Τρίτη, 11 Οκτωβρίου 2016

Leaked from the state budget -2017 Norway: Fix for the weakest link.

A l l new FireFighters`s in Norway must have the minimum basic education ( 2 Years full time Ed.) Video from "Grunnkurs 01/2015 NBSK" Around 50% off the Norwegian pop. is served by part time / voluntary FF`s. The level of skill have been sub-par in manny of them. Not annymore! From 2017, anny new FF must have the minimum 2 year edukation. Not to early IMO! ExEMTNor

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Management of a 16-Year-Old With Axillary Lymphadenopathy: The Cat's in the Bag

Lymphadenopathy is a common presentation in primary care. The burden is placed on the provider to complete a thorough history and physical examination to choose proper diagnostic tests, if needed, to determine the diagnosis of and treatment for the underlying cause. It is of the utmost importance to determine if the cause of the lymphadenopathy is an infectious process or a malignancy that requires immediate referral. A case of lymphadenopathy in a 16-year-old boy that required three providers for diagnosis is presented.

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Acute esophageal necrosis

Abstract

Acute esophageal necrosis (AEN) or "black esophagus" is a rare condition presented by patients with critical state of health and characterized by a darkened esophagus, usually the distal third, in upper digestive endoscopy. The main clinical manifestation is upper gastrointestinal bleeding and there may be abdominal pain, dysphagia, nausea, vomiting, fever and syncope associated. The diagnosis depends on clinical suspicion and performing endoscopy, the biopsy not being required. In this article we present a case of a patient who had lots of comorbidities and developed AEN during a post-operative period, and discuss the importance of AEN in an increasingly ageing population.



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Urban Shield 2016 Red Area Command

Learn more about 2016 Urban Shield lessons for EMS here.

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Urban Shield 2016 Red Area Command

Learn more about 2016 Urban Shield lessons for EMS here.

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Robot-assisted and conventional therapies produce distinct rehabilitative trends in stroke survivors

Comparing the efficacy of alternative therapeutic strategies for the rehabilitation of motor function in chronically impaired individuals is often inconclusive. For example, a recent randomized clinical trial ...

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Esophagogastric Junction Morphology and Distal Esophageal Acid Exposure

Abstract

Background

The Chicago classification has recently added a morphological subclassification for the esophagogastric junction (EGJ). Our aim was to assess the distal esophageal acid exposure in patients with this new Chicago EGJ-type IIIa and IIIb classification.

Study Design

From a prospectively collected high-resolution manometry (HRM) database, we identified patients who underwent 24-h pH study between October 2011 and June 2015 and were diagnosed with EGJ-type III based on HRM. Chicago EGJ-type III is defined as the inter-peak nadir pressure ≤gastric pressure and a lower esophageal sphincter (LES)–crural diaphragm (CD) separation >2 cm [IIIa-pressure inversion point (PIP) remains at CD level and IIIb-PIP remains at LES level]. We classified the patients into reflux group [DeMeester score >14.72 or Fraction time pH (<4) > 4.2 %] and non-reflux group based on 24-h pH study.

Results

Fifty patients were identified that satisfied the study criteria, of which 37 patients (74 %) were EGJ-type IIIa. In those with EGJ-type IIIb, abdominal LES length (AL) in reflux group was significantly shorter than the non-reflux group (0.8 vs. 1.8, p < 0.05). EGJ-type IIIa patients showed significantly higher value for DeMeester score and Fraction time pH and more often had a positive pH study than EGJ-type IIIb patients (DeMeester score: 26.7 vs. 11.7, p < 0.05; Fraction time pH: 7.9 vs. 2.6, p < 0.05; positive pH study: 81.1 vs. 30.8 %, p < 0.001). Reflux was more common in LES–CD ≥ 3 cm than that in LES–CD < 3 cm (85 vs. 56.7 %, p < 0.05).

Conclusion

A subset of patients with >2-cm LES–CD separation (type IIIb) maintain a physiological intra-abdominal location of the EGJ and are less likely to have reflux. A LES–CD ≥ 3 cm seems to discern a hiatus hernia of clinical significance.



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Quality Investigation of 3D Printer Filament Using Laboratory X-Ray Tomography

3D Printing and Additive Manufacturing , Vol. 0, No. 0.


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Urban Shield 2016 Red Area Command

Learn more about 2016 Urban Shield lessons for EMS here.

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Urban Shield 2016 Red Area Command

Learn more about 2016 Urban Shield lessons for EMS here.

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Construction Site Paramedic - Medcor Inc.

Sick of riding in the back of an ambulance" Tired of the 24 hour shifts" Do you routinely engage in conversations with everyone you meet" Do you treat your patients as good, if not better than you would treat yourself" Do you like job perks, good pay, and great benefits" If so this may very well be the last job application you'll ever have to fill out! Here's the top 5 reasons why: Stability! ...

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Construction Site Paramedic in The Dalles, OR. - Medcor Inc.

<a Sick of riding in the back of an ambulance" Tired of the 24 hour shifts" Do you routinely engage in conversations with everyone you meet" Do you treat your patients as good, if not better than you would treat yourself" Do you like job perks, good pay, and great benefits" If so this may very well be the last job application you'll ever have to fill out! Here's the top 5 reasons why: ...

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Adductor canal block for knee surgical procedures: review article

Adductor canal block (ACB) has recently emerged as an alternative to femoral nerve block for pain control after various knee procedures especially knee arthroplasty. In this review article, we will review the anatomy of adductor canal, sonoanatomy, and ultrasound-guided approach for ACB as well as review current evidence regarding the indications of the ACB.

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Severe respiratory depression and bradycardia before induction of anesthesia and onset of Takotsubo cardiomyopathy after cardiopulmonary resuscitation

A 69-year-old woman undergoing treatment for hypertension and epilepsy was scheduled to undergo cataract surgery. All preoperative examination results were within normal limits. Despite being tense, she walked to the operating room. Approximately 2 minutes after an intravenous line was established by an anesthesia resident, severe hypoxia and bradycardia developed, and she lost consciousness. Cardiopulmonary resuscitation was initiated immediately, and after 1 minute, she regained consciousness, and her breathing and circulation recovered.

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Fiberoptic-guided intubation after insertion of the i-gel airway device in spontaneously breathing patients with difficult airway predicted: a prospective observational study

To assess the viability of performing fiberoptic-guided orotracheal intubation through the i-gel airway device previously inserted in spontaneously breathing patients with predicted difficult airway to achieve a patent airway.

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Soft palate trauma induced during GlideScope intubation

The GlideScope (GVL; Saturn Biomedical Systems, Burnaby, British Columbia, Canada) is a rigid indirect video laryngoscope device that facilitates exposure of the larynx for placement of the endotracheal tube. This blade also reduces the requirement for anterior displacement of the tongue. A unique feature is the acutely angled blade which provides an improved glottic view. Herein, we present 2 instances of soft palate trauma, a rare oropharyngeal complication linked to GlideScope use. In the first case, the GlideScope was used for pedagogical purposes for intubation in a knee surgery.

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Comparison of anesthetic management and outcomes of robot-assisted vs pure laparoscopic radical prostatectomy

Limited data are available regarding the anesthetic management and outcome of patients undergoing pure laparoscopic radical prostatectomy (LRP) and robotic-assisted LRP (RALP). Therefore, our primary objective was to compare the anesthetic management between these 2 groups. Our secondary objective was to determine the incidence of adverse outcomes associated with RALP, which requires an extreme Trendelenburg position.

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Transapical transcatheter aortic valve implantation performed with a retrolaminar block

Transapical transcatheter aortic valve implantation (TA-TAVI) has been developed for the treatment of patients with severe aortic stenosis and unacceptably high estimated surgical risks [1]. In addition, the TAVI may be able to perform earlier rising compared with aortic valve replacement. However, as the TA-TAVI approach is through an intercostal thoracotomy, it is difficult to manage the associated perioperative pain, and the patients often experience severe pain. A thoracic paravertebral nerve block is reported to provide effective analgesia for the TA-TAVI [2]; however, the thoracic paravertebral nerve block is a difficult technique owing to the deep nerve block site.

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The clinical utility of the Fluid Intravenous Alert monitor

We would like to report on the clinical utility of an intravenous (IV) fluid monitor, the Fluid IV Alert (FIVATM; FIVAMed Inc, Halifax, Canada). The FIVATM is a handheld, battery-operated class I medical device that clips onto the chamber of the IV tubing set (Fig. 1). The device uses an infrared emitter and sensors to detect the refractional change in light traveling through fluid and air, which triggers both an audio and visual (LED) alarm to alert the clinician to change the empty fluid bag. In addition, it also pinches the tubing when the alarm is triggered, thus preventing air from entering the IV line.

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Are EMS leaders worth what they cost?

I have an easy way to make a group of EMS leaders in my conference sessions squirm in theirs seats.

I ask them, "While you're all here at this meeting are 911 phone calls getting answered and crews getting dispatched back home" Are paramedics taking EKGs, giving IV dextrose to hypoglycemic diabetics and completing their electronic patient care reports" Are patients being transported to the hospital, their care transferred to the hospital staff and then your crews going back in service""

I've asked these questions to thousands of EMS leaders and no one has ever said, "Nope."

So if all the essential functions of your system are happening while you're away at a conference, what good are you" What value do you provide"

Presumably, you get paid more than everyone except a handful of overtime mongers. Wouldn't it be a smarter use of financial resources to take that money spent on your salary and benefits and use it to buy a new ambulance or a few new cardiac monitors"

Two ways leaders add value
Before my soft body armor gets tested for real, I'll let them off the hook. In addition to making sure the fuel bill is paid, the county contract gets renewed, your billing practices are not felonious and setting a vision for wall posters and wallet cards, I believe that leaders add real value in two essential ways:

The first way is to make sure that all the key processes in your organization are doing what they are supposed to be doing. The second is to make things better, to make improvements. These improvements can be focused on making performance better, like improving resuscitation rates, or fixing a problem, like poor response times in the suburbs, or taking advantage of an opportunity, like a new law that allows paramedics to vaccinate. These improvements are focused on making something tangibly and measurably better for the patients, the community, the people who work in the system or the organization itself.

Model for Improvement
In this new Paramedic Chief column, our team at FirstWatch along with our customers and colleagues will share actionable strategies, concepts and ideas to make real improvements. While we will draw from disciplines like Six Sigma, Lean Thinking, the Institute for Healthcare Improvement and others you will not need to have a black belt to put these ideas to work in your own EMS system.

Of all the many improvement structures, frameworks and models, we've chosen one to be the frame of our improvement racecar: the Model for Improvement.

Study, act, plan and do is a virtuous cycle for continual improvement. Used with permission from The Associates for Performance Improvement in Austin, Texas.

This model was created by some rock star statisticians more than two decades ago and was adopted by the Institute for Healthcare Improvement as their framework for making things better in health care worldwide. It's much simpler than most of the models you'll find, yet when used correctly its power is mindboggling.

Leaders get lots of requests:

  • A lead paramedic field training officer telling you that it's time for us to implement RSI.
  • The police chief wants access to your patient data on drug overdoses.
  • The mechanic who wants you to become an auto parts distributor to save money.

Will an improvement make things better" Ask two questions
One of the most transformative tricks in your improvement-focused toolkit is to respond to all of these requests with the first two questions in the Model for Improvement:

  • "What are we trying to accomplish""
  • "How will we know that a change is an improvement""

My experience is that asking these two questions prevents waste faster than a cupcake left under the supervision of a Labrador retreiver. For example, in one community when Steve, the chair of the city council saw Cindy, the EMS chief, at the dedication ceremony for the county hospital's new cardiac cath lab, he said, "It looks like we are going to have the votes to fund the new fire station on Bancroft and 3rd. Should we add a third bay so you can place a paramedic ambulance there""

"What do you hope to accomplish by adding a paramedic ambulance to that station," Cindy asked"

Steve responded, "Better service on the south side."

"That makes sense," Cindy said. "If we put an ambulance at that station, how will we know if it has improved service""

"Faster response times," Steve said. "I guess."

Cindy thought for a moment. "I'll look at the data, but we currently post 12-hour rigs near the shopping mall and I think that our response times are great in that area," Cindy said. "Posting a rig in that station might actually slow their response time because of its location."

When leaders who practice these tools and principles are asked, "So, what value do you provide as an EMS leader"" They point to performance charts showing how many more people in their community are resuscitated from cardiac arrest now than they were a year ago. They show how the change in scheduling improved employee satisfaction and decreased fatigue. They show how their system reliably gets STEMI patients to balloon inflation in less than 90 minutes, not from the hospital door, but from the first ring of the 911 phone in the primary PSAP.

They are able to show in a statistically valid way how their leadership matters. Our commitment is to equip you to more effectively improve the things that matter.

We believe strongly in the Institute for Healthcare Improvement's all teach, all learn approach to collaboration and we invite you to participate in the creation of this column. If you have topics you'd like us to write about or problems that you'd like us to address, please share them in the comments or email them to me.



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EMT Paramedic - Baylor Scott & White Health

EMT Paramedic Job # 25294, 28560, 28561 Baylor Scott & White Health Temple, TX Administers efficient, rapid, quality care and transport to critically ill or injured patients in a dynamic and demanding environment. Provides critical are interventions and patient transport, in an independent capacity, to provide quality care to a varied patient population. Ensures that ambulance is maintained in a ...

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Initiator tRNA binding prompts ribosome maturation [Genetics]

Ribosome biogenesis, a complex multistep process, results in correct folding of rRNAs, incorporation of >50 ribosomal proteins, and their maturation. Deficiencies in ribosome biogenesis may result in varied faults in translation of mRNAs causing cellular toxicities and ribosomopathies in higher organisms. How cells ensure quality control in ribosome biogenesis for...

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Function of deacetylase complex in DNA methylation [Genetics]

DNA methylation, heterochromatin protein 1 (HP1), histone H3 lysine 9 (H3K9) methylation, histone deacetylation, and highly repeated sequences are prototypical heterochromatic features, but their interrelationships are not fully understood. Prior work showed that H3K9 methylation directs DNA methylation and histone deacetylation via HP1 in Neurospora crassa and that the histone...

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The role of codon usage on gene expression [Genetics]

Codon usage biases are found in all eukaryotic and prokaryotic genomes, and preferred codons are more frequently used in highly expressed genes. The effects of codon usage on gene expression were previously thought to be mainly mediated by its impacts on translation. Here, we show that codon usage strongly correlates...

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Are EMS leaders worth what they cost?

I have an easy way to make a group of EMS leaders in my conference sessions squirm in theirs seats.

I ask them, "While you're all here at this meeting are 911 phone calls getting answered and crews getting dispatched back home? Are paramedics taking EKGs, giving IV dextrose to hypoglycemic diabetics and completing their electronic patient care reports? Are patients being transported to the hospital, their care transferred to the hospital staff and then your crews going back in service?" 

I've asked these questions to thousands of EMS leaders and no one has ever said, "Nope."

So if all the essential functions of your system are happening while you're away at a conference, what good are you? What value do you provide? 

Presumably, you get paid more than everyone except a handful of overtime mongers. Wouldn't it be a smarter use of financial resources to take that money spent on your salary and benefits and use it to buy a new ambulance or a few new cardiac monitors?

Two ways leaders add value
Before my soft body armor gets tested for real, I'll let them off the hook. In addition to making sure the fuel bill is paid, the county contract gets renewed, your billing practices are not felonious and setting a vision for wall posters and wallet cards, I believe that leaders add real value in two essential ways:

The first way is to make sure that all the key processes in your organization are doing what they are supposed to be doing. The second is to make things better, to make improvements. These improvements can be focused on making performance better, like improving resuscitation rates, or fixing a problem, like poor response times in the suburbs, or taking advantage of an opportunity, like a new law that allows paramedics to vaccinate. These improvements are focused on making something tangibly and measurably better for the patients, the community, the people who work in the system or the organization itself.

Model for Improvement
In this new Paramedic Chief column, our team at FirstWatch along with our customers and colleagues will share actionable strategies, concepts and ideas to make real improvements. While we will draw from disciplines like Six Sigma, Lean Thinking, the Institute for Healthcare Improvement and others you will not need to have a black belt to put these ideas to work in your own EMS system. 

Of all the many improvement structures, frameworks and models, we've chosen one to be the frame of our improvement racecar: the Model for Improvement. 

Study, act, plan and do is a virtuous cycle for continual improvement. Used with permission from The Associates for Performance Improvement in Austin, Texas.

This model was created by some rock star statisticians more than two decades ago and was adopted by the Institute for Healthcare Improvement as their framework for making things better in health care worldwide. It's much simpler than most of the models you'll find, yet when used correctly its power is mindboggling. 

Leaders get lots of requests: 

  • A lead paramedic field training officer telling you that it's time for us to implement RSI.
  • The police chief wants access to your patient data on drug overdoses.
  • The mechanic who wants you to become an auto parts distributor to save money.  

Will an improvement make things better? Ask two questions
One of the most transformative tricks in your improvement-focused toolkit is to respond to all of these requests with the first two questions in the Model for Improvement:

  • "What are we trying to accomplish?"
  • "How will we know that a change is an improvement?"

My experience is that asking these two questions prevents waste faster than a cupcake left under the supervision of a Labrador retreiver. For example, in one community when Steve, the chair of the city council saw Cindy, the EMS chief, at the dedication ceremony for the county hospital's new cardiac cath lab, he said, "It looks like we are going to have the votes to fund the new fire station on Bancroft and 3rd. Should we add a third bay so you can place a paramedic ambulance there?" 

"What do you hope to accomplish by adding a paramedic ambulance to that station," Cindy asked?

Steve responded, "Better service on the south side." 

"That makes sense," Cindy said. "If we put an ambulance at that station, how will we know if it has improved service?"

"Faster response times," Steve said. "I guess."

Cindy thought for a moment. "I'll look at the data, but we currently post 12-hour rigs near the shopping mall and I think that our response times are great in that area," Cindy said. "Posting a rig in that station might actually slow their response time because of its location."

When leaders who practice these tools and principles are asked, "So, what value do you provide as an EMS leader?" They point to performance charts showing how many more people in their community are resuscitated from cardiac arrest now than they were a year ago. They show how the change in scheduling improved employee satisfaction and decreased fatigue. They show how their system reliably gets STEMI patients to balloon inflation in less than 90 minutes, not from the hospital door, but from the first ring of the 911 phone in the primary PSAP.

They are able to show in a statistically valid way how their leadership matters. Our commitment is to equip you to more effectively improve the things that matter.

We believe strongly in the Institute for Healthcare Improvement's all teach, all learn approach to collaboration and we invite you to participate in the creation of this column. If you have topics you'd like us to write about or problems that you'd like us to address, please share them in the comments or email them to me.



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Attend a conference because EMS is bigger than your department

An EMS conference launched me from ambulance corps member to the full world of EMS history, current practice and professional camaraderie.

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Association of the melanocortin 4 receptor gene rs17782313 polymorphism with rewarding value of food and eating behavior in Chilean children

Abstract

Studies conducted in monozygotic and dizygotic twins have established a strong genetic component in eating behavior. Rare mutations and common variants of the melanocortin 4 receptor (MC4R) gene have been linked to obesity and eating behavior scores. However, few studies have assessed common variants in MC4R gene with the rewarding value of food in children. The objective of the study was to evaluate the association between the MC4R rs17782313 polymorphism with homeostatic and non-homeostatic eating behavior patterns in Chileans children. This is a cross-sectional study in 258 Chilean children (44 % female, 8–14 years old) showing a wide variation in BMI. Anthropometric measurements (weight, height, Z-score of BMI and waist circumference) were performed by standard procedures. Eating behavior was assessed using the Eating in Absence of Hunger Questionnaire (EAHQ), the Child Eating Behavior Questionnaire (CEBQ), the Three-Factor Eating Questionnaire (TFEQ), and the Food Reinforcement Value Questionnaire (FRVQ). Genotype of the rs17782313 nearby MC4R was determined by a Taqman assay. Association of the rs17782313 C allele with eating behavior was assessed using non-parametric tests. We found that children carrying the CC genotype have higher scores of food responsiveness (p value = 0.02). In obese girls, carriers of the C allele showed lower scores of satiety responsiveness (p value = 0.02) and higher scores of uncontrolled eating (p value = 0.01). Obese boys carrying the C allele showed lower rewarding value of food in relation to non-carriers. The rs17782313 C allele is associated with eating behavior traits that may predispose obese children to increased energy intake and obesity.



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Remember 2 Things: Making the decision to wear body armor

EMS body armor can minimize the risk of injury during a violent attack. Steve Whitehead, host of Remember 2 Things, discusses a couple points for EMS agencies to keep in mind if they make the decision to have crews wear body armor. Check out more news, feature articles, resources and tips about EMS body armor.

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Identifying and busting the top EMS myths

EMS has its own set of myths that don't hold up under scrutiny. In this video two physicians discuss a lecture they gave at the National Association of EMS Physicians meeting on top EMS myths. Read about the topics they presented in their EMS mythbusters presentation.

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EMS training time: To pay or not to pay

By Christie Mellott

With the U.S. Department of Labor's changes to the so-called "white collar" exemptions under the federal Fair Labor Standards Act scheduled to take effect on December 1, 2016, many employers are taking the time now to review all of their pay practices.

One particularly confusing pay practices topic for EMS employers concerns properly paying employees for training time. The general rule for determining the compensability of training time under the Fair Labor Standards Act is set forth in the Fair Labor Standards Act regulations at 29 C.F.R. § 785.27. This regulation states that:

Attendance at lectures, meetings, training programs and similar activities need not be counted as working time if the following four criteria are met:

  1. Attendance is outside the employee's regular working hours;
  2. Attendance is in fact voluntary;
  3. The course, lecture, or meeting is not directly related to the employee's job; and
  4. The employee does not perform any productive work during such attendance.

If any of these three elements are not met, then the employee must get paid for attending the training. But, if the employee attends a truly voluntary training session outside of his or her working hours, and does not do any work for his or her employer during this training, then the employer will not have to pay the employee. This issue is important for both employers and employees. Employees' time is limited, and additional time for training is time away from family, friends and personal interests. While some employers will pay for training even when not required, many employers do not want to pay employees if they are not required to.

EMS provider maintenance of prerequisites
It is important to distinguish between training time and maintaining the prerequisites EMS employees need to keep their jobs. Paramedics, EMTs and all the other EMS classifications need a certain amount of continuing education to maintain their certifications.

If a person is being paid to be a paramedic and his state requires him to get a certain number of continuing education credits in order to maintain his paramedic certification, then attending these continuing education courses would not necessarily be hours worked that an employer would be required to pay under the Fair Labor Standards Act. In other words, an employer generally does not have to pay an employee to attend the standard continuing education classes, as long as they are outside of working hours and the employee does no other work during the class. For example, if the paramedic chooses to take a continuing education class on athletic injuries in his spare time to obtain the continuing education he needs to renew his paramedic certification, his employer is not required to pay him.

But, if this same paramedic's medical director requires him to take PALS, PHTLS, ACLS or other types of training, even though attending these courses may get the paramedic continuing education credits, because these particular courses are mandatory at the paramedic's place of employment, then the employee must be paid for attending these training classes at his hourly rate plus any overtime that he may have incurred during the workweek.

One other thing to keep in mind is whether an EMS provider's state may require PALS, PHTLS, ACLS or other types of training to maintain the EMS provider's certification. If the certification is required by the state as opposed to being required by the employer, then this would be a different situation and, if the other factors are met, the time might not be compensable for these certifications. In other words, if the state a paramedic lives in requires her to have a PALS certification to maintain her paramedic license, then she may not get paid to go the PALS class if she goes to it in her spare time and performs no other work for the employer at the class.

When do EMS employers need to pay for training"
If an employee takes a particular continuing education class because she thinks it sounds interesting and she needs the continuing education credits, as long as this class is outside her normal schedule, it is not a class her employer requires, and she does not perform any work for the employer at the class, then she would not need to be compensated for attending the class. If any one of these requirements is not met, then the employee would have to be compensated.

When compensating employees for training, most EMS employees will be entitled to their hourly rate of pay for attending the training and working their shifts, plus any overtime incurred during that workweek, unless the employee is truly a management-level employee who properly meets one of the "white collar" exemptions. Some EMS employers have adopted one of the lawful alternate methods of paying overtime, such as the fluctuating workweek, or the 7(k) exemption for public agency firefighters, if the employee works over 40 hours in a workweek. If the employer has adopted one of these alternatives, then this may lawfully affect the amount of overtime that the employee receives.

Assuming the employer has not adopted a lawful alternate method for paying overtime, then the employee must be paid overtime at one and a half times the employee's regular rate of pay for all hours worked in a given workweek. The standard overtime rule applies to all non-exempt employees regardless of whether the employee is classified as full-time, part-time or per diem. The important thing is the hours worked in a workweek, not the classification of the employee as full-time, part-time or per diem.

Top takeaway for EMS employees and employers
EMS employees work hard and deserve to get paid for all the work that they do, and this work includes attending compensable training sessions. It is equally important for both employees and employers to know and understand the rules for when training sessions are compensable. This way, employees will have the confidence of knowing with certainty whether their employer is paying them correctly for the training sessions.



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Identifying and busting the top EMS myths

EMS has its own set of myths that don't hold up under scrutiny. In this video two physicians discuss a lecture they gave at the National Association of EMS Physicians meeting on top EMS myths. Read about the topics they presented in their EMS mythbusters presentation.

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Efficacy and safety of single fecal microbiota transplantation for Japanese patients with mild to moderately active ulcerative colitis

Abstract

Background

The clinical utility of fecal microbiota transplantation (FMT) in patients with ulcerative colitis (UC) is still controversial. We investigated the efficacy and safety of single FMT for patients with mild to moderately active UC in a Japanese population.

Methods

Fifty-seven patients were evaluated for eligibility, and 16 patients were excluded. Forty-one patients with UC refractory to standard medical therapy were treated with single FMT by colonoscopic administration. Changes in the fecal microbiota were assessed by 16S ribosomal DNA based terminal restriction fragment length polymorphism analysis.

Results

At 8 weeks after FMT, no patient achieved clinical remission, and 11 of 41 patients (26.8 %) showed clinical response. The full Mayo score and the Mayo clinical score significantly decreased at week 8 [full Mayo score 5.5 ± 2.4 (mean ± standard deviation) at initiation and 4.6 ± 2.2 at week 8, P < 0.004; Mayo clinical score 4.0 ± 2.0 at initiation and 3.0 ± 1.9 at week 8, P < 0.001], but there were no statistically significant effects on the Mayo endoscopic score. No adverse events occurred after FMT or during the follow-up period of 8 weeks. The proportion of Bifidobacterium was significantly higher in the donor feces used for responders than in the donor feces used for nonresponders. The proportion of Lactobacillales and Clostridium cluster IV were significantly higher in the donor feces used for nonresponders.

Conclusions

Single FMT by colonoscopy was performed safely in all patients, but sufficient clinical efficacy and microbial restoration were not confirmed in patients with mild to moderately active UC.



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Critical Care Transport Paramedic - VitaLink - NHRMC

Critical Care Transport Paramedic - VitaLink Full-Time, Nights New Hanover Regional Medical Center Wilmington, NC The Critical Care Paramedic provides high quality patient care and safe medical transport to sick and injured patients in all age groups. Uses an interdisciplinary model to work with the AirLink/VitaLink Staff Nurse and other appropriate medical personnel to establish and prioritize a plan ...

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Paramedic – Vitalink - NHRMC

Paramedic – Vitalink Full-Time, Evening New Hanover Regional Medical Center Wilmington, NC The Staff Paramedic provides high quality patient care and safe medical transport to sick and injured patients in all age groups. Develops a plan of care for each patient that is consistent with approved treatment protocols, policies and procedures. Responsible for the operation of emergency vehicles. Essential ...

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Staff Nurse – Vitalink - NHRMC

Staff Nurse – Vitalink Full-Time, Rotating Schedule New Hanover Regional Medical Center Wilmington, NC The Staff RN provides high quality patient care and safe medical transport to sick and injured patients in all age groups. Essential Responsibilities: Collaborates with team and initiates care plan based on patient assessment and significant other input/data. Continuously reviews and revises ...

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Remember 2 Things: Making the decision to wear body armor

EMS body armor can minimize the risk of injury during a violent attack. Steve Whitehead, host of Remember 2 Things, discusses a couple points for EMS agencies to keep in mind if they make the decision to have crews wear body armor. Check out more news, feature articles, resources and tips about EMS body armor.

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Identifying and busting the top EMS myths

EMS has its own set of myths that don't hold up under scrutiny. In this video two physicians discuss a lecture they gave at the National Association of EMS Physicians meeting on top EMS myths. Read about the topics they presented in their EMS mythbusters presentation.

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Why telephone CPR improves cardiac arrest survival

Dr. Ben Bobrow discusses telephone CPR, also known as dispatcher assisted CPR, by bystanders or laypeople to improve survival from sudden cardiac arrest. Telephone CPR using specific protocols is an incredible opportunity to engage bystanders in giving care. Learn more about this important step for improving sudden cardiac arrest survival in your community.

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Remember 2 Things: Making the decision to wear body armor

EMS body armor can minimize the risk of injury during a violent attack. Steve Whitehead, host of Remember 2 Things, discusses a couple points for EMS agencies to keep in mind if they make the decision to have crews wear body armor. Check out more news, feature articles, resources and tips about EMS body armor.

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Identifying and busting the top EMS myths

EMS has its own set of myths that don't hold up under scrutiny. In this video two physicians discuss a lecture they gave at the National Association of EMS Physicians meeting on top EMS myths. Read about the topics they presented in their EMS mythbusters presentation.

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Why telephone CPR improves cardiac arrest survival

Dr. Ben Bobrow discusses telephone CPR, also known as dispatcher assisted CPR, by bystanders or laypeople to improve survival from sudden cardiac arrest. Telephone CPR using specific protocols is an incredible opportunity to engage bystanders in giving care. Learn more about this important step for improving sudden cardiac arrest survival in your community.

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The pipeline of physiology courses in community colleges: to university, medical school, and beyond

Community colleges are significant in the landscape of undergraduate STEM (science technology, engineering, and mathematics) education (9), including biology, premedical, and other preprofessional education. Thirty percent of first-year medical school students in 2012 attended a community college. Students attend at different times in high school, their first 2 yr of college, and postbaccalaureate. The community college pathway is particularly important for traditionally underrepresented groups. Premedical students who first attend community college are more likely to practice in underserved communities (2). For many students, community colleges have significant advantages over 4-yr institutions. Pragmatically, they are local, affordable, and flexible, which accommodates students' work and family commitments. Academically, community colleges offer teaching faculty, smaller class sizes, and accessible learning support systems. Community colleges are fertile ground for universities and medical schools to recruit diverse students and support faculty. Community college students and faculty face several challenges (6, 8). There are limited interactions between 2- and 4-yr institutions, and the ease of transfer processes varies. In addition, faculty who study and work to improve the physiology education experience often encounter obstacles. Here, we describe barriers and detail existing resources and opportunities useful in navigating challenges. We invite physiology educators from 2- and 4-yr institutions to engage in sharing resources and facilitating physiology education improvement across institutions. Given the need for STEM majors and health care professionals, 4-yr colleges and universities will continue to benefit from students who take introductory biology, physiology, and anatomy and physiology courses at community colleges.



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Conceptualizing physiology of arterial blood pressure regulation through the logic model



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10 more habits paramedics can't shake

Do you check pulses while shaking hands? Or maybe you're the guy in the grocery store parking lot pulling a shopping cart behind you like you're at the front of a stretcher.

No need to be ashamed — you're not alone. We know EMS habits die hard.

We asked our Facebook fans what habit they have that's hard to shake even when off the clock or after retirement; check out some of our favorites below.

Don't see a habit you have? Add it in the comments.

1. "Eating fast. It's very difficult to eat a meal at a reasonable pace because of the years of working for a private company. I'm often the first one finished." — Rick Jones

2. "I always look at the rear view mirror in my personal car on a hard stop to see if I set off the drive cam." — James Weber

3. "When you pull up to get gas in your personal vehicle and make sure you're not getting diesel like your ambulance needs." — Allen Davis

4. "In my POV when someone randomly pulls over on the street, I always look down to see if my code three lights are on." — Daniel Quirin

5. "When I meet people, I assess their veins for how hard or easy they would be to stick." — Rick Wyatt

6. "I catch myself watching people when I'm in a crowded location always looking for signs of someone in distress and I always back into a parking space so I'm in response mode." — Nisa Baynes

7. "I can't stand drawn out stories. If you take too long to get to the point, I will interrupt and start asking questions to get the pertinent information. I want the most amount of info in the shortest amount of time." — Jessie Anderson

8. "When attending any event, I am looking to identify the locations of AEDs and the medical and law enforcement staff." — Glenn C Gerber

9. "Always looking at elderly people as a possible fall victim and being prepared to assist if needed." — Lisa Leonardo

10. "If it's my day off and someone asks me for a Band-Aid, I'll check my watch so I can note the time." — Tim S Huddleston



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Remember 2 Things: Making the decision to wear body armor

EMS body armor can minimize the risk of injury during a violent attack. Steve Whitehead, host of Remember 2 Things, discusses a couple points for EMS agencies to keep in mind if they make the decision to have crews wear body armor. Check out more news, feature articles, resources and tips about EMS body armor.

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Why telephone CPR improves cardiac arrest survival

Dr. Ben Bobrow discusses telephone CPR, also known as dispatcher assisted CPR, by bystanders or laypeople to improve survival from sudden cardiac arrest. Telephone CPR using specific protocols is an incredible opportunity to engage bystanders in giving care. Learn more about this important step for improving sudden cardiac arrest survival in your community.

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10 more habits paramedics can't shake

Do you check pulses while shaking hands" Or maybe you're the guy in the grocery store parking lot pulling a shopping cart behind you like you're at the front of a stretcher.

No need to be ashamed — you're not alone. We know EMS habits die hard.

We asked our Facebook fans what habit they have that's hard to shake even when off the clock or after retirement; check out some of our favorites below.

Don't see a habit you have" Add it in the comments.

1. "Eating fast. It's very difficult to eat a meal at a reasonable pace because of the years of working for a private company. I'm often the first one finished." — Rick Jones

2. "I always look at the rear view mirror in my personal car on a hard stop to see if I set off the drive cam." — James Weber

3. "When you pull up to get gas in your personal vehicle and make sure you're not getting diesel like your ambulance needs." — Allen Davis

4. "In my POV when someone randomly pulls over on the street, I always look down to see if my code three lights are on." — Daniel Quirin

5. "When I meet people, I assess their veins for how hard or easy they would be to stick." — Rick Wyatt

6. "I catch myself watching people when I'm in a crowded location always looking for signs of someone in distress and I always back into a parking space so I'm in response mode." — Nisa Baynes

7. "I can't stand drawn out stories. If you take too long to get to the point, I will interrupt and start asking questions to get the pertinent information. I want the most amount of info in the shortest amount of time." — Jessie Anderson

8. "When attending any event, I am looking to identify the locations of AEDs and the medical and law enforcement staff." — Glenn C Gerber

9. "Always looking at elderly people as a possible fall victim and being prepared to assist if needed." — Lisa Leonardo

10. "If it's my day off and someone asks me for a Band-Aid, I'll check my watch so I can note the time." — Tim S Huddleston



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Remember 2 Things: Body Armor



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Why telephone CPR improves cardiac arrest survival



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Effect of lidocaine with and without epinephrine on lymphatic contractile activity in mice in vivo

Abstract

A local anesthetic, lidocaine, is known to affect cutaneous blood flow when injected into the skin. However, it is unknown if dermal lymphatic function can also be affected. Therefore, we characterized lymphatic function in response to administration of lidocaine with and without epinephrine. Non-invasive near-infrared fluorescence imaging (NIRFI) with intradermal injection of indocyanine green (ICG) was used to characterize the lymphatic "pumping" function in mice after subcutaneous injection of 2 % lidocaine with and without 1:100,000 epinephrine or saline. NIRFI was performed for 10–20 min immediately after and 1, 3, and 5 h after these interventions. Lymphatic contraction frequencies significantly decreased 10 min after subcutaneous injection of lidocaine and remained plateaued for another 5 min, before returning to baseline. However, addition of 1:100,000 epinephrine to 2 % lidocaine rapidly increased lymphatic contraction frequencies at 5 min post-injection, which returned to baseline levels 15 min later. Injection of saline also increased lymphatic contraction frequency 5 min after injection, which returned to baseline 10 min post-injection. Although lidocaine administration showed a decrease in lymphatic function, the combination of epinephrine with lidocaine resulted in a predominant net effect of increased contractile activity.



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Self-management programmes in TMD: results from an international Delphi process

Abstract

Self-management (SM) programmes are commonly used for initial treatment of patients with temporomandibular disorders (TMD). The programmes described in the literature, however, vary widely with no consistency in terminology used, components of care, or their definitions. The aims of this study were, therefore, to: construct an operationalized definition of self-management appropriate for the treatment of patients with TMD; identify the components of that self-management currently being used; create sufficiently clear and non-overlapping standardized definitions for each of those components. A four-round Delphi process with eleven international experts in the field of TMD was conducted to achieve these aims. In the first round, the participants agreed upon six principal concepts of self-management. In the remaining three rounds, consensus was achieved upon the definition and the six components of self-management. The main components identified and agreed upon by the participants to constitute the core of a SM programme for TMD were: education; jaw exercises; massage; thermal therapy; dietary advice and nutrition; and parafunctional behaviour identification, monitoring, and avoidance. This Delphi process has established the principal concepts of self-management and a standardized definition has been agreed with the following components for use in clinical practice: education; self-exercise; self-massage; thermal therapy; dietary advice and nutrition; and parafunctional behaviour identification, monitoring, and avoidance. The consensus-derived concepts, definitions, and components of SM, offer a starting point for further research in order to advance the evidence base for, and clinical utility of, TMD SM.

This article is protected by copyright. All rights reserved.



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Preferential use of minor codons in the translation initiation region of human genes

Abstract

More than 31,000 protein-coding sequences (CCDS) have been identified in the human genome. Here, we analyzed codon usage in all human CCDS and found that there is a preferential usage of minor codons for Ala (CGC), Pro (CCG), Ser (UCG), and Thr (ACG) in the initial 50-codon sequences of the CCDS. These codons, with consensus XCG sequences, are most infrequently used among their synonymous codons. Thus, the tRNA concentrations per codon are considered to be highest for the minor codons for Ala, Pro, Ser and Thr in comparison with other synonymous codons for each of them to enhance the translation efficiency. This suggests that human genes are regulated at the level of translation by preferentially using minor codons within the first 50 codons of the CCDS. This hypothesis was experimentally confirmed by comparing the expression of the luciferase gene encoded by minor codons with that encoded by major codons.



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Do general practitioners predominantly see patients with coughs and colds: Medical students’ and the general public’s perceptions

2016-10-11T03-05-04Z
Source: Journal of Contemporary Medical Education
Nicole Koehler.
Introduction: Anecdotally it is perceived that general practitioners (GPs) predominantly see patients with coughs and colds. The aim of the study was to ascertain medical students and the general publics perceptions of what problems they believe GPs in Australia manage. Method: An anonymous online survey was completed by 357 medical students and 183 members of the general public. Results: Students and the general public generally had similar perceptions. Respiratory conditions were most frequently mentioned in response to asking participants to list the five most common problems they think GPs manage. When subsequently asked to rank order a list of 15 problems managed by GPs, prescriptions was ranked first by the largest percentage of participants. Upper respiratory tract infections were second and third most commonly ranked first by the general public and students respectively. More than half of all students with a non-general practice career preference and the general public either agreed or strongly agreed with the statement GPs predominantly see patients with coughs and colds. Discussion: It is possible that medical students erroneous perceptions in regards to the type of problems GPs manage contributes to their decision as to whether to pursue a career in general practice.


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Imaging of pancreatic cancer: What the surgeon wants to know

Clinical Imaging

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Effectiveness of elbasvir and grazoprevir combination, with or without ribavirin, for treatment-experienced patients with chronic hepatitis c infection

Gastroenterology

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A phase Ib study of selumetinib (AZD6244, ARRY-142886) in combination with sorafenib in advanced hepatocellular carcinoma (HCC)

Annals of Oncology

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New therapeutic target for Crohn's disease

Sanford-Burnham Medical Research Institute News

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Outcome of neoadjuvant therapies for cancer of the oesophagus or gastro-oesophageal junction based on a national data registry

British Journal of Surgery

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Outcomes after extended pancreatectomy in patients with borderline resectable and locally advanced pancreatic cancer

British Journal of Surgery

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Selective depletion of tumour suppressors Deleted in Colorectal Cancer (DCC) and neogenin by environmental and endogenous serine proteases: Linking diet and cancer

BMC Cancer

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Common asthma drug could prevent liver disease, reduce need for liver transplants

Baylor Health Care System

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Phase 2 study of lenvatinib in patients with advanced hepatocellular carcinoma

Journal of Gastroenterology

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Research uncovers defender against cancer-promoting liver damage

Sanford-Burnham Medical Research Institute News

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Effect of liraglutide treatment on jejunostomy output in patients with short bowel syndrome: an open-label pilot study

Journal of Parenteral and Enteral Nutrition

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Timing of upper endoscopy influences outcomes in patients with acute nonvariceal upper GI bleeding

Gastrointestinal Endoscopy

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Accuracy and inter-observer agreement of diffusion weighted imaging in pediatric inflammatory bowel disease

Clinical Imaging

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Colorectal cancer liver metastasis trends in the kingdom of Saudi Arabia

Saudi Journal of Gastroenterology

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Can 3D high resolution anorectal manometry detect anal sphincter defects in patients with faecal incontinence?

Colorectal Disease

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Bile duct study uncovers cancer triggers

University of Edinburgh College of Medicine News

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Unresectable hepatocellular carcinoma: radioembolization versus chemoembolization: A systematic review and meta-analysis

Cardiovascular and Interventional Radiology

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Non-invasive diagnosis

Cardiff University News

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Pethidine hydrochloride is a better sedation method for pharyngeal observation by trans-oral endoscopy compared with no sedation and midazolam

Digestive Endoscopy

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'Self-assembling' molecules help key signalling pathway in bowel cancer

Institute of Cancer Research

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Expanding frontiers in weight-control research explored by young investigators

Abstract

At the 93rd annual meeting of the Physiological Society of Japan, a symposium entitled "Expanding frontiers in weight-control research explored by young investigators" was organized. The latest research on weight control was presented by young up-and-coming investigators. The symposium consisted of the following presentations: Gastrointestinal brush cells, immunity, and energy homeostasis; Impact of a brown rice-derived bioactive product on feeding regulation and fuel metabolism; A novel G protein-coupled receptor-regulated neuronal signaling pathway triggers sustained orexigenic effects; and NMDA receptor co-agonist d-serine regulates food preference. These four talks presented at the symposium were summarized as a series of short reviews in this review.



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Posterior resting states EEG asymmetries are associated with hedonic valuation of food

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Publication date: Available online 10 October 2016
Source:International Journal of Psychophysiology
Author(s): Marlies E. van Bochove, Eva Ketel, Miles Wischnewski, Joost Wegman, Esther Aarts, Benjamin de Jonge, W. Pieter Medendorp, Dennis J.L.G. Schutter
Research on the hedonic value of food has been important in understanding the motivational and emotional correlates of normal and abnormal eating behaviour. The aim of the present study was to explore associations between hemispheric asymmetries recorded during resting state electroencephalography (EEG) and hedonic valuation of food. Healthy adult volunteers were recruited and four minutes of resting state EEG were recorded from the scalp. Hedonic food valuation and reward sensitivity were assessed with the hedonic attitude to food and behavioural activation scale. Results showed that parieto-occipital resting state EEG asymmetries in the alpha (8–12Hz) and beta (13–30Hz) frequency range correlate with the hedonic valuation of food. Our finding suggests that self-reported sensory-related attitude towards food is associated with interhemispheric asymmetries in resting state oscillatory activity. Our findings contribute to understanding the electrophysiological correlates of hedonic valuation, and may provide an opportunity to modulate the cortical imbalance by using non-invasive brain stimulation methods to change food consumption.



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