BACKGROUND A virtual patient (VP) can be a useful tool to foster the development of medical history-taking skills without the inherent constraints of the bedside setting. Although VPs hold the promise of contributing to the development of students' skills, documenting and assessing skills acquired through a VP is a challenge. OBJECTIVE We propose a framework for the automated assessment of medical history taking within a VP software and then test this framework by comparing VP scores with the judgment of 10 clinician-educators (CEs). METHODS We built upon 4 domains of medical history taking to be assessed (breadth, depth, logical sequence, and interviewing technique), adapting these to be implemented into a specific VP environment. A total of 10 CEs watched the screen recordings of 3 students to assess their performance first globally and then for each of the 4 domains. RESULTS The scores provided by the VPs were slightly higher but comparable with those given by the CEs for global performance and for depth, logical sequence, and interviewing technique. For breadth, the VP scores were higher for 2 of the 3 students compared with the CE scores. CONCLUSIONS Findings suggest that the VP assessment gives results akin to those that would be generated by CEs. https://www.selleckchem.com/products/mptp-hydrochloride.html Developing a model for what constitutes good history-taking performance in specific contexts may provide insights into how CEs generally think about assessment. ©Jean Setrakian, Geneviève Gauthier, Linda Bergeron, Martine Chamberland, Christina St-Onge. Originally published in JMIR Medical Education (http//mededu.jmir.org), 12.03.2020.BACKGROUND Internet search data on health-related terms can reflect people's concerns about their health status in near real time, and hence serve as a supplementary metric of disease characteristics. However, studies using internet search data to monitor and predict chronic diseases at a geographically finer state-level scale are sparse. OBJECTIVE The aim of this study was to explore the associations of internet search volumes for lung cancer with published cancer incidence and mortality data in the United States. METHODS We used Google relative search volumes, which represent the search frequency of specific search terms in Google. We performed cross-sectional analyses of the original and disease metrics at both national and state levels. A smoothed time series of relative search volumes was created to eliminate the effects of irregular changes on the search frequencies and obtain the long-term trends of search volumes for lung cancer at both the national and state levels. We also performed analyses of decoalence, incidence, and mortality rates of a broader range of cancers and even more health issues. ©Chenjie Xu, Hongxi Yang, Li Sun, Xinxi Cao, Yabing Hou, Qiliang Cai, Peng Jia, Yaogang Wang. Originally published in the Journal of Medical Internet Research (http//www.jmir.org), 12.03.2020.Inhibitory neurons play critical roles in regulating and shaping olfactory responses in vertebrates and invertebrates. In insects, these roles are performed by relatively few neurons, which can be interrogated efficiently, revealing fundamental principles of olfactory coding. Here, with electrophysiological recordings from the locust and a large-scale biophysical model, we analyzed the properties and functions of GGN, a unique giant GABAergic neuron that plays a central role in structuring olfactory codes in the locust mushroom body. Our simulations suggest that depolarization of GGN at its input branch can globally inhibit KCs several hundred microns away. Our in vivo recordings show that GGN responds to odors with complex temporal patterns of depolarization and hyperpolarization that can vary with odors and across animals, leading our model to predict the existence of a yet-undiscovered olfactory pathway. Our analysis reveals basic new features of GGN and the olfactory network surrounding it.Mammalian spermiogenesis is a remarkable cellular transformation, during which round spermatids elongate into chromatin-condensed spermatozoa. The signaling pathways that coordinate this process are not well understood, and we demonstrate here that homeodomain-interacting protein kinase 4 (HIPK4) is essential for spermiogenesis and male fertility in mice. HIPK4 is predominantly expressed in round and early elongating spermatids, and Hipk4 knockout males are sterile, exhibiting phenotypes consistent with oligoasthenoteratozoospermia. Hipk4 mutant sperm have reduced oocyte binding and are incompetent for in vitro fertilization, but they can still produce viable offspring via intracytoplasmic sperm injection. Optical and electron microscopy of HIPK4-null male germ cells reveals defects in the filamentous actin (F-actin)-scaffolded acroplaxome during spermatid elongation and abnormal head morphologies in mature spermatozoa. We further observe that HIPK4 overexpression induces branched F-actin structures in cultured fibroblasts and that HIPK4 deficiency alters the subcellular distribution of an F-actin capping protein in the testis, supporting a role for this kinase in cytoskeleton remodeling. Our findings establish HIPK4 as an essential regulator of sperm head shaping and potential target for male contraception. © 2020, Crapster et al.Volatile isoprenoids produced by plants are emitted in vast quantities into the atmosphere, with substantial effects on global carbon cycling. Yet, the molecular mechanisms regulating the balance between volatile and non-volatile isoprenoid production remain unknown. Isoprenoids are synthesised via sequential condensation of isopentenyl pyrophosphate (IPP) to dimethylallyl pyrophosphate (DMAPP), with volatile isoprenoids containing fewer isopentenyl subunits. The DMAPPIPP ratio could affect the balance between volatile and non-volatile isoprenoids, but the plastidic DMAPPIPP ratio is generally believed to be similar across different species. Here we demonstrate that the ratio of DMAPPIPP produced by hydroxymethylbutenyl diphosphate reductase (HDR/IspH), the final step of the plastidic isoprenoid production pathway, is not fixed. Instead, this ratio varies greatly across HDRs from phylogenetically distinct plants, correlating with isoprenoid production patterns. Our findings suggest that adaptation of HDR plays a previously unrecognised role in determining in vivo carbon availability for isoprenoid emissions, directly shaping global biosphere-atmosphere interactions.
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Endovascular repair of infra renal aortic aneurysm is becoming the preferable method of intervention compared to open surgery due to the lower early morbidity rates. One of the complications during the procedure is contra-lateral gate (CLG) maldeployment. Learning the endovascular salvage options is necessary to avoid the morbidities of open surgical conversion.
we present a case of maldeployment during an endovascular exclusion of aortic aneurysm in a high cardiac risk patient for whom an endovascular management was successful.
We discuss the detailed technical aspect in managing CLG maldeployment in our case as well as variable options from literature.
Despite the available possibility to convert to open, there are multiple endovascular bail out alternatives to manage maldeployment that can be successfully performed by experienced interventionalist.
Despite the available possibility to convert to open, there are multiple endovascular bail out alternatives to manage maldeployment that can be successfully performed by experienced interventionalist.
The calcaneo-fibular impingement syndrome is frequent after calcaneal fracture. The impinging lesion could be in bone and/or in soft tissue. The operative treatment aims to remove the impinging lesions either by open or endoscopic surgery.
We report a case of a 33-year female patient with calcaneo-fibular impingement syndrome. The condition was managed using endoscopic bone resection, soft tissue debridement and peroneal tendons release.
Endoscopic treatment of calcalneo-fibular impingement syndrome has gradually been broadened as a safe, minimally invasive, and effective procedure. This endoscopic approach could reduce the wound complications associated with the open procedure and ensure early return to activity, better cosmetic and better patient satisfaction. The lateral approach could reduce nervous and tendinous complications associated with posterior approach.
The endoscopic surgery using lateral approach is a reliable and a minimally invasive technique to address calcaneo-fibular impinging. However, this procedure is less useful for advanced cases of calcaneal malunion (Stephens and Sanders II and III).
The endoscopic surgery using lateral approach is a reliable and a minimally invasive technique to address calcaneo-fibular impinging. However, this procedure is less useful for advanced cases of calcaneal malunion (Stephens and Sanders II and III).
Trapped fourth ventricle (TFV) also known as isolated fourth ventricle (IFV) is a rare clinico-radiologic entity with only a few cases reported in the literatures. The aim of this article is to present the first case of this condition in our center and highlight the challenges of arriving at clinical diagnosis and treatment in a resource limited setting.
An 18 months old girl who had ventriculoperitoneal shunt insertion for post meningitic hydrocephalus 4 months earlier presented with restlessness, ataxia, fever and inability to control her neck of one-week duration. On examination she was restless and had retro-colis with a Glasgow Coma Scale (GCS) score of 11/15 (E4V2M5). She had an associated facial and abducent nerve palsies with global hypertonia, hyper-reflexia and muscle power of 3/5. She was initially treated for shunt infection and malfunction. However, shunt series and CSF analysis were within normal limits and CSF culture yielded no growth of microorganisms. A CT scan of the brain which was ordered earlier was delayed for 10 days due to financial constraints. The CT scan revealed a trapped fourth ventricle and slit lateral and third ventricle. She had emergency fourth ventriculoperitoneal shunt inserted on the left because of the pre-existing supratentorial shunt on the right. https://www.selleckchem.com/TGF-beta.html She did well after the surgery and was discharged on the 10th postoperative day. She was doing well 12 months after the surgery.
TFV may occur after insertion of VPS for post-meningitic hydrocephalus. This may present a diagnostic dilemma. Insertion of a second VPS may be an option in a resource limited setting.
TFV may occur after insertion of VPS for post-meningitic hydrocephalus. This may present a diagnostic dilemma. Insertion of a second VPS may be an option in a resource limited setting.
Little is known about the neural underpinnings of pediatric trichotillomania (TTM). We examined error-related negativity (ERN)-amplitude and theta-EEG power differences among youth with TTM, OCD, and healthy controls (HC).
Forty channel EEG was recorded from 63 pediatric participants (22 with TTM, 22 with OCD, and 19 HC) during the Eriksen Flanker Task. EEG data from inhibitory control were used to derive estimates of ERN amplitude and event-related spectral power associated with motor inhibition.
TTM and HC were similar in brain activity patterns in frontal and central regions and TTM and OCD were similar in the parietal region. Frontal ERN-amplitude was significantly larger in OCD relative to TTM and HC, who did not differ from each other. The TTM group had higher theta power compared to OCD in frontal and central regions, and higher theta than both comparison groups in right motor cortex and superior parietal regions. Within TTM, flanker task performance was correlated with EEG activity in frontal, central, and motor cortices whereas global functioning and impairment were associated with EEG power in bilateral motor and parietal cortices.
Findings are discussed in terms of shared and unique neural mechanisms in TTM and OCD and treatment implications.
Findings are discussed in terms of shared and unique neural mechanisms in TTM and OCD and treatment implications.
Frailty is prevalent in older adults and has adverse effects on multiple health outcomes. Pain, insomnia, and depressive symptoms are commonly seen and treatable symptoms in older adults and are associated with frailty. However, it is unknown whether these symptoms are independently associated with frailty and how they interact with each other creating a greater impact on frailty than individual symptoms. It is important to understand these associations for nurses to provide high-quality patient-centered care for older adults with frailty.
To determine independent associations of pain, insomnia, and depressive symptoms with frailty and examine their synergistic impact on frailty among older adults.
A cross-sectional analysis of a cohort study.
Communities in the United States.
Community-dwelling older adults from the National Health and Aging Trend Study (N=7,609), a nationally representative survey of Medicare Beneficiaries in the United States.
Frailty status was determined by five criteria of the Physical Frailty Phenotype exhaustion, low physical activity, weakness, slowness, and shrinking.
Geometric scaling predicts a major challenge for legged, terrestrial locomotion. Locomotor support requirements scale identically with body mass (α M1), while force-generation capacity should scale α M2/3 as it depends on muscle cross-sectional area. Mammals compensate with more upright limb postures at larger sizes, but it remains unknown how sprawling tetrapods deal with this challenge. Varanid lizards are an ideal group to address this question because they cover an enormous body size range while maintaining a similar bent-limb posture and body proportions. This study reports the scaling of ground reaction forces and duty factor for varanid lizards ranging from 7 g to 37 kg. Impulses (force×time) (α M0.99-1.34) and peak forces (α M0.73-1.00) scaled higher than expected. Duty factor scaled α M0.04 and was higher for the hindlimb than the forelimb. The proportion of vertical impulse to total impulse increased with body size, and impulses decreased while peak forces increased with speed.
Functional electrical stimulation (FES) induced cycling has been shown to be an effective rehabilitation for those with lower limb movement disorders. However, a consequence of FES is an electromechanical delay (EMD) existing between the stimulation input and the onset of muscle force. The objective of this study is to determine if the cycle crank angle has an effect on the EMD.
Experiments were performed on 10 participants, five healthy and five with neurological conditions resulting in movement disorders. A motor fixed the crank arm of a FES-cycle in 10° increments and at each angle stimulation was applied in a random sequence to a combination of the quadriceps femoris and gluteal muscle groups. The EMD was examined by considering the contraction delay (CD) and the residual delay (RD), where the CD (RD) is the time latency between the start (end) of stimulation and the onset (cessation) of torque. https://www.selleckchem.com/products/epacadostat-incb024360.html Two different measurements were used to examine the CD and RD. Further, two multiple linear regressions werrehabilitative treatments.Implications for rehabilitationNew model predicts the delayed response of muscle torque production to electrical stimulation as a function of limb position during FES cycling.The model can inform closed-loop electrical stimulation induced rehabilitative cycling.
Aphasia after stroke has been shown to lead to communication difficulties between healthcare professionals (HCP) and people with aphasia. Clinical guidelines emphasize the importance of teaching HCP to use supportive conversative techniques through communication partner training (CPT). The aim of this study is to explore and describe the experiences of HCP in communicating with people with aphasia and their needs and wishes for the content in CPT.
The data were collected through qualitative semi-structured interviews with 17 HCP. HCP were recruited from two geriatric rehabilitation centres in the Netherlands and one academic hospital in Belgium. The interviews drew upon the qualitative research methodologies ethnography and phenomenology and were thematically analysed using the six steps of Braun & Clarke.
Three themes were derived from the interviews. HCP experienced that communication difficulties impede healthcare activities (theme 1) and reported the need to improve communication through organizCP to use supportive conversation techniques and tools.An important condition for successful implementation of communication partner trainings in healthcare centres is to identify the experiences of HCP with communication with people with aphasia and their needs and wishes for training content.This study shows that communication problems between HCP and people with aphasia impede diagnosis and therapy with considerable implications for healthcare quality.The suggestions that HCP have concerning the content of communication partner trainings can be placed under "education" and "implementation and post-training support." HCP describe specific roles for speech-and language therapists to fulfil after the training and suggest two main changes that should be made at an organizational level.In this study, we investigated whether alertness training in healthy older adults increases visual processing speed (VPS) and whether functional connectivity in the cingulo-opercular network predicts training gain. Using the theory of visual attention, we derived quantitative estimates of VPS before and after training. In Study 1, 75 healthy older adults participated in alertness training, active-control training, or no training (n = 25 each). A significant Group × Session interaction indicated an increase in VPS in the alertness-training group but not in the control group, despite VPS not differing significantly between groups before training. In Study 2, 29 healthy older adults underwent resting-state functional MRI and then participated in alertness training. Pretraining functional connectivity in the cingulo-opercular network correlated with the individual training-induced change in VPS. In conclusion, results indicate that alertness training improves visual processing in older adults and that functional connectivity in the cingulo-opercular network provides a neural marker for predicting individual training gain.
While there is increasing effort among medical schools to recruit diverse students, there is a paucity of research into the unique experiences of these students during their transition to medicine. This study explored how experiences during medical school orientation influence students' transition into the medical profession.
Semi-structured interviews were conducted (April-August 2019) with 16 first-year Canadian medical students. We applied descriptive thematic analysis using a constant comparative approach. Verbatim transcripts were coded and analyzed to elucidate themes.
Participants highlighted the importance of social orientation during their transition into medical school and noted experiencing complex social pressures during this time. They shared how incoming students were introduced to the dominant medical professional identity during orientation. Participants noted tensions during this period, many of which revolved around the dominant identity and their past, present and future selves.
Longstanding issues of diversity and inclusion in medicine manifest from day one of medical school.
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BACKGROUND A virtual patient (VP) can be a useful tool to foster the development of medical history-taking skills without the inherent constraints of the bedside setting. Although VPs hold the promise of contributing to the development of students' skills, documenting and assessing skills acquired through a VP is a challenge. OBJECTIVE We propose a framework for the automated assessment of medical history taking within a VP software and then test this framework by comparing VP scores with the judgment of 10 clinician-educators (CEs). METHODS We built upon 4 domains of medical history taking to be assessed (breadth, depth, logical sequence, and interviewing technique), adapting these to be implemented into a specific VP environment. A total of 10 CEs watched the screen recordings of 3 students to assess their performance first globally and then for each of the 4 domains. RESULTS The scores provided by the VPs were slightly higher but comparable with those given by the CEs for global performance and for depth, logical sequence, and interviewing technique. For breadth, the VP scores were higher for 2 of the 3 students compared with the CE scores. CONCLUSIONS Findings suggest that the VP assessment gives results akin to those that would be generated by CEs. https://www.selleckchem.com/products/mptp-hydrochloride.html Developing a model for what constitutes good history-taking performance in specific contexts may provide insights into how CEs generally think about assessment. ©Jean Setrakian, Geneviève Gauthier, Linda Bergeron, Martine Chamberland, Christina St-Onge. Originally published in JMIR Medical Education (http//mededu.jmir.org), 12.03.2020.BACKGROUND Internet search data on health-related terms can reflect people's concerns about their health status in near real time, and hence serve as a supplementary metric of disease characteristics. However, studies using internet search data to monitor and predict chronic diseases at a geographically finer state-level scale are sparse. OBJECTIVE The aim of this study was to explore the associations of internet search volumes for lung cancer with published cancer incidence and mortality data in the United States. METHODS We used Google relative search volumes, which represent the search frequency of specific search terms in Google. We performed cross-sectional analyses of the original and disease metrics at both national and state levels. A smoothed time series of relative search volumes was created to eliminate the effects of irregular changes on the search frequencies and obtain the long-term trends of search volumes for lung cancer at both the national and state levels. We also performed analyses of decoalence, incidence, and mortality rates of a broader range of cancers and even more health issues. ©Chenjie Xu, Hongxi Yang, Li Sun, Xinxi Cao, Yabing Hou, Qiliang Cai, Peng Jia, Yaogang Wang. Originally published in the Journal of Medical Internet Research (http//www.jmir.org), 12.03.2020.Inhibitory neurons play critical roles in regulating and shaping olfactory responses in vertebrates and invertebrates. In insects, these roles are performed by relatively few neurons, which can be interrogated efficiently, revealing fundamental principles of olfactory coding. Here, with electrophysiological recordings from the locust and a large-scale biophysical model, we analyzed the properties and functions of GGN, a unique giant GABAergic neuron that plays a central role in structuring olfactory codes in the locust mushroom body. Our simulations suggest that depolarization of GGN at its input branch can globally inhibit KCs several hundred microns away. Our in vivo recordings show that GGN responds to odors with complex temporal patterns of depolarization and hyperpolarization that can vary with odors and across animals, leading our model to predict the existence of a yet-undiscovered olfactory pathway. Our analysis reveals basic new features of GGN and the olfactory network surrounding it.Mammalian spermiogenesis is a remarkable cellular transformation, during which round spermatids elongate into chromatin-condensed spermatozoa. The signaling pathways that coordinate this process are not well understood, and we demonstrate here that homeodomain-interacting protein kinase 4 (HIPK4) is essential for spermiogenesis and male fertility in mice. HIPK4 is predominantly expressed in round and early elongating spermatids, and Hipk4 knockout males are sterile, exhibiting phenotypes consistent with oligoasthenoteratozoospermia. Hipk4 mutant sperm have reduced oocyte binding and are incompetent for in vitro fertilization, but they can still produce viable offspring via intracytoplasmic sperm injection. Optical and electron microscopy of HIPK4-null male germ cells reveals defects in the filamentous actin (F-actin)-scaffolded acroplaxome during spermatid elongation and abnormal head morphologies in mature spermatozoa. We further observe that HIPK4 overexpression induces branched F-actin structures in cultured fibroblasts and that HIPK4 deficiency alters the subcellular distribution of an F-actin capping protein in the testis, supporting a role for this kinase in cytoskeleton remodeling. Our findings establish HIPK4 as an essential regulator of sperm head shaping and potential target for male contraception. © 2020, Crapster et al.Volatile isoprenoids produced by plants are emitted in vast quantities into the atmosphere, with substantial effects on global carbon cycling. Yet, the molecular mechanisms regulating the balance between volatile and non-volatile isoprenoid production remain unknown. Isoprenoids are synthesised via sequential condensation of isopentenyl pyrophosphate (IPP) to dimethylallyl pyrophosphate (DMAPP), with volatile isoprenoids containing fewer isopentenyl subunits. The DMAPPIPP ratio could affect the balance between volatile and non-volatile isoprenoids, but the plastidic DMAPPIPP ratio is generally believed to be similar across different species. Here we demonstrate that the ratio of DMAPPIPP produced by hydroxymethylbutenyl diphosphate reductase (HDR/IspH), the final step of the plastidic isoprenoid production pathway, is not fixed. Instead, this ratio varies greatly across HDRs from phylogenetically distinct plants, correlating with isoprenoid production patterns. Our findings suggest that adaptation of HDR plays a previously unrecognised role in determining in vivo carbon availability for isoprenoid emissions, directly shaping global biosphere-atmosphere interactions.
Endovascular repair of infra renal aortic aneurysm is becoming the preferable method of intervention compared to open surgery due to the lower early morbidity rates. One of the complications during the procedure is contra-lateral gate (CLG) maldeployment. Learning the endovascular salvage options is necessary to avoid the morbidities of open surgical conversion.
we present a case of maldeployment during an endovascular exclusion of aortic aneurysm in a high cardiac risk patient for whom an endovascular management was successful.
We discuss the detailed technical aspect in managing CLG maldeployment in our case as well as variable options from literature.
Despite the available possibility to convert to open, there are multiple endovascular bail out alternatives to manage maldeployment that can be successfully performed by experienced interventionalist.
Despite the available possibility to convert to open, there are multiple endovascular bail out alternatives to manage maldeployment that can be successfully performed by experienced interventionalist.
The calcaneo-fibular impingement syndrome is frequent after calcaneal fracture. The impinging lesion could be in bone and/or in soft tissue. The operative treatment aims to remove the impinging lesions either by open or endoscopic surgery.
We report a case of a 33-year female patient with calcaneo-fibular impingement syndrome. The condition was managed using endoscopic bone resection, soft tissue debridement and peroneal tendons release.
Endoscopic treatment of calcalneo-fibular impingement syndrome has gradually been broadened as a safe, minimally invasive, and effective procedure. This endoscopic approach could reduce the wound complications associated with the open procedure and ensure early return to activity, better cosmetic and better patient satisfaction. The lateral approach could reduce nervous and tendinous complications associated with posterior approach.
The endoscopic surgery using lateral approach is a reliable and a minimally invasive technique to address calcaneo-fibular impinging. However, this procedure is less useful for advanced cases of calcaneal malunion (Stephens and Sanders II and III).
The endoscopic surgery using lateral approach is a reliable and a minimally invasive technique to address calcaneo-fibular impinging. However, this procedure is less useful for advanced cases of calcaneal malunion (Stephens and Sanders II and III).
Trapped fourth ventricle (TFV) also known as isolated fourth ventricle (IFV) is a rare clinico-radiologic entity with only a few cases reported in the literatures. The aim of this article is to present the first case of this condition in our center and highlight the challenges of arriving at clinical diagnosis and treatment in a resource limited setting.
An 18 months old girl who had ventriculoperitoneal shunt insertion for post meningitic hydrocephalus 4 months earlier presented with restlessness, ataxia, fever and inability to control her neck of one-week duration. On examination she was restless and had retro-colis with a Glasgow Coma Scale (GCS) score of 11/15 (E4V2M5). She had an associated facial and abducent nerve palsies with global hypertonia, hyper-reflexia and muscle power of 3/5. She was initially treated for shunt infection and malfunction. However, shunt series and CSF analysis were within normal limits and CSF culture yielded no growth of microorganisms. A CT scan of the brain which was ordered earlier was delayed for 10 days due to financial constraints. The CT scan revealed a trapped fourth ventricle and slit lateral and third ventricle. She had emergency fourth ventriculoperitoneal shunt inserted on the left because of the pre-existing supratentorial shunt on the right. https://www.selleckchem.com/TGF-beta.html She did well after the surgery and was discharged on the 10th postoperative day. She was doing well 12 months after the surgery.
TFV may occur after insertion of VPS for post-meningitic hydrocephalus. This may present a diagnostic dilemma. Insertion of a second VPS may be an option in a resource limited setting.
TFV may occur after insertion of VPS for post-meningitic hydrocephalus. This may present a diagnostic dilemma. Insertion of a second VPS may be an option in a resource limited setting.
Little is known about the neural underpinnings of pediatric trichotillomania (TTM). We examined error-related negativity (ERN)-amplitude and theta-EEG power differences among youth with TTM, OCD, and healthy controls (HC).
Forty channel EEG was recorded from 63 pediatric participants (22 with TTM, 22 with OCD, and 19 HC) during the Eriksen Flanker Task. EEG data from inhibitory control were used to derive estimates of ERN amplitude and event-related spectral power associated with motor inhibition.
TTM and HC were similar in brain activity patterns in frontal and central regions and TTM and OCD were similar in the parietal region. Frontal ERN-amplitude was significantly larger in OCD relative to TTM and HC, who did not differ from each other. The TTM group had higher theta power compared to OCD in frontal and central regions, and higher theta than both comparison groups in right motor cortex and superior parietal regions. Within TTM, flanker task performance was correlated with EEG activity in frontal, central, and motor cortices whereas global functioning and impairment were associated with EEG power in bilateral motor and parietal cortices.
Findings are discussed in terms of shared and unique neural mechanisms in TTM and OCD and treatment implications.
Findings are discussed in terms of shared and unique neural mechanisms in TTM and OCD and treatment implications.
Frailty is prevalent in older adults and has adverse effects on multiple health outcomes. Pain, insomnia, and depressive symptoms are commonly seen and treatable symptoms in older adults and are associated with frailty. However, it is unknown whether these symptoms are independently associated with frailty and how they interact with each other creating a greater impact on frailty than individual symptoms. It is important to understand these associations for nurses to provide high-quality patient-centered care for older adults with frailty.
To determine independent associations of pain, insomnia, and depressive symptoms with frailty and examine their synergistic impact on frailty among older adults.
A cross-sectional analysis of a cohort study.
Communities in the United States.
Community-dwelling older adults from the National Health and Aging Trend Study (N=7,609), a nationally representative survey of Medicare Beneficiaries in the United States.
Frailty status was determined by five criteria of the Physical Frailty Phenotype exhaustion, low physical activity, weakness, slowness, and shrinking.
Geometric scaling predicts a major challenge for legged, terrestrial locomotion. Locomotor support requirements scale identically with body mass (α M1), while force-generation capacity should scale α M2/3 as it depends on muscle cross-sectional area. Mammals compensate with more upright limb postures at larger sizes, but it remains unknown how sprawling tetrapods deal with this challenge. Varanid lizards are an ideal group to address this question because they cover an enormous body size range while maintaining a similar bent-limb posture and body proportions. This study reports the scaling of ground reaction forces and duty factor for varanid lizards ranging from 7 g to 37 kg. Impulses (force×time) (α M0.99-1.34) and peak forces (α M0.73-1.00) scaled higher than expected. Duty factor scaled α M0.04 and was higher for the hindlimb than the forelimb. The proportion of vertical impulse to total impulse increased with body size, and impulses decreased while peak forces increased with speed.
Functional electrical stimulation (FES) induced cycling has been shown to be an effective rehabilitation for those with lower limb movement disorders. However, a consequence of FES is an electromechanical delay (EMD) existing between the stimulation input and the onset of muscle force. The objective of this study is to determine if the cycle crank angle has an effect on the EMD.
Experiments were performed on 10 participants, five healthy and five with neurological conditions resulting in movement disorders. A motor fixed the crank arm of a FES-cycle in 10° increments and at each angle stimulation was applied in a random sequence to a combination of the quadriceps femoris and gluteal muscle groups. The EMD was examined by considering the contraction delay (CD) and the residual delay (RD), where the CD (RD) is the time latency between the start (end) of stimulation and the onset (cessation) of torque. https://www.selleckchem.com/products/epacadostat-incb024360.html Two different measurements were used to examine the CD and RD. Further, two multiple linear regressions werrehabilitative treatments.Implications for rehabilitationNew model predicts the delayed response of muscle torque production to electrical stimulation as a function of limb position during FES cycling.The model can inform closed-loop electrical stimulation induced rehabilitative cycling.
Aphasia after stroke has been shown to lead to communication difficulties between healthcare professionals (HCP) and people with aphasia. Clinical guidelines emphasize the importance of teaching HCP to use supportive conversative techniques through communication partner training (CPT). The aim of this study is to explore and describe the experiences of HCP in communicating with people with aphasia and their needs and wishes for the content in CPT.
The data were collected through qualitative semi-structured interviews with 17 HCP. HCP were recruited from two geriatric rehabilitation centres in the Netherlands and one academic hospital in Belgium. The interviews drew upon the qualitative research methodologies ethnography and phenomenology and were thematically analysed using the six steps of Braun & Clarke.
Three themes were derived from the interviews. HCP experienced that communication difficulties impede healthcare activities (theme 1) and reported the need to improve communication through organizCP to use supportive conversation techniques and tools.An important condition for successful implementation of communication partner trainings in healthcare centres is to identify the experiences of HCP with communication with people with aphasia and their needs and wishes for training content.This study shows that communication problems between HCP and people with aphasia impede diagnosis and therapy with considerable implications for healthcare quality.The suggestions that HCP have concerning the content of communication partner trainings can be placed under "education" and "implementation and post-training support." HCP describe specific roles for speech-and language therapists to fulfil after the training and suggest two main changes that should be made at an organizational level.In this study, we investigated whether alertness training in healthy older adults increases visual processing speed (VPS) and whether functional connectivity in the cingulo-opercular network predicts training gain. Using the theory of visual attention, we derived quantitative estimates of VPS before and after training. In Study 1, 75 healthy older adults participated in alertness training, active-control training, or no training (n = 25 each). A significant Group × Session interaction indicated an increase in VPS in the alertness-training group but not in the control group, despite VPS not differing significantly between groups before training. In Study 2, 29 healthy older adults underwent resting-state functional MRI and then participated in alertness training. Pretraining functional connectivity in the cingulo-opercular network correlated with the individual training-induced change in VPS. In conclusion, results indicate that alertness training improves visual processing in older adults and that functional connectivity in the cingulo-opercular network provides a neural marker for predicting individual training gain.
While there is increasing effort among medical schools to recruit diverse students, there is a paucity of research into the unique experiences of these students during their transition to medicine. This study explored how experiences during medical school orientation influence students' transition into the medical profession.
Semi-structured interviews were conducted (April-August 2019) with 16 first-year Canadian medical students. We applied descriptive thematic analysis using a constant comparative approach. Verbatim transcripts were coded and analyzed to elucidate themes.
Participants highlighted the importance of social orientation during their transition into medical school and noted experiencing complex social pressures during this time. They shared how incoming students were introduced to the dominant medical professional identity during orientation. Participants noted tensions during this period, many of which revolved around the dominant identity and their past, present and future selves.
Longstanding issues of diversity and inclusion in medicine manifest from day one of medical school.
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