Predicting occupational performance: handwriting versus keyboarding.

PURPOSE: To determine whether there is a correlation between handwriting and keyboarding speed and accuracy, and whether handwriting and keyboarding share common underlying components. METHODS: Sixty-three typically developing 5th-grade students attended a series of 15 keyboarding lessons for a total of 5 hours. Prior to the lessons, cognitive, sensory, and motor skills related to handwriting were evaluated. Prior to and following the lessons keyboarding and handwriting accuracy and speed were also tested. Correlations were employed to examine relationships between handwriting and keyboarding skills and multiple regression analyses were used to examine the contribution of performance components to handwriting and keyboarding performance. RESULTS: Following keyboarding instruction, a significant correlation was found between handwriting and keyboarding speed, but not in accuracy of these tasks. Similarly, some of the specific tests measuring tactile and oculo-motor functions were found to be related to both handwriting and keyboarding speed, yet accuracy of these tasks did not share common underlying components. CONCLUSIONS: It appears that handwriting and keyboarding accuracy may entail different skills, suggesting that keyboarding may be a potential alternative writing tool for students with handwriting difficulties. It also appears that when students write slowly, handwriting speed should be considered prior to recommending keyboarding for these students. Additional research is required to further support these findings.     

Sodium channels accumulate at the tips of injured axons

The axolemmal distribution of voltage-gated sodium channels largely determines the regions of axonal electrical excitability. Using a wellcharacterized anti–sodium channel antibody, we examined peripheral nerve fibers focally injured by exposure to the neurotoxic agent, potassium tellurite (K₂TeO₃). Immunocytochemical and radioimmunoassay data showed a focal accumulation of sodium channels within the tips of injured axons. The major increase in sodium channel concentration occurred between 7 and 11 days after toxin exposure; however, immunocytochemically, excess sodium channels persisted in several axonal endings for a much longer time. The accumulation of sodium channels at injured axonal tips may be responsible, in part, for ectopic axonal excitability and the resulting abnormal sensory phenomena (especially pain and paresthesias) which frequently complicate peripheral nerve injury in humans. © 1994 John Wiley & Sons, Inc.     

Low‐Temperature Polymerization of Olefins in the Presence of Titanium Monoamidinate/MAO Catalyst

This paper reports the predominantly syndiotactic‐specific polymerization of propylene in the presence of titanium monoamidinate/methylaluminoxane (MAO) catalysts. The same catalysts, depending on the reaction conditions, also promote either predominantly 1,4‐cis or 1,4‐trans polymerization of 1,3‐butadiene and polymerization of styrene either to highly syndiotactic or to stereoirregular polymer. Some preliminary information about the features of propylene polyinsertion is also reported.

Expansion of the 20–24 ppm region of the ¹³C NMR spectrum of sample 2. The starred resonance at 21.75 ppm and the shoulders are not assigned.     

Variation in acute fluid resuscitation among pediatric burn centers

BackgroundAccurate resuscitation of pediatric patients with large thermal injury is critical to achieving optimal outcomes. The goal of this project was to describe the degree of variability in resuscitation guidelines among pediatric burn centers and the impact on fluid estimates.MethodsFive pediatric burn centers in the Pediatric Injury Quality Improvement Collaborative (PIQIC) contributed data from patients with ≥15% total body surface area (TBSA) burns treated from 2014 to 2018. Each center's resuscitation guidelines and guidelines from the American Burn Association were used to calculate estimated 24-h fluid requirements and compare these values to the actual fluid received.ResultsDifferences in the TBSA burn at which fluid resuscitation was initiated, coefficients related to the Parkland formula, criteria to initiate dextrose containing fluids, and urine output goals were observed. Three of the five centers’ resuscitation guidelines produced statistically significant lower mean fluid estimates when compared with the actual mean fluid received for all patients across centers (4.53 versus 6.35 ml/kg/% TBSA, p < 0.001), (4.90 versus 6.35 ml/kg/TBSA, p = 0.002) and (3.38 versus 6.35 ml/kg/TBSA, p < 0.0001).ConclusionsThis variation in practice patterns led to statistically significant differences in fluid estimates. One center chose to modify its resuscitation guidelines at the conclusion of this study.     

Assessing opioid administration in pediatric burn patients with nonsurgical management

BackgroundDespite the vast literature studying the opioid crisis, sparse data describe this in the pediatric burn population. This study sought to assess patient-level characteristics and their potential effects on opioid administration in nonsurgical pediatric burn inpatients.MethodsAdmitted burn patients from 2013 to 2018 with nonsurgical management at an American Burn Association (ABA) verified pediatric burn center were retrospectively identified. Morphine milligram equivalents by weight (MME/kg) per admission were evaluated through a multiple loglinear regression with race, sex, age, total body surface area burned (TBSA), and burn depth as predictors. Simple linear regression was used to evaluate the temporal trend of median opioid utilization.ResultsA total of 806 patients (55% White, 35% Black, 5% Hispanic, 5% Other) were included. In an adjusted analysis, no differences in opioid administration were seen by sex, burn degree, or for Blacks and Hispanics when compared with Whites. Increased MME/kg was associated with older age (10–18 years; p < 0.0001) and larger burns (>5% TBSA burned; p < 0.0001). From 2013 to 2018, median MME/kg per admission declined significantly (2013:0.21, 2018:0.09; p = 0.0103).ConclusionsNonsurgical burn patients who were older and presented with larger TBSA experienced marked increases in opioid utilization. Overall, opioid administration decreased over time.     

Relationship of systolic BP to obstructive sleep apnea in patients with heart failure

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is an independent risk factor for hypertension in the general population. Hypertension is, in turn, an important risk factor for the development and progression of congestive heart failure (CHF). Our objective was to determine whether OSA would be associated with elevated daytime BP in medically treated patients with CHF. DESIGN: Cross-sectional study. SETTING: Tertiary care, university-affiliated sleep disorders and heart failure clinics. PATIENTS: Three hundred one consecutive patients with CHF. MEASUREMENTS AND RESULTS: We measured daytime BP and performed overnight sleep studies to assess for the presence of OSA. Among these patients, OSA was present in 121 patients (40%) and their systolic BP was significantly higher than in patients without OSA. Patients with OSA were 2.89 times (95% confidence interval, 1.25 to 6.73) more likely to have systolic hypertension (ie, BP > or = 140 mm Hg) than those without OSA after controlling for other risk factors, including obesity. The degree of systolic BP elevation was directly related to the frequency of obstructive apneas and hypopneas. CONCLUSIONS: In medically treated patients with CHF, daytime systolic BP and the prevalence of systolic hypertension are significantly increased in patients with OSA, compared to those without OSA, independent of other potentially confounding factors. OSA may therefore have contributed to the presence of systolic hypertension in some of these patients.     

Intestinal Depletion of NaPi‐IIb/Slc34a2 in Mice: Renal and Hormonal Adaptation

The Na⁺‐dependent phosphate‐cotransporter NaPi‐IIb (SLC34A2) is widely expressed, with intestine, lung, and testis among the organs with highest levels of mRNA abundance. In mice, the intestinal expression of NaPi‐IIb is restricted to the ileum, where the cotransporter localizes specifically at the brush border membrane (BBM) and mediates the active transport of inorganic phosphate (Pi). Constitutive full ablation of NaPi‐IIb is embryonically lethal whereas the global but inducible removal of the transporter in young mice leads to intestinal loss of Pi and lung calcifications. Here we report the generation of a constitutive but intestinal‐specific NaPi‐IIb/Slc34a2–deficient mouse model. Constitutive intestinal ablation of NaPi‐IIb results in viable pups with normal growth. Homozygous mice are characterized by fecal wasting of Pi and complete absence of Na/Pi cotransport activity in BBM vesicles (BBMVs) isolated from ileum. In contrast, the urinary excretion of Pi is reduced in these animals. The plasma levels of Pi are similar in wild‐type and NaPi‐IIb–deficient mice. In females, the reduced phosphaturia associates with higher expression of NaPi‐IIa and higher Na/Pi cotransport activity in renal BBMVs, as well as with reduced plasma levels of intact FGF‐23. A similar trend is found in males. Thus, NaPi‐IIb is the only luminal Na⁺‐dependent Pi transporter in the murine ileum and its absence is fully compensated for in adult females by a mechanism involving the bone‐kidney axis. The contribution of this mechanism to the adaptive response is less apparent in adult males. © 2015 American Society for Bone and Mineral Research.