Search

The purpose of this study was to examine coactivation patterns of the lateral and medial quadriceps and the lateral and medial hamstrings during low- and moderate-speed isokinetic movements. Twelve female athletes performed isokinetic knee assessments at 60 and 180 degrees/s. Root mean square electromyographic (rmsEMG) activity and the median frequency of the EMG (mfEMG) were determined by placing bipolar surface electrodes on the vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), and medial hamstrings (MH). Results of rmsEMG indicated that the VM showed almost twice the coactivation of the VL (p <.05), and that the BF showed almost four times the coactivation of the MH (P < .05). Finally, differences were noted in the mfEMG (p < .05), with the VM displaying different recruitment patterns at 180 degrees/s as an agonist compared to that as an antagonist. Results indicated that when acting as antagonists, the VM and BF display the greatest EMG patterns during isokinetic knee joint movement. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the effect of ankle position on the electromyographic (EMG) activity, peak torque, and peak knee flexion to extension torque ratio during isokinetic testing of the knee. Twelve healthy female athletes performed six maximal knee extension and flexion repetitions with their dominant legs at 60 and 180 degrees/s with the ankle in a plantar flexed position and again in a dorsiflexed position. Root mean square EMG (rmsEMG) activity was determined by placing bipolar surface electrodes on the quadriceps and the hamstrings. Ankle position had no effect on the rmsEMG activity of the quadriceps or the hamstrings at either 60 or 180 degrees/s. Significant differences were noted for peak flexor torque at 60 degrees/s (p < .001) and 180 degrees/s (P <.0 1) and for peak torque flexor/extensor ratio (p <.01), with higher values observed with ankle dorsiflexion. This suggests that ankle position affects knee flexor torque and flexor/extensor ratio but not hamstring activity during isokinetic testing of the knee. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the efficacy of closed kinetic chain exercises in preferentially recruiting the oblique fibers of the vastus medialis obliquus (VMO). Fifteen athletically active females, 6 with patellofemoral pain syndrome (PFPS) and 9 without PFPS, performed two isometric and two dynamic closed kinetic chain exercises. The isometric exercises were a static lunge with 30 degrees of knee flexion (SL@30 degrees) and with 70 degrees of knee flexion (SL@70 degrees). The dynamic exercises were a step-up/step-down exercise (SUSD) and a modified wall slide (MWS). Selective recruitment of the VMO occurred during the MWS (p < .05) and the SUSD in the subjects without PFPS (p < .05). For the SL@70 degrees (p < .01), the MWS (p < .01), and the SUSD (n < .05), subjects with PFPS had greater activity of the vastus lateralis (VL), resulting in a lower VMO:VL ratio for those exercises (p < .05). It was concluded that the closed kinetic chain exercises examined in this study do not preferentially recruit the VMO in individuals. with PFPS. In addition, individuals with PFPS have a lower VMO:VL ratio during these exercises compared to individuals without PFPS. [ABSTRACT FROM AUTHOR]

Background: An informant-based screening tool for dementia may be useful in population-based studies of minority populations.Objective: Investigate the feasibility of screening for very mild dementia in a community sample of African Americans using an informant-based screening tool (AD8).Design: Cohort study.Participants: One hundred forty-seven persons from the African American Health (AAH) project were screened for dementia; 61 of 93 who were invited had follow-up clinical assessments for dementia diagnosis.Measurements: The AD8, Mini-Mental State Examination, Short Blessed Test, Brief Instrument for Dementia Detection, and a neuropsychologic battery were administered at visit 1. The Clinical Dementia Rating (CDR) was administered at visit 2 by clinicians blinded to visit 1 results; the presence of dementia was determined by a CDR greater than 0.Results: Four hundred sixty-five individuals from the AAH cohort were sent a letter describing the study and, among this group, 252 individuals were contacted by phone to request participation in this study. Six percent (14/252) of the participants contacted by phone were unable to identify an informant (required for the AD8). One hundred fifty individuals agreed by phone to participate of which 2% (n=3) did not have an informant available at the time of participation. The AD8 alone was effective at discriminating between CDR 0 and CDR 0.5 (area under the curve=0.847; P<0.001; 95% confidence interval, 0.73-0.96).Conclusions: A brief informant-based instrument, the AD8, has high sensitivity and specificity for distinguishing CDR 0 from CDR 0.5 in the community. Informant availability may not be a barrier for using the AD8 in an African American community sample; however, further study in larger samples with a higher response rate, different community settings (eg, community clinics), and among older age groups (eg, age 75+) is warranted to confirm this. [ABSTRACT FROM AUTHOR]

Examining the effects of fatigue on hamstrings' functioning can provide useful information regarding their role in stabilizing the knee joint. The purpose of the present investigation was to determine the effect of fatiguing, maximum effort, reciprocal isokinetic flexion-extension movements on peak torque (PT) and average torque (AVT) of the knee flexors and extensors, and agonist and antagonist medial hamstrings (MH) and biceps femoris (BF) surface electromyography (SEMG), as measured by the root mean square amplitude (RMS) and median frequency of the frequency spectrum (MDF). Ten healthy adult female university students (age=22.5 ± 2.0 years) performed 32 maximal effort contractions of the quadriceps (extension) followed by maximal effort contractions of the hamstrings (flexion) at an angular velocity of 400°· s{-1}. Data were normalized (as a percentage) and compared to maximum voluntary contractions (MVC) at repetitions 8, 16, 24, and 32. Separate repeated measures analyses of variance were performed on data to determine changes from MVC levels. Results indicated: (1) there were significant declines in PT and AVT from MVC levels across repetitions tested; (2) when acting as agonists MH and BF displayed increased RMS across repetitions tested, except from repetition 8-to-16; (3) when acting as antagonists MH and BF displayed no significant differences in RMS across repetitions tested; and, (4) there was a steady decline in MDF across repetitions tested in both MH and BF muscles when acting as agonists and antagonists, indicating a shift in motor unit recruitment from fast-to-slow twitch units. Based on the results, it appears that the MH and BF behave in unison when acting as either agonists or antagonists but as a muscle pair, they behave differently when acting in agonist or antagonist mode. As agonists, the MH and BF displayed increased amplitude and decreased spectral frequency over the course of a fatiguing, maximum effort, reciprocal isokinetic flexion-extension test performed at 400°·s{-1}. However, when acting as antagonists, they displayed stable amplitude with decreasing spectral frequency. [ABSTRACT FROM AUTHOR]

In exploring the cognitive reserve hypothesis in persons with substantial Alzheimer disease neuropathology, we aimed to determine the extent to which educational attainment and densities of diffuse plaques, neuritic plaques, and neurofibrillary tangles predict dementia. Participants were 1563 individuals aged 65 years or above who were assessed for dementia within 1 year of death. Generalized linear mixed models were used to examine whether education and density ratings of diffuse plaques and neuritic plaques, and neurofibrillary tangle stage were associated with a dementia diagnosis. Education interacted with densities of neuritic plaques to predict dementia. Tangle density independently predicted dementia, but did not interact with education. Diffuse plaque density was unrelated to dementia when adjusted for densities of neuritic plaques and tangles. Among individuals with Alzheimer disease neuropathology, educational attainment, as a surrogate of cognitive reserve, modifies the influence of neuritic, but not diffuse, plaque neuropathology on the expression of dementia. [ABSTRACT FROM AUTHOR]

Objective: Little is known about changes in self-rated health (SRH) among African Americans. Method: We examined SRH changes and trajectories among 998 African Americans 49 to 65 years old who we reinterviewed annually for 4 years, using multinomial logistic regression and mixed effect models. Results: Fifty-five percent had the same SRH at baseline and 4 years later, 25% improved, and 20% declined. Over time, men were more likely to report lower SRH levels, individuals with hypertension were less likely to report lower SRH levels, and those with congestive heart failure at baseline were more likely to report higher SRH levels. Lower SRH trajectory intercepts were observed for those with lower socioeconomic status, poorer health habits, disease history, and worse functional status. Those with better cognitive status had higher SRH trajectory intercepts. Discussion: The decline in SRH levels among 49- to 65-year-old African Americans is comparable to that of Whites. [ABSTRACT FROM AUTHOR]

The initial Point of View: Directions for Research (Neurorehabilitation and Neural Repair, 2007;21:3-13) identified confounders that might limit the impact that rehabilitation multicenter clinical trials may have upon altering practice patterns. Part of that viewpoint addressed the Extremity Constraint Induced Therapy Evaluation (EXCITE) Trial and highlighted some of its perceived strengths and limitations. The present Point of View expands upon factors worthy of consideration in planning and executing clinical trials in neurorehabilitation based upon experiences encountered by the EXCITE team. Cost factors and patient attributes, both of which profoundly influence the ability of clinical researchers to execute the ideal study, are among these factors. In particular, the costs associated with large trials necessitate compromise in study design or implementation, resulting in a dichotomy between what should be undertaken and what can be accomplished. [ABSTRACT FROM AUTHOR]

Context: Single-site studies suggest that a 2-week program of constraint-induced movement therapy (CIMT) for patients more than 1 year after stroke who maintain some hand and wrist movement can improve upper extremity function that persists for at least 1 year. Objective: To compare the effects of a 2-week multisite program of CIMT vs usual and customary care on improvement in upper extremity function among patients who had a first stroke within the previous 3 to 9 months. Design and Setting: The Extremity Constraint Induced Therapy Evaluation (EXCITE) trial, a prospective, single-blind, randomized, multisite clinical trial conducted at 7 US academic institutions between January 2001 and January 2003. Participants: Two hundred twenty-two individuals with predominantly ischemic stroke. Interventions: Participants were assigned to receive either CIMT (n = 106; wearing a restraining mitt on the less-affected hand while engaging in repetitive task practice and behavioral shaping with the hemiplegic hand) or usual and customary care (n = 116; ranging from no treatment after concluding formal rehabilitation to pharmacologic or physiotherapeutic interventions); patients were stratified by sex, prestroke dominant side, side of stroke, and level of paretic arm function. Main Outcome Measures: The Wolf Motor Function Test (WMFT), a measure of laboratory time and strength-based ability and quality of movement (functional ability), and the Motor Activity Log (MAL), a measure of how well and how often 30 common daily activities are performed. Results: From baseline to 12 months, the CIMT group showed greater improvements than the control group in both the WMFT Performance Time (decrease in mean time from 19.3 seconds to 9.3 seconds [52% reduction] vs from 24.0 seconds to 17.7 seconds [26% reduction]; between-group difference, 34% [95% confidence interval {CI}, 12%-51%]; P<.001) and in the MAL Amount of Use (on a 0-5 scale, increase from 1.21 to 2.13 vs from 1.15 to 1.65; between-group difference, 0.43 [95% CI, 0.05-0.80]; P<.001) and MAL Quality of Movement (on a 0-5 scale, increase from 1.26 to 2.23 vs 1.18 to 1.66; between-group difference, 0.48 [95% CI, 0.13-0.84]; P<.001). The CIMT group achieved a decrease of 19.5 in self-perceived hand function difficulty (Stroke Impact Scale hand domain) vs a decrease of 10.1 for the control group (between-group difference, 9.42 [95% CI, 0.27-18.57]; P=.05). Conclusion: Among patients who had a stroke within the previous 3 to 9 months, CIMT produced statistically significant and clinically relevant improvements in arm motor function that persisted for at least 1 year. Trial Registration clinicaltrials.gov Identifier: NCT00057018. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To investigate the association between cognitive ability and physical performance in a population-based sample of middle-aged African Americans. DESIGN: Cross-sectional study, 2000/2001. SETTING: St. Louis, Missouri. PARTICIPANTS: Nine hundred ninety-eight African Americans born between 1936 and 1950. MEASUREMENTS: Cognitive function was measured using the Mini-Mental State Examination (MMSE) and the Animal Naming Test of verbal fluency. Physical performance was measured using eight tests: chair stand, semitandem stand, tandem stand eyes open, tandem stand eyes closed, one-leg stand, usual gait speed, grip strength, and peak expiratory flow. RESULTS: There was a statistically significant and monotonic (progressively worsening) trend of the eight physical performance measures across cognitive tertiles in all eight MMSE analyses and five of eight Animal Naming analyses, controlling for age, sex, education, geographic area, depressive symptoms, and comorbid conditions. CONCLUSION: The association between physical performance and cognitive function appears robust. The results extend previous reports for adults aged 65 and older to a measure of verbal fluency and to a population-based sample of African Americans aged 49 to 65. Further research is needed to disentangle the temporal sequence and identify potential interventions to prevent declines in function. [ABSTRACT FROM AUTHOR]

This article studies the problem of combining correlated diagnostic tests to maximize the discriminating power between the diseased population and the healthy population. The authors consider all possible linear combinations of multiple diagnostic tests and search for the one that achieves the largest area under the receiver operating characteristic (ROC) curve. They discuss the statistical estimation of the optimum linear combination test and the associated maximum area under the ROC curve. Their approach is based on the assumption of multivariate normal distribution of the multiple diagnostic tests. They also present the application of the proposed techniques to the neuropathologic diagnosis of Alzheimer's disease based on brain lesions from 5 different brain locations using a data set from the Washington University Alzheimer's Disease Research Center. [ABSTRACT FROM AUTHOR]

The purpose of this study was twofold: 1) compare the effect of movement velocity and movement pattern on the electromyographic activity (EMG) of the quadriceps as measured by the Root Mean Square of the electromyogram (rmsEMG) and the Median Frequency of the electromyogram (mfEMG) during isokinetic testing and 2) compare the effect of movement pattern on the torque production of the quadriceps during isokinetic testing. Fourteen healthy adult females with no known knee pathologies and familiarity with isokinetic testing performed six continuous isokinetic movements at 100 degrees x s {-1}, 200 degrees x s {-1}, 300 degrees x s {-1} and 400 degrees x s {-1}. Movements were performed in a reciprocal pattern, (maximal knee extension followed by maximal knee flexion), and a non-reciprocal pattern (maximal extension followed by relaxation of the hamstrings). Statistical analyses revealed there was a difference in the rmsEMG for the quadriceps on the effect of velocity (F=3.2, P<0.05) with post hoc analysis revealing significant differences in the rmsEMG between 100 and 300 degrees x s {-1} (F= 5.6, P<0.05), and between 100 and 400 degrees x s {-1} (F = 6.7, P<0.01) with the highest rmsEMG being seen during the slowest velocities. For the mfEMG there were significant differences when comparing the velocity of movement F= 7.8, P<0.001), specifically when comparing the slowest velocity 100 degrees x s {-1} with 200 degrees x s {-1} (F = 4.9, P<0.05), 300 degrees x s {-1} (F= 8.8, P<0.005) and 400 degrees x s {-1} (F = 22.7, P<0.001) with the highest mfEMG observed at the lower velocities. No difference was noted either in EMG or torque between the reciprocal and non-reciprocal movements. The results of this study suggests that during isokinetic testing the EMG activity of the quadriceps is altered as velocity changes with regard to the rmsEMG and mfEMG. Specifically as velocity increases overall muscle activity decreases as measured by the rmsEMG. In addition as velocity increases there is a shifting toward recruitment of slower velocity muscle fibers as measured by the mfEMG. These results also suggest that movement pattern (reciprocal vs. non reciprocal) does not effect the EMG for quadriceps activity during isokinetic knee extension. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of leg rotation on the vastus medialis oblique/vastus lateralis (VMO/VL) electromyogram (EMG) activity ratio during two closed chain knee extension exercises prescribed for patellofemoral pain syndrome (PFPS). Design and Setting: Subjects performed step-up/stepdown (SUSD) and modified wall-slide (MWS), exercises with the leg neutral (SUSD/N, MWS/N), internally rotated (SUSD/I, MWS/I), and externally rotated (SUSD/E, MWS/E), respectively, for determination of root mean square EMG. Subjects: Six athletically active females symptomatic for PFPS and nine athletically active asymptomatic female control subjects. Measurements: The EMG activity of the VMO and the VL was collected while the subjects performed the exercises. Root mean square EMG was determined and then normalized to the subjects' maximal voluntary isometric contractions for calculation and analysis of the VMO/VL activity ratio. Results: Leg rotation had no effect on the VMO/VL activity ratio for the symptomatic group. The SUSD/E produced a lower VMO/VL activity ratio compared with the SUSD/N to (p < .01) and the SUSD/I (p < .01) in the control group. Similarly, the VMO/VL activity ratio for the MWWS/E was lower than for the MWS/I (p < 0.01). Conclusions. These results suggest that external rotation of the leg may affect VMO/VL activity ratio during closed chain knee extension exercises in individuals without PFPS but not in individuals symptomatic for PFPS. [ABSTRACT FROM AUTHOR]

Objective: To determine if short-term exercise reduces falls and fall-related injuries in the elderly.Design: A preplanned meta-analysis of the seven Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT)--independent, randomized, controlled clinical trials that assessed intervention efficacy in reducing falls and frailty in elderly patients. All included an exercise component for 10 to 36 weeks. Fall and injury follow-up was obtained for up to 2 to 4 years.Setting: Two nursing home and five community-dwelling (three health maintenance organizations) sites. Six were group and center based; one was conducted at home.Participants: Numbers of participants ranged from 100 to 1323 per study. Subjects were mostly ambulatory and cognitively intact, with minimum ages of 60 to 75 years, although some studies required additional deficits, such as functionally dependent in two or more activities of daily living, balance deficits or lower extremity weakness, or high risk of falling.Interventions: Exercise components varied across studies in character, duration, frequency, and intensity. Training was performed in one area or more of endurance, flexibility, balance platform, Tai Chi (dynamic balance), and resistance. Several treatment arms included additional nonexercise components, such as behavioral components, medication changes, education, functional activity, or nutritional supplements.Main Outcome Measures: Time to each fall (fall-related injury) by self-report and/or medical records.Results: Using the Andersen-Gill extension of the Cox model that allows multiple fall outcomes per patient, the adjusted fall incidence ratio for treatment arms including general exercise was 0.90 (95% confidence limits [CL], 0.81, 0.99) and for those including balance was 0.83 (95% CL, 0.70, 0.98). No exercise component was significant for injurious falls, but power was low to detect this outcome.Conclusions: Treatments including exercise for elderly adults reduce the risk of falls. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this study was to evaluate whether a history of purging behaviors in individuals with binge eating disorder (BED) is associated with increased comorbid psychopathology, dietary restraint, severity of eating pathology, and attitudinal disturbance in self-esteem and body image. METHOD: Sixty-three women meeting DSM-IV criteria for BED who were participating in a psychotherapy treatment study were subclassified according to whether they reported a history of purging behavior using self-induced vomiting or laxatives (HP; N = 24) or no such history (NHP; N = 39). The two groups were compared on the following variables: DSM-IV Axis I Lifetime diagnoses, Hamilton Depression Rating Scale, Body Shape Questionnaire, Three Factor Eating Questionnaire, Binge Eating Scale, and the Rosenberg Self-Esteem Scale. RESULTS: Data analyses revealed no significant differences between the two BED subgroups on any of the measures. DISCUSSION: These findings indicate that a history of purging behavior in BED is not associated with increased rates of comorbid psychopathology, severity of eating problems, dietary restraint, or attitudinal disturbance. Purging history does not appear to be a clinically meaningful variable with which to subclassify individuals with BED. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this study was to compare three group cognitive-behavioral therapy (CBT) treatment models and a waiting list control condition (WL). METHOD: Sixty-one women who met DSM-IV criteria for binge eating disorder (BED) received treatment with the same cognitive-behavioral treatment manual in 14 one-hour sessions over an 8-week period. All sessions consisted of psychoeducation for the first 30 min and group discussion for the second half hour. In the therapist-led condition (TL; n = 16), a doctoral therapist led both the psychoeducational component and group discussion. In the partial self-help condition (PSH; n = 19), participants viewed a 30-min psychoeducational videotape, followed by participation in a therapist-led discussion. In the structured self-help condition (SH; n = 15), subjects viewed the 30-min psychoeducational videotape and subsequently led their own 30-min discussion. Eleven subjects were assigned to a wait-list control condition (WL). The primary outcome variables were frequency and duration of self-reported binge eating episodes. RESULTS: A mixed effects linear modeling (random regression) analysis indicated that subjects in all three active treatment conditions showed a decrease in binge eating symptoms over time. No group differences in rates of change over time were observed, although analysis of covariance indicated that all three treatment conditions showed significantly greater improvement in binge eating compared to the WL condition. DISCUSSION: The findings from this preliminary study suggest that CBT for BED can be delivered effectively in a structured group self-help format. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Subclinical status for functional limitation and disability help explain pathways to difficulties with functional limitation and disability, but data on their measurement stability are minimal. We evaluated the reproducibility of measuring subclinical status in a random subset of 92 community-dwelling St. Louis African Americans aged 49 to 65 years old. METHODS: We examined test-retest reliability of subclinical status using Fried's measurement method of changing either the frequency or method of task performance for five functional limitations, three basic activities of daily living (ADLs), and four instrumental ADLs, as well as summary scales reflecting these three constructs. We also performed sensitivity analyses of test-retest interval and alternative definitional approaches (using only method, only frequency, or both). RESULT: Weighted kappas for individual tasks across three performance levels (high functioning, subclinical status, and task difficulty) indicated moderate agreement for one task and substantial agreement for 11 tasks. Intraclass correlation coefficients for the three scales demonstrated outstanding agreement. The most reproducible definition of subclinical status involved the either/or method. DISCUSSION: Excellent test-retest reproducibility was demonstrated in this population-based sample of late middle-aged African Americans using Fried's method of measuring subclinical status. [ABSTRACT FROM AUTHOR]

OBJECTIVES: In this article we explore the measurement properties of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) in 49- to 65-year-old African Americans, compare their health-related quality of life (HRQoL) with that of the nation, and evaluate the association of selected covariates with HRQoL. METHODS: A probability sample of 998 African Americans in St. Louis received comprehensive in-home assessments. We used an item analysis, exploratory and confirmatory factor analysis, and internal consistency reliability to evaluate the measurement properties of the eight SF-36 scales and their interrelationships. We used a multiple linear regression analysis to characterize the effects of the demographic, socioeconomic status, psychosocial attributes, and biomedical markers. RESULTS: Assessments averaged 2.5 hr. Each SF-36 scale was unidimensional, all items had robust factor loadings, and all but one scale achieved excellent (alpha > or = .80) internal consistency reliability levels. The overall factor structure of the SF-36 scales was generally consistent with national norms. Substantial variance was explained by the covariates, mostly attributable to socioeconomic status and the biomedical markers. CONCLUSIONS: The SF-36 is a reliable and valid measure of HRQoL for use with African Americans. In this sample, the HRQoL was below national averages. Future social epidemiologic studies should include grip strength, vision, and hearing assessments, which had substantial and consistent associations with the SF-36 scale scores. [ABSTRACT FROM AUTHOR]

Background and Objectives: Accredited neurosurgery fellowship training is available in 10 subspecialties and can sometimes be completed during the postgraduate year (PGY)-7 residency year. However, it is not clear whether there are sufficient residency graduates to fill the number of positions available, and residency curriculum structure to support enfolded training is evolving., Methods: Detailed information about the 117 accredited neurosurgery residency programs and the 282 accredited neurosurgery fellowships was obtained from the Accreditation Council for Graduate Medical Education and Committee on Advanced Subspecialty Training, respectively. Information about residency chief year structure (PGY-6 vs PGY-7) was obtained electronically from each program. An analysis was performed to correlate residency and fellowship training characteristics at each program., Results: The total number of neurosurgery fellowship positions available per year (352) is much higher than the total number of residency positions (237). Eighty-eight (75%) institutions with a neurosurgery residency offer at least 1 fellowship, and 51 of these have more fellowships than graduating residents. The resident complement at each program correlates with the number of fellowships offered (r2 = .56, P < .05), and the average institutional resident complement where fellowships are offered is greater than 2 per year. Thirty-eight residencies (32%) use a PGY-6 chief model (allowing for enfolded fellowships), and these programs offer significantly more fellowship programs on average than those using a traditional PGY-7 chief model (3.0 vs 2.1, P < .05). For most subspecialties, a minority of fellowships are offered in programs with a PGY-6 chief model., Conclusion: The number of accredited neurosurgery subspecialty fellowship slots in the United States far exceeds the number of graduating neurosurgery residents. There is no standard for residency curriculum or enfolded fellowships, but smaller programs offer fewer opportunities for subspecialty training. There may be advantages to a uniform approach that standardizes subspecialty training across programs and matches fellowship availability to demand., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Objective: Major depressive disorder in older adults (late-life depression; LLD) is frequently associated with cognitive impairment, and some deficits (e.g., executive function) have been associated with a higher level of treatment resistance. However, the cognitive profile of treatment-resistant LLD (TR-LLD) has not been characterized. We hypothesized that patients with TR-LLD would show deficits in cognitive function, especially executive function, and that executive function deficits would predict poorer response to pharmacotherapy., Design: Secondary analysis of baseline cognitive data from OPTIMUM, a multicenter RCT evaluating pharmacotherapy strategies for TR-LLD., Setting: Five outpatient academic medical centers (4 US, 1 Canada)., Participants: About 369 participants aged 60 and older from the OPTIMUM study., Measurements: Baseline scores on individual tasks and composite scores from the NIH Toolbox-Cognition Battery were transformed into demographically-adjusted T-scores and compared to published norms. Impairments in the set shifting and inhibitory control tasks were investigated as predictors of depressive symptom change following treatment using ANCOVA models., Results: Participants had low performance on tasks evaluating inhibitory control, processing speed, verbal/nonverbal memory, and the fluid composite, but normative performance on working memory and set shifting. Participants had high estimated premorbid IQ (superior Performance on oral reading recognition). Age and physical comorbidity negatively associated with processing speed. Impairments in set shifting predicted less improvement in depressive symptoms; impairments in inhibitory control did not., Conclusions: Participants with TR-LLD presented with broad cognitive deficits relative to healthy norms. Given poorer outcomes following standard pharmacotherapy associated with impaired set shifting, future research needs to identify alternative treatment strategies., Competing Interests: DISCLOSURES NJA receives support from the University of British Columbia Institute of Mental Health, CIHR-CANTRAIN, and Michael Smith Health Research BC. DMB receives research support from CIHR, NIH, Brain Canada and the Temerty Family through the CAMH Foundation and the Campbell Family Research Institute. He received research support and in-kind equipment support for an investigator-initiated study from Brainsway Ltd. He was the site principal investigator for three sponsor-initiated studies for Brainsway Ltd. He also received in-kind equipment support from Magventure for two investigator-initiated studies. He received medication supplies for an investigator-initiated trial from Indivior. He is a scientific advisor for Sooma Medical. He is the Co-Chair of the Clinical Standards Committee of the Clinical TMS Society (unpaid). HL receives grant support from NIH and the US Department of Defense. EJL receives honoraria for consulting with Boehinger-Ingelheim, Merck, Pritikin ICR, Prodeo, IngenioRx; grant support from Janssen; and has a patent pending for Sigma1 agonists for COVID. BGP received research support from the Peter & Shelagh Godsoe Endowed Chair in Late-Life Mental Health, CAMH Foundation, and Discovery Fund, National Institute of Aging, Brain Canada, the Canadian Institutes of Health Research, the Alzheimer's Drug Discovery Foundation, the Ontario Brain Institute, the Centre for Aging and Brain Health Innovation, the Bright Focus Foundation, the Alzheimer's Society of Canada, the W. Garfield Weston Foundation, the Weston Brain Institute, the Canadian Consortium on Neurodegeneration in Aging and Genome Canada. Dr. Pollock receives honoraria from the American Geriatrics Society for book authorship and holds United States Provisional Patent Nos. 6/490,680, 17/396,030, and Canadian Provisional Patent No. 3,054,093 for a cell-based assay and kits for assessing serum anticholinergic activity. JFK has received research support from Janssen and served as an advisor to Biogen and Aifred Health. He receives compensation from Physician's Postgraduate Press and American Journal of Geriatric Psychiatry for editorial service. MPM receives research support from the Canadian Institutes of Health Research, The Weston Brain Institute, and the Krembil Research Institute. JPM receives grant support from NIH and PCORI. BHM holds and receives support from the Labatt Family Chair in Biology of Depression in Late-Life Adults at the University of Toronto. He currently receives or has received within the past 5 years research support from Brain Canada, the Canadian Institutes of Health Research, the CAMH Foundation, the Patient-Centered Outcomes Research Institute (PCORI), the US National Institute of Health (NIH), Capital Solution Design LLC (software used in a study founded by CAMH Foundation), and HAPPYneuron (software used in a study founded by Brain Canada). He has also been an unpaid consultant to Myriad Neuroscience., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: Tobacco use is known to affect incidence and postoperative outcome for several neurosurgical disorders, but its relationship to trigeminal neuralgia (TN) is not known. We sought to identify unique population characteristics that correlate with tobacco use in a cohort of patients with TN who underwent microvascular decompression (MVD), including effect on long-term postoperative outcome., Methods: Data about 171 patients with classic TN treated with MVD were obtained from a prospectively maintained registry. Patients were classified as smokers or nonsmokers based on the use of tobacco within the 6 months before surgery. Analysis of clinical characteristics and postoperative outcome was performed., Results: Compared with nonsmokers with TN, MVD patients using tobacco were significantly younger (53 vs 62 years, P < .01) and less likely to report pain in a single distribution of the trigeminal nerve (36% vs 65%, P < .01). There was no difference between smokers and nonsmokers in the presence of some degree of continuous pain, severity of neurovascular compression, sex, race, obesity, pain duration before presentation, immediate postoperative outcome, length of stay, or postoperative complication profile. Among 128 patients followed for at least 6 months, smokers were significantly less likely to be pain-free off medications at the last follow-up (36% vs 57%, P < .05)., Conclusion: In patients undergoing MVD for TN, smoking is associated with younger age of TN onset, more widespread facial pain, and worse long-term postoperative outcome after MVD. These features suggest that TN in smokers may represent a more severe disease form compared with TN in nonsmokers with different responses to treatment., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Background: The Patient Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS) are commonly used scales to measure depression severity in older adults., Methods: We utilized data from the Optimizing Outcomes of Treatment-Resistant Depression in Older Adults (OPTIMUM) clinical trial to produce conversion tables relating PHQ-9 and MADRS total scores. We split the sample into training (N = 555) and validation samples (N = 187). Equipercentile linking was performed on the training sample to produce conversion tables for PHQ-9 and MADRS. We compared the original and estimated scores in the validation sample with Bland-Altman analysis. We compared the depression severity level using the original and estimated scores with Chi-square tests., Results: The Bland-Altman analysis confirmed that differences between the original and estimated scores for at least 95 % of the sample fit within 1.96 standard deviations of the mean difference. Chi-square tests showed a significant difference in the proportion of participants at each depression severity category determined using the original and estimated scores., Limitations: The conversion tables should be used with caution when comparing depression severity at the individual level., Conclusions: Our conversion tables relating PHQ-9 and MADRS scores can be used to compare treatment outcomes using aggregate data in studies that only used one of these scales., Competing Interests: Declaration of competing interest The original clinical trial was supported by a Patient-Centered Outcomes Research Institute (PCORI) Award (TRD-1511-33321). Dr. Lenze received additional support from the Taylor Family Institute for Innovative Psychiatric Research at Washington University School of Medicine, as well as the Washington University Institute of Clinical and Translational Sciences grant (UL1TR002345) from the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH). Dr. Blumberger reports grants from Canadian Institutes of Health Research (CIHR) and the Temerty family through the Centre for Addiction and Mental Health (CAMH) Foundation during the conduct of the study; nonfinancial support from Magventure (in-kind equipment support for investigator-initiated research); grants from Brainsway (principal investigator of an investigator-initiated study and site principal investigator for sponsored clinical trials), National Institutes of Health (NIH), Brain Canada Foundation, Campbell Family Research Institute, and Patient-Centered Outcomes Research Institute outside the submitted work; received medication supplies for an investigator-initiated trial from Indivior; and has participated in advisory boards for Janssen and Welcony. Dr. Flint has received grant support from the US National Institutes of Health, the Patient-Centered Outcomes Research Institute, the Canadian Institutes of Health Research, Brain Canada, the Ontario Brain Institute, and Alzheimer's Association. Dr. Miller has no financial relationships with commercial interests. Dr. Mulsant received additional support from the Labatt Family Chair in Biology of Depression in Late-Life Adults at the University of Toronto. He holds and receives support from the Labatt Family Chair in Biology of Depression in Late-Life Adults at the University of Toronto. He currently receives or has received research support from Brain Canada, the CAMH Foundation, the Canadian Institutes of Health Research, and the US National Institutes of Health (NIH); research support from Bristol-Myers Squibb (medications for an NIH-funded clinical trial), Eli Lilly and Company (medications for an NIH-funded clinical trial), Pfizer (medications for an NIH-funded clinical trial), Capital Solution Design LLC (software used in a study funded by CAMH Foundation), and HAPPYneuron (software used in a study funded by Brain Canada). Dr. Lavretsky received support from grants (K24 AT009198, R01 AT008383, and R01 MH114981) from the NIH. Dr. Brown received additional support from the National Institute of Mental Health OPTIMUM NEURO grant (5R01MH114980). Dr. Reynolds receives payment from the American Association of Geriatric Psychiatry as Editor-in-Chief of the American Journal of Geriatric Psychiatry and royalty income for intellectual property as co-inventor of the Pittsburgh Sleep Quality Index. Other authors have no conflict of interest to disclose., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Recent research has reported effects of socioeconomic status on neurobehavioral development as early as infancy, including positive associations between income and brain structure, functional connectivity, and behavior later in childhood (Ramphal, Whalen, et al., 2020; Triplett et al., 2022). This study extends this literature by investigating the relation of maternal prenatal social disadvantage (PSD) to neonatal amygdala and hippocampus functional connectivity and whether socioeconomic-related alterations in functional connectivity subsequently predict behavior at age 12 months in a large, socioeconomically diverse sample ( N = 261 mother-infant dyads). PSD was assessed across gestation; neonatal magnetic resonance imaging was completed within the first weeks of life; and infant internalizing and externalizing symptoms were evaluated using the Infant-Toddler Social and Emotional Assessment at age 12 months. The results showed that PSD was significantly related to neonatal right amygdala and left hippocampus functional connectivity with prefrontal and motor-related regions. Social disadvantage-related right amygdala and left hippocampus functional connectivity with these regions was subsequently related to infant externalizing and internalizing symptoms at age 12 months. Building off an emerging literature exploring prenatal impacts on neonatal functional connectivity, this study further emphasizes the important role of the maternal environment during gestation on infant brain function and its relationship with externalizing and internalizing behavior in the first years of life. The results suggest that the prenatal socioeconomic environment may be a promising target for interventions aimed at improving infant neurobehavioral outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

There has been growing research interest in developing methodology to evaluate the health care providers' performance with respect to a patient outcome. Random and fixed effects models are traditionally used for such a purpose. We propose a new method, using a fusion penalty to cluster health care providers based on quasi-likelihood. Without any priori knowledge of grouping information, our method provides a desirable data-driven approach for automatically clustering health care providers into different groups based on their performance. Further, the quasi-likelihood is more flexible and robust than the regular likelihood in that no distributional assumption is needed. An efficient alternating direction method of multipliers algorithm is developed to implement the proposed method. We show that the proposed method enjoys the oracle properties; namely, it performs as well as if the true group structure were known in advance. The consistency and asymptotic normality of the estimators are established. Simulation studies and analysis of the national kidney transplant registry data demonstrate the utility and validity of our method., (© 2024 Wiley‐VCH GmbH.)

Cell migration during many fundamental biological processes including metastasis requires cells to traverse tissue with heterogeneous mechanical cues that direct migration as well as determine force and energy requirements for motility. However, the influence of discrete structural and mechanical cues on migration remains challenging to determine as they are often coupled. Here, we decouple the pro-invasive cues of collagen fiber alignment and tension to study their individual impact on migration. When presented with both cues, cells preferentially travel in the axis of tension against fiber alignment. Computational and experimental data show applying tension perpendicular to alignment increases potential energy stored within collagen fibers, lowering requirements for cell-induced matrix deformation and energy usage during migration compared to motility in the direction of fiber alignment. Energy minimization directs migration trajectory, and tension can facilitate migration against fiber alignment. These findings provide a conceptual understanding of bioenergetics during migration through a fibrous matrix., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)