Emory Rehabilitation Hospital

Marketers' claims about the environmental effects of products and their packaging are becoming more pervasive. Consumer organizations, government, and marketers have long realized that consumers receive such claims with some degree of skepticism. An investigation of how consumer skepticism affects the response to “green” marketing claims would be facilitated by a reliable and valid measure of skepticism. This paper describes a two‐stage research project and the resulting four‐item measure of skepticism toward environmental claims made in advertising and on packages. The scale has acceptable levels of reliability and validity.

The purpose of this retrospective cohort study was to examine the associations among chronic kidney disease, anemia, and risk of death among patients with heart failure. Retrospective cohort study. Patients with a principal diagnosis of heart failure (ICD9 codes 402.01, 402.11, 402.91, 404.01, 404.11, 404.91, and 428.xx) were included. Chronic kidney disease (CKD) was defined as a serum creatinine >1.4 mg/dl for women and >1.5 mg/dl for men. There were 665 eligible patients in the sample with a mean (SD) age of 75.7 (10.9) yr; 60% were women, 71% were white, and 38% had CKD. On admission, a hematocrit > or =40% was found for 30.3% of the patients; 22.9% had a hematocrit between 36% and 40%, 33.2% between 30% and 35%, and 13.6% had a hematocrit of <30%. The 1-yr death rates among individuals with and without CKD were 44.9% and 31.4%, respectively (relative risk [RR], 1.43; 95% confidence interval [CI], 1.17 to 1.75). The mortality at 1 yr was 31.2% for individuals with a hematocrit > or =40%; 33.8% (RR, 1.08; 95% CI. 0.79 to 1.47) for hematocrit 36 to 39%; 36.7% (RR, 1.17; 95% CI, 0.89 to 1.54) for hematocrit between 30 and 35%; and 50.0% (RR, 1.60; 95% CI, 1.19 to 2.16) for those with a hematocrit <30% (chi(2) for trend was 7.37; P = 0.007). Both hematocrit and serum creatinine were independently associated with increased risk of death during follow-up after controlling for other patient risk factors. In conclusion, CKD and anemia are frequent among older patients with heart failure and are independent predictors of subsequent risk of death.

Abstract Das Leben auf der Erde beruht auf Verbindungen mit einem Kohlenstoffgerüst. Bis zum heutigen Tage haben Chemiker die Welt der Biomoleküle und Biopolymere um etwa 10 7 verschiedene synthetische Moleküle und Polymere erweitert, deren Struktur ebenfalls von der Bildung stabiler CC‐Bindungen abhängt. Obwohl die Stabilität von CC‐Bindungen seit über hundert Jahren wohlbekannt ist, waren Graphit und Diamant bis vor kurzem die einzigen auf der Erde in makroskopischen Mengen verfügbaren und strukturell charakterisierten Kohlenstoffallotrope. Mit der Darstellung makroskopischer Mengen an Buckminsterfulleren C 60 und an höheren Fullerenen wie C 70 , C 76 , und C 78 sowie der Erforschung der faszinierenden Eigenschaften dieser Kohlenstoffkugeln hat sich diese Situation inzwischen drastisch geändert. Im Laufe der kommenden Jahrzehnte wird der Entwurf, die Darstellung und das Studium neuer molekularer und polymerer allotroper Formen des Kohlenstoffs eine zentrale Stellung in der Chemie einnehmen. Dies wird zu einer wesentlichen Vertiefung unserer grundlegenden Kenntnisse über die aus Kohlenstoff aufgebaute Materie führen und — wie die aktuelle C 60 ‐Forschung zeigt — völlig neue Perspektiven für technologische Entwicklungen bieten. Dieser Artikel gibt eine übersicht über organisch‐chemische Synthesestrategien für ausschließlich aus Kohlenstoff aufgebaute Moleküle und Polymere, welche strukturell von den bekannten Graphit‐ und Diamant‐Netzwerken und auch von den Fullerenen abweichen. Wir diskutieren auch die aktuelle Fullerenforschung, wobei wir besonderes Gewicht auf die Synthesestrategien legen wollen, welche zu den Fullerenen sowie deren übergangsmetallkomplexen führen.

STUDY DESIGN: In a prospective, single-blinded study, the incidence of false-positive screening tests for sacroiliac joint dysfunction was investigated using the standing flexion, seated flexion, and Gillet tests in 101 asymptomatic subjects. OBJECTIVES: This study determined if these commonly used sacroiliac screening tests can be abnormal in an asymptomatic population. SUMMARY OF BACKGROUND DATA: The sacroiliac joint is a potential source of back and leg pain. One condition affecting this joint is termed sacroiliac joint dysfunction. Diagnosis of this is made primarily by physical examination using screening tests as preliminary diagnostic tools. These screening tests evaluate for asymmetry in sacroiliac motion due to a relative, unilateral hypomobility in one the sacroiliac joints. The specificity of these tests, however, has not been thoroughly evaluated in a well-selected asymptomatic population. METHODS: A single-blinded examiner performed the standing flexion, seated flexion, and Gillet tests on all subjects. An asymptomatic and a symptomatic group were studied. RESULTS: Overall, 20% of asymptomatic individuals had positive findings in one or more of these tests. The specific percentage of false positives are reported by test, age, sex, and side. CONCLUSION: This study suggests that asymmetry in sacroiliac motion due to relative hypomobility as determined by these tests can occur in asymptomatic joints. Obviously, one should not rely solely on these tests to diagnose symptomatic sacroiliac dysfunction.

Abstract Using bipolar fine‐wire electrodes, we examined the right and left longus colli (LC) and sternocleidomastoideus (StM) muscles electromyographically in ten healthy young adults. Action potentials were recorded on FM magnetic tape and each experiment was also videotaped. The head‐neck motions were recorded using a special neck goniometer. The muscles were studied in sitting, supine, prone and lateral positions, both during free movements and against resistance. There was complete inactivity in both muscles in relaxed sitting, normal breathing, deep expiration, and wet and dry swallowing. There was very marked synchronous EMG activity of the LC and StM muscles during resisted forward flexion, marked activity during neck flexion against head weight in the supine position, and during resisted right and left side‐bending. Variable activity was found in both muscles during deep breathing, coughing, forceful blowing, loading on top of the head, resisted backward extension, neck holding against head weight in the prone position and in twisting movements downwards and upwards. During free flexion‐extension movements, LC and StM act synchronously. During free lateral bending they work homolaterally, but during free rotation to the right, the right LC works with the left StM and vice versa.

Myocardial perfusion imaging (MPI) using nuclear cardiology techniques has been widely applied in clinical practice because of its well-documented value in the diagnosis and prognosis of coronary artery disease. Industry has developed innovative designs for dedicated cardiac SPECT cameras that constrain the entire detector area to imaging just the heart. New software that recovers image resolution and limits image noise has also been implemented. These SPECT innovations are resulting in shortened study times or reduced radiation doses to patients, promoting easier scheduling, higher patient satisfaction, and, importantly, higher image quality. This article describes these cardiocentric SPECT software and hardware innovations, which provide a strong foundation for the continued success of myocardial perfusion SPECT.

Abstract The geniohyoid, anterior belly of digastric, mylohyoid, and genioglossus muscles of 20 human subjects were studied electromyographically to determine the temporal relationships of their activities during the act of swallowing. Although the firing order of the four muscles varied within the same subject, the best estimate of the “true” firing sequence was established for each of the 18 subjects who provided statistically significant data. However, no definite universal pattern could be established for the four muscles because there was great inter‐subject variability in both the duration and the sequence of activity. Therefore, at least with respect to these four muscles, each individual has his own swallowing pattern, but different people may swallow quite differently. The type of bolus (saliva vs water) may influence the duration of the muscles' activity. On the other hand, posture (semi‐reclined vs sitting) did not seem to have any influence. There was no evidence to indicate that posture and/or the type of bolus are correlated with the sequence of muscular activity. The anterior belly of the digastric muscle was not active in one‐quarter of the swallows studied. When active during deglutition, all muscles had a general electromyographic pattern of one to many summations of activity separated by relatively quiet periods before and after each swallow.

This review focusses on cross-modal plasticity resulting from visual deprivation. This is viewed against the background of task-specific visual cortical recruitment that is routine during tactile tasks in the sighted and that may depend in part on visual imagery. Superior tactile perceptual performance in the blind may be practice-related, although there are unresolved questions regarding the effects of Braille-reading experience and the age of onset of blindness. While visual cortical areas are clearly more involved in tactile microspatial processing in the blind than in the sighted, it still remains unclear how to reconcile these tactile processes with the growing literature implicating visual cortical activity in a wide range of cognitive tasks in the blind, including those involving language, or with studies of short-term, reversible visual deprivation in the normally sighted that reveal plastic changes even over periods of hours or days.

Abstract The deep layers of the transversospinal back muscles were studied in 25 healthy human subjects. Bipolar fine wire electrodes were inserted bilaterally at the level of the sixth thoracic and the third lumbar spinous processes. Activity was registered simultaneously in sitting and standing, and during movements while in these positions. It was shown that the same muscle group displayed different patterns of activity in the thoracic compared to the lumbar level. Variations in the pattern of activity during forward flexion, extension and axial rotation suggest that the transversospinal muscles adjust the motion between individual vertebrae. The experimental evidence confirms the anatomical hypothesis that the multifidi are stabilizers rather than prime movers of the whole vertebral column.

ABSTRACT The microbiome is increasingly implicated in immune regulation and mortality from sepsis. Mice with identical genetic backgrounds but distinct microbiomes were obtained from different vendors and analyzed following cecal ligation and puncture (CLP), β diversity of the microbiome measured from feces demonstrated significant differences between The Jackson Laboratory (Jax; Bar Harbor, ME, USA) and Charles River Laboratories (CR; Wilmington, MA, USA) C57/B6 mice. Jax mice had 7‐d mortality of 90% following CLP, whereas CR mice had a mortality of 53%. Differences in vendor were associated with altered immunophenotype with increased splenic IFN‐γ + CD4 + T cells, effector memory CD4 + T cells, and central memory CD4 + T cells and increased Peyer's patch effector memory CD4 + T cells in septic CR mice. To determine whether differences in the microbiome were responsible for these differences, Jax and CR mice were cohoused for 3 wk, after which they assumed a similar microbiota composition. Cohoused mice had improved survival following CLP compared to Jax mice and had similar survival regardless of their vendor of origin. All differences in immunophenotype between septic Jax and CR mice disappeared following cohousing. These findings suggest that the microbiome plays a crucial role in survival and the host immune response from sepsis and represents a potential target for therapeutic intervention.—Fay, K. T., Klingensmith, N. J., Chen, C.‐W., Zhang, W., Sun, Y., Morrow, K. N., Liang, Z., Burd, E. M., Ford, M. L., Coopersmith, C. M. The gut microbiome alters immunophenotype and survival from sepsis. FASEB J. 33, 11258–11269 (2019). www.fasebj.org

This electromyographic study shows that the popliteus muscle is a prime medial rotator of the tibia on the femur. Apparently its action during rotation and flexion of the knee also is to withdraw and protect the lateral meniscus. By giving rotatory stability to the knee, it appears to prevent forward dislocation of the femur on the tibia during flexion of the knee.

BACKGROUND AND PURPOSE: The modified Emory Functional Ambulation Profile (mEFAP) is an easily administered test that measures the time to ambulate through 5 common environmental terrains with or without an assistive device or manual assistance. The mEFAP was evaluated for its interrater reliability, test-retest reliability, concurrent validity, and sensitivity to change during outpatient rehabilitation for poststroke gait dysfunction. METHODS: Twenty-six poststroke patients were followed up prospectively in a rehabilitation day-treatment program. The mEFAP, Berg Balance Test (BBT), and 7-item mobility subsection of the Functional Independence Measure + Functional Assessment Measure (FAMm) were completed at admission and discharge. RESULTS: mEFAP interrater reliability (intraclass coefficient [ICC] 0.999) and test-retest reliability (ICC 0.998) were high. The BBT demonstrated high interrater (ICC 0.992) but poor test-retest (ICC 0.605) reliability. Initial and final scores comparing the mEFAP with the BBT (r=-0.735, r=-0.703) and the mEFAP with the FAMm (r=0.685, r=-0.775) were strongly correlated. Improvement on the mEFAP correlated with improved BBT performance (r=-0.524). There was no correlation between overall change observed on the FAMm and change on the mEFAP (r=-0.145). Total mEFAP and all mEFAP subtask scores improved over time (P:<0.0001). CONCLUSIONS: The mEFAP is a reliable gait-assessment tool for patients with stroke and is sensitive to change in ambulation speed.

OBJECTIVE: To develop a scalp dermatitis-specific quality-of-life instrument. METHODS: Based on the results of directed focus sessions with 8 patients with scalp psoriasis or seborrheic dermatitis, we conceptualized 3 major constructs that explain the way scalp dermatoses affect patient quality of life: symptoms, functioning, and emotions. We constructed a 23-item instrument, Scalpdex, and tested its reliability, responsiveness, and validity. RESULTS: Fifty-two dermatology patients completed the study. We demonstrated construct validity by confirming that the factors derived by principal axes factor analyses with orthogonal rotation correlated to our hypothesized scales (r = 0.76-0.84) and that differences in symptom, functioning, and emotion scores differed among the varying levels of self-reported scalp severity more than would be expected by chance (P<.05 by analysis of variance). The instrument demonstrated reliability with internal consistency (Cronbach alpha, 0.62-0.80) and reproducibility (intraclass correlation coefficient, 0.90-0.97). The quality-of-life scores changed in the expected direction in our test for responsiveness (P<or=.05, by paired t test for functioning and emotion for those who improved). We ascertained the discriminant capability of Scalpdex compared with a dermatological generic quality-of-life tool, Skindex, by demonstrating superior responsiveness (P<or=.005 by paired t test in functioning and emotion) and improved overall sensitivity in individual items. CONCLUSIONS: Scalpdex is, to our knowledge, the first quality-of-life instrument specifically for patients with scalp dermatitis that is reliable, valid, and responsive. Clinicians can use the instrument to determine which aspect of the disease most bothers the patient and to evaluate quality of life as one variable of responsiveness to the therapeutic intervention.

Rotational stability of the knee has been traditionally difficult to quantify, limiting the ability of the orthopedic community to determine the potential role of rotational laxity in the etiology of anterior cruciate ligament (ACL) injuries. The purposes of this multicenter cohort study were to evaluate the reliability of a robotic axial rotation measurement system, determine whether the uninjured knees of patients that had previous contralateral ACL reconstruction demonstrated different rotational biomechanical characteristics than a group of healthy volunteers, and determine whether knee rotational biomechanical characteristics differ between male and female non-injured limbs in groups of both healthy volunteers and patients with a previous contralateral ACL injury. Fourteen healthy volunteers and 79 patients with previous unilateral ACL injury participated in this study. Patients were tested using a computerized tibial axial rotation system. Only the normal (non-operated) knee data were used for analysis. In order to assess the reliability of the robotic measurement system, 10 healthy volunteers were tested daily over four consecutive days by four different examiners. Rotational laxity and compliance measures demonstrated excellent reliability (ICC = 0.97). Patients with a contralateral ACL injury demonstrated significantly increased tibial internal rotation (20.6° vs. 11.4°, P < 0.001) and reduced external rotation (16.7° vs. 26.6°, P < 0.001) compared to healthy volunteers. Females demonstrated significantly increased internal and external rotation, as well as significantly increased rotational compliance compared with males (P < 0.05). Computer-assisted measurement techniques may offer clinicians an accurate, reliable, non-invasive method to select the most appropriate preventative or surgical interventions for patients with increased knee rotational laxity.

OBJECTIVE: To evaluate the clinical safety and efficacy of botulinum toxin type B (MYOBLOC) in reducing myofascial pain associated with piriformis syndrome. DESIGN: This was a single-center, outpatient, open-label study of patients with piriformis syndrome. Subjects were treated unilaterally or bilaterally, depending on their symptoms. Evaluations and procedures were performed by a single examiner who was not blinded, and there were no control subjects in this case series. Each piriformis muscle was infiltrated from one injection site under electromyographic guidance with 5000 units of botulinum toxin type B. RESULTS: A total of 20 patients were enrolled in this study. Significant reductions in mean visual analog scale scores for buttock and hip pain were noted at weeks 4, 12, and 16 and for low back pain at weeks 2, 12, and 16. Visual analog scale scores for general and low back pain, pain radiating into lower limbs, and tingling were significantly lower at week 2 after injection, suggesting early onset. A total of 95% of patients reported fair to excellent improvement in pain. Botulinum toxin type B was considered to have fair to excellent efficacy in 90% of patients, as evaluated by the investigator rating of overall efficacy. Botulinum toxin treatment was well tolerated. Dry mouth was the most common treatment emergent adverse event, reported in 6 of 20 patients. CONCLUSIONS: Findings suggest the possibility that botulinum toxin type B may be of potential benefit in the treatment of pain attributed to piriformis syndrome.

Abstract The paper summarizes a technique for implementing the “DRASTIC” groundwater‐vulnerability model within the context of an automated raster‐based geographic information system. Discussion focuses on a methodological development and a statewide project completed recently in Nebraska. The final products, a comprehensive flow chart illustrating procedures and a map of calculated potential pollution hazard, are presented. The methodology can be executed successfully with minimal training and experience. Areas of Nebraska considered vulnerable to groundwater pollution are identified.

Several recent reviews have suggested that cognitive rehabilitation may hold promise in the treatment of memory deficits experienced by patients with mild cognitive impairment. In contrast to the previous reviews that mainly focused on outcome, the current review examines key methodological challenges that are critical for designing and interpreting research studies and translating results into clinical practice. Using methodological details from 36 studies, we first examine diagnostic variability and how the use of cutoffs may bias samples toward more severely impaired patients. Second, the strengths and limitations of several common rehabilitative techniques are discussed. Half of the reviewed studies used a multi-technique approach that precludes the causal attribution between any specific technique and subsequent improvement. Third, there is a clear need to examine the dose-response relationship since this information was strikingly absent from most studies. Fourth, outcome measures varied widely and frequently depended on neuropsychological tests with little theoretical justification or ecological relevance. Fifth, we discuss how the variability in each of these other four areas complicates efforts to examine training generalization. Overall, future studies should place greater emphasis on ecologically relevant treatment approaches and outcome measures and we propose a hierarchical model that may aid in this pursuit.

The clinical examination is a basic language of orthopaedics; it is how orthopaedic surgeons communicate with one another. However, each surgeon speaks a different dialect that has been influenced by where and with whom that surgeon trained, as well as that person's own experiences. Because of the inherent variability in the magnitude, direction, and rate of force application during the clinical examination, manual arthrometers were developed in an attempt to more consistently quantify the clinical examination. Instrumented manual devices, such as the KT-1000 (MEDmetric, San Diego, CA), were the first to provide objective numbers to surgeons and researchers evaluating anteroposterior (AP) knee joint laxity. Although these devices provide surgeons with feedback related to the amount of force applied, the rate at which the force is applied is uncontrolled, resulting in a lack of reliability similar to that of the clinical examination itself. In addition to potential errors in measuring AP laxity, rotational laxity has proven to be very difficult to quantify. Robotic systems that make use of computer-driven motors to perform laxity testing have recently been developed to control the magnitude, direction, and rate of force application and thus improve the accuracy and reliability of both AP and rotational laxity evaluation. This review discusses the evolution of instrumented clinical knee examination over the past 3 decades and highlights the advantages and disadvantages of the various testing systems, as well as how current and future developments in this area may improve the field of orthopaedics by minimizing the flaws of the manual clinical examination.

PURPOSE: To determine whether glenoid retroversion is a predictor of posterior shoulder instability, contralateral instability, or recurrent instability in patients with traumatic, contact-related posterior shoulder instability. METHODS: Patients who underwent shoulder stabilization by 2 senior orthopaedic sport surgeons were identified retrospectively. Patients with a connective tissue disorder, multidirectional instability, or non-trauma-induced pathology were excluded. Patients with a glenoid lesion involving greater than 25% of the glenoid or an engaging humeral lesion were also excluded. Thus patients with a traumatic injury and a magnetic resonance imaging scan available for review were included. Magnetic resonance imaging scans were reviewed, and glenoid version was measured using the glenoid vault method. Charts were reviewed for epidemiologic data, recurrent instability requiring reoperation, evidence of glenoid/humeral bone lesions, and contralateral shoulder instability requiring surgery. Both recurrence and contralateral injury were defined based on having repeat surgery. RESULTS: We identified 143 patients who met the inclusion criteria. Twenty-eight patients had posterior instability, whereas 115 patients had anterior instability. Patients with posterior instability had significantly more glenoid retroversion than patients with anterior instability (-15.4° ± 5.14° v -12.1° ± 6.9°; P < .016). Patients with retroversion of more than -16° showed a higher incidence of contralateral injuries (P < .036). However, no difference in postsurgical recurrent instability was noted. CONCLUSIONS: Our data show that patients with posterior instability have a higher incidence of having a retroverted glenoid. Patients with increased retroversion showed increased posterior contralateral instability. Furthermore, patients with posterior instability and no humeral bone lesions may be more likely to incur contralateral injuries than those with humeral lesions. These data suggest that glenoid version and concomitant injury patterns may be used to help physicians counsel patients on their future risks of contralateral injury. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Abstract Introduction Administration of cholic acid, or its synthetic derivative, 6‐alpha‐ethyl‐23(S)‐methylcholic acid ( INT ‐777), activates the membrane GPCR , TGR 5, influences whole body metabolism, reduces atherosclerosis, and benefits the cardiovascular physiology in mice. Direct effects of TGR 5 agonists, and the role for TGR 5, on myocardial cell biology and stress response are unknown. Methods Mice were fed chow supplemented with 0.5% cholic acid ( CA ) or 0.025% INT ‐777, a specific TGR 5 agonist, or regular chow for 3 weeks. Anthropometric, biochemical, physiologic (electrocardiography and echocardiography), and molecular analysis was performed at baseline. CA and INT ‐777 fed mice were challenged with acute exercise‐induced stress, acute catecholamine‐induced stress, and hemodynamic stress induced by transverse aortic constriction ( TAC ) for a period of 8 weeks. In separate experiments, mice born with constitutive deletion of TGR 5 in cardiomyocytes ( CM ‐ TGR 5 del ) were exposed to exercise, inotropic, and TAC ‐induced stress. Results Administration of CA and INT ‐777 supplemented diets upregulated TGR 5 expression and activated Akt, PKA , and ERK 1/2 in the heart. CA and INT ‐777 fed mice showed improved exercise tolerance, improved sensitivity to catecholamine and attenuation in pathologic remodeling of the heart under hemodynamic stress. In contrast, CM ‐ TGR 5 del showed poor response to exercise and catecholamine challenge as well as higher mortality and signs of accelerated cardiomyopathy under hemodynamic stress. Conclusions Bile acids, specifically TGR 5 agonists, induce cytoprotective changes in the heart and improve myocardial response to physiologic, inotropic, and hemodynamic stress in mice. TGR 5 plays a critical role in myocardial adaptability, and TGR 5 activation may represent a potentially attractive treatment option in heart failure.