Drug abuse and responsible fathering: a comparative study of men enrolled in methadone maintenance treatment

AIM: Because very little is known about the parenting of drug-abusing men, this study was designed to document ways that drug abuse contributes to compromise of responsible fathering. DESIGN, SETTING, PARTICIPANTS: Generalized linear models and data representing different dimensions of responsible fathering were used to clarify ways that the fathering of 106 men receiving methadone maintenance treatment differed from that of 118 men living in the same community with no history of alcohol or drug abuse. MEASUREMENT: Men who enrolled in the study completed two structured interviews and a battery of five self-report measures selected to document current and historical dimensions of responsible fathering. FINDINGS: When the opioid-dependent fathers were compared to the other fathers, there were significant differences in: (i) economic resources to support family formation; (ii) patterns of pair-bonding; (iii) patterns of procreation; and (iv) parenting behavior. When fathering of the youngest biological child was examined, the opioid-dependent fathers confirmed few differences in historical dimensions of fathering, but they reported significant differences in current dimensions reflecting: (i) constricted personal definitions of the fathering role; (ii) poorer relationships with biological mothers; (iii) less frequent residence with the child; (iv) less frequent provision of financial support; (v) less involvement in positive parenting; (vi) poorer appraisal of self as a father; and (vii) less satisfaction as a father. CONCLUSIONS: The findings highlight ways that drug abuse contributes to compromise of responsible fathering, and they raise questions about ways that the drug abuse treatment system might better address parenting as a treatment issue for men.     

Noninvasive Methods for Determining Pulmonary Vascular Function in Children with Pulmonary Arterial Hypertension: Application of a Mechanical Oscillator Model

Objective. Noninvasive diagnostics for pulmonary arterial hypertension (PAH) have traditionally sought to predict main pulmonary artery pressure from qualitative or direct quantitative measures of the flow velocity pattern obtained from spectral Doppler ultrasound examination of the main pulmonary artery. A more detailed quantification of flow velocity patterns in the systemic circuit has been obtained by parameterizing the flow trace with a simple dynamic system model. Here, we investigate such a model's utility as a noninvasive predictor of total right heart afterload and right heart function. Design. Flow velocity and pressure was measured within the main pulmonary artery during right heart catheterization of patients with normal hemodynamics (19 subjects, 20 conditions) and those with PAH undergoing reactivity evaluation (34 patients, 69 conditions). Our model parameters were obtained by least‐squares fitting the model velocity to the measured flow velocity. Results. Five parameter means displayed significant (P < .05) differences between normotensive and hypertensive groups. The model stiffness parameter correlated to actual pulmonary vascular resistance (r = 0.4924), pulmonary vascular stiffness (r = 0.6811), pulmonary flow (r = 0.6963), and stroke work (r = 0.7017), while the model initial displacement parameter had good correlation to stiffness (r = 0.6943) and flow (r = 0.6958). Conclusions. As predictors of total right heart afterload (resistance and stiffness) and right ventricle work, the model parameters of stiffness and initial displacement offer more comprehensive measures of the disease state than previous noninvasive methods and may be useful in routine diagnostic monitoring of patients with PAH.     

The Cancer Imaging Archive (TCIA): Maintaining and Operating a Public Information Repository

The National Institutes of Health have placed significant emphasis on sharing of research data to support secondary research. Investigators have been encouraged to publish their clinical and imaging data as part of fulfilling their grant obligations. Realizing it was not sufficient to merely ask investigators to publish their collection of imaging and clinical data, the National Cancer Institute (NCI) created the open source National Biomedical Image Archive software package as a mechanism for centralized hosting of cancer related imaging. NCI has contracted with Washington University in Saint Louis to create The Cancer Imaging Archive (TCIA)—an open-source, open-access information resource to support research, development, and educational initiatives utilizing advanced medical imaging of cancer. In its first year of operation, TCIA accumulated 23 collections (3.3 million images). Operating and maintaining a high-availability image archive is a complex challenge involving varied archive-specific resources and driven by the needs of both image submitters and image consumers. Quality archives of any type (traditional library, PubMed, refereed journals) require management and customer service. This paper describes the management tasks and user support model for TCIA.     

Understanding Athletic Trainers' Beliefs Toward a Multifacted Sport-Related Concussion Approach: Application of the Theory of Planned Behavior

Context:

Practice guidelines recommend a multifaceted approach for managing concussions, but a relatively small percentage of athletic trainers (ATs) follow these recommendations. Understanding ATs'' beliefs toward the recommended concussion practice guidelines is the first step in identifying interventions that could increase compliance. The theory of planned behavior (TPB) allows us to measure ATs'' beliefs toward the recommended concussion practice guidelines.

Objective:

To examine the influence of ATs'' beliefs toward the current recommended concussion guidelines on concussion-management practice through an application of the TPB.

Design:

Cross-sectional study.

Setting:

A Web link with a survey was e-mailed to 1000 randomly selected members of the National Athletic Trainers'' Association (NATA).

Patients or Other Participants:

A total of 221 certified ATs working in secondary school/clinic, high school, and college/university settings.

Main Outcome Measure(s):

A 66-item survey reflecting the current recommended concussion guidelines of the NATA and International Conference on Concussion in Sport was created to measure beliefs using the TPB constructs attitude toward the behavior (BA), subjective norms (SN), perceived behavioral control (PBC), and behavioral intention (BI) of ATs. We used a linear multiple regression to determine if the TPB constructs BA, SN, and PBC predicted BI and if PBC and BI predicted behavior according to the TPB model.

Results:

We found that BA, SN, and PBC predicted BI (R = 0.683, R² = 0.466, F_3,202 = 58.78, P < .001). The BA (t₂₀₂ = 5.53, P < .001) and PBC (t₂₀₂ = 9.64, P < .001) contributed to the model, whereas SN (t₂₀₂ = −0.84, P = .402) did not. The PBC and BI predicted behavior (R = 0.661, R² = 0.437, F_2,203 = 78.902, P < .001).

Conclusions:

In this sample, the TPB constructs predicted BI and behavior of ATs'' compliance with recommended concussion-management guidelines. The BA and PBC were the most influential constructs, indicating that those with positive attitudes toward concussion-management recommendations are more likely to implement them, and ATs are less likely to implement them when they do not believe they have the power to do so. We theorize that interventions targeting ATs'' attitudes and control perceptions will lead to improved compliance.Key Words: concussion management, traumatic brain injuries, practice guidelines

Key Points

• Using the theory of planned behavior constructs to investigate the application of recommended concussion-management guidelines by athletic trainers, we found that attitudes toward the behavior and perceived behavioral control were most influential.
• Interventions that take into account athletic trainers'' attitudes and perceived control may help to increase compliance with concussion-management guidelines.

Given estimates of 1.6 to 3.8 million sport-related concussions occurring in the United States each year,¹ sports medicine professionals must be able to evaluate and manage concussions properly. With most athletic injuries, the sports medicine team can clearly define the presence and severity of an injury; however, factors such as an athlete''s age² and sex³ and the location and magnitude of an impact⁴ can make it difficult to clearly define the severity of a concussion.To help sports medicine professionals who care for concussed athletes, a number of organizations^5–8 have proposed the use of a multifaceted approach to evaluate and manage sport-related concussions. The guidelines established by these organizations for the evaluation and management of sport-related concussions endorse the use of (1) a clinical examination,^5,7,8 (2) a symptom checklist,⁶ (3) postural-control assessment,^6–8 (4) neuropsychological testing,^5–8 (5) baseline testing when available for high–concussion-risk athletes,^6,7 and (6) a return-to-play protocol with a daily increase in activity once an athlete has been deemed symptom free.^5–8 Also, the recommendations emphasize that it is imperative to focus on the athlete''s data gathered from the evaluation when making a return-to-play (RTP) decision throughout the concussion-management process rather than relying on a predetermined timeline.^6–8The multifaceted approach to evaluating and managing concussions has been recommended since 2002.⁵ Sports medicine professionals have shown a steady but slow increase in compliance with the recommendations over the past decade, yet barriers to incorporation of these standards remain.^9–11 To improve compliance, it is important to understand sports medicine professionals'' beliefs about the multifaceted approach to concussion management.¹² If we can understand why a minority of sports medicine professionals use recommended concussion-management guidelines, we can identify strategies to change common practices. The theory of planned behavior (TPB) offers an avenue to investigate these beliefs.The TPB focuses on theoretical constructs that are concerned with individual motivational factors (behavioral intention [BI]) as determinants of the likelihood of performing a specific behavior.^13–15 The TPB includes measures of attitude, subjective normative perceptions, and perceived behavioral control (PBC) that determine BI, with BI leading to a behavior. The TPB assumes that all other factors, including demographics and the environment, operate through the model constructs and do not independently contribute to explaining the likelihood of performing a behavior.The TPB has 4 guiding constructs: (1) attitude toward the behavior (BA), or an individual''s positive or negative evaluation of self-performance of a behavior and an individual''s belief about the consequences of that behavior; (2) subjective norms (SN), or an individual''s perception of what other persons think about the individual performing the behavior and the individual''s motivation to comply; (3) PBC, or a perception that the individual has control over performing a behavior; and (4) BI, or the individual''s intent to perform or not perform the behavior based on the weight of the first 3 constructs (Figure 1). The TPB depicts behavior (B) as a linear regression function: B = w₁BI + w₂PBC, where w₁ and w₂ are empirically determined weights.Open in a separate windowFigure 1. Theory of planned behavior results with Pearson r (beta weight) for each construct. ^a Significant at P < .001.The following is an example of how the TPB can help us understand the decision-making process of a sports medicine professional in determining whether to use a concussion-management technique. An athletic trainer (AT) believes it is important to implement neuropsychological testing after every concussion (BA). The AT may or may not be influenced by his or her perceptions about how the head coach feels regarding this concussion-management tool (SN). Finally, the AT must decide if he or she has enough authority in the athletic department to acquire the funds to purchase the neuropsychological tests (PBC). According to the TPB, the summation of these 3 constructs results in the AT''s intention to perform neuropsychological tests. An AT who intends to perform neuropsychological tests is more likely to do so. However, if the AT feels that he or she lacks full volitional control over the behavior (PBC), the BI may have less influence on behavior.To understand why a minority of sports medicine professionals are currently applying the concussion-management guidelines, we would like to understand their beliefs and perceptions regarding the guidelines. Therefore, the purpose of our study was to examine the influence of ATs'' attitudes and beliefs toward the current recommended concussion-management guidelines through an application of the TPB.     

Chronic myopathy due to immunoglobulin light chain amyloidosis

Amyloid myopathy associated with a plasma cell dyscrasia is a rare cause of muscle hypertrophy. It can be a challenging diagnosis, since pathological findings are often elusive. In addition, the mechanism by which immunoglobulin light-chain deposition stimulates muscle overgrowth remains poorly understood. We present a 53-year old female with a 10-year history of progressive generalized muscle overgrowth. Congo-red staining and immunohistochemistry revealed perivascular lambda light chain amyloid deposits, apparent only in a second muscle biopsy. The numbers of central nuclei and satellite cells were increased, suggesting enhanced muscle progenitor cell formation. Despite the chronicity of the light chain disease, the patient showed complete resolution of hematologic findings and significant improvement of her muscle symptoms following autologous bone marrow transplantation. This case highlights the importance of early diagnosis and therapy for this treatable cause of a chronic myopathy with muscle hypertrophy.     

Validation of multiple subject-specific finite element models of unicompartmental knee replacement

Accurate computer modelling of the fixation of unicompartmental knee replacements (UKRs) is a valuable design tool. However, models must be validated with in vitro mechanical tests to have confidence in the results. Ten fresh-frozen cadaveric knees with differing bone densities were CT-scanned to obtain geometry and bone density data, then implanted with cementless medial Oxford UKRs by an orthopaedic surgeon. Five strain gauge rosettes were attached to the tibia and femur of each knee and the bone constructs were mechanically tested. They were re-tested following implanting the cemented versions of the implants.Finite element models of four UKR tibiae and femora were developed. Sensitivity assessments and convergence studies were conducted to optimise modelling parameters. The cemented UKR pooled R² values for predicted versus measured bone strains were 0.85 and 0.92 for the tibia and femur respectively. The cementless UKR pooled R² values were slightly lower at 0.62 and 0.73 which may have been due to the irregularity of bone resections. The correlation of the results was attributed partly to the improved material property prediction method used in this project. This study is the first to validate multiple UKR tibiae and femora for bone strain across a range of specimen bone densities.