Normative study of grip and wrist flexion strength employing a BTE Work Simulator

The BTE Work Simulator is used in strengthening and endurance programs providing objective information concerning a patient's progress from such programs. This study establishes normative data for grip and wrist flexion strength employing a BTE Work Simulator. For each part of this study, the right hand of 200 normal men between the ages of 30 and 40 years were tested. This study has established benchmark or reference values for the BTE Work Simulator. Normative values provide both objective data, for comparison of the patient to the general population, and long-term goals for which to strive during the rehabilitation process.     

Elemental analysis using radioisotope excited X-ray fluorescence

The measurement of energies and intensities of fluorescent X-rays emitted from a given material when atoms are bombarded with suitable projectiles like electrons, protons, α-particles or protons has been successfully used for non-destructive elemental analysis. Use of radioisotopes as a source of exciting radiation in combination with high resolution semiconductor detectors in X-ray fluorescence has found wide applications in elemental analysis. Energy dispersive X-ray fluorescence is useful in multi-elemental analysis, and thus finds a wide variety of applications. A radioisotope excited X-ray fluorescence spectrometer consisting of a 30 mm² × 3 mm Si(Li) detector having a resolution of 200 eV at 5.9 keV coupled to a System 100 Canberra multichannel analyser has been used. A side source geometry using 20 mCi ¹⁰⁹Cd source together with PC AXIL software have been used for the study of environmental and geological samples in Botswana.     

Mutations in raised Drosophila melanogaster affect experience-dependent aspects of sexual behavior in both sexes

Many aspects of the reproductive behavior of Drosophila melanogaster are modified dramatically by experience and age. Males' courtship of immature males and fertilized females decreases over time. Females' receptivity to copulation, and the behaviors that females perform and elicit, are affected by their age and sexual experience. We show that mutations in a raised stock affect all of these age- and experience-dependent aspects of male and female sexual behavior. Experience has no effect on raised males' courtship of immature males and has opposite effects on raised and wild-type males' courtship of fertilized females. In comparison to controls, raised females become sexually mature at an earlier age, and sexually mature raised virgin females copulate more quickly. Following mating, raised females elicit more courtship and remate faster and more frequently than control females.     

Deciphering the role of transforming growth factor-beta 1 as a diagnostic-prognostic-therapeutic candidate against hepatocellular carcinoma

Transforming growth factor-beta (TGF-β) is a multifunctional cytokine that performs a dual role as a tumor suppressor and tumor promoter during cancer progression. Among different ligands of the TGF-β family, TGF-β1 modulates most of its biological outcomes. Despite the abundant expression of TGF-β1 in the liver, steatosis to hepatocellular carcinoma (HCC) progression triggers elevated TGF-β1 levels, contributing to poor prognosis and survival. Additionally, elevated TGF-β1 levels in the tumor microenvironment create an immunosuppressive stage via various mechanisms. TGF-β1 has a prime role as a diagnostic and prognostic biomarker in HCC. Moreover, TGF-β1 is widely studied as a therapeutic target either as monotherapy or combined with immune checkpoint inhibitors. This review provides clinical relevance and up-to-date information regarding the potential of TGF-β1 in diagnosis, prognosis, and therapy against HCC.     

Getting Performance Metrics Right: A Qualitative Study of Staff Experiences Implementing and Measuring Practice Transformation

BACKGROUND

Quality improvement is a central goal of the patient-centered medical home (PCMH) model, and requires the use of relevant performance measures that can effectively guide comprehensive care improvements. Existing literature suggests performance measurement can lead to improvements in care quality, but may also promote practices that are detrimental to patient care. Staff perceptions of performance metric implementation have not been well-researched in medical home settings.

OBJECTIVE

To describe primary care staff (clinicians and other staff) experiences with the use of performance metrics during the implementation of the Veterans Health Administration’s (VHA) Patient Aligned Care Team (PACT) model of care.

DESIGN

Observational qualitative study; data collection using role-stratified focus groups and semi-structured interviews.

PARTICIPANTS

Two hundred and forty-one of 337 (72 %) identified primary care clinic staff in PACT team and clinic administrative/other roles, from 15 VHA clinics in Oregon and Washington.

APPROACH

Data coded and analyzed using conventional content analysis techniques.

KEY RESULTS

Primary care staff perceived that performance metrics: 1) led to delivery changes that were not always aligned with PACT principles, 2) did not accurately reflect patient-priorities, 3) represented an opportunity cost, 4) were imposed with little communication or transparency, and 5) were not well-adapted to team-based care.

CONCLUSIONS

Primary care staff perceived responding to performance metrics as time-consuming and not consistently aligned with PACT principles of care. The gaps between the theory and reality of performance metric implementation highlighted by PACT team members are important to consider as the medical home model is more widely implemented.

     

Asymmetrical movements of the lumbopelvic region: Is this a potential mechanism for low back pain in people with lower limb amputation?

Low back pain (LBP) is a major secondary disabling condition following lower limb amputation including persons with above-knee and below-knee amputation. Whilst the increasing prevalence of this musculoskeletal problem in people with lower limb amputation is well recognised, the mechanisms of LBP in this population have been poorly explored. Asymmetrical movements and loading patterns have been found in persons following lower limb amputation and linked to the high prevalence of LBP in this population. However, some argue that such asymmetries are part of the ‘normal’ adaptive process following lower limb amputation. We hypothesise that there is potential for some of the kinematic and kinetic adaptations in the lumbopelvic and trunk region to be ‘mal-adaptive’, potentially acting as a contributing factor for the onset or maintenance of LBP symptoms in this population. Evidence for movement and muscle asymmetries around the lumbopelvic and lower limb region provides some support for an association between LBP and movement asymmetry in the general population. It is therefore reasonable to hypothesise that movement asymmetries will demonstrate an association with LBP in lower limb amputee populations. Previous studies investigating movement and loading patterns within this population have focused mainly on gait analysis. Therefore, there is a need for further research to investigate the presence and potential association of asymmetrical movement patterns of the lumbopelvic region with LBP in a range of specific functional tasks. Results of such studies will identify the asymmetrical movement patterns and functional tasks associated with LBP in this population. Furthermore, it will inform future case-control and longitudinal studies to specifically investigate the putative links for such asymmetrical movement patterns as risk factors to LBP in this population.     

Louisiana's “Medically Futile” Unborn Child List: Ethical Lessons at the Post-Dobbs Intersection of Reproductive and Disability Justice

Ableist attitudes and structures are increasingly recognized across all sectors of health care delivery. After Dobbs, novel questions arose in the United States concerning how to protect reproductive autonomy while avoiding discrimination against and devaluation of disabled persons. In this essay, we examine the Louisiana Department of Health's emergency declaration, “List of Conditions That Shall Deem an Unborn Child ‘Medically Futile,’” issued August 1, 2022. We raise a number of medical, ethical, and public health concerns that lead us to argue that the declaration should be rescinded. Analysis of this ethically objectionable declaration provides valuable lessons about how to uphold both reproductive and disability justice in a post-Dobbs landscape.