Sheridan VA Medical Center

OBJECTIVE: To gather epidemiologic data on injury type, treatment, and recovery from rock climbing injuries. METHODS: Design: retrospective cross-sectional study. SETTING: web-based survey. PARTICIPANTS: rock climbers who sustained a climbing-related injury during the prior 24 months. Criteria for inclusion: aged ≥18 years; participation in rock climbing at least 4 times per year in the United States. INTERVENTIONS: none. MAIN OUTCOME MEASURES: percentage of injured climbers seeking medical care, providers seen, subspecialty referral, development of chronic problems, factors affecting return to climbing, injuries by climbing type, body region, and injury type. RESULTS: Data were collected over a 60-day period using the Research Electronic Data Capture (REDCap) survey system. Seven hundred and eight surveys were collected from 553 male and 155 female climbers. Thirteen hundred ninety seven injuries were reported, and 975 injuries were suitable for analysis. The most common provider initially seen was a primary care provider. Subspecialty referral was commonly obtained. Injury patterns differed by climbing type. The percentage of respondents that returned to climbing before their injury was fully healed was 51.1%, and 44.9% of respondents developed chronic problems related to their climbing injury. Twenty-eight percent of respondents were unable to return to their previous level of climbing performance. Several factors were associated with delayed recovery from climbing injury. CONCLUSIONS: A significant number of climbers sought healthcare after injury. A majority of climbers who sought treatment were referred to subspecialist providers. About one-half of climbers were symptomatic when they returned to climbing and developed chronic problems after injury. Factors associated with slower return to climbing included increasing age, smoking, fractures, and surgery.

The struggling second and third graders in this mixed methods study increased their reading comprehension after a 10‐week Readers Theatre podcasting project. Podcasting made the students aware of a wider audience, which enhanced the authenticity and social nature of the strategy, and made their performances permanent so they could be stored and conveniently retrieved for later listening and evaluation. Finally, students discussed their podcasts using visual vocabulary such as “watch,” “show,” “look good,” and “show my voice,” uncovering the concept of audio as a visual medium. Since visualization is a critical strategy used by skilled readers, podcasting has the potential to strengthen this aspect of Readers Theatre.

A technique is described for the dissociation and fractionation by isopycnic centrifugation (4,000 x g, 60 minutes, 4 degrees C) in linear bovine albumin density gradients (12 ml, pH 5.2 real osmolality 333 mmol/Kg water, 1.030-1.075 g/cm3) of cells ( less than or equal to 3 x 10(7)/gradient) released by a strictly standardised combination of mechanical and enzymatic means from a transplantable methylcholanthrene induced BALB/c fibrosarcoma. Optimal conditions for reproducible localisation of cell bands with maintenance of both satisfactory resolution and satisfactory viable cell recovery ( greater than 80%) were established by means of a series of simultaneous double fractionation experiments. When rebanding was performed under these conditions the density of the median of the cell count of the refractioned cells shifted less than 0.0005 g/cm3. Experiments also showed that close adherence to certain aspects of the tissue dissociation and fractionation protocol was necessary to avoid reduced cell yields and viabilities, density-dependent selective cell lossses, reductions in resolution and shifts in the location of cell bands. Other aspects of the protocol were tolerant to variation without introducting artefacts.

Duncecap larkspur (Delphinium occidentale [Wats.] Wats.) is an important perennial weed on high-elevation rangelands because of significant cattle losses due to toxic alkaloids in the plant. Aminocyclopyrachlor was evaluated at six rates between 17.5 and 315 g ai · ha-1 for larkspur control alone, and in combination with chlorsulfuron or metsulfuron, at a high-elevation location in Wyoming. Aminocyclopyrachlor-containing treatments were compared with 1120 g ai · ha-1 picloram and 63 g ai · ha-1 metsulfuron-methyl. Herbicides were applied to two sites in a randomized complete block design with four replicates each on June 18, 2010 at the first site and June 28, 2011 at the second site. Larkspur mortality, plant species richness, vegetation cover, and grass biomass datawere collected 1 yr after treatment. Cover datawere used to calculate vegetation diversity and to assess changes in species composition associated with herbicide application. A four-parameter log-logistic model was used to evaluate larkspur mortality, species richness, and vegetation cover in response to aminocyclopyrachlor rate. Ninety-percent larkspur reduction was obtained with aminocyclopyrachlor applied alone at rates of 168-303 g ha-1, depending on site. Mixture of aminocyclopyrachlor plus chlorsulfuron at a 2.5:1 ratio required 102-127 g ha-1 of aminocyclopyrachlor to reduce larkspur 90%. Aminocyclopyrachlor plus metsulfuron was the most effective herbicide combination for larkspur control of those we evaluated, requiring 47+15 g ha-1, respectively, to reduce larkspur 90%. Species richness and diversitywere reduced by herbicide rates required to effectively control larkspur. Graminoid biomass was not significantly impacted by herbicide or rate. Aminocyclopyrachlor may be a useful tool for duncecap larkspur control. Addition of chlorsulfuron ormetsulfuron to aminocyclopyrachlor increased larkspur control but had a greater impact on associated nontarget vegetation. © 2016 The Society for Range Management. Published by Elsevier Inc.

A transplantable methylcholanthrene-induced fibrosarcoma of female BALB/c mice (the MC-2 fibrosarcoma) was dissociated by combined mechanical and enzymatic means, then fractionated by isopycnic centrifugation in linear albumin gradients. In some experiments recovered cells were both cultured in soft nutrietn agar and inoculated subcutaneously into syngeneic recipients. In these experiments a highly significant correlation was observed between subsequtnt colony number and rapid growth phase tumor size suggesting identity of clonigenic and tumorigenic cells. It was consistently found that clonigenic cells were markedly depleted from the low density extremes of the cell density distribution profiles suggesting that the low density neoplastic cells had irreversibly left the growth fraction. With increasing tumor age, sequential studies showed that both total and clonigenic cell density distribution profiles were variable, showing no obvious trend, suggesting that in the age (13-35 days) and size (2-8 g) range studied growth fraction changes had little selective effect on cells of any specific density. These results imply that a marked selective depletion of low density clonigenic cells (or selective accumulation of low density non-proliferative cells) must mainly occur during an earlier phase of tumor growth. Studies on several other murine solid tumors also showed maximal depletion of clonigenic cells from the least dense fractions, suggesting that this situation may be common.

Anger is a commonly reported problem among returning veterans, yet little attention has been devoted to studying treatment engagement among veterans who report anger problems but do not have posttraumatic stress disorder (PTSD). This study compares Iraq-Afghanistan veterans with anger/no PTSD (n = 159) to others reporting significant PTSD symptoms (n = 285) and those reporting neither anger nor PTSD (n = 716) on rates of treatment utilization, perceived barriers to treatment, and preferences for care. Relative to the PTSD group, the anger/no-PTSD group was significantly less likely to have received mental health treatment in the last year, despite endorsing barriers to treatment at a lower rate. Furthermore, the anger/no-PTSD group endorsed fewer preferences than the PTSD group. Results suggest that the anger/no-PTSD group is a unique subgroup that may be less likely to identify a need for treatment. Implications are discussed.

Fanconi syndrome (FS) is a severe grade of drug-induced proximal tubule toxicity. There are numerous causes for acquired FS, and drug toxicity is one of the most common. FS is known to be associated with the nucleoside reverse transcriptase inhibitor (NRTI) tenofovir disoproxil fumarate (TDF). TDF is often used in combination with emtricitabine (FTC) for preexposure prophylaxis (PrEP) of human immunodeficiency virus (HIV) infection. TDF/FTC-induced FS has been observed as a dose-related phenomenon that is directly correlated to kidney function, high levels of absorption of the drug into the proximal tubule, and interactions with other medications. This case report describes a patient who acquired FS after starting TDF/FTC for PrEP in the setting of chronic kidney disease (CKD) with concomitant tacrolimus therapy, a known nephrotoxic agent.

BACKGROUND: This study of umbilical catheterization deliberate practice training compared skill and knowledge outcomes of umbilical catheterization using a tissue-hybrid simulator (REAL) versus a synthetic simulated umbilical cord task trainer (ART). METHODS: This was a prospective randomized control study. Pediatric residents were randomized to REAL or ART umbilical catheterization deliberate practice training. Pre-post-training changes in skill performance and knowledge scores for REAL and ART groups were compared. Fidelity of REAL and ART were compared by neonatologists. RESULTS: Twenty-seven pediatric residents completed training. Post-training mean skill scores were improved compared to pre-test scores (REAL, P < 0.001; ART, P < 0.0001). Post-training skill, knowledge, and self-efficacy scores were not different between the REAL and ART groups. Fidelity of REAL was higher than ART for neonatologists (P < 0.01). CONCLUSIONS: The face validity of REAL was superior to ART, but resident umbilical cord deliberate practice training demonstrated no difference in skill, knowledge, and self-efficacy improvements between REAL and ART. Further studies on real patients are needed to evaluate the impact of using real or simulated umbilical cords for umbilical venous catheter/umbilical arterial catheter training.

Adult health nurse practitioner, Outpatient Service, Veterans Administration Hospital, Sheridan, Wyo.

Journal For Healthcare Quality: February 1989 - Volume 11 - Issue 1 - p 27 doi: 10.1111/j.1945-1474.1989.tb00378.x

Introduction: An average of 17.5 Veterans died by suicide each day in 2021, highlighting the importance of research and prevention efforts aimed at suicide risk. Attentional processes have emerged as a possible predictor of suicide behaviors (SB), yet associated neural correlates remain understudied, particularly in the Veteran population. Methods: The current study examines sustained and selective attention performance as indexed by the Ruff 2 & 7 Selective Attention Test and anterior cingulate cortex (ACC) volume as they relate to SB in Veterans. A subset of Veterans also completed a structural magnetic resonance imaging protocol. Participants were grouped on history of suicidal ideation (SI), suicide attempt (SA), and no SB (HC). Results: Analyses from the Ruff 2 & 7 test showed that Veterans with a history of SA performed more slowly on Automatic Detection Speed (ADS) and Controlled Search Speed (CSS) compared to Veterans with SI and no SB. SI and SA group differences on ADS and CSS remained after Bonferroni correction, and CSS differences remained after controlling for depressive and anxious symptoms. There were no between-group differences on Ruff 2 & 7 Accuracy measures. When analyses were divided by sex, males with a history of SA performed more slowly than SI and HC on ADS and more slowly on CSS and Total Speed than males with a history of SI. Results remained significant after controlling for depressive and anxious symptoms. When Bonferroni corrections were applied, males with a history of SA performed more slowly on ADS, CSS, and Total Speed compared to males with a history of SI. Female Veterans with a history of SA performed more slowly than female HC on CSS only; however, these findings were no longer significant after controlling for depressive and anxious symptoms. No significant differences were found between female groups on ADS or Total Speed. Measures of left rostral ACC gray matter (GM) volume for the combined female and male Veteran sample were positively correlated with ADS and CSS scores in HC but not SA. Conversely, right rostral ACC GM volume negatively correlated with ADS and CSS scores in the SA group but not HC. Right rostral ACC white matter volume correlated positively with ADS and CSS in HC. Discussion: These findings highlight associations between attention speed, ACC volume, and SB even after controlling for acute mood symptoms, in addition to emphasizing the importance of including sex in analyses.