Emory Rehabilitation Hospital

Marketers' claims about the environmental effects of products and their packaging are becoming more pervasive. Consumer organizations, government, and marketers have long realized that consumers receive such claims with some degree of skepticism. An investigation of how consumer skepticism affects the response to “green” marketing claims would be facilitated by a reliable and valid measure of skepticism. This paper describes a two‐stage research project and the resulting four‐item measure of skepticism toward environmental claims made in advertising and on packages. The scale has acceptable levels of reliability and validity.

The purpose of this retrospective cohort study was to examine the associations among chronic kidney disease, anemia, and risk of death among patients with heart failure. Retrospective cohort study. Patients with a principal diagnosis of heart failure (ICD9 codes 402.01, 402.11, 402.91, 404.01, 404.11, 404.91, and 428.xx) were included. Chronic kidney disease (CKD) was defined as a serum creatinine >1.4 mg/dl for women and >1.5 mg/dl for men. There were 665 eligible patients in the sample with a mean (SD) age of 75.7 (10.9) yr; 60% were women, 71% were white, and 38% had CKD. On admission, a hematocrit > or =40% was found for 30.3% of the patients; 22.9% had a hematocrit between 36% and 40%, 33.2% between 30% and 35%, and 13.6% had a hematocrit of <30%. The 1-yr death rates among individuals with and without CKD were 44.9% and 31.4%, respectively (relative risk [RR], 1.43; 95% confidence interval [CI], 1.17 to 1.75). The mortality at 1 yr was 31.2% for individuals with a hematocrit > or =40%; 33.8% (RR, 1.08; 95% CI. 0.79 to 1.47) for hematocrit 36 to 39%; 36.7% (RR, 1.17; 95% CI, 0.89 to 1.54) for hematocrit between 30 and 35%; and 50.0% (RR, 1.60; 95% CI, 1.19 to 2.16) for those with a hematocrit <30% (chi(2) for trend was 7.37; P = 0.007). Both hematocrit and serum creatinine were independently associated with increased risk of death during follow-up after controlling for other patient risk factors. In conclusion, CKD and anemia are frequent among older patients with heart failure and are independent predictors of subsequent risk of death.

Abstract Das Leben auf der Erde beruht auf Verbindungen mit einem Kohlenstoffgerüst. Bis zum heutigen Tage haben Chemiker die Welt der Biomoleküle und Biopolymere um etwa 10 7 verschiedene synthetische Moleküle und Polymere erweitert, deren Struktur ebenfalls von der Bildung stabiler CC‐Bindungen abhängt. Obwohl die Stabilität von CC‐Bindungen seit über hundert Jahren wohlbekannt ist, waren Graphit und Diamant bis vor kurzem die einzigen auf der Erde in makroskopischen Mengen verfügbaren und strukturell charakterisierten Kohlenstoffallotrope. Mit der Darstellung makroskopischer Mengen an Buckminsterfulleren C 60 und an höheren Fullerenen wie C 70 , C 76 , und C 78 sowie der Erforschung der faszinierenden Eigenschaften dieser Kohlenstoffkugeln hat sich diese Situation inzwischen drastisch geändert. Im Laufe der kommenden Jahrzehnte wird der Entwurf, die Darstellung und das Studium neuer molekularer und polymerer allotroper Formen des Kohlenstoffs eine zentrale Stellung in der Chemie einnehmen. Dies wird zu einer wesentlichen Vertiefung unserer grundlegenden Kenntnisse über die aus Kohlenstoff aufgebaute Materie führen und — wie die aktuelle C 60 ‐Forschung zeigt — völlig neue Perspektiven für technologische Entwicklungen bieten. Dieser Artikel gibt eine übersicht über organisch‐chemische Synthesestrategien für ausschließlich aus Kohlenstoff aufgebaute Moleküle und Polymere, welche strukturell von den bekannten Graphit‐ und Diamant‐Netzwerken und auch von den Fullerenen abweichen. Wir diskutieren auch die aktuelle Fullerenforschung, wobei wir besonderes Gewicht auf die Synthesestrategien legen wollen, welche zu den Fullerenen sowie deren übergangsmetallkomplexen führen.

STUDY DESIGN: In a prospective, single-blinded study, the incidence of false-positive screening tests for sacroiliac joint dysfunction was investigated using the standing flexion, seated flexion, and Gillet tests in 101 asymptomatic subjects. OBJECTIVES: This study determined if these commonly used sacroiliac screening tests can be abnormal in an asymptomatic population. SUMMARY OF BACKGROUND DATA: The sacroiliac joint is a potential source of back and leg pain. One condition affecting this joint is termed sacroiliac joint dysfunction. Diagnosis of this is made primarily by physical examination using screening tests as preliminary diagnostic tools. These screening tests evaluate for asymmetry in sacroiliac motion due to a relative, unilateral hypomobility in one the sacroiliac joints. The specificity of these tests, however, has not been thoroughly evaluated in a well-selected asymptomatic population. METHODS: A single-blinded examiner performed the standing flexion, seated flexion, and Gillet tests on all subjects. An asymptomatic and a symptomatic group were studied. RESULTS: Overall, 20% of asymptomatic individuals had positive findings in one or more of these tests. The specific percentage of false positives are reported by test, age, sex, and side. CONCLUSION: This study suggests that asymmetry in sacroiliac motion due to relative hypomobility as determined by these tests can occur in asymptomatic joints. Obviously, one should not rely solely on these tests to diagnose symptomatic sacroiliac dysfunction.

Abstract Using bipolar fine‐wire electrodes, we examined the right and left longus colli (LC) and sternocleidomastoideus (StM) muscles electromyographically in ten healthy young adults. Action potentials were recorded on FM magnetic tape and each experiment was also videotaped. The head‐neck motions were recorded using a special neck goniometer. The muscles were studied in sitting, supine, prone and lateral positions, both during free movements and against resistance. There was complete inactivity in both muscles in relaxed sitting, normal breathing, deep expiration, and wet and dry swallowing. There was very marked synchronous EMG activity of the LC and StM muscles during resisted forward flexion, marked activity during neck flexion against head weight in the supine position, and during resisted right and left side‐bending. Variable activity was found in both muscles during deep breathing, coughing, forceful blowing, loading on top of the head, resisted backward extension, neck holding against head weight in the prone position and in twisting movements downwards and upwards. During free flexion‐extension movements, LC and StM act synchronously. During free lateral bending they work homolaterally, but during free rotation to the right, the right LC works with the left StM and vice versa.

Myocardial perfusion imaging (MPI) using nuclear cardiology techniques has been widely applied in clinical practice because of its well-documented value in the diagnosis and prognosis of coronary artery disease. Industry has developed innovative designs for dedicated cardiac SPECT cameras that constrain the entire detector area to imaging just the heart. New software that recovers image resolution and limits image noise has also been implemented. These SPECT innovations are resulting in shortened study times or reduced radiation doses to patients, promoting easier scheduling, higher patient satisfaction, and, importantly, higher image quality. This article describes these cardiocentric SPECT software and hardware innovations, which provide a strong foundation for the continued success of myocardial perfusion SPECT.

BACKGROUND: The Illness Intrusiveness Ratings Scale (IIRS) measures the extent to which disease or its treatment or both interfere with activities in important life domains. Before comparing IIRS scores within or across groups it is crucial to determine whether a common underlying factor structure exists across patient populations. OBJECTIVE: To investigate the factor structure underlying the IIRS and evaluate its stability across diagnoses. METHODS: IIRS responses from 5,671 respondents were pooled from 15 separate studies concerning quality of life in eight patient groups: rheumatoid arthritis; osteoarthritis; systemic lupus erythematosus; multiple sclerosis; end-stage renal disease (maintenance dialysis); renal transplantation; heart, liver, and lung transplantation; and insomnia. Data were gathered by different methods (eg, interview, self-administered, mail survey) and in diverse contexts (eg, individual vs. group). RESULTS: Exploratory maximum-likelihood factor analysis identified three underlying factors in a randomly selected subset of respondents (n = 400), corresponding to "Relationships and Personal Development," "Intimacy," and "Instrumental" life domains. Confirmatory factor analysis corroborated the stability of this structure in an independent subsample (n = 2100). Complementary goodness-of-fit indices confirmed the consistency of the three-factor solution, corroborating that IIRS scores are uniquely defined across patient populations. Coefficient alpha was high for total and subscale scores. CONCLUSIONS: IIRS scores can be compared meaningfully within and across patient groups. Both total and subscale scores can be used depending on research objectives.

STUDY DESIGN: Nine asymptomatic volunteers underwent 40 provocative intra-articular injections of the thoracic zygapophyseal joints. OBJECTIVE: The purpose of the study was to isolate and stimulate the thoracic zygapophyseal joints via fluoroscopically guided intra-articular injections to determine whether they are potential pain generators. SUMMARY OF BACKGROUND DATA: Experimentally, the cervical and lumbar zygapophyseal joints have been shown to produce pain, and tentative referral patterns have been established. Referral patterns based on stimulation of the thoracic zygapophyseal joints have not been previously reported. METHODS: Four subjects underwent right-sided T3-T4, T5-T6, T7-T8, and T9-T10 joint injections, and four subjects underwent left-sided T4-T5, T6-T7, T8-T9, and T10-T11 joint injections. One subject underwent both the right- and left-sided joint injections. The zygapophyseal joints were injected with contrast medium only, and the quality, intensity, and distribution of evoked pain was recorded. RESULTS: In this asymptomatic population, 72.5% of joints injected produced a sensation/pain that was different from the sensation of needle advancement through the soft tissues. In 27.5% of joints injected, there was no evoked pain despite adequate capsular distension. Evoked referral patterns were consistent in all subjects. Significant overlap occurred in the referral patterns, with most thoracic regions sharing 3-5 different joint referral zones. CONCLUSIONS: This study provides preliminary confirmation that the thoracic zygapophyseal joints can cause both local and referred pain. A referral pain diagram has been constructed.

Abstract The geniohyoid, anterior belly of digastric, mylohyoid, and genioglossus muscles of 20 human subjects were studied electromyographically to determine the temporal relationships of their activities during the act of swallowing. Although the firing order of the four muscles varied within the same subject, the best estimate of the “true” firing sequence was established for each of the 18 subjects who provided statistically significant data. However, no definite universal pattern could be established for the four muscles because there was great inter‐subject variability in both the duration and the sequence of activity. Therefore, at least with respect to these four muscles, each individual has his own swallowing pattern, but different people may swallow quite differently. The type of bolus (saliva vs water) may influence the duration of the muscles' activity. On the other hand, posture (semi‐reclined vs sitting) did not seem to have any influence. There was no evidence to indicate that posture and/or the type of bolus are correlated with the sequence of muscular activity. The anterior belly of the digastric muscle was not active in one‐quarter of the swallows studied. When active during deglutition, all muscles had a general electromyographic pattern of one to many summations of activity separated by relatively quiet periods before and after each swallow.

The concept that the endplate noise and endplate spike components of motor endplate potentials represent normal endplate potentials seems to be flawed. The morphology of the normal miniature endplate potentials described in the physiology literature is different from the morphology of the noise-like component of endplate potentials. This noise-like component is identified as normal in current electromyographic literature. There is strong experimental evidence that one source of the endplate noise component is grossly increased release (up to three orders of magnitude) of acetylcholine from the nerve terminal of that neuromuscular junction. The spikes can be accounted for by release of additional acetylcholine in response to mechanical stimulation by the electromyographic needle. Other possibilities exist.

OBJECTIVE: To compare laparoscopic versus open gastric bypass procedures with respect to 30-day morbidity and mortality rates, using multi-institutional, prospective, risk-adjusted data. SUMMARY BACKGROUND DATA: Laparoscopic Roux-en-Y gastric bypass for weight loss is being performed with increasing frequency, partly driven by consumer demand. However, there are no multi-institutional, risk-adjusted, prospective studies comparing laparoscopic and open gastric bypass outcomes. METHODS: A multi-institutional, prospective, risk-adjusted cohort study of patients undergoing laparoscopic and open gastric bypass procedures was performed from hospitals (n = 15) involved in the Private Sector Study of the National Surgical Quality Improvement Program (NSQIP). Data points have been extensively validated, are based on standardized definitions, and were collected by nurse reviewers who are audited for accuracy. RESULTS: From 2000 to 2003, data from 1356 gastric bypass procedures was collected. The 30-day mortality rate was zero in the laparoscopic group (n = 401), and 0.6% in the open group (n = 955) (P = not significant). The 30-day complication rate was significantly lower in the laparoscopic group as compared with the open group: 7% versus 14.5% (P < 0.0001). Multivariate logistic regression analysis was performed to control for potential confounding variables and showed that patients undergoing an open procedure were more likely to develop a complication, as compared with patients undergoing an laparoscopic procedure (odds ratio = 2.08; 95% confidence interval, 1.33-3.25). Propensity score modeling revealed similar results. A prediction model was derived, and variables that significantly predict higher complication rates after gastric bypass included an open procedure, a high ASA class (III, IV, V), functionally dependent patient, and hypertension as a comorbid illness. CONCLUSIONS: Multicenter, prospective, risk-adjusted data show that laparoscopic gastric bypass is safer than open gastric bypass, with respect to 30-day complication rate.

This review focusses on cross-modal plasticity resulting from visual deprivation. This is viewed against the background of task-specific visual cortical recruitment that is routine during tactile tasks in the sighted and that may depend in part on visual imagery. Superior tactile perceptual performance in the blind may be practice-related, although there are unresolved questions regarding the effects of Braille-reading experience and the age of onset of blindness. While visual cortical areas are clearly more involved in tactile microspatial processing in the blind than in the sighted, it still remains unclear how to reconcile these tactile processes with the growing literature implicating visual cortical activity in a wide range of cognitive tasks in the blind, including those involving language, or with studies of short-term, reversible visual deprivation in the normally sighted that reveal plastic changes even over periods of hours or days.

Abstract The deep layers of the transversospinal back muscles were studied in 25 healthy human subjects. Bipolar fine wire electrodes were inserted bilaterally at the level of the sixth thoracic and the third lumbar spinous processes. Activity was registered simultaneously in sitting and standing, and during movements while in these positions. It was shown that the same muscle group displayed different patterns of activity in the thoracic compared to the lumbar level. Variations in the pattern of activity during forward flexion, extension and axial rotation suggest that the transversospinal muscles adjust the motion between individual vertebrae. The experimental evidence confirms the anatomical hypothesis that the multifidi are stabilizers rather than prime movers of the whole vertebral column.

ABSTRACT The microbiome is increasingly implicated in immune regulation and mortality from sepsis. Mice with identical genetic backgrounds but distinct microbiomes were obtained from different vendors and analyzed following cecal ligation and puncture (CLP), β diversity of the microbiome measured from feces demonstrated significant differences between The Jackson Laboratory (Jax; Bar Harbor, ME, USA) and Charles River Laboratories (CR; Wilmington, MA, USA) C57/B6 mice. Jax mice had 7‐d mortality of 90% following CLP, whereas CR mice had a mortality of 53%. Differences in vendor were associated with altered immunophenotype with increased splenic IFN‐γ + CD4 + T cells, effector memory CD4 + T cells, and central memory CD4 + T cells and increased Peyer's patch effector memory CD4 + T cells in septic CR mice. To determine whether differences in the microbiome were responsible for these differences, Jax and CR mice were cohoused for 3 wk, after which they assumed a similar microbiota composition. Cohoused mice had improved survival following CLP compared to Jax mice and had similar survival regardless of their vendor of origin. All differences in immunophenotype between septic Jax and CR mice disappeared following cohousing. These findings suggest that the microbiome plays a crucial role in survival and the host immune response from sepsis and represents a potential target for therapeutic intervention.—Fay, K. T., Klingensmith, N. J., Chen, C.‐W., Zhang, W., Sun, Y., Morrow, K. N., Liang, Z., Burd, E. M., Ford, M. L., Coopersmith, C. M. The gut microbiome alters immunophenotype and survival from sepsis. FASEB J. 33, 11258–11269 (2019). www.fasebj.org

BACKGROUND AND PURPOSE: The modified Emory Functional Ambulation Profile (mEFAP) is an easily administered test that measures the time to ambulate through 5 common environmental terrains with or without an assistive device or manual assistance. The mEFAP was evaluated for its interrater reliability, test-retest reliability, concurrent validity, and sensitivity to change during outpatient rehabilitation for poststroke gait dysfunction. METHODS: Twenty-six poststroke patients were followed up prospectively in a rehabilitation day-treatment program. The mEFAP, Berg Balance Test (BBT), and 7-item mobility subsection of the Functional Independence Measure + Functional Assessment Measure (FAMm) were completed at admission and discharge. RESULTS: mEFAP interrater reliability (intraclass coefficient [ICC] 0.999) and test-retest reliability (ICC 0.998) were high. The BBT demonstrated high interrater (ICC 0.992) but poor test-retest (ICC 0.605) reliability. Initial and final scores comparing the mEFAP with the BBT (r=-0.735, r=-0.703) and the mEFAP with the FAMm (r=0.685, r=-0.775) were strongly correlated. Improvement on the mEFAP correlated with improved BBT performance (r=-0.524). There was no correlation between overall change observed on the FAMm and change on the mEFAP (r=-0.145). Total mEFAP and all mEFAP subtask scores improved over time (P:<0.0001). CONCLUSIONS: The mEFAP is a reliable gait-assessment tool for patients with stroke and is sensitive to change in ambulation speed.

OBJECTIVE: To develop a scalp dermatitis-specific quality-of-life instrument. METHODS: Based on the results of directed focus sessions with 8 patients with scalp psoriasis or seborrheic dermatitis, we conceptualized 3 major constructs that explain the way scalp dermatoses affect patient quality of life: symptoms, functioning, and emotions. We constructed a 23-item instrument, Scalpdex, and tested its reliability, responsiveness, and validity. RESULTS: Fifty-two dermatology patients completed the study. We demonstrated construct validity by confirming that the factors derived by principal axes factor analyses with orthogonal rotation correlated to our hypothesized scales (r = 0.76-0.84) and that differences in symptom, functioning, and emotion scores differed among the varying levels of self-reported scalp severity more than would be expected by chance (P<.05 by analysis of variance). The instrument demonstrated reliability with internal consistency (Cronbach alpha, 0.62-0.80) and reproducibility (intraclass correlation coefficient, 0.90-0.97). The quality-of-life scores changed in the expected direction in our test for responsiveness (P<or=.05, by paired t test for functioning and emotion for those who improved). We ascertained the discriminant capability of Scalpdex compared with a dermatological generic quality-of-life tool, Skindex, by demonstrating superior responsiveness (P<or=.005 by paired t test in functioning and emotion) and improved overall sensitivity in individual items. CONCLUSIONS: Scalpdex is, to our knowledge, the first quality-of-life instrument specifically for patients with scalp dermatitis that is reliable, valid, and responsive. Clinicians can use the instrument to determine which aspect of the disease most bothers the patient and to evaluate quality of life as one variable of responsiveness to the therapeutic intervention.

This electromyographic study shows that the popliteus muscle is a prime medial rotator of the tibia on the femur. Apparently its action during rotation and flexion of the knee also is to withdraw and protect the lateral meniscus. By giving rotatory stability to the knee, it appears to prevent forward dislocation of the femur on the tibia during flexion of the knee.

OBJECTIVE: This study was designed to measure visual acuity during active vertical head movement and to examine its relationship to subjective reports of oscillopsia. STUDY DESIGN: This was a prospective, clinical study. SETTING: The study was performed in a tertiary, ambulatory referral center. PATIENTS: Thirty normal subjects, 13 patients with unilateral vestibular hypofunction, 11 patients with bilateral vestibular loss, and 10 patients with nonvestibular dizziness were examined. Vestibular loss was confirmed with caloric or rotary chair testing. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURE: Reliability, sensitivity, and specificity of a computerized test that measures visual acuity during active vertical head movement. Subjective complaint of oscillopsia was measured by use of a visual analog scale. RESULTS: The active vertical head movement test was reliable both for normal subjects (intraclass correlation coefficient, r = 0.89) and for patients with dizziness (intraclass correlation coefficient, r = 0.94). Age contributed significantly to active vertical head movement in normal subjects and in patients with dizziness over the age of 46 years but not in younger subjects. Older subjects had a decrement in active vertical head movement compared with younger subjects. Subjective reports of oscillopsia did not correlate positively with active vertical head movement. CONCLUSION: The active vertical head movement test is a reliable measure of visual acuity during active vertical head motion. The effect of age on active vertical head movement may reflect the physiologic impact of neuronal loss with aging. The poor correlation between active vertical head movement and reports of oscillopsia may be caused by the predictability of head movements during the active vertical head movement test compared with the unpredictability of head movements during walking.

Rotational stability of the knee has been traditionally difficult to quantify, limiting the ability of the orthopedic community to determine the potential role of rotational laxity in the etiology of anterior cruciate ligament (ACL) injuries. The purposes of this multicenter cohort study were to evaluate the reliability of a robotic axial rotation measurement system, determine whether the uninjured knees of patients that had previous contralateral ACL reconstruction demonstrated different rotational biomechanical characteristics than a group of healthy volunteers, and determine whether knee rotational biomechanical characteristics differ between male and female non-injured limbs in groups of both healthy volunteers and patients with a previous contralateral ACL injury. Fourteen healthy volunteers and 79 patients with previous unilateral ACL injury participated in this study. Patients were tested using a computerized tibial axial rotation system. Only the normal (non-operated) knee data were used for analysis. In order to assess the reliability of the robotic measurement system, 10 healthy volunteers were tested daily over four consecutive days by four different examiners. Rotational laxity and compliance measures demonstrated excellent reliability (ICC = 0.97). Patients with a contralateral ACL injury demonstrated significantly increased tibial internal rotation (20.6° vs. 11.4°, P < 0.001) and reduced external rotation (16.7° vs. 26.6°, P < 0.001) compared to healthy volunteers. Females demonstrated significantly increased internal and external rotation, as well as significantly increased rotational compliance compared with males (P < 0.05). Computer-assisted measurement techniques may offer clinicians an accurate, reliable, non-invasive method to select the most appropriate preventative or surgical interventions for patients with increased knee rotational laxity.

The paper summarizes a technique for implementing the “DRASTIC” groundwater‐vulnerability model within the context of an automated raster‐based geographic information system. Discussion focuses on a methodological development and a statewide project completed recently in Nebraska. The final products, a comprehensive flow chart illustrating procedures and a map of calculated potential pollution hazard, are presented. The methodology can be executed successfully with minimal training and experience. Areas of Nebraska considered vulnerable to groundwater pollution are identified.