk factors with risk factors for wound development and aberrant healing, as well as to identify a gap in literature regarding critical connections between ACEs, chronic illness, and wound development/healing, with associated practice implications. METHODOLOGY: A literature search of English-language articles was conducted using the Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and PubMed using the search terms adverse childhood experiences, adults, wounds, chronic disease or illness, and epigenetics. The searches yielded 561 publications regarding ACEs, chronic illness or disease, and adult; 182 for ACEs; and 547 for epigenetics and wounds. Abstracts were reviewed to remove duplicates and studies with participants who were <18 years old. Publications were reviewed for salience; those discussing the biologic plausibility of ACEs contributing to adult illnesses and associated wound development and healing were reviewed for inclusion. RESULTS: Sixty-eight (68) publications were found appropriate for review and included population-based studies; literature reviews; epidemiologic data; meta-analyses; and systematic, cross-sectional, observational, and prospective studies as singular or mixed methods designs. A substantial overlap was found in terms of risk factors generated by ACE exposure and risk factors for wound development/healing, as was a gap in the literature regarding this relationship. Epigenetic mechanisms and altered brain development are implicated in processes through which childhood adversity erodes human health. CONCLUSION: Adult health risks as a result of exposure to ACEs and critical connections with risks for wound development and disrupted wound healing via epigenetic influences are recognized in the literature. Practice implications include considering screening for the risk factor of ACEs exposure in adult patients to identify this additional risk factor and practicing patient-centered, trauma-informed care. Further research into the integrative roles of these factors is warranted.

Disturbances of visual motion perception in bipolar disorder.

OBJECTIVES: While cognitive deficits have been well documented in patients with bipolar disorder, visual perception has been less well characterized. Such deficits appear in schizophrenia, which shares genetic risk factors with bipolar disorder, and may contribute to disturbances in visual cognition and learning. METHODS: The present study investigated visual perception in bipolar disorder using psychophysical tests of contrast sensitivity, dot motion discrimination, and form discrimination. The relationship of these measures to mood state, medication status, and cognitive function was investigated. Sixty-one patients with type I bipolar disorder and 67 comparison subjects were tested. RESULTS: Results indicated a deficit in dot motion trajectory discrimination in both euthymic and ill individuals with bipolar disorder, as well as a global deficit in moving grating contrast sensitivity. Ill individuals with bipolar disorder were impaired in psychomotor processing, but this finding was not related to visual processing performance. CONCLUSIONS: These findings could be due to disturbances in specific visual pathways involved in the processing of motion properties, or to a more general deficit which impairs processing of temporally modulated stimuli.

The ambiguous role of the paraeducator in the general physical education environment.

The use of paraeducators has increased as a main mechanism to include more students with disabilities in the public schools in the U.S. Although the utilization of paraeducators is intended to be a supportive service delivery option, many concerns and challenges have resulted. The purpose of this study was to examine the role of the paraeducator in the general physical education environment from the perspectives of special education, physical education, and adapted physical education teachers and paraeducators. Data were collected from a phenomenological approach using questionnaires, interviews, and observations. Results indicate concerns about the clarity of the role of the paraeducator in physical education. Emerging themes include elastic definitions of student protection and teacher backup, contradictory expectations and mixed acceptance, and paraeducators' role ambiguity. Findings regarding the role of the paraeducator are essential in determining both best practice and legal policy for the appropriate utilization of paraeducators in physical education.

Accounting for patient variability in finite element analysis of the intact and implanted hip and knee: a review.

It is becoming increasingly difficult to differentiate the performance of new joint replacement designs using available preclinical test methods. Finite element analysis is commonly used and the majority of published studies are performed on representative anatomy, assuming optimal implant placement, subjected to idealised loading conditions. There are significant differences between patients and accounting for this variability will lead to better assessment of the risk of failure. This review paper provides a comprehensive overview of the techniques available to account for patient variability. There is a brief overview of patient-specific model generation techniques, followed by a review of multisubject patient-specific studies performed on the intact and implanted femur and tibia. In particular, the challenges and limitations of manually generating models for such studies are discussed. To efficiently account for patient variability, the application of statistical shape and intensity models (SSIM) are being developed. Such models have the potential to synthetically generate thousands of representative models generated from a much smaller training set. Combined with the automation of the prosthesis implantation process, SSIM provides a potentially powerful tool for assessing the next generation of implant designs. The potential application of SSIM are discussed along with their limitations.

Influence of femur size and morphology on load transfer in the resurfaced femoral head: A large scale, multi-subject finite element study.

Femoral resurfacing has become an increasingly popular procedure, especially for young, active patients. The procedure is known to alter load transfer through the proximal femur and this has been linked with the most commonly observed complication, neck fracture. An intriguing observation noted by registry data and clinical studies is an inverse relationship between implant size and revision rate. While computational analysis has become an established part of biomedical engineering, the majority of work uses a single or small set of bone models, with a single implant size, due to the constraints of time and data availability. Therefore, it has been infeasible to run a study incorporating natural inter-patient variability or the performance of smaller implants could not be meaningfully studied. In previous work a statistical model of the whole femur was used to generate large numbers of unique, realistic, FE-ready femur models describing both geometry and material properties. The current study demonstrates a methodology for virtually implanting and performing stress analysis of cemented femoral resurfacing components, with model specific sizing and orientation. Automated analysis of 400 generated femurs, in both implanted and intact configurations showed the strain changes induced by resurfacing. This produced a statistically meaningful number of results and allowed the examination of outliers. Results showed increased femoral neck strain changes potentially increasing the risk of neck fracture, associated with smaller, less dense femurs and smaller implant sizes; agreeing with clinical observations. The study demonstrates a methodology for more comprehensive analyses, based on populations rather than individuals.

Statistical modelling of the whole human femur incorporating geometric and material properties.

When analysing the performance of orthopaedic implants the vast majority of computational studies use either a single or limited number of bone models. The results are then extrapolated to the population as a whole, overlooking the inherent and large interpatient variability in bone quality and geometry. This paper describes the creation of a three dimensional, statistical, finite element analysis (FEA) ready model of the femur using principal component analysis. To achieve this a registration scheme based on elastic surface matching and a mesh morphing algorithm has been developed. This method is fully automated enabling registration and generation of high resolution models. The variation in both geometry and material properties was extracted from 46 computer tomography scans and captured by the statistical model. Analysis of mesh quality showed this was maintained throughout the model generation and sampling process. Reconstruction of the training femurs showed 35 eigenmodes were required for accurate reproduction. A set of unique, anatomically realistic femur models were generated using the statistical model, with a variation comparable to that seen in the population. This study illustrates a methodology with the potential to generate femur models incorporating material properties for large scale multi-femur finite element studies.

Use of a statistical model of the whole femur in a large scale, multi-model study of femoral neck fracture risk.

Interpatient variability is often overlooked in orthopaedic computational studies due to the substantial challenges involved in sourcing and generating large numbers of bone models. A statistical model of the whole femur incorporating both geometric and material property variation was developed as a potential solution to this problem. The statistical model was constructed using principal component analysis, applied to 21 individual computer tomography scans. To test the ability of the statistical model to generate realistic, unique, finite element (FE) femur models it was used as a source of 1000 femurs to drive a study on femoral neck fracture risk. The study simulated the impact of an oblique fall to the side, a scenario known to account for a large proportion of hip fractures in the elderly and have a lower fracture load than alternative loading approaches. FE model generation, application of subject specific loading and boundary conditions, FE processing and post processing of the solutions were completed automatically. The generated models were within the bounds of the training data used to create the statistical model with a high mesh quality, able to be used directly by the FE solver without remeshing. The results indicated that 28 of the 1000 femurs were at highest risk of fracture. Closer analysis revealed the percentage of cortical bone in the proximal femur to be a crucial differentiator between the failed and non-failed groups. The likely fracture location was indicated to be intertrochantic. Comparison to previous computational, clinical and experimental work revealed support for these findings.

Use of GIS to identify optimal settings for cancer prevention and control in African American communities.

OBJECTIVE: Rarely have Geographic Information Systems (GIS) been used to inform community-based outreach and intervention planning. This study sought to identify community settings most likely to reach individuals from geographically localized areas. METHOD: An observational study conducted in an urban city in Missouri during 2003-2007 placed computerized breast cancer education kiosks in seven types of community settings: beauty salons, churches, health fairs, neighborhood health centers, Laundromats, public libraries and social service agencies. We used GIS to measure distance between kiosk users' (n=7297) home ZIP codes and the location where they used the kiosk. Mean distances were compared across settings. RESULTS: Mean distance between individuals' home ZIP codes and the location where they used the kiosk varied significantly (p<0.001) across settings. The distance was shortest among kiosk users in Laundromats (2.3 mi) and public libraries (2.8 mi) and greatest among kiosk users at health fairs (7.6 mi). CONCLUSION: Some community settings are more likely than others to reach highly localized populations. A better understanding of how and where to reach specific populations can complement the progress already being made in identifying populations at increased disease risk.

Integrating adult learning principles into training for public health practice.

Providing training and planned learning experiences to practitioners and community partners is fundamental to effective public health. The extent to which principles of adult learning currently guide such training is unknown and likely varies widely. The purpose of this article is to introduce five principles of adult learning and discuss how each can be applied in assessing trainee needs, planning and delivering training, and evaluating training processes and outcomes. Training guided by these principles should facilitate adult learning, collaborative efforts, and mutual respect between agencies, practitioners, and community partners.

Accuracy of pedometer steps and time for youth with disabilities.

The purpose of the study was to examine the accuracy of pedometer steps and activity time (Walk4Life, WL) for youth with developmental disabilities. Eighteen youth (11 girls, 7 boys) 4-14 years completed six 80-meter self-paced walking trials while wearing a pedometer at five waist locations (front right, front left, back right, back left, middle back). Trials were video taped to determine actual steps and activity time. Time exhibited a smaller percent error in comparison to steps across locations. Apart from the front left, location had minimal influence on accuracy. The WL demonstrates acceptable accuracy for steps and activity time.