Source: International Journal of Therapies and Rehabilitation Research
Hesham Ahmed Ali, Aliaa Mohammed Rehan, Khaled Al-Sayed Ayaad, Walid Reda Awadallah.
Background & Purpose, Non-anatomical repair is the only choice in presence of bony defect in anterior shoulder instability, few evidence based rehabilitation protocol try to return the patients to a fully functional status; this study try to investigate effect of either labrum preservation or removal on shoulder function and proprioception in patients with same surgical procedure. Subjects & Methods, Twenty nine patients with age ranged between 25 and 52 years old were enrolled in this study. All received a standardized physical therapy rehabilitation protocol. Shoulder function (Pain severity, range of motion and muscle strength was quantified). Proprioception acuity was measured using the closed kinetic chain upper extremity stability test (CKCUET). All measurements were done at 2nd (during phase I) and 15th weeks (at the end of Phase III).RESULTS, within group comparisons showed significant improvement in all measured variables between the 2nd and 16th weeks in patients of two groups (p
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Δευτέρα, 15 Φεβρουαρίου 2016
Effect of Standard Physical Therapy Protocol on Two Different Techniques of Same Non-Anatomical Repair Procedure of Anterior Shoulder Instability
Phenotypic flexibility of thermogenesis in the hwamei (Garrulax canorus): responses to cold acclimation
Cold acclimation in birds involves a comprehensive array of physiological and morphological adjustment ranging from changes in aerobic enzyme activity to metabolic rate and organ mass. In the present study, we investigated phenotypic variation in thermogenic activity in the hwamei (Garrulax canorus) under normal (35°C) or cold (15°C) ambient temperature conditions. Acclimation to an ambient temperature of 15°C for 4 wk significantly increased the body mass, basal metabolic rate (BMR), and energy intake, including both gross energy intake and digestible energy intake, compared with birds kept at 35°C. Furthermore, birds acclimated to 15°C increased the dry mass of their liver and kidneys, but not their heart and pectoral muscles, and displayed higher state-4 respiration in the liver, kidneys, heart, and pectoral muscles, and higher cytochrome-c oxidase (COX) activity in liver, kidney, and pectoral muscle, compared with those kept at 35°C. There was a positive correlation between BMR and state-4 respiration in all of the above organs except the liver, and between BMR and COX activity in all of the above organs. Taken together, these data illustrate the morphological, physiological, and enzymatic changes associated with cold acclimation, and support the notion that the hwamei is a bird species from temperate climates that exhibits high phenotypic flexibility of thermogenic capacity.
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Knowledge of depression among immigrants within Spanish primary care is limited. This database study investigates the incidence of depressive disorders among immigrants and natives within primary care in Aragón (Spain). Participants were patients registered in an electronic record register, aged above 20 years diagnosed with depression. Incidence of depression was calculated and compared per continent of origin, gender and age with the Mann-Whitney U test and the Kruskal–Wallis test. The population consisted of 11,088 patients with depression of whom 93.0 % natives and 7.0 % immigrants. Incidence of depression amongst male immigrants was lower than amongst male natives (OR 0.80). Eastern European males showed the lowest incidence 4.1 (3.5–5.3). The gender difference in incidence was larger in immigrants than in natives (OR 3.4 vs. 2.7). Due to male immigrants the incidence of depression within primary care is lower among immigrants. Equal care should be provided to patients of both genders and all origin.
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Undocumented Immigrant Women in Spain: A Scoping Review on Access to and Utilization of Health and Social Services
This scoping review summarizes and analyzes relevant studies related to the evidence published on undocumented immigrant women's access to and utilization of health and social services in Spain. Scientific literature was identified by entering search terms in seven electronic databases which combined retrieved health sciences peer-reviewed articles (Pubmed, Embase, CINAHL Plus and Scopus) and grey literature databases (Europa OpenGrey, DART-Europe and Google Scholar) published between 2004 and 2014 and written in Spanish or in English presenting data about Spain. Those that fulfill the inclusion criteria were selected after a blind peer reviewed process when pertinence and quality was debated. A total of 16 publications were included, the main topics being socio-cultural differences in the access and utilization of social and health services and barriers faced by immigrant women. None of the studies focused exclusively on undocumented women, hence further research is needed in this area.
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The purpose of this study was to determine whether trauma-induced coagulopathy is due to changes in 1) thrombin activity, 2) plasmin activity, and/or 3) factors that stimulate or inhibit thrombin or plasmin. Sprague-Dawley rats were anesthetized with 1–2% isoflurane/100% oxygen, and their left femoral artery and vein were cannulated. Polytrauma included right femur fracture, and damage to the small intestines, the left and medial liver lobes, and right leg skeletal muscle. Rats were then bled 40% of blood volume. Plasma samples were taken before trauma, and at 30, 60, 120, and 240 min. Polytrauma and hemorrhage led to a significant fall in prothrombin levels. However, circulating thrombin activity did not change significantly over time. Antithrombin III and α2 macroglobulin fell significantly by 2 h, then rose by 4 h. Soluble thrombomodulin was significantly elevated over the 4 h. Circulating plasmin activity, plasminogen, and D-dimers were elevated for the entire 4 h. Tissue plasminogen activator (tPA) was elevated at 30 min, then decreased below baseline levels after 1 h. Plasminogen activator inhibitor-1 was significantly elevated at 2–4 h. Neither tissue factor pathway inhibitor nor thrombin activatable fibrinolysis inhibitor changed significantly over time. The levels of prothrombin and plasminogen were 30–100 times higher than their respective active enzymes. Polytrauma and hemorrhage in rats lead to a fibrinolytic coagulopathy, as demonstrated by an elevation in plasmin activity, D-dimers, and tPA. These results are consistent with the observed clinical benefit of tranexamic acid in trauma patients.
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The "metabolic sensor" function of rat supraoptic oxytocin and vasopressin neurons is attenuated during lactation but not in diet-induced obesity
The oxytocin (OT) and vasopressin (VP) neurons of the supraoptic nucleus (SON) demonstrate characteristics of "metabolic sensors". They express insulin receptors and glucokinase (GK). They respond to an increase in glucose and insulin with an increase in intracellular [Ca2+] and increased OT and VP release that is GK dependent. Although this is consistent with the established role of OT as an anorectic agent, how these molecules function relative to the important role of OT during lactation and whether deficits in this metabolic sensor function contribute to obesity remain to be examined. Thus, we evaluated whether insulin and glucose-induced OT and VP secretion from perifused explants of the hypothalamo-neurohypophyseal system are altered during lactation and by diet-induced obesity (DIO). In explants from female day 8 lactating rats, increasing glucose (Glu, 5 mM) did not alter OT or VP release. However, insulin (Ins; 3 ng/ml) increased OT release, and increasing the glucose concentration in the presence of insulin (Ins+Glu) resulted in a sustained elevation in both OT and VP release that was not prevented by alloxan, a GK inhibitor. Explants from male DIO rats also responded to Ins+Glu with an increase in OT and VP regardless of whether obesity had been induced by feeding a high-fat diet (HFD). The HFD-DIO rats had elevated body weight, plasma Ins, Glu, leptin, and triglycerides. These findings suggest that the role of SON neurons as metabolic sensors is diminished during lactation, but not in this animal model of obesity.
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Deficiency of vitamin D (VD) is associated with preeclampsia (PE), a hypertensive disorder of pregnancy characterized by proinflammatory immune activation. We sought to determine whether VD supplementation would reduce the pathophysiology and hypertension associated with the reduced uterine perfusion pressure (RUPP) rat model of PE. Normal pregnant (NP) and RUPP rats were supplemented with VD2 or VD3 (270 IU and 15 IU/day, respectively) on gestation days 14–18 and mean arterial pressures (MAPs) measured on day 19. MAP increased in RUPP to 123 ± 2 mmHg compared with 102 ± 3 mmHg in NP and decreased to 113 ± 3 mmHg with VD2 and 115 ± 3 mmHg with VD3 in RUPP rats. Circulating CD4+ T cells increased in RUPP to 7.90 ± 1.36% lymphocytes compared with 2.04 ± 0.67% in NP but was lowered to 0.90 ± 0.19% with VD2 and 4.26 ± 1.55% with VD3 in RUPP rats. AT1-AA, measured by chronotropic assay, decreased from 19.5 ± 0.4 bpm in RUPPs to 8.3 ± 0.5 bpm with VD2 and to 15.4 ± 0.7 bpm with VD3. Renal cortex endothelin-1 (ET-1) expression was increased in RUPP rats (11.6 ± 2.1-fold change from NP) and decreased with both VD2 (3.3 ± 1.1-fold) and VD3 (3.1 ± 0.6-fold) supplementation in RUPP rats. Plasma-soluble FMS-like tyrosine kinase-1 (sFlt-1) was also reduced to 74.2 ± 6.6 pg/ml in VD2-treated and 91.0 ± 16.1 pg/ml in VD3-treated RUPP rats compared with 132.7 ± 19.9 pg/ml in RUPP rats. VD treatment reduced CD4+ T cells, AT1-AA, ET-1, sFlt-1, and blood pressure in the RUPP rat model of PE and could be an avenue to improve treatment of hypertension in response to placental ischemia.
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Endogenous VMH amylin signaling is required for full leptin signaling and protection from diet-induced obesity
Amylin enhances arcuate (ARC) and ventromedial (VMN) hypothalamic nuclei leptin signaling and synergistically reduces food intake and body weight in selectively bred diet-induced obese (DIO) rats. Since DIO 125I-amylin dorsomedial nucleus-dorsomedial VMN binding was reduced, we postulated that this contributed to DIO ventromedial hypothalamus (VMH) leptin resistance, and that impairing VMH (ARC + VMN) calcitonin receptor (CTR)-mediated signaling by injecting adeno-associated virus (AAV) expressing a short hairpin portion of the CTR mRNA would predispose diet-resistant (DR) rats to obesity on high-fat (45%) diet (HFD). Depleting VMH CTR by 80–90% in 4-wk-old male DR rats reduced their ARC and VMN 125I-labeled leptin binding by 57 and 51%, respectively, and VMN leptin-induced phospho-signal transducer and activator of transcription 3-positive neurons by 59% vs. AAV control rats. After 6 wk on chow, VMH CTR-depleted DR rats ate and gained the equivalent amount of food and weight but had 18% heavier fat pads (relative to carcass weight), 144% higher leptin levels, and were insulin resistant compared with control AAV DR rats. After 6 wk more on HFD, VMH CTR-depleted DR rats ate the same amount but gained 28% more weight, had 60% more carcass fat, 254% higher leptin levels, and 132% higher insulin areas under the curve during an oral glucose tolerance test than control DR rats. Therefore, impairing endogenous VMH CTR-mediated signaling reduced leptin signaling and caused DR rats to become more obese and insulin resistant, both on chow and HFD. These results suggest that endogenous VMH amylin signaling is required for full leptin signaling and protection from HFD-induced obesity.
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Pudendal but not tibial nerve stimulation inhibits bladder contractions induced by stimulation of pontine micturition center in cats
This study examined the possibility that pudendal nerve stimulation (PNS) or tibial nerve stimulation (TNS) inhibits the excitatory pathway from the pontine micturition center (PMC) to the urinary bladder. In decerebrate cats under α-chloralose anesthesia, electrical stimulation of the PMC (40 Hz frequency, 0.2-ms pulse width, 10–25 s duration) using a microelectrode induced bladder contractions >20 cmH2O amplitude when the bladder was filled to 60–70% capacity. PNS or TNS (5 Hz, 0.2 ms) at two and four times the threshold (2T and 4T) to induce anal or toe twitch was applied to inhibit the PMC stimulation-induced bladder contractions. Propranolol, a nonselective β-adrenergic receptor antagonist, was administered intravenously (1 mg/kg iv) to determine the role of sympathetic pathways in PNS/TNS inhibition. PNS at both 2T and 4T significantly (P < 0.05) reduced the amplitude and area under the curve of the bladder contractions induced by PMC stimulation, while TNS at 4T facilitated the bladder contractions. Propranolol completely eliminated PNS inhibition and TNS facilitation. This study indicates that PNS, but not TNS, inhibits PMC stimulation-induced bladder contractions via a β-adrenergic mechanism that may occur in the detrusor muscle as a result of reflex activity in lumbar sympathetic nerves. Neither PNS nor TNS activated a central inhibitory pathway with synaptic connections to the sacral parasympathetic neurons that innervate the bladder. Understanding the site of action involved in bladder neuromodulation is important for developing new therapies for bladder disorders.
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The role of cerebral oxygenation and regional cerebral blood flow on tolerance to central hypovolemia
Tolerance to central hypovolemia is highly variable, and accumulating evidence suggests that protection of anterior cerebral blood flow (CBF) is not an underlying mechanism. We hypothesized that individuals with high tolerance to central hypovolemia would exhibit protection of cerebral oxygenation (ScO2), and prolonged preservation of CBF in the posterior vs. anterior cerebral circulation. Eighteen subjects (7 male/11 female) completed a presyncope-limited lower body negative pressure (LBNP) protocol (3 mmHg/min onset rate). ScO2 (via near-infrared spectroscopy), middle cerebral artery velocity (MCAv), posterior cerebral artery velocity (PCAv) (both via transcranial Doppler ultrasound), and arterial pressure (via finger photoplethysmography) were measured continuously. Subjects who completed ≥70 mmHg LBNP were classified as high tolerant (HT; n = 7) and low tolerant (LT; n = 11) if they completed ≤60 mmHg LBNP. The minimum difference in LBNP tolerance between groups was 193 s (LT = 1,243 ± 185 s vs. HT = 1,996 ± 212 s; P < 0.001; Cohen's d = 3.8). Despite similar reductions in mean MCAv in both groups, ScO2 decreased in LT subjects from –15 mmHg LBNP (P = 0.002; Cohen's d=1.8), but was maintained at baseline values until –75 mmHg LBNP in HT subjects (P < 0.001; Cohen's d = 2.2); ScO2 was lower at –30 and –45 mmHg LBNP in LT subjects (P ≤ 0.02; Cohen's d ≥ 1.1). Similarly, mean PCAv decreased below baseline from –30 mmHg LBNP in LT subjects (P = 0.004; Cohen's d = 1.0), but remained unchanged from baseline in HT subjects until –75 mmHg (P = 0.006; Cohen's d = 2.0); PCAv was lower at –30 and –45 mmHg LBNP in LT subjects (P ≤ 0.01; Cohen's d ≥ 0.94). Individuals with higher tolerance to central hypovolemia exhibit prolonged preservation of CBF in the posterior cerebral circulation and sustained cerebral tissue oxygenation, both associated with a delay in the onset of presyncope.
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The endocrine system regulates growth mainly through the growth hormone (GH)/insulin-like growth factors (IGFs) axis and, although exercise promotes growth, little is known about its modulation of these factors. The aim of this work was to characterize the effects of 5 wk of moderate sustained swimming on the GH-IGFs axis in gilthead sea bream fingerlings. Plasma IGF-I/GH ratio and tissue gene expression of total IGF-I and three splice variants, IGF-II, three IGF binding proteins, two GH receptors, two IGF-I receptors, and the downstream molecules were analyzed. Fish under exercise (EX) grew more than control fish (CT), had a higher plasma IGF-I/GH ratio, and showed increased hepatic IGF-I expression (mainly IGF-Ia). Total IGF-I expression levels were similar in the anterior and caudal muscles; however, IGF-Ic expression increased with exercise, suggesting that this splice variant may be the most sensitive to mechanical action. Moreover, IGFBP-5b and IGF-II increased in the anterior and caudal muscles, respectively, supporting enhanced muscle growth. Furthermore, in EX fish, hepatic IGF-IRb was reduced together with both GHRs; GHR-II was also reduced in anterior muscle, while GHR-I showed higher expression in the two muscle regions, indicating tissue-dependent differences and responses to exercise. Exercise also increased gene and protein expression of target of rapamycin (TOR), suggesting enhanced muscle protein synthesis. Altogether, these data demonstrate that moderate sustained activity may be used to increase the plasma IGF-I/GH ratio and to potentiate growth in farmed gilthead sea bream, modulating the gene expression of different members of the GH-IGFs axis (i.e., IGF-Ic, IGF-II, IGFBP-5b, GHR-I, and TOR).
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EMS personnel are becoming receptive to the idea that body armor is now the accepted level of all-hazard personal protective equipment. Much like the cultural shift to the routine wearing of gloves and eye protection for protection against infectious disease exposure, the appropriate use of body armor must become an organizational norm for incident response, even incidents that are not obviously violent or likely to become so.
The need for EMS body armor is in part from the changing role and operations of EMS personnel during and after an active shooter/multiple casualty incident has been changing for several years. The "Fire/Emergency Medical Services Department Operational Considerations and Guide for Active Shooter and Mass Casualty Incidents" describes incorporating tactical medicine into active shooter events. The FEMA information comes with other lectures during the Special Operations Medical Association conference which talked about ways to get EMS and fire department personnel into the warm or hot zone .
The National Fire Protection Association (NFPA) Chiefs support the Rescue Task Force concept. This medical response method equips fire and EMS personnel with body armor and sends them into the warm and hot zones, which has been almost unheard of up until recently .
Considerations, planning and interagency training should occur around the concept of properly trained, armored medical personnel who are escorted into areas of mitigated risk, which are clear but not secure areas, to execute triage, medical stabilization at the point of wounding, and provide for evacuation or sheltering-in-place. Some jurisdictions accomplish this through the deployment of Rescue Task Forces.
In addition to active shooter response EMS agencies are also considering body armor to protect personnel from the daily risk of violent patient encounters. A volunteer firefighter was shot and killed by an Arkansas man when the firefighter responder for a medical emergency call at the man's home. Ambulances have been shot at and EMS personal in Detroit and San Diego were stabbed by bystanders
Types of body armor
Before purchasing body armor paramedic chiefs and EMS leaders need to understand its construction to make an informed decision about the level of protection EMS providers need.
Soft armor panels are typically constructed of multiple layers of ballistic-resistant materials which are sometimes called aramid fibers. The number of layers within the panel and the order in which these layers are placed influence its overall performance. Additional energy from the projectile is absorbed by each successive layer of material.
A soft armor panel works much like a baseball catcher's mitt. When a handgun bullet strikes the panel, it is caught in a web of strong fibers. These fibers absorb and disperse the impact energy that is transmitted to the panel from the bullet. This process causes the bullet to deform or mushroom .
Hard armor plates may be constructed from ceramics, compressed laminate sheets, metallic plates or composites that incorporate more than one material.
Generally speaking, hard armor plates work in one of two ways: They can either capture and deform the bullet, or they can break up the bullet. In both instances, the armor then absorbs and distributes the force of the impact .
What level of protection do EMS providers need"
Do EMS providers need protection from pistol threats or rifle threats" Soft aramid fiber ballistic vests stop pistol and fragmentation threats, but it takes a rigid rifle plate to stop a rifle bullet.
For handgun protection it is important to know that Level II-A, Level II and Level III-A all stop the overwhelming majority of pistol projectiles an EMS provider will ever likely encounter (plus 12 gauge, OO buckshot), and also to know that NO vest is ever 100 percent bulletproof under ALL conceivable circumstances .
There is always a tradeoff between more protection and wear-ability or concealability — so the level of protection chosen is a personal choice. It is better to purchase a lower protection level that personnel will wear consistently, than the highest protection that isn't regularly worn by personnel. The best vest for you is the one you are actually wearing when shot .
- Level II-A generally ~4 mm thick
- Level II generally ~5 mm thick
The biggest difference between those two levels is the amount of blunt trauma impact protection. Ballistic Protection Levels are:
- Level II-A has become quite rare, but could actually be the best choice if thinness, comfort and concealability are the most important factors over blunt trauma protection. Average Cost: $400-500 (New).
- Level II is often worn by police officers and provides a good balance between blunt trauma protection, versus cost, and thickness/comfort. Average Cost: $500-700 (New).
- Stab-Resistant vests are available, but are generally not recommended, due to the added cost, unless there is a significant knife threat. Stab-resistance makes the vest a little heavier and thicker and significantly stiffer, and therefore less comfortable and concealable. Secondly a regular ballistic vest does offer some knife protection from a slashing knife attack .
How to buy body armor for EMS personnel
EMS agencies looking to acquire body armor for their personnel should look at products that have undergone testing following the test procedures contained in the National Institute of Justice (NIJ) document, "Ballistic Resistance of Body Armor, NIJ Standard–0101.06."
This is a minimum performance standard developed in collaboration with the Office of Law Enforcement Standards of the National Institute of Standards and Technology. It is produced as part of the Standards and Testing Program of the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice Programs, U.S. Department of Justice .
The National Institute of Justice companion document, "Selection and Application Guide to Ballistic-Resistant Body Armor: For Law Enforcement, Corrections and Public Safety" (NIJ Selection and Application Guide-0101.06) that provides a wealth of information for any EMS agency looking to purchase body armor for its personnel.
What is the least expensive and good protection"
Level II-A is adequate and may be the best choice if lightweight and/or comfort is the first priority over more blunt trauma protection. A cost-effective solution for EMS agencies on a tight budget may be a Police surplus Level II ballistic vest.
In ballistic tests, used body armor performed as well as new according to the NIJ research. The aramid fiber used in the construction of ballistic vests is good for many years as demonstrated in the NIJ research. Surplus vests can be purchased for approximately $200 and up.
Before you buy:
- Choose a reliable and licensed supplier when making a purchase. This will make sure that you are getting the best quality possible.
- Do not forget to check the background and number of years of experience of the manufacturer before you would actually make a deal.
- Choose a manufacturer that is NIJ accredited for guaranteed safety use.
- If you are going to buy a used vest, make sure it was taken care of properly.
Wearing your armor
Regardless of your level of protection choice, it is paramount that the armor fit correctly. Most carriers or vests are designed to fit slightly below or at your collarbones and end an inch or two above the waist. The armor you wear should enable you to reach your portable radio and other equipment. The wrong time to find out that your trauma scissors hang up on your vest is when you need them.
1. Imminent Threat Solutions. Is Body Armor Truly Coming for EMS and Fire" TCCC and C-TECC Updates from SOMA 2013. [Available online] http://ift.tt/1eHjy38
2. National Institute of Justice. Selection and Application Guide to Ballistic-Resistant Body Armor for Law Enforcement, Corrections and Public Safety. NIJ Selection and Application Guide-0101.06. p. 6. [Available online] http://ift.tt/1PXPX9A
3. BulletProofME. What PROTECTION LEVEL should I get" [Available online] http://ift.tt/1mE7kQV
4. National Institute of Justice. Ballistic Resistance of Body Armor, NIJ Standard–0101.06. p. V. [Available online] http://ift.tt/1PXPX9E
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The release of the "2016 Montana EMS Report to the Education and Local Government Interim Committee" has spawned the most recent set of alarming news reports on the state of rural EMS, echoing the concerns of Wisconsin, Nebraska, the Dakotas, Indiana, Iowa, Pennsylvania, New Jersey and New York State . All those states rely heavily on volunteer ambulances and volunteer fire department based EMS to provide anywhere from 60 to 90 percent of EMS.
For at least 10 years, multiple studies by federal and state agencies, and those contracted through private consulting firms have all reached the same conclusion: The entire EMS system in the U.S. is fractured, unsustainable, and in danger of an imminent and critical failure, with dire warnings of the impending collapse of the volunteer EMS system.
Volunteer agencies, who have traditionally filled the service void in rural areas, have insufficient call volume or tax base to support full-time municipal or private EMS response. These agencies are being crushed under the weight of increased call volume, skyrocketing expenses, and the need to request more and more time from their often dwindling membership to participate in additional training, administrative functions, and fund raising.
Despite the studies, reports, and warnings the crisis continues without answers to three critical questions:
1. Why is EMS still not an essential service"
Yet despite the recommendations of every study and white paper written in the last 20 years, and efforts by elected officials in several states, EMS is still not defined as an essential service by the federal government or most state governments
2. Where is the money appropriated for EMS"
Most states appropriate funds for trauma systems and EMS through various means such as add-ons to traffic and criminal violations and tobacco taxes. Those funds are often funneled into a general fund or utilized as a slush fund to balance deficits in state budgets, never reaching the EMS initiatives it was intended for. 
3. Why are citizens resigned to reliance on luck"
The Montana report summary warns that without change the state's citizens and visitors are reliant on luck. The report states, "We hope government officials and community members in rural Montana are able to identify and implement sustainable solutions before their luck runs out."
Hope and luck are two words that have no place in a discussion regarding the provision of EMS.
Immediate action required
Many volunteer agencies seem wary of showing their hand to local government out of fear they will be replaced or disciplined.
Don't be. Bring your financial statements and your heart to the conversation.
The volunteer model for providing EMS is by far the least expensive and the easiest to customize to the individual needs of each community. Volunteer EMS and firefighters save taxpayers $140 Billion dollars a year. 
In North Dakota, South Dakota, Nebraska, Iowa, Minnesota, Wyoming and Montana, volunteer EMS collectively saves $240 million each year . Volunteer EMS and fire departments save $7 billion in New York state .
Start with local funding
Surveys have showed that the public is clueless about EMS until they need it. Don't wait for negative press and doom and gloom media presentations to create a bad impression.
The public needs to be educated and supportive, not victims of emotional extortion.
Start public education locally and proactively so the community can make an informed decision about how 911 responses will be guaranteed, what level of service is expected, how much that service will cost and how it will get paid for.
Remove known obstacles to recruitment
Part of the solution is remove barriers to participation. Here are proven solutions:
- Recruit non-medical volunteers to provide daycare or provide funding for daycare services.
- Hire or recruit non EMT personnel to provide administrative and operational functions, including fundraising.
- Subscribe personnel to distance education and online training programs which make initial and continuing education convenient and accessible.
- Ensure that funds appropriated for EMS are in a dedicated fund and prioritize that money to subsidize education costs and health and safety initiatives.
- Use existing PSA's that show EMS, especially volunteering, in a positive light, and that appeal to your target audience. Check out this video example from the NVFC.
- Debunk the notion that today's volunteer EMTs are a bunch of decrepit old geezers. Read this inspiring AARP story.
Create meaningful incentives
Retaining capable and experienced volunteers is always easier than recruiting, selecting and training replacements. Consider implementing these incentives to retain the members you already have:
- Ask your town government to offer healthcare benefits. Research shows that upwards of 25 percent of EMT's do not have healthcare .
- Request and lobby for volunteers to get state funded opportunities for free education at local community colleges.
- Subsidize, fully or partially, all EMS education costs for volunteers. No one who gives their time and talent to provide an essential service to the community should be expected to pay for the privilege of doing so.
- Support legislation to provide tax credits for public safety volunteers . Given the amount of money they save the taxpayer this is a fair reward.
Take charge of your future
"The best way to predict the future is to create it"
The foundation of volunteer rescue squads and the volunteer fire departments was built by people who recognized the need for action long before there were actual careers in the field, or any consideration that profit could be made from human suffering or disasters. Why are the problems, as well as the future, of the volunteer service being left up to people on the outside to fix it"
The solution is not to fund more committees, or studies, or focus groups.
In the words of Toby Keith, it is time for "a little less talk and a lot more action."
1. 2016 Montana EMS Report to the Education and Local Government Interim Committee
2. Millions in State Funds Not Reaching Volunteer Fire Departments
3. NVFC , multiple sources:
4. Rural EMS Faces its own Emergency http://ift.tt/1SPWHsO
5. FASNY Legislative Outreach 2015
6. EMS Workforce Guidelines http://ift.tt/1SPWK7T
7. House Bill 343 http://ift.tt/151Z31d
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Semantic dementia (SD) is a variant of the Frontotemporal Lobar Degeneration (FTLD), a spectrum of non-Alzheimer's dementias (Neary et al., 1998). It is characterized by a progressive language disorder with fluent, empty spontaneous speech, and loss of word meaning, commonly manifested by impaired naming and semantic paraphrases. Following this, SD has also been referred to as the semantic variant of primary progressive aphasia (Gorno-Tempini et al., 2011). According to the diagnostic guidelines of this clinical syndrome, it also encompasses a variety of symptoms such as loss of sympathy and empathy, and narrowed preoccupations (Snowden et al., 2001; Rankin et al., 2005).
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Although bar charts are popular among researchers and are ubiquitous in quantitative software packages, they do not always provide the best visualization for a dataset. This column discusses a simple, alternative graphical method that is often underappreciated: the box plot, also known as the box-and-whisker plot. The basic elements of the box plot are presented, along with how to correctly interpret box plots, variations that are available to provide more information, and free online software that researchers can use to create box plots for publication.
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Inspiratory stretch by mechanical ventilation worsens lung injury. However, it is not clear whether and how the ventilator damages lungs in the absence of preexisting injury. We hypothesized that subtle loss of lung aeration during general anesthesia regionally augments ventilation and distension of ventilated air spaces. In eight supine anesthetized and intubated rats, hyperpolarized gas MRI was performed after a recruitment maneuver following 1 h of volume-controlled ventilation with zero positive end-expiratory pressure (ZEEP), FiO2 0.5, and tidal volume 10 ml/kg, and after a second recruitment maneuver. Regional fractional ventilation (FV), apparent diffusion coefficient (ADC) of 3He (a measurement of ventilated peripheral air space dimensions), and gas volume were measured in lung quadrants of ventral and dorsal regions of the lungs. In six additional rats, computed tomography (CT) images were obtained at each time point. Ventilation with ZEEP decreased total lung gas volume and increased both FV and ADC in all studied regions. Increases in FV were more evident in the dorsal slices. In each lung quadrant, higher ADC was predicted by lower gas volume and by increased mean values (and heterogeneity) of FV distribution. CT scans documented 10% loss of whole-lung aeration and increased density in the dorsal lung, but no macroscopic atelectasis. Loss of pulmonary gas at ZEEP increased fractional ventilation and inspiratory dimensions of ventilated peripheral air spaces. Such regional changes could help explain a propensity for mechanical ventilation to contribute to lung injury in previously uninjured lungs.
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Last Word on Viewpoint: A call for research to assess and promote functional resilience in astronaut crews
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Endurance training prevents negative effects of the hypoxia mimetic dimethyloxalylglycine on cardiac and skeletal muscle function
Hypoxic preconditioning is a promising strategy to prevent hypoxia-induced damages to several tissues. This effect is related to prior stabilization of the hypoxia-inducible factor-1α via inhibition of the prolyl-hydroxylases (PHDs), which are responsible for its degradation under normoxia. Although PHD inhibition has been shown to increase endurance performance in rodents, potential side effects of such a therapy have not been explored. Here, we investigated the effects of 1 wk of dimethyloxalylglycine (DMOG) treatment (150 mg/kg) on exercise capacity, as well as on cardiac and skeletal muscle function in sedentary and endurance-trained rats. DMOG improved maximal aerobic velocity and endurance in both sedentary and trained rats. This effect was associated with an increase in red blood cells without significant alteration of skeletal muscle contractile properties. In sedentary rats, DMOG treatment resulted in enhanced left ventricle (LV) weight together with impairment in diastolic function, LV relaxation, and pulse pressure. Moreover, DMOG decreased maximal oxygen uptake (state 3) of isolated mitochondria from skeletal muscle. Importantly, endurance training reversed the negative effects of DMOG treatment on cardiac function and restored maximal mitochondrial oxygen uptake to the level of sedentary placebo-treated rats. In conclusion, we provide here evidence that the PHD inhibitor DMOG has detrimental influence on myocardial and mitochondrial function in healthy rats. However, one may suppose that the deleterious influence of PHD inhibition would be potentiated in patients with already poor physical condition. Therefore, the present results prompt us to take into consideration the potential side effects of PHD inhibitors when administrated to patients.
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The American Journal of Emergency Medicine
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Safety and efficacy of dual direct-acting antiviral therapy (daclatasvir and asunaprevir) for chronic hepatitis C virus genotype 1 infection in patients on hemodialysis
Journal of Gastroenterology
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Journal of Pediatric Surgery
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Journal of Clinical Gastroenterology
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The clinical characteristics of primary gastric lymphoma detected during screening for gastric cancer in Korea
Journal of Gastroenterology and Hepatology
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Effectiveness of anise oil for treatment of mild to moderate depression in patients with irritable bowel syndrome: a randomized active and placebo-controlled clinical trial
Journal of Evidence-Based Complementary & Alternative Medicine
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Follow-up study on CDX1 and CDX2 mRNA expression in noncancerous gastric mucosae after Helicobacter pylori eradication
Digestive Diseases and Sciences
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International Journal of Colorectal Disease
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SHh-Gli1 signaling pathway promotes cell survival by mediating baculoviral IAP repeat-containing 3 (BIRC3) gene in pancreatic cancer cells
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Bloating is associated with worse quality of life, treatment satisfaction, and treatment responsiveness among patients with constipation-predominant irritable bowel syndrome and functional constipation
Neurogastroenterology & Motility
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International Journal of Surgery
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Increases in sex hormones during anti-tumor necrosis factor α therapy in adolescents with Crohn's disease
The Journal of Pediatrics
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Development and validation of a noninvasive prediction model for nonalcoholic steatohepatitis resolution after lifestyle intervention
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Perceived diagnostic delay and cancer-related distress: A cross-sectional study of patients with colorectal cancer
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Pediatric Surgery International
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Journal of Viral Hepatitis
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Oesophageal motility disorders in infected immigrants with Chagas disease in a non-endemic European area
United European Gastroenterology Journal
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Role of neoadjuvant treatment in clinical T2N0M0 oesophageal cancer: results from a retrospective multi-center European study
European Journal of Cancer
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Reshaping clinical science: Introduction to the Special Issue on Psychophysiology and the NIMH Research Domain Criteria (RDoC) initiative
The National Institute of Mental Health's (NIMH) Research Domain Criteria (RDoC) initiative seeks to establish new dimensional conceptions of mental health problems, through the investigation of clinically relevant "process" constructs that have neurobiological as well as psychological referents. This special issue provides a detailed overview of the RDoC framework by NIMH officials Michael Kozak and Bruce Cuthbert, and spotlights RDoC-oriented investigative efforts by leading psychophysiological research groups as examples of how clinical science might be reshaped through application of RDoC principles. Accompanying commentaries highlight key aspects of the work by each group, and discuss reported methods/findings in relation to promises and challenges of the RDoC initiative more broadly.
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As highlighted by articles in the current special issue, the RDoC initiative holds promise for advancing understanding of mental health problems. However, the initiative is at its early stages and it remains unclear what level of progress can be achieved and how quickly. In this closing article, we identify major challenges facing RDoC and propose concrete approaches to addressing these challenges, including (a) clearer specification of clinical problems for study, with use of symptom dimensions from integrative dimensional models of psychopathology as provisional, modifiable referents; (b) encouragement of research on a distinct set of traits corresponding to process constructs from the RDoC matrix—those represented across animal, child temperament, and adult personality literatures—to serve as interfaces between matrix constructs and clinical problems; (c) an emphasis in the near term on use of proximal units of analysis in RDoC studies—in particular, on physiological, behavioral, and self-report measures of matrix constructs (examined as states or traits, or both); (d) inclusion of a clear ontogenetic-developmental component in RDoC research projects; (e) routine analysis of the psychometric properties of nonreport (e.g., physiological, task-behavioral) variables, including systematic evaluation of their reliability and convergent-discriminant validity; (f) modification of existing grant review criteria to prioritize replication and synergy in RDoC investigative work; and (g) creation of a cumulative data network system (RDoC–DataWeb) to encourage and facilitate coordination of research efforts across RDoC research groups.
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Neuroscientists have been exploring the mechanism of auditory verbal hallucinations. In this commentary, I review studies by Judy Ford, who employed a vocalization paradigm to test the hypothesis of impaired corollary discharge in psychotic patients who experience auditory verbal hallucinations. I highlight the strengths of this research program and reflect on the challenge of reducing a complex clinical feature to an abnormality of basic cognitive processes, such as language and memory.
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The Research Domain Criteria (RDoC) initiative endeavors to foster a science of psychopathology based around dimensions of brain-behavior relationships as opposed to subjectively based diagnostic categories. A rapidly accumulating array of transdiagnostic commonalities, across multiple objective and subjective measures, underscores the clear potential of this initiative. At the same time, a road map for guiding future RDoC research efforts is needed that draws upon the wealth of extant disorder-specific findings. In this issue, Hamm and colleagues provide an example of conceptualizing within-disorder processes in terms of dimensional brain-behavior relationships that advances the understanding of panic disorder with agoraphobia beyond the conventional nosological framework. Their findings and conceptual model are reviewed and discussed in terms of broader transdiagnostic implications.
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The goal of the Research Domain Criteria (RDoC) is to develop an interdisciplinary science of psychopathology, forming a template for research and disconnecting conceptual and empirical questions from traditional diagnostic entities. In this article, we review some of the challenges in the implementation of this framework within the field of pathological fear and anxiety, specifically commenting on the article by Hamm and colleagues (2016). The study of pathological fear and anxiety has had considerable, yet stalled, success in its understanding of underlying mechanisms, prevention, and treatment. With a shift toward RDoC, it is unclear what to do with the existing diagnostic labels, and the importance of defining and measuring phenotypes becomes paramount. Additional concerns include the role of psychological constructs and mechanisms, the use of self-report measures, the examination of replication and clinical utility, and the measurement of the role of the environment. Though a laudable and potentially necessary shift in focus, it remains to be seen whether new overall insights into psychopathology will emerge from focusing on small units of analyses and piecing them together and whether these insights will directly translate into the prevention of psychopathology, more efficacious treatments, and improved lives of patients.
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Taking an RDoC lens to the study of panic disorder: A commentary on Hamm et al. and other thoughts on RDoC
The Research Domain Criteria (RDoC) initiative put forth by the National Institute of Mental Health represents an exciting new framework in which to study psychopathology. The article by Hamm et al. (2016) is an interesting application of an "RDoC lens" toward a program of research on panic disorder. This commentary highlights the many strengths of the Hamm et al. (2016) study—most notably the article's application of a well-studied animal model of anxiety (Fanselow's, , threat imminence model) to humans, utilization of an interesting behavioral paradigm (as an analog for avoidance behaviors in panic disorder), and using RDoC to examine predictors of treatment response. This commentary also discusses several questions about RDoC that arise out of Hamm et al. For example, (a) How should participants be selected for RDoC studies? (b) Are RDoC constructs risk factors (and risk factors for what)? (c) Besides Hamm et al.'s, approach, how else can RDoC be used in treatment studies? In sum, Hamm et al. is a very good example of an RDoC study, and in this early phase of the initiative, more examples for how the approach plays out are needed.
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The creation of the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) project has been the driving force behind the reconceptualization of the pathogenesis of psychiatric disorders. In this commentary, I explore whether the error-related negativity can be considered as a transdiagnostic marker of sustained threat based on findings from Weinberg, Meyer et al.'s (2016) study in relation to current findings in the literature. Potential alternative study designs, use of a multimodal approach to the assessment of a specific phenotype of clinical phenomenon, and the importance of integrating a neurodevelopmental perspective are also discussed.
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Psychobiological operationalization of RDoC constructs: Methodological and conceptual opportunities and challenges
NIMH's Research Domain Criteria (RDoC) project seeks to advance the diagnosis, prevention, and treatment of mental disorders by promoting psychobiological research on dimensional constructs that might cut across traditional diagnostic boundaries (Kozak & Cuthbert, ). At the core of this approach is the notion that these dimensional constructs can be assessed across different units of analysis (e.g., genes, physiology, behavior), enriching the constructs and providing more complete explanations of clinical problems. While the conceptual aspects of RDoC have been discussed in several prior papers, its methodological aspects have received comparatively less attention. For example, how to integrate data from different units of analysis has been relatively unclear. Here, we discuss one means of psychobiologically operationalizing RDoC constructs across different units of analysis (the psychoneurometric approach; Yancey et al., ), highlighting ways in which this approach might be refined in future iterations. We conclude that there is much to be learned from this technique; however, greater attention to scale-development methods and to psychometrics will likely benefit this and other methodological approaches to combining measurements across multiple units of analysis.
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Achieving Research Domain Criteria (RDoC) goals depends in part on how well scientists can grasp its principles and execute studies within its framework. Ford provides an exemplary illustration of a research program that aligns with RDoC guidelines. The future success of RDoC depends not just on research like that of Ford and colleagues. RDoC also must inspire the development of reliable neurobehavioral measures with demonstrable clinical validity that produce replicable findings leading to the establishment of neurocircuit-based behavioral dimensions that inform clinical work. Large samples not typically attainable in a clinical neuroscience laboratory or easily imagined within the confines of the RDoC matrix will be required if RDoC is to develop the insights and tools needed to establish incremental value over the DSM. Innovation that goes beyond reliance on the RDoC matrix and measures of neurocircuitry can help facilitate achievement of RDoC's goal of developing a science of psychopathology based on neurobiological systems.
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The Research Domain Criteria (RDoC) initiative of the National Institute of Mental Health shows great promise in providing guidance for research on mental illness but has prompted considerable controversy. Papers by Yancey, Venables, and Patrick and Kozak and Cuthbert illustrate and clarify a number of important features of RDoC. The present commentary evaluates the former paper in light of the latter paper and addresses several common misunderstandings about RDoC. The concept of endophenotypes and diverse psychophysiological approaches will likely be central in RDoC-inspired research.
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Research on the neural response to errors has an important role in the Research Domain Criteria (RDoC) project, since it is likely to link psychopathology to the dysfunction of neural systems underlying basic behavioral functions, with the error-related negativity (ERN) appearing as a unit of measurement in three RDoC domains. A recent report builds on previous research by examining the ERN as a measure of the sustained threat construct and providing evidence that the ERN may reflect sensitivity more specifically to endogenous threat. Data from 515 adolescent females indicate that the ERN was enlarged primarily in older adolescents with self-reported checking behaviors, although it was blunted in adolescents with depressive symptoms regardless of age. Potential future studies for replicating and extending the research on the ERN and obsessive-compulsive (OC) behaviors are discussed, including studies that more fully characterize OC symptom dimensions, studies that integrate other measures of error-related brain activity and use computational modeling, studies that combine longitudinal, family, and molecular genetic measures, and interventional studies that specifically modulate error-related brain activity in individuals with OC behaviors.
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Panic disorder with agoraphobia from a behavioral neuroscience perspective: Applying the research principles formulated by the Research Domain Criteria (RDoC) initiative
In the current review, we reconceptualize a categorical diagnosis—panic disorder and agoraphobia—in terms of two constructs within the domain "negative valence systems" suggested by the Research Domain Criteria initiative. Panic attacks are considered as abrupt and intense fear responses to acute threat arising from inside the body, while anxious apprehension refers to anxiety responses to potential harm and more distant or uncertain threat. Taking a dimensional view, panic disorder with agoraphobia is defined with the threat-imminence model stating that defensive responses are dynamically organized along the dimension of the proximity of the threat. We tested this model within a large group of patients with panic disorder and agoraphobia (N = 369 and N = 124 in a replication sample) and found evidence that panic attacks are indeed instances of circa strike defense. This component of the defensive reactivity was related to genetic modulators within the serotonergic system. In contrast, anxious apprehension—characterized by attentive freezing during postencounter defense—was related to general distress and depressive mood, as well as to genetic modulations within the hypothalamic-pituitary-adrenal (HPA) axis. Patients with a strong behavioral tendency for active and passive avoidance responded better to exposure treatment if the therapist guides the patient through the exposure exercises.
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In this article, we provide a commentary on Kozak and Cuthbert ()'s theoretical paper discussing the NIMH Research Domain Criteria (RDoC) initiative and on Latzman et al. (2016)'s empirical investigation of the RDoC negative valence systems domain in chimpanzees, conducted with experimental procedures across genetic, neurobiological, and behavioral levels of analysis. We discuss the pros and cons of the RDoC approach to research on mental illness as well as the strengths and weaknesses of the implementation of this approach in the chimpanzee study.
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Psychophysiology of threat response, paradigm shifts in psychiatry, and RDoC: Implications for genetic investigation of psychopathology
Two articles in this issue seek to further the goal of NIMH's Research Domain Criteria (RDoC) initiative to develop new approaches for investigating mental disorders, using fundamental dimensions that cut across traditional disorder categories and align more closely with mechanisms that underlie psychopathology. One article, by Lang, McTeague, and Bradley, describes the construction of such a disorder cross-crossing dimension of fear response. The other, by Kozak and Cuthbert, expounds upon the basis and conceptualization of research targets under RDoC. Possible implications of these developments for psychiatric genetics research are discussed.
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The NIMH Research Domain Criteria (RDoC) project represents a welcome effort to circumvent the limitations of psychiatric categories as phenotypes for psychopathology research. Here, we describe the hierarchical and dimensional structure of phenotypic psychopathology and illustrate how this structure provides phenotypes suitable for RDoC research on neural correlates of psychopathology. A hierarchical and dimensional approach to psychopathology phenotypes holds great promise for delineating connections between neuroscience constructs and the patterns of affect, cognition, and behavior that constitute manifest psychopathology.
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Error-related negativity (ERN) and sustained threat: Conceptual framework and empirical evaluation in an adolescent sample
The error-related negativity (ERN) currently appears as a physiological measure in relation to three Research Domain Criteria (RDoC) constructs: Cognitive Control, Sustained Threat, and Reward Learning. We propose a conceptual model in which variance in the ERN reflects individual differences in the degree to which errors are evaluated as threatening. We also discuss evidence for the placement of the ERN in the "Sustained Threat" construct, as well as evidence that the ERN may more specifically reflect sensitivity to endogenous threat. Following this, we present data from a sample of 515 adolescent females demonstrating a larger ERN in relation to self-reported checking behaviors, but only in older adolescents, suggesting that sensitivity to internal threat and the ERN-checking relationship may follow a developmental course as adolescents develop behavioral control. In contrast, depressive symptoms were linked to a smaller ERN, and this association was invariant with respect to age. Collectively, these data suggest that the magnitude of the ERN is sensitive both to specific anxiety-related processes and depression, in opposing directions that may reflect variation in internal threat sensitivity. We discuss directions for future research, as well as ways in which findings for the ERN complement and challenge aspects of the current RDoC matrix.
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Psychoneurometric operationalization of threat sensitivity: Relations with clinical symptom and physiological response criteria
The National Institute of Mental Health's Research Domain Criteria (RDoC) initiative calls for the incorporation of neurobiological approaches and findings into conceptions of mental health problems through a focus on biobehavioral constructs investigated across multiple domains of measurement (units of analysis). Although the constructs in the RDoC system are characterized in "process terms" (i.e., as functional concepts with brain and behavioral referents), these constructs can also be framed as dispositions (i.e., as dimensions of variation in biobehavioral functioning across individuals). Focusing on one key RDoC construct, acute threat or "fear," the current article illustrates a construct-oriented psychoneurometric strategy for operationalizing this construct in individual difference terms—as threat sensitivity (THT+). Utilizing data from 454 adult participants, we demonstrate empirically that (a) a scale measure of THT+ designed to tap general fear/fearlessness predicts effectively to relevant clinical problems (i.e., fear disorder symptoms), (b) this scale measure shows reliable associations with physiological indices of acute reactivity to aversive visual stimuli, and (c) a cross-domain factor reflecting the intersection of scale and physiological indicators of THT+ predicts effectively to both clinical and neurophysiological criterion measures. Results illustrate how the psychoneurometric approach can be used to create a dimensional index of a biobehavioral trait construct, in this case THT+, which can serve as a bridge between phenomena in domains of psychopathology and neurobiology. Implications and future directions are discussed with reference to the RDoC initiative and existing report-based conceptions of psychological traits.
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This article describes the National Institute of Mental Health's Research Domain Criteria (RDoC) initiative. The description includes background, rationale, goals, and the way the initiative has been developed and organized. The central RDoC concepts are summarized and the current matrix of constructs that have been vetted by workshops of extramural scientists is depicted. A number of theoretical and methodological issues that can arise in connection with the nature of RDoC constructs are highlighted: subjectivism and heterophenomenology, desynchrony and theoretical neutrality among units of analysis, theoretical reductionism, endophenotypes, biomarkers, neural circuits, construct "grain size," and analytic challenges. The importance of linking RDoC constructs to psychiatric clinical problems is discussed. Some pragmatics of incorporating RDoC concepts into applications for NIMH research funding are considered, including sampling design.
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Neuroethology as a translational neuroscience strategy in the era of the NIMH Research Domain Criteria
The article by Latzman et al. in the current special issue utilizes a novel dataset consisting of behavioral, brain, and genomic data from a sample of 76 captive chimpanzees to make the case that negative affective expression is influenced by variation in the gene coding for arginine vasopressin receptor 1A (AVPR1A), in a sex-linked manner. A novel feature of this study is the ethological approach employed by the authors, i.e., the use of scratching as a behavioral indicator of negative affective state. I comment on conceptual and methodological aspects of this work, and consider how it interfaces with the Research Domain Criteria (RDoC) framework as described by Kozak and Cuthbert in their article for this issue.
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KCC2 is the central regulator of neuronal Cl− homeostasis, and is critical for enabling strong hyperpolarizing synaptic inhibition in the mature brain. KCC2 hypofunction results in decreased inhibition and increased network hyperexcitability that underlies numerous disease states including epilepsy, neuropathic pain and neuropsychiatric disorders. The current holy grail of KCC2 biology is to identify how we can rescue KCC2 hypofunction in order to restore physiological levels of synaptic inhibition and neuronal network activity. It is becoming increasingly clear that diverse cellular signals regulate KCC2 surface expression and function including neurotransmitters and neuromodulators. In the present review we explore the existing evidence that G-protein coupled receptor (GPCR) signaling can regulate KCC2 activity in numerous regions of the nervous system including the hypothalamus, hippocampus, and spinal cord. In this Review we present key evidence from the literature suggesting that GPCR signaling is a conserved mechanism for regulating chloride homeostasis. This evidence includes: (1) the activation of group 1 metabotropic glutamate receptors (mGluRs) and metabotropic Zn2+ receptors (mZnRs) strengthens GABAergic inhibition in CA3 pyramidal neurons through a regulation of KCC2; (2) activation of the 5-hydroxytryptamine type 2A serotonin receptors (5-HT2Rs) upregulates KCC2 cell surface expression and function, restores endogenous inhibition in motorneurons, and reduces spasticity in rats; and (3) activation of A3A-type adenosine receptors (A3AR) rescues KCC2 dysfunction and reverses allodynia in a model of neuropathic pain. We propose that GPCR-signals are novel endogenous Cl− extrusion enhancers that may regulate KCC2 function.
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