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Background Increasing physical activity (PA) in rural communities is a vital prevention tactic in multiple chronic diseases; however, little is known on the multilevel correlates of PA rural areas. A better understanding of domain-specific PA adds context for promoting PA in rural communities. The current study sought to determine factors associated with domain-specific and overall moderate-vigorous physical activity (MVPA) in rural communities. Methods Surveys were conducted across 14 rural mid-Western communities, with the final analytical sample including 1241 adults (ages 19–96, M = 57.0 [SD = 16.7], 67.8% female, 83.8% white). Generalized linear models with negative binomial distributions examined the relation between demographics, trail use, and perceptions of the neighborhood environment, with domain-specific and overall MVPA, measured via the Global Physical Activity Questionnaire. Results Rural residents reported an average of 617 total minutes of weekly MVPA (SD = 1141), with 58.5% meeting MVPA guidelines. Higher age, female gender, and higher educated individuals had lower levels of overall and occupational MVPA. Females, higher education, and perceived indoor recreational access were associated with lower levels of transportation-related MVPA, while trail use was associated with increased transportation MVPA. Higher age and female gender respondents had lower levels of recreational MVPA, while trail users and those who perceived favorable indoor recreational access had higher levels of recreational MVPA. Conclusions PA primarily occurred in the occupational domain among this sample of rural mid-Western adults. Findings highlight the need for multilevel interventions to address PA across multiple domains in rural communities, especially among females and older adults.

Binocular rivalry occurs when incompatible images are presented simultaneously but separately to each eye. Perceptual dominance reverses over time such that one image temporarily dominates perception, while the other image is suppressed. Prior research has shown that briefly-presented probes modulate perception such that probes presented to the suppressed eye tend to produce shorter percept durations relative to when probes are presented to the dominant eye. This pattern suggests that probes strengthen the competitive strength of the image over which they appear. However, it remains unclear whether probe-modulated effects on binocular rivalry are equivalent across the visual field, in particular as a function of whether probes appear within the region of interocular conflict (i.e on-object) or outside the region of interocular conflict (i.e. off-object). We tested this by manipulating whether probes appeared on-object or off-object. We replicate prior work showing that suppressed-eye probes produce shorter percept durations relative to dominant-eye probes. Critically, however, we show that percept duration also varies as a function of whether probes appear on vs. off the rivalry objects; that is, differences in percept duration between suppressed-eye and dominant-eye probes were much larger for on-object than off-object probes. Importantly, however, the difference between suppressed-eye and dominant-eye probes was still significant for off-object probes. Together these results suggest dynamic mechanisms at work in probe-mediated rivalry, such that on-object probe effects are larger relative to smaller, yet reliable off-object effects.

Background: Traditionally, treatment with the excimer laser requires determining the minimal erythema dose on healthy skin or using plaque-based induration; however, these protocols often lead to underdosing of psoriatic plaques and reduced treatment efficacy. Objective: To prospectively evaluate the effect of the excimer laser on plaque psoriasis using an optimal therapeutic dose (OTD) protocol. Methods: Subjects with stable plaque psoriasis were tested with the Multi-Microdose (MMD) tip on the XTRAC excimer laser to determine a minimum blistering dose (MBD). Treatment was then initiated at 20% less than the MBD. A single psoriatic lesion was treated once weekly for up to 11 sessions. The change from baseline of the target lesion's modified psoriasis area severity index (mPASI), quality of life and safety were evaluated. Results: Thirteen subjects with a mean age of 48.9±14.9 years and Fitzpatrick skin types I-IV participated in the study. Target plaque mPASI significantly decreased at all time points relative to baseline with significant improvement by the second treatment. Patients reached mPASI-75 within 5±2 sessions. By the end of the study 92% of patients achieved mPASI-75. On average, patients maintained an mPASI score ≥50% for 60 days. Treatment was well tolerated with no erosions or hyperpigmentation. Erythema was the most common adverse event. Conclusion: The OTDTM protocol with the MMD® tip allows determining the optimal dose locally on the psoriatic plaque itself. Consequently, ineffectual dosing levels and treatments are minimized. The OTD protocol reduces treatment frequency from 2-3 times per week to once weekly. J Drugs Dermatol. 2020;19(4):349-354. doi:10.36849/JDD.2020.4891.

Introduction Post-traumatic stress disorder (PTSD) is associated with an increased risk of cardiovascular and metabolic diseases and physical inactivity. Cardiorespiratory fitness (CRF), which is modifiable by physical activity, is a strong independent predictor of cardiometabolic health. However, the relationship between CRF and cardiometabolic health in veterans with PTSD is unknown. Thus, this study aimed to explore the cross-sectional relationships among CRF, indices of cardiometabolic health (ie, HbA1c, blood lipids, blood pressure, waist-hip ratio, and body mass index), and PTSD severity in veterans with PTSD. Materials and Methods This study was approved by the local Institutional Review Board. All participants were informed of the study risks and provided consent prior to participation. Participants (n = 13) completed a cardiopulmonary exercise test, a fasting blood draw, and the Clinician Administered PTSD Scale. Correlations between CRF and cardiometabolic health were examined with Spearman’s rank correlations, and differences in PTSD symptom severity were explored as a function of CRF (ie, low-to-moderate vs. high CRF), using multiple linear regression. Results Peak oxygen uptake ($\dot{\mathrm{V}}$O2peak) was correlated with high-density lipoproteins rho = 0.60, P = 0.04 and diastolic blood pressure rho = −0.56, P = 0.05. Ventilatory threshold was correlated with HbA1c rho = −0.61, P = 0.03 and diastolic blood pressure rho = −0.56, P = 0.05. Higher CRF was associated with lower total PTSD severity standardized β = −0.84, P = 0.01, adjusted R2 = 0.47, total Cluster C symptoms (avoidance/numbing) β = −0.71, P = 0.02, adjusted R2 = 0.49, and total Cluster D symptoms (hyperarousal) β = −0.89, P = 0.01, adjusted R2 = 0.41, while adjusting for age and smoking status. Conclusions These preliminary findings suggest that CRF and by proxy physical activity may be important factors in understanding the increased risk of cardiovascular and metabolic disease associated with PTSD.

Background: Incisional hernias can be associated with pain or discomfort. Surgical repair especially mesh reinforcement, may likewise induce pain. The primary objective was to assess the incidence of pain after hernia repair in patients with and without pre-operative pain or discomfort. The secondary objectives were to determine the preferred mesh type, mesh location and surgical technique in minimizing postoperative pain or discomfort. Materials and methods: A registry-based prospective cohort study was performed, including patients undergoing incisional hernia repair between September 2011 and May 2019. Patients with a minimum follow-up of 3–6 months were included. The incidence of hernia related pain and discomfort was recorded perioperatively. Results: A total of 1312 patients were included. Pre-operatively, 1091 (83%) patients reported pain or discomfort. After hernia repair, 961 (73%) patients did not report pain or discomfort (mean follow-up = 11.1 months). Of the pre-operative asymptomatic patients (n = 221), 44 (20%, moderate or severe pain: n = 14, 32%) reported pain or discomfort after mean follow-up of 10.5 months. Of those patients initially reporting pain or discomfort (n = 1091), 307 (28%, moderate or severe pain: n = 80, 26%) still reported pain or discomfort after a mean follow-up of 11.3 months postoperatively. Conclusion: In symptomatic incisional hernia patients, hernia related complaints may be resolved in the majority of cases undergoing surgical repair. In asymptomatic incisional hernia patients, pain or discomfort may be induced in a considerable number of patients due to surgical repair and one should be aware if this postoperative complication.

Background:We describe a thick fascial band arising from the medial aspect of the lateral plantar aponeurosis diving deep into the forefoot crossing over a branch of the lateral plantar nerve. Because a review of current literature resulted in limited and outdated sources, we sought to first determine the frequency of this fascial band and the location where it crosses the lateral plantar nerve and, second, discuss the clinical applications these anatomical findings could have.Methods:50 pairs of cadaveric feet (n = 100) were dissected to investigate for presence of the fascial band and its interaction with the lateral plantar nerve. Images were taken of each foot with the fascial band. ImageJ was used to take 2 measurements assessing the relationship of the tuberosity of the base of the fifth metatarsal to where the nerve crossed deep to the fascial band.Results:Overall, 38% of the feet possessed the fascial band. It was found unilaterally in 10 pairs and bilaterally in 14 pairs. On average, the point at which the lateral plantar nerve passed deep to the fascial band was 2.0 cm medial and 1.7 cm anterior to the tuberosity of the base of the fifth metatarsal.Conclusion:When present, the deep band of the lateral plantar aponeurosis (PA) was consistently found to be crossing the lateral plantar nerve. The discovery of the location where this most commonly occurs has not been previously reported and adds an interesting dimension that elevates an anatomical study to one that has clinical potential.Clinical Relevance:The established target zone gives a precise location for where the relationship between the deep band of the lateral PA and the lateral plantar nerve exists when evaluating the foot. The target zone provides a potential springboard for future investigations concerning said relationship clinically.

Background. Physical activity (PA) rates are lower in rural populations, compared to urban and suburban counterparts. Since PA is shown to decrease the risk of cancers and chronic diseases, increasing PA in rural environments is an important disease-prevention strategy. However, in order to develop effective interventions for rural populations, more research is needed. The purpose of the study was to elicit rural residents’ thoughts and perceptions related to PA and walking trail use. Methods. Key informant interviews were conducted via telephone, with 62 adults, living in six rural communities in southeast Missouri, who identified as stakeholders, walking trail users, and nontrail users. Participants were recruited through word of mouth and snowball sampling. Interviews were digitally audio-recorded, transcribed, and qualitatively analyzed. Findings. Analysis revealed variation within the rural population, with each town unique in what constituted barriers and facilitators to PA. Life priorities other than physical health were found to be important motivators to PA and also influenced how PA was obtained. Community size was found to impact community resources and infrastructure, although this was mitigated by poverty rates. Conclusion. Rural communities are distinct from one another with different views and approaches to PA. Future interventions designed to increase PA should be mindful of differences at the individual and town levels and avoid a one-size-fits-all approach. Interventions would benefit from insight and support from community members and stakeholders, to facilitate a tailored approach to increase PA.

Background Intramedullary fixation of a comminuted subcapital metacarpal fracture using a headless compression screw was first described in 2010. The purpose of this study was to identify and evaluate all studies reporting clinical outcomes of intramedullary screw fixation of metacarpal fractures. Methods A comprehensive search of the literature was performed under Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify all relevant studies. Outcome measures included mean follow-up, evidence of radiographic union, functional outcomes, and quality-of-life measures. Results Nine articles for a total of 169 metacarpal fractures were identified. Average patient age was 32 years; 86.5 percent of the patients were men; and the majority of fractures occurred in the small finger (74 percent). Most fractures occurred in the neck (n = 66), followed by shaft (n = 31) and head (n = 10). The average follow-up was 11 months, with an average metacarpophalangeal joint flexion of 86 degrees (n = 83) and digit total active motion of 251 degrees (n = 72). Radiographic union was achieved in 100% of reported cases (n = 132) at or before the latest follow-up. Grip strength in four studies showed an average of 96 percent compared to the contralateral hand. No serious complications were reported. Nine minor complications were reported, including four cases of hardware removal in asymptomatic patients. Conclusion The review of the literature suggests intramedullary fixation of metacarpal neck and shaft fractures using headless compression screws has thus far proven to be a safe and successful surgical treatment option resulting in excellent clinical outcomes.

Post-9/11 U.S. veterans are clinically complex with multiple co-occurring health conditions that lead to increased morbidity and mortality, risk for suicide, and decreased quality of life, but underutilization and resistance to treatment remain significant problems. Increased isolation and decreased community and social support due to coronavirus disease (COVID-19) have exacerbated mental health risk. This study evaluated the safety and feasibility of home-based telemental health group workshops to improve reintegration and social connection in post-9/11 U.S. military personnel. Seventy-four (61 males/13 females) post-9/11 U.S. military veterans were randomized to receive 12 sessions of STEP-Home cognitive-behavioral group workshop or present-centered group therapy. Treatment was delivered either in person (traditional medical center setting, treatment as usual [TAU]), or via home-based synchronous videoconferencing (VC). The change to VC occurred due to social distancing guidelines during COVID-19. Mean age was 41.0 years (SD = 11.5, range 24-65). Forty-five (36 males/9 females) participated in VC and 29 (25 males/4 females) in TAU. Demographics were similar across treatment milieu. There were no differences in therapist treatment adherence for TAU versus VC. Therapist satisfaction was higher for TAU groups (q value.05). Veterans showed higher enrollment, attendance, group cohesion, and veteran-to-veteran support for VC compared to TAU (q values.05). Safety procedures were successfully implemented via VC. Results demonstrate the safety, feasibility, and high satisfaction of group telemental health in U.S. veterans. Higher enrollment and treatment adherence for telemental health delivery resulted in a greater likelihood of receiving an effective treatment dose than TAU. Strong group cohesion and veteran-to-veteran support were achievable via telehealth. Telemental health offers convenient, efficient, and cost-effective care options for veterans and may be particularly helpful for patients with high psychiatric burden.

Despite the increasing proportion of women in U.S. medical schools, there are relatively few women in leadership positions, and a number of recent publications have highlighted many factors that could contribute to gender inequity and inequality in medicine. The Association of Pulmonary, Critical Care, and Sleep Division Directors, an organization of Division Directors from across the United States, convened a workshop to review data and obtain input from leaders on the state of gender equity in our field. The workshop identified a number of factors that could contribute to gender inequality and inequity: gender climate (including implicit and perceived biases); disproportionate family responsibilities; lack of women in leadership positions; poor retention of women; and lack of gender equality in compensation. The panel members developed a roadmap of concrete recommendations for societies, leaders, and individuals that should promote gender equity to achieve gender equality and improve retention of women in the field of pulmonary, critical care, and sleep medicine.

Background We hypothesized that propofol, a unique general anesthetic that engages N-methyl-D-aspartate and gamma-aminobutyric acid receptors, has antidepressant properties. This open-label trial was designed to collect preliminary data regarding the feasibility, tolerability, and efficacy of deep propofol anesthesia for treatment-resistant depression. Methods Ten participants with moderate-to-severe medication-resistant depression (age 18–45 years and otherwise healthy) each received a series of 10 propofol infusions. Propofol was dosed to strongly suppress electroencephalographic activity for 15 minutes. The primary depression outcome was the 24-item Hamilton Depression Rating Scale. Self-rated depression scores were compared with a group of 20 patients who received electroconvulsive therapy. Results Propofol treatments were well tolerated by all subjects. No serious adverse events occurred. Montreal Cognitive Assessment scores remained stable. Hamilton scores decreased by a mean of 20 points (range 0–45 points), corresponding to a mean 58% improvement from baseline (range 0–100%). Six of the 10 subjects met the criteria for response (>50% improvement). Self-rated depression improved similarly in the propofol group and electroconvulsive therapy group. Five of the 6 propofol responders remained well for at least 3 months. In posthoc analyses, electroencephalographic measures predicted clinical response to propofol. Conclusions These findings demonstrate that high-dose propofol treatment is feasible and well tolerated by individuals with treatment-resistant depression who are otherwise healthy. Propofol may trigger rapid, durable antidepressant effects similar to electroconvulsive therapy but with fewer side effects. Controlled studies are warranted to further evaluate propofol’s antidepressant efficacy and mechanisms of action. ClinicalTrials.gov: NCT02935647.

Summary Actions are guided by a Bayesian-like interaction between priors based on experience and current sensory evidence. Here, we unveil a complete neural implementation of Bayesian-like behavior, including adaptation of a prior. We recorded the spiking of single neurons in the smooth eye movement region of the frontal eye fields (FEFSEM), a region that is causally involved in smooth pursuit eye movements. Monkeys tracked moving targets in contexts that set different priors for target speed. Before the onset of target motion, preparatory activity encodes and adapts in parallel with the behavioral adaptation of the prior. During the initiation of pursuit, FEFSEM output encodes a maximum a posteriori estimate of target speed based on a reliability-weighted combination of the prior and sensory evidence. FEFSEM responses during pursuit are sufficient both to adapt a prior that may be stored in FEFSEM and, through known downstream pathways, to cause Bayesian-like behavior in pursuit.

Stigma is a primary barrier to care and support for people living with HIV (PLWH). We explored relationships between HIV-related stigma and treatment adherence and the effects of psychological and structural factors on these relationships. HIV treatment adherence, stigma, and coping strategies were measured with questionnaires. Participants included 285 PLWH in Haiti. Multivariable linear regression was used to estimate predictors of treatment adherence. Structural equation modeling was used to determine whether relationships between stigma and treatment adherence variables were mediated by coping variables. Mean adherence was 93.1%; 72.3% of participants reported ≥ 95% adherence. Perceived stigma and quality-of-care satisfaction scores significantly predicted treatment adherence. Maladaptive coping did not act as a mediator between perceived stigma and treatment adherence, which could be due to stronger effects of perceived stigma on treatment adherence. Our study may help to improve treatment adherence and the care and quality of life for PLWH.

Summary Background and aims Old adults suffering from dysphagia have difficulties swallowing, chewing and/or eating, and are therefore at high risk of undernutrition. In-between-meals that are texture modified are of particular importance for people suffering from dysphagia. To meet their adequate daily amount of food intake they are recommended to eat 3–5 in-between-meals daily. The aim of the current pilot study was to identify the most liked in-between-meals for old adults based on flavour and describe the basic sensory properties of these in-between-meals. Following, the equality between flavour and appearance-based preferences was investigated. Methods From three nursing homes 30 old adults aged 70 years or older suffering from dysphagia were recruited. They were assessing 20 texture modified in-between-meals based on their flavour and appearance on a 3 point hedonic scale. Results When participants were asked to assign liking based on flavour, the most liked in-between-meals were frozen, cold and sweet (vanilla ice cream, strawberry parfait and panna cotta). These meals were among the in-between-meals richest in fat and energy. Liking based on flavour and appearance was equal in 18 out of 20 samples. Furthermore, nutritional and sensory characteristics of the preferred meals were described. Conclusion Flavour and sensory-based ranking of in-between-meals opens the possibility to design new in-between-meals to old adults with dysphagia, by choosing the most liked in-between-meals to offer the target group.

Introduction This phase III, double-blind, randomised, placebo-controlled trial (and extension phase) was designed to assess the efficacy and safety of velmanase alfa (VA) in alpha-mannosidosis (AM) patients. Methods Twenty-five patients were randomised to weekly 1 mg/kg VA or placebo for 52 weeks. At study conclusion, placebo patients switched to VA; 23 patients continued receiving VA in compassionate-use/follow-on studies and were evaluated in the extension phase [last observation (LO)]. Co-primary endpoints were changes in serum oligosaccharide (S-oligo) and in the 3-min stair-climb test (3MSCT). Results Mean relative change in S-oligo in the VA arm was −77.6% [95% confidence interval (CI) −81.6 to −72.8] at week 52 and −62.9% (95% CI −85.8 to −40.0) at LO; mean relative change in the placebo arm was −24.1% (95% CI −40.3 to −3.6) at week 52 and −55.7% (95% CI −76.4 to −34.9) at LO after switch to active treatment. Mean relative change in 3MSCT at week 52 was −1.1% (95% CI −9.0 to 7.6) and − % (95% CI −13.4 to 6.5) for VA and placebo, respectively. At LO, the mean relative change was 3.9% (95% CI −5.5 to 13.2) in the VA arm and 9.0% (95% CI −10.3 to 28.3) in placebo patients after switch to active treatment. Similar improvement pattern was observed in secondary parameters. A post hoc analysis investigated whether some factors at baseline could account for treatment outcome; none of those factors were predictive of the response to VA, besides age. Conclusions These findings support the utility of VA for the treatment of AM, with more evident benefit over time and when treatment is started in the paediatric age. Electronic supplementary material The online version of this article (10.1007/s10545-018-0185-0) contains supplementary material, which is available to authorized users.

People can use a target template consisting of one or more features to guide attention and gaze to matching objects in a search array. But can we also use feature information to guide attention away from known irrelevant items? Some studies found a benefit from foreknowledge of a distractor feature, whereas others found a cost. Importantly, previous work has largely relied on end-of-trial manual responses; it is unclear how feature-guided avoidance might unfold as candidate objects are inspected. In the current experiments, participants were cued with a distractor feature to avoid, then performed a visual search task while eye movements were recorded. Participants initially fixated a to-be-avoided object more frequently than predicted by chance, but they also demonstrated avoidance of cue-matching objects later in the trial. When provided more time between cue stimulus and search array, participants continued to be initially captured by a cued-color item. Furthermore, avoidance of cue-matching objects later in the trial was not contingent on initial capture by a cue-matching object. These results suggest that the conflicting findings in previous negative-cue experiments may be explained by a mixture of two independent processes: initial attentional capture by memory-matching items and later avoidance of known irrelevant items. (PsycINFO Database Record

Contrast-enhanced T1-weighted MR imaging of the liver is typically acquired using breath-hold techniques to reduce motion artifacts and to allow for optimal diagnostic image quality. Insufficient breath-holds during MR data collection can cause severe reduction of image quality up to the point of being non-diagnostic. The aim of this study was to evaluate the subjective and objective clinical image quality of a novel free-breathing radial k-space sampling MR technique.Consent for this study was given by the local IRB committee. 86 patients who underwent both breath-hold (BH) and free-breathing (FB) late-phase contrast T1w-FS-FFE liver MRI using conventional BH Cartesian (Cartesian-eTHRIVE) and FB "pseudo golden angle" radial k-space sampling (Radial-eTHRIVE) were included in this retrospective analysis. Subjective analysis comprised 5-point Likert scale ratings (1 = very good; 5 = non-diagnostic) for "artifact impact", "anatomic sharpness", "vessel sharpness", "contrast impression", and "overall diagnostic quality". Relative signal intensities in different ROIs were compared between Cartesian-eTHRIVE and Radial-eTHRIVE. For statistical differences paired Wilcoxon test and paired t-test have been performed (p 0.05).The MR scan time was significantly longer for FB Radial-eTHRIVE (2 min, 54 s) compared to BH Cartesian-eTHRIVE (0 min 15 s). Cartesian-eTHRIVE demonstrated a superior subjective contrast impression and objective measurements revealed an increased lesion-to-liver-contrast for hypointense liver lesions (Hypo-LTLC: 0.33 ± 0.19 vs. 0.20 ± 0.11; p = 0.000), while no difference was observed for hyperintense liver lesions (Hyper-LTLC). Subjective evaluation showed superior anatomic sharpness ratings by both readers for Radial-eTHRIVE. Most importantly, in a subgroup analysis of patients who were unable to perform adequate breath-holds, free-breathing Radial-eTHRIVE still demonstrated good subjective image quality.Free-breathing, radial k-space sampling T1w MRI of the liver delivers high diagnostic image quality, especially in patients who are unable to adequately perform breath-hold maneuvers. Thus, Radial-eTHRIVE can be an important clinical alternative in patients with impaired respiration status.· Delayed-phase contrast-enhanced MRI of the liver can be robustly performed using a "pseudo golden angle" Radial-eTHRIVE sequence.. · Free-breathing Radial-eTHRIVE yields good diagnostic image quality in case of a high artifact burden in breath-hold Cartesian-eTHRIVE and thus could be used as a "back-up" for patients with impaired respiratory capacity.. · A lower lesion-to-liver-contrast ratio is observed for hypointense liver lesions in free-breathing Radial-eTHRIVE sequence..· Hedderich DM, Weiss K, Spiro JE et al. Clinical Evaluation of Free-Breathing Contrast-Enhanced T1w MRI of the Liver using Pseudo Golden Angle Radial k-Space Sampling. Fortschr Röntgenstr 2018; 190: 601 - 609.ZIEL: Für die kontrastmittelverstärkte Magnetresonanztomografie (MRT) der Leber wird üblicherweise eine T1w-FS-FFE in Atemanhaltetechnik durchgeführt, um Bewegungsartefakte zu minimieren und eine gute diagnostische Qualität zu gewährleisten. Allerdings kann eine insuffiziente Durchführung des Atemanhaltemanövers die Bildqualität deutlich negativ beeinflussen. Ziel dieser Arbeit war es, die Bildqualität einer neuartigen MR-Sequenz mit radialer „Pseudo-Golden-Angle“-k-Raumabtastung in freier Atmung in der klinischen Routine zu evaluieren.Es erfolgte eine retrospektive Auswertung der Leber-MRT in der späten Kontrastmittelphase bei 86 Patienten, die sowohl mittels der konventionellen kartesianischen k-Raumabtastung (Cartesian-eTHRIVE) in Atemanhaltung (BH) als auch mittels der radialen „Pseudo-Golden-Angle“-k-Raumabtastung (Radial-eTHRIVE) in freier Atmung (FB) untersucht wurden. Es wurden sowohl objektive als auch subjektive Qualitätsparameter durch zwei verblindete Reader erhoben und mittels Wilcoxon-Test und gepaartem t-Test verglichen (p 0,05).Die Untersuchungszeit war für die FB-Radial-eTHRIVE signifikant länger als für die BH-Cartesian-eTHRIVE (2 min 54 s vs. 0 min 15 s). Subjektiv zeigte sich ein besseres Kontrastverhalten der Cartesian-eTHRIVE mit einem objektiv höheren Kontrast für hypointense Leberläsionen (0,33 ± 0,19 vs. 0,20 ± 0,11; p = 0,000). Die subjektive Bewertung ergab eine signifikante Überlegenheit bezügliche der Schärfe der Anatomie und der Gefäße der FB-Radial-eTHRIVE. Im Falle starker Atemartefakte in der BH-Cartesian-eTHRIVE zeigte sich in freier Atmung mit der Radial-eTHRIVE weiterhin eine gute diagnostische Bildqualität.Die radiale Pseudo-Golden-Angle-T1w-FS-FFE liefert eine hohe diagnostische Bildqualität in der kontrastmittelverstärkten Leber-MRT bei freier Atmung, sodass die Radial-eTHRIVE in freier Atmung bei Patienten mit ausgeprägten Atemartefakten in der DCE-MRT eine sehr hilfreiche „add-on“-Sequenz in der klinischen Routine darstellt.· Die radiale Pseudo-Golden-Angle-k-Raumabtastung in der späten KM-Phase der Leber-MRT liefert zuverlässig eine gute diagnostische Bildqualität.. · Im Falle starker Atemartefakte in der konventionellen k-Raumabtastung bleibt eine hohe diagnostische Bildqualität erhalten.. · Der Kontrast hypointenser Leberläsionen ist für die Radial-eTHRIVE herabgesetzt..

Nationally, racial and ethnic disparities in childhood asthma plateaued from 2005 to 2013. We assessed trends in childhood asthma in Miami, Florida using Youth Risk Behavior Surveillance System (YRBSS) data and emergency department (ED) utilization and hospitalization rates by zip code population characteristics. Asthma prevalence in Miami did not vary significantly by race/ethnicity in YRBSS respondents in 2005 (16.2–17.2%, all groups), but rose in African–Americans and Hispanics and declined in Whites by 2013 to 27.9, 20.9 and 12.6%, respectively (P = 0.02). Median asthma ED visit rates rose from 106.8 (2006–2008) to 138.2 (2011–2013; P = 0.004) per 10,000 children. High-poverty and majority African–American zip codes were 6.3 and 7.3 times more likely to have asthma ED visit rates > 200 than others (P

The purpose of this study was to determine if screw placement in the reduction and association of the scaphoid and the lunate (RASL) procedure affected the ability of the scapholunate joint to withstand force. After completely disrupting of the scapholunate ligament in 29 fresh-frozen cadaveric wrists, we placed the RASL screw either distal or proximal to the lateral aspect of the dorsal ridge of the scaphoid and into the dorsal or volar aspect of the lunate. Specimens were subjected to repeated cycles of transcarpal axial force, mimicking clenched-fist loading, until failure. Screw placement distal to the lateral aspect of the dorsal scaphoid ridge was significantly associated with failure when examined manually, radiographically (1.8 vs. 0.5 mm) and using real-time motion capture (diastasis: 1.6 vs. 0.4 mm; Euler angle: 4.5 ° vs. 0.8 °). The lateral aspect of the dorsal ridge is a reliable radiographic landmark on the scaphoid and provides surgeons with a convenient starting point to achieve the most biomechanically stable RASL construct, and, therefore, enhances the potential for an optimal clinical outcome.

A long-standing core question in cognitive science is whether different modalities and representation types (pictures, words, sounds, etc.) access a common store of semantic information. Although different input types have been shown to activate a shared network of brain regions, this does not necessitate that there is a common representation, as the neurons in these regions could still differentially process the different modalities. However, multi-voxel pattern analysis can be used to assess whether, e.g., pictures and words evoke a similar pattern of activity, such that the patterns that separate categories in one modality transfer to the other. Prior work using this method has found support for a common code, but has two limitations: they have either only examined disparate categories (e.g. animals vs. tools) that are known to activate different brain regions, raising the possibility that the pattern separation and inferred similarity reflects only large scale differences between the categories or they have been limited to individual object representations. By using natural scene categories, we not only extend the current literature on cross-modal representations beyond objects, but also, because natural scene categories activate a common set of brain regions, we identify a more fine-grained (i.e. higher spatial resolution) common representation. Specifically, we studied picture- and word-based representations of natural scene stimuli from four different categories: beaches, cities, highways, and mountains. Participants passively viewed blocks of either phrases (e.g. "sandy beach") describing scenes or photographs from those same scene categories. To determine whether the phrases and pictures evoke a common code, we asked whether a classifier trained on one stimulus type (e.g. phrase stimuli) would transfer (i.e. cross-decode) to the other stimulus type (e.g. picture stimuli). The analysis revealed cross-decoding in the occipitotemporal, posterior parietal and frontal cortices. This similarity of neural activity patterns across the two input types, for categories that co-activate local brain regions, provides strong evidence of a common semantic code for pictures and words in the brain.

Research on the neural correlates of consciousness (NCC) has implicated an assortment of brain regions, ERP components, and network properties associated with visual awareness. Recently, the P3b ERP component has emerged as a leading NCC candidate. However, typical P3b paradigms depend on the detection of some stimulus change, making it difficult to separate brain processes elicited by the stimulus itself from those associated with updates or changes in visual awareness. Here we used binocular rivalry to ask whether the P3b is associated with changes in awareness even in the absence of changes in the object of awareness. We recorded ERPs during a probe-mediated binocular rivalry paradigm in which brief probes were presented over the image in either the suppressed or dominant eye to determine whether the elicited P3b activity is probe or reversal related. We found that the timing of P3b (but not its amplitude) was closely related to the timing of the report of a perceptual change rather than to the onset of the probe. This is consistent with the proposal that P3b indexes updates in conscious awareness, rather than being related to stimulus processing per se. Conversely, the probe-related P1 amplitude (but not its latency) was associated with reversal latency, suggesting that the degree to which the probe is processed increases the likelihood of a fast perceptual reversal. Finally, the response-locked P3b amplitude (but not its latency) was associated with the duration of an intermediate stage between reversals in which parts of both percepts coexist (piecemeal period). Together, the data suggest that the P3b reflects an update in consciousness and that the intensity of that process (as indexed by P3b amplitude) predicts how immediate that update is.

Background Total shoulder arthroplasty (TSA) is a likely target for future bundled payment initiatives, necessitating accurate preoperative risk stratification. The purpose of this study was to identify risk factors for unplanned readmission and severe adverse events, to risk stratify TSA patients based on these risk factors, and to assess timing of complications after TSA. Methods Data were collected from patients undergoing TSA from 2009 to 2014 in the American College of Surgeons National Surgical Quality Improvement Program. Bivariate and multivariate analyses of risk factors for severe adverse events or readmission were assessed. Patients were risk stratified, and timing of severe adverse events and cause of readmission were evaluated. Results The analysis included 5801 TSA patients; 146 (2.5%) suffered severe adverse events, and 158 (2.7%) had a 30-day unplanned readmission. The most common severe adverse events were reoperation (40%), thrombolic event (deep venous thrombosis or pulmonary embolism; 14%), cardiac event (10%), and death (8.2%). Pneumonia (8.9%) and thrombolic event (7.6%) were the most common medically related causes, whereas dislocation (7.6%) and postoperative infection or wound complication (5.1%) were the most common surgical causes for readmission. Multivariate analysis identified inflammatory arthritis ( P = .026), male gender ( P = .019), age ( P P = .024), and American Society of Anesthesiologists class 3/4 ( P = .01) as independent predictors for unplanned 30-day readmission and all but inflammatory arthritis for severe adverse events ( P ≤ .05 for all). Patients with ≥3 risk factors had an 11.56 ( P = .002) and 3.43 ( P = .013) times increased odds of unplanned readmission and severe adverse events occurring within 2 weeks after surgery, respectively, compared with patients with 0 risk factors. Conclusions Patients at high risk of TSA complications and readmission should be identified preoperatively to improve outcomes and to lower costs. Bundled payment initiatives must account for both patient- and procedure-related risk factors.

OBJECTIVE Cognitive stress during shift work contributes to burnout in emergency department (ED) workers. We hypothesize that if physicians and nurses interact with a therapy dog for 5 minutes while on ED shift, both their perceived and their manifested stress levels will decrease. METHODS In this single-center, prospective, randomized controlled clinical trial (NCT03628820), we tested the effectiveness of therapy dogs versus coloring a mandala and versus no intervention (control) on provider stress. Consenting emergency medicine physicians and nurses provided three self-reported assessments of stress and saliva samples at the start (T1), at the middle (T2), and near the end (T3) of shift. Thirty minutes prior to T2, participants were randomized to either interacting with a therapy dog or coloring for 5 minutes; controls had neither. Stress was assessed on visual analog scale (VAS, 0-100 mm) and with salivary cortisol (Salimetrics) and the modified Perceived Stress Scale (mPSS-10). To assess potential change in participant behavior, patients of providers in either group were asked to complete an internally derived survey of empathic behaviors displayed by providers at T1 and T3. RESULTS We enrolled 122 providers (n = 39 control, n = 40 coloring, n = 43 dog); 48% were residents, and 60% enrolled on an evening shift. At T1, mean (±SD) VAS score was not different between groups (18.2 [±17.8] mm). At T3, VAS tended to increase with coloring (24.5 mm), remain unchanged in controls (20 mm), and decreased slightly with dogs (13.6 mm, p = 0.018 vs. coloring, Tukey's post hoc). Salivary cortisol levels were consistently highest at the beginning of each providers' shift and were significantly decreased versus control in both the dog and the coloring groups (p

Aims To demonstrate that early adolescent binge drinking (BD) increases the risk for and/or severity of psychopathology in post-9/11 Veterans and determine if mild traumatic brain injury (mTBI) modifies risk. Methods Post-9/11 Veterans (n = 375) were classified into two groups: 57 Veterans with a history of early adolescent BD (E-BD; age of onset Results Logistic regression and analysis of variance (ANOVA) analyses revealed that the E-BD’s had significantly higher prevalence of alcohol use disorders (AUDs) and more severe symptoms of AUD, substance use disorder (SUD), depression and stress. Two-way ANOVAs showed that history of military mTBI was differentially associated with posttraumatic stress disorder (PTSD) incidence and severity among Veterans who had engaged in early adolescent BD. Specifically, Veterans with a history of both early adolescent BD and military mTBI were at greater risk for a PTSD diagnosis and had more severe symptoms of PTSD than those with only a history of adolescent BD. The greater PTSD symptom severity in the comorbid group was driven by hyperarousal symptoms. Conclusions A history of BD during early adolescence is prevalent among Veterans and is related to higher risk for AUD and more severe AUD, SUD, mood and stress symptoms later in life. Veterans with early BD and military mTBI showed greater incidence and severity of PTSD, indicating that mTBI, a common comorbidity among post-9/11 Veterans, exacerbates risk.

Glucocorticoids (GCs) act via the glucocorticoid receptor (NR3C1, GR alpha) to combat overshooting responses to infectious stimuli, including lipopolysaccharide (LPS). As such, GCs inhibit the activity of downstream effector cytokines, such as tumor necrosis factor (TNF). PPAR alpha (NR1C1) is a nuclear receptor described to function on the crossroad between lipid metabolism and control of inflammation. In the current work, we have investigated the molecular mechanism by which GCs and PPAR alpha agonists cooperate to jointly inhibit NF-kappa B-driven expression in A549 cells. We discovered a nuclear mechanism that predominantly targets Mitogen- and Stress-activated protein Kinase-1 activation upon co-triggering GR alpha and PPAR alpha. In vitro GST-pull down data further support that the anti-inflammatory mechanism may additionally involve a non-competitive physical interaction between the p65 subunit of NF-kappa B, GR alpha, and PPAR alpha. Finally, to study metabolic effector target cells common to both receptors, we overlaid the effect of GR alpha and PPAR alpha crosstalk in mouse primary hepatocytes under LPS-induced inflammatory conditions on a genome-wide level. RNA-seq results revealed lipid metabolism genes that were upregulated and inflammatory genes that were additively downregulated. Validation at the cytokine protein level finally supported a consistent additive anti-inflammatory response in hepatocytes.

Hepatoblastoma (HB) is the most common liver tumor in children under the age of 3 years worldwide. While many patients achieve good outcomes with surgical resection and conventional chemotherapy, there is still a high‑risk population that exhibits a poor treatment response and unfavorable prognosis, which warrants the search for novel treatment options. In recent years, it has become clear that genetic events alone are not sufficient to explain the aggressive phenotype of this embryonal malignancy. Instead, epigenetic modifications and aberrant gene expression seem to be key drivers of HB. In the present study, expression analyses such as reverse transcription‑quantitative polymerase chain reaction revealed that the oncogene, MYCN proto‑oncogene basic‑helix‑loop‑helix transcription factor (MYCN) was upregulated in HB and other pediatric liver tumors, due to the transcriptional activity of its antisense transcript MYCN opposite strand (MYCNOS). Pyrosequencing demonstrated the hypomethylated regions in the promoter of MYCN and MYCNOS, suggesting that an epigenetic mechanism may underlie the induction of aberrant expression. Transient MYCN knockdown in HB cells resulted in growth inhibition over time. In addition, treating HB cells with the MYCN inhibitors JQ1 and MLN8237 led to the significant downregulation of MYCN either at the mRNA or protein levels, respectively. The underlying mechanism of action of the two inhibitors was revealed to be associated with the induction of dose‑dependent growth arrest, by arresting cells at either the G1/G0 or G2 phase. Furthermore, MLN8237 and JQ1 were able to cause spindle disturbances and/or apoptosis in HB cells. The present results suggest that MYCN may be a promising biomarker for HB and a potential therapeutic target in patients with tumors overexpressing MYCN.

Background Physical activity (PA) has demonstrated a decreased risk in various cancers and other chronic diseases; however, rural residents are less likely to attain recommended levels of PA compared to urban and suburban counterparts. Given rural residents make up 15% of the United States population, there is a need for novel approaches to increase PA among this population. The goal of the present study is to investigate the effectiveness of a multilevel intervention to increase PA rates among rural residents. Methods/design Guided by an ecological framework, a group-randomized design will be used to evaluate the effects of a three-level intervention for increasing PA among adult residents residing in 6 rural communities (n = 600) along with 6 control communities (n = 600). The intervention includes components at the individual (short message service [SMS] text messages), interpersonal (social support in walking groups), and community levels (events at existing trails). Innovative methods to encourage participation will be employed as well as a focus on life priorities (family, recreation, hobbies) other than health. Aim 1 includes a literature review and key informant interviews to determine the local contexts for intervention adaptation. Aim 2 will employ a set of interventions at the individual, interpersonal, and community-levels to evaluate their impact on moderate-to-vigorous PA as measured by self-reported (telephone survey) and objectively assessed (accelerometry) measures. These data are supplemented by location based on Global Positioning System and community audits, which provide information on recreational amenities, programs/policies, and street segments. Discussion This study is among the first of its kind to test a multilevel intervention in a rural setting, address life priorities that compliment health outcomes, and examine moderation between behavioral interventions and the natural environments where people are physically active. Our results will influence the field by enhancing the ability to scale-up innovative, PA interventions with the potential to reach high-risk, rural populations. Trial registration Clinical Trials NCT03683173, September 25, 2018.

Contextual information plays a critical role in directed forgetting (DF) of lists of items, whereas DF of individual items has been primarily associated with item-level processing. This study was designed to investigate whether context processing also contributes to the forgetting of individual items. Participants first viewed a series of words, with task-irrelevant scene images (used as “context tags”) interspersed between them. Later, these words reappeared without the scenes and were followed by an instruction to remember or forget that word. Multivariate pattern analyses of fMRI data revealed that the reactivation of context information associated with the studied words (i.e., scene-related activity) was greater whereas the item-related information diminished after a forget instruction compared to a remember instruction. Critically, we found the magnitude of the separation between item information and context information predicted successful forgetting. These results suggest that the unbinding of an item from its context may support the intention to forget, and more generally they establish that contextual processing indeed contributes to item-method DF.

The United States spends $12 billion each year on ∼332,000 total hip arthroplasty (THA) procedures with the postoperative period accounting for ∼40% of costs. The purpose of this study was to evaluate the effect of surgical scheduling (day of week and start time) on clinical outcomes, hospital length of stay (LOS), and rate of nonhome discharge in THA patients.Analysis of perioperative variables was performed for patients who underwent THA at an urban tertiary care teaching hospital from 2009 to 2014.A total of 580 THA patients were included for analysis. LOS was higher for the Thursday/Friday cohort compared to Monday/Tuesday (3.7 vs 3.4 days; P = .03). Patients who had a surgical start time after 2 PM had longer LOS compared to patients operated on before 2 PM (3.9 vs 3.5 days; P = .03). After controlling for patient comorbidities and THA surgical approach (direct anterior vs posterior), Thursday/Friday THAs were associated with a 3.27 times risk of extended LOS (75th percentile LOS) compared to Monday/Tuesday THAs (P.001). Additionally, case start before 2 PM was protective and associated with a 0.46 times odds of extended LOS (P = .01). LOS reduction opportunity for changing surgical start time to before 2 PM was 0.9 days for high-risk patients (American Society of Anesthesiology class 3/4 and/or liver disease) and 0.2 days for low-risk patients (American Society of Anesthesiology class 1/2).Patients who underwent THA Thursday/Friday or had start times after 2 PM had significantly extended hospital LOS. Preoperative risk modification along with adjustments to surgical scheduling and/or perioperative staffing may reduce LOS and thus hospital expenditures for THA procedures.

Metabolic syndrome is increasingly common in U.S. adolescents and has been linked to cognitive dysfunction. Purpose of this study is to explore associations between metabolic syndrome and cognitive impairment in U.S. adolescents using population-based data.Participants included adolescents aged 12-16 years who participated in the National Health and Nutrition Examination Survey (NHANES) III. The main outcome measures included assessments of cognitive function using Wide Range Achievement Test-Revised (WRAT-R) and Wechsler Intelligence Scale for Children-Revised (WISC-R) tools. The WRAT-R consisted of mathematics and reading tests. The WISC-R consisted of block design test, which measures spatial visualization and motor skills, and digit span test, which measures working memory and attention. Linear regression models were used to examine associations between metabolic syndrome and cognitive function. We used education levels of the family reference person, while controlling for education levels because of missing data.Presence or absence of metabolic syndrome was tested in 1170 of 2216 NHANES III participants aged 12-16 years. Regression models showed that participants with metabolic syndrome scored an average 1.25 [95% confidence interval (CI) = -2.14 to -0.36] points lower in reading examination and an average 0.89 (95% CI = -1.65 to -0.13) points lower in digit span examination, compared to those without metabolic syndrome. In addition, components of metabolic syndrome-elevated systolic blood pressure and increased waist circumference (WC)-were associated with impaired working memory/attention, and higher fasting glucose and increased WC were associated with poorer reading test scores.Metabolic syndrome was associated with impaired reading, working memory, and attention among adolescents.

Hepatoblastoma (HB) is the most common liver tumor of childhood, usually occurring in children under the age of 3 y. The prognosis of patients presenting with distant metastasis, vascular invasion and advanced tumor stages remains poor and children that do survive often face severe late effects from the aggressive chemotherapy regimen. To identify potential new therapeutics for high risk HB we used a 1,000-gene expression signature as input for a Connectivity Map (CMap) analysis, which predicted histone deacetylase (HDAC) inhibitors as a promising therapy option. Subsequent expression analysis of primary HB and HB cell lines revealed a general overexpression of HDAC1 and HDAC2, which has been suggested to be predictive for the efficacy of HDAC inhibition. Accordingly, treatment of HB cells with the HDAC inhibitors SAHA and MC1568 resulted in a potent reduction of cell viability, induction of apoptosis, reactivation of epigenetically suppressed tumor suppressor genes, and the reversion of the 16-gene HB classifier toward the more favorable expression signature. Most importantly, the combination of HDAC inhibitors and cisplatin – a major chemotherapeutic agent of HB treatment - revealed a strong synergistic effect, even at significantly reduced doses of cisplatin. Our findings suggest that HDAC inhibitors skew HB cells toward a more favorable prognostic phenotype through changes in gene expression, thus indicating a targeted molecular mechanism that seems to enhance the anti-proliferative effects of conventional chemotherapy. Thus, adding HDAC inhibitors to the treatment regimen of high risk HB could potentially improve outcomes and reduce severe late effects.

How do we know that a kitchen is a kitchen by looking? Traditional models posit that scene categorization is achieved through recognizing necessary and sufficient features and objects, yet there is little consensus about what these may be. However, scene categories should reflect how we use visual information. Therefore, we test the hypothesis that scene categories reflect functions, or the possibilities for actions within a scene. Our approach is to compare human categorization patterns with predictions made by both functions and alternative models. We collected a large-scale scene category distance matrix (5 million trials) by asking observers to simply decide whether 2 images were from the same or different categories. Using the actions from the American Time Use Survey, we mapped actions onto each scene (1.4 million trials). We found a strong relationship between ranked category distance and functional distance (r = .50, or 66% of the maximum possible correlation). The function model outperformed alternative models of object-based distance (r = .33), visual features from a convolutional neural network (r = .39), lexical distance (r = .27), and models of visual features. Using hierarchical linear regression, we found that functions captured 85.5% of overall explained variance, with nearly half of the explained variance captured only by functions, implying that the predictive power of alternative models was because of their shared variance with the function-based model. These results challenge the dominant school of thought that visual features and objects are sufficient for scene categorization, suggesting instead that a scene's category may be determined by the scene's function.

The iliotibial band (ITB) is used in anterior cruciate ligament (ACL) reconstruction in skeletally immature patients as well as several other orthopedic reconstructions. The purpose of this study is to determine the size of the ITB as an autograft option in ACL reconstruction surgery or other orthopedic soft tissue reconstructions. Five adult cadavers resulting in nine ITB were used. Thickness and width of the ITB were determined. Using ITB width of 15–60 mm, single and doubled graft sizes were determined using standard surgical graft size technique. Geometric calculations based on average graft thickness were used to mathematically confirm the graft size of the ITB. The ITB is less than 1 mm in thickness in males and females. Cadaveric measurements were less than 1 mm larger than mathematical measurements, in majority of measurements. ITB autograft can be harvested to a maximum 9 mm single-stranded graft or > 12 mm doubled graft. A minimum of 50 mm of ITB width is required to make a 8 mm graft. ITB is a versatile graft that can be used for a graft size up to 9 mm single strand and over 12 mm double strand. A minimum of 50 mm width of ITB is required to obtain a 8 mm-diameter autograft. To ensure appropriate graft size, surgeons should consider harvesting the maximum amount of ITB when performing ACL reconstructions in skeletally immature patients. Surgeons have a quick reference for the width of ITB they should harvest based on the size of graft they require for a successful surgery.

Sensory information is encoded by populations of cortical neurons. Yet, it is unknown how this information is used for even simple perceptual choices such as discriminating orientation. To determine the computation underlying this perceptual choice, we took advantage of the robust visual adaptation in mouse primary visual cortex (V1). We first designed a stimulus paradigm in which we could vary the degree of neuronal adaptation measured in V1 during an orientation discrimination task. We then determined how adaptation affects task performance for mice of both sexes and tested which neuronal computations are most consistent with the behavioral results given the adapted population responses in V1. Despite increasing the reliability of the population representation of orientation among neurons, and improving the ability of a variety of optimal decoders to discriminate target from distractor orientations, adaptation increases animals' behavioral thresholds. Decoding the animals' choice from neuronal activity revealed that this unexpected effect on behavior could be explained by an overreliance of the perceptual choice circuit on target preferring neurons and a failure to appropriately discount the activity of neurons that prefer the distractor. Consistent with this all-positive computation, we find that animals' task performance is susceptible to subtle perturbations of distractor orientation and optogenetic suppression of neuronal activity in V1. This suggests that to solve this task the circuit has adopted a suboptimal and task-specific computation that discards important task-related information.SIGNIFICANCE STATEMENTA major goal in systems neuroscience is to understand how sensory signals are used to guide behavior. This requires determining what information in sensory cortical areas is used, and how it is combined, by downstream perceptual choice circuits. Here we demonstrate that when performing a go/no-go orientation discrimination task, mice suboptimally integrate signals from orientation tuned visual cortical neurons. While they appropriately positively weight target-preferring neurons, they fail to negatively weight distractor-preferring neurons. We propose that this all-positive computation may be adopted because of its simple learning rules and faster processing, and may be a common approach to perceptual decision-making when task conditions allow.

An increased frequency of nontyphoidal salmonellosis is well established in cancer patients, but it is unclear whether this represents increased susceptibility to exogenous infection or opportunistic, endogenous reactivation of asymptomatic carriage. In a retrospective study, a simple case definition was used to identify the probable presence of reactivation salmonellosis in five cancer patients between 1996 and 2002. Reactivation salmonellosis was defined as the development of nosocomial diarrhea >72 h after admission and following the administration of antineoplastic chemotherapy in an HIV-seronegative cancer patient who was asymptomatic on admission, in the absence of epidemiological evidence of a nosocomial outbreak. Primary salmonellosis associated with unrecognized nosocomial transmission or community acquisition and an unusually prolonged incubation period could not entirely be ruled out. During the same time period, another opportunistic infection, Pneumocystis pneumonia, was diagnosed in six cancer patients. Presumably, asymptomatic intestinal Salmonella colonization was converted to invasive infection by chemotherapy-associated intestinal mucosal damage and altered innate immune mechanisms. According to published guidelines, stool specimens from patients hospitalized for longer than 72 h should be rejected unless the patient is neutropenic or >or=65 years old with significant comorbidity. However, in this study neutropenia was present in only one patient, and four patients were

Background Musculoskeletal injuries of the upper extremity are frequently treated with temporary external immobilization. Traditionally, long arm posterior splints have been used to limit flexion/extension of the elbow. However, long arm posterior splints have been observed to fail clinically, necessitating a stronger alternative. In this study, we assessed the biomechanical strength of the long arm posterior splint compared with a new spiral splint design. Methods One male and one female participant were placed 10 times in long arm posterior splints and 10 times in spiral splints. Both splint types were subjected to a downward mechanical load of 39.2 N (4 kg) and assessed for a change in both flexion/extension and pronation/supination. Results There was no significant difference in starting position or starting flexion/extension between the 2 splint designs. Posterior splints allowed significantly greater initial pronation/supination compared with spiral splints. Both splint groups had significant increases in flexion/extension and pronation/supination compared with their starting ranges of motion. There was no significant difference in the change in pronation/supination between the 2 splint groups. Finally, posterior splints allowed a significantly greater change in flexion/extension compared with spiral splints. Conclusion Spiral splints offered less initial pronation/supination than long arm posterior splints. Furthermore, spiral splints are able to resist flexion/extension of the elbow after application of a downward mechanical load better than posterior splints, thus suggesting spiral splints are mechanically superior to long arm posterior splints.

In five experiments, we examined whether a task-irrelevant item in visual working memory (VWM) interacts with perceptual selection when VWM must also be used to maintain a template representation of a search target. This question is critical to distinguishing between competing theories specifying the architecture of interaction between VWM and attention. The single-item template hypothesis (SIT) posits that only a single item in VWM can be maintained in a state that interacts with attention. Thus, the secondary item should be inert with respect to attentional guidance. The multiple-item template hypothesis (MIT) posits that multiple items can be maintained in a state that interacts with attention; thus, both the target representation and the secondary item should be capable of guiding selection. This question has been addressed previously in attention capture studies, but the results have been ambiguous. Here, we modified these earlier paradigms to optimize sensitivity to capture. Capture by a distractor matching the secondary item in VWM was observed consistently across multiple types of search task (abstract arrays and natural scenes), multiple dependent measures (search reaction time (RT) and oculomotor capture), multiple memory dimensions (color and shape), and multiple search stimulus dimensions (color, shape, common objects), providing strong support for the MIT. (PsycINFO Database Record

Improved understanding of the lung microbiome in HIV-infected individuals could lead to better strategies for diagnosis, therapy, and prophylaxis of HIV-associated pneumonias. Differences in the oral and lung microbiomes in HIV-infected and HIV-uninfected individuals are not well defined. Whether highly active antiretroviral therapy influences these microbiomes is unclear.We determined whether oral and lung microbiomes differed in clinically healthy groups of HIV-infected and HIV-uninfected subjects.Participating sites in the Lung HIV Microbiome Project contributed bacterial 16S rRNA sequencing data from oral washes and bronchoalveolar lavages (BALs) obtained from HIV-uninfected individuals (n = 86), HIV-infected individuals who were treatment naive (n = 18), and HIV-infected individuals receiving antiretroviral therapy (n = 38).Microbial populations differed in the oral washes among the subject groups (Streptococcus, Actinomyces, Rothia, and Atopobium), but there were no individual taxa that differed among the BALs. Comparison of oral washes and BALs demonstrated similar patterns from HIV-uninfected individuals and HIV-infected individuals receiving antiretroviral therapy, with multiple taxa differing in abundance. The pattern observed from HIV-infected individuals who were treatment naive differed from the other two groups, with differences limited to Veillonella, Rothia, and Granulicatella. CD4 cell counts did not influence the oral or BAL microbiome in these relatively healthy, HIV-infected subjects.The overall similarity of the microbiomes in participants with and without HIV infection was unexpected, because HIV-infected individuals with relatively preserved CD4 cell counts are at higher risk for lower respiratory tract infections, indicating impaired local immune function.

Theories of attention and visual search explain how attention is guided toward objects with known target features. But can attention be directed away from objects with a feature known to be associated only with distractors? Most studies have found that the demand to maintain the to-be-avoided feature in visual working memory biases attention toward matching objects rather than away from them. In contrast, Arita, Carlisle, and Woodman (2012) claimed that attention can be configured to selectively avoid objects that match a cued distractor color, and they reported evidence that this type of negative cue generates search benefits. However, the colors of the search array items in Arita et al. (2012) were segregated by hemifield (e.g., blue items on the left, red on the right), which allowed for a strategy of translating the feature-cue information into a simple spatial template (e.g., avoid right, or attend left). In the present study, we replicated the negative cue benefit using the Arita et al. (2012), method (albeit within a subset of participants who reliably used the color cues to guide attention). Then, we eliminated the benefit by using search arrays that could not be grouped by hemifield. Our results suggest that feature-guided avoidance is implemented only indirectly, in this case by translating feature-cue information into a spatial template.

Asthma is the most common chronic pediatric condition (14%) and the leading cause of school absenteeism in the USA. However, little is known about asthma prevalence and distribution in schoolchildren in the Florida Keys region (Monroe County). Thus, the objectives of this study were to assess asthma prevalence, symptoms, cost and distribution in schoolchildren in the Florida Keys region and to pinpoint where asthma management services are most needed.Cross-sectional survey data on asthma prevalence, symptoms and socio-demographics was collected and analyzed by race, sex, grade and zip code. A total of 2313 parents of schoolchildren in the Florida Keys completed the adapted Harlem Empowerment Zone Asthma Initiative Questionnaire. The questionnaire was distributed to school principals, who sent them home with students to be filled out by parents or caregivers. We also analyzed data from the online Monroe County 2012 Florida Youth Tobacco Survey, the 2011 Florida CHARTS, the Medical Expenditures Panel Survey, and emergency departments (ED). Data were analyzed by race, sex, and grade.In total 14.5% of respondents had been told their child had asthma and 9.6% reported their child had wheezing in the last 12 months. The prevalence was higher in the Lower Keys and Key West regions. Parents from households where anyone smoked cigarettes (OR 1.52, 95% CI 1.11-2.09) and those who had a male child (1.53, 1.17-2.00) more often reported that their child had asthma. The rate of asthma-related ED visits for Black non-Hispanic schoolchildren (1202 per 100,000) was substantially higher than the numbers for White (250.2 per 100,000) and Hispanic schoolchildren (325.1 per 100,000). Most of the direct cost of asthma was concentrated in children in grades four through seven ($1236.02-$2147.02 per child).The asthma prevalence in a sample of schoolchildren in the Florida Keys region was comparable to the nationwide prevalence. Black non-Hispanic schoolchildren had more asthma-related ED visits that White and Hispanic schoolchildren. Most of the direct cost of asthma is concentrated in children in late elementary through early middle school grades. Interventions are needed, particularly targeting Black schoolchildren in late elementary through early middle school grades in Lower Keys and Key West region.

Purpose: The purpose of this retrospective study was to investigate the relationship of specific prosthetic complications in patients with a maxillary complete removable dental prosthesis (CRDP) opposing a mandibular metal-resin implant-fixed complete dental prosthesis (MRIFCDP) with respect to anteroposterior (AP) spread and cantilever length. Materials and Methods: Of the 46 patients contacted for this study, 23 patients responded. All patients had been treated with a maxillary CRDP and a mandibular MRIFCDP. They were reviewed for prosthetic complications, and the AP spread and cantilever length were evaluated. A polyvinyl siloxane impression was made of each MRIFCDP so that cantilever length and AP spread could be measured. The average recall time was 8.5 years. The mechanical complications noted were screw-related complications, including both the prosthetic and the abutment screw, consisting of loosening and/or fracture, and fracture of the metal framework. Three different individuals repeated each measurement three times. Inter- and intrarater reliability was evaluated with the intraclass correlation coefficient, and a linear regression analysis of age and average cantilever length to AP spread ratio was calculated. In addition, calculations using this ratio were divided into two groups (> 2.1 and ≤ 2.1) and examined with each variable individually. A logistic regression analysis was performed for a comparison between the two AP spread ratio groups by age, right cantilever length, left cantilever length, average cantilever length, posterior spread, and failures. Results: None of the predictor values was significant for the linear regression analysis of age, cantilever length, and AP ratio on number of failures. There was no significance in complications between the groups that had an AP spread ratio > 2.1 and groups that had an AP spread ratio ≤ 2.1. Conclusions: There was no statistical significance in predicting whether a screw-related complication would occur in relation to age, cantilever length, or AP spread ratio. There was no increase or decrease in complications whether the AP spread ratio was greater than or less than or equal to 2.1. In mandibular MRIFCDPs opposing maxillary complete denture situations, screw-related complications may be less likely regardless of the patient’s age, cantilever length, or AP spread ratio of the prosthesis.

Objects can be simultaneously categorized at multiple levels of specificity ranging from very broad (“natural object”) to very distinct (“Mr. Woof”), with a mid-level of generality (basic level: “dog”) often providing the most cognitively useful distinction between categories. It is unknown, however, how this hierarchical representation is achieved in the brain. Using multivoxel pattern analyses, we examined how well each taxonomic level (superordinate, basic, and subordinate) of real-world object categories is represented across occipitotemporal cortex. We found that, although in early visual cortex objects are best represented at the subordinate level (an effect mostly driven by low-level feature overlap between objects in the same category), this advantage diminishes compared to the basic level as we move up the visual hierarchy, disappearing in object-selective regions of occipitotemporal cortex. This pattern stems from a combined increase in within-category similarity (category cohesion) and between-category dissimilarity (category distinctiveness) of neural activity patterns at the basic level, relative to both subordinate and superordinate levels, suggesting that successive visual areas may be optimizing basic level representations.

With the introduction of combination antiretroviral therapy (ART) worldwide, youth with perinatal HIV infection are increasingly surviving childhood and transitioning to adult care. Although a normal life span is anticipated posttransition, successful transition to adult HIV care has proven difficult, with worse outcomes posttransition than in pediatric and adult care. This study is a qualitative analysis of data from 4 focus groups of pre- and posttransition patients, caregivers, and healthcare providers in the Dominican Republic at an institution that provides comprehensive treatment including ART for HIV-infected persons of all ages. All groups discussed the problems and challenges that patients, caregivers, and providers experience while living the transition process and beyond. Five major themes emerged: the trauma of transition itself, ART adherence, experience and impact of stigma, social supports and barriers, and recommendations for improving outcomes. Participants’ insights offered approaches for a versatile structured transition process.

Inherent correlations between visual and semantic features in real-world scenes make it difficult to determine how different scene properties contribute to neural representations. Here, we assessed the contributions of multiple properties to scene representation by partitioning the variance explained in human behavioral and brain measurements by three feature models whose inter-correlations were minimizeda priorithrough stimulus preselection. Behavioral assessments of scene similarity reflected unique contributions from a functional feature model indicating potential actions in scenes as well as high-level visual features from a deep neural network (DNN). In contrast, similarity of cortical responses in scene-selective areas was uniquely explained by mid- and high-level DNN features only, while an object label model did not contribute uniquely to either domain. The striking dissociation between functional and DNN features in their contribution to behavioral and brain representations of scenes indicates that scene-selective cortex represents only a subset of behaviorally relevant scene information.

4D dynamic MR angiography (4D-MRA) using pseudo-continuous arterial spin labeling (pCASL), combined with Keyhole and View-sharing (4D-PACK) for scan acceleration, is introduced. Its validity for arterial inflow dynamics visualization was investigated through comparison with 4D-pCASL and contrast inherent inflow enhanced multiphase angiography (CINEMA).Six healthy volunteers were included in the study. The arterial transit time (ATT) in 4D-PACK was measured at multiple regions in middle cerebral artery (MCA), and Pearson's correlation coefficient with ATT in 4D-pCASL was calculated. The contrast-to-noise ratio (CNR) in 4D-PACK was measured in four MCA segments and compared with that in 4D-pCASL and CINEMA. Arterial visualization in 4D-PACK was assessed qualitatively in patients with moyamoya disease and arteriovenous malformation by comparing with CINEMA.4D-PACK achieved a 36% scan time reduction compared with 4D-pCASL. The correlation coefficient for ATT measured by 4D-pCASL and 4D-PACK was greater than 0.96. The CNR was significantly higher using 4D-PACK compared with CINEMA in the M4 segment (P 0.01). In patient examinations, the flow in the collateral artery or draining vein was better visualized in 4D-PACK compared with CINEMA.4D-PACK accelerates 4D-pCASL, shows similar inflow dynamics as 4D-pCASL and shows better peripheral visualization compared with CINEMA. Magn Reson Med 80:719-725, 2018. © 2018 International Society for Magnetic Resonance in Medicine.

Real-life decision-making often involves combining multiple probabilistic sources of information under finite time and cognitive resources. To mitigate these pressures, people “satisfice”, foregoing a full evaluation of all available evidence to focus on a subset of cues that allow for fast and “good-enough” decisions. Although this form of decision-making likely mediates many of our everyday choices, very little is known about the way in which the neural encoding of cue information changes when we satisfice under time pressure. Here, we combined human functional magnetic resonance imaging (fMRI) with a probabilistic classification task to characterize neural substrates of multi-cue decision-making under low (1500 ms) and high (500 ms) time pressure. Using variational Bayesian inference, we analyzed participants’ choices to track and quantify cue usage under each experimental condition, which was then applied to model the fMRI data. Under low time pressure, participants performed near-optimally, appropriately integrating all available cues to guide choices. Both cortical (prefrontal and parietal cortex) and subcortical (hippocampal and striatal) regions encoded individual cue weights, and activity linearly tracked trial-by-trial variations in the amount of evidence and decision uncertainty. Under increased time pressure, participants adaptively shifted to using a satisficing strategy by discounting the least informative cue in their decision process. This strategic change in decision-making was associated with an increased involvement of the dopaminergic midbrain, striatum, thalamus, and cerebellum in representing and integrating cue values. We conclude that satisficing the probabilistic inference process under time pressure leads to a cortical-to-subcortical shift in the neural drivers of decisions.

We investigated the dynamics of brain processes facilitating conscious experience of external stimuli. Previously, we proposed that alpha (8–12 Hz) oscillations, which fluctuate with both sustained and directed attention, represent a pulsed inhibition of ongoing sensory brain activity. Here we tested the prediction that inhibitory alpha oscillations in visual cortex are modulated by top–down signals from frontoparietal attention networks. We measured modulations in phase-coherent alpha oscillations from superficial frontal, parietal, and occipital cortices using the event-related optical signal (EROS), a measure of neuronal activity affording high spatiotemporal resolution, along with concurrently recorded EEG, while participants performed a visual target detection task. The pretarget alpha oscillations measured with EEG and EROS from posterior areas were larger for subsequently undetected targets, supporting alpha's inhibitory role. Using EROS, we localized brain correlates of these awareness-related alpha oscillations measured at the scalp to the cuneus and precuneus. Crucially, EROS alpha suppression correlated with posterior EEG alpha power across participants. Sorting the EROS data based on EEG alpha power quartiles to investigate alpha modulators revealed that suppression of posterior alpha was preceded by increased activity in regions of the dorsal attention network and decreased activity in regions of the cingulo-opercular network. Cross-correlations revealed the temporal dynamics of activity within these preparatory networks before posterior alpha modulation. The novel combination of EEG and EROS afforded localization of the sources and correlates of alpha oscillations and their temporal relationships, supporting our proposal that top–down control from attention networks modulates both posterior alpha and awareness of visual stimuli.