Τρίτη, 15 Νοεμβρίου 2016

Evidence of degraded representation of speech in noise, in the aging midbrain and cortex

Humans have a remarkable ability to track and understand speech in unfavorable conditions, such as in background noise, but speech understanding in noise does deteriorate with age. Results from several studies have shown that in younger adults, low-frequency auditory cortical activity reliably synchronizes to the speech envelope, even when the background noise is considerably louder than the speech signal. However, cortical speech processing may be limited by age-related decreases in the precision of neural synchronization in the midbrain. To understand better the neural mechanisms contributing to impaired speech perception in older adults, we investigated how aging affects midbrain and cortical encoding of speech when presented in quiet and in the presence of a single-competing talker. Our results suggest that central auditory temporal processing deficits in older adults manifest in both the midbrain and in the cortex. Specifically, midbrain frequency following responses to a speech syllable are more degraded in noise in older adults than in younger adults. This suggests a failure of the midbrain auditory mechanisms needed to compensate for the presence of a competing talker. Similarly, in cortical responses, older adults show larger reductions than younger adults in their ability to encode the speech envelope when a competing talker is added. Interestingly, older adults showed an exaggerated cortical representation of speech in both quiet and noise conditions, suggesting a possible imbalance between inhibitory and excitatory processes, or diminished network connectivity that may impair their ability to encode speech efficiently.



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Effect of informational content of noise on speech representation in the aging midbrain and cortex

The ability to understand speech is significantly degraded by aging, particularly in noisy environments. One way that older adults cope with this hearing difficulty is through the use of contextual cues. Several behavioral studies have shown that older adults are better at following a conversation when the target speech signal has high contextual content or when the background distractor is not meaningful. Specifically, older adults gain significant benefit in focusing on and understanding speech if the background is spoken by a talker in a language that is not comprehensible to them (i.e., a foreign language). To understand better the neural mechanisms underlying this benefit in older adults, we investigated aging effects on midbrain and cortical encoding of speech when in the presence of a single competing talker speaking in a language that is meaningful or meaningless to the listener (i.e., English vs. Dutch). Our results suggest that neural processing is strongly affected by the informational content of noise. Specifically, older listeners' cortical responses to the attended speech signal are less deteriorated when the competing speech signal is an incomprehensible language rather than when it is their native language. Conversely, temporal processing in the midbrain is affected by different backgrounds only during rapid changes in speech and only in younger listeners. Additionally, we found that cognitive decline is associated with an increase in cortical envelope tracking, suggesting an age-related over (or inefficient) use of cognitive resources that may explain their difficulty in processing speech targets while trying to ignore interfering noise.



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NC EMS agency completes Mannequin Challenge

Pasquotank-Camden EMS takes on the Mannequin Challenge.

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NC EMS agency completes Mannequin Challenge

Pasquotank-Camden EMS takes on the Mannequin Challenge.

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Enhanced bone formation in sheep vertebral bodies after minimally-invasive treatment with a novel, PLGA-fiber reinforced brushite cement

Injectable, brushite-forming calcium phosphate cements (CPC) show potential for bone replacement, but they exhibit low mechanical strength. This study tested a CPC reinforced with poly (l-lactide-co-glycolide) acid (PLGA) fibers in a minimally-invasive, sheep lumbar vertebroplasty model.

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C7 sagittal vertical axis is the determinant of the C5–7 angle in cervical sagittal alignment

Previous studies have indicated that the T1 slope correlates with cervical lordosis. In contrast, the specific impact of C7 sagittal vertical axis (C7SVA) on cervical lordosis remains unknown.

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NC EMS agency completes Mannequin Challenge

Pasquotank-Camden EMS takes on the Mannequin Challenge.

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NC EMS agency completes Mannequin Challenge

Pasquotank-Camden EMS takes on the Mannequin Challenge.

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The topographical distribution of epileptic spikes in juvenile myoclonic epilepsy with and without photosensitivity

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Publication date: Available online 14 November 2016
Source:Clinical Neurophysiology
Author(s): P.R. Bauer, K. Gorgels, W. Spetgens, N.E.C. van Klink, F.S.S. Leijten, J.W. Sander, G.H. Visser, M. Zijlmans
[Objective]Up to 30% of people with juvenile myoclonic epilepsy (JME) have photoparoxysmal responses (PPR). Recent studies report on structural and pathophysiological differences between people with JME with (JME+PPR) and without PPR (JME-PPR). We investigated whether electrophysiological features outside photic stimulation differ between these subtypes.[Methods]We analysed EEG recordings of people with JME at a tertiary epilepsy centre and an academic hospital. Photosensitivity was assessed in a drug-naïve condition. We compared the occurrence and involvement of posterior electrodes for focal abnormalities and generalised spike-wave activity in the EEG outside photic stimulation between JME+PPR and JME-PPR.[Results]We included EEG recordings of 18 people with JME+PPR and 21 with JME-PPR. People with JME-PPR had less focal abnormalities in the posterior brain regions than people with JME+PPR (19% vs 55%, p<0.05). There was no difference in the distribution of generalised spike-wave activity between people with JME+PPR and JME-PPR.[Conclusion]This study demonstrates electrophysiological correlates of the previously described structural and physiological differences between JME+PPR and JME-PPR.[Significance]Findings support the hypothesis that posterior interictal EEG abnormalities reflect localised cortical hyperexcitability, which makes patients with JME more sensitive to photic stimuli.



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Time-Frequency Phase-Synchrony Approaches with ERPs

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Publication date: Available online 15 November 2016
Source:International Journal of Psychophysiology
Author(s): Selin Aviyente, Anne Tootell, Edward M. Bernat
Time-frequency signal processing approaches are well-developed, and have been widely employed for the study of the energy distribution of event-related potential (ERP) data across time and frequency. Wavelet time-frequency transform (TFT) and Cohen's class of time-frequency distributions (TFD) are the most widely used in the field. While ERP TFT approaches have been most extensively developed for amplitude measures, reflecting the magnitude of regional neuronal activity, time-frequency phase-synchrony measures have gained increased utility in recent years for the assessment of functional connectivity. Phase synchrony measures can be used to index the functional integration between regions (interregional), in addition to the consistency of activity within region (intertrial). In this paper, we focus on a particular class of time-frequency distributions belonging to Cohen's class, known as the Reduced Interference Distribution (RID) for quantifying functional connectivity, which we recently introduced (Aviyente et al., 2011). The present report first summarizes common time-frequency approaches to computing phase-synchrony with ERP data in order to highlight the similarities and differences relative to the RID. In previous work, we demonstrated differences between the RID and wavelet approaches to indexing phase-synchrony, and have applied the RID to demonstrate that RID-based time-frequency phase-synchrony measures can index increased functional connectivity between medial and lateral prefrontal regions during control processing, observed in the theta band during the error-related negativity (ERN). Because ERN amplitude measures have been associated with two other widely studied medial-frontal theta components (no-go N2; feedback negativity, FN), the application of the RID phase synchrony measure in the present report extends our previous work with ERN to include theta activity during the no-go N2 (inhibitory processing) and the feedback negativity (FN; loss feedback processing). Findings support the idea that similar medial-lateral prefrontal functional connectivity underlies the ERN, no-go N2, and FN components, and provide initial validation that the proposed RID-based time-frequency phase-synchrony measure can index this activity.



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Why every EMS agency needs a stronger safety culture

Health care organizations, EMS included, gradually develop their own unique culture, heritage and values which are passed on to new employees. The culture is, ultimately, driven by the leadership.

Many EMS organizations find their culture is somewhere between a retributive style and an authoritarian type of culture with policies and procedures enforced by punitive measures. This has led to a tradition of not admitting that a mistake was made, since the typical result is the termination of the individual who committed the error.

Errors are causes by human factors and systems design
But are errors truly the result of an individual intentionally wanting to cause harm" Research has shown that many errors in health care are not so much the result of an individual, but rather a compilation of human factors and systems design.

"Medical errors most often result from a complex interplay of multiple factors. Only rarely are they due to the carelessness or misconduct of single individuals," Lucien L. Leape, MD, Harvard School of Public Health, said.

EMS operates at a fast pace and is extremely dependent on reliable systems. When a system or process fails, the outcome is not usually the fault of the provider. However, unless a provider feels safe to come forward and report a process failure it will remain flawed leaving the organization at risk for a patient event. An organization must develop a patient safety culture in which a health care provider feels safe to point out a process that has, or could, fail.

Develop a 'Just Culture'
Just Culture, a philosophy which looks at the balance between human and system accountability, is a hot topic in safety and in the reduction of errors in today's medical industry. Implementing this philosophy can make an impact by creating a culture within an organization that encourages open dialog. This allows for mistakes, near misses and adverse events to be openly analyzed without the fear of blame.

Eunice Halverson, MA, Center for Patient Safety Patient Specialist states, "Culture is the atmosphere'created by beliefs and attitudes which shape employee behavior. Developing a strong patient safety culture has the greatest impact on incident reduction. It is the most important factor in laying the foundation for a safe environment for patients and employees."

CPS fully supports the implementation of Just Culture in health care organizations across the continuum of care. The reporting of events is important and necessary to learn how to prevent errors from occurring.

Organizations with cultures that support the open communication of errors while in a non-punitive environment — a just culture — are more likely to see high levels of improvement in patient safety.

Just Culture reshapes our understanding of accountability, the role of the system, and the role of human behavior. It creates a consistent way to promote a safe environment by managing the system and the behavior.

Medicine, aviation and a growing number of other fields have made significant moves toward Just Culture in recent years. This is noteworthy not only because of the successes that have been achieved, but as a dramatic example of cultural shift, because Just Culture contrasts with the traditional culture in health care and other high-risk disciplines, which often held individuals accountable for all errors or mishaps.

Although Just Culture does not hold individuals accountable for system failings over which they have no control, it is not a blame-free model. It acknowledges that humans inevitably make mistakes, and that systems should be designed to reduce the chance of harm in the event of such mistakes (Strategy for a National EMS Culture of Safety).

Halverson acknowledges an organization can begin to improve its culture when leaders are completely dedicated to improving patient safety and when actions emulate what they speak. "If top managers are not on board, patient safety competes with core business operations, such as productivity and profitability — and, unfortunately, patient safety almost always loses."

Halverson issues this reminder to senior leaders, "You are accountable — keep patient safety a priority!"



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Orthopedic surgeon discusses importance of EMS care

NEW ORLEANS — Paul Gladden, MD, an orthopedic surgeon who serves as an Associate Professor within Tulane's Orthopedic Surgery program, gave the first clinically oriented talk at the fourth annual McSwain EMS Trauma Conference. Gladden was able to cover the treatment process for a variety of orthopedic trauma patients from the time EMS arrives to the patient's discharge from the hospital while applying his experience working in the prehospital, air medical and tactical settings.

Gladden kept his talk lighthearted as he covered a number of topics including pelvic fractures, open fractures, dislocations and gunshot wounds. Here are some memorable quotes, key takeaways and additional resources from the session.

Memorable quotes on orthopedic trauma
Gladden when discussing the challenges of trauma assessment and splinting shared these memorable quotes.

"It's what we do, we take care of really bad problems really quietly and we don't get any credit for it."

"If your belly is bigger than mine, I'm not operating on you."
Gladden regarding the feasibility of operating on a morbidly obese man with a pelvic fracture.

"They are going to bleed, and they are going to bleed like crazy."
Gladden regarding open pelvic fractures

"Never splint in the position found."
Gladden explaining the importance of improving blood flow and patient comfort

"Most follow up for bad, bad trauma patients keeps occurring in the trauma center when you see them back with another traumatic injury"

Key takeaways on splinting
Gladden's presentation on orthopedic injuries and splinting had many important lessons for EMS providers. Here are my top takeaways.

  • Binding the pelvis of a patient with a pelvic trauma saves lives. It can be done with anything from a specialty device, to a bed sheet or even a waist belt from the patient, a bystander, or even the provider so long as it isn't so tight that a secondary crush injury is created.
  • Any pelvic wrap or binding should be checked regularly to ensure placement is maintained, this is particularly true for patients that are overweight.
  • The survival curve for traumatic injuries means that half the patients die prior to their arrival to the hospital. But appropriate care and transport decisions can change the curve. Prehospital administration of antibiotics may not affect the first few days of survival, but it can change outcome in the weeks that follow an injury.
  • If possible, providers should always reduce, reposition or realign an open fracture or dislocation since blood flow is likely compromised. If not done in the prehospital setting, it's usually the first thing orthopedic surgeons will do upon arrival to the hospital. Any concerns about further injury are minimal, since if the initial trauma didn't break it, it's unlikely anything else will.
  • Mangled extremities are straightforward, figure out a way to stop the bleeding since the life must take priority over the limb.

Additional resources on splinting
Learn more about orthopedic trauma and splinting.



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Mountain View HS Stabbing Press Conference



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Mountain View HS Stabbing Press Conference



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Mountain View HS Stabbing Press Conference



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Mountain View HS Stabbing Press Conference



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Telomere shortening and metabolic compromise underlie dystrophic cardiomyopathy [Genetics]

Duchenne muscular dystrophy (DMD) is an incurable X-linked genetic disease that is caused by a mutation in the dystrophin gene and affects one in every 3,600 boys. We previously showed that long telomeres protect mice from the lethal cardiac disease seen in humans with the same genetic defect, dystrophin deficiency....

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Fusion transcriptome profiling provides insights into alveolar rhabdomyosarcoma [Genetics]

Gene fusions and fusion products were thought to be unique features of neoplasia. However, more and more studies have identified fusion RNAs in normal physiology. Through RNA sequencing of 27 human noncancer tissues, a large number of fusion RNAs were found. By analyzing fusion transcriptome, we observed close clusterings between...

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Locomotor training through a novel robotic platform for gait rehabilitation in pediatric population: short report

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Cerebral Palsy (CP) is a disorder of posture and movement due to a defect in the immature brain. The use of robotic devices as alternative treatment to improve the gait function in patients with CP has increas...

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Exploratory analysis of real personal emergency response call conversations: considerations for personal emergency response spoken dialogue systems

The purpose of this study was to derive data from real, recorded, personal emergency response call conversations to help improve the artificial intelligence and decision making capability of a spoken dialogue ...

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Mass. girl, 9, meets paramedic who delivered her

By EMS1 Staff

AMHERST, Mass. — A 9-year-old girl met the firefighter-paramedic who delivered her during a surprise appearance at her fire safety education graduation ceremony Oct. 25. 

Vaishali Konowitz was presented her Student Awareness of Fire Education program certificate, along with 200 other students who completed the program. 

Her family arranged for firefighter-paramedic Christopher Bak to present Vaishali with her certificate, reported the Amherst Bulletin. Bak helped deliver her on Feb. 22, 2007. The surprise reunion marked the fourth grader's birthday, but also the anniversary of Bak's father's death. 

"It's said that when one person dies, another is born," Bak said. "Well, she was born on the anniversary of my father's death."

Bak, a 40-year veteran, said Vaishali's birth is the only delivery he's been in charge of.

"We don't deal with too many happy and well patients," Bak said. "It's usually someone in some type of distress ... but this is one of those times where you're happy to be there."

SAFE officials said Vaishali's birth story was a great example of the importance of knowing when and how to call 911.

"It allows her [Vaishali] to recognize some of the important people in the rescue community, and that she has a relationship with some already, and they're not just some uniformed people on the streets," Chip Konowitz, Vaishali's father, said. 



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The human physiological impact of global deoxygenation

Abstract

There has been a clear decline in the volume of oxygen in Earth's atmosphere over the past 20 years. Although the magnitude of this decrease appears small compared to the amount of oxygen in the atmosphere, it is difficult to predict how this process may evolve, due to the brevity of the collected records. A recently proposed model predicts a non-linear decay, which would result in an increasingly rapid fall-off in atmospheric oxygen concentration, with potentially devastating consequences for human health. We discuss the impact that global deoxygenation, over hundreds of generations, might have on human physiology. Exploring the changes between different native high-altitude populations provides a paradigm of how humans might tolerate worsening hypoxia over time. Using this model of atmospheric change, we predict that humans may continue to survive in an unprotected atmosphere for ~3600 years. Accordingly, without dramatic changes to the way in which we interact with our planet, humans may lose their dominance on Earth during the next few millennia.



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Lifestyle factors associated with infertility in a rural area: A cross-sectional study

2016-11-15T10-47-57Z
Source: International Journal of Medical Science and Public Health
Shilpa Acharya, Chethana Rame Gowda.
Background: Lifestyle factors are the modifiable habits and ways of life that can greatly influence overall health and well-being, including fertility. Objectives: (1) To describe the sociodemographic characteristics prevailing among infertile subjects of the study population, (2) to identify lifestyle factors associated with infertility. Materials and Methods: A cross-sectional descriptive study was conducted at rural field practice area of Tertiary Hospital, Bengaluru. Complete enumeration of entire primary health center (PHC) area covering 26,190 population. In-depth interview using a pre-tested pre-structured questionnaire was conducted enumerating all couples with infertility in the entire PHC area and their lifestyle factors. Results: The significant lifestyle factors include frequency of intercourse, body mass index, alcohol, and tobacco consumption. Conclusion: Thus, lifestyle factors play a role in determining reproductive status and have a significant impact on fertility.


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Study of knowledge and skills of anganwadi workers regarding breastfeeding and infant and young child feeding practices

2016-11-15T10-47-57Z
Source: International Journal of Medical Science and Public Health
Amanjot K Singh, Anuradha Nadda, Ritu Rochwani, Parmal Singh, Zahid Ali Khan, Goel R K D.
Background: Field workers from the community are the key persons for spreading the knowledge about breastfeeding and infant and young child feeding practices among people. Antenatal counseling on breastfeeding and postnatal lactation support are likely to improve rates of exclusive breastfeeding. Objective: The present study was designed with the aim to examine the knowledge and skills of the anganwadi workers (AWWs), with respect to a few key elements of the services provided by them, in an urban city Patiala. Materials and Methods: An observational and cross-sectional study was carried out among the AWWs of urban Patiala in October-November 2012. 197 AWWs voluntarily participated. After taking oral consent, AWWs were interviewed with a pretested, semistructured, self-administered questionnaire developed in a local language. The answers were compared with the desired responses. The collected data were compiled in Microsoft Excel and analyzed with the help of SPSS version 20. Results: In the present study, more than 80% of all the AWWs had correct knowledge regarding initiation of breastfeeding, prelacteal feed, colostrum, exclusive breastfeeding, and complementary feeding. However, there were still some serious gaps such as in frequency of breastfeeding, continuation of breastfeeding after starting a complementary feed and during illness, and the concept of bottle feeding. Conclusion: The existing antenatal advice by AWWs on Breastfeeding and optimal infant and young child feeding is inadequate and needs to be strengthened.


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Appraisal of integrated management of neonatal and childhood illness program in two districts of Assam

2016-11-15T10-47-57Z
Source: International Journal of Medical Science and Public Health
Swapna D Kakoty, Priyanka Das.
Background: Integrated management of neonatal and childhood illness (IMNCI) is an important reproductive and child health strategy to lower infant and neonatal mortality in the country. In India, Assam is one of the states with very high infant mortality. Objectives: Assess the status of IMNCI implementation in Barpeta and Nalbari district/s of Assam. Materials and Methods: A rapid appraisal of IMNCI was undertaken in Nalbari and Barpeta districts of Assam. Qualitative survey methods and secondary data analysis was used. Interview of stakeholders, observation of services, logistic, and supervisory support to the program was assessed. The data were manually analyzed for thematic areas. Results: Logistics and drug support were good. Gaps in program implementation were found at all level. Integrated Child Development Services involvement lacked clear direction. Conclusion: An intersectoral resource intensive program requires supportive environment for implementation.


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A study of adherence pattern toward antihypertensive therapy (antihypertensive drugs, dietary habits, and physical activity) and certain factors affecting it

2016-11-15T10-47-57Z
Source: International Journal of Medical Science and Public Health
Pratiksha A Sutar, Hemangini K Shah.
Background: Adherence to antihypertensive treatment (pharmacological intervention and lifestyle modification) and related factors is an essential to hypertension (HTN)management and aids in planning intervention for its control. Objectives: The objective of this study was to analyze the adherence pattern of hypertensives toward antihypertensive treatment and factors affecting it and assess the impact of such adherence on HTN control. Materials and Methods: A hospital-based cross-sectional study was carried out at the outpatient department of medicine department at a tertiary hospital in Goa. Totally 213 patients with confirmed diagnosis of HTN and currently on antihypertensive treatment, selected through systematic randomized sampling, were interviewed using structured and clinically assessed questionnaire. Results: Adherence to antihypertensive drugs, dietary approach to stop HTN (DASH)diet, and recommended physical activity was studied along with sociodemographic factors, comorbidities, addiction, body mass index, medication, and other factors. Nearly 64.79% were highly adherent toward the antihypertensive drug treatment while 30.52% and 4.69% showed moderate and low adherence, respectively. A significant association was noticed between the presence of comorbidities and drug adherence, wherein patients with comorbidities showed higher adherence. Nearly 23.94% patients were highly adherent toward the DASH diet, while 51.64% were moderately adherent although not significantly associated. Almost 68.08% showed moderate activity while only 10.83% indulged in vigorous activity. A significant association was noted with age, employment status, and number of medications prescribed in determining adherence to physical activity. Conclusion: Presence of comorbidities, sex and age, number of antihypertensives, and employment status were seen to be associated with high adherence toward the treatment.


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An epidemiological study of animal bite cases in a tertiary care center of Bhopal city: A cross-sectional study

2016-11-15T10-47-57Z
Source: International Journal of Medical Science and Public Health
Seema Patel, Manju Toppo, Rama Lodha.
Background: Rabies is 100% fatal, 100% vaccine preventable disease, yet continues to kill. There are no global estimates of dog bite incidence; however, studies suggest that dog bites account for tens of millions of injuries annually. Tens of thousands of people die from rabies each year; one person dies every 10 min, with the greatest burden in Asia and Africa. Rabies is the 10th biggest cause of death due to infectious diseases worldwide, and it causes more than 59,000 fatalities per year worldwide. Objective: To determine the profile of animal bite cases attending the Anti-rabies Clinic of Hamidia Hospital, Bhopal. Materials and Methods: It was a cross-sectional study carried out at Anti-rabies Clinic of Hamidia Hospital, Bhopal. The study was carried out by interviewing 1200 cases of animal bite for a period of 1 year. Result: A total of 1200 cases of animal bites were interviewed and examined in the present study. Most commonly (34.58%) affected age group was


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The thigh and leg of Homo naledi

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Publication date: Available online 15 November 2016
Source:Journal of Human Evolution
Author(s): Damiano Marchi, Christopher S. Walker, Pianpian Wei, Trenton W. Holliday, Steven E. Churchill, Lee R. Berger, Jeremy M. DeSilva
This paper describes the 108 femoral, patellar, tibial, and fibular elements of a new species of Homo (Homo naledi) discovered in the Dinaledi chamber of the Rising Star cave system in South Africa. Homo naledi possesses a mosaic of primitive, derived, and unique traits functionally indicative of a bipedal hominin adapted for long distance walking and possibly running. Traits shared with australopiths include an anteroposteriorly compressed femoral neck, a mediolaterally compressed tibia, and a relatively circular fibular neck. Traits shared with Homo include a well-marked linea aspera, anteroposteriorly thick patellae, relatively long tibiae, and gracile fibulae with laterally oriented lateral malleoli. Unique features include the presence of two pillars on the superior aspect of the femoral neck and a tubercular distal insertion of the pes anserinus on the tibia. The mosaic morphology of the H. naledi thigh and leg appears most consistent with a species intermediate between Australopithecus spp. and Homo erectus and, accordingly, may offer insight into the nature of the earliest members of genus Homo. These fossils also expand the morphological diversity of the Homo lower limb, perhaps indicative of locomotor diversity in our genus.



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The skull of Homo naledi

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Publication date: Available online 14 November 2016
Source:Journal of Human Evolution
Author(s): Myra F. Laird, Lauren Schroeder, Heather M. Garvin, Jill E. Scott, Mana Dembo, Davorka Radovčić, Charles M. Musiba, Rebecca R. Ackermann, Peter Schmid, John Hawks, Lee R. Berger, Darryl J. de Ruiter
The species Homo naledi was recently named from specimens recovered from the Dinaledi Chamber of the Rising Star cave system in South Africa. This large skeletal sample lacks associated faunal material and currently does not have a known chronological context. In this paper, we present comprehensive descriptions and metric comparisons of the recovered cranial and mandibular material. We describe 41 elements attributed to Dinaledi Hominin (DH1–DH5) individuals and paratype U.W. 101-377, and 32 additional cranial fragments. The H. naledi material was compared to Plio-Pleistocene fossil hominins using qualitative and quantitative analyses including over 100 linear measurements and ratios. We find that the Dinaledi cranial sample represents an anatomically homogeneous population that expands the range of morphological variation attributable to the genus Homo. Despite a relatively small cranial capacity that is within the range of australopiths and a few specimens of early Homo, H. naledi shares cranial characters with species across the genus Homo, including Homo habilis, Homo rudolfensis, Homo erectus, and Middle Pleistocene Homo. These include aspects of cranial form, facial morphology, and mandibular anatomy. However, the skull of H. naledi is readily distinguishable from existing species of Homo in both qualitative and quantitative assessments. Since H. naledi is currently undated, we discuss the evolutionary implications of its cranial morphology in a range of chronological frameworks. Finally, we designate a sixth Dinaledi Hominin (DH6) individual based on a juvenile mandible.



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Robot-assisted laparoscopic colpectomy in female-to-male transgender patients; technique and outcomes of a prospective cohort study

Abstract

Background

Gender-affirming surgeries in female-to-male (FtM) transgender patients include mostly hysterectomy, bilateral salpingo-oophorectomy and mastectomy. Sometimes further surgery is performed, such as phalloplasty. Colpectomy may be performed to overcome gender dysphoria and disturbing vaginal discharge; furthermore, it may be important in reducing the risk of fistulas due to the phalloplasty procedure with urethral elongation. Colpectomy prior to the reconstruction of the neourethra seems to reduce fistula rates on the very first anastomosis. Therefore, at our center, colpectomy has become a standard procedure prior to phalloplasty and metoidioplasty with urethral elongation. Colpectomy is known as a procedure with potentially serious complications, e.g., extensive bloodloss, vesicovaginal fistula or rectovaginal fistula. Colpectomy performed via the vaginal route can be a challenging procedure due to lack of exposure of the surgical field, as many patients are virginal. Therefore, we investigated whether robot-assisted laparoscopic hysterectomy with bilateral salpingo-oophorectomy (TLH–BSO) followed by robot-assisted laparoscopic colpectomy (RaLC) is an alternative for the vaginal approach.

Methods

Robot TLH/BSO and RaLC as a single-step procedure was performed in 36 FtM patients in a prospective cohort study.

Results

Median length of the procedure was 230 min (197–278), which reduced in the second half of the patients, median blood loss was 75 mL (30–200), and median discharge was 3 days (2–3) postoperatively. One patient with a major complication (postoperative bleeding with readmission and transfusion) was reported.

Conclusion

To our knowledge, this is the first report of RaLC. Our results show that RaLC combined with robot TLH–BSO is feasible as a single-step surgical procedure in FtM transgender surgery. Future studies are needed to compare this technique to the two-step surgical approach and on its outcome and complication rates of subsequent phalloplasty.



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Intraoperative near-infrared autofluorescence imaging of parathyroid glands

Abstract

Objective

To identify parathyroid glands intraoperatively by exposing their autofluorescence using near-infrared light.

Methods

Fluorescence imaging was carried out during minimally invasive and open parathyroid and thyroid surgery. After identification, the parathyroid glands as well as the surrounding tissue were exposed to near-infrared (NIR) light with a wavelength of 690–770 nm using a modified Karl Storz near-infrared/indocyanine green (NIR/ICG) endoscopic system. Parathyroid tissue was expected to show near-infrared autofluorescence, captured in the blue channel of the camera. Whenever possible the visual identification of parathyroid tissue was confirmed histologically.

Results

In preliminary investigations, using the original NIR/ICG endoscopic system we noticed considerable interference of light in the blue channel overlying the autofluorescence. Therefore, we modified the light source by interposing additional filters. In a second series, we investigated 35 parathyroid glands from 25 patients. Twenty-seven glands were identified correctly based on NIR autofluorescence. Regarding the extent of autofluorescence, there were no noticeable differences between parathyroid adenomas, hyperplasia and normal parathyroid glands. In contrast, thyroid tissue, lymph nodes and adipose tissue revealed no substantial autofluorescence.

Conclusion

Parathyroid tissue is characterized by showing autofluorescence in the near-infrared spectrum. This effect can be used to distinguish parathyroid glands from other cervical tissue entities.



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Biliary tract visualization using near-infrared imaging with indocyanine green during laparoscopic cholecystectomy: results of a systematic review

Abstract

Background

Near-infrared imaging with indocyanine green (ICG) has been extensively investigated during laparoscopic cholecystectomy (LC). However, methods vary between studies, especially regarding patient selection, dosage and timing. The aim of this systematic review was to evaluate the potential of the near-infrared imaging technique with ICG to identify biliary structures during LC.

Methods

A comprehensive systematic literature search was performed. Prospective trials examining the use of ICG during LC were included. Primary outcome was biliary tract visualization. Risk of bias was assessed using ROBINS-I. Secondly, a meta-analysis was performed comparing ICG to intraoperative cholangiography (IOC) for identification of biliary structures. GRADE was used to assess the quality of the evidence.

Results

Nineteen studies were included. Based upon the pooled data from 13 studies, cystic duct (Lusch et al. in J Endourol 28:261–266, 2014) visualization was 86.5% (95% CI 71.2–96.6%) prior to dissection of Calot's triangle with a 2.5-mg dosage of ICG and 96.5% (95% CI 93.9–98.4%) after dissection. The results were not appreciably different when the dosage was based upon bodyweight. There is moderate quality evidence that the CD is more frequently visualized using ICG than IOC (RR 1.16; 95% CI 1.00–1.35); however, this difference was not statistically significant.

Conclusion

This systematic review provides equal results for biliary tract visualization with near-infrared imaging with ICG during LC compared to IOC. Near-infrared imaging with ICG has the potential to replace IOC for biliary mapping. However, methods of near-infrared imaging with ICG vary. Future research is necessary for optimization and standardization of the near-infrared ICG technique.



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Erratum to: Laparoscopic gastrectomy for gastric cancer in the elderly patients



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10 tips to never miss atrial flutter with 2:1 conduction

One of the most, if not the most, misdiagnosed dysrhythmias in all settings is atrial flutter with 2:1 conduction. Have you missed it"

When atrial flutter is conducted 2:1, the resulting ventricular rate is around 125-175 per minute (usually around 150). This is because the P waves (flutter waves) in atrial flutter occur at about 250-350 per minute (usually around 300).

At this rate, it can appear that there is a P wave in front of each QRS and a T wave after each QRS. This causes the misdiagnosis of sinus tachycardia or SVT. Remember SVT is a catch-all term that includes atrial tachycardia, AVRT and AVNRT.

The interpretive algorithms of ECG machines often get atrial flutter with 2:1 conduction wrong, just like people do.

Most ECG students are shown examples of atrial flutter that have 3:1, 4:1 or even 5:1 conduction, which exposes many flutter waves in a row, making them easy to recognize.

What is atrial flutter"
Atrial flutter is a re-entrant tachycardia that occurs in the atria. It can occur suddenly, and is sometimes associated with periods of atrial fibrillation. The AV node is bombarded by a regular atrial rhythm of around 300 per minute. New-onset atrial flutter is most often conducted 2:1, because that is a comfortable rate (around 150 per minute) for the AV node to conduct.

When we see slower ventricular rates and conduction ratios of 3:1 or more, it is usually due to medications or other causes of enhanced refractoriness of the AV node. Atrial flutter can lead to fast rates at 2:1 conduction, and VERY fast rates at 1:1 conduction.

In patients with accessory pathways that bypass the slow conduction of the AV node, like Wolff-Parkinson-White Syndrome, 1:1 conduction of atrial flutter or atrial fib can be life-threatening. As cardiac output is decreased and cardiac workload increased, ventricular fibrillation can result.

10 tips to avoid missing atrial flutter with 2:1 conduction.
You won't find atrial flutter it if you aren't looking for it. Here are 10 tips to avoid missing atrial flutter.

1. Suspect any tachycardia
Any rhythm around 150 bpm should be suspected of being atrial flutter with 2:1 conduction. Remember that sinus rhythms tend to fluctuate slightly. For example, if your patient talks or moves around in bed, the rate may go up slightly. Re-entrant tachycardias hit a fast rate suddenly and maintain that rate until they end suddenly.

2. You see no obvious reason for sinus tachycardia
Consider atrial flutter if the patient has no obvious reason for sinus tachycardia. Most people with sinus tach, especially over 130 bpm, will usually have a readily-apparent reason for the tachycardia, like fever, fear, pain, anxiety, exertion, drugs, hypovolemia or hypoxia.

3. Be systematic in your approach to ECGs
Get your first impression, then think of alternate diagnoses and apply rhythm interpretation criteria. By evaluating the P waves, QRS complexes, intervals and rate, you may discover that your first impression was wrong.

4. Use more than one lead
For rhythm interpretation, the more leads the better. A 12-lead ECG can help immensely in seeing the flutter waves, because some leads are better for viewing atrial activity than others. In some leads, atrial flutter will not have a sawtooth pattern. You might consider using a Lewis lead, which enhances detection of atrial activity.

5. Watch a longer rhythm strip
Sometimes, 2:1 atrial flutter will momentarily conduct as 3:1 or more and the flutter waves will be apparent.

6. Pay attention to rhythm when treating SVT
Sometimes, atrial flutter will be mistaken for atrial tach, one of the SVT catch all rhythms, and treated with adenosine. This can cause a momentary slowing of the ventricular complexes, uncovering the flutter waves. While this is not recommended as a diagnostic procedure, it sometimes becomes one.

7. Consider atrial flutter even with wide QRS complexes
Atrial flutter can produce a wide-complex tachycardia, especially in the setting of hyperkalemia. Look carefully for the flutter waves.


8. Use the Bix Rule
This interpretation rule named after Harold Bix, a Viennese cardiologist and colleague of Dr. Henry Marriott, states that if a P wave appears halfway between two QRS complexes, there is likely a P wave hidden in the QRS complexes.

9. Rule out atrial fib
Atrial flutter has "F" waves, which are very regular and all alike in each lead. Atrial fibrillation has "f" waves, which may look like flutter waves at times, but are irregular and not all alike. In addition, the QRS rhythm will be irregularly irregular in atrial fibrillation.

10. Practice rhythm interpretation
Now that you are more aware of atrial flutter with 2:1 conduction, the best way to get good at recognizing it is regular practice. Look at as many strips of confirmed 2:1 conduction as you can and your eye will become trained to see it. You will learn to see the rhythm strip as separate atrial activity and ventricular activity portions and the hidden flutter waves will stand out for you.

With these tips and practice, you will be much less likely to mistake atrial flutter with 2:1 conduction for another tachycardia.

Works referenced
Burns, E. (2012). Life In The Fast Lane. Retrieved from lifeinthefastlane.com: http://ift.tt/1iz9mi0

Dawn Altman, R. E.-P., & Kenneth Grauer, M. (2013, January 19). ECG Guru. Retrieved from ecgguru.com: http://ift.tt/2eX1jv6

Vince DiGiulio, E.-C. (2011, December 22). Medial Approach. Retrieved from medialapproach.com: http://ift.tt/2gdNOw1

Watford, C. (2011, February 28). My Variables Only Have 6 Letters. Retrieved from sixlettervariable.blogspot.com: http://ift.tt/2eWZnml"m=1



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Effects of a 12-week, short-interval, intermittent, low-intensity, slow-jogging program on skeletal muscle, fat infiltration, and fitness in older adults: randomized controlled trial

Abstract

Purpose

We developed a short-interval, low-intensity, slow-jogging (SJ) program consisting of sets of 1 min of SJ at walking speed and 1 min of walking. We aimed to examine the effects of an easily performed SJ program on skeletal muscle, fat infiltration, and fitness in older adults.

Methods

A total of 81 community-dwelling, independent, older adults (70.8 ± 4.0 years) were randomly assigned to the SJ or control group. The SJ group participants were encouraged to perform 90 min of SJ at their anaerobic threshold (AT) intensity and 90 min of walking intermittently per week. Aerobic capacity at the AT and sit-to-stand (STS) scores were measured. Intracellular water (ICW) in the legs was assessed by segmental multi-frequency bioelectrical impedance analysis. Subcutaneous (SAT) and intermuscular (IMAT) adipose tissue and muscle cross-sectional area (CSA) were measured at the mid-thigh using computed tomography.

Results

A total of 75 participants (37 SJ group, 38 controls) completed the 12-week intervention. The AT and STS improved in the SJ group compared with the controls (AT 15.7 vs. 4.9 %, p < 0.01; STS 12.9 vs. 4.5 %, p < 0.05). ICW in the upper leg increased only in the SJ group (9.7 %, p < 0.05). SAT and IMAT were significantly decreased only in the SJ group (p < 0.01).

Conclusion

The 12-week SJ program was easily performed by older adults with low skeletal muscle mass, improved aerobic capacity, muscle function, and muscle composition in older adults.



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Construction Site EMT - Medcor Inc.

Job Description Sick of riding in the back of an ambulance" Tired of the 24 hour shifts in the ER" 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 ...

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Identifying gene–gene interactions that are highly associated with four quantitative lipid traits across multiple cohorts

Abstract

Genetic loci explain only 25–30 % of the heritability observed in plasma lipid traits. Epistasis, or gene–gene interactions may contribute to a portion of this missing heritability. Using the genetic data from five NHLBI cohorts of 24,837 individuals, we combined the use of the quantitative multifactor dimensionality reduction (QMDR) algorithm with two SNP-filtering methods to exhaustively search for SNP–SNP interactions that are associated with HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), total cholesterol (TC) and triglycerides (TG). SNPs were filtered either on the strength of their independent effects (main effect filter) or the prior knowledge supporting a given interaction (Biofilter). After the main effect filter, QMDR identified 20 SNP–SNP models associated with HDL-C, 6 associated with LDL-C, 3 associated with TC, and 10 associated with TG (permutation P value <0.05). With the use of Biofilter, we identified 2 SNP–SNP models associated with HDL-C, 3 associated with LDL-C, 1 associated with TC and 8 associated with TG (permutation P value <0.05). In an independent dataset of 7502 individuals from the eMERGE network, we replicated 14 of the interactions identified after main effect filtering: 11 for HDL-C, 1 for LDL-C and 2 for TG. We also replicated 23 of the interactions found to be associated with TG after applying Biofilter. Prior knowledge supports the possible role of these interactions in the genetic etiology of lipid traits. This study also presents a computationally efficient pipeline for analyzing data from large genotyping arrays and detecting SNP–SNP interactions that are not primarily driven by strong main effects.



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Recorded interviews with human and medical geneticists

Abstract

A series of 100 recorded interviews with human and medical geneticists has been carried out and some general results are reported here. Twenty countries across the world are represented, mostly European, with a particular emphasis on the United Kingdom. A priority was given to older workers, many of whom were key founders of human genetics in their own countries and areas of work, and over 20 of whom are now no longer living. The interviews also give valuable information on the previous generation of workers, as teachers and mentors of the interviewees, thus extending the coverage of human genetics back to the 1930s or even earlier. A number of prominent themes emerge from the interview series; notably the beginnings of human cytogenetics from the late 1950s, the development of medical genetics research and its clinical applications in the 1960s and 1970s, and more recently the beginnings and rapid growth of human molecular genetics. The interviews provide vivid personal portraits of those involved, and also show the effects of social and political issues, notably those arising from World War 2 and its aftermath, which affected not only the individuals involved but also broader developments in human genetics, such as research related to risks of irradiation. While this series has made a start in the oral history of this important field, extension and further development of the work is urgently needed to give a fuller picture of how human genetics has developed.



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Fine Particle Air Pollution May Alter Newborn Thyroid Function

Clinical Thyroidology Nov 2016, Vol. 28, No. 11: 337-339.


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Preoperative FNA Cytology May Diagnose Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features

Clinical Thyroidology Nov 2016, Vol. 28, No. 11: 352-354.


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Design and Development of a Novel Frozen-Form Additive Manufacturing System for Tissue Engineering Applications

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


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Does resistance exercise exert a role in hippocampal neurogenesis?



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Neural mechanisms for spatial computation



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Are stem cell-derived neural cells physiologically credible?



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Sensory processing during absence seizures



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Neurogenic hyperalgesia: illuminating its mechanisms with an infrared laser



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Issue Information



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HOSPITAL BASED STUDY OF THYROID DISORDERS IN RURAL POPULATION OF GURGAON, HARYANA

2016-11-15T00-10-33Z
Source: International Journal of Current Research and Review
Poonam Arora, Smita Prasad, Busi Karunanand.
Introduction: Endocrine disorders pose a major threat to public health. Current research shows that 300 million people are suffering from thyroid disorders globally and 42 million among them reside in India. Objective: Our objective is to find the prevalence of thyroid disorders in rural population of Gurgaon, Haryana. Materials and Methods: This study was conducted in SGT Medical College & Hospital, Budhera, Gurgaon, Haryana from January, 2015 to July, 2016. 3940 patients were screened for thyroid function. Thyroid function was assessed by quantitative estimation of T3 (Triiodothyronine), T4 (Thyroxine) and TSH (Thyroid Stimulating Hormone) in serum by chemiluminscent immuno assay. Results: The prevalence of thyroid disorder was found to be 25.17% (992) in the study population. 74.82% (2948) patients were euthyroid. Among the thyroid dysfunction patients 16.85% (665) belonged to hypothyroidism group (11.70% primary, 3.20% sub clinical and 3.24% clinically euthyroid) and 8.29% (327) to hyperthyroidism group (2.66% primary, 0.15% T3 thyrotoxicosis, 0.58% sub clinical and 4.89% central) Conclusion: The study findings call for a review of current practices in the management of thyroid disorders because of high prevalence of thyroid disorder in the reproductive age group (21-40). Thyroid disorders must be actively screened and monitored and to be effectively treated in diagnosed patients.


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CONCENTRATED GROWTH FACTOR MEMBRANE - A NOVEL BARRIER FOR ACCELERATED REPAIR OF GINGIVAL DEFECT ALONG WITH SLIDING FLAP TECHNIQUE

2016-11-15T00-10-33Z
Source: International Journal of Current Research and Review
Ramakrishnan T., Shobana P., VidyaSekhar, Nirmala J.I., Ebenezer, Sivaranjani K..
Aim: Periodontal regenerative procedures like root coverage procedures are still a valid treatment option for exposed root surfaces caused by gingival recession. So far, many alloplastic as well as autologous materials were used for regeneration; of which platelet was found to be having greater regenerative potentiality and several platelet aggregates were developed recently in the field of regeneration. The concentrated growth factor (CGF) is the new generation platelet aggregate; this CGF may be a valuable aid in the field of regeneration to speed up the process of healing. Case Report: This case report elaborates the use of CGF as a barrier membrane, along with laterally displaced procedure to accelerate soft tissue healing, in lower anterior tooth (31) with class II gingival recession in a 20 years old female patient. Discussion: Many studies about concentrated growth factor showed a great regenerative properties and versatility. Its use has been proposed in various procedures like filling the extraction socket, sinus lift procedures, moreover it can also be combined with bone grafts to accelerate bone formation. Conclusion: The result of this case report suggested that the CGF barrier membrane has the potential to accelerate the soft tissue healing which when combined with the root coverage procedures like sliding flap technique, thus results in achieving the expected gain in the width of the attached gingival in class II Gingival recession defects.


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