Comparison of a functional obstacle course with an index of clinical gait and balance and postural sway

BACKGROUND: Older adults commonly experience falls because of balance and mobility problems. Better assessment methods are needed to understand and correct balance and mobility disorders. METHODS: We used a low technology, functional obstacle course (FOC) to measure balance and mobility in 352 community-dwelling elderly participants. To establish concurrent validity of the FOC, we compared performance on the FOC with two established measures of balance and mobility: performance on the Tinetti Index (TI) and postural sway area measured on a force platform. RESULTS: Bivariate correlation analyses revealed significant inverse correlations between FOC completion time, the TI balance and gait subscores, and the TI total score (r = -.73 to -.78). The FOC quality scores and TI balance and subscores gait and TI total scores (r = .76 to .82) were significantly positively correlated. FOC time had significant, but small, positive correlations with sway area with eyes open (r = .18) and closed (r = .17) and nonsignificant correlation with sway area with visual feedback. FOC quality also had significant, but smaller, inverse correlations with sway area with eyes open (r = -.024) and closed (r = -.015), and nonsignificant correlation with sway area with visual feedback. Regression analysis showed that TI gait and balance measures accounted for most of the variance found in FOC performance. CONCLUSIONS: Our findings support the position that the FOC and the TI measure dynamic balance, whereas postural sway measures a different aspect of balance. Advantages of the FOC include the evaluation of environmentally influenced falls and balance problems.     

Looking ahead in times of uncertainty: The role of anticipatory justice in an organizational change context.

Our study drew on past theorizing on anticipatory justice (D. L. Shapiro & B. L. Kirkman, 2001) and fairness heuristic theory (K. Van den Bos, E. A. Lind, & H. A. M. Wilke, 2001) to build and test a model of employee reactions to a smoking ban. The results of a longitudinal study in a hospital showed that employee levels of preban anticipatory justice were predicted by their global sense of their supervisor’s fairness. The combination of anticipatory justice and global supervisory fairness then predicted the experienced justice of the ban 3 months after its implementation, with the effects of the 2 predictors dependent on perceptions of uncertainty and outcome favorability regarding the ban. Finally, experienced (interpersonal) justice predicted significant other ratings of employee support for the ban. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Can “good” stressors spark “bad” behaviors? The mediating role of emotions in links of challenge and hindrance stressors with citizenship and counterproductive behaviors.

The authors combined affective events theory (H. M. Weiss & Cropanzano, 1996) and the transactional stress model (R. S. Lazarus & Folkman, 1984) to build and test a model specifying the dynamic, emotion-based relationships among challenge and hindrance stressors and citizenship and counterproductive behaviors. The study employed an experience sampling methodology. Results showed that challenge stressors had offsetting indirect links with citizenship behaviors through attentiveness and anxiety and a positive indirect effect on counterproductive behaviors through anxiety. Hindrance stressors had a negative indirect effect on citizenship behaviors through anxiety and a positive indirect effect on counterproductive behaviors through anxiety and anger. Finally, multilevel moderating effects showed that the relationship between hindrance stressors and anger varied according to employees’ levels of neuroticism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Traumatic brain contusions: a clinical role for the kinin antagonist CP-0127

Focal cerebral contusions can be dynamic and expansive, leading to delayed neurological deterioration. Due to the high mortality associated with such cerebral contusions, our standard practice had evolved into evacuating contusions in patients who had a deterioration in level of consciousness, lesions > 30 cc and CT suggestion of raised ICP. Experimental brain edema studies have implicated kinins in causing 2 degrees brain swelling. CP-0127 (Bradycor), a specific bradykinin antagonist, has been found to reduce cerebral edema in a cold lesion model in rats. In a randomized, single blind pilot study, a 7 day infusion of CP-0127 (3.0 micrograms/kg/min) was compared to placebo in patients with focal cerebral contusions presenting within 24-96 hours of closed head injury with an initial GCS 9-14. The ICP, GCS, and vital signs were monitored hourly. The total lesion burden (TLB) was measured on serial CT scans. There were no differences in age, baseline GCS, TLB, initial ICP, or laboratory findings between the two groups (n = 20). The mean (+/- s.d.) rise in peak ICP from baseline was greater in the placebo group than with CP-0127 (21.9 +/- 4.7 vs 9.5 +/- 2.0, P = 0.018). In addition, the mean reduction in GCS in the placebo group was significantly greater than in the CP-0127 group (4 +/- 1.0 vs 0.6 +/- 0.4, P = 0.002). Significantly raised ICP and clinically significant neurological deterioration occurred in 7/9 patients on placebo (77%) and only in 1 patient (9%; n = 11) on CP-0127, mandating surgery (P = 0.005). There were no adverse drug reactions, significant changes in vital signs or variations in the laboratory values. The cerebral perfusion pressure was adequately maintained in all patients irrespective of therapy. These preliminary results with CP-0127 provide supporting evidence that the kinin-kallikrein system could be involved in cerebral edema. In this study, treatment with CP-0127 appeared to alter the natural history of traumatic brain contusions by preventing the 2 degrees brain swelling. In addition, CP-0127 obviated the need for surgery in the majority of treated patients. CP-0127 could act on the cerebral vasculature to limit dys-autoregulation and brain swelling or on the blood brain barrier to reduce cerebral edema.     

Shear‐Thinning Supramolecular Hydrogels with Secondary Autonomous Covalent Crosslinking to Modulate Viscoelastic Properties In Vivo

Clinical percutaneous delivery of synthetically engineered hydrogels remains limited due to challenges posed by crosslinking kinetics—too fast leads to delivery failure, too slow limits material retention. To overcome this challenge, supramolecular assembly is exploited to localize hydrogels at the injection site and introduce subsequent covalent crosslinking to control final material properties. Supramolecular gels are designed through the separate pendant modifications of hyaluronic acid (HA) by the guest–host pair cyclodextrin and adamantane, enabling shear‐thinning injection and high target site retention (>98%). Secondary covalent crosslinking occurs via addition of thiols and Michael‐acceptors (i.e., methacrylates, acrylates, vinyl sulfones) on HA and increases hydrogel moduli (E = 25.0 ± 4.5 kPa) and stability (>3.5 fold in vivo at 28 d). Application of the dual‐crosslinking hydrogel to a myocardial infarct model shows improved outcomes relative to untreated and supramolecular hydrogel alone controls, demonstrating its potential in a range of applications where the precise delivery of hydrogels with tunable properties is desired.