Don't Just Stand There. Rethinking the Ideal Body Posture for Otorhinolaryngologists

Surgeons have a high rate of work-related musculoskeletal injuries; an area that has received little attention. These injuries result in surgeons performing less efficiently, needing to take time off work, suffering higher rates of burnout, and may ultimately lead surgeons to retire earlier than planned. Otorhinolaryngologists are at particular risk for work-related musculoskeletal injuries. Beyond the clinician, sustaining such injuries can negatively impact patient safety. Ergonomic interventions have been used effectively to reduce work-related musculoskeletal injuries in other professions, yet not in surgery. With traditional teachings of ideal body postures to avoid injury and manual handling training being re-evaluated, it is important to explore evidence based interventions for reducing work-related musculoskeletal injuries in otorhinolaryngologists. New research encourages us to shift the focus away from the traditional one-size-fits-all approach to ergonomics and toward postural recommendations and education that promote a dynamic, individualized approach to avoiding sustained, static and awkward postures.

Changes in Physical Activity and Television Viewing From Pre-pregnancy Through Postpartum Among a Socioeconomically Disadvantaged Perinatal Adolescent Population

STUDY OBJECTIVE

Adolescent pregnancy contributes to accelerated trajectories of adiposity and cardiometabolic diseases. Two potentially low-cost prevention strategies include promoting physical activity (PA) and limiting television (TV) viewing. Few studies have explored these behavior patterns in perinatal adolescents. This study sought to characterize PA and TV viewing in a socioeconomically disadvantaged perinatal adolescent population.

DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS

A cross-sectional, retrospective, 10-item survey was used to explore behavior patterns in 79 predominantly Black (86%) postpartum adolescents.

MAIN OUTCOME MEASURES

Outcomes included self-reported changes in PA from pre-pregnancy through pregnancy, and 7-day recall of PA and TV viewing in postpartum.

RESULTS

The majority of adolescents (66%) reported being active on ≥3 days/week in pre-pregnancy; however, many reported low PA (≤2 days/wk) in their first (59%), second (66%), and third (54%) trimesters. Adolescents who reported being active on ≥5 days/wk in pre-pregnancy (19%) experienced first trimester PA decline, which subsequently plateaued. This group remained the most active throughout pregnancy. In postpartum, over half (54%) of all adolescents reported low PA and irrespective of PA, spent considerable time watching TV (median = 1680.0 minutes, inerquartile range = 2940).

CONCLUSION

Interventions promoting PA coupled with reducing TV viewing during pregnancy and in postpartum may benefit perinatal adolescents. The findings from this study suggest that PA history is a predictor of gestational PA, and low PA and high TV viewing in postpartum underscore the need for behavioral intervention. Conducting a brief assessment of PA history in early gestation may offer important insight.

MRNIP is a replication fork protection factor

The remodeling of stalled replication forks to form four-way DNA junctions is an important component of the replication stress response. Nascent DNA at the regressed arms of these reversed forks is protected by RAD51 and the tumor suppressors BRCA1/2, and when this function is compromised, stalled forks undergo pathological MRE11-dependent degradation, leading to chromosomal instability. However, the mechanisms regulating MRE11 functions at reversed forks are currently unclear. Here, we identify the MRE11-binding protein MRNIP as a novel fork protection factor that directly binds to MRE11 and specifically represses its exonuclease activity. The loss of MRNIP results in impaired replication fork progression, MRE11 exonuclease-dependent degradation of reversed forks, persistence of underreplicated genomic regions, chemosensitivity, and chromosome instability. Our findings identify MRNIP as a novel regulator of MRE11 at reversed forks and provide evidence that regulation of specific MRE11 nuclease activities ensures protection of nascent DNA and thereby genome integrity.

Simulated participant methodology in paediatric surgical training: Exploring contemporary practices

Surgical training is long and complex. At the core of clinical practice is communication. Voice is central to relationships of care. Communication and other person-centred competencies are well articulated in surgical training programs. Simulated participant (SP) methodology has seen significant development over its contemporary history. Most commonly in paediatrics SPs portray the roles of parents. However, children and adolescents as SPs are increasingly employed to support the development and assessment of the complex concept of voice. There are specific considerations in all phases of SP-based work, and these are heightened for children and adolescents. This article explores contemporary SP practices in health professional education with a focus on paediatric surgery training.

On the use of multivariate statistical methods for combining in-stream monitoring data and spatial analysis to characterize water quality conditions in the White River basin, Indiana, USA

Mechanistic hydrologic and water quality models provide useful alternatives for estimating water quality in unmonitored streams. However, developing these elaborate models for large watersheds can be time-consuming and expensive, in addition to challenges that arise during calibration when there is limited spatial and/or temporal monitored in-stream water quality data. The main objective of this research was to investigate different approaches for developing multivariate analysis models as alternative methods for rapidly assessing relationships between spatio-temporal physical attributes of the watershed and water quality conditions in monitored streams, and then using the developed relationships for estimating water quality conditions in unmonitored streams. The study compares the use of various statistical estimates (mean, geometric mean, trimmed mean, and median) of monitored water quality variables to represent annual and seasonal water quality conditions. The relationship between these estimates and the spatial data is then modeled via linear and non-linear multivariate methods. Overall, the non-linear techniques for classification outperformed the linear techniques with an average cross-validation accuracy of 79.7%. Additionally, the geometric mean based models outperformed models based on other statistical indicators with an average cross-validation accuracy of 80.2%. Dividing the data into annual and quarterly datasets also offered important insights into the behavior of certain water quality variables impacted by seasonal variations. The research provides useful guidance on the use and interpretation of the various statistical estimates and statistical models for multivariate water quality analyses.

Microlinguistic deficits in the narrative discourse of adults with traumatic brain injury

BACKGROUND

Recent studies of microlinguistic impairments in the narrative discourse of adults with traumatic brain injury (TBI) have applied syntactic analyses, with some noting no deficits and others specific problems with sentence formulation. An alternative approach to examining the microlinguistic dysfunction in the discourse of individuals with TBI is through the use of propositional analysis. The advantage of propositional analysis is that it enables one to assess semantic complexity of utterances apart from sentence structure and grammaticality.

AIMS

The present study applied propositional analysis to the story narratives of participants with TBI and participants with no brain injury (NBI). Specifically, the mean number of propositions within a sentence was tallied, in other words the participants' ability to insert multiple ideas into single surface sentences. It was hypothesized that the participants with TBI would produce fewer propositions per sentence because of organizational problems than the participants with NBI, regardless of level of education.

METHODS AND PROCEDURES

Two story narratives (retelling and generation) previously elicited from the two participant groups (TBI (n = 53) and NBI (n = 42)) were analysed. For each language sample, the number of propositions was tallied and divided by the number of T-units. The resulting number, the propositional complexity index (PCI), was the average number of predicates per sentence.

OUTCOMES AND RESULTS

Results indicated that the group with TBI produced significantly fewer propositions per T-unit.

CONCLUSIONS

The present findings are in harmony with the notion that the participants with TBI studied presented with impairments of both micro- and macrolinguistic processes involved with the organization of semantic information in discourse. Clinical implications are discussed.

The effect of creosote on vitellogenin production in rainbow trout (Oncorhynchus mykiss)

As part of a broader investigation into the effects of creosote treatments on the aquatic biota in pond microcosms, we examined the possible implications for vitellogenin (Vtg) production in Oncorhynchus mykiss [rainbow trout (RT)]. Vtg is the precursor of egg yolk protein and has emerged as a useful biomarker of exposure to estrogenic substances. Our a priori intent was to assess the ability of the creosote treatments (nominal cresoste concentrations were 0, 3, and 10 microl/L immediately after the last subsurface addition) to induce estrogenic responses in RT. The data showed no evidence of an estrogenic response in the treated fish. During the course of the experiment, however, the fish matured and began to produce Vtg, probably in response to endogenous estrogen. A posteriori analysis of the Vtg data from the maturing fish showed that after 28 days, the plasma Vtg concentrations were about 15-fold lower in fish from the creosote-treated microcosms compared with fish from the reference microcosm. Although the experiment design does not permit mechanistic insights, our observation suggests that exposure of female fish to PAH mixtures such as creosote can impair the production of Vtg with possible health implications for embryos and larvae.

An ELISA for brown trout (Salmo trutta) vitellogenin and its use in bioassays for environmental estrogens

An enzyme linked immunosorbent assay (ELISA) was developed for the detection of the egg yolk precursor vitellogenin (Vg) in plasma of brown trout (Salmo trutta). Purified Vg from a 17 beta-estradiol-induced trout was used as the competing antigen in the ELISA which is based on polyclonal antibodies. The ELISA's performance was optimized and characterized. The assay's working range was (25-500 ng ml-1), its sensitivity was (10.5 ng ml-1), and it had an intra-assay coefficient of variation of less than 10% between 30 and 1000 ng ml-1. The ELISA was used in bioassays for the detection of environmental estrogens, including estrogen mimics, in whole and fractionated industrial waste waters. Those bioassays were based on intraperitoneal (i.p.) injection-, static renewal-, and flow through exposure systems. The response threshold of both bioassays is limited to 1-2 micrograms ml-1 Vg by a low level plasma interference that was regularly detected in plasma from non-induced male fish. The responsiveness of the bioassays was characterized using progressive doses of 17 beta-estradiol. The i.p.-based assay, which was responsive to at least 100 micrograms kg-1 of 17 beta-estradiol, was used to screen extracts of pulp mill effluent and black liquor for estrogenic effects. Neither extract induced Vg in our assay. The i.p. assay was also used to test 4-tert-octylphenol (OP) and the PAH derivative, retene, for estrogenic activity. OP induced Vg in the i.p.-exposed fish; no Vg induction was detected in the retene-exposed fish. The static renewal bioassay, which was responsive to at least 0.1 microgram ml-1 of 17 beta-estradiol over a 15-day exposure period, was used to screen whole pulp mill effluents for estrogenic effects. No Vg induction was detected in the effluent-treated fish.

A comparison of two methods for the computer analysis of arterial blood pressure waveforms

Two different methods, one analogue and one digital, for the analysis of the arterial blood pressure waveform are described and compared. Little difference was found in the systolic and diastrlic pressures determined by the two methods.

Psychiatry in the public health framework

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