Easterseals

Endoscopic Mini or Less Open Sublay (eMILOS) is a transhernial endoscopically assisted approach for anterior abdominal wall hernia repair that has demonstrated excellent long-term outcomes. Performed through a small skin incision directly over the hernia, the eMILOS technique minimizes additional access trauma, but remains technically demanding with conventional instruments. This study investigates the preclinical feasibility of adapting the da Vinci SP system to perform the transhernial SP MILOS technique. This preclinical study evaluated the technical feasibility of performing daVinci SP MILOS hernia repair using human cadavers. The da Vinci SP robotic platform and its standard instruments were employed. Procedural steps, technical considerations, limitations, and potential advantages were systematically documented. The procedure was completed through a 1.8-cm skin incision. Correct placement of the Access Port (AP) and defining the custom remote center (CRC) at the posterior fascial edge was essential for optimal trocar orientation and to limit collisions with the incision. The AP can be positioned below the skin or below the fascia depending on work flow and surgeon preference. The retrorectus space was developed robotically from xiphoid to pubis, with full 360° transhernial exposure. Transversus abdominis release and lateral dissection into the preperitoneal and pretransversalis planes were successfully achieved. In this preclinical cadaveric study, the SP MILOS technique provided 360° transhernial access to the retrorectus space without platform repositioning. Our initial experience supports its feasibility as a new single-port robotic option for ventral hernia repair, eliminating access trauma to the abdominal wall through a single, minimal skin incision.

The aim of this thesis was to examine the contribution of the cerebellum to motivational processes and reward- and punishment-based learning processes associated with aggression. Chapter 2 reviewed evidence from lesion, structural and functional neuroimaging and brain stimulation studies in support of a role of the cerebellum in aggression. The evidence points towards a differential contribution of the medial and lateral cerebellum to aggression. In particular, the medial cerebellum is involved in emotion-driven, fast responding during imminent threat and provocation and mediates impulsive aggression. In contrast, the posterolateral cerebellum is involved in slower, top-down cognitive control processes which support premeditated and instrumental forms of aggression. Chapters 3 and 4 tested the cerebellar lateralization hypothesis of motivational direction in approach-related aggressive (chapter 3) and avoidance-related (chapter 4) behavior. In chapter 3, a baseline and during-task state anger-dependent increase in aggressive behavior was found during left cathodal-right anodal cerebellar as compared to sham tDCS. Furthermore, aggression was positively correlated with heart rate during active tDCS, while an inverse association was observed during sham tDCS. Subsequently, the reversed bipolar cerebellar tDCS montage (i.e., left anodal-right cathodal) was applied in chapter 4 to study its effect on reversal learning during threat of shock. Higher levels of shock anxiety were associated with increased reversal learning rate after the first reversal in the active compared to sham tDCS condition. Additionally, higher scores on trait impulsivity were associated with reduced reversal learning rate after the second reversal in the active compared to sham tDCS condition. The results from chapters 3 and 4 support the cerebellar lateralization model of motivational direction, which states that left-to-right dominant cerebellar activity is associated with avoidance (flight) motivation, whereas right-to-left dominant cerebellar activity is associated with approach (fight) motivation. Moreover, the results demonstrate affective context-relevant state- and trait-dependent effects of cerebellar tDCS. In addition, this thesis examined the contributions of the cerebellum to reward- and punishment-based learning processes to get insights into the role of motivated learning and mental flexibility in aggressive behavior. The activation likelihood estimation meta-analysis of functional MRI studies in chapter 5 revealed distinct patterns of cerebellar activity associated with reward anticipation and reward outcome processing in healthy adults. More specifically, reward anticipation was associated with activity in the bilateral anterior lobe, bilateral lobule VI, left Crus I and the posterior vermis, while reward outcome was associated with activity in the declive and left lobule VI. In chapter 6, cTBS was applied to the cerebellum of healthy adult volunteers to investigate the direct contribution of the cerebellum to reward- and punishment-based reversal learning. Medial posterior cerebellar cTBS reduced learning rate after the first reversal and diminished the implementation of the optimal strategy after learning the second reversal as compared to right posterolateral cerebellar and right occipital lobe cTBS. Taken together, the findings of this thesis support the involvement of the cerebellum in motivational and reward- and punishment-based learning processes associated with aggression. In the remainder of this chapter, these findings as well as potential clinical implications will be discussed.

ABSTRACT As a follow-up to a prior article that examined articles published in the Journal of Organizational Behavior Management from 1982 through 2012 to assess the use of Michael’s motivating operations (MO) concept in organizational behavior management research, we evaluated articles published therein from 2013 through 2022 that contained the term “motivating operation” or a related term. Forty articles used a relevant term. The terms were used in attempts to categorize and explain diverse behavioral effects of many kinds of variables. Many articles construed verbal stimuli, such as rules and goals, as MOs. Michael did not consider verbal stimuli in his seminal work on MOs, and we, like other authors, suggest broadening the concept to include such stimuli.

Giant paratesticular liposarcoma (PLS) is an uncommon tumour, often misdiagnosed pre-operatively, which presents as a painless scrotal mass. Early detection and prompt surgical management provide the best outcome. We present an 87-year-old patient with gradually enlarging, painless left scrotal swelling. Ultrasound on initial presentation suggested a benign hernia, resulting in an 11-month treatment delay. Computed tomography (CT) thereafter showed paratesticular scrotal mass measuring 14 x 8 x 7cm. Radical inguinal orchidectomy with high ligation of the spermatic cord was performed. Histopathology and cytogenetics confirmed PLS with both de-differentiated and well-differentiated features involving the spermatic cord margin. The patient had rapid progression to fatal lung metastasis within three months of surgery. Our case highlights that any suspicious fat swelling should be investigated thoroughly and excised promptly if paratesticular liposarcoma is suspected, as delayed management gives poor outcomes.

BackgroundApplied behavior analysis (ABA) is an evidence-based approach to autism spectrum disorder that has been shown in clinical trials to improve child functional status. There is substantial focus in ABA on setting and tracking individualized goals that are patient-centered, but limited research on how to measure progress on such patient-centered outcomes.PurposeThe purpose of this investigation was to assess concordance between patient-centered and standard outcome measures of treatment progress in a real-world clinical sample of children receiving ABA for autism spectrum disorder.MethodsThis observational study used a clinical sample of children ages 3 to 16 years (N = 154) who received 24 months of ABA from an integrated health system. Concordance between three outcome measures after ABA was assessed using a correlation matrix: (1) patient-centered measures of progress on individualized treatment goals, (2) caregiver-centered measure of progress on treatment participation goals, and (3) the Vineland Adaptive Behavior Scales adaptive behavior composite.ResultsThere was limited concordance among measures at both 12 and 24 months of ABA. None of the patient-centered measures showed significant positive correlation with adaptive behavior composite difference scores at either 12 or 24 months, nor did the caregiver measure. The percentage of children achieving clinically meaningful gain on patient-centered goal measures increased between 12 and 24 months of ABA, while the percentage of children achieving clinically meaningful gains in adaptive behavior declined during the same time period.ConclusionsIn a health system implementation of ABA, there was limited concordance between patient-centered and standard measures of clinically meaningful treatment progress for children with ASD. Clinicians should have ongoing dialogue with patients and parents/caregivers to ensure that interventions for ASD are resulting in progress towards outcomes that are meaningful to patients and families.

ObjectiveThe purpose of this study was to assess satisfaction with telehealth interventions for a large nonprofit organization that transitioned interventions for individuals with autism spectrum disorder (ASD) to telehealth during a pandemic. Services provided via telehealth included applied behavior analysis (ABA), speech and language, and occupational therapies. A secondary survey evaluated reasons for declining telehealth services.MethodsA survey was administered to 10,567 families who were receiving autism interventions. A total of 440 respondents answered all the questions on the survey, and their results were included in this study. A secondary survey was administered to 223 individuals who declined to have telehealth autism interventions.ResultsThere was not a clinically meaningful difference in satisfaction across service types. Although all ratings were in the high range, caregivers ranked speech therapists as more dependable than ABA therapists, and this difference was statistically significant. The findings suggested that the majority of caregivers were generally satisfied with services provided in a telehealth format. For those who declined services, the majority indicated a discomfort with the use of technology.ConclusionsThe participants of telehealth autism interventions reported high general satisfaction and indicated an improvement in their quality of life. Results provide suggestive evidence that increased satisfaction of telehealth services may allow for further acceptability and access for participants. Future research should evaluate participant and clinician satisfaction with telehealth versus in-person interventions.

The term social model hospice first appeared late in the 20th century as a label for a complementary model to medical hospice care. Two decades later, the term is inconsistently defined and used by scholars, health care providers, public consumers, and those within the movement. The purpose of this review is to trace the development of the concept and confirm an evolving definition based on Rodgers' evolutionary method. Database and hand searching was done for the years 1975 to 2020, resulting in 25 publications for analysis. Unique antecedents include presence of a resource crisis, unmet needs falling outside the scope of medical hospice care, and desire to experience death outside the medical system and/or personal home. Attributes include a dedicated home, round-the-clock, individualized end-of-life care; care option when dying at home becomes unmanageable; collaboration with medical hospice services; nonprofit organization funded by community philanthropy; environment to support loved ones; and community volunteer involvement. Noted consequences are effective end-of-life care for dying patients and their families, innovative health care design, nationwide network of like-minded providers, and platform for end-of-life community education. Clarity of the concept will facilitate access to end-of-life care, further the model's development, formalize research endeavors, and foster community education.

Artificial water-treatment wetlands can reduce nitrogen and phosphorous nutrient concentrations in wastewater effluent to improve water quality and decrease eutrophication in natural waters. The Orlando Easterly Wetlands (OEW) is an engineered wetland that polishes 57 million liters of wastewater per day, lowering the total nitrogen and phosphorous concentrations through biological, physical, and chemical processes. In addition to purifying the water, the wetlands provide habitat for avian, mammalian, reptilian and macroinvertebrate species. Previous research has shown that avian species affect the eutrophication of agricultural reservoirs near their roost. The research herein quantifies uric acid in avian and reptilian excretory product and tracks its concentration profile throughout the OEW over a seven-month period. This measure of the non-anthropogenic contribution to nitrogen within the park includes winter months when large numbers of migratory birds occupy the wetland. The enzymatic decomposition of uric acid and the subsequent fluorimetric analysis were used to quantify uric acid throughout the flow train of the OEW. High concentrations of 2–4 mg/L uric acid were found in the influent, but drastically declined to concentrations below 0.2 mg/L in the effluent.

A draft report by the International Commission on Radiation Units and Measurements (ICRU) Report Committee 26 (RC26) will recommend alternative definitions of the operational quantities that are better estimators of radiation protection quantities. Dose coefficients for use with physical field quantities—fluence and, for photons, air kerma—are given for various particle types over a broad energy range. For the skin dosimetry, several changes are of particular interest. Specifically, the use of absorbed dose instead of dose equivalent has been selected as the operational quantity since deterministic effects are of primary interest in the skin. In addition, newly recommended phantoms are specified for computing the operational dose coefficients. The report also addresses computational approaches such as tally volumes, depths, source areas, and rotational angles. In this work, dose coefficients calculated for local skin in support of the ICRU report are presented. Energy-dependent dose coefficients were calculated in phantoms specified for the trunk (slab), the ankle or wrist (pillar), and the finger (rod). The phantom specifications in this work were taken directly from the draft report. Full transport of secondary charged particles from neutron interactions was performed and an analysis of the depth-dose profiles in the slab phantom is presented, The last complete set of neutron dose coefficients for the extremities was published more than 25 years ago. Given the limited data available, it is difficult for many facilities to obtain clear guidance on how monitoring should be performed and how dosimeters should be calibrated so spectra from commonly encountered neutron sources were used to generate source-specific dose coefficients in each of the phantoms. Both energy-dependent and source-specific dose coefficients are provided for rotational angles up to 180 degrees for the rod and pillar phantoms and up to 75 degrees for the slab phantom.

Military service presents unique challenges and opportunities for health care and public health. In the USA, there are over 2 million military servicemembers, 20 million veterans, and millions more military and veteran family members. Military servicemembers and eligible family members, many veterans, and retirees receive health care through the two largest learning health care systems in the USA, managed and delivered through the Departments of Defense (DoD), Veterans Affairs (VA), and contracted health care organizations. Through a network of collaborative relationships, DoD, VA, and partnering health care and research organizations (university, corporate, community, and government) accelerate research translation into best practices and policy across the USA and beyond. This article outlines military and veteran health research translation as summarized from a collaborative workshop led by experts across health care research, practice, and administration in DoD, VA, the National Institutes of Health, and affiliated universities. Key themes and recommendations for research translation are outlined in areas of: (a) stakeholder engagement and collaboration; (b) implementation science methods; and (c) funding along the translation continuum. Overall, the ability to rapidly translate research into clinical practice and policy for positive health outcomes requires collaborative relationships among many stakeholders. This includes servicemembers, veterans, and their families along with researchers, health care clinicians, and administrators, as well as policymakers and the broader population.