The biomechanics of splitting hairs.

Splitting of hair, creating 'split ends', is a very common problem which has been extensively documented. However, the mechanics underlying the splitting phenomenon are poorly understood. This is partly owing to the lack of a test in which splitting can be generated and quantified under laboratory conditions.

A critical care follow-up service evaluation: Acquired peripheral nerve injury after admission with COVID-19 respiratory disease.

Anticipated sequelae of critical care admission for COVID-19 disease remain unclear. Our Edinburgh-based critical care follow-up service identified patterns with nerve injury in 13 of 35 patients who attended following a critical care admission between 15/03/2020 and 25/12/2020. This included 7 cases of meralgia parasthetica, 1 brachial plexopathy, 2 common peroneal neuropathies and 3 ulnar neuropathies.

Physicians' use of plain language during discussions of prostate cancer clinical trials with patients.

Objective: This study described physicians' use of plain language during patient-physician cancer clinical trial discussions.

Methods: Video-recorded clinical interactions and accompanying transcripts were taken from a larger study of communication and clinical trials (PACCT). Interactions (n = 25) were selected if they included invitations to participate in a clinical trial.

User acceptability of saliva and gargle samples for identifying COVID-19 positive high-risk workers and household contacts.

Throughout the COVID-19 pandemic nasopharyngeal or nose and/or throat swabs (NTS) have been the primary approach for collecting patient samples for the subsequent detection of viral RNA. However, this procedure, if undertaken correctly, can be unpleasant and therefore deters individuals from providing high quality samples. To overcome these limitations other modes of sample collection have been explored.

Are Transmetatarsal Amputations a Durable Limb Salvage Option? A Single-Institution Descriptive Analysis.

In limb and life-threatening diabetic foot infections, transmetatarsal amputations are often indicated as a limb salvage procedure. The aim of this study is to analyze the long-term durability of initially successful transmetatarsal amputations in the diabetic population. We defined a successful transmetatarsal amputation as one which had clinical healing 1 year after surgery.

The impact of age on patient tolerance of mycophenolate following kidney transplantation.

Background: In Scotland, standard maintenance immunosuppression following kidney transplantation consists of mycophenolate (MPA), tacrolimus and prednisolone irrespective of recipient age. We analyzed the tolerability of this immunosuppression regimen and the association with transplant outcomes.

Methods: A national, multicentre retrospective analysis of patients transplanted in 2015 and 2016, comparing graft function, acute rejection, significant infection rates and immunosuppression dosing between patients aged 18 and 59 years (Group 1) and ≥60 years (Group 2).

The influence of a question prompt list on patient-oncologist information exchange in an African-American population.

Objectives: Question Prompt Lists (QPL) increase patient active participation in oncology interactions, but questions remain regarding how QPLs influence patient-oncologist information exchange. We examined how a QPL influenced information exchange during oncology interactions with African-American patients.

Methods: Data were self-reports and video recordings from a parent study testing the effects of a QPL in the outpatient clinics of two urban cancer hospitals.

In vitro characterisation of the erosion of soft tissues by surgical mesh.

Surgical mesh is used widely in operations to treat hernias, prolapsed organs, urinary incontinence, etc. A major complication following surgery is so-called "mesh erosion", in which the mesh material rubs on adjacent soft tissue, causing it to wear away. Mesh erosion is the subject of a large body of clinical case histories, but there is no literature reporting in vitro laboratory experiments to investigate this phenomenon.

Partnering around cancer clinical trials (PACCT): study protocol for a randomized trial of a patient and physician communication intervention to increase minority accrual to prostate cancer clinical trials.

Background: Cancer clinical trials are essential for testing new treatments and represent state-of-the-art cancer treatment, but only a small percentage of patients ever enroll in a trial. Under-enrollment is an even greater problem among minorities, particularly African Americans, representing a racial/ethnic disparity in cancer care. One understudied cause is patient-physician communication, which is often of poor quality during clinical interactions between African-American patients and non-African-American physicians.

Building Motivation in African American Caregivers of Adolescents With Obesity: Application of Sequential Analysis.

Objective: We sought to examine communication between counselors and caregivers of adolescents with obesity to determine what types of counselor behaviors increased caregivers' motivational statements regarding supporting their child's weight loss.

Methods: We coded 20-min Motivational Interviewing sessions with 37 caregivers of African American 12-16-year-olds using the Minority Youth Sequential Coding for Observing Process Exchanges. We used sequential analysis to determine which counselor communication codes predicted caregiver motivational statements.

Exploring ambivalence in motivational interviewing with obese African American adolescents and their caregivers: A mixed methods analysis.

Objective: We conducted an exploratory mixed methods study to describe the ambivalence African-American adolescents and their caregivers expressed during motivational interviewing sessions targeting weight loss.

Methods: We extracted ambivalence statements from 37 previously coded counseling sessions. We used directed content analysis to categorize ambivalence related to the target behaviors of nutrition, activity, or weight.

Strategies of persuasion in offers to participate in cancer clinical trials I: Topic placement and topic framing.

Clinical trials are the gold standard in medical research evaluating new treatments in cancer care; however, in the United States, too few patients enroll in trials, especially patients from minority groups. Offering patients the option of a clinical trial is an ethically-charged communicative event for oncologists. One particularly vexed ethical issue is the use of persuasion in trial offers.

Provider communication behaviors that predict motivation to change in black adolescents with obesity.

Objective: The goal of this research was to identify communication behaviors used by weight loss counselors that mostly strongly predicted black adolescents' motivational statements. Three types of motivational statements were of interest: change talk (CT; statements describing their own desires, abilities, reasons, and need for adhering to weight loss recommendations), commitment language (CML; statements about their intentions or plans for adhering), and counterchange talk (CCT; amotivational statements against change and commitment).

Methods: Thirty-seven black adolescents with obesity received a single motivational interviewing session targeting weight-related behaviors.

A disparity of words: racial differences in oncologist-patient communication about clinical trials.

Background: African Americans are consistently underrepresented in cancer clinical trials. Minority under-enrolment may be, in part, due to differences in the way clinical trials are discussed in oncology visits with African American vs. White patients.

Accounting for medical communication: parents' perceptions of communicative roles and responsibilities in the pediatric intensive care unit.

Through discourse analysis of transcribed interviews conducted over the phone with parents whose child died in the Pediatric Intensive Care Unit (PICU) (n = 51), this study uncovers parents' perceptions of clinicians' and their own communicative roles and responsibilities in the context of team-based care. We examine parents' descriptions and narratives of communicative experiences they had with PICU clinicians, focusing on how parents use accounts to evaluate the communicative behaviors they report (n = 47). Findings indicate that parental perceptions of communicative responsibilities are more nuanced than assumed in previous research: Parents identified their own responsibilities as participating as part of the team of care, gathering information, interacting with appropriate affect, and working to understand complex and uncertain medical information.

Coordination of eye and head components of movements evoked by stimulation of the paramedian pontine reticular formation.

Constant frequency microstimulation of the paramedian pontine reticular formation (PPRF) in head-restrained monkeys evokes a constant velocity eye movement. Since the PPRF receives significant projections from structures that control coordinated eye-head movements, we asked whether stimulation of the pontine reticular formation in the head-unrestrained animal generates a combined eye-head movement or only an eye movement. Microstimulation of most sites yielded a constant-velocity gaze shift executed as a coordinated eye-head movement, although eye-only movements were evoked from some sites.

Situating end-of-life decision making in a hybrid ethical frame.

Good communication in EOL (end-of-life) discussions is described at a general level in the literature, but there are few studies of EOL discussions at the level of interaction, with data drawn from the actual talk between physicians and families. In this article I present a discourse analysis of EOL discussions from an American ICU (intensive care unit) where the decision to withdraw life support is situated in a hybrid ethical frame co-constructed as the final phase of the EOL discussion. In Mishler's (1984) terms, the final phase of the EOL discussion merges the voice of medicine and the voice of the lifeworld, with both physicians and families initiating, developing, and repeating particular topics that encompass not only the logistics of death but also the ethics of the end-of-life decision.

Establishing terminal status in end-of-life discussions.

The communicative purpose of an end-of-life discussion is to change the goals of treatment for a terminal patient from therapeutic to comfort care. In this study, the authors present a comparative discourse analysis of end-of-life discussions that reached a consensus to change the goals of treatment and discussions that did not. They found that the presentation of medical information was subtly different across these discussions: Decision-making discussions were based on a consistent accumulation of negative evidence, whereas non-decision-making discussions were inconsistent in this respect, including mention of positive rather than negative outcomes of medical problems, discussion of possible treatment options, and mitigating summary statements.

The cause and clinical significance of central tumor photopenia on thallium scintigraphy of pediatric osteosarcoma of the extremity.

Objective: The objectives of our study were to determine whether central tumor photopenia on thallium-201 (201Tl) scintigraphy of primary osteosarcoma results from central tumor necrosis or dense central tumor ossification and to determine the relation of this finding to tumor response to chemotherapy and to patient survival.

Materials And Methods: After the institutional review board approved our study and waived the need for patient or parental consent, two radiologists independently reviewed 201Tl scans, conventional radiographs, and MR images of 57 patients obtained at diagnosis of extremity primary nonmetastatic osteosarcoma to detect the presence of central tumor photopenia on 201Tl scintigraphy and estimate outer tumor ossification versus inner tumor ossification and enhancement. The dynamic enhanced MRI parameters dynamic vector magnitude (DVM) and k(ep) (measure of the exchange rate between plasma and extracellular fluid space) were compared for outer tumor versus inner tumor, and the relation among 201Tl scintigraphy, conventional radiography, MRI, and the dynamic enhanced MRI parameters was analyzed.

Structure and variation in end-of-life discussions in the Surgical Intensive Care Unit.

The research reported here is an exploratory discourse analysis of a corpus of six end-of-life discussions in a Surgical Intensive Care Unit (SICU), describing the structure and variations of the four phases of an end-of-life discussion in terms of the function of each of these phases: the Opening (Phase 1), Description of Current Status (Phase 2), Holistic Decision Making (Phase 3), and Logistics of Dying (Phase 4). Of particular interest is Phase 2, in which the presentation of medical information culminates in an inferential summary statement that functions to establish the patient's status as terminal. We argue that it is Phase 2 that is crucial in the functional progression of an end-of-life discussion toward a decision to move from therapeutic to palliative care, since it is in Phase 2 that physicians and families interactionally achieve a consensus that allows a decision to withdraw or withhold further treatment, including life support, which would be futile and only prolong the patient's suffering.

Effect of Native American ancestry on iron-related phenotypes of Alabama hemochromatosis probands with HFE C282Y homozygosity.

Background: In age-matched cohorts of screening study participants recruited from primary care clinics, mean serum transferrin saturation values were significantly lower and mean serum ferritin concentrations were significantly higher in Native Americans than in whites. Twenty-eight percent of 80 Alabama white hemochromatosis probands with HFE C282Y homozygosity previously reported having Native American ancestry, but the possible effect of this ancestry on hemochromatosis phenotypes was unknown.

Methods: We compiled observations in these 80 probands and used univariate and multivariate methods to analyze associations of age, sex, Native American ancestry (as a dichotomous variable), report of ethanol consumption (as a dichotomous variable), percentage transferrin saturation and loge serum ferritin concentration at diagnosis, quantities of iron removed by phlebotomy to achieve iron depletion, and quantities of excess iron removed by phlebotomy.

Ancestry reported by white adults with cutaneous melanoma and control subjects in central Alabama.

Background: We sought to evaluate the hypothesis that the high incidence of cutaneous melanoma in white persons in central Alabama is associated with a predominance of Irish and Scots descent.

Methods: Frequencies of country of ancestry reports were tabulated. The reports were also converted to scores that reflect proportional countries of ancestry in individuals.

Countries of ancestry reported by hemochromatosis probands and control subjects in central Alabama.

Objectives: We sought to evaluate the hypothesis that the relatively high HFE C282Y allele frequency in White persons in central Alabama (0.0896) is due to a predominance of persons of Irish and Scots descent, and is not attributable to Native American ancestry common in this geographic area.

Design: Eighty evaluable hemochromatosis probands with C282Y homozygosity and 319 White controls reported countries of ancestry of their grandparents.

Effects of partial lidocaine inactivation of the paramedian pontine reticular formation on saccades of macaques.

To investigate the brain stem control of saccadic eye movements, the paramedian pontine reticular formation (PPRF) in rhesus monkeys was temporarily and partially inactivated with the local anesthetic lidocaine. The influence on ipsilesional, contralesional, and upward saccades was examined. While the effects of the inactivation on contralesional and upward saccades were inconsistent and small, consistent and marked modifications were observed for ipsilesional movements.