Forbes Hospital

BACKGROUND: Although religions is important to many people with cancer, few studies have explored the relationship between religious coping and well-being in a prospective manner, using validated measures, while controlling for important covariates. METHODS: One hundred ninety-eight women with stage I or II and 86 women with stage IV stage breast cancer were recruited. Standardized assessment instruments and structured questions were used to collect data at study entry and 8 to 12 months later. Religious coping was measured with validated measures of positive and negative religious coping. Linear regression models were used to explore the relationships between positive and negative religious coping and overall physical and mental well-being, depression, and life satisfaction. RESULTS: The percentage of women who used positive religious coping (i.e., partnering with God or looking to God for strength, support, or guidance) "a moderate amount" or "a lot" was 76%. Negative religious coping (i.e., feeling abandoned by or anger at God) was much less prevalent; 15% of women reported feeling abandoned by or angry at God at least "a little." Positive religious coping was not associated with any measures of well-being. Negative religious coping predicted worse overall mental health, depressive symptoms, and lower life satisfaction after controlling for sociodemographics and other covariates. In addition, changes in negative religious coping from study entry to follow-up predicted changes in these well-being measures over the same time period. Cancer stage did not moderate the relationships between religious coping and well-being. CONCLUSIONS: Negative religious coping methods predict worse mental heath and life satisfaction in women with breast cancer.

Postpartum hemorrhage, the loss of more than 500 mL of blood after delivery, occurs in up to 18 percent of births and is the most common maternal morbidity in developed countries. Although risk factors and preventive strategies are dearly documented, not all cases are expected or avoidable. Uterine atony is responsible for most cases and can be managed with uterine massage in conjunction with oxytocin, prostaglandins, and ergot alkaloids. Retained placenta is a less common cause and requires examination of the placenta, exploration of the uterine cavity, and manual removal of retained tissue. Rarely, an invasive placenta causes postpartum hemorrhage and may require surgical management. Traumatic causes include lacerations, uterine rupture, and uterine inversion. Coagulopathies require dotting factor replacement for the identified deficiency. Early recognition, systematic evaluation and treatment, and prompt fluid resuscitation minimize the potentially serious outcomes associated with postpartum hemorrhage.

Abstract The electrodes of a polymer electrolyte fuel cell (PEFC) are composite porous layers consisting of carbon and platinum nanoparticles and a polymer electrolyte binder. The proper composition and arrangement of these materials for fast reactant transport and high electrochemical activity is crucial to achieving high performance, long lifetimes, and low costs. Here, the microstructure of a PEFC electrode using nanometer‐scale X‐ray computed tomography (nano‐CT) with a resolution of 50 nm is investigated. The nano‐CT instrument obtains this resolution for the low‐atomic‐number catalyst support and binder using a combination of a Fresnel zone plate objective and Zernike phase contrast imaging. High‐resolution, non‐destructive imaging of the three‐dimensional (3D) microstructures provides important new information on the size and form of the catalyst particle agglomerates and pore spaces. Transmission electron microscopy (TEM) and mercury intrusion porosimetry (MIP) is applied to evaluate the limits of the resolution and to verify the 3D reconstructions. The computational reconstructions and size distributions obtained with nano‐CT can be used for evaluating electrode preparation, performing pore‐scale simulations, and extracting effective morphological parameters for large‐scale computational models.

Abstract This paper proposes that dominant theories of human motivation rest on the notion of salient unmet needs. Motivational theories, represented by biological instinct theories ( thesis ) and social cognitive theories ( antithesis ), are now showing signs of synthesis within the domain of consumer research. Consumer and marketing research techniques can be made more insightful and actionable by introducing measures of the behavioural and emotional meaning of unmet needs through integration of the key elements of motivation research within a quantitative measurement system. Copyright © 2004 Henry Stewart Publications.

Clutches can be used to enhance the functionality of springs or actuators in robotic devices. Here we describe a lightweight, low-power clutch used to control spring engagement in an ankle exoskeleton. The clutch is based on electrostatic adhesion between thin electrode sheets coated with a dielectric material. Each electrode pair weighs 1.5 g, bears up to 100 N, and changes states in less than 30 ms. We placed clutches in series with elastomer springs to allow control of spring engagement, and placed several clutched springs in parallel to discretely adjust stiffness. By engaging different numbers of springs, the system produced six different levels of stiffness. Force at peak displacement ranged from 14 to 501 N, and the device returned 95% of stored mechanical energy. Each clutched spring element weighed 26 g. We attached one clutched spring to an ankle exoskeleton and used it to engage the spring only while the foot was on the ground during 150 consecutive walking steps. Peak torque was 7.3 N·m on an average step, and the device consumed 0.6 mW of electricity. Compared to other electrically-controllable clutches, this approach results in three times higher torque density and two orders of magnitude lower power consumption per unit torque. We anticipate this technology will be incorporated into exoskeletons that tune stiffness online and into new actuator designs that utilize many lightweight, low-power clutches acting in concert.

PURPOSE OF REVIEW: This review covers a group of human malformation syndromes, which are caused by inborn errors of cholesterol synthesis. The Smith-Lemli-Opitz syndrome (SLOS) is an autosomal recessive, multiple malformation, and mental retardation syndrome that is the prototypical example of this group of disorders. In the 10 years since the biochemical cause of SLOS was identified, other malformation syndromes have been shown to result from defects in this pathway. These include desmosterolosis, lathosterolosis, X-linked dominant chondrodysplasia punctata type 2 (CDPX2), congenital hemidysplasia with ichthyosiform erythroderma and limb defects (CHILD syndrome), hydrops-ectopic calcification-moth-eaten skeletal dysplasia (HEM dysplasia), and some cases of Antley-Bixler syndrome. These disorders represent the first true merging of dysmorphology with biochemical genetics. RECENT FINDINGS: Recent studies report the identification of human lathosterolosis patients, indicate that SLOS is a relatively common genetic disorder that may be a major unrecognized cause of fetal loss, suggest that correction of the biochemical defect can improve central nervous system function, and show that perturbed sonic hedgehog signaling due to decreased sterol levels likely underlies some of the malformations in SLOS and lathosterolosis. SUMMARY: Recognition of the biochemical defect in these syndromes has given insight into the role that cholesterol plays during normal development, into understanding the pathophysiological processes that underlie the clinical problems found in these disorders, and into developing therapeutic interventions.

Postpartum hemorrhage is common and can occur in patients without risk factors for hemorrhage. Active management of the third stage of labor should be used routinely to reduce its incidence. Use of oxytocin after delivery of the anterior shoulder is the most important and effective component of this practice. Oxytocin is more effective than misoprostol for prevention and treatment of uterine atony and has fewer adverse effects. Routine episiotomy should be avoided to decrease blood loss and the risk of anal laceration. Appropriate management of postpartum hemorrhage requires prompt diagnosis and treatment. The Four T's mnemonic can be used to identify and address the four most common causes of postpartum hemorrhage (uterine atony [Tone]; laceration, hematoma, inversion, rupture [Trauma]; retained tissue or invasive placenta [Tissue]; and coagulopathy [Thrombin]). Rapid team-based care minimizes morbidity and mortality associated with postpartum hemorrhage, regardless of cause. Massive transfusion protocols allow for rapid and appropriate response to hemorrhages exceeding 1,500 mL of blood loss. The National Partnership for Maternal Safety has developed an obstetric hemorrhage consensus bundle of 13 patient- and systems-level recommendations to reduce morbidity and mortality from postpartum hemorrhage.

ABSTRACT The population genetic structure of Phytophthora infestans in Ecuador was assessed from 101 isolates collected from 1990 to 1992 and 111 isolates collected in 1993. All isolates were analyzed for mating type and allozyme genotype. Both samples were dominated (>95%) by a clonal lineage (EC-1) defined from neutral markers: 90/100 genotype for glucose-6-phosphate isomerase, 96/100 genotype for peptidase, A1 mating type, and a previously unreported nuclear DNA fingerprint. The remaining isolates belonged to the US-1 clonal lineage, which has a worldwide distribution. Isolates in the 1993 sample were analyzed for virulence and metalaxyl sensitivity. All representatives of EC-1 had complex patho-types, with three pathotypes representing >60% of the collection. There was variation for metalaxyl sensitivity. There was no evidence for geographical substructuring on the basis of neutral markers, but there was evidence for limited substructuring based on metalaxyl sensitivity and specific virulence. We hypothesize that EC-1 has been recently introduced to Ecuador.

Mouse embryonal carcinoma F9 cells were exposed to retinoic acid and dibutyryl cyclic AMP. The treated cells synthesized and secreted into the culture medium the basal lamina components, laminin (GP-1 and GP-2) and entactin. The time course of secretion of the basal lamina components was examined by electron microscopic and immunochemical procedures. The induction of the cells resulted in major morphological changes and the deposition of both laminin and entactin at the cell surface and cell junctions. Intracellular deposits of laminin could be localized to the endoplasmic reticulum and membrane-bound intracytoplasmic vacuoles. Concomitant with the appearance of laminin and entactin, there was a loss of fibronectin synthesis and a marked decrease in a 190,000-Da sulfated glycoprotein that appeared to be related to entactin. In the induced cells, laminin and entactin were associated in a complex that could be dissociated with low concentrations of sodium dodecyl sulfate. The induction of laminin and entactin seem to be independent. The enhanced synthesis of laminin appeared to be under transcriptional regulation since it was found that induced F9 cells contained translatable mRNA for GP-2 when tested in a rabbit reticulocyte lysate system. The uninduced cells did not contain detectable quantities of translatable GP-2 mRNA.

Introduction: Painful lumbar spinal disorders represent a leading cause of disability in the US and worldwide. Interventional treatments for lumbar disorders are an effective treatment for the pain and disability from low back pain. Although many established and emerging interventional procedures are currently available, there exists a need for a defined guideline for their appropriateness, effectiveness, and safety. Objective: The ASPN Back Guideline was developed to provide clinicians the most comprehensive review of interventional treatments for lower back disorders. Clinicians should utilize the ASPN Back Guideline to evaluate the quality of the literature, safety, and efficacy of interventional treatments for lower back disorders. Methods: The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations. Experts from the fields of Anesthesiology, Physiatry, Neurology, Neurosurgery, Radiology, and Pain Psychology developed the ASPN Back Guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for back-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using United States Preventive Services Task Force (USPSTF) criteria and consensus points are presented. Results: After a comprehensive review and analysis of the available evidence, the ASPN Back Guideline group was able to rate the literature and provide therapy grades to each of the most commonly available interventional treatments for low back pain. Conclusion: The ASPN Back Guideline represents the first comprehensive analysis and grading of the existing and emerging interventional treatments available for low back pain. This will be a living document which will be periodically updated to the current standard of care based on the available evidence within peer-reviewed literature.

Previous studies have shown that ablation of cranial neural crest results in heart malformations in chick embryos. Cranial neural crest cells populate all of the pharyngeal arches and provide the mesenchymal walls of the aortic arch arteries. Neural crest cells migrate from the pharyngeal apparatus into the outflow region of the heart. However, it is not known which of the pharyngeal arches contribute ectomesenchyme to the developing heart nor has a pattern of distribution in the outflow region been established. In the present study, premigratory presumptive arch neural crest from quail embryos was grafted homotopically onto early chick embryos. On Day 6 of incubation, the chimeric embryos were fixed and processed for histological evaluation. The neural crest providing mesenchyme to pharyngeal arches 1 and 2 was not associated with the developing heart. Neural crest presumptive for arches 3, 4, and 6 was found distributed to the outflow region of the heart. Neural crest from arch 4 contributed the largest number of cells to the developing aorticopulmonary and conotruncal septa. This information indicates that ablations of neural crest presumptive for arches 3, 4, and 6 influence heart development directly while lesions of other areas of cranial neural crest probably influence heart development only secondarily with the primary effects occurring in the pharyngeal arches.

This study examines the impact of OSHA inspections on injuries in manufacturing plants. The authors use the same model and some of the same plant-level data employed by several earlier studies that found large effects of OSHA inspections on injuries for 1979–85. These new estimates indicate that an OSHA inspection imposing a penalty reduced lost-workday injuries by about 19% in 1979–85, but that this effect fell to 11% in 1987–91, and to a statistically insignificant 1% in 1992–98. The authors cannot fully explain this overall decline, which they find for nearly all subgroups they examine—by inspection type, establishment size, and industry, for example. Among other findings are that, across the years studied, inspections with penalties were more effective than those without, and the effects on injury rates were greater in smaller plants and nonunion plants than in large plants and union plants.

The vertebrate fossil record of the Lesser Antilles, restricted to the late Quaternary, contains a wealth of biogeographical and systematic data on Caribbean amphibians, reptiles, birds, and mammals. Fifteen noncultural (paleontological) sites, known from seven islands, are both late Pleistocene and Holocene in age. New fossil material from seven of these sites is described herein. Thirty-three cultural (archaeological) sites, known from 16 islands, are mostly less than 2,000 years old (latest Holocene). The vertebrate record from the first two millennia of human occupation in the Lesser Antilles (ca. 4,000-2,000 years ago) is relatively poorly documented, but the record is sufficient for the following 1,500 years to reveal patterns of human subsistence and their effect on indigenous populations of vertebrates. Noncultural. late Pleistocene vertebrates are best known from caves in the Leeward Islands, especially Barbuda. Practically all of the numerous extinct species or populations of iguanians, various birds, and bats from these sites in the Leeward Islands have Greater Antillean affinity. The faunal distinction between the Greater and Lesser Antilles that is evident today was almost nonexistent during the late Pleistocene at least as far south as the Guadeloupe Passage. The Holocene vertebrate record, whether from cultural or noncultural sites, reveals 79 species and populations that no longer occur on a given island. Most, perhaps all. of these faunal losses can be related to prehistoric and/or historic human activities.

PURPOSE: assess psychometric properties of scales developed to assess experience and perception of physical, psychological, and existential suffering in older individuals. DESIGN AND METHODS: scales were administered to 3 populations of older persons and/or their family caregivers: individuals with Alzheimer's disease (AD) and their family caregivers (N = 105 dyads), married couples in whom 1 partner had osteoarthritis (N = 53 dyads), and African American and Hispanic caregivers of care recipients with AD (N = 121). Care recipients rated their own suffering, whereas caregivers provided ratings of perceived suffering of their respective care recipients. In addition, quality of life, health, and functional status data were collected from all respondents via structured in-person interviews. RESULTS: three scales showed high levels of internal consistency, test-retest reliability, and convergent and discriminant validity. The scales were able to discriminate differences in suffering as a function of type of disease, demonstrated high intra-person correlations and moderately high inter-person correlations and exhibited predicted patterns of association between each type of suffering and indicators of quality of life, health status, and caregiver outcomes of depression and burden. IMPLICATIONS: suffering is an important but understudied domain. This article provides valuable tools for assessing the experience and perception of suffering in humans.

Spontaneous thoughts, the output of a broad category of uncontrolled and inaccessible higher order mental processes, arise frequently in everyday life. The seeming randomness by which spontaneous thoughts arise might give people good reason to dismiss them as meaningless. We suggest that it is precisely the lack of control over and access to the processes by which they arise that leads people to perceive spontaneous thoughts as revealing meaningful self-insight. Consequently, spontaneous thoughts potently influence judgment. A series of experiments provides evidence supporting two hypotheses. First, we hypothesize that the more a thought is perceived to be spontaneous, the more it is perceived to provide meaningful self-insight. Participants perceived more spontaneous kinds of thought (e.g., intuition) to reveal greater self-insight than did more controlled kinds of thought in Study 1 (e.g., deliberation). In Studies 2 and 3, participants perceived thoughts with the same content and target to reveal greater self-insight when spontaneously rather than deliberately generated (i.e., childhood memories and impressions formed). Second, we hypothesize that the greater self-insight attributed to thoughts that are (perceived to be) spontaneous leads those thoughts to more potently influence judgment. Participants felt more sexually attracted to an attractive person whom they thought of spontaneously than deliberately in Study 4, and reported their commitment to a current romantic relationship would be more affected by the spontaneous rather than deliberate recollection of a good or bad experience with their romantic partner in Study 5.

PURPOSE OF REVIEW: Neurologic injury remains a common complication in patients undergoing mechanical support for cardiac and respiratory failure with either left ventricular assist devices (LVAD) or extracorporeal membrane oxygenation (ECMO). Cerebral near-infrared spectroscopy (NIRS) has been recognized clinically as a valid, continuous, and practical monitor of cerebral perfusion in cardiac surgery. Recently, interest in utilizing this technology to monitor patients while undergoing LVAD and ECMO placement and their resultant care has expanded. The purpose of this review is to discuss the practical approaches to using cerebral NIRS for LVAD and ECMO implantation. RECENT FINDINGS: Recent studies suggest that implementation of cerebral NIRS monitoring during LVAD and ECMO implantation may reduce the perioperative neurological complications. In addition, cerebral NIRS can function as a first-alert monitor to warn of problems with oxygenation, ventilation, mixed venous oxygen saturation, and cardiac output. SUMMARY: Despite an overall small body of literature, early evidence suggests a possible beneficial effect of utilizing cerebral NIRS during LVAD and ECMO implantation. Prospective randomized studies are needed to develop algorithm-based therapies centered on NIRS monitoring. On the basis of potential benefits and minimal risks in relation to cerebral NIRS, it is recommended that it be utilized during the operative and immediate postoperative period in the LVAD and ECMO patient population.

Remotely and selectively turning on and off the magnetization of many micro-scale magnetic actuators could be a great enabling feature in fields such as microrobotics and microfluidics. We present an array of addressable 800 × 800 × 75 μm3 micropumps made from a composite material whose net magnetic moment can be selectively turned on or off by application of a large magnetic field pulse. The material is made from a mixture of micron-scale neodymium-iron-boron and ferrite particles, and can be formed into arbitrary actuator shapes using a simple molding procedure. By selectively controlling the orientation of each of an array of micro-actuators prior to the application of the field pulse, the magnetic on/off state of each can be controlled independently. The micropumps are actuated by rotating magnetic fields up to 12 kA m−1 in strength to pump liquid through 100 μm fluid channels. A distinct transition between the on and off states is seen by application of pulsed magnetic fields of about 240 kA m−1 in strength. As a demonstration, we show addressable on/off control of two micropumps and five simple spinning magnetic microactuators, with potential applications for lab-on-a-chip type fluidic devices.

The timing of reproduction is critical in an environmentally unpredictable area such as the Caatinga region of Brazil. Most of the small mammal species in the Caatinga reproduce year round but with varying degrees of success. The caviomorph rodents and marsupials are able to maintain higher population levels than the murid rodents, with a generally lower gross output of young.

Empirical investigations implicate emotional eating (EE) in dysfunctional eating behavior such as uncontrolled overeating and insufficient weight loss following bariatric surgery. They demonstrate that EE may be a conscious or reflexive behavior motivated by multiple negative emotions and/or feelings of distress about loss-of-control eating. EE, however, has not been targeted in pre- or postoperative interventions or examined as an explanatory construct for failed treatment of dysfunctional eating. Three cases suggest that cognitive behavioral treatment (CBT) might alleviate EE. One describes treatment for distress provoked by loss-of-control eating. The first of two others, associated with negative emotions/life situations, link treatment of a super-super-preoperative obese individual's reflexive EE with 52% excess BMI (body mass index) loss maintained for the past year, 64 months after surgery. The second relates treatment of conscious/reflexive EE with 84.52% excess BMI loss 53 months after surgery. Implications for research and treatment are discussed.

This longitudinal study examined the psychological, social, and economic impact of recurrent cancer and its treatment on an initial sample of 268 patients. Structured interviews were conducted at the initiation of palliative radiation therapy and four and eight months later (n = 161 at final follow-up). Data were obtained on health status, psychological functioning, personality attributes, social support, health care utilization, and finances. Except for medical transportation, most of the patients' concrete needs did not change over time. Economic issues independently predicted psychological outcomes. Patients' perceived stress, role restriction, self-esteem, and total symptoms dccrcased over time, whereas their dispositional pessimism increased.