Evaluating Note Frequency and Velocity During Improvised Active Music Therapy in Clients With Parkinson's Disease

The purpose of this article was to report on the findings of the note frequency and velocity measures during Improvised Active Music Therapy (IAMT) sessions with individuals with Parkinson's disease (PD). In this single-subject multiple baseline design across subjects, the article reports the note frequency (note count) and velocity of movement (mean note velocity) played by three right-handed participants while playing uninterrupted improvised music on a simplified electronic drum-set. During baseline, the music therapist played rhythmic accompaniment on guitar using a low-moderate density of syncopation. During treatment, the Music Therapist introduced rhythms with a moderate-high density of syncopation. The music content of the sessions was transformed into digital music using a musical instrument digital interface. Results of this study indicated that all participants exhibited an increase in note count during baseline until reaching a plateau at treatment condition and were found to be significantly positively correlated with the Music Therapist's note count. All participants played more notes with upper extremity (UE) across conditions than with lower extremity. All participants also scored similar total mean velocity across conditions. Two participants demonstrated higher mean note velocity with UE than right foot, whereas the other participant did not demonstrate this difference. Two participants also exhibited greater mean note velocity variability with left foot within and across conditions. More research is required to identify commonalities in note count and mean note velocity measures in individuals with PD during IAMT sessions.

The effect of first-time 4-wheeled walker use on the gait of younger and older adults

INTRODUCTION

The 4-wheeled walker is intended to enhance balance and gait for older adults. Yet, some research suggests that walking aids increase falls risk. An understanding of the influence of age with walker use on gait performance is required.

OBJECTIVE

To examine the effect of initial 4-wheeled walker use on spatiotemporal gait parameters between younger and older adults.

DESIGN

Cross-sectional, repeated-measures.

SETTING

Community-dwelling.

PARTICIPANTS

Twenty-five younger (age: 26.5 ± 4.1 years) and 24 older (age: 68.5 ± 10.5 years) adults participated. Younger adults were aged 18 to 35 years, whereas older adults were 50 years or older. Included were people not requiring the use of a walking aid, and those able to converse in English.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE(S)

Gait velocity and stride time variability were recorded using accelerometers. Gait was examined under three conditions: unassisted walking; walking with a 4-wheeled walker; and walking with a 4-wheeled walker while completing a secondary task. Conditions were performed across two walking paths: straight and figure-of-8 Walk Test. Separate mixed-methods analyses of variance (ANOVAs; within-subject: condition/path; between-subject: group) were used for statistical analyses.

RESULTS

Velocity was lower when walking using a walker while completing a cognitive task (p < .001), in the figure-of-8 Walk Test (p < .001), and in older adults (p = .001). Stride time variability increased with walking path and condition difficulty (p < .001) for the straight path versus the figure-of-8 Walk Test.

CONCLUSIONS

Using a 4-wheeled walker resulted in a slower and more inconsistent gait pattern across both age groups. Walking more complex configurations resulted in the prioritization of gait over the cognitive task while performing the dual-task conditions. No evidence of an age-related difference in the effect of initial walker use on gait was observed. Nonetheless, walkers are cognitively demanding and their introduction should warrant a clinical follow-up.

Gait in younger and older adults during rhythmic auditory stimulation is influenced by groove, familiarity, beat perception, and synchronization demands

Music-based Rhythmic auditory stimulation (RAS) is a cueing intervention used to regulate gait impairments in conditions such as Parkinson's disease or stroke. Desire to move with music ('groove') and familiarity have been shown to impact younger adult gait while walking with music, and these effects appear to be influenced by individual rhythmic ability. Importantly, these factors have not been examined in older adults. The aim of this study was to determine how gait outcomes during RAS are influenced by musical properties (familiarity, 'groove') in both free and synchronized walking for younger and older adults with good and poor beat perception ability. To do this, participants were randomized to either free or synchronized walking groups. Each participant's gait was assessed on a pressure sensitive walkway during high versus low groove and high versus low familiarity music, as well as metronome, cueing trials. Individual beat perception ability was evaluated using the Beat Alignment Test. Results showed that the effects of synchronization and groove were mostly consistent across age groups. High groove music elicited faster gait in both age groups, with longer strides only among young adults, than low groove music; synchronizing maximized these effects. Older adults with poor beat perception were more negatively affected by unfamiliar stimuli while walking than younger adults. This suggests that older adults, like younger adults, may benefit from synchronized RAS to high groove cues but may be more vulnerable to cognitive demands associated with walking to unfamiliar stimuli. This should be accounted for in clinical implementations of RAS.

Young drivers' determinants of driving under the influence of cannabis: Findings from the Youth Cannabis and Driving Survey (YouCanDS)

INTRODUCTION

Driving under the influence of cannabis (DUIC) is proven to increase the risk of collisions and is most common among young drivers (ages 16 to 24). However, little is known about the specific determinants of DUIC behavior among youth, which limits the capacity to develop evidence-based prevention and intervention efforts. This study developed and evaluated a youth DUIC questionnaire, which was used to establish the DUIC determinants of young drivers.

METHOD

The questionnaire was based on the theoretical framework of general deterrence and general prevention. Data obtained included: demographics, past cannabis use and DUIC experiences, DUIC intention, experiences riding as a passenger with someone DUIC, knowledge and credibility of the law, attitudes towards DUIC, and social controls. The resulting questionnaire was validated for a sample of 426 young drivers in the province of Ontario, Canada. An ordinal regression was conducted to examine the relationships between questionnaire items and DUIC intention.

RESULTS

The questionnaire displayed good construct validity and internal consistency across four out of five domains (KMO and Cronbach α values ≥ 0.70). Of the 426 respondents (52.6% female), 356 (83.6%) reported previous cannabis use, with 296 (69.5%) doing so in the past year, and 142 (33.3%) reporting DUIC. Furthermore, 179 (42%) study participants indicated at least a slight chance of DUIC in the next year. The regression analysis identified six variables predictive of DUIC intention: past DUIC incidence, perceived percent of those convicted that receive the penalty, moral awareness, perceived dangerousness, minor accident risk, and vicarious punishment avoidance.

CONCLUSIONS

Preventive efforts should emphasize these determinants when designing targeted strategies and interventions. Practical Applications: These efforts should focus on educating the dangers and risk of a vehicle collision, that law enforcement has the capacity to apprehend and appropriately punish individuals DUIC, and that DUIC is wrong and socially unacceptable.

Improvised active music therapy for clients with Parkinson’s disease: A feasibility study

The purpose of this study was to test the feasibility of delivering Improvised Active Music Therapy sessions in measuring the impact of acquisition of rhythmic complexity levels on gait performance in individuals with Parkinson’s disease. In this single subject multiple baseline design, the study measured the ability of three right-handed participants with Parkinson’s disease to acquire greater density of syncopation, as a measure of rhythmic complexity levels, while playing uninterrupted improvised music on a simplified electronic drum-set. The music content of the sessions was transformed into digital music data in real-time using Musical Instrument Digital Interface. The Musical Instrument Digital Interface data were analyzed to determine the participants’ and the Music Therapist’s density of syncopation (on acoustic guitar) during baseline and treatment conditions. Results from visual analyses and Pearson’s correlations on the outcomes indicated conflicting and inconclusive outcomes about whether higher acquisition of rhythmic complexity levels improves gait performance in individuals with Parkinson’s disease. Despite this, evidence was found to support the overall value of Improvised Active Music Therapy sessions on gait performance. The study design, the intervention, and outcome measures were found to be feasible and could be scaled-up into a larger trial.

The Differential Effect of First-Time Single-Point Cane Use between Healthy Young and Older Adults

BACKGROUND

Walking aids are often introduced to older adults to enable independent mobility. Single-point canes are the most common device used. Benefits are tempered by research suggesting that walking aids increase fall risk. A better understanding of the effect of walking aid use on gait performance is required.

OBJECTIVE

To evaluate differences in the effect of initial single-point cane use on gait between younger (YAs) and older adults (OAs).

DESIGN

Cross-sectional.

SETTING

Community-dwelling.

PARTICIPANTS

Twenty-six YAs (mean age ± standard deviation [SD]: 23.7 ± 2.8 years) and 25 OAs (mean age ± SD: 70.8 ± 14.1 years) participated. Inclusion criteria were 18 to 35 years of age for YAs or ≥50 years for OAs, be able to ambulate unassisted, and without any condition affecting mobility.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE(S)

Gait velocity and stride time variability under different walking path configurations (straight path, Groningen Meander Walking Test, Figure-of-8 Walk Test) and conditions (unassisted walking, walking with a single-point cane, and walking with a single-point cane while completing a cognitive task) were recorded in a laboratory. The arithmetic task of subtracting 1s from 100 was used as the secondary cognitive task. Data analysis included separate three-way mixed analyses of variance (ANOVAs; path/condition/group).

RESULTS

There was a statistically significant two-way interaction between walking path and condition for velocity (P < .001, ω²  = 0.03) and stride time variability (P = .032, ω²  = 0.02). In addition, a significant main effect of group was also observed (velocity: P = .004, ω²  = 0.07; stride time variability: P = .001, ω²  = 0.09).

CONCLUSIONS

Using a single-point cane decreased velocity and increased stride time variability in both YAs and OAs. However, the cognitive load and effect on gait of initial cane use was not different between age groups. Standardized guidelines aimed at facilitating a client's transition toward the safe use of a walking aid are needed. Future research should evaluate if training can mitigate some of the adverse changes to gait stability observed with initial walking aid use.

Effect of Learning to Use a Mobility Aid on Gait and Cognitive Demands in People with Mild to Moderate Alzheimer's Disease: Part II - 4-Wheeled Walker

BACKGROUND

Cognitive deficits and gait problems are common and progressive in Alzheimer's disease (AD). Prescription of a 4-wheeled walker is a common intervention to improve stability and independence, yet can be associated with an increased falls risk.

OBJECTIVES

1) To examine changes in spatial-temporal gait parameters while using a 4-wheeled walker under different walking conditions, and 2) to determine the cognitive and gait task costs of walking with the aid in adults with AD and healthy older adults.

METHODS

Twenty participants with AD (age 79.1±7.1 years) and 22 controls (age 68.5±10.7 years) walked using a 4-wheeled walker in a straight (6 m) and Figure of 8 path under three task conditions: single-task (no aid), dual-task (walking with aid), and multi-task (walking with aid while counting backwards by ones).

RESULTS

Gait velocity was statistically slower in adults with AD than the controls across all conditions (all p values <0.025). Stride time variability was significantly different between groups for straight path single task (p = 0.045), straight path multi-task (p = 0.031), and Figure of 8 multi-task (0.036). Gait and cognitive task costs increased while multi-tasking, with performance decrement greater for people with AD. None of the people with AD self-prioritized gait over the cognitive task while walking in a straight path, yet 75% were able to shift prioritization to gait in the complex walking path.

CONCLUSION

Learning to use a 4-wheeled walker is cognitively demanding and any additional tasks increases the demands, further adversely affecting gait. The increased cognitive demands result in a decrease in gait velocity that is greatest in adults with AD. Future research needs to investigate the effects of mobility aid training on gait performance.

Executive function as a mediating factor between visual acuity and postural stability in cognitively healthy adults and adults with Alzheimer's dementia

BACKGROUND

Falls in older adults, notably those with Alzheimer's dementia (AD), are prevalent. Vision and balance impairments are prominent falls risk factors in older adults. However, recent literature in the cognitively impaired suggests that executive function (EF) is important for falls risk assessments. The study objectives were to: 1) to compare balance among people with AD, healthy older adults (OA), and healthy young adults (YA) and 2) to quantify the interaction of visual acuity and EF on postural stability.

METHODS

We recruited 165 individuals (51 YA, 48 OA, and 66 AD). Trail Making Tests (A and B) quantified EF and the Colenbrander mixed contrast chart measured high and low contrast visual acuity. Accelerometers recorded postural sway during the Modified Test for Sensory Integration. A two-way repeated measures ANOVA examined postural sway differences across groups. Mediation analysis quantified the association of EF in the relationship between contrast sensitivity and postural sway.

RESULTS

Significant EF and visual acuity between-group differences were observed (p < 0.001). For postural sway, a significant interaction existed between group and balance condition (p < 0.001). In general, EF was a significant mediator between visual acuity and postural sway. Visual acuity, EF and postural sway was worse with increased age, particularly in the AD group.

CONCLUSIONS

Mediation analysis revealed that individuals with poorer visual acuity had poorer EF, and those with poorer executive function had poorer balance control. These results highlight the importance of assessing not only vision and balance but also EF, especially in older individuals living with AD.

Effect of dual-tasking on walking and cognitive demands in adults with Alzheimer's dementia experienced in using a 4-wheeled walker

BACKGROUND

Learning to walk with a 4-wheeled walker increases cognitive demands in people with Alzheimer's dementia (AD). However, it is expected that experience will offset the increased cognitive demand. Current research has not yet evaluated gait in people with AD experienced in using a 4-wheeled walker under complex gait situations.

RESEARCH QUESTION

What is the effect of dual-task testing on the spatial-temporal gait parameters and cognitive performance of people with AD experienced with a 4-wheeled walker?

METHODS

Twenty-three adults with mild to moderate AD (87.4 ± 6.2 years, 48 % female) and at least 6 months of walker use experience participated. Three walking configurations: 1) straight path (SP), 2) Groningen Meander Walking Test (GMWT), and 3) Figure of 8 path (F8) were tested under two walking conditions: 1) single-task (walking with aid) and 2) dual-task (walking with aid and completing a cognitive task). Tri-axial accelerometers collected velocity, cadence and stride time variability (STV). Gait and cognitive task cost were the percentage difference between single-task and dual-task conditions. Two-way repeated measures ANOVAs were used to answer the study question.

RESULTS

A significant interaction between walking configuration and condition was found for velocity (p = 0.002, ω² = 0.36), cadence (p = 0.04, ω² = 0.15) and STV (p < 0.001, ω² = 0.53). Velocity and cadence decreased and STV increased with increasing walking configuration complexity and upon dual-tasking. Dual-task gait and cognitive task cost deteriorated in all walking configurations, but gait was prioritized in the GMWT and F8 configurations. Despite familiarity, experienced walker users with AD exhibit impaired gait when walking in complex situations which increases falls risk. Upon dual-task, individuals with AD self-prioritized a posture-first strategy in complex configurations.

SIGNIFICANCE

Dual-task testing in experienced users results in slower walking, fewer steps and increased STV, which increases falls risk in people with mild to moderate AD and becomes most pronounced in complex environments.

Resonance assisted jump-in voltage reduction for electrostatically actuated nanobeam-based gateless NEM switches

Electrostatically actuated nanobeam-based electromechanical switches have shown promise for versatile novel applications, such as low power devices. However, their widespread use is restricted due to poor reliability resulting from high jump-in voltages. This article reports a new method for lowering the jump-in voltage by inducing mechanical oscillations in the active element during the switching ON process, reducing the jump-in voltage by more than three times. Ge_0.91Sn_0.09 alloy and Bi₂Se₃ nanowire-based nanoelectromechanical switches were constructed in situ to demonstrate the operation principles and advantages of the proposed method.

Beat perception ability and instructions to synchronize influence gait when walking to music-based auditory cues

Synchronizing gait to music-based auditory cues (rhythmic auditory stimulation) is a strategy used to manage gait impairments in a variety of neurological conditions, including Parkinson's disease. However, knowledge of how to individually optimize music-based cues is limited. The purpose of this study was to investigate how instructions to synchronize with auditory cues influences gait outcomes among healthy young adults with either good or poor beat perception ability. 65 healthy adults walked to metronome and musical stimuli with high and low levels of perceived groove (how much it induces desire to move) and familiarity at a tempo equivalent to their self-selected walking pace. Participants were randomized to instruction conditions: (i) synchronized: match footsteps with the beat, or (ii) free-walking: walk comfortably. Participants were classified as good or poor beat perceivers using the Beat Alignment Test. In this study, poor beat perceivers show better balance-related parameters (stride width and double-limb support time) when they are not instructed to synchronize their gait with cues (versus when synchronization was required). Good beat perceivers, in contrast, were better when instructed to synchronize gait (versus when no synchronization was required). Changes in stride length and velocity were influenced by musical properties, in particular the perceived 'groove' (greater stride length and velocity with high- versus low-groove cues) and, in some cases, this interacted with beat perception ability. The results indicate that beat perception ability and instructions to synchronize indeed influence spatiotemporal gait parameters when walking to music- and metronome-based rhythmic auditory stimuli. Importantly, these results suggest that both low groove cues and instructing poor beat perceivers to synchronize may interfere with performance while walking, thus potentially impacting both empirical and clinical outcomes.

Understanding Parkinson’s through visual narratives: “I’m not Mrs. Parkinson’s”

Introduction

Although it is accepted that individuals with Parkinson’s disease must navigate challenges such as receiving their diagnosis and changing daily occupations, little is known about how they navigate. The purpose of this study is to deepen the current understanding of the experience of living with Parkinson’s disease and its implications for occupation through a narrative visual methodology (photo-elicitation).

Method

Six individuals with Parkinson’s disease were asked to take photographs and share verbal narrative accounts to illustrate their experience of living with Parkinson’s disease.

Findings

Results highlight the interrelationship between occupation and identity, as many of the participants’ stories were interpreted as foregrounding the negotiation of occupation, and how such negotiation shaped their sense of identity. Overall, three major themes were identified: (1) Framing the meaning of Parkinson’s disease (accepting the disease as part of who they were); (2) Negotiating engagement in occupation (ongoing deliberation over whether to continue engaging in certain aspects of life as Parkinson’s disease progressed); and (3) Being ready to accept changes that impact personal or social identity (readiness to accept help and to identify as someone with Parkinson’s disease).

Conclusion

Attending to insights regarding the lived experience of Parkinson’s disease will enhance quality of care through informing an enriched client-centered, occupation-based approach.

Assessment of Caregiving Constructs: Toward a Personal, Familial, Group, and Cultural Construction of Dementia Care through the Eyes of Personal Construct Psychology

Conditions that cause cognitive impairment and behavioural and personality changes, such as Alzheimer's disease (AD) and related dementia, have global impact across cultures. However, the experience of dementia care can vary between individuals, families, formal caregivers, and social groups from various cultures. Self-reported measures, caregiving stress models, and conceptual theories have been developed to address the physical, financial, psychological, and social factors associated with the experience of dementia care. Given the cross-cultural variability in the experience of dementia care, it is important for such methodologies to take individual and cultural construct systems into account. We contend that personal and group constructs associated with dementia care should be explored in both the formal and informal caregiving contexts. Therefore, in this paper we introduce the theory of Personal Construct Psychology (PCP) with its explicit philosophy, well-elaborated theory, and derived assessment methods as a potential constructivist research approach to examine the personal, familial, group, and cultural construct systems that determine the experience of dementia caregiving. These concepts and assessment procedures are illustrated in this paper through case study examples and scenarios from the context of dementia care with a focus on family home caregivers. This paper elaborates the assessment and therapeutic approaches of personal construct theory (PCT) to further expand alternatives for support services and program interventions and to amplify policies for dementia care within and across cultures.

Clinical Presentation of Anxiety in Parkinson's Disease: A Scoping Review

Up to 40% of all individuals with Parkinson's disease (PD) are estimated to experience anxiety that interferes with daily functioning. This article describes research regarding the presentation of anxiety in PD and the influence anxiety has on participation in this population. A scoping review identified 1,635 articles, of which 49 met the inclusion criteria. This review identified that anxiety in PD is often associated with a range of clinical correlates related to demographic and clinical characteristics (age, gender, disease stage, duration, progression), motor symptoms (tremor, bradykinesia, dystonia, freezing of gait, symptom severity), treatment-related complications (on/off fluctuations, on with dyskinesia, unpredictable off), and non-motor symptoms (sleep abnormalities, fatigue, cognitive impairment, depression). These findings can be used to increase clinicians' awareness toward the specific clinical correlates linked to anxiety in PD so that mental health concerns can be detected and addressed more readily in practice.

Correction: Site controlled red-yellow-green light emitting InGaN quantum discs on nano-tipped GaN rods

Correction for 'Site controlled red-yellow-green light emitting InGaN quantum discs on nano-tipped GaN rods' by M. Conroy et al., Nanoscale, 2016, 8, 11019-11026.

Site controlled red-yellow-green light emitting InGaN quantum discs on nano-tipped GaN rods

We report a method of growing site controlled InGaN multiple quantum discs (QDs) at uniform wafer scale on coalescence free ultra-high density (>80%) nanorod templates by metal organic chemical vapour deposition (MOCVD). The dislocation and coalescence free nature of the GaN space filling nanorod arrays eliminates the well-known emission problems seen in InGaN based visible light sources that these types of crystallographic defects cause. Correlative scanning transmission electron microscopy (STEM), energy-dispersive X-ray (EDX) mapping and cathodoluminescence (CL) hyperspectral imaging illustrates the controlled site selection of the red, yellow and green (RYG) emission at these nano tips. This article reveals that the nanorod tips' broad emission in the RYG visible range is in fact achieved by manipulating the InGaN QD's confinement dimensions, rather than significantly increasing the In%. This article details the easily controlled method of manipulating the QDs dimensions producing high crystal quality InGaN without complicated growth conditions needed for strain relaxation and alloy compositional changes seen for bulk planar GaN templates.

Toward a Mixed-Methods Research Approach to Content Analysis in The Digital Age: The Combined Content-Analysis Model and its Applications to Health Care Twitter Feeds

Background

Twitter’s 140-character microblog posts are increasingly used to access information and facilitate discussions among health care professionals and between patients with chronic conditions and their caregivers. Recently, efforts have emerged to investigate the content of health care-related posts on Twitter. This marks a new area for researchers to investigate and apply content analysis (CA). In current infodemiology, infoveillance and digital disease detection research initiatives, quantitative and qualitative Twitter data are often combined, and there are no clear guidelines for researchers to follow when collecting and evaluating Twitter-driven content.

Objective

The aim of this study was to identify studies on health care and social media that used Twitter feeds as a primary data source and CA as an analysis technique. We evaluated the resulting 18 studies based on a narrative review of previous methodological studies and textbooks to determine the criteria and main features of quantitative and qualitative CA. We then used the key features of CA and mixed-methods research designs to propose the combined content-analysis (CCA) model as a solid research framework for designing, conducting, and evaluating investigations of Twitter-driven content.

Methods

We conducted a PubMed search to collect studies published between 2010 and 2014 that used CA to analyze health care-related tweets. The PubMed search and reference list checks of selected papers identified 21 papers. We excluded 3 papers and further analyzed 18.

Results

Results suggest that the methods used in these studies were not purely quantitative or qualitative, and the mixed-methods design was not explicitly chosen for data collection and analysis. A solid research framework is needed for researchers who intend to analyze Twitter data through the use of CA.

Conclusions

We propose the CCA model as a useful framework that provides a straightforward approach to guide Twitter-driven studies and that adds rigor to health care social media investigations. We provide suggestions for the use of the CCA model in elder care-related contexts.

Synthesis and catalytic properties of highly branched palladium nanostructures using seeded growth

In order to develop nanocatalysts with enhanced catalytic performance, it is important to be able to synthesize nanocrystals enclosed by high-index surface facets, due to their high density of low coordinated atoms at step, ledge and kink sites. Here, we report a facile seed-mediated route to the synthesis of highly branched Pd nanostructures with a combination of {113}, {115} and {220} high-index surface planes. The size of these nanostructures is readily controlled by a simple manipulation of the seed concentration. The selective use of oleylamine and oleic acid was also found to be critical to the synthesis of these structures, with Pd icosahedra enclosed by low-index {111} facets being produced when hexadecylamine was employed as capping ligand. The structure-property relationship of these nanostructures as catalysts in Suzuki-cross coupling reactions was then investigated and compared, with the high-index faceted branched Pd nanostructures found to be the most effective catalysts.

Clinical Assessments as Predictors of Primary On-Road Outcomes in Parkinson's Disease

Parkinson's disease (PD) is a neurodegenerative disorder that affects fitness to drive. Research that has examined clinical predictors of fitness to drive in PD, using the on-road assessment as the gold standard, has generally used a dichotomous pass/fail decision. However, on-road assessments may also result in one of two additional outcomes (pass with recommendations, or fail-remediable). Individuals within these subgroups may benefit from interventions to improve their fitness to drive abilities. This study investigated clinical predictors that could be indicative of the pass, pass with recommendations, or fail-remediable categories for drivers with PD (N = 99). Trails B, Left Finger to Nose Test, and contrast sensitivity measures were identified as significant predictors for the pass, and pass with recommendations subgroups. No significant predictors were identified for the fail-remediable subgroup. Results from this study provide a foundation for clinicians to identify drivers who can benefit from recommendations to preserve their driving abilities.

Electric current induced modification of germanium nanowire NEM switch contact

We present an investigation of contact properties of a germanium (Ge) nanowire based nanoelectromechanical (NEM) switch in its ON state. The contact stiffness in the ON state was evaluated by detecting the nanowire's resonance frequency. It was found that the resonance frequency increases when electric current flows through the nanowire/counter electrode contact area. The reason for modification in the contact area is referred to as electric-current-induced processes in the native oxide layer covering the nanowires. The presented resonance shift method is a simple way to indicate strengthening of the nanowire/counter electrode contact area without disassembling the contact.

The Sport Concussion Education Project. A brief report on an educational initiative: from concept to curriculum

Current research on concussion is primarily focused on injury identification and treatment. Prevention initiatives are, however, important for reducing the incidence of brain injury. This report examines the development and implementation of an interactive electronic teaching program (an e-module) that is designed specifically for concussion education within an adolescent population. This learning tool and the accompanying consolidation rubric demonstrate that significant engagement occurs in addition to the knowledge gained among participants when it is used in a school curriculum setting.

Hockey Concussion Education Project, Part 2. Microstructural white matter alterations in acutely concussed ice hockey players: a longitudinal free-water MRI study

OBJECT

Concussion is a common injury in ice hockey and a health problem for the general population. Traumatic axonal injury has been associated with concussions (also referred to as mild traumatic brain injuries), yet the pathological course that leads from injury to recovery or to long-term sequelae is still not known. This study investigated the longitudinal course of concussion by comparing diffusion MRI (dMRI) scans of the brains of ice hockey players before and after a concussion.

METHODS

The 2011-2012 Hockey Concussion Education Project followed 45 university-level ice hockey players (both male and female) during a single Canadian Interuniversity Sports season. Of these, 38 players had usable dMRI scans obtained in the preseason. During the season, 11 players suffered a concussion, and 7 of these 11 players had usable dMRI scans that were taken within 72 hours of injury. To analyze the data, the authors performed free-water imaging, which reflects an increase in specificity over other dMRI analysis methods by identifying alterations that occur in the extracellular space compared with those that occur in proximity to cellular tissue in the white matter. They used an individualized approach to identify alterations that are spatially heterogeneous, as is expected in concussions.

RESULTS

Paired comparison of the concussed players before and after injury revealed a statistically significant (p < 0.05) common pattern of reduced free-water volume and reduced axial and radial diffusivities following elimination of free-water. These free-water-corrected measures are less affected by partial volumes containing extracellular water and are therefore more specific to processes that occur within the brain tissue. Fractional anisotropy was significantly increased, but this change was no longer significant following the free-water elimination.

CONCLUSIONS

Concussion during ice hockey games results in microstructural alterations that are detectable using dMRI. The alterations that the authors found suggest decreased extracellular space and decreased diffusivities in white matter tissue. This finding might be explained by swelling and/or by increased cellularity of glia cells. Even though these findings in and of themselves cannot determine whether the observed microstructural alterations are related to long-term pathology or persistent symptoms, they are important nonetheless because they establish a clearer picture of how the brain responds to concussion.

Hockey Concussion Education Project, Part 1. Susceptibility-weighted imaging study in male and female ice hockey players over a single season

OBJECT

Concussion, or mild traumatic brain injury (mTBI), is a commonly occurring sports-related injury, especially in contact sports such as hockey. Cerebral microbleeds (CMBs), which appear as small, hypointense lesions on T₂*-weighted images, can result from TBI. The authors use susceptibility-weighted imaging (SWI) to automatically detect small hypointensities that may be subtle signs of chronic and acute damage due to both subconcussive and concussive injury. The goal was to investigate how the burden of these hypointensities changes over time, over a playing season, and postconcussion, in comparison with subjects who did not suffer a medically observed and diagnosed concussion.

METHODS

Images were obtained in 45 university-level adult male and female ice hockey players before and after a single Canadian Interuniversity Sports season. In addition, 11 subjects (5 men and 6 women) underwent imaging at 72 hours, 2 weeks, and 2 months after concussion. To identify subtle changes in brain tissue and potential CMBs, nonvessel clusters of hypointensities on SWI were automatically identified, and a hypointensity burden index was calculated for all subjects at the beginning of the season (BOS), the end of the season (EOS), and at postconcussion time points (where applicable).

RESULTS

A statistically significant increase in the hypointensity burden, relative to the BOS, was observed for male subjects with concussions at the 2-week postconcussion time point. A smaller, nonsignificant rise in the burden for female subjects with concussions was also observed within the same time period. There were no significant changes in burden for nonconcussed subjects of either sex between the BOS and EOS time points. However, there was a statistically significant difference in the burden between male and female subjects in the nonconcussed group at both the BOS and EOS time points, with males having a higher burden.

CONCLUSIONS

This method extends the utility of SWI from the enhancement and detection of larger (> 5 mm) CMBs, which are often observed in more severe cases of TBI, to cases involving smaller lesions in which visual detection of injury is difficult. The hypointensity burden metric proposed here shows statistically significant changes over time in the male subjects. A smaller, nonsignificant increase in the burden metric was observed in the female subjects.

Hockey Concussion Education Project, Part 3. White matter microstructure in ice hockey players with a history of concussion: a diffusion tensor imaging study

OBJECT

The aim of this study was to examine the brain's white matter microstructure by using MR diffusion tensor imaging (DTI) in ice hockey players with a history of clinically symptomatic concussion compared with players without a history of concussion.

METHODS

Sixteen players with a history of concussion (concussed group; mean age 21.7 ± 1.5 years; 6 female) and 18 players without a history of concussion (nonconcussed group; mean age 21.3 ± 1.8 years, 10 female) underwent 3-T DTI at the end of the 2011-2012 Canadian Interuniversity Sports ice hockey season. Tract-based spatial statistics (TBSS) was used to test for group differences in fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and the measure "trace," or mean diffusivity. Cognitive evaluation was performed using the Immediate Postconcussion Assessment and Cognitive Test (ImPACT) and the Sport Concussion Assessment Tool-2 (SCAT2).

RESULTS

TBSS revealed a significant increase in FA and AD, and a significant decrease in RD and trace in several brain regions in the concussed group, compared with the nonconcussed group (p < 0.05). The regions with increased FA and decreased RD and trace included the right posterior limb of the internal capsule, the right corona radiata, and the right temporal lobe. Increased AD was observed in a small area in the left corona radiata. The DTI measures correlated with neither the ImPACT nor the SCAT2 scores.

CONCLUSIONS

The results of the current study indicate that a history of concussion may result in alterations of the brain's white matter microstructure in ice hockey players. Increased FA based on decreased RD may reflect neuroinflammatory or neuroplastic processes of the brain responding to brain trauma. Future studies are needed that include a longitudinal analysis of the brain's structure and function following a concussion to elucidate further the complex time course of DTI changes and their clinical meaning.

Physical activity among preschoolers during indoor and outdoor childcare play periods

Preschoolers' (n = 31) physical activity (PA) levels during indoor and outdoor childcare hours were explored using accelerometers. Participants engaged in 0.54 min/h (SD = 0.59) of moderate-to-vigorous PA (MVPA) and 14.42 min/h (SD = 6.78) of total PA (TPA) indoors compared with 5.03 min/h (SD = 4.92) of MVPA and 31.68 min/h (SD = 0.83) of TPA outdoors. Boys and girls engaged in significantly more TPA outdoors; however, only boys demonstrated a significant increase in MVPA outdoors.

Validity of the Nintendo Wii® balance board for the assessment of standing balance in Parkinson’s disease

Background:

Impaired postural stability places individuals with Parkinson’s at an increased risk for falls. Given the high incidence of fall-related injuries within this population, ongoing assessment of postural stability is important.

Objective:

To evaluate the validity of the Nintendo Wii® balance board as a measurement tool for the assessment of postural stability in individuals with Parkinson’s.

Subjects:

Twenty individuals with Parkinson’s participated.

Intervention:

Subjects completed testing on two balance tasks with eyes open and closed on a Wii® balance board and biomechanical force platform.

Main Measures:

Bland–Altman plots and a two-way, random-effects, single measure intraclass correlation coefficient model were used to assess concurrent validity of centre-of-pressure data.

Results:

Concurrent validity was demonstrated to be excellent across balance tasks (intraclass correlation coefficients = 0.96, 0.98, 0.92, 0.94).

Conclusions:

This study suggests that the Wii® balance board is a valid tool for the quantification of postural stability among individuals with Parkinson’s.

The effects of word length, articulation, oral-motor movement, and lexicality on gait: a pilot study

Previous research has suggested that articulatory demands are important predictors of the impact of dual-task interference on spatial-temporal parameters of gait. In this study, we evaluated the effects of word length, oral-motor movement, articulation, and lexicality, within a verbal task, on a continuous gait task. Fifteen healthy young women participated in a study in which two word lengths (monosyllabic and bisyllabic) were crossed with four levels of secondary task complexity (no dual-task, non-speech movement, spoken non-word, and spoken word). Spatial and temporal parameters of gait were measured using a 23' instrumented carpet. Results indicated a significant multivariate main effect for task type, F(15, 120)=3.07, that explained 71.1% of the demonstrated variability in gait. Univariate analyses of this main effect revealed statistically significant effects for velocity, step time, swing time, and stance time, but no statistically significant effect for step length. Post hoc analyses suggested that dual-task interference produced significant changes in the parameters of gait, but that this interference was not significantly greater with non-words as compared to the non-speech movement condition, nor was it significantly greater with words as compared to non-words. The results of this systematic deconstruction of a simple verbal task suggest that the motor component of a secondary speech task may produce the largest amount of interference within a dual-task interference paradigm.

Application of serial sectioning FIB/SEM tomography in the comprehensive analysis of arrays of metal nanotubes

The ever-increasing interest in nanostructured materials and shrinking dimensions of state-of-the-art devices pose new challenges both in synthesis and metrology. Although an extensive range of nanotubular materials of different compositions and for various applications are reported in the literature, often detailed structural characterisation of these materials is limited. This is due to the fact that techniques and characterisation protocols for structural analysis of 'buried' nano-scale features, defects or inhomogenities that are difficult to obtain by conventional imaging methods, are still not fully developed. In the case of 1D nanoporous structures, the continuity of the nano-tubular channels, their uniformity and orientation is of particular interest. Herein, we employ a serial sectioning technique on a dual beam FIB followed by 3D volume reconstruction for comprehensive analysis of tubular metal nanostructures encapsulated within porous anodic alumina. Using this technique, we demonstrate a nano-tomography characterisation protocol that can be used for analysis of nanoporous structures with emphasis on their channel uniformity and orientation. We demonstrate that high-resolution nano-tomography can be performed to visualise pores as small as 60 nm in diameter, with conical or globular shapes, and to quantitatively estimate their localisation and distribution along one-dimensional metal structures. We specifically chose to examine Cu-nanotubes, deposited electrochemically within anodic alumina template, because there is a great deal of debate regarding the deposition process. Hence, the comprehensive analysis shown here is not only demonstrating the applicability of the developed characterisation methodology but it is also, in conjunction with other advanced electron microscopy methods such as elemental nano-scale STEM/EDX mapping, providing conclusive evidence of the key factors at play during the deposition process.

1000 Fieldwork Hours: Analysis of Multi-Site Evidence

Background. Internationally, the World Federation of Occupational Therapists has established a minimum of 1,000 hours as the fieldwork standard.Purpose. To examine student development in fieldwork across placements to determine if students achieve entry-level competence after completion of 1,000 hours of fieldwork.Methods. Archival data (N=400) from six occupational therapy programs were analyzed to examine the acquisition of fieldwork competency over time as measured by the Competency Based Fieldwork Evaluation Scale.Findings. Competency scores increased with each fieldwork placement, the majority of students achieved entry-level scores upon completion of their final fieldwork placement. While, on average, some competency scores exceeded entry level by 1,000 hours, Practice Knowledge, Clinical Reasoning, and Facilitating Change fell just short.Implications. The identification of a plan for addressing the lower ratings in these three competencies should be considered.

Dual-task interference: the effects of verbal cognitive tasks on upright postural stability in Parkinson's disease

Although dual-task interference has previously been demonstrated to have a significant effect on postural control among individuals with Parkinson's disease, the impact of speech complexity on postural control has not been demonstrated using quantitative biomechanical measures. The postural stability of twelve participants with idiopathic Parkinson's disease and twelve healthy age-matched controls was evaluated under three conditions: (1) without a secondary task, (2) performing a rote repetition task and (3) generating a monologue. Results suggested a significant effect of cognitive load on biomechanical parameters of postural stability. Although both groups increased their postural excursion, individuals with Parkinson's disease demonstrated significantly reduced excursion as compared with that of healthy age-matched controls. This suggests that participants with Parkinson's disease may be overconstraining their postural adjustments in order to focus attention on the cognitive tasks without losing their balance. Ironically, this overconstraint may place the participant at greater risk for a fall.

Plantar cutaneous sensory stimulation improves single-limb support time, and EMG activation patterns among individuals with Parkinson's disease

Parkinson's disease is a chronic neurological disorder that results in gait and posture impairment. There is increasing evidence that these motor impairments may be partially due to deficits within the sensory system. In this study, the effects of a facilitatory insole that provides increased plantar sensory stimulation, was evaluated during gait, in a group of individuals with Parkinson's disease in comparison with healthy age-matched controls. Spatial-temporal parameters of gait were evaluated using an instrumented carpet, and muscle activation patterns were evaluated using surface EMG. All participants were tested with both a facilitatory (ribbed) insole and a conventional (flat) insole while walking 20 feet. Results indicated that the use of the facilitatory insole produced a significant increase in single-limb support time. Additionally, the muscle activation sequence of the tibialis anterior was normalized by the facilitatory insole, at the time of initial ground contact. These changes may lead to an overall improvement in gait pattern and stability, and suggest that the use of this type of facilitatory insole may be a useful treatment strategy for improving the gait of individuals with Parkinson's disease. This also provides support for the role of facilitation of the sensory system in improving motor output in individuals with Parkinson's disease.

Dual task performance in a healthy young adult population: results from a symmetric manipulation of task complexity and articulation

The ability to execute and maintain gait while performing simultaneous cognitive, verbal, or motor tasks ('dual-tasking') is beneficial in many ways. It is well-documented, however, that dual-tasking can result in cognitive or motoric interference that results in diminished gait performance, and impaired secondary task performance. When manipulating cognitive load, it is common to have participants respond verbally to stimuli. While this is an ecologically valid way to measure the effects of cognitive load on gait, it ignores the additional demands inherent in the verbal aspect of the task. In the present study, we manipulated complexity and articulation within a single working memory task, in order to examine their relative impact on continuous spatiotemporal gait parameters. Fourteen healthy young adults (11 women) aged 18-30 (M=22.14, S.D.=2.28) were asked to memorize a random, non-repeating, sequence of three, five, or seven digits. Articulation was manipulated by either having participants rehearse the digits aloud, or rehearse the digits silently during the performance of the gait task. Gait parameters were quantified with a GAITRite instrumented carpet. Velocity, step time, swing time, and stance time demonstrated a significant (p<0.05) interaction between complexity and articulation, with articulation having a greater effect at higher levels of complexity. These results suggest that verbal secondary tasks may actually create a 'triple-task' in which the cognitive complexity of the task interacts with both the articulatory demands of the response modality, and the motoric demands of the gait task.

Are Television Commercials Still Achievement Scripts for Women?

Content analyses of television advertising document the ubiquity of traditional images of women, yet few studies have explored their impact. One noteworthy exception is the experiment by Geis, Brown, Jennings, and Porter (1984) . These researchers found that the achievement aspirations of controls and women exposed to traditional images were lower than those of both women who viewed nontraditional replicas and men, leading to the conclusion that women's aspirations were muted by sexist advertising. An updated extension and modification of their study with 185 college women and 96 men did not find an interaction between gender and ad exposure, suggesting some changes over time in women's aspirations, as well as in the content and impact of commercials. Although women's achievement scripts now appear more similar to men's, as well as more resistant to sexist exposure, there are signs in the present data and related research that women's aspirations are not fully impervious to sexism in the media.

Mesoporous silicas impregnated with cobalt and nickel oxide nanoparticles and the growth of carbon nanotubes there from

Metal oxide-based nanoparticles of cobalt or nickel were deposited inside the pores and on the surface of hexagonal mesoporous silicas by a direct synthesis technique using Pluronic P85 and P123 surfactants as structure directing agents with the appropriate metal phthalocyanine as a metal precursor. Metal loadings were between 0.4-3.2 wt.%. XPS studies showed that the initial form of the metal oxide nanoparticles were [CoO] and [NiO] respectively. Samples of these materials formed from the P85 surfactant and 3.0 wt.% were used to grow carbon nanotubes (CNTs) from acetylene feedstock in a catalytic chemical vapour deposition (CCVD) reactor at 800 degrees C. CNT growth appeared to be random and the CNTs had diameters ranging from < 10 to > 90 nm. Treatment of the metal impregnated silicas with nitric acid produced materials which, under the same CNT growth conditions, afforded more uniform CNTs with diameters between 5-15 nm. No significant loss in mesophase ordering was seen in the TEM, PXRD or nitrogen physisorption analysis of the acid washed samples. CNTs grown with cobalt impregnated silicas formed with the P123 surfactant had diameters in the range 15-25 nm. Raman spectroscopy of the CNT products showed the nanotubes were highly graphitised and of good quality.

Combined administration of serogroup B meningococcal vaccine and conjugated serogroup C meningococcal vaccine is safe and immunogenic in college students

This study evaluated the first use of a combination of the lyophilized components of the conjugated group C vaccine Menjugate reconstituted with the liquid group B outer membrane vesicle (OMV) vaccine MeNZB. At 6-week intervals, healthy residential students received three doses of MeNZB alone or concomitantly with one dose of Menjugate (MeNZB+MenC). Short-lasting injection-site reactions of mild or moderate intensity were frequent in both groups. There were no vaccine-related serious adverse events. After three doses, the percentage of subjects with serum bactericidal assay (SBA) titres > or = 1:8 against the serogroup B strain NZ98/254 was 82% for MeNZB+MenC and 78% for MeNZB. All subjects in the MeNZB+MenC group achieved SBA titres > or = 1:8 against serogroup strain C11 and 67% in the MeNZB group. All SBA and ELISA responses of the combined vaccine were at least as good as for MeNZB alone. After vaccination, the pharyngeal carriage rate of any meningococcus in the vaccinated group had declined from 40% to 21%.

Nonlinear frequency-dependent attenuation in sandy sediments

This paper summarizes evidence of a nonlinear frequency dependence of attenuation for compressional waves in shallow-water waveguides with sandy sediment bottoms. Sediment attenuation is found consistent with alpha(f) = alpha(f(o)) x (f/f(o))n, n approximately 1.8 +/- 0.2 at frequencies less than 1 kHz in agreement with the theoretical expectation, (n = 2), of Biot [J. Acoust. Soc. Am. 28(2), 168-178, 1956]. For frequencies less than 10 kHz, the sediment layers, within meters of the water-sediment interface, appear to play a role in the attenuation that strongly depends on the power law. The accurate calculation of sound transmission in a shallow-water waveguide requires the depth-dependent sound speed, density, and frequency-dependent attenuation.

Predicting in Vivo Soft Tissue Masses of the Lower Extremity Using Segment Anthropometric Measures and DXA

The purpose of this study was to derive and validate regression equations for the prediction of fat mass (FM), lean mass (LM), wobbling mass (WM), and bone mineral content (BMC) of the thigh, leg, and leg + foot segments of living people from easily measured segmental anthropometric measures. The segment masses of 68 university-age participants (26 M, 42 F) were obtained from full-body dual photon x-ray absorptiometry (DXA) scans, and were used as the criterion values against which predicted masses were compared. Comprehensive anthropometric measures (6 lengths, 6 circumferences, 8 breadths, 4 skinfolds) were taken bilaterally for the thigh and leg for each person. Stepwise multiple linear regression was used to derive a prediction equation for each mass type and segment. Prediction equations exhibited high adjustedR2values in general (0.673 to 0.925), with higher correlations evident for the LM and WM equations than for FM and BMC. Predicted (equations) and measured (DXA) segment LM and WM were also found to be highly correlated (R2= 0.85 to 0.96), and FM and BMC to a lesser extent (R2= 0.49 to 0.78). Relative errors between predicted and measured masses ranged between 0.7% and –11.3% for all those in the validation sample (n= 16). These results on university-age men and women are encouraging and suggest that in vivo estimates of the soft tissue masses of the lower extremity can be made fairly accurately from simple segmental anthropometric measures.

Salmonella Brandenburg - emergence of a new strain affecting stock and humans in the South Island of New Zealand

AIMS

To report information on the spread of a new strain of Salmonella Brandenburg, which affected livestock and humans in the South Island of New Zealand, and a series of small case studies designed to investigate potential transmission of infection.

METHODS

Information on the occurrence and spread of S. Brandenburg in livestock was gathered from laboratory diagnostic submissions, from case studies on the faecal excretion rate in ewes, carrier status of black-backed gulls (Larus dominicanus), spread of S. Brandenburg organisms in sheep yards, infection in lambs going to meat plants, and from post-abortion pathological changes in the reproductive tract of ewes.

RESULTS

A newly recognised strain of S. Brandenburg was first diagnosed in aborting sheep from a flock in mid Canterbury in the South Island in 1996. Subsequently, the disease spread to other farms in mid and south Canterbury in 1997 and to Southland and Otago in the lower half of the South Island in 1998-2003. In 1999, the same strain was responsible for abortions in cattle and gastroenteritis in calves and adult cattle. The same strain of bacterium also caused disease in horses, goats, deer, pigs and humans. Spread of the disease on farms was strongly associated with aborting ewes, which resulted in considerable environmental contamination. During the abortion season, black-backed gulls appeared to spread the disease to other farms. Other potential sources of infection were carrier sheep, contaminated water sources and contaminated sheepyard dust. Damage to the reproductive tract may affect the ability of surviving ewes to conceive.

CONCLUSION

Important features of this disease are its high morbidity and mortality within a flock or herd, rapid local spread and its role as an occupational, health and safety risk to farm workers and their families.

The effect of localized leg muscle fatigue on tibial impact acceleration

OBJECTIVE

The objective of this study was to assess the effect of localized leg muscle fatigue on tibial acceleration following impact.

BACKGROUND

Peak tibial accelerations measured just distal to the knee joint during running have been shown to increase with general body fatigue. However, the role that local leg muscle fatigue plays in shock attenuation is not clear.

METHODS

The unshod, dominant foot of 24 healthy women in two different age groups was impacted into a vertical force plate, using a human pendulum method. Impact velocity and force approximated that found in running. EMG activity of the gastrocnemius and tibialis anterior muscles was monitored during fatiguing isometric exercise to assess fatigue, and quantified at impact as a measure of muscle activation level. A skin-mounted uni-axial accelerometer, was located at the tibial tubercle under pre-load, to measure tibial acceleration at impact.

RESULTS

There was a significant decrease in peak tibial acceleration (P = 0.008) and acceleration slope (P = 0.033) following fatigue. There were no significant main effects or interactions for age group or muscle group for all tibial response variables.

CONCLUSION

The reduction in peak tibial acceleration following fatigue (for the test performed) is contrary to the response documented following whole-body fatigue.

Reducing the morbidity from extravasation injuries

Extravasation is defined as the leakage of solutions from the vein. This may cause damage to surrounding tissue during intravenous fluid administration. Extravasation has an incidence of 5% of all cytotoxic drug administrations. In the authors' hospital, a protocol has been set up using the dilution flush-out technique. Extravasation packs containing cannulae, normal saline, hyaluronidase, and instructions on how to manage extravasation injuries, accompanied by an audit sheet to assist follow-up, have been introduced to allow the treatment of extravasation at the ward level in an attempt to reduce morbidity from the injury. Between December 1997 and December 1999, 18 adult patients were identified with extravasation injuries after the administration of cytotoxic medication. Seventeen were treated immediately according to the protocol. One, however, was not. Patients were followed-up for 6 months after injury. The 17 patients treated immediately needed no further surgical intervention, whereas the 1 patient not treated needed a split skin graft to cover the defect. The authors recommend the placement of "extravasation packs" on all wards where cytotoxic drugs are prescribed and that all staff members are familiar with this regime. These steps help to reduce the morbidity of a potentially damaging injury.

Kaposiform haemangioendothelioma: case report and review of the literature

Kaposiform haemangioendothelioma (KHE) is a rare vascular tumour, predominantly of infancy and early childhood, that has a close association with Kasabach-Merritt syndrome. Despite benign histology, this tumour frequently behaves aggressively, causing significant morbidity and mortality as a result of the compression and invasion of surrounding structures as well as from associated haematological and lymphoproliferative syndromes. There is a need for a high index of suspicion when presented with large, enlarging or abnormal vascular lesions in infancy and, less commonly, in adulthood. An early diagnosis of KHE can lead to prompt treatment, which may be life saving. To date, there have been only four reported cases of KHE occurring in patients over the age of 18 years. We report an otherwise well 26-year-old woman who presented with a KHE of the left thigh, and briefly review the literature. We believe this to be the second reported case of KHE in the UK and the first in an adult patient.