Exploring a peer-based physical activity program in the community for adults with moderate-to-severe traumatic brain injury

PRIMARY OBJECTIVE

To explore the experiences of program mentors, participants, and employees involved in a peer-based physical activity (PA) program for adults with moderate-to-severe TBI, being piloted by a community fitness center, to develop the program as a measurable intervention.

RESEARCH DESIGN

We adopted an exploratory case study approach through an interpretivist paradigm, which focused on discovering realities about the peer-based PA program across the study participants' views, backgrounds, and experiences.

METHODS AND PROCEDURES

Semi-structured focus groups and individual interviews were conducted with nine adult program participants (3 peer mentors, 6 participants), and three program employees. Inductive content analysis was used to develop themes about their perceived experiences.

MAIN OUTCOMES AND RESULTS

44 open-codes were grouped into 10 subthemes and three final themes: 1) program impacts identified the importance of the program in daily life and resulting psychological, physical, and social outcomes; 2) program characteristics highlighted program leaders, accessibility, and social inclusion; 3) program sustainability included program adherence, benefits for the center, and the program's future.

CONCLUSIONS

Perceptions of program experiences and outcomes identified how peer-based PA for adults with moderate-to-severe TBI can lead to meaningful activities, functioning better, and buy-in from all parties. Implications for research and practice related to supporting health-related behaviors after TBI through group-based, autonomy-supporting approaches are discussed.

Examining Theoretical Factors That Influence Teachers' Intentions to Implement Inclusive Physical Education

Purpose: The purpose of the current study was to apply the Theoretical Domains Framework (TDF) and Capability, Opportunity, Motivation, and Behavior model (COM-B) to examine theoretical predictors of teachers' intentions to implement inclusive physical education. Methods: Ontario primary and secondary teachers (n = 383) completed an online questionnaire which assessed potential factors associated with intentions toward implementation of inclusive physical education. Results: The final statistical model explained 72% of variance in intentions to implement inclusive physical education with the following theoretical domains identified as significant (p<.05) predictors: knowledge (β .09), professional role and identity (β .22), memory, attention, and decision making (β .14), social influence (β .37), and emotion (β -.20). Regarding the COM-B, the component Motivation explained the greatest amount of variance in intentions to implement inclusive physical education. Conclusions: The application of the TDF and COM-B model in this study work to extend current literature through advancing understanding regarding cognitive, affective, and social factors related to teachers' intentions to implement inclusive physical education. Teacher training strategies should take into consideration multidimensional approaches to support teachers' motivations to implement inclusive physical education. Future research and intervention should seek to target and foster factors such as social influences, social/professional role and identity, and knowledge. These factors, in turn, may improve teachers' intentions to implement inclusive physical education.

Lung transplantation in the United States, 1999-2008

This article highlights trends and changes in lung and heart-lung transplantation in the United States from 1999 to 2008. While adult lung transplantation grew significantly over the past decade, rates of heart-lung and pediatric lung transplantation have remained low. Since implementation of the lung allocation score (LAS) donor allocation system in 2005, decreases in the number of active waiting list patients, waiting times for lung transplantation and death rates on the waiting list have occurred. However, characteristics of recipients transplanted in the LAS era differed from those transplanted earlier. The proportion of candidates undergoing lung transplantation for chronic obstructive pulmonary disease decreased, while increasing for those with pulmonary fibrosis. In the LAS era, older, sicker and previously transplanted candidates underwent transplantation more frequently compared with the previous era. Despite these changes, when compared with the pre-LAS era, 1-year survival after lung transplantation did not significantly change after LAS inception. The long-term effects of the change in the characteristics of lung transplant recipients on overall outcomes for lung transplantation remain unknown. Continued surveillance and refinements to the LAS system will affect the distribution and types of candidates transplanted and hopefully lead to improved system efficiency and outcomes.

Respiratory viral infections within one year after pediatric lung transplant

Abstract: To characterize epidemiology and risk factors for respiratory viral infections (RVI) in pediatric lung transplant recipients within the first post‐transplant year, a retrospective multicenter study of pediatric lung transplant recipients from 1988 to 2005 was conducted at 14 centers in the United States and Europe. Data were recorded for 1 year post transplant. Associations between RVI and continuous and categorical risk factors were assessed using Wilcoxon's rank‐sum and χ² tests, respectively. Associations between time to RVI and risk factors or survival were assessed by multivariable Cox proportional hazards models. Of 576 subjects, 79 subjects (14%) had 101 RVI in the first year post transplant. Subjects with RVI were younger than those without RVI (median ages 9.7, 13; P<0.01). Viruses detected included adenovirus (n=25), influenza (n=9), respiratory syncytial virus (n=21), parainfluenza virus (n=19), enterovirus (n=4), and rhinovirus (n=22). In a multivariable model for time to first RVI, etiology other than cystic fibrosis (CF), younger age, and no induction therapy were independently associated with risk of RVI. Cytomegalovirus serostatus and acute rejection were not associated with RVI. RVI was independently associated with decreased 12‐month survival (hazard ratio 2.6, 95% confidence interval 1.6–4.4). RVI commonly occurs after pediatric lung transplantation with risk factors including younger age and non‐CF diagnosis. RVI is associated with decreased 1‐year survival.

American Society of Transplantation executive summary on pediatric lung transplantation

Lung transplantation in children poses distinctly different challenges from those seen in the adult population. This consensus statement reviews the experience in the field of pediatric lung transplantation and highlights areas that deserve further investigation.

(C2) Saliva, breast milk, and mucosal fluids in HIV transmission

The oral environment has received various amounts of attention in association with HIV infection and pathogenesis. Since HIV infection occurs through mucosal tissue, oral factors-including tissue, fluids, and compartments-are of interest in furthering our understanding of the diagnosis, infectivity, transmission, and pathogenesis of disease. This report reviews: (1) HIV testing and diagnoses with oral fluids; (2) post-natal acquisition of HIV in association with breast-feeding from HIV-positive mothers; and (3) oral sex and HIV transmission. In the first, we examine how oral fluids are used to detect HIV infection and review current consensus on the role of salivary molecules as markers for immunosuppression. Second, lactation-associated HIV acquisition is reviewed, with special consideration of emerging issues associated with the impact of anti-retroviral therapies. Last, we consider current data on the risk of HIV infection in association with oral sex. Investigation of these diverse topics has a common goal: understanding how HIV presents in the oral environment, with an aim to rapid and accessible HIV diagnosis, and improved prevention and treatment of infection.

Correlation between candiduria and departmental antibiotic use

The incidence of candiduria is increasing in teaching hospitals. We examined the hypothesis that this trend was correlated with the amount of departmental antibiotic consumption. In the setting of a large teaching hospital in Israel, the correlation coefficient between departmental intravenous antibiotic consumption (expressed as daily defined dose (DDD)/1000 patient-days) and the incidence of candiduria per 1000 patient-days was 0.47 (P=0.03). For broad-spectrum antibiotics, the corresponding correlation coefficient was 0.66 (P=0.001). The strongest correlation with candiduria was shown for the use of meropenem (r=0.79, P<0.001) and ceftazidime (r=0.66, P=0.001). This is the first time that departmental habits of antibiotic use have been shown to be strongly correlated with the incidence of candiduria in hospitalized patients. These results add an important new dimension to the strategy of restricting broad-spectrum antibiotics.

Post-lung transplantation bronchiolitis obliterans syndrome: usefulness of expiratory thin-section CT for diagnosis

PURPOSE

To assess the usefulness of thin-section expiratory computed tomography (CT), as compared with that of thin-section inspiratory CT, in detecting airway obstruction and air trapping in pediatric lung transplant recipients with bronchiolitis obliterans syndrome (BOS).

MATERIALS AND METHODS

Thin-section CT scans were obtained at full inspiration and end expiration in 21 pediatric lung transplant recipients with proved BOS and in 41 transplant recipients with normal airways. True diagnosis was based on pulmonary function test results. Inspiration CT scans were scored for extent of decreased attenuation of the lung parenchyma; expiration CT scans were scored for extent of air trapping.

RESULTS

The sensitivity of inspiratory CT for enabling diagnosis of BOS was 71%; the specificity, 78%; the positive predictive value, 62%; and the negative predictive value, 84%. The sensitivity of expiratory CT for enabling diagnosis of BOS was 100%; the specificity, 71%; the positive predictive value, 64%; and the negative predictive value, 100%. Expiratory CT scores correlated more strongly (rho = 0.75, P <.01) with pulmonary function test-based scores than did inspiratory CT scores (rho = 0.48, P <.01). Nominal logistic regression analysis revealed that expiratory CT was a more powerful predictor of true diagnosis (P <.01) than was inspiratory CT (P =.10).

CONCLUSION

Expiratory CT is sensitive for depicting BOS-related airway abnormalities and may be more useful than inspiratory CT for diagnosis of small airway obstruction.

Posttransplant lymphoproliferative disease in children: correlation of histology to clinical behavior

PURPOSE

To determine whether the morphologic features of posttransplant lymphoproliferative disease (PTLD) correlated to a response to therapy.

PATIENTS AND METHODS

We reviewed our experience with PTLD in the pediatric population. We identified 32 patients with a total of 36 episodes of PTLD. The diagnosis was confirmed by tissue examination and classified according to the degree of monomorphic features of the lesion. Thirty-four of 36 episodes were managed with immunosuppression reduction, and the patients were assessed for their response to this strategy. Chemotherapy was used to treat 10 of 15 patients who had progressive disease, and their subsequent course was also analyzed.

RESULTS

Sixteen of 17 (94%) patients with polymorphic morphology responded to immunosuppression reduction compared with only 5 of 17 (29%) patients with monomorphic features (P < 0.001). All of the patients with progressive disease who did not receive additional therapy died. Standard chemotherapy regimens for lymphoma were administered to 10 patients with progressive disease, with a high response rate (90%), durable remissions, and acceptable toxicity.

CONCLUSIONS

We conclude that the morphologic characteristics of PTLD provide information to potentially help guide treatment strategies in the management of this disease. Standard chemotherapy regimens for malignant lymphoma appear to be a viable treatment option for patients with progressive disease, although further investigation is needed.

Lunotriquetral injuries in the athlete

The athlete with an LT injury typically presents with ulnar-sided wrist pain after a high-energy impaction of the wrist. Reagan's LT ballottement test and Kleinman's shear test help the examiner identify these injuries. A thorough radiographic examination includes standard PA and lateral radiographs. Magnetic resonance imaging or arthrography can be performed, but the sensitivity of these imaging studies varies. The palmar portion of the LT interosseous ligament, dorsal radiocarpal ligament, and dorsal intercarpal ligament play the most significant roles in LT stability. Lunotriquetral injuries without instability respond well to immobilization. Arthroscopy is valuable in staging and determining treatment but requires a thorough radiocarpal and midcarpal examination. Acute LT injuries with instability are treated with arthroscopic-assisted reduction and pinning. If desired, this procedure can be incorporated with an open ligament repair through a volar approach. Chronic LT tears without instability can also be treated arthroscopically. Treatment of the chronic LT tear with instability depends on the degree of collapse. Treatment in the athlete includes ligament reconstruction with capsulodesis or, rarely, intercarpal LT arthrodesis.

Percutaneous and arthroscopic screw fixation of scaphoid fractures in the athlete

The authors prefer to treat nondisplaced acute scaphoid fractures in the athlete on an individualized basis. Percutaneous or arthroscopic-assisted fixation are valuable techniques to employ when prolonged immobilization is a concern. Return to athletic competition has been rapid using these methods. Morbidity has been minimal, and there have been no nonunions to date at the authors' institution.

Changes in mitochondrial mass, membrane potential, and cellular adenosine triphosphate content during the cell cycle of human leukemic (HL-60) cells

Oxidative phosphorylation within the inner mitochondrial membrane generates the majority of cellular adenosine triphosphate (ATP) required for normal physiological functions (including regulation of cell volume and solute concentration, maintenance of cellular architecture, and synthesis of essential macromolecules). Its efficient functioning depends on the maintenance of an electrochemical gradient and is tightly coupled to the energetic demands of the cell and/or tissue. Commitment to and completion of the cell division cycle are sensitive to changes in the availability of mitochondrially derived ATP, although the relationship between cell cycle and mitochondrial physiology is poorly understood. Using vital, mitochondrial-specific fluorochromes to differentiate between mitochondrial mass (10-N-nonyl acridine orange) and mitochondrial membrane potential (Rhodamine 123), together with a quantification of total cellular ATP levels, it was possible to generate profiles of these mitochondrial characteristics in HL-60 cells at different stages of their cell cycle. The data suggest that the availability of ATP changes in a cell cycle-specific manner and cannot be predicted by changes in mitochondrial mass or membrane potential. Furthermore, transition points in the cell cycle where ATP availability is low with respect to the amount of functional inner mitochondrial membrane have been observed. We suggest that these cell cycle phase transitions are sensitive to inhibition of mitochondrial activity because the basal levels of available ATP at these points are nearer to a theoretical "minimal threshold" below which cell cycle progression is inhibited.

Mitochondrial contributions to cancer cell physiology: redox balance, cell cycle, and drug resistance

Alterations in the biochemistry of mitochondria have been associated with cell transformation and the acquisition of drug resistance to certain chemotherapeutic agents, suggesting that mitochondria may play a supportive role for the cancer cell phenotype. Mitochondria are multifunctional organelles that contribute to the cellular adenosine triphosphate (ATP) pool and cellular redox balance through the production of reactive oxygen intermediates (ROI). Our laboratory has focused on these mitochondrial functions in the context of cancer cell physiology to evaluate the potential role of mitochondria as controllers of tumour cell proliferation. Low concentrations of ROI have been implicated as messengers in intracellular signal transduction mechanisms; thus an imbalance of ROI production from the mitochondria may support cancer cell growth. In addition, suppression of mitochondrial ATP production can halt cell cycle progression at two energetic checkpoints, suggesting that the use of tumor-selective agents to reduce ATP production may offer a therapeutic target for cancer growth control.

Accumulation of human promyelocytic leukemic (HL-60) cells at two energetic cell cycle checkpoints

Agents that disrupt mitochondrial function were used to monitor the contribution of ATP to cell cycle progression. Following nontoxic exposure to these agents, flow cytometric analysis of the cell population showed a significant increase in the proportion of cells in G1 at low doses of the agent and in G2-M at higher doses, in accordance with the degree of ATP reduction induced by the compound. These data indicate that cycling cells must maintain a minimal ATP content to satisfy the energy requirement of the checkpoint that allows passage through G1 into S phase. Once committed, successful passage through G2 into mitosis is also conditional upon maintenance of a critical ATP content sufficient to satisfy the second energy-sensitive checkpoint that exists at this transition. These data establish a foundation for future investigations into the energy dependence of cell cycle events and propose novel means for cell cycle intervention.

An improved invertebrate synaptosomal preparation with cholinergic properties

Our laboratory has previously characterized a high affinity choline uptake system (HAChUS) in Limulus tissues and synaptosomes. We report here on the characterization of the HAChUS in synaptosomes prepared selectively from central nervous system tissues shown to be enriched for presumed cholinergic functions; namely the protocerebrum, corpora pedunculata and abdominal ganglia. Synaptosomes were prepared from these tissues by means of a modification of the subfractionation procedure developed by Dowdall and Whittaker. In our modification, we harvested a PP2L fraction exclusively from the S2 fraction. Compared to the P2L fraction, the PP2L was greater than three times more efficient in [3H]choline uptake and was significantly more sensitive to inhibition with micromolar concentrations of hemicholinium-3. The PP2L fraction HAChUS was shown to have characteristics common to the HAChUS of identified cholinergic tissues.

Successful use of a paracorporeal left ventricular assist device in man

A paracorporeal left ventricular assist device (LVAD) with a capacity to pump 8 L/min of blood was employed in a clinical trial, and this report details the first survivor. A 60-year-old man could not be separated from the pump oxygenator following coronary artery bypass grafting, and, therefore, an LVAD was employed. Almost the entire left ventricular workload was assumed by the mechanical pump so that the myocardium was allowed to rest and recover. The LVAD support was continued for 105 hours. It provided satisfactory total body perfusion with maintenance of good hemodynamics--without serious deleterious effects on hematologic factors. The patient is alive and active without cardiac symptoms 16 months after his operation. The total experience with 13 LVAD implantations warrants continuation of the clinical trials in selected patients.

Number of nuclei in mammalian cardiac myocytes

The numbers of nuclei per cardiac muscle cell were determined in adult mammalian hearts after previous enzymatic isolation of individual myocytes. A high percentage of binucleation was observed in rat (78 ± 1.8%), rabbit (78 ± 0.8%), guinea pig (81 ± 1.6%), cat (76 ± 1.5%), dog (47 ± 2.4%,), and beef (45 ± 1.1%), while the human myocytes were found predominantly mononucleated (90%) and only 10 ± 2.2% of them were binucleated. These findings are in agreement with our data obtained after serial sectioning of the myocardium of the above species and subsequent reconstruction of individual myocytes. We also found that in fetal and neonatal rat the cardiac myocytes are predominantly mononucleated (95% and 84%, respectively), that the binucleation develops during the early postnatal period, and that adult values are reached by 12–14 days of age. When the body growth and consequently also the heart growth were either accelerated or slowed down by nutritional intervention during the above period, the rate of appearance of binucleation correlated with the organ size rather than with the age of the rat. Early postnatal increase in binucleation was also observed in rabbit, cat, and dog during normal growth. The regional distribution of the above phenomenon was found to be uniform throughout both ventricles.