Care ally-assisted massage for Veterans with chronic neck pain: TOMCATT results.

PURPOSE: Chronic neck pain (CNP) is prevalent and challenging to treat. Despite evidence of massage's effectiveness for CNP, multiple accessibility barriers exist. The Trial Outcomes for Massage: Care Ally-Assisted vs. Therapist Treated (TOMCATT) study examined a care ally-assisted massage (CA-M) approach compared to a waitlist control prior to a study design modification (WL-C0). METHODS: CA-M consisted of in-person training for veteran/care-ally dyads to learn a standardized 30-minue massage routine, instructional DVD, and printed treatment manual. Participants were to complete three care ally-assisted massage sessions weekly for 12-weeks. Outcomes collected at baseline, 1-, 3-, and 6-months included validated measures of neck pain severity and associated disability. Linear mixed-model approaches were used for analysis with 3-months as the primary outcome timepoint. RESULTS: Participants (N = 203) were 56.7 ± 14 years old, 75% White, 15% female, and 75% married/partnered. Among 102 CA-M participants, 45% did not attend the in-person training and subsequently withdrew from the study and were more likely to be younger (p = .016) and employed (p = .004). Compared to WL-C0, CA-M participants had statistically significant reductions in pain-related disability at 3-months (-3.4, 95%CI = [-5.8, -1.0]; p = .006) and 6-months (-4.6, 95%CI = [-7.0, -2.1]; p < .001) and pain severity at 3-months (-1.3, 95%CI = [-1.9, -0.8]; p < .001) and 6-months (-1.0, 95%CI = [-1.6, -0.4]; p = .007), respectively. CONCLUSION: In this analysis, CA-M led to greater reductions in CNP with disability and pain severity compared to WL-C0, despite treatment engagement and retention challenges. Future work is needed to determine how to better engage Veterans and their care-allies to attend CA-M training.

Effects of covered solid sorbent tube sample holders on organic vapor measurements.

A study was conducted to examine whether there are significant differences between organic vapor concentrations measured using charcoal tubes with three different configurations: uncovered sample holder (open tube), SKC, and Buck brand covered sample holders. A fractional factorial experimental design was used with the following factors and levels: vapor (n-hexane vs. m-xylene), pump type (pulsating vs. continuous), exposure profile (variable vs. constant), flow rate (30 mL/min vs. 200 mL/min), duration (30 min vs. 80 min), and sample placement (mannequin vs. free hanging). Two of each sampler configuration (six total) were placed in an exposure chamber, and a dynamic test-atmosphere generation system was used to prepare atmospheres containing approximately 12-15 ppm n-hexane or m-xylene with exposure profiles and sampling conducted according to a run sheet generated for the experimental design. A total of 24 runs were completed with six samplers per run, yielding 144 samples that were analyzed by gas chromatography/flame ionization detector. Concentration results for each pair of SKC and Buck covered sample holders were averaged and normalized by dividing by the average result for the open tube sampler from the same run to eliminate the effect of daily variation in chamber concentrations. The resulting ratio of covered sample tube holder and open tube concentrations was used as the response variable. Results of analysis of variance using the general linear model (MINITAB 16) identified statistically significant main effects and/or interactions for pump type, exposure profile, flow rate, and sample holder. However, the magnitude of the effects was generally less than 10%, and overall mean concentration ratios were 0.989 and 1.02 for the Buck and SKC sample holders, respectively. These results show good agreement between covered sample holder results and open tube measurements and demonstrate that exposure assessment errors resulting from the use of covered sorbent tube sample holders for organic vapor monitoring are relatively small (<10%) and not likely to be of practical importance.

Selecting Processes to Minimize Hexavalent Chromium from Stainless Steel Welding: Eight welding processes/shielding gas combinations were assessed for generation of hexavalent chromium in stainless steel welding fumes.

Eight welding processes/shielding gas combinations were assessed for generation of hexavalent chromium (Cr6+) in stainless steel welding fumes. The processes examined were gas metal arc welding (GMAW) (axial spray, short circuit, and pulsed spray modes), flux cored arc welding (FCAW), and shielded metal arc welding (SMAW). The Cr6+ fractions were measured in the fumes; fume generation rates, Cr6+ generation rates, and Cr6+ generation rates per unit mass of welding wire were determined. A limited controlled comparison study was done in a welding shop including SMAW, FCAW, and three GMAW methods. The processes studied were compared for costs, including relative labor costs. Results indicate the Cr6+ in the fume varied widely, from a low of 2800 to a high of 34,000 ppm. Generation rates of Cr6+ ranged from 69 to 7800 µg/min, and Cr6+ generation rates per unit of wire ranged from 1 to 270 µg/g. The results of field study were similar to the findings in the laboratory. The Cr6+ (ppm) in the fume did not necessarily correlate with the Cr6+ generation rate. Physical properties were similar for the processes, with mass median aerodynamic diameters ranging from 250 to 336 nm, while the FCAW and SMAW fumes were larger (360 and 670 nm, respectively). CONCLUSION: The pulsed axial spray method was the best choice of the processes studied based on minimal fume generation, minimal Cr6+ generation, and cost per weld. This method is usable in any position, has a high metal deposition rate, and is relatively simple to learn and use.

Dimensional analysis of actigraphic derived sleep data.

Nonlinear dimensional analyses can be a useful tool in understanding the underlying behavior of dynamical systems, including biological systems. Many biological functions can be modeled as chaotic processes, including sleep. Sleep data can be obtained from several methods, such as electroencephalograms, polysomnography, and actigraph. Actigraphy, because of its low level of invasiveness, is an increasingly popular method of obtaining sleep data. This study analyzed actigraphy data with nonlinear dimensional analyses to determine if such analytic methods would be useful in sleep studies. Participants wore actigraphs on their wrists, which recorded movement for several days. Several sleep quality variables, such as movement during sleep and total sleep time, were derived from these sleep data. These variables were used to determine whether the quality of sleep was good or poor. Lagged phase space plots were graphed and nonlinear parameters for the fractal dimension and the correlation dimension were computed for each participant. Descriptive and inferential statistics were performed to determine if the nonlinear parameters showed significant differences with respect to sleep quality.

Genetic susceptibility to progressive massive fibrosis in coal miners.

Progressive massive fibrosis (PMF) is a chronic interstitial lung disease with a complex aetiology that can occur after cumulative dust exposure. A case-control study was conducted to test the hypothesis that single nucleotide polymorphisms (SNPs) within genes involved in inflammatory and fibrotic processes modulate the risk of PMF development. The study population consisted of 648 underground coal miners participating in the National Coal Workers Autopsy Study, of which 304 were diagnosed with PMF. SNPs that influence the regulation of interleukin (IL)-1, IL-6, tumour necrosis factor-alpha, transforming growth factor-beta1, vascular endothelial growth factor (VEGF), epidermal growth factor intercellular cell adhesion molecule (ICAM)-1 and matrix metalloproteinase-2 genes were determined using a 5'-nuclease real-time PCR assay. There were no significant differences in the distribution of any individual SNP or haplotype between the PMF and control groups. However, the polygenotype of VEGF +405/ICAM-1 +241/IL-6 -174 (C-A-G) conferred an increased risk for PMF (odds ratio 3.4, 95% confidence interval 1.3-8.8). The present study suggests that the examined genetic variations that help regulate inflammatory and fibrotic processes are unlikely to strongly influence susceptibility to this interstitial lung disease, although the role of vascular endothelial growth factor, intercellular cell adhesion molecule-1 and interleukin-6 polymorphisms in the development of progressive massive fibrosis may require further investigation.

Individual, sexual, seasonal, and temporal variation in the amount of sagebrush lizard scent marks.

Although many animals deposit scent marks, previous studies have focused almost entirely on rodents or on the chemical structure of the signal. Here, we study the quantity and temporal pattern of chemical deposition by the territorial sagebrush lizard Sceloporus graciosus, measuring both femoral pore and fecal deposits. Specifically, we tested whether variation in deposition is a good cue of individual and sexual identity and/or whether it is more closely associated with body size and reproductive state, indicators of physiological condition. The results support the latter hypothesis. We found that although the amount of fluid deposited on a single perch (rarely quantified in mammals) carries little information on individual or sexual identity, it reflects the physiological condition and reproductive state of individual lizards and is replenished on a roughly weekly cycle, potentially providing additional information on the producer's activity level. The amount of deposition may thus provide important information to chemical receivers making mate choice and territorial defense decisions. The results further suggest that seasonal increases in gland production allow lizards to mark more sites rather than to influence the quality of the signal on a single perch.

A statistical test to determine the quality of accelerometer data.

Accelerometer data quality can be inadequate due to data corruption or to non-compliance of the subject with regard to study protocols. We propose a simple statistical test to determine if accelerometer data are of good quality and can be used for analysis or if the data are of poor quality and should be discarded. We tested several data evaluation methods using a group of 105 subjects who wore Motionlogger actigraphs (Ambulatory Monitoring, Inc.) over a 15 day period to assess sleep quality in a study of health outcomes associated with stress among police officers. Using leave-one-out cross-validation and calibration-testing methods of discrimination statistics, error rates for the methods ranged from 0.0167 to 0.4046. We found that the best method was to use the overall average distance between consecutive time points and the overall average mean amplitude of consecutive time points. These values gave us a classification error rate of 0.0167. The average distance between points is a measure of smoothness in the data, and the average mean amplitude between points gave an average reading. Both of these values were then normed to determine a final statistic, K, which was then compared to a cut-off value, K(C), to determine data quality.

A novel eIF2B-dependent mechanism of translational control in yeast as a response to fusel alcohols.

Fusel alcohols are natural products of amino acid catabolism in the yeast Saccharomyces cerevisiae that cause morphological changes similar to those seen during pseudohyphal growth. We have discovered that certain of these alcohols, including butanol and isoamyl alcohol, bring about a rapid inhibition of translation at the initiation step. This inhibition is strain specific and is not explained by previously described translational control pathways. Using genetic mapping, we have identified a proline to serine allelic variation at amino acid 180 of the GCD1 gene product as the genetic locus that allows translational regulation upon butanol addition. Gcd1p forms part of the eIF2B guanine nucleotide complex that is responsible for recycling eIF2-GDP to eIF2-GTP. This represents one of the key limiting steps of translation initiation and we provide evidence that fusel alcohols target eIF2B in order to bring about translational regulation.

The potency (ED50) and cardiovascular effects of rapacuronium (Org 9487) during narcotic-nitrous oxide-propofol anesthesia in neonates, infants, and children.

UNLABELLED: We studied the neuromuscular blocking effects of rapacuronium (Org 9487) (dose-response curve, onset, and 50% effective dose [ED50] value), and changes in heart rate and blood pressure, as well as evidence of histamine release in neonates, infants, and children in an open-label, randomized, two-center study. Fifteen neonates, 30 infants, and 30 children were studied. Anesthesia was induced and maintained with propofol, nitrous oxide:oxygen (60:40), and fentanyl. Mechanomyographic monitoring of neuromuscular function was performed at the thumb. The potency (ED50) for neonates, infants, and children were 0.32 (95% confidence interval [CI] 0.15-0.61), 0.28 (95% CI 0.11-0.61), and 0.39 (95% CI 0.17-0.85) mg/kg, respectively. Neonates who received 0.3, 0.6, or 0.9 mg/kg Org 9487 developed a maximum T1 twitch depression of 34 +/-28%, 98 +/- 3%, and 99 +/- 2%, respectively. Time-to-peak effect (onset time) for 0.9 mg/kg Org 9487 was 57 +/- 20 s. Maximum percent T1 twitch depression (+/-SD) in infants who received 0.3, 0.6, or 0.9 mg/kg rapacuronium was 41 +/- 34%, 96 +/- 7%, and 100 +/- 1%, respectively. Time-to-peak effect for 0.9 mg/kg Org 9487 was 62 +/- 29 s. In children 0.3, 0.6, and 0.9 mg/kg rapacuronium resulted in an average percent T1 twitch suppression of 29 +/- 23, 83 +/- 11, and 90 +/- 16, respectively. Time-to-peak effect of 0.9 mg/kg Org 9487 was 96 +/- 33 s, respectively. There was no evidence of histamine release or significant changes in heart rate or blood pressure in either group at any dose. Rapacuronium is a low-potency nondepolarizing muscle relaxant with a fast onset of relaxation and minimal cardiovascular effects. Its potency (ED50) is similar in neonates (0.32 mg/kg), infants (0.28 mg/kg), and children (0.39 mg/kg). T1 suppression (90% +/- 16) is less and time to peak effect (96 +/- 33 s) is greater (0.9 mg/kg rapacuronium) in children, compared with the combined group of infants and neonates. IMPLICATIONS: This study assesses the potency of rapacuronium (Org 9487) in pediatric patients. The potency of rapacuronium is similar in neonates (0.32 mg/kg), infants (0.28 mg/kg), and children (0.39 mg/kg).

Intestinal sleeve anastomosis: a comparative study with end-to-end anastomosis.

This study examines the utility of a sleeve anastomosis with comparison to conventional end to end anastomosis. Thirty New Zealand white rabbits were randomized to sleeve (n = 15) or end-to-end (n = 15) small bowel anastomosis. Five rabbits of each group were sacrificed at 3 days, 7 days, and 6 weeks. Anastomoses were assessed for integrity, bursting strength, and stenosis and examined histologically. Ten control specimens of small bowel were tested for bursting pressure. Three rabbits died postoperatively (1 sleeve and 2 end-to-end). A fourth rabbit (sleeve) was sacrificed early at 3 weeks and had a total stenosis at the anastomosis. The remaining 26 rabbits were reoperated at the prescribed times. There was no evidence of infection or dehiscence in any of these rabbits. Both end-to-end and sleeve anastomoses were equivalent for bursting pressure at all times and, at 7 days and 6 weeks, were similar to controls. The stenotic index revealed no evidence of proximal dilation suggestive of obstruction in the 26 rabbits. For sleeve anastomoses the length of the projected bowel into the lumen persisted at the 6-week stage. Histologically there was good evidence of healing in both the sleeve and end-to-end anstomoses and the serosal surface of the sleeved bowel had epithelialized. Sleeve anastomosis has been demonstrated to heal well and to be as strong as conventional end-to-end anastomosis. Further studies are warranted to determine its role in intestinal anastomosis and potential as a valve.

The effect of age on halothane-induced alterations of contractility in isolated rat aorta.

Aging is implicated as a factor which increases the susceptibility to volatile anesthetic-induced depression of the cardiovascular system. However, little is known regarding mechanisms responsible for this enhanced depression. Current experiments examined the effects of 1.2 and 2.4 vol.% halothane on norepinephrine-induced contractility in endothelium-intact and -denuded aortic preparations isolated from 4-, 14-, and 24-month-old Fisher-344 rats. Prior to exposure to halothane, endothelium removal significantly enhanced the sensitivity to norepinephrine in all age groups without altering the maximum tension. Additionally, in endothelium-intact preparations, increasing age from 4 to 24 months decreased the sensitivity to norepinephrine. Exposure to 2.4 vol.% halothane caused a significant decline in the maximum tension generated in response to norepinephrine in all groups. There were no differences in the amount of depression seen with 2.4 vol.% halothane either within age groups or between endothelium-intact and -denuded preparations of the same age. Halothane at 1.2 vol.% caused a significant reduction in the amount of tension generated in the 4-month-old, endothelium-denuded group. However, all age groups with and without endothelium tended to decrease to a similar degree at 1.2 vol.% halothane, and there were no differences either within age groups or between endothelium-intact and -denuded preparations of the same age. In the 4- and 14-month-old endothelium-intact groups, both 1.2 and 2.4 vol.% halothane decreased the sensitivity to norepinephrine.(ABSTRACT TRUNCATED AT 250 WORDS)

Clothiapine in the management of schizophrenia.

Forty Black men diagnosed as schizophrenic and admitted to Ingutsheni Hospital during a period of 3 months, were allocated alternately to treatment with either clothiapine or chlorpromazine. Six patients were excluded from the trial because of an incorrect diagnosis and 34, 17 in each group, completed the trial. The 2 groups were comparable for both severity and symptoms of their illnesses. Degrees of regression of psychotic symptoms as assessed by the Brief Psychiatric Rating Scale, were comparable for the 2 groups. Adverse effects were not troublesome with clothiapine and there was no evidence of disturbed liver function, but haemoglobin values and white cell counts were sometimes decreased. EEG studies showed that clothiapine produced an increase in the slow activity but no paroxysmal acitvity. It was concluded that clothiapine is a valuable drug for the management of actue schizophrenia.