PURPOSEThe purpose was to examine gait characteristics between collegiate athletes who did and did not sustain a lower-extremity musculoskeletal (LEMSK) injury in the year after concussion.
...METHODSThirty-four NCAA collegiate athletes with diagnosed concussions were divided into two groups based on if they did (n = 16) or did not (n = 18) sustain a LEMSK in the year after concussion. Participants completed baseline testing before the start of the season and again at return to play postconcussion. Injuries were tracked using an electronic medical database. Participants were instrumented with three APDM Opal triaxial accelerometers and performed five single-task (ST) and five dual-task (DT) gait trials. Participants traversed a 10-meter walkway, turned around a specified endpoint, and returned to the original line. During DT, participants simultaneously walked and answered mini-mental style questions. A linear mixed-effects model assessed interactions and/or main effects between groups for gait speed, double support time, cadence, stride length, and cognitive accuracy.
RESULTSThe LEMSK group walked slower (ST, 1.15 ± 0.10 m·s; DT, 1.01 ± 0.10 m·s) than the uninjured group (ST, 1.23 ± 0.11 m·s; DT, 1.10 ± 0.11 m·s) during both ST (P = 0.04) and DT (P = 0.03). The injury group spent longer in double support (ST, 20.19% ± 2.34%; DT, 21.92% ± 2.13%) than the uninjured group (ST, 18.16% ± 2.60%; DT, 20.00% ± 2.32%) during both ST (P = 0.02) and DT (P = 0.02). The injury group had a significantly lower cognitive accuracy (89.56% ± 6.48%) than the uninjured group (95.40% ± 7.08%) across time points (P = 0.02).
CONCLUSIONSThere were significant differences in gait characteristics and cognitive accuracy between those who did and did not sustain a LEMSK injury after concussion. The LEMSK group demonstrated a conservative gait strategy both before and after their concussive injury.
Lecture is prominent, but practices vary
A large body of evidence demonstrates that strategies that promote student interactions and cognitively engage students with content (
1
) lead to gains in ...learning and attitudinal outcomes for students in science, technology, engineering, and mathematics (STEM) courses (
1
,
2
). Many educational and governmental bodies have called for and supported adoption of these student-centered strategies throughout the undergraduate STEM curriculum. But to the extent that we have pictures of the STEM undergraduate instructional landscape, it has mostly been provided through self-report surveys of faculty members, within a particular STEM discipline e.g., (
3
–
6
). Such surveys are prone to reliability threats and can underestimate the complexity of classroom environments, and few are implemented nationally to provide valid and reliable data (
7
). Reflecting the limited state of these data, a report from the U.S. National Academies of Sciences, Engineering, and Medicine called for improved data collection to understand the use of evidence-based instructional practices (
8
). We report here a major step toward a characterization of STEM teaching practices in North American universities based on classroom observations from over 2000 classes taught by more than 500 STEM faculty members across 25 institutions.
ABSTRACT We study the stellar population properties of the IRAC-detected 6 z 10 galaxy candidates from the Spitzer UltRa Faint SUrvey Program. Using the Lyman Break selection technique, we find a ...total of 17 galaxy candidates at 6 z 10 from Hubble Space Telescope images (including the full-depth images from the Hubble Frontier Fields program for MACS 1149 and MACS 0717) that have detections at signal-to-noise ratios ≥ 3 in at least one of the IRAC 3.6 and 4.5 m channels. According to the best mass models available for the surveyed galaxy clusters, these IRAC-detected galaxy candidates are magnified by factors of ∼1.2-5.5. Due to the magnification of the foreground galaxy clusters, the rest-frame UV absolute magnitudes M1600 are between −21.2 and −18.9 mag, while their intrinsic stellar masses are between 2 × 108M and 2.9 × 109M . We identify two Ly emitters in our sample from the Keck DEIMOS spectra, one at zLy = 6.76 (in RXJ 1347) and one at zLy = 6.32 (in MACS 0454). We find that 4 out of 17 z 6 galaxy candidates are favored by z 1 solutions when IRAC fluxes are included in photometric redshift fitting. We also show that IRAC 3.6-4.5 color, when combined with photometric redshift, can be used to identify galaxies which likely have strong nebular emission lines or obscured active galactic nucleus contributions within certain redshift windows.
Objective
To ascertain the incidence of massive transfusion (MT) in obstetrics in the UK, and describe its management and clinical outcomes.
Design
A population‐based cross‐sectional study conducted ...through the UK Obstetric Surveillance System (UKOSS).
Settings
All UK hospitals with consultant‐led maternity units.
Population
Any pregnant woman at ≥20 weeks of gestation receiving ≥8 units of red blood cells within 24 hours of giving birth, from July 2012 to June 2013.
Methods
Prospective case identification through the monthly mailing of UKOSS.
Results
We identified 181 women who had undergone MT, making the estimated incidence of MT associated with postpartum haemorrhage (PPH) 23 per 100 000 maternities (95% confidence interval 19–26) per year. The median estimated blood loss was 6 l (interquartile range 4.5–8.0 l). The majority of women presented outside working hours (63%), 40% had had previous caesarean sections and 3% had normal vaginal births without risk factors. The main cause for MT was uterine atony (40%) and the main mode of birth was caesarean section (69%). Of the 181 women, 15 received >20 units of red blood cells. In total, 45% of women underwent hysterectomy, and among all causes of PPH, placenta accreta had the highest hysterectomy rate. Two women died, 82% were admitted to intensive care/high‐dependency units, and 28% developed major morbidities.
Conclusion
Massive transfusion due to PPH is associated with high rates of morbidity and hysterectomy. Clinical and research efforts should focus on approaches to recognise and optimise timely resuscitation and management of these severe cases.
Tweetable
Massive transfusion due to postpartum haemorrhage is associated with high rates of morbidity and hysterectomy.
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Massive transfusion due to postpartum haemorrhage is associated with high rates of morbidity and hysterectomy.
Interest in mangrove rehabilitation has increased rapidly since 2003, as has awareness of the damaging effects of natural and anthropogenic pressures that contribute to mangrove loss, which is ...estimated at 1–2 % per annum. The major pressures are from urbanization and other development in all areas and forestry and fisheries especially where communities depend on mangroves for their livelihood. However rehabilitation success has been uncertain, reflecting gaps in integration between human and ecological components of the rehabilitation system. In particular there are government level issues of gaps and inconsistency in policy and failure in application. Some rehabilitation efforts have had limited success for several reasons including: having insufficient information, using inappropriate methods, not involving local communities, or not following all the steps in the processes that have been identified in the literature. A multi-disciplinary and integrated approach is needed to assist future planning and this needs capacity from a variety of areas in government, research and community. The review concludes with hope for a future where governments work with communities to develop policies and strategies for rehabilitating mangrove for resilience to changing environments.
Although barriers related to lesbian, gay, bisexual, transgender and queer (LGBTQ) youth's experiences accessing sexual health services have been examined in detail, research into the experiences and ...perceptions of clinicians providing these services has been conspicuously absent. The aim of this article is to explore the perceptions and experiences of clinicians providing sexual health services for LGBTQ youth. Drawing on in-depth, semi-structured interviews, this study examines 24 clinicians' experiences providing sexual health services to LGBTQ youth in five communities in British Columbia, Canada. Our findings reveal how many clinicians provide services to LGBTQ youth with a lack of cultural competency--either implicitly (e.g. by describing heteronormative practices) or explicitly (e.g. by expressing frustration that they had not been sufficiently provided with appropriate training related to LGBTQ youth sexual health). Institutional norms and values were identified as the dominant barriers in the effective provision of LGBTQ-tailored services. Many clinicians find themselves unprepared to provide culturally competent sexual health services that have both the capacity to address individual-level issues (e.g. promoting condom use) while considering (and adapting services to) the broader socio-cultural and structural conditions that can render LGBTQ youth socially vulnerable.
We have investigated the influence of mast cells on the barrier function of intestinal epithelium during nematode infection. Trichinella spiralis infection induces a strong type 2 cytokine-mediated ...inflammation, resulting in a critical mucosal mastocytosis that is known to mediate expulsion of the parasites from the intestine. The host response to infection is also characterized by an increase in mucosal leakiness. We show here that intestinal epithelial permeability is markedly elevated during infection, with kinetics that mirror the adaptive immune response to primary and secondary infection. Furthermore, we have identified degradation of the tight junction protein, occludin, thereby providing a mechanism for increased paracellular permeability during helminth infection. We further demonstrate by using anti-c-kit antibody and IL-9 transgenic mice that mast cells are directly responsible for increasing epithelial paracellular permeability and that mice deficient in a mast cell-specific protease fail to increase intestinal permeability and fail to expel their parasite burden. These results provide the mechanism whereby mucosal mast cells mediate parasite expulsion from the intestine.
Apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC) is silenced by promoter methylation in many types of tumors, yet ASC's role in most cancers remains unknown. ...Here, we show that ASC is highly expressed in a model of medulloblastoma, the most common malignant pediatric brain cancer; ASC is also expressed in human medulloblastomas. Importantly, while ASC deficiency did not affect normal cerebellar development, ASC knockout mice on the Smoothened (ND2:SmoA1) transgenic model of medulloblastoma exhibited a profound reduction in medulloblastoma incidence and a delayed tumor onset. A similar decrease in tumorigenesis with ASC deficiency was also seen in the hGFAP-Cre:SmoM2 mouse model of medulloblastoma. Interestingly, hyperproliferation of the external granule layer (EGL) was comparable at P20 in both wild-type and ASC-deficient SmoA1 mice. However, while the apoptosis and differentiation markers remained unchanged at this age, proliferation makers were decreased, and the EGL was reduced in thickness and area by P60. This reduction in proliferation with ASC deficiency was also seen in isolated SmoA1 cerebellar granule precursor cells in vitro, indicating that the effect of ASC deletion on proliferation was cell autonomous. Interestingly, ASC-deficient SmoA1 cerebella exhibited disrupted expression of genes in the transforming growth factor-β pathway and increased level of nuclear Smad3. Taken together, these results demonstrate an unexpected role for ASC in Sonic hedgehog-driven medulloblastoma tumorigenesis, thus identifying ASC as a promising novel target for antitumor therapy.
Watershed-scale management efforts to improve conservation of water resources in agricultural watersheds depend upon the effectiveness of integrated multiple agricultural best management practices ...(BMPs). To more comprehensively assess the effectiveness of combined BMPs on water quality requires large-scale, long-term (>10 year) studies measuring key water quality parameters. One such suite of critical water quality parameters includes water clarity, total suspended solids (TSS), and total dissolved solids (TDS). To address this, Beasley Lake, a 25 ha (62 ac) oxbow lake located in a 915 ha (2,261 ac) watershed of intensive row crop agricultural activity, was studied. The lake was sediment impaired when monitoring was initiated in 1995 and was a candidate to assess the effectiveness of watershed-wide BMPs on lake water clarity (as Secchi depth), TSS concentrations, and TDS. A variety of BMPs within row crop fields, at field edges throughout the watershed, and enrollment of 112 ha (277 ac) into the Conservation Reserve Program (CRP) between 1997 to 2006 focused on reducing soil erosion and concomitant sediment runoff. Selected parameters were measured approximately biweekly from 1996 to 2009. During this 14-year period, changes in row crop management and BMP implementations and alterations were observed and recorded in conjunction with targeted water quality parameters. While annual improvement in water quality occurred, distinct seasonal effects were noticeable. Observed changes in water clarity and TSS concentrations were greatest during spring and least in winter in association with increased BMPs, vegetated buffer strips west of the lake, and CRP north of the lake. Observed decreases in TDS concentrations were greatest during summer and fall in association with implemented CRP north of the lake. Reductions in spring TSS by >60% often directly increased spring water clarity by >100%. Results of this study indicate clear improvement in lake water quality with watershed-wide implementation of integrated multiple agricultural BMPs, and these improvements, manifested most strongly during spring, will assist to promote a healthy, sustainable lake ecosystem."
Faecal microbiota transplantation (FMT) is effective in the treatment of Clostridium difficile infection, where efficacy correlates with changes in microbiota diversity and composition. The effects ...of FMT on recipient microbiota in inflammatory bowel diseases (IBD) remain unclear. We assessed the effects of FMT on microbiota composition and function, mucosal immune response, and clinical outcome in patients with chronic pouchitis. Eight patients with chronic pouchitis (current PDAI ≥7) were treated with FMT via nasogastric administration. Clinical activity was assessed before and four weeks following FMT. Faecal coliform antibiotic sensitivities were analysed, and changes in pouch faecal and mucosal microbiota assessed by 16S rRNA gene pyrosequencing and (1)H NMR spectroscopy. Lamina propria dendritic cell phenotype and cytokine profiles were assessed by flow cytometric analysis and multiplex assay. Following FMT, there were variable shifts in faecal and mucosal microbiota composition and, in some patients, changes in proportional abundance of species suggestive of a "healthier" pouch microbiota. However, there were no significant FMT-induced metabolic or immunological changes, or beneficial clinical response. Given the lack of clinical response following FMT via a single nasogastric administration our results suggest that FMT/bacteriotherapy for pouchitis patients requires further optimisation.
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