Πέμπτη 14 Απριλίου 2016
All EMS stakeholders asked to comment on revision to EMS Agenda
WASHINGTON — NHTSA, on behalf of the Federal Interagency Committee on Emergency Medical Services, is seeking public input for a planned revision of the 1996 EMS Agenda for the Future.
In 1996 NHTSA, in partnership with HRSA, published the EMS Agenda for the Future as a vision for the future of EMS systems in the United States. Changes envisioned in that document included the National EMS Information System, the "EMS Education Agenda for the Future: A Systems Approach," universal wireless 9-1-1, automatic crash notification and the recognition of EMS as a physician sub-specialty.
A major revision of the EMS Agenda for the future was an April 2014 recommendation of the National Emergency Medical Services Advisory Council. The NEMSAC asked NHTSA to undertake a major revision as soon as possible using a consensus and data-driven process with broad stakeholder representation.
On June 19, 2014, FICEMS unanimously approved a motion to proceed with a revision of the EMS Agenda, with a focus on data-driven approaches to future improvements.
All sources, including public, private, governmental, academic, professional, public interest groups and other interested parties are asked to comment on the planned revision. NHTSA intends to work closely with EMS stakeholders in revising the EMS Agenda, which will envision the evolution of EMS systems over the next 30 years.
Notice of the planned revision was posted to the Federal Register on April 1, 2016.
Submit responses on these questions using the Federal eRulemaking Portal by June 30, 2016.
1. What are the most critical issues facing EMS systems that should be addressed in the revision of the EMS Agenda? Please be as specific as possible.
2. What progress has been made in implementing the EMS Agenda since its publication in 1996?
3. How have you used the EMS Agenda? Please provide specific examples.
4. As an EMS stakeholder, how might the revised EMS Agenda be most useful to you?
5. What significant changes have occurred in EMS systems at the national, State and local levels since 1996?
6. What significant changes will impact EMS systems over the next 30 years?
7. How might the revised EMS Agenda support the following FICEMS Strategic Plan goals:
a. Coordinated, regionalized, and accountable EMS and 9-1-1 systems that provide safe, high-quality care;
b. data-driven and evidence-based EMS systems that promote improved patient care quality;
c. EMS systems fully integrated into State, territorial, local, tribal, regional, and Federal preparedness planning, response, and recovery;
d. EMS systems that are sustainable, forward looking, and integrated with the evolving health care system;
e. an EMS culture in which safety considerations for patients, providers, and the community permeate the full spectrum of activities; and
f. a well-educated and uniformly credentialed EMS workforce.
8. How could the revised EMS Agenda contribute to enhanced emergency medical services for children?
9. How could the revised EMS Agenda address the future of EMS data collection and information sharing?
10. How could the revised EMS Agenda support data-driven and evidence-based improvements in EMS systems?
11. How could the revised EMS Agenda enhance collaboration among EMS systems, health care providers, hospitals, public safety answering points, public health, insurers, palliative care and others?
12. How will innovative patient care delivery and finance models impact EMS systems over the next 30 years?
13. How could the revised EMS Agenda promote community preparedness and resilience?
14. How could the revised EMS Agenda contribute to improved coordination for mass casualty incident preparedness and response?
15. How could the revised EMS Agenda enhance the exchange of evidence based practices between military and civilian medicine?
16. How could the revised EMS Agenda support the seamless and unimpeded transfer of military EMS personnel to roles as civilian EMS providers?
17. How could the revised EMS Agenda support interstate credentialing of EMS personnel?
18. How could the revised EMS Agenda support improved patient outcomes in rural and frontier communities?
19. How could the revised EMS Agenda contribute to improved EMS education systems at the local, State, and national levels?
20. How could the revised EMS Agenda lead to improved EMS systems in tribal communities?
21. How could the revised EMS Agenda promote a culture of safety among EMS personnel, agencies and organizations?
22. Are there additional EMS attributes that should be included in the revised EMS Agenda? If so, please provide an explanation for why these additional EMS attributes should be included.
23. Are there EMS attributes in the EMS Agenda that should be eliminated from the revised edition? If so, please provide an explanation for why these EMS attributes should be eliminated.
24. What are your suggestions for the process that should be used in revising the EMS Agenda?
25. What specific agencies/organizations/entities are essential to involve, in a revision of the EMS Agenda?
26. Do you have any additional comments regarding the revision of the EMS Agenda?
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EMT-BASIC - Heart Song Care Transport
HEART SONG CARE TRANSPORT is Hiring new or experience EMT-Basics for ambulance transportation services. This can include non-emergent and emergency calls throughout the Hampton Roads Virginia Areas and District 4. Full time and Part time hours are available. All that wants to apply simply need to send their resume to JaredM@heartsongcare.com.
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Systematic review: brain metastases from colorectal cancer—Incidence and patient characteristics
BMC Cancer
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Clinical outcomes after spontaneous and nucleos(t)ide analogue-treated HBsAg seroclearance in chronic HBV infection
Alimentary Pharmacology and Therapeutics
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Factors predicting through-the-scope gastroduodenal stenting outcomes in patients with gastric outlet obstruction: A large multicenter retrospective study in west Japan
Gastrointestinal Endoscopy
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Randomized phase II placebo controlled study of codrituzumab in previously treated patients with advanced hepatocellular carcinoma
Journal of Hepatology
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Evaluating intestinal infections: a systematic approach
Advances in Anatomic Pathology
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Fecal calprotectin level correlated with both endoscopic severity and disease extent in ulcerative colitis
BMC Gastroenterology
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Discordant diagnostic results due to a hepatitis b virus t123a hbsag mutant
Diagnostic Microbiology and Infectious Disease
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Prevalence, characteristics, and treatment outcomes of reflux hypersensitivity detected on pH-impedance monitoring
Neurogastroenterology & Motility
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Outbreak investigation of suspected hepatities E among South Sudan refugees, Gambella regional state, Ethiopia, July 2014
International Journal of Infectious Diseases
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Endoscopic scores for inflammatory bowel disease in the era of mucosal healing: Old problem, new perspectives
Digestive and Liver Diseases
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The effect of cirrhosis on the risk for failure of nonoperative management of blunt liver injuries
The Journal of Emergency Medicine
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Hepatitis b virus capsids have diverse structural responses to small-molecule ligands bound to the heteroaryldihydropyrimidine pocket
Journal of Virology
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Psyllium fiber reduces abdominal pain in children with irritable bowel syndrome in a randomized, double-blind trial
Clinical Gastroenterology and Hepatology
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Plasma interleukin-10 predicts short-term mortality of acute-on-chronic hepatitis B liver failure
Alimentary Pharmacology and Therapeutics
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Cognition predicts quality of life among patients with end stage liver disease
Psychosomatics
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Diverticular disease and additional comorbidities associated with increased risk of dementia
Journal of Gastroenterology and Hepatology
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The use of an institutional pediatric abdominal trauma protocol improves resource use
The Journal of Emergency Medicine
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Cancer recurrence following immune-suppressive therapies in patients with immune-mediated diseases: a systematic review and meta-analysis
Gastroenterology
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Systemic Lidocaine Fails to Improve Postoperative Pain, But Reduces Time to Discharge Readiness in Patients Undergoing Laparoscopic Sterilization in Day-Case Surgery: A Double-Blind, Randomized, Placebo-Controlled Trial.
Background and Objectives: Perioperative systemic lidocaine provides postoperative analgesia, decreases opioid consumption, and facilitates rehabilitation in abdominal surgery. We hypothesized that systemic lidocaine has analgesic effects in women undergoing day-case laparoscopic sterilization. Methods: Eighty women were randomized in this prospective, double-blind trial to receive either lidocaine (intravenous bolus of 1.5 mg/kg at induction of anesthesia, followed by an infusion of 1.5 mg [middle dot] kg-1 [middle dot] h-1, which was continued until 30 minutes after arrival at the postanesthesia care unit [PACU]) or placebo. The primary end point was the proportion of patients with a numeric rating scale (NRS) of greater than 3, 30 minutes after arrival at the PACU. Secondary outcomes included total opioid consumption, postoperative pain scores, incidence of postoperative nausea and vomiting, and time to readiness for discharge. This clinical trial was registered (Eudra CT 2011-001315-31). Results: Thirty minutes after PACU admission, the proportion of patients with an NRS score of greater than 3 did not differ between the groups (lidocaine group: 59% vs placebo group: 58%). The postoperative NRS for pain over the entire observation period was not significantly different between lidocaine and placebo groups (mean, 3.1 [SD, 0.7] vs 2.8 [SD, 0.6]; P = 0.4). Groups did not differ with respect to perioperative opioid consumption. Patients in the placebo group suffered significantly less from nausea (NRS: 0.1 [SD, 0.1] [placebo] vs 0.3 [SD, 0.1] [lidocaine]; P = 0.02) and required less postoperative nausea and vomiting rescue medication (1 patient in the placebo group vs 7 in the lidocaine group; P = 0.03). The time to meet hospital discharge criteria was significantly lower in the lidocaine group (median, 177 minutes [range, 96-408 minutes] vs 221 minutes [range, 121-420 minutes]; P = 0.02). The mean lidocaine plasma levels at the end of IV lidocaine infusion was 2.5 (SD, 1.1) [mu]g/mL. Conclusions: In laparoscopic sterilization, systemic lidocaine reduces time to readiness for hospital discharge. Copyright (C) 2016 by American Society of Regional Anesthesia and Pain Medicine.
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Initial Experience of the American Society of Regional Anesthesia and Pain Medicine Coags Regional Smartphone Application: A Novel Report of Global Distribution and Clinical Usage of an Electronic Decision Support Tool to Enhance Guideline Use.
Background and Objectives: Decision support tools have been demonstrated to improve adherence to medical guidelines; however, smartphone applications (apps) have not been studied in this regard. In a collaboration between Vanderbilt University and the American Society of Regional Anesthesia and Pain Medicine (ASRA), the ASRA Coags Regional app was created to be a decision support tool for the 2010 published guideline on regional anesthesia for patients receiving anticoagulation. This is a review of the distribution and usage of this app. Methods: The app was created to be a user-friendly version of the guideline. Download statistics were collected from April 2014 to October 2015, and app usage data were collected from October 2014 to October 2015. Usage data were analyzed for number of devices, number of search sessions, medications searched, and types of procedures. Results: There were 8381 downloads, with 83% from North America. Of users who allowed data tracking, 4504 unique devices were identified with 30,003 separate search events. The most searched-for medications were rivaroxaban (n = 4427; 11%), clopidogrel (n = 4042; 10%), and enoxaparin, prophylactic twice daily dosing (n = 3249; 8%). Neuraxial procedures (n = 22,477; 78%) were the most commonly searched-for procedures and over half (n = 22,773; 52%) the users were interested in how long to hold a medication before performing a procedure. Conclusions: This is the first publication of download and usage data concerning medical smartphone apps. It provides a template for future app uptake and use in clinical practice. The app platform provides a new mechanism of rapidly disseminating guidelines and facilitating distribution of frequent updates. Copyright (C) 2016 by American Society of Regional Anesthesia and Pain Medicine.
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Effect of kinesio tape application on hemiplegic shoulder pain and motor ability: a pilot study.
The aim of our single-group pre-post design pilot study was to evaluate the short-term effect of kinesio taping (KT) application on pain and motor ability of hemiplegic shoulder pain (HSP) patients. Eleven poststroke patients with HSP hospitalized in the Department of Neurology C, Loewenstein Rehabilitation Hospital, Raanana, Israel, received a KT application in addition to their usual rehabilitation protocol. KT, consisting of one to three strips according to a predefined algorithm, was applied to the painful shoulder region. A 10 cm Visual Analog Scale of shoulder pain at rest and at arm movement, active and passive pain-free abduction range of motion, Box & Blocks, and Fugl-Meyer upper extremity motor assessment were performed before treatment and 24 h after wearing the KT. After applying the KT, there was no significant change in any variables. Short-term KT application, used in our study, produced no change in shoulder pain, range of motion, or ability of upper limb in HSP patients. Additional studies should evaluate the effect of long-term application and different types of KT applications on HSP. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.
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ApoE and SNAP-25 Polymorphisms Predict the Outcome of Multidimensional Stimulation Therapy Rehabilitation in Alzheimers Disease
Background. Alzheimer's disease (AD) is a highly prevalent neurodegenerative disorder. Rate of decline and functional restoration in AD greatly depend on the capacity for neural plasticity within residual neural tissues; this is at least partially influenced by polymorphisms in genes that determine neural plasticity, including Apolipoprotein E4 (ApoE4) and synaptosomal-associated protein of 25 kDa (SNAP-25). Objective. We investigated whether correlations could be detected between polymorphisms of ApoE4 and SNAP-25 and the outcome of a multidimensional rehabilitative approach, based on cognitive stimulation, behavioral, and functional therapy (multidimensional stimulation therapy [MST]). Methods. Fifty-eight individuals with mild-to-moderate AD underwent MST for 10 weeks. Neuro-psychological functional and behavioral evaluations were performed blindly by a neuropsychologist at baseline and after 10 weeks of therapy using Mini-Mental State Examination (MMSE), Functional Living Skill Assessment (FLSA), and Neuropsychiatric Inventory (NPI) scales. Molecular genotyping of ApoE4 and SNAP-25 rs363050, rs363039, rs363043 was performed. Results were correlated with MMSE, NPI and FLSA scores by multinomial logistic regression analysis. Results. Polymorphisms in both genes correlated with the outcome of MST for MMSE and NPI scores. Thus, higher overall MMSE scores after rehabilitation were detected in ApoE4 negative compared to ApoE4 positive patients, whereas the SNAP-25 rs363050(G) and rs363039(A) alleles correlated with significant improvements in behavioural parameters. Conclusions. Polymorphisms in genes known to modulate neural plasticity might predict the outcome of a multistructured rehabilitation protocol in patients with AD. These data, although needing confirmation on larger case studies, could help optimizing the clinical management of individuals with AD, for example defining a more intensive treatment in those subjects with a lower likelihood of success.
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Integration of Sensory, Spinal, and Volitional Descending Inputs in Regulation of Human Locomotion
We reported previously that both transcutaneous electrical spinal cord stimulation and direct pressure stimulation of the plantar surfaces of the feet can elicit rhythmic, involuntary, step-like movements in non-injured subjects with their legs in a gravity-neutral apparatus. The present experiments investigated the convergence of spinal and plantar pressure stimulation and voluntary effort in the activation of locomotor movements in uninjured subjects under full body weight support in a vertical position. For all conditions, leg movements were analyzed using electromyographic (EMG) recordings and optical motion capture of joint kinematics. Spinal cord stimulation elicited rhythmic hip and knee flexion movements accompanied by EMG bursting activity in the hamstrings of 6/6 subjects. Similarly, plantar stimulation induced bursting EMG activity in the ankle flexor and extensor muscles in 5/6 subjects. Moreover, the combination of spinal and plantar stimulation exhibited a synergistic effect in all 6 subjects, eliciting greater motor responses than either modality alone. While the motor responses to spinal verses plantar stimulation seems to activate distinct, but overlapping spinal neural networks, when engaged simultaneously, the stepping responses were functionally complementary. As observed during induced (involuntary) stepping, the most significant modulation of voluntary stepping occurred in response to the combination of spinal and plantar stimulation. In light of the known automaticity and plasticity of spinal networks in absence of supraspinal input, these findings support the hypothesis that spinal and plantar stimulation may be effective tools for enhancing the recovery of motor control in individuals with neurological injuries and disorders.
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Specific imbalance of excitatory/inhibitory signaling establishes seizure onset pattern in temporal lobe epilepsy
Low-voltage fast (LVF) and hypersynchronous (HYP) patterns are the seizure onset patterns most frequently observed in intracranial EEG recordings from mesial temporal lobe epilepsy (MTLE) patients. Both patterns also occur in models of MTLE in vivo and in vitro, and these studies have highlighted the predominant involvement of distinct neuronal network/neu-rotransmitter receptor signaling in each of them. First, LVF onset seizures in epileptic rodents can originate from several limbic structures, frequently spread, and are associated with high frequency oscillations (HFOs) in the ripple band (80-200 Hz), while HYP onset seizures initiate in the hippocampus, and tend to remain focal with predominant fast ripples (250-500 Hz). Second, in vitro intracellular recordings from principal cells in limbic areas indicate that pharmacologically induced, seizure-like discharges with LVF onset are initiated by a synchronous inhibitory event or by a hyperpolarizing IPSPs barrage; in contrast, HYP onset is associated with a progressive impairement of inhibition and concomitant unrestrained enhance¬ment of excitation. Finally, in vitro optogenetic experiments show that under comparable experimental conditions (i.e., 4-aminopyridine application), the initiation of LVF or HYP onset seizures depends on the preponderant involvement of interneuronal or principal cell networks, respec¬tively. Overall, these data may provide insight to delineate better therapeutic targets in the treatment of patients presenting with MTLE and, perhaps, with other epileptic disorders as well.
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A Sodium Afterdepolarization in Rat Superior Colliculus Neurons and its Contribution to Population Activity
The mammalian superior colliculus (SC) is a midbrain structure that integrates multimodal sensory inputs and computes commands to initiate rapid eye movements. SC neurons burst with the sudden onset of a visual stimulus, followed by persistent activity that may underlie shifts of attention and decision-making. Experiments in vitro suggest that circuit reverberations play a role in the burst activity in the SC, but the origin of persistent activity is unclear. Here we characterized an after-depolarization (ADP) that follows action potentials in slices of rat SC. Population responses seen with voltage-sensitive dye imaging consisted of rapid spikes followed immediately by a second distinct depolarization of lower amplitude and longer duration. Patch clamp recordings showed qualitatively similar behavior: in nearly all neurons throughout the SC rapid spikes were followed by an ADP. Ionic and pharmacological manipulations along with experiments with current and voltage steps indicated that the ADP of SC neurons arises from Na+ current that either persists or resurges following Na+ channel inactivation at the end of an action potential. Comparisons of pharmacological properties and frequency dependence revealed a clear parallel between patch-clamp recordings and voltage imaging experiments, indicating a common underlying membrane mechanism for the ADP in both single neurons and populations. The ADP can initiate repetitive spiking at intervals consistent with the frequency of persistent activity in the SC. These results indicate that SC neurons have intrinsic membrane properties that can contribute to electrical activity that underlies shifts of attention and decision-making.
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Regionally distinct cutaneous afferent populations contribute to reflex modulation evoked by stimulation of the tibial nerve during walking
During walking, cutaneous reflexes in ankle flexor muscle (tibialis anterior: TA) evoked by tibial nerve (TIB) stimulation are predominantly facilitatory at early swing phase, but reverse to suppression at late swing phase. Although the TIB innervates a large portion of the skin of foot sole, the extent to which specific foot sole regions contribute to the reflex reversals during walking remains unclear. Therefore, we investigated regional cutaneous contributions from discrete portions of the foot sole on reflex reversal in TA following TIB stimulation during walking. Summation effects on reflex amplitudes when applying combined stimulation from foot sole regions with TIB were examined. Middle latency responses (MLRs: 70-120 ms) after TIB stimulation were strongly facilitated during the late stance to mid-swing phases and reversed to suppression just before heel strike. Both forefoot medial (f-M) and forefoot lateral (f-L) stimulation in foot sole induced facilitation during stance to swing transition phases, but heel (HL) stimulation evoked suppression during the late stance to the end of swing phases. At the stance to swing transition, a summation of MLR amplitude occurred only for combined f-M&TIB stimulation. However, the same was not true for the combined HL&TIB stimulation. At the swing to stance transition, there was a suppressive reflex summation only for HL&TIB stimulation. In contrast, this summation was not observed for the f-M&TIB stimulation. Our results suggest that reflex reversals evoked by TIB stimulation arise from distinct reflex pathways to TA produced by separate afferent populations innervating specific regions of the foot sole.
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ATM protein is located on presynaptic vesicles and its deficit leads to failures in synaptic plasticity
Ataxia-telangiectasia is a multi-systemic disorder that includes a devastating neurodegeneration phenotype. The ATM (ataxia-telangiectasia mutated) protein is well-known for its role in the DNA damage response. Yet ATM is also found in association with cytoplasmic vesicular structures - endosomes and lysosomes as well as neuronal synaptic vesicles. In keeping with this latter association, electrical stimulation of the Schaffer collateral pathway in hippocampal slices from ATM-deficient mice does not elicit normal long term potentiation (LTP). The current study was undertaken to assess the nature of this deficit. Theta burst-induced LTP was reduced in Atm-/- animals with the reduction most pronounced at burst stimuli that included six or greater trains. To assess whether the deficit was associated with a pre- or post-synaptic failure, we analyzed paired-pulse facilitation and found that it too was significantly reduced in Atm-/- mice. This indicates a deficit in presynaptic function. As further evidence that these synaptic effects of ATM deficiency were presynaptic, we used stochastic optical reconstruction microscopy (STORM). Three-dimensional reconstruction revealed that ATM is significantly more closely associated with Piccolo (a pre-synaptic marker) than with Homer1 (a post-synaptic marker). These results underline how, in addition to its nuclear functions, ATM plays an important functional role in the neuronal synapse where it participates in the regulation of presynaptic vesicle physiology.
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Voltage imaging to understand connections and functions of neuronal circuits
Understanding of the cellular mechanisms underlying brain functions, such as cognition and emotions, requires monitoring of membrane voltage at the cellular, circuit and system levels. Seminal voltage-sensitive dye and calcium-sensitive dye imaging studies have demonstrated parallel detection of electrical activity across populations of interconnected neurons in a variety of preparations. A game-changing advance made in recent years has been the conceptualization and development of the optogenetic tools, including genetically encoded indicators of voltage (GEVI) or calcium (GECI), and genetically encoded light-gated ion channels (actuators, e.g. channelrhodopsin2). Compared to low molecular weight calcium and voltage indicators (dyes), the optogenetic imaging approaches are: (i) cell-type specific, (ii) less invasive, (iii) able to relate activity and anatomy and (iv) they facilitate long-term recordings of individual cells' activities over weeks, thereby allowing direct monitoring of the emergence of learned behaviors and underlying circuit mechanisms. We highlight the potential of novel approaches based on genetically encoded voltage indicators and compare those to calcium imaging approaches. We also discuss how novel approaches based on genetically encoded voltage (and calcium) indicators coupled with genetically encoded actuators will promote progress in our knowledge of brain circuits and systems.
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Dissociating Vestibular and Somatosensory Contributions to Spatial Orientation
Inferring object orientation in the surroundings heavily depends on our internal sense of direction of gravity. Previous research showed that this sense is based on the integration of multiple information sources, including visual, vestibular (otolithic) and somatosensory signals. The individual noise characteristics and contributions of these sensors can be studied using spatial orientation tasks, such as the subjective visual vertical (SVV) task. A recent study reported that patients with complete bilateral vestibular loss perform similar as healthy controls on these tasks, from which it was conjectured that the noise levels of both otoliths and body somatosensors are roll-tilt dependent. Here, we tested this hypothesis in ten healthy human subjects by roll-tilting the head relative to the body to dissociate tilt-angle dependencies of otolith and somatosensory noise. Using a psychometric approach, we measured bias and variability in perceived orientation of a briefly flashed line relative to the gravitational vertical (SVV task). Measurements were taken at multiple body-in-space orientations (-90 to 90deg, steps of 30deg) and head-on-body roll-tilts (30deg left-ear-down, aligned, 30deg right-ear-down). Results showed that verticality perception is processed in a head-in-space reference frame, with a bias that increased with larger head-in-space orientations. Variability patterns indicated a larger contribution of the otolith organs around upright and a more substantial contribution of the body somatosensors at larger body-in-space roll-tilts. Simulations show that these findings are consistent with a statistical model that involves tilt-dependent noise levels of otolith and somatosensory signals, confirming dynamic shifts in the weights of sensory inputs with tilt angle.
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Beta modulation reflects name retrieval in the human anterior temporal lobe: An intracranial recording study
Naming people, places, and things is a fundamental human ability that is often impaired in patients with language-dominant anterior temporal lobe (ATL) dysfunction or ATL resection as part of epilepsy treatment. Convergent lines of evidence point to the importance of the ATL in name retrieval. The physiologic mechanisms that mediate name retrieval in the ATL, however, are not well understood. The purpose of this study was to characterize the electrophysiologic responses of the human ATL during overt cued naming of famous people and objects. Eight neurosurgical patients with suspected temporal lobe epilepsy who underwent implantation of intracranial electrodes for seizure focus localization were the subjects of this study. Specialized coverage of the ATL was achieved in each subject. The subjects named pictures of U.S. presidents and images of common hand-held tools. Event-related band power was measured for each ATL recording site. Both the left and right ATL demonstrated robust and focal increases in beta band (14 - 30 Hz) power during person and tool naming. The onset of this response typically occurred at 400 ms, but sometimes as early as 200 ms. Visual naming of famous people and tools is associated with robust and localized modulation of the beta band in both the left and right ATL. Measurement of visual naming responses may provide the groundwork for future mapping modalities to localize eloquent cortex in the ATL.
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Visual-Vestibular Processing In The Human Sylvian Fissure
Unlike other sensory systems, the cortical organization of the human vestibular system is not well established. A central role is assumed for the region of the posterior Sylvian fissure, close to the posterior insula. At this site, activation during vestibular stimulation has been observed in previous imaging studies and labeled as the parieto-insular vestibular cortex area (PIVC). However, vestibular responses are found in other parts of the Sylvian fissure as well, including a region that is referred to as the posterior insular cortex (PIC). The anatomical and functional relationship between PIC and PIVC is still poorly understood, because both areas have never been compared in the same participants. Therefore, in order to better understand the apparently more complex organization of vestibular cortex in the Sylvian fissure, we employed caloric and visual object motion stimuli during functional magnetic resonance imaging and compared location and function of PIVC and PIC in the same participants. Both regions responded to caloric vestibular stimulation, but only the activation pattern in right PIVC reliably represented the direction of the caloric stimulus. Conversely, activity in PIVC was suppressed during stimulation with visual object motion, whereas PIC showed activation. Area PIC is located at a more posterior site in the Sylvian fissure than PIVC. Our results suggest that PIVC and PIC should be considered separate areas in the vestibular Sylvian network, both in terms of location and function.
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Sensory reweighting dynamics following removal and addition of visual and proprioceptive cues
Removing or adding sensory cues from one sensory system during standing balance causes a change in the contribution of remaining sensory systems, a process referred to as sensory reweighting. While reweighting changes have been described in many studies under steady state conditions, less is known about the temporal dynamics of reweighting following sudden transitions to different sensory conditions. The current study changed sensory conditions by periodically adding or removing visual (lights On/Off) or proprioceptive cues (surface sway referencing On/Off) in 12 young, healthy subjects. Evidence for changes in sensory contributions to balance were obtained by measuring the time course of medial-lateral sway responses to a constant amplitude 0.56 Hz sinusoidal stimulus applied as support surface tilt (proprioceptive contribution), as visual scene tilt (visual contribution), or as binaural galvanic vestibular stimulation (vestibular contribution), and by analyzing the time course of sway variability. Sine responses and variability of body sway velocity showed significant changes following transitions and were highly correlated under steady state conditions. A dependence of steady state responses on upcoming transitions was observed suggesting that knowledge of impending changes can influence sensory weighting. Dynamic changes in sway in the period immediately following sensory transitions were very inhomogeneous across sway measures and in different experimental tests. In contrast to steady state results, sway response and variability measures were not correlated with one another in the dynamic transition period. Several factors influence sway responses following addition or removal of sensory cues, partly instigated by, but also obscuring the effects of reweighting dynamics.
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Changes in muscle spindle firing in response to length changes of neighboring muscles.
Skeletal muscle force can be transmitted to the skeleton not only via its tendons of origin and insertion, but also through connective tissues linking the muscle belly to surrounding structures. Through such epimuscular myofascial connections, length changes of a muscle may cause length changes within an adjacent muscle and, hence, affect muscle spindles. The aim of the present study was to investigate the effects of epimuscular myofascial forces on feedback from muscle spindles in triceps surae muscles of the rat. We hypothesized that, within an intact muscle compartment, muscle spindles not only signal length changes of the muscle they are located in, but can also sense length changes that occur as a result of changing the length of synergistic muscles. Action potentials from single afferents were measured intra-axonally in response to ramp-hold-release (RHR) stretches of an agonistic muscle at different lengths of its synergist, as well as in response to synergist RHRs. A decrease in force threshold was found for both soleus and lateral gastrocnemius afferents along with an increase in length threshold for soleus afferents. In addition, muscle spindle firing could be evoked by RHRs of the synergistic muscle. We conclude that muscle spindles not only signal length changes of the muscle they are located in, but also local length changes that occur as a result of changing the length and relative position of synergistic muscles.
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Impaired Carotid Baroreflex Control of Arterial Blood Pressure in Multiple Sclerosis
Multiple sclerosis (MS), a progressive neurological disease, can lead to impairments in the autonomic control of cardiovascular function. We tested the hypothesis that individuals with relapsing-remitting MS (n=10; 7 females, 3 males; 13 ± 4 yrs from diagnosis) exhibit impaired carotid baroreflex control of blood pressure and heart rate compared to sex, age, and body weight matched healthy individuals (CON: n=10; 7 females, 3 males). At rest, 5-s trials of neck pressure (NP; +40 Torr) and neck suction (NS; -60 Torr) were applied to simulate carotid hypotension and hypertension, respectively, while mean arterial pressure (MAP; finger photoplethysmography), heart rate (HR), cardiac output (CO; Modelflow), and total vascular conductance (TVC) were continuously measured. In response to NP, there was a blunted increase in peak MAP responses (MS: 5±2 mmHg) in individuals with MS compared to healthy controls (CON: 9±3 mmHg; P=0.005), whereas peak HR responses were not different between groups. At the peak MAP response to NP, individuals with MS demonstrated an attenuated decrease in TVC (MS, -10±4% baseline vs. CON, -15±4% baseline, P=0.012), whereas changes in CO were similar between groups. Following NS, all cardiovascular responses (i.e., nadir MAP and HR and percent changes in CO and TVC) were not different between MS and CON groups. These data suggest that individuals with MS have impaired carotid baroreflex control of blood pressure via a blunted vascular conductance response resulting in a diminished ability to increase MAP in response to a hypotensive challenge.
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Cover Image, Volume 170A, Number 5, May 2016
The cover image, by Sarah Smithson et al., is based on the Research Article Cerebro-costo-mandibular syndrome: Clinical, radiological, and genetic findings, DOI: 10.1002/ajmg.a.37587.
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Syringe Pump Performance Maintained with IV Filter Use During Low Flow Rate Delivery for Pediatric Patients.
BACKGROUND: Complex surgical and critically ill pediatric patients rely on syringe infusion pumps for precise delivery of IV medications. Low flow rates and in-line IV filter use may affect drug delivery. To determine the effects of an in-line filter to remove air and/or contaminants on syringe pump performance at low flow rates, we compared the measured rates with the programmed flow rates with and without in-line IV filters. METHODS: Standardized IV infusion assemblies with and without IV filters (filter and control groups) attached to a 10-mL syringe were primed and then loaded onto a syringe pump and connected to a 16-gauge, 16-cm single-lumen catheter. The catheter was suspended in a normal saline fluid column to simulate the back pressure from central venous circulation. The delivered infusate was measured by gravimetric methods at predetermined time intervals, and flow rate was calculated. Experimental trials for initial programmed rates of 1.0, 0.8, 0.6, and 0.4 mL/h were performed in control and filter groups. For each trial, the flow rate was changed to double the initial flow rate and was then returned to the initial flow rate to analyze pump performance for titration of rates often required during medication administration. These conditions (initial rate, doubling of initial rate, and return to initial rate) were analyzed separately for steady-state flow rate and time to steady state, whereas their average was used for percent deviation analysis. Differences between control and filter groups were assessed using Student t tests with adjustment for multiplicity (using n = 3 replications per group). RESULTS: Mean time from 0 to initial flow (startup delay) was
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Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Total Laparoscopic Hysterectomy: A Randomized, Controlled, Observer-Blinded Trial.
BACKGROUND: In this randomized, controlled, observer-blinded study, we evaluated analgesia provided by transversus abdominis plane (TAP) block after elective total laparoscopic hysterectomy in terms of reduced postoperative morphine consumption as the primary end point. METHODS: Fifty-two patients were randomly divided into 2 groups: patients in group T (TAP, n = 26) received an ultrasound-guided bilateral TAP block with 40 mL of 0.375% levobupivacaine and morphine patient-controlled analgesia, whereas patients in group C (control, n = 26) received morphine patient-controlled analgesia. Secondary outcomes included pain measurements (Numeric Rating Scale from 0 to 10) during the first 24 hours postoperatively, times to postanesthesia care unit discharge, times to surgical ward discharge, incidence of postoperative nausea and vomiting, functional capacity measurements in terms of 2-minute walking test, and first oral solid intake. RESULTS: Demographic and anthropometric variables were similar in the 2 groups. The total dose of morphine consumed by patients during postanesthesia care unit stay was 6 (0-8) mg in group T vs 8 (5.5-8.5) mg in group C (P = 0.154). Postoperative morphine consumption during the first 24 hours was 10.55 +/- 10.24 mg in group C vs 10.73 +/- 13.45 mg in group T (P = 0.950). The 95% confidence interval of the difference between means of 24-hour morphine consumption was -7.45 to +7.09. The 2 groups were comparable. There were no significant differences in secondary outcome variables between groups. CONCLUSIONS: TAP block did not reduce morphine consumption during the first postoperative 24 hours after elective total laparoscopic hysterectomy. (C) 2016 International Anesthesia Research Society
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Prevalence of clinical diseases in crossbred Frieswal bulls at an organized bull rearing unit
2016-04-13T23-22-50Z
Source: International Journal of Livestock Research
Naimi Chand, Ajayvir Singh Sirohi, Shrikant Tyagi, Ankur Sharma, Hemlata Hemlata, Devendra Kumar.
The present study was conducted in crossbred Frieswal bulls at an organized bull rearing unit. The analysis of 592 recorded clinical cases of bulls revealed 74.6, 21.0 and 4.4% medicinal, surgical and reproductive disorders, respectively. Of the total clinical cases, highest numbers (44.60%) were recorded during rainy season followed by summer (30.74%) and winter season (24.66%). The major clinical diseases prevalent in bulls were lameness, fever, tick infestation, abscess, wound, inappetance, diarrhea, balanoposthitis and conjunctivitis. Occurrence of fever, wound and abscess was more in rainy season while tick infestation and diarrhea were more prevalent during summer season. Lameness, balanoposthitis, dermatitis were found to occur more during winter season.
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