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Background: Local field potentials (LFPs) represent the summation of periodic (oscillations) and aperiodic (fractal) signals. Although previous studies showed changes in beta band oscillations and burst characteristics of the subthalamic nucleus (STN) in Parkinson's disease (PD), how aperiodic activity in the STN is related to PD pathophysiology is unknown. Objectives: The study aimed to characterize the long‐term effects of STN–deep brain stimulation (DBS) and dopaminergic medications on aperiodic activities and beta bursts. Methods: A total of 10 patients with PD participated in this longitudinal study. Simultaneous bilateral STN‐LFP recordings were conducted in six separate visits during a period of 18 months using the Activa PC + S device in the off and on dopaminergic medication states. We used irregular‐resampling auto‐spectral analysis to separate oscillations and aperiodic components (exponent and offset) in the power spectrum of STN‐LFP signals in beta band. Results: Our results revealed a systematic increase in both the exponent and the offset of the aperiodic spectrum over 18 months following the DBS implantation, independent of the dopaminergic medication state of patients with PD. In contrast, beta burst durations and amplitudes were stable over time and were suppressed by dopaminergic medications. Conclusions: These findings indicate that oscillations and aperiodic activities reflect at least partially distinct yet complementary neural mechanisms, which should be considered in the design of robust biomarkers to optimize adaptive DBS. Given the link between increased gamma‐aminobutyric acidergic (GABAergic) transmission and higher aperiodic activity, our findings suggest that long‐term STN‐DBS may relate to increased inhibition in the basal ganglia. © 2022 International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

In a typical go/no-go task a single imperative stimulus is presented each trial, either a go or no-go stimulus. Participants are instructed to initiate a known response upon appearance of the go-signal and withhold the response if the no-go signal is presented. It is unclear whether the go-response is prepared in advance of the imperative stimulus in a go/no-go task. Moreover, it is unclear if inhibitory control processes suppress preparatory go-activation. The purpose of the present experiment was 1) to determine whether the go-response is prepared in advance of stimulus identification with the use of a startling acoustic stimulus (SAS), and 2) investigate the inhibitory role of the right inferior frontal gyrus (rIFG) and pre-supplementary motor area (preSMA) during the performance of a go/no-go task with the use of continuous theta burst stimulation (cTBS). The experiment consisted of three phases; a pre-cTBS phase in which participants completed a go/no-go and simple-RT task, followed by offline cTBS to temporarily deactivate either rIFG or preSMA (with a sham control), then a post-cTBS phase which was identical to the pre-cTBS phase. Results revealed that stimulation to both cortical sites impaired participants’ ability to withhold movements during no-go trials. Notably, rIFG or preSMA stimulation did not affect the latency of voluntary go-responses and did not enable the SAS to involuntarily trigger responses. These findings suggest that preparation and initiation of the go-response occurs after the imperative stimulus, with the rIFG and preSMA involved in inhibiting the go-response once the stimulus is identified as a no-go signal. [ABSTRACT FROM AUTHOR]

Increased reaction times (RT) during choice-RT tasks stem from a requirement for additional processing as well as reduced motor-specific preparatory activation. Transcranial direct current stimulation (tDCS) can modulate primary motor cortex excitability, increasing (anodal stimulation) or decreasing (cathodal stimulation) excitability in underlying cortical tissue. The present study investigated whether lateralized differences in choice-RT would result from the concurrent modulation of left and right motor cortices using bi-hemispheric tDCS. Participants completed a choice-RT task requiring either a left or right wrist extension. In forced-choice trials an illuminated target indicated the required response, whereas in free-choice trials participants freely selected either response upon illumination of a central fixation. Following a pre-test trial block, offline bi-hemispheric tDCS (1 mA) was applied over the left and right motor cortices for 10 minutes, which was followed by a post-tDCS block of RT trials. Twelve participants completed three experimental sessions, two with real tDCS (anode right, anode left), as well as a sham tDCS session. Post-tDCS results showed faster RTs for both right and left responses irrespective of tDCS polarity during forced-choice trials, while sham tDCS had no effect. In contrast, no stimulation-related RT or response selection differences were observed in free-choice trials. The present study shows evidence of an effector-independent speeding of response initiation in a forced-choice RT task following bi-hemispheric tDCS and yields novel information regarding the functional effect of bi-hemispheric tDCS. [ABSTRACT FROM AUTHOR]

During a simple reaction time (RT) task, movements can be initiated early and involuntarily through presentation of a loud startling acoustic stimulus (SAS), a phenomenon termed the StartReact effect. In order to infer that activity in startle-related structures led to the early response triggering, it is important to observe a concurrent startle reflex in sternocleidomastoid. It is generally accepted that to consistently elicit a startle reflex, the SAS must be both intense and unpredictable. However, it remains unclear what effect explicit foreknowledge of an impending SAS has on the effectiveness of a SAS to elicit a startle reflex when preparing a motor response. To test this, participants completed two separate blocks of a simple RT task (counterbalanced order), where the control auditory go-signal was replaced with a SAS on 20 % of trials. In an unwarned block, knowledge of the trial type (SAS vs. control) was not provided in advance, while in a warned block, the trial type was forewarned. Results revealed that while foreknowledge of an impending SAS reduced the magnitude of the startle reflex, it did not affect the proportion of startle reflexes elicited or the magnitude of the StartReact effect. An increase in control trial RT was observed during the unwarned block, but only when it was performed first. These results indicate that preparation of a motor response leads to sufficiently increased activation in startle-related neural structures such that even with explicit knowledge of an upcoming SAS, participants are unable to proactively gate the upcoming sensory input. [ABSTRACT FROM AUTHOR]

It has been proposed that, in a stop-signal task (SST), independent go- and stop-processes "race" to control behavior. If the go-process wins, an overt response is produced, whereas, if the stop-process wins, the response is withheld. One prediction that follows from this proposal is that, if the activation associated with one process is enhanced, it is more likely to win the race. We looked to determine whether these initiation and inhibition processes (and thus response outcomes) could be manipulated by using a startling acoustic stimulus (SAS), which has been shown to provide additional response activation. In the present study, participants were to respond to a visual go-stimulus; however, if a subsequent stop-signal appeared, they were to inhibit the response. The stop-signal was presented at a delay corresponding to a probability of responding of 0.4 (determined from a baseline block of trials). On stop-trials, a SAS was presented either simultaneously with the go-signal or stop-signal or 100, 150, or 200 ms following the stop-signal. Results showed that presenting a SAS during stop-trials led to an increase in probability of responding when presented with or following the stop-signal. The latency of SAS responses at the stop-signal + 150 ms and stop-signal + 200 ms probe times suggests that they would have been voluntarily inhibited but instead were involuntarily initiated by the SAS. Thus results demonstrate that go-activation endures even 200 ms following a stop-signal and remains accessible well after the response has been inhibited, providing evidence against a winner-take-all race between independent go- and stop-processes. New & noteworthy: In this study, a startling acoustic stimulus (SAS) was used to determine whether response outcome could be manipulated in a stop-signal task. Results revealed that presenting a SAS during stop-signal trials led to an increase in probability of responding even when presented 200 ms following the stop-signal. The latency of SAS responses indicates that go-activation remains accessible and modifiable well after the response is voluntarily inhibited, providing evidence against an irrevocable commitment to inhibition. [ABSTRACT FROM AUTHOR]

In a stop-signal task participants are instructed to initiate a movement in response to a go signal, but to inhibit this movement if an infrequent stop signal is presented after the go. Reaction time (RT) in a stop-signal task is typically longer compared with that in a simple RT task, which may be attributed to a reduced readiness to initiate the response caused by the possibility of having to inhibit the response. The purpose of this experiment was to probe the preparatory activation level of the motor response during a stop-signal task using a startling acoustic stimulus (SAS), which has been shown to involuntarily trigger sufficiently prepared responses at a short latency. Participants completed two separate tasks: a simple RT task, followed by a stop-signal RT task. During both tasks, an SAS (120 dB) was pseudorandomly presented concurrently with the go signal. As expected, RT during the simple RT task was significantly shorter than during the stop-signal task. A significant reduction in RT was noted when an SAS was presented during the simple RT task; however, during the stop-signal task, an SAS resulted in either a significant speeding or a moderate delay in RT. Additionally, the subset of SAS trial responses with the shortest RT latencies produced during the stop-signal task were also delayed compared with the short-latency SAS trial responses observed during the simple RT task. Despite evidence that a response was prepared in advance of the go signal during a stop-signal task, it appears that the amount of preparatory activation was reduced compared with that achieved during a simple RT task. [ABSTRACT FROM AUTHOR]

Background: The proportion of Canadians living with Alzheimer disease and related dementias is projected to rise, with an increased burden on the primary health care system in particular. Our objective was to describe the prevalence and management of dementia in a community-dwelling sample using electronic medical record (EMR) data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), which consists of validated, national, point-of-care data from primary care practices. Methods: We used CPCSSN data as of Dec. 31, 2012, for patients 65 years and older with at least 1 clinical encounter in the previous 2 years. A validated case definition for dementia was used to calculate the national and provincial prevalence rates, to examine variations in prevalence according to age, sex, body mass index, rural or urban residence, and select comorbid conditions, and to describe patterns in the pharmacologic management of dementia over time at the provincial level. Results: The age-standardized prevalence of dementia among community-dwelling patients 65 years and older was 7.3%. Prevalence estimates increased with age; they also varied between provinces, and upward trends were observed. Dementia was found to be associated with comorbid diabetes, depression, epilepsy and parkinsonism. Most of the patients with dementia did not have a prescription for a dementia-related medication recorded in their EMR between 2008 and 2012 inclusive. Those who had a prescription were most often prescribed donepezil by their primary care provider. Interpretation: Overall prevalence estimates for dementia based on EMR data in this sample managed in primary care were generally in line with previous estimates based on administrative data, survey results or clinical sources. [ABSTRACT FROM AUTHOR]

Objectives: Family interaction and intergenerational dynamics have been known to influence the efficacy of therapeutic interventions and as such, the understanding of such dynamics in the experience of transitions can assist in strengthening the support provided to families living with such diagnoses. As such, the aims and objectives of this work were to develop a deeper understanding of family transition in early-onset dementia and to construct a representative model of this experience. Method: This qualitative study used an 'initial-and-follow-up' interview design with semistructured in-depth interviews in participants' homes. A framework approach to qualitative data analysis was used in order to identify important points of transition in the family experience of early-onset dementia and how families frame and respond to their own health expectations. Results: Nine families provided written informed consent to participate in the study. The nine participating families were made up of 20 participants, including nine spousal pairs and two young adult children. Each family participated in two research interviews in their individual homes. Four major themes emerged from the data: Diagnosis; Finances; Relationships; and Meaningful Activity. Conclusion: Transitions experienced by families in early-onset dementia can be significantly impacted by the opportunity and availability of meaningful activity and/or a purposeful role. Not only does this activity benefit both the person with dementia and their family, but also supports much needed home and community living for people with dementia, as demonstrated by predicted future bed shortages in Canadian hospitals and long term care facilities. [ABSTRACT FROM AUTHOR]

When a startling acoustic stimulus (SAS) is presented during a simple reaction time (RT) task, it can trigger the prepared response through an involuntary initiation pathway. Previous research modelling the effects of presenting a SAS at various intervals following a non-startling auditory imperative signal (IS) suggested that involuntary initiation-related neural activation is additive with the voluntary initiation processes. The current study tested the predictions of this additive model when the SAS and IS are of different modalities by using a visual rather than auditory go-signal. Because voluntary RT latencies are delayed for visual stimuli compared to acoustic stimuli, it was hypothesised that the time course of additive activation would be similarly delayed. Participants performed 150 RT trials requiring a targeted 20° wrist extension task with a SAS presented 0–125 ms following a visual go-signal. Results were not different to those predicted by an additive model ( p = 0.979), yet were significantly different to those predicted by a horse-race model ( p = 0.037), indicating a joint contribution of voluntary and involuntary activation, even when the IS and SAS are of different modalities. Furthermore, the results indicated that voluntary RT differences due to stimulus modality are attributable to processes that occur prior to the increase in initiation-related activation. [ABSTRACT FROM AUTHOR]

Previous studies have used a secondary probe reaction time (RT) task to assess attentional demands of a primary task. The current study used a startling acoustic stimulus (SAS) in a probe RT paradigm to test the hypothesis that attentional resources would be directly related to limitations in response preparation. Participants performed an easy or difficult version of a continuous primary task that was either primarily motor in nature (pursuit tracking) or cognitive (counting backward). Concurrently, participants responded to an auditory cue as fast as possible by performing a wrist extension secondary movement. On selected trials, the auditory cue was replaced with a SAS (120 dB), which is thought to involuntarily trigger a prepared response and thus bypass any response initiation bottleneck that may be present when trying to perform two movements. Although startle trials were performed at a shorter latency, both non-startle and startle probe trials resulted in a delayed RT, as compared to single-task trials, consistent with reduced preparation of the secondary task. In addition, analysis of SAS trial RT when a startle indicator was present versus absent provided evidence that the secondary task was at a lowered state of preparation when engaged in the cognitive primary task as compared to a motor primary task, suggesting a facilitative effect on preparatory activation when both the primary and secondary tasks are motoric in nature. [ABSTRACT FROM AUTHOR]

The present study investigated whether differences in reaction time (RT) between movements initiated to a visual cue (directly cued) versus movements initiated to a location other than the visual cue (indirectly cued) arise because of varying levels of inhibition within the motor system during response preparation. Unlike typical visuomotor mental rotation (VMR) experiments, this study employed a simple RT paradigm to allow response preparation to occur in advance of the imperative stimulus (IS). Participants responded to the IS by either moving directly to the location of a visual cue or to a location that required a mental transformation between the visual cue and the intended movement goal (i.e., a location 60, 90, or 120 degrees rotated with respect to the visual cue). To probe motor-related activation during response preparation, a startling acoustic stimulus (SAS, 124 dB) was randomly presented 500 ms, 1,000 ms, or 1,500 ms after visual cue onset, but before the IS. Results showed similar RTs during nonstartle control trials regardless of rotation angle and whether trials were completed in a random or blocked design. Additionally, SAS trials showed a low incidence of early response triggering across all time points regardless of whether the movement was directly or indirectly cued. In contrast, directly cued movements performed outside of the VMR context showed a high incidence of SAS response triggering. These results suggest that when a stimulus to target-goal transformation might be required, inhibitory suppression of motor-related activation arises regardless of whether the final movement is directly or indirectly cued. [ABSTRACT FROM AUTHOR]

We evaluate binding energies of trions X±, excitons bound by a donor or acceptor charge XD(A), and overcharged acceptors or donors in two-dimensional atomic crystals by mapping the three-body problem in two dimensions onto one particle in a three-dimensional potential treatable by a purposely developed boundary-matching-matrix method. We find that in monolayers of transition metal dichalcogenides the dissociation energy of X± is typically much larger than that of localized exciton complexes, so that trions are more resilient to heating, despite the fact that their recombination line in optics is less redshifted from the exciton line than the line of XD(A). [ABSTRACT FROM AUTHOR]

Quantum Monte Carlo methods provide in principle a highly accurate treatment of the many-body problem of calculating the ground and excited states of condensed systems. In practice, however, uncontrolled errors, such as those arising from the fixed-node and pseudopotential approximations can be problematic. We show that the accuracy of some quantum Monte Carlo calculations is limited by the properties of currently available pseudopotentials. The use of pseudopotentials involves several approximations, and we will focus on one that is relatively simple to correct during the pseudopotential design phase. It is necessary to include angular-momentum channels in the pseudopotential for excited angular-momentum states and to choose the local channel appropriately to obtain accurate results. Variational and diffusion Monte Carlo calculations for Zn, O, and Si atoms and ions demonstrate these issues. Adding higher-angular-momentum channels into the pseudopotential description reduces such errors without a significant increase in computational cost. [ABSTRACT FROM AUTHOR]

Highlights: [•] Stop-signal anticipation-timing performance was examined following tDCS over SMA. [•] Anodal tDCS led to a decreased probability of inhibition on stop trials. [•] Anodal tDCS resulted in early response initiation compared to pre-tDCS. [•] No change in the probability of inhibition was found following cathodal tDCS. [ABSTRACT FROM AUTHOR]

Abstract: Previous investigations comparing direct versus indirectly cued movements have consistently shown that indirectly cued movements take longer to prepare (Neely and Heath, 2010. Brain Res. 1366, 129–140) and involve the recruitment of additional brain areas (Connolly et al., 2000. J. Neurophysiol. 84, 1645–1655). ). This increase in processing time has been associated with the additional cognitive transformations required of the task (Neely and Heath, 2010. Brain Res. 1366, 129–140).. In the present study we investigated whether differences between direct versus indirectly cued movements are also reflected in the time course of motor preparation. Participants performed a targeting task, moving directly to the location of a visual cue (i.e., directly cued movement) or to a location that differed by 60°, 90°, or 120° with respect to the visual cue provided (i.e., indirectly cued movements). Participants were instructed to initiate their movements concurrently with an anticipated go-signal. To examine the time course of motor preparation, a startling acoustic stimulus (SAS, 124dB) was randomly presented 150ms, 500ms, or 1000ms prior to the go-signal. Results from the startle trials revealed that the time course of motor preparation was similar regardless of the angle of rotation required and hence whether it was a direct or indirectly cued trial. Specifically, motor preparation was delayed until less than 500ms prior to movement initiation for both direct and indirectly cued movements. These findings indicate that similar motor preparation strategies are engaged for both types of cued movements, suggesting that the time to prepare a motor response may be similar regardless of whether a cognitive transformation is required. [Copyright &y& Elsevier]

Comments on the issues concerning the interchange of personal health information in Canada. Increase in the use of electronic patients record; Legislation on health information; Ethical debate concerning the accessibility of health record systems.

'Quality of life' has become an important feature of research into patient outcomes, but an agreed definition of the term remains elusive. In order to empirically assess the meaning of quality of life for lay people, an ethnographic study was conducted using a sample of 22 patients suffering chronic, moderately severe asthma. The findings indicated that asthma was in general not considered to be important in the process of assessing or experiencing quality. The principal source of vaiue for respondents was described as the experience of happiness in the context of emotionally-significant social relationships. Sources of value appeared to be subject to variation between individuals and through time, implying that quality of life should be considered to be an existential concept. The process of attributing value to a subjective condition is best conceived of as an aesthetic one, involving an emotional engagement with (rather than rational evaluation of) everyday experience. [ABSTRACT FROM AUTHOR]

Growing evidence suggests that both the medial prefrontal cortex (mPFC) and the subthalamic nucleus (STN) play crucial roles in conflict processing, but how these two structures coordinate their activities remains poorly understood. We simultaneously recorded electroencephalogram from the mPFC and local field potentials from the STN using deep brain stimulation electrodes in 13 Parkinson's disease patients while they performed a Stroop task. Both mPFC and STN showed significant increases in theta activities (2-8 Hz) in incongruent trials compared to the congruent trials. The theta activity in incongruent trials also demonstrated significantly increased phase synchronization between mPFC and STN. Furthermore, the amplitude of gamma oscillation was modulated by the phase of theta activity at the STN in incongruent trials. Such theta-gamma phase-amplitude coupling (PAC) was much stronger for incongruent trials with faster reaction times than those with slower reaction times. Elevated theta-gamma PAC in the STN provides a novel mechanism by which the STN may operationalize its proposed "hold-your-horses" role. The co-occurrence of mPFC-STN theta phase synchronization and STN theta-gamma PAC reflects a neural substrate for fronto-subthalamic communication during conflict processing. More broadly, it may be a general mechanism for neuronal interactions in the cortico-basal ganglia circuits via a combination of long-range, within-frequency phase synchronization and local cross-frequency PAC. [ABSTRACT FROM AUTHOR]

Background: The Dixon-Woods et al. Candidacy Framework, a valuable tool since its 2006 introduction, has been widely utilized to analyze access to various services in diverse contexts, including healthcare. This social constructionist approach examines micro, meso, and macro influences on access, offering concrete explanations for access challenges rooted in socially patterned influences. This study employed the Candidacy Framework to explore the experiences of individuals living with rheumatoid arthritis (RA) and their formal care providers. The investigation extended to assessing supports and innovations in RA diagnosis and management, particularly in primary care. Methods: This systematic review is a Critical Interpretive Synthesis (CIS) of qualitative and mixed methods literature. The CIS aimed to generate theory from identified constructs across the reviewed literature. The study found alignment between the seven dimensions of the Candidacy Framework and key themes emerging from the data. Notably absent from the framework was an eighth dimension, identified as the "embodied relational self." This dimension, central to the model, prompted the proposal of a revised framework specific to healthcare for chronic conditions. Results: The CIS revealed that the eight dimensions, including the embodied relational self, provided a comprehensive understanding of the experiences and perspectives of individuals with RA and their care providers. The proposed Candidacy 2.0 (Chronic Condition (CC)) model demonstrated how integrating approaches like Intersectionality, concordance, and recursivity enhanced the framework when the embodied self was central. Conclusions: The study concludes that while the original Candidacy Framework serves as a robust foundation, a revised version, Candidacy 2.0 (CC), is warranted for chronic conditions. The addition of the embodied relational self dimension enriches the model, accommodating the complexities of accessing healthcare for chronic conditions. Trial Registration: This study did not involve a health care intervention on human participants, and as such, trial registration is not applicable. However, our review is registered with the Open Science Framework at https://doi.org/10.17605/OSF.IO/ASX5C. [ABSTRACT FROM AUTHOR]

Evaluates the efficacy of routine self monitoring of peak flow for asthma outpatients. Differences between patients randomized self monitoring of peak flow and conventional monitoring; Increase in general practice consultations of recorded peak flow meter; Guidelines for asthma management.

Evaluates the integrated care for asthma in clinical, social and economic terms. Difference between patients receiving integrated asthma care and conventional outpatient care; Percentage of forced expiratory volume; Efficacy of integrated care for asthma patients.

• DBS is a therapeutic as well as an investigative tool to reveal STN function. • Clinical and electrophysiological evidence suggest the STN is critical for cognition. • The STN plays a role in inhibition, decision-making, motivation and emotion. • The STN is an integration hub for associative, limbic and sensorimotor information. Recent progress in targeted interrogation of basal ganglia structures and networks with deep brain stimulation in humans has provided insights into the complex functions the subthalamic nucleus (STN). Beyond the traditional role of the STN in modulating motor function, recognition of its role in cognition was initially fueled by side effects seen with STN DBS and later revealed with behavioral and electrophysiological studies. Anatomical, clinical, and electrophysiological data converge on the view that the STN is a pivotal node linking cognitive and motor processes. The goal of this review is to synthesize the literature to date that used DBS to examine the contributions of the STN to motor and non-motor cognitive functions and control. Multiple modalities of research have provided us with an enhanced understanding of the STN and reveal that it is critically involved in motor and non-motor inhibition, decision-making, motivation and emotion. Understanding the role of the STN in cognition can enhance the therapeutic efficacy and selectivity not only for existing applications of DBS, but also in the development of therapeutic strategies to stimulate aberrant circuits to treat non-motor symptoms of Parkinson's disease and other disorders. [ABSTRACT FROM AUTHOR]

A new phase V of hydrogen was recently claimed in experiments above 325 GPa and 300 K. Because of the extremely small sample size at such record pressures the measurements were limited to Raman spectroscopy. The experimental data on increase of pressure show decreasing Raman activity and darkening of the sample, which suggests band gap closure and impending molecular dissociation, but no definite conclusions could be reached. Furthermore, the available data are insufficient to determine the structure of phase V, which remains unknown. Introducing saddle-point ab initio random structure searching, we find several new structural candidates of hydrogen which could describe the observed properties of phase V. We investigate hydrogen metallization in the proposed candidate structures, and demonstrate that smaller band gaps are associated with longer bond lengths. We conclude that phase V is a stepping stone towards metallization. [ABSTRACT FROM AUTHOR]

Corticospinal output pathways have typically been considered to be the primary driver for voluntary movements of the hand/forearm; however, more recently, reticulospinal drive has also been implicated in the production of these movements. Although both pathways may play a role, the reticulospinal tract is thought to have stronger connections to flexor muscles than to extensors. Similarly, movements involuntarily triggered via a startling acoustic stimulus (SAS) are believed to receive greater reticular input than voluntary movements. To investigate a differential role of reticulospinal drive depending on movement type or acoustic stimulus, corticospinal drive was transiently interrupted using high-intensity transcranial magnetic stimulation (TMS) applied during the reaction time (RT) interval. This TMS-induced suppression of cortical drive leads to RT delays that can be used to assess cortical contributions to movement. Participants completed targeted flexion and extension movements of the wrist in a simple RT paradigm in response to a control auditory go signal or SAS. Occasionally, suprathreshold TMS was applied over the motor cortical representation for the prime mover. Results revealed that TMS significantly increased RT in all conditions. There was a significantly longer TMS-induced RT delay seen in extension movements than in flexion movements and a greater RT delay in movements initiated in response to control stimuli compared with SAS. These results suggest that the contribution of reticulospinal drive is larger for wrist flexion than for extension. Similarly, movements triggered involuntarily by an SAS appear to involve greater reticulospinal drive, and relatively less corticospinal drive, than those that are voluntarily initiated. NEW & NOTEWORTHY Through the use of the transcranial magnetic stimulation-induced silent period, we provide novel evidence for a greater contribution of reticulospinal drive, and a relative decrease in corticospinal drive, to movements involuntarily triggered by a startle compared with voluntary movements. These results also provide support for the notion that both cortical and reticular structures are involved in the neural pathway underlying startle-triggered movements. Furthermore, our results indicate greater reticulospinal contribution to wrist flexion than extension movements. [ABSTRACT FROM AUTHOR]

Highlights • A startling acoustic stimulus (SAS) was used to probe motor preparatory state. • The SAS was presented during the 500-ms foreperiod of a simple reaction time (RT) task. • The number of responses elicited by the SAS plateaued 400 ms after the warning signal. • For a simple RT task with a short foreperiod, response preparation can take 300–400 ms. Abstract Response preparation in simple reaction time (RT) tasks has been modeled as an increase in neural activation to a sub-threshold level, which is maintained until the go-signal. However, the amount of time required for response preparation following a warning signal (WS) is currently unclear, as experiments typically employ long foreperiods to ensure maximal preparation. The purpose of the present experiments was to examine the time course of motor preparation in a simple RT task when given a limited amount of time to engage in preparatory processing. In Experiment 1, participants completed wrist extension movements in a simple RT paradigm with a short (500 ms) fixed foreperiod, and a long (8.5–10.5 s) inter-trial interval. To probe response preparation, a startling acoustic stimulus (SAS), which involuntarily triggers the release of sufficiently prepared responses, was randomly presented during the foreperiod at one of six equally spaced time points between 0 and 500 ms prior to the go-signal. Results showed that the long inter-trial interval was not always effective at preventing participants from engaging in preparatory processing between trials; thus, in Experiment 2 participants performed wrist flexion or extension movements in an instructed delay paradigm, where the required movement was cued by the WS. Results showed that the proportion of startle trials where the intended response was elicited by the SAS at short latency significantly increased until 100 ms prior to the go-signal, indicating response preparation can take up to 300–400 ms following the WS in a simple RT task with a short fixed foreperiod. [ABSTRACT FROM AUTHOR]

The article provides information on nanometre-sized diamond molecule called diamondoids. The molecule possesses a number of interesting and unusual optoelectronic properties such as a negative electron affinity. It also consists of one or more cages of carbon atoms, which have the same structure as bulk diamond, with the dangling bonds on the surfaces of the molecules being terminated by hydrogen atoms.

Objective: Documenting cannabis use is important for patient care, but no formal requirements for consistent reporting exist in primary care. The objective of this study was to understand how cannabis use is documented in primary care electronic medical record (EMR) data. Results: This was a cross-sectional study using de-identified EMR data from over 398,000 patients and 333 primary care providers in Alberta, Canada. An automated pattern-matching algorithm was developed to identify text and ICD-9 diagnostic codes indicating cannabis use in the EMR. There was a total of 11,724 records indicating cannabis use from 4652 patients, representing approximately 1.2% of the patient sample. Commonly used terms and ICD-9 codes included cannabis, marijuana/marihuana, THC, 304.3 and 305.2. Nabilone was the most frequently prescribed cannabinoid medication. Slightly more males and those with a chronic condition had cannabis use recorded more often. Overall, very few patients have cannabis use recorded in primary care EMR data and this is not captured in a systematic way. We propose several strategies to improve the documentation of cannabis use to facilitate more effective clinical care, research, and surveillance. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) is an important contributor to the health of Canadians. However, the extent that PA is included in family medicine residents' education is largely unknown. This study surveyed curriculum experts in Canadian family medicine residency programs to understand what residents learn about PA and to what extent this varies across programs. Methods: Seventeen family medicine residency program websites were reviewed for information pertaining to their PA curriculum. Additionally, curriculum experts were invited to complete a cross-sectional survey to better understand the extent that PA curriculum is included in their programs. Results: Most (82.4%) of the eligible programs responded to the survey; of which, the majority (92.9%) indicated that residents learn that: physical inactivity is a risk factor for chronic conditions, to incorporate PA into patient care plans, and to recommend PA as prevention for chronic diseases. However, only half (50.0%) of the programs stated that they believe residents will be sufficiently prepared to incorporate PA in the care they provide patients. Less than half (42.9%) of the programs teach PA guidelines, and few (21.4%) teach about PA-related referral to an allied health care provider or community program. Conclusions: The instruction about PA that family physicians receive in Canadian residency programs varies depending on the program. A standard to ensure residents are sufficiently and competently prepared to recommend and advise PA as treatment and prevention is needed. Additional studies are needed to understand the opinions and teachings of preceptors who may have an influence over the residency training of Canadian family physicians. [ABSTRACT FROM AUTHOR]

Background: Primary care initiatives face an imperative to not only reduce barriers to care for their patients but also to uniquely accommodate the complex needs of at-risk patient populations. Patient-centered multidisciplinary care team models for primary care, like the Alex Seniors Clinic, are one approach for providing comprehensive care for marginalized seniors. The purpose of this qualitative study was to explore patient perspectives on the responsiveness of the Alex Seniors Clinic to their stated health needs. Results: Themes reflected participants' perspectives on factors impacting their health needs as vulnerable seniors as well as on the measures that the Alex Seniors Clinic has taken to meet those needs. Factors impacting health included: the nature of their relationships to the physical environment in which they lived, the nature of the relationships they had to others in that environment, and independence and autonomy. Participants identified accessibility, respect and support, and advocacy as the ways in which the clinic was working to address those health needs. Conclusions: While respect and support, as well as advocacy, effectively addressed some patient needs, participants felt that accessibility problems continue to be health-related barriers for clinic patients. This may be due to the fact that issues of accessibility reflect larger community and social problems. Nevertheless, it is only through engaging the patient community for input on clinic approaches that an understanding can be gained of how closely a clinic's care goals are currently aligning with patient perspectives of the care and services they receive. [ABSTRACT FROM AUTHOR]

Background: The dementias are long-term, chronic conditions caused by progressive neurological degeneration. Current literature suggests that cardiovascular disease risk factors may contribute to the onset of dementia; however, evidence of these associations is inconsistent.Objectives: This study aimed to examine the impact of risk factors on dementia onset in older adults diagnosed and managed in Canadian primary care settings.Methods: A retrospective cohort study was employed utilizing electronic medical records data in the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Patients aged 65+ years with no dementia diagnosis at baseline who were followed from 2009 to 2017 with a run-in year to exclude existing undiagnosed dementia cases. Multivariate Cox proportional hazard models were used to estimate risk.Results: Age was associated with an increased incidence risk of dementia in both examined age groups: 65-79 years (13%) and 80+ years (5%). History of depression increased dementia risk by 38% and 34% in the age groups. There were significant associations with lower social deprivation area quintile, smoking history, osteoarthritis, and diabetes mellitus in patients aged 65-79 years but not in those aged 80+ years. Sex, hypertension, obesity, dyslipidemia, and the use of antihypertensive medications and statins were not associated with risk of incident dementia diagnosis.Conclusions: The association between chronic health conditions and dementia onset is complicated. Primary care electronic medical record data might be useful for research in this topic, though follow-up time is still relatively short to observe a clear causal relationship. Future studies with more complete data may provide evidence for dementia preventive strategies within primary care practice. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in Canada. Assessment and management of CVD risk is essential in reducing disease burden. This includes both clinical risk factors and socioeconomic factors, though few studies report on socioeconomic status in relation to CVD risk and treatment. The primary objective of this study was to estimate the cardiovascular risk of patients attending primary care practices across Canada; secondly, to evaluate concordance with care indicators suggested by current clinical practice guidelines for statin prescribing according to patients' cardiovascular risk and socioeconomic status. Methods: This cross-sectional observational study used the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database, which is comprised of clinical data from primary care electronic medical records. Patients aged 35-75y with at least one visit to their primary care provider between 2012 and 2016 were included. Patients were assigned to a CVD risk category (high, medium, low) and a deprivation quintile was calculated for those with full postal code available. Descriptive analyses were used to determine the proportion of patients in each risk category. Logistic regression was used to evaluate the consistency of statin prescribing according to national clinical guidelines by risk category and deprivation quintile. Results: A total of 324,526 patients were included. Of those, 116,947 (36%) of patients were assigned to a high CVD risk category, primarily older adults, males, and those with co-morbidities. There were statistically significant differences between least (quintile 1) and most (quintile 5) deprived socioeconomic quintiles, with those at high CVD risk disproportionately in Q5 (odds ratio 1.4). Overall, 48% of high-risk patients had at least one statin prescription in their record. Patients in the lower socioeconomic groups had a higher risk of statin treatment which deviated from clinical guidelines. Conclusions: Primary care patients who are at high CVD risk are more often male, older, have more co-morbidities and be assigned to more deprived SES quintiles, compared to those at low CVD risk. Additionally, patients who experience more challenging socioeconomic situations may be less likely to receive CVD treatment that is consistent with care guidelines. [ABSTRACT FROM AUTHOR]

The nonadditive dispersion contribution to the binding energy of three one-dimensional (ID) wires is investigated using wires modeled by (i) chains of hydrogen atoms and (ii) homogeneous electron gases. We demonstrate that the nonadditive dispersion contribution to the binding energy is significantly enhanced compared with that expected from Axilrod-Teller-Muto-type triple-dipole summations and follows a different power-law decay with separation. The tri wire nonadditive dispersion for ID electron gases scales according to the power law d-β, where d is the wire separation, with exponents β(rs) smaller than 3 and slightly increasing with rs from 2.4 at rs = 1 to 2.9 at rs = 10, where rs is the density parameter of the ID electron gas. This is in good agreement with the exponent β = 3 suggested by the leading-order charge-flow contribution to the triwire nonadditivity, and is a significantly slower decay than the ~d-7 behavior that would be expected from triple-dipole summations. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the content of physical activity inputs in Canadian family physician electronic medical records. Of 1 225 948 patients aged 18–64 years, a sample of 1535 patients' charts were reviewed. A minority (n = 148; 9.6%) of patients had at least 1 mention of physical activity at any time. Insufficient information existed to determine physical activity domain (21.6%), purpose (50.0%), or meeting of guidelines (98.1%). Novelty: This study examines the physical activity content of what Canadian family physicians document in their electronic medical records. [ABSTRACT FROM AUTHOR]

Background: Dementia is an increasing concern in many countries, especially in those experiencing rapid growth in the proportion of older adults in their population.Objective: This study aims to describe trends and demographic characteristics of incident dementia cases in community-dwelling older adults managed by primary care physicians.Methods: We used electronic medical records from the Canadian Primary Care Sentinel Surveillance Network database to conduct a retrospective analysis to determine the number of, and trends for, incident diagnoses of dementia. Age-standardized annual incidence rates were calculated. Participants in our cohort are Canadian community dwelling seniors aged 65+ years who were not diagnosed with dementia before baseline with at least six years of record at their primary care clinics.Results: The cohort consisted of 39 067 patients of whom 57% were females; the mean (SD) follow-up was 8.4 (1.5) years. During follow-up, 4935 patients were diagnosed with dementia. The risk for dementia diagnosis increased with increasing age but decreased in the last four years among people aged 80 and older at baseline (P < 0.001). People with dementia were more likely to be females (P = 0.001) and urban residents (P < 0.001), they are less likely to be classified into the least deprived group (P = 0.012).Conclusions: The incidence of dementia diagnosis increased with age except in the oldest old in both sexes. This may be attributed to the effect of mortality competing risk. Future research on the association between risk factors and dementia should consider studying dementia among the oldest old separately to minimize bias. [ABSTRACT FROM AUTHOR]

Objectives: This paper explores the role of immigrant-serving agencies in facilitating access to dementia services and supports provided by dementia service agencies (particularly the health authority and local chapters of the Alzheimer Society) through their propensity to develop trusting relationships between staff and clients. Design: Our research is a qualitative case study of Punjabi and Korean speakers living in the Lower Mainland of BC, Canada. Data are drawn from interviews with 15 dyads of persons with dementia and their family caregivers (10 Punjabi, 5 Korean), six focus groups (one focus group with each of 8–10 older men, older women, and mixed gender working age adults in each community). We also interviewed 20 managerial and frontline staff of dementia service agencies, i.e. the health authority and the local Alzheimer Society (n = 11) and two immigrant-serving agencies (n = 9), each dedicated to either Punjabi or Korean-speaking clients. We adopted the Candidacy framework for understanding access to dementia services and supports and the concept of trust as guiding precepts in this study. Results: Families of persons with dementia are pivotal to identification of a problem requiring professional help, navigation to appropriate services and acceptance of services offered. However, trust in family members should not be taken for granted, since family dynamics are complex. Alternative sources of trusted support are therefore needed. Immigrant-serving agencies are more often instrumental in establishing trusted relationships between their staff and clients, but they often lack detailed knowledge about heath conditions, their treatment and management, and they lack power to implement statutory care. Conclusions: Partnerships between mainstream mental health/dementia services and the community sector have proven successful in increasing the accessibility of specialized resources, while maximizing their combined trustworthiness, accessibility and effectiveness. Such partnerships should become fundamental components of health service strategy and provision for vulnerable and underserved immigrant older adults. [ABSTRACT FROM AUTHOR]

We use a combined ab initio calculations and k · p theory based approach to derive a low-energy effective Hamiltonian for monolayer MoS2 at the K point of the Brillouin zone. It captures the features which are present in first-principles calculations but not explained by the theory of Xiao et al. [Phys Rev Lett 108, 196802 (2012)], namely the trigonal warping of the valence and conduction bands, the electron-hole symmetry breaking, and the spin splitting of the conduction band. We also consider other points in the Brillouin zone which might be important for transport properties. Our findings lead to a more quantitative understanding of the properties of this material in the ballistic limit. [ABSTRACT FROM AUTHOR]

There is a paucity of qualitative research in the intersection of refugee return studies and the health professional ‘brain drain’ literature. This study uses a multiple life history approach to examine factors influencing the return of 15 Sudanese physicians to their home country. In 2006 the University of Calgary and Samaritan’s Purse Canada implemented a training programme for these 15 refugees from Sudan exiled since 1985 who had trained as physicians in Cuba. We found that barriers to their return were overcome by programme assistance with financial obligations, navigation of Canadian government processes involving citizenship, and English language and medical skills upgrading. The arrival of these individuals in their homeland where they currently practise medicine required the sustained alignment of returnee commitment and motivation to return with significant support. These findings highlight the potential for targeted return assistance programmes in stimulating a reversal of ‘brain drain’ migration. [ABSTRACT FROM PUBLISHER]

This article explores clients' perceptions of a family practice-based social work program as a step towards better understanding the feasibility of social work as an integral part of primary care in Ontario, Canada. A questionnaire was developed based on an instrument designed to measure levels of satisfaction with social work services and for which there is some evidence for face validity and internal consistency. A single family practice unit with a solo practitioner, results can be generalized only with caution. However, they are relevant to the current debate on the future of primary care in Canada, and may be so in other jurisdictions internationally. Relationship problems, with their attendant emotional and psychological difficulties, were the most commonly reported reason for social work contact, reinforcing the need for specialist couple and family therapy in addition to current provision. Most respondents reported that the program was effective in helping them deal with their situation, and that they were satisfied with the service received.

Background: Research based in primary care suggests that hearing loss may be underreported as well as inconsistently recorded in patient histories. In this study, we aimed to develop and validate a case definition for hearing loss among older adults in primary care, using electronic medical records. Methods: We used data from adult patients aged 55 years and older from 13 practices in the Southern Alberta Primary Care Research Network database, part of the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), from Dec. 1, 2014, to Dec. 31, 2016. We developed a hearing loss case definition that was translated into an electronic algorithm. A record review was undertaken as the reference standard, followed by application of the algorithm to the sample. Validation metrics included sensitivity, specificity, positive predictive value and negative predictive value, as well as prevalence. We assessed risk factors using the Fisher exact test and odds ratios. Results: The sample included 1000 patients; 496 (49.6%) were female and the mean age was 67.5 (standard deviation 9.6) years. Sensitivity of the case definition algorithm was determined to be 87.3% (95% confidence interval [CI] 76.5%–94.4%) with specificity valued at 94.8% (95% CI 93.1%–96.1%). Positive and negative predictive values were 52.9% (95% CI 42.8%–62.8%) and 99.1% (95% CI 98.2%–99.6%), respectively. The prevalence of hearing loss within the sample was 6.3% (95% CI 4.9%–7.9%). Older age was a significant risk factor for hearing loss (t = 4.98, 95% CI 3.76–8.65). Men had greater odds of hearing loss than women (odds ratio 1.65, 95% CI 0.98–2.79). Interpretation: The validated case definition for hearing loss in community-based older adults had high sensitivity and specificity. It may be applied to surveillance and future epidemiologic research within the CPCSSN database. [ABSTRACT FROM AUTHOR]

The interconnection of the angular gyrus of right posterior parietal cortex (PPC) and the left motor cortex (LM1) is essential for goal-directed hand movements. Previous work with transcranial magnetic stimulation (TMS) showed that right PPC stimulation increases LM1 excitability, but right PPC followed by left PPC-LM1 stimulation (LPPC-LM1) inhibits LM1 corticospinal output compared with LPPC-LM1 alone. It is not clear if right PPC-mediated inhibition of LPPC-LM1 is due to inhibition of left PPC or to combined effects of right and left PPC stimulation on LM1 excitability. We used paired-pulse TMS to study the extent to which combined right and left PPC stimulation, targeting the angular gyri, influences LM1 excitability. We tested 16 healthy subjects in five paired-pulsed TMS experiments using MRI-guided neuronavigation to target the angular gyri within PPC. We tested the effects of different right angular gyrus (RAG) and LM1 stimulation intensities on the influence of RAG on LM1 and on influence of left angular gyrus (LAG) on LM1 (LAG-LM1). We then tested the effects of RAG and LAG stimulation on LM1 short-interval intracortical facilitation (SICF), short-interval intracortical inhibition (SICI), and long-interval intracortical inhibition (LICI). The results revealed that RAG facilitated LM1, inhibited SICF, and inhibited LAG-LM1. Combined RAG-LAG stimulation did not affect SICI but increased LICI. These experiments suggest that RAG-mediated inhibition of LAG-LM1 is related to inhibition of early indirect (I)-wave activity and enhancement of GABAB receptor-mediated inhibition in LM1. The influence of RAG on LM1 likely involves ipsilateral connections from LAG to LM1 and heterotopic connections from RAG to LM1. NEW & NOTEWORTHY Goal-directed hand movements rely on the right and left angular gyri (RAG and LAG) and motor cortex (M1), yet how these brain areas functionally interact is unclear. Here, we show that RAG stimulation facilitated right hand motor output from the left M1 but inhibited indirect (I)-waves in M1. Combined RAG and LAG stimulation increased GABAB, but not GABAA, receptor-mediated inhibition in left M1. These findings highlight unique brain interactions between the RAG and left M1. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a common chronic condition affecting nearly a quarter of Canadians. Hypertension surveillance in Canada typically relies on administrative data and/or national surveys. Routinely-captured data from primary care electronic medical records (EMRs) are a complementary source for chronic disease surveillance, with longitudinal patient-level details such as sociodemographics, blood pressure, weight, prescribed medications, and behavioural risk factors. As EMR data are generated from patient care and administrative tasks, assessing data quality is essential before using for secondary purposes. This study evaluated the quality of primary care EMR data from one province in Canada within the context of hypertension surveillance.Methods: We conducted a cross-sectional, descriptive study using primary care EMR data collected by two practice-based research networks in Alberta, Canada. There were 48,377 adults identified with hypertension from 53 clinics as of June 2018. Summary statistics were used to examine the quality of data elements considered relevant for hypertension surveillance.Results: Patient year of birth and sex were complete, but other sociodemographic information (ethnicity, occupation, education) was largely incomplete and highly variable. Height, weight, body mass index and blood pressure were complete for most patients (over 90%), but a small proportion of outlying values indicate data inaccuracies were present. Most patients had a relevant laboratory test present (e.g. blood glucose/glycated hemoglobin, lipid profile), though a very small proportion of values were outside a biologically plausible range. Details of prescribed antihypertensive medication, such as start date, strength, dose, frequency, were mostly complete. Nearly 80% of patients had a smoking status recorded, though only 66% had useful information (i.e. categorized as current, past, or never), and less than half had their alcohol use described; information related to amount, frequency or duration was not available.Conclusions: Blood pressure and prescribed medications in primary care EMR data demonstrated good completeness and plausibility, and contribute valuable information for hypertension epidemiology and surveillance. The use of other clinical, laboratory, and sociodemographic variables should be used carefully due to variable completeness and suspected data errors. Additional strategies to improve these data at the point of entry and after data extraction (e.g. statistical methods) are required. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a common chronic condition affecting nearly a quarter of Canadians. Hypertension surveillance in Canada typically relies on administrative data and/or national surveys. Routinely-captured data from primary care electronic medical records (EMRs) are a complementary source for chronic disease surveillance, with longitudinal patient-level details such as sociodemographics, blood pressure, weight, prescribed medications, and behavioural risk factors. As EMR data are generated from patient care and administrative tasks, assessing data quality is essential before using for secondary purposes. This study evaluated the quality of primary care EMR data from one province in Canada within the context of hypertension surveillance. Methods: We conducted a cross-sectional, descriptive study using primary care EMR data collected by two practice-based research networks in Alberta, Canada. There were 48,377 adults identified with hypertension from 53 clinics as of June 2018. Summary statistics were used to examine the quality of data elements considered relevant for hypertension surveillance. Results: Patient year of birth and sex were complete, but other sociodemographic information (ethnicity, occupation, education) was largely incomplete and highly variable. Height, weight, body mass index and blood pressure were complete for most patients (over 90%), but a small proportion of outlying values indicate data inaccuracies were present. Most patients had a relevant laboratory test present (e.g. blood glucose/glycated hemoglobin, lipid profile), though a very small proportion of values were outside a biologically plausible range. Details of prescribed antihypertensive medication, such as start date, strength, dose, frequency, were mostly complete. Nearly 80% of patients had a smoking status recorded, though only 66% had useful information (i.e. categorized as current, past, or never), and less than half had their alcohol use described; information related to amount, frequency or duration was not available. Conclusions: Blood pressure and prescribed medications in primary care EMR data demonstrated good completeness and plausibility, and contribute valuable information for hypertension epidemiology and surveillance. The use of other clinical, laboratory, and sociodemographic variables should be used carefully due to variable completeness and suspected data errors. Additional strategies to improve these data at the point of entry and after data extraction (e.g. statistical methods) are required. [ABSTRACT FROM AUTHOR]

The relative contributions of reticulospinal versus corticospinal pathways for movement production are thought to be dependent on the type of response involved. For example, unilateral distal movements involving the hand and finger have been thought to be primarily driven by corticospinal output, whereas bilateral responses are considered to have greater reticulospinal drive. The current study investigated whether a difference in the relative contribution of reticulospinal drive to a bimanual versus unimanual finger movement could be assessed using a StartReact protocol. The StartReact effect refers to the early and involuntary initiation of a prepared movement when a startle reflex is elicited. A decreased response latency on loud stimulus trials where a startle reflex is observed in sternocleidomastoid (SCM+ trials) confirms the StartReact effect, which is attributed to increased reticulospinal drive associated with engagement of the startle reflex circuitry. It was predicted that a StartReact effect would be absent for the predominantly corticospinal-mediated unimanual finger movement but present for the bimanual finger movement due to stronger reticulospinal drive. Results supported both predictions as reaction time was statistically equivalent for SCM+ and SCM+ trials during unimanual finger movements but significantly shorter for SCM+ trials during bimanual finger movements. These results were taken as strong and novel evidence for increased reticulospinal output for bimanual finger movements. NEW & NOTEWORTHY The relative contributions of reticulospinal and corticospinal pathways to movement initiation are relatively unknown but appear to depend on the involved musculature. Here, we show that unimanual finger movements, which are predominantly initiated via corticospinal pathways, are not triggered at short latency by a startling acoustic stimulus (SAS), while bimanual finger movements are triggered by the SAS. This distinction is attributed to increased reticulospinal drive for bilateral responses. [ABSTRACT FROM AUTHOR]

Background: To date, there has been no validated method to identify cases of pelvic floor disorders in primary care electronic medical record (EMR) data. We aimed to develop and validate symptom-based case definitions for urinary incontinence, fecal incontinence and pelvic organ prolapse in women, for use in primary care epidemiologic or clinical research. Methods: Our retrospective study used EMR data from the Southern Alberta Primary Care Research Network (SAPCReN) and the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) in southern Alberta. Trained researchers remotely reviewed a random sample of EMR charts of women aged 18 years or older from 6 rural and urban clinics to validate case definitions for urinary incontinence, fecal incontinence and pelvic organ prolapse. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), and estimated SAPCReN prevalence as appropriate. Results: Charts of 900 women were included. Sensitivity was 81.9% (95% confidence interval [CI] 75.1–87.2) for urinary incontinence, 61.2% (95% CI 46.2–74.5) for fecal incontinence, and 51.8% (95% CI 40.6–62.8) for pelvic organ prolapse. Corresponding specificity values were 71.9% (95% CI 68.4–75.1), 99.2% (95% CI 98.2–99.6) and 98.8% (95% CI 97.7–99.4), PPVs 40.6% (95% CI 35.4–46.0), 81.1% (95% CI 64.3–91.4) and 81.1% (95% CI 67.6–90.1), and NPVs 94.4% (95% CI 92.1–96.1), 97.8% (95% CI 96.5–98.6) and 95.3% (95% CI 93.6–96.6). The SAPCReN-observed prevalence for urinary incontinence was 29.7% (95% CI 29.3–30.0), but the adjusted prevalence was 2.97%. Interpretation: The case definition for urinary incontinence met our standard for validity (sensitivity and specificity > 70%), and the case definitions for fecal incontinence and pelvic organ prolapse had PPVs greater than 80%. The urinary incontinence definition may be used in epidemiologic research, and those for fecal incontinence and pelvic organ prolapse may be used in quality-improvement studies or creation of disease registries. Our symptom-based case definitions could also be adapted for research in other EMR settings. [ABSTRACT FROM AUTHOR]