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PURPOSE OF REVIEW: Cervical spine pain with or without radicular symptoms is a common condition leading to high utilization of the healthcare system with over 10 million medical visits per year. Many patients undergo surgical interventions and unfortunately are still left with neck and upper extremity pain, sometimes referred to as "Failed Neck Surgery Syndrome." When these options fail, cervical spinal cord stimulation can be a useful tool to decrease pain and suffering as well as reduce prescription medication use. RECENT FINDINGS: Spinal cord stimulation is a well-established therapy for chronic back and leg pain and is becoming more popular for neck and upper extremity pain. Recent studies have explored cervical spinal cord stimulation with successful outcomes regarding improved pain scores, functional outcomes, and reduction of prescription medication use. Continued research into cervical spinal cord stimulation is essential for maximizing its therapeutic potential for patients with chronic neck and upper extremity pain. This review highlights the importance of cervical spinal cord stimulation as an option for patients with failed neck surgery syndrome.

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Cerebellar-brain inhibition (CBI) is a transcranial magnetic stimulation (TMS) paradigm indexing excitability of cerebellar projections to motor cortex (M1). Stimulation involved with CBI is often considered to be uncomfortable, and alternative ways to index connectivity between cerebellum and the cortex would be valuable. We therefore sought to assess the utility of electroencephalography in conjunction with TMS (combined TMS-EEG) to record the response to CBI. A total of 33 volunteers (25.7 ± 4.9 years, 20 females) participated across three experiments. These investigated EEG responses to CBI induced with a figure-of-eight (F8; experiment 1) or double cone (DC; experiment 2) conditioning coil over cerebellum, in addition to multisensory sham stimulation (experiment 3). Both F8 and DC coils suppressed early TMS-evoked EEG potentials (TEPs) produced by TMS to M1 (P < 0.05). Furthermore, the TEP produced by CBI stimulation was related to the motor inhibitory response to CBI recorded in a hand muscle (P < 0.05), but only when using the DC coil. Multisensory sham stimulation failed to modify the M1 TEP. Cerebellar conditioning produced changes in the M1 TEP that were not apparent following sham stimulation, and that were related to the motor inhibitory effects of CBI. Our findings therefore suggest that it is possible to index the response to CBI using TMS-EEG. In addition, while both F8 and DC coils appear to recruit cerebellar projections, the nature of these may be different.

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Biological invasions are accelerating worldwide, causing major ecological and economic impacts in aquatic ecosystems. The urgent decision-making needs of invasive species managers can be better met by the integration of biodiversity big data with large-domain models and data-driven products. Remotely sensed data products can be combined with existing invasive species occurrence data via machine learning models to provide the proactive spatial risk analysis necessary for implementing coordinated and agile management paradigms across large scales. We present a workflow that generates rapid spatial risk assessments on aquatic invasive species using occurrence data, spatially explicit environmental data, and an ensemble approach to species distribution modeling using five machine learning algorithms. For proof of concept and validation, we tested this workflow using extensive spatial and temporal hybridization and occurrence data from a well-studied, ongoing, and climate-driven species invasion in the upper Flathead River system in northwestern Montana, USA. Rainbow Trout (RBT; Oncorhynchus mykiss), an introduced species in the Flathead River basin, compete and readily hybridize with native Westslope Cutthroat Trout (WCT; O. clarkii lewisii), and the spread of RBT individuals and their alleles has been tracked for decades. We used remotely sensed and other geospatial data as key environmental predictors for projecting resultant habitat suitability to geographic space. The ensemble modeling technique yielded high accuracy predictions relative to 30-fold cross-validated datasets (87% 30-fold cross-validated accuracy score). Both top predictors and model performance relative to these predictors matched current understanding of the drivers of RBT invasion and habitat suitability, indicating that temperature is a major factor influencing the spread of invasive RBT and hybridization with native WCT. The congruence between more time-consuming modeling approaches and our rapid machine-learning approach suggest that this workflow could be applied more broadly to provide data-driven management information for early detection of potential invaders.

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STUDY DESIGN: Secondary analysis of cross-sectional population-based self-report data. OBJECTIVE: To determine how well the Pain Medication Questionnaire (PMQ) measures risk of pain medication misuse and its precision in separating individuals with spinal cord injury (SCI) into meaningful classification categories. SETTING: Academic medical center in Southeastern United States. METHODS: Data were collected from a population-based registry of SCI (n=971). Eligible participants included adults with traumatic SCI with residual effects who were at least 1 year post injury and 18 years of age and who had PMQ data in which they reported active use of pain medication at the time of the study (n=745). RESULTS: Most items (23/26) of the PMQ contributed to a single unidimensional construct. Rasch analysis results revealed that the rating scale, majority of persons (>93%), and majority of items (20/23) fit the Rasch measurement model. The PMQ demonstrated adequate reliability (person reliability =0.67) and separated persons into two strata-those likely to misuse pain medication and those with low liklihood of misusing pain medication. CONCLUSIONS: Findings offer a deeper understanding of the measurement properties of the PMQ as a precursor for widespread population-based studies to elucidate the incidence of pain medication misuse in persons with SCI. Results also have important research and clinical implications for commonly used PMQ total score cut-offs, which may misclassify an individual's risk of pain medication misuse.

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We tested whether the G894T and T-786C NOS3 polymorphisms were associated with exercise cardiovascular (CV) hemodynamics in sedentary, physically active, and endurance-trained postmenopausal women. CV hemodynamic parameters including heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressures and cardiac output (Q), as determined by acetylene rebreathing, stroke volume (SV), arteriovenous oxygen difference (a-vO2 diff), and total peripheral resistance (TPR) were measured during submaximal (40, 60, 80 %) and maximal (approximately 100 % VO2max) exercise. NOS3 G894T genotype was not significantly associated, either independently or interactively with habitual physical activity (PA) level, with SBP, Q, TPR, or a-vO2 diff during submaximal or maximal exercise. However, NOS3 894T non-carriers had a higher submaximal exercise HR than NOS3 894T allele carriers (120 +/- 2 vs. 112 +/- 2 beats/min, p = 0.007). NOS3 894T allele carriers had a higher SV than 894T non-carriers (78 +/- 2 vs. 72 +/- 2 ml/beat, p = 0.03) during submaximal exercise. NOS3 894T non-carriers also had a higher maximal exercise HR averaged across habitual PA groups than T allele carrier women (165 +/- 2 vs. 158 +/- 2 beats/min, p = 0.04). NOS3 894T allele carriers also tended to have a higher SV during maximal exercise than 894T non-carriers (70 +/- 2 vs. 64 +/- 2 ml/beat, p = 0.08). NOS3 T-786C genotype was not significantly associated, either independently or interactively, with any of the CV hemodynamic measures during submaximal or maximal exercise. These results suggest an association of NOS3 G894T genotype with submaximal and maximal exercise CV hemodynamic responses, especially HR, in postmenopausal women.

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The ACE I/D polymorphism has been shown to interact with habitual physical activity levels in postmenopausal women to associate with submaximal and with maximal exercise hemodynamics. This investigation was designed to assess the potential relationships between ACE genotype and oxygen consumption (VO2), cardiac output (Q), stroke volume (SV), heart rate (HR), blood pressure (BP), total peripheral resistance (TPR), and arteriovenous oxygen difference ([a-v]O2 diff) during submaximal and maximal exercise in young sedentary and endurance-trained women. Seventy-seven 18-35-yr-old women underwent a maximal exercise test and a number of cardiac output tests on a treadmill using the acetylene rebreathing technique. ACE genotype was not significantly associated with VO2max (II 41.4+/-1.2, ID 39.8+/-0.9, DD 39.8+/-1.1 ml/kg/min, p=ns) or maximal HR (II 191+/-2, ID 191+/-1, DD 193+/-2 bpm, p=ns). In addition, systolic and diastolic BP, (a-v)O2 diff, TPR, SV, and Q during maximal exercise were not significantly associated with ACE genotype. During submaximal exercise, SBP, Q, SV, HR, TPR, and (a-v)O2 diff were not significantly associated with ACE genotype. However, the association between diastolic BP during submaximal exercise and ACE genotype approached significance (p=0.08). In addition, there were no statistically significant interactions between ACE genotype and habitual physical activity (PA) levels for any of the submaximal or the maximal exercise hemodynamic variables. We conclude that the ACE I/D polymorphism was not associated, independently or interacting with habitual PA levels, submaximal, or maximal cardiovascular hemodynamics in young women.

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Extracellular ATP is a broad-spectrum cytotoxic agent that produces effects via cell surface P2 purinoceptors. The ligand-gated P2X purinoceptor subtype has very high sequence homology with the RP-2 gene, which encodes for apoptosis. The P2X RNA found in rat vas deferens is expressed preferentially by apoptotic thymocytes. P2X purinoceptor-mediated phasic (twitch) motor responses of the isolated rat vas deferens to neurogenic or exogenous ATP were rapidly, specifically and irreversibly potentiated by bis(2-chloroethyl)sulfide (HD 10-100 microM). Both untreated and HD-potentiated neurogenic responses were Ca++ dependent, blocked in the absence of Ca++ plus 0.1 mM EGTA, by the neuronal Ca++ channel blocker omega-conotoxin-MVIIC (3 microM), by the P2 purinoceptor antagonist suramin (100 microM) and by tetrodotoxin (100 nM). HD also potentiated the effects of ATP on isolated guinea pig taenia caecum, where the nucleotide acts at G protein-coupled P2Y purinoceptor subtypes to cause relaxation. HD failed to inhibit the metabolism of ATP by ecto-ATPase in vas deferens or to cause the release of endogenous ATP. Potentiation of the twitch response to electric field stimulation by HD was attenuated or eliminated in tissues excised from rats previously challenged with topically applied HD, suggesting that HD absorbed into the systemic circulation had already effected maximal potentiation of ATP responses before in vitro testing. The physiological consequences of HD-induced potentiation of the extracellular actions of ATP are discussed in relation to apoptosis and necrosis.

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Problem-based learning (PBL) employs approaches to teaching and learning in nurse education that develop meaningful links between theory and practice. The adoption of such approaches, however, may require changes in pedagogical beliefs and practices which reflect a student-centred approach to teaching and learning. This paper focuses on a group of volunteer nurse educators (n = 14) who attended a 7-month professional development programme centred on introducing pedagogical changes when adopting PBL. From this group, three nurse educators participated in an in-depth study which aimed to examine the processes of conceptual change associated with adopting PBL as part of alternative teaching strategies. These three participants held common concerns about the changes required to their current teaching practices when moving to a new pedagogical approach. On completion of the programme, varying degrees of change in existing instructional practices were evident. This change was found to result from engaging educators in reflection about practice, providing opportunities to implement the new approaches on a trial basis, and providing feedback and support throughout the change process.

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This paper addresses the need to adopt teaching-learning approaches in nursing education that develop links between theory and clinical practice in a meaningful way. Problem-based learning (PBL) is such an approach and is gaining popularity in tertiary nursing programmes in Australia. PBL, as an example of the constructivist philosophy, focuses on students' existing knowledge as a starting point for conceptual change teaching. The implications for the nurse educator's role when using PBL are discussed in terms of assumptions about the nature of teaching and learning; conceptual change teaching; ability to focus; the role of negotiation; and the ability to analyse student learning. These factors are seen to be critical components of the pedagogy necessary for nurse educators to utilize PBL approaches effectively.

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Three oximes currently being evaluated for adoption as replacement nerve agent therapy by various countries were compared for therapeutic efficacy against the toxic organophosphate inhibitors soman and tabun under a standard set of conditions. These oximes together with PAM-Cl and toxogonin, were also compared for efficacy against GF, an agent weaponized by Iraq. The order of effectiveness against soman was HI-6 greater than HLö-7 greater than pyrimidoxime. HLö-7 was very effective against tabun poisoning while HI-6 and pyrimidoxime were of moderate value. Against GF, HI-6 and HLö-7 were extremely effective, toxogonin was moderately effective, and PAM-Cl and pyrimidoxime were the least effective. HI-6 provided a high level of protection against all of the agents tested as did HLö-7 to a slightly lesser degree. The other oximes suffered from their lack of effects against one or more of the organophosphates.

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Female rats poisoned with multiple LD50s of soman or tabun have been shown previously to respond to the protective effects of HI-6 more positively than male rats. This present study was designed first to determine the distribution pattern and concentration of [14C] HI-6 in rats, and secondly, to determine the possibility that HI-6 might be located in high concentrations in critical tissues in the female as opposed to the male. To these ends, [14C] HI-6 was administered to groups of male and female rats and its radiolabelled distribution determined by whole body autoradiography and/or by measurement of its actual concentration, by scintillation spectrometry. The experiments were repeated in the presence of 2 x LD50 soman and supporting therapy with atropine. In both sexes, HI-6 levels were highest in the kidney, followed in order by cartilage greater than plasma greater than liver greater than heart greater than or equal to lung greater than or equal to diaphragm greater than brain and spinal cord. The relative distribution in the two sexes was confirmed by both methods and was not significantly altered in the presence of soman and atropine. The lack of a measurable difference in tissue distribution of [14C] HI-6 derived radioactivity between males and females suggested that the hormone-dependent difference in the protective effects previously observed was not due to selective accumulation of [14C] HI-6 in organs believed to be important in its therapeutic activity, such as brain or diaphragm.

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The protective ratio produced by HI-6 (with atropine) against soman and tabun poisoning in rats and guinea pigs was determined. The amount of protection afforded by HI-6 decreased with time following poisoning, prompting us to examine the effects of repeated doses of HI-6 (four additional) given over a 5-hr period. In addition, it was determined that HI-6 produced much better protection in female rats than male rats, which led to a study of the hormone dependence of this activity. When in addition to the first dose of HI-6 four additional doses were given over a 5-hr period, the protective ratio, defined as LD50 in treated animals/LD50 in untreated animals, in males against soman, increased from 4.2 to 7.8, and against tabun, from 2.5 to 6.6. A single dose of HI-6 produced a protective ratio in females of 10.5 against soman and 4.3 against tabun, whereas multiple doses increased these values to greater than 27 and 22, respectively. A regimen consisting of gonad removal and long-term treatment with a sex hormone of the opposite gender reversed the sex-related differences in response to the protective effects of HI-6. In addition a single injection of HI-6 (plus atropine), 1 min following either soman or tabun, produced good protective ratios in guinea pigs against both soman (between 4 and 5) and tabun (5.1); however, there was no apparent hormone-dependent effect similar to that obtained in rats. The results demonstrate unequivocal protective effects of HI-6 against tabun and a very dramatic hormone-dependent factor in its activity against either organophosphate.(ABSTRACT TRUNCATED AT 250 WORDS)

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The acute toxicity of soman was assessed in eight strains of mice (ALAS, CD-1, C57BL, CF1, CFW, C3H, DBA and BALB/c). In fasted animals the LD50 values for soman varied from 98 micrograms/kg in C57BL mice to 151 micrograms/kg in BALB/c mice. In general in non-fasted mice the soman LD50 was not significantly changed except in ALAS strain where the soman LD50 value increased significantly. The different sensitivities to soman poisoning among the various strains does not appear to be due totally to differences in level of brain acetylcholinesterase. Fasting had no significant effect on the activity of brain acetylcholinesterase and soman toxicity in CD -1 mice whereas, upon fasting ALAS strain mice for 18 hr, there was a 25% decrease in brain acetylcholinesterase which could explain their increased sensitivity to soman however, it is possible that other biochemical changes may also play a role.

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