Background: Cognitive training is beneficial in various clinical settings, although its perioperative feasibility and impact remain unknown. The objective of this pilot study was to determine the feasibility of home-based cognitive prehabilitation before major surgery in older adults. Materials and Methods: Sixty-one patients were enrolled, randomized, and allocated to either a home-based preoperative cognitive training regimen or no training before surgery. Outcomes included postoperative delirium incidence (primary outcome; assessed with the 3D-Confusion Assessment Method), perioperative cognitive function based on NIH Toolbox measures, hospital length of stay, and physical therapy session participation. Reasons for declining enrollment were reported, as were reasons for opting out of the training program. Results: Postoperative delirium incidence was 6 of 23 (26%) in the prehabilitation group compared with 5 of 29 (17%) in the control group (P=0.507). There were no significant differences between groups in NIH Toolbox cognitive function scoring, hospital length of stay, or physical therapy participation rates. Study feasibility data were also collected and reported. The most common reasons for declining enrollment were lack of computer access (n=19), time commitment (n=9), and feeling overwhelmed (n=9). In the training group, only 5 of 29 (17%) included patients were able to complete the prescribed 7 days of training, and 14 of 29 (48%) opted out of training once home. Most common reasons were feeling overwhelmed (n=4) and computer difficulties (n=3). Conclusions: Short-term, home-based cognitive training before surgery is unlikely to be feasible for many older patients. Barriers to training include feeling overwhelmed, technical issues with training, and preoperative time commitment. P.E.V. is supported by National Institutes of Health Grant K23GM126317. The study was also supported by the Department of Anesthesiology, University of Michigan Medical School (Ann Arbor, MI). The methodology of this trial was presented as a poster presentation at the Foundation for Anesthesia Education and Research 2017 Medical Student Anesthesia Research Fellowship Symposium (MSARF Fellow: A.R.D.). The authors have no funding or conflicts of interest to disclose. Address correspondence to: Phillip E. Vlisides, MD, Department of Anesthesiology, University of Michigan Medical School, 1H247 UH, SPC-5048, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5048 (e-mail: pvliside@med.umich.edu). Received September 12, 2018 Accepted November 16, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved
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Κυριακή 16 Δεκεμβρίου 2018
Electrophysiology as a theoretical and methodological hub for the neural sciences
Abstract
Electrophysiology is a direct measure of neuronal processes, and it is uniquely sensitive to canonical neural operations that underlie emergent psychological operations. These qualities make it well suited for discovery of aberrant neural mechanisms that underlie complicated disease states. This technique is routinely utilized in vitro, in vivo, and in outpatient neurological clinics, offering a translatable bridge between animal models and human patients. The bench‐to‐bedside potential of this approach is unparalleled, yet it also remains undeveloped due to the slow inertia of legacy techniques and interpretations. In this review, I discuss these strengths of the method, and I detail compelling reasons why future advancements can have a direct and tangible influence over clinical practice. I hope to motivate a blurring of traditional boundaries between preclinical, computational, imaging, and clinical fields by advancing electrophysiology as a common hub for methodological integration and theoretical advancement.
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8 reasons we are on the cusp of Peak EMS
A bold prediction that EMS patient transport to the hospital by ambulance is sure to peak, level off and decline as we near 2020
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A Survey on the Prevalence and Risk Indicators of Erosive Tooth Wear among Adolescents in Guangzhou, South China
Abstract
Background
Erosive tooth wear (ETW) has become a crucial oral health problem over the decades in China.
Objectives
To explore the prevalence and risk indicators of ETW among adolescents in Guangzhou, south China.
Methods
A cross‐sectional survey of 720 participants was conducted in Guangzhou, using an equal‐sized, stratified, multistage random sampling approach. The participants were from two different age groups(12‐ and 15‐year‐olds), 360 per group. The ratio of males to females was 1:1 in each group. ETW was recorded utilizing the basic erosive wear examination (BEWE) index as the dependent variable. Independent variables included age, gender, region, socioeconomic status, dietary factors, oral health measures and others.
Results
The prevalence rates (weighted) of ETW and dentin exposure (DE) were 56.1% and 26.2% among adolescents in Guangzhou, with mean teeth (weighted) of 1.8±2.5 and 0.6±1.5, respectively. No matter the prevalence or the mean teeth, the 15‐year‐olds were higher than the 12‐year‐olds; the mean teeth of ETW of males was higher than that of females; the mean teeth of ETW and DE of the adolescents of low socioeconomic status were higher than those of high socioeconomic status. Medium to high risk levels were found for 10.1%. In the multiple regression model, age, gender and taking acidic foods/drinks before sleep were associated with ETW.
Conclusions
Moderate ETW in the permanent dentition was common among adolescents in Guangzhou. However, the teeth involved were low. Dietary factors and demographics were the main risk indicators.
This article is protected by copyright. All rights reserved.
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Evidences of different meteorological patterns governing 7Be and 210Pb surface levels in the southern Iberian Peninsula
Publication date: March 2019
Source: Journal of Environmental Radioactivity, Volume 198
Author(s): E.G. San Miguel, M.A. Hernández-Ceballos, H. García-Mozo, J.P. Bolívar
Abstract
7Be, 210Pb and PM10 levels in surface air have been simultaneously measured at two sampling sites in the southern Iberian Peninsula for a period of two years. Each site covers one different meteorological area of the Guadalquivir valley, from the mouth (Huelva) to the middle point (Cordoba). The objective of the present study is to analyse the spatial variability of both natural radionuclides, and to identify and characterise the meteorological patterns associated with similar and different surface concentration levels in this complex region. Concentrations are similar in both sampling sites. 7Be level is in the 0.6–15.5 mBq m−3 range in Huelva and 1.2–13.3 mBq m−3 in Córdoba, 210Pb activity concentrations are between 0.04 and 2.30 mBq m−3 in Huelva, and between 0.03 and 1.2 mBq m−3 in Cordoba, and PM10 concentrations are found to be in the 5.1–81.3 μg m−3 range in Huelva, and 8.2–76.3 μg m−3 in Cordoba, respectively. A linear regression analysis indicates more regional variability for 210Pb than for 7Be between simultaneous measurements. Principal components analysis (PCA) is applied to the datasets and the results reveal that aerosol behaviour is mainly represented by two components, which explain 82% of the total variance. The analysis of surface measurements and meteorological parameters revealed that component F1 groups sampling periods in which the influence of similar meteorological conditions over the region lead to similar 7Be, 210Pb and PM10 concentration levels in both sampling sites. On the other hand, component F2 detaches the 7Be, 210Pb and PM10 concentration levels between monitoring sites, and the meteorological analysis shows how surface concentrations within this component are associated with the development of different mesoscale circulations in each part of the valley. The identification of sampling periods characterised by differences in surface concentrations and wind patterns between stations suggests that the valley could not be considered as one single unit for certain meteorological scenarios. These results evidence how the understanding of wind characteristics within a complex terrain provide some essential knowledge in the regionalization and/or optimization of monitoring networks.
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Inter-ictal network of focal epilepsy and effects of clinical factors on network activity
Publication date: Available online 16 December 2018
Source: Clinical Neurophysiology
Author(s): Béla Clemens, Johanna Dömötör, Miklós Emri, Szilvia Puskás, István Fekete
Abstract
Objective
Aim of the study was to explore the inter-ictal, resting-state EEG network in patients with focal epilepsy (FE) and to specify clinical factors that influence network activity.
Methods
Functional EEG connectivity (EEGfC) differences were computed between 232 FE patients (FE group) and 77 healthy controls. EEGfC was computed among 23 cortical regions within each hemisphere, for 25 very narrow bands from 1 to 25 Hz. We computed independent effects for six clinical factors on EEGfC in the FE group, by ANOVA and post-hoc t-statistics, corrected for multiple comparisons by false discovery rate method.
Results
Robust, statistically significant EEGfC differences emerged between the FE and the healthy control groups. Etiology, seizure type, duration of the illness and antiepileptic treatment were independent factors that influenced EEGfC. Statistically significant results occurred selectively in one or a few very narrow bands and outlined networks. Most abnormal EEGfC findings occurred at frequencies that mediate integrative and motor activities.
Conclusions
FE patients have abnormal resting-state EEGfC network activity. Clinical factors significantly modify EEGfC.
Significance
Delineation of the FE network and modifying factors can open the way for targeted investigations and introduction of EEGfC into epilepsy research and practice.
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From Research to Clinic: A sensor reduction method for high-density EEG neurofeedback systems
Publication date: Available online 16 December 2018
Source: Clinical Neurophysiology
Author(s): Prasanta Pal, Daniel L. Theisen, Michael Datko, Remko van Lutterveld, Alexandra Roy, Andrea Ruf, Judson A. Brewer
Abstract
Objective
To accurately deliver a source-estimated neurofeedback (NF) signal developed on a 128-sensors EEG system on a reduced 32-sensors EEG system.
Methods
A linearly constrained minimum variance beamformer algorithm was used to select the 64 sensors which contributed most highly to the source signal. Monte Carlo-based sampling was then used to randomly generate a large set of reduced 32-sensors montages from the 64 beamformer-selected sensors. The reduced montages were then tested for their ability to reproduce the 128-sensors NF. The high-performing montages were then pooled and analyzed by a k-means clustering machine learning algorithm to produce an optimized reduced 32-sensors montage.
Results
Nearly 4,500 high-performing montages were discovered from the Monte Carlo sampling. After statistically analyzing this pool of high performing montages, a set of refined 32-sensors montages was generated that could reproduce the 128-sensors NF with greater than 80% accuracy for 72% of the test population.
Conclusion
Our Monte Carlo reduction method was used to create reliable reduced-sensors montages which could be used to deliver accurate NF in clinical settings.
Significance
A translational pathway is now available by which high-density EEG-based NF measures can be delivered using clinically accessible low-density EEG systems.
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The endocast of StW 573 (“Little Foot”) and hominin brain evolution
Publication date: January 2019
Source: Journal of Human Evolution, Volume 126
Author(s): Amélie Beaudet, Ronald J. Clarke, Edwin J. de Jager, Laurent Bruxelles, Kristian J. Carlson, Robin Crompton, Frikkie de Beer, Jelle Dhaene, Jason L. Heaton, Kudakwashe Jakata, Tea Jashashvili, Kathleen Kuman, Juliet McClymont, Travis R. Pickering, Dominic Stratford
Abstract
One of the most crucial debates in human paleoneurology concerns the timing and mode of the emergence of the derived cerebral features in the hominin fossil record. Given its exceptional degree of preservation and geological age (i.e., 3.67 Ma), StW 573 ('Little Foot') has the potential to shed new light on hominin brain evolution. Here we present the first detailed comparative description of the external neuroanatomy of StW 573. The endocast was virtually reconstructed and compared to ten southern African hominin specimens from Makapansgat, Malapa, Sterkfontein and Swartkrans attributed to Australopithecus and Paranthropus. We apply an automatic method for the detection of sulcal and vascular imprints. The endocranial surface of StW 573 is crushed and plastically deformed in a number of locations. The uncorrected and therefore minimum cranial capacity estimate is 408 cm3 and plots at the lower end of Australopithecus variation. The endocast of StW 573 approximates the rostrocaudally elongated and dorsoventrally flattened endocranial shape seen in Australopithecus and displays a distinct left occipital petalia. StW 573 and the comparative early hominin specimens share a similar sulcal pattern in the inferior region of the frontal lobes that also resembles the pattern observed in extant chimpanzees. The presumed lunate sulcus in StW 573 is located above the sigmoid sinus, as in extant chimpanzees, while it is more caudally positioned in SK 1585 and StW 505. The middle branch of the middle meningeal vessels derives from the anterior branch, as in MH 1, MLD 37/38, StW 578. Overall, the cortical anatomy of StW 573 displays a less derived condition compared to the late Pliocene/early Pleistocene southern African hominins (e.g., StW 505, SK 1585).
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Reflections on the history and legacy of scientific racism in South African paleoanthropology and beyond
Publication date: January 2019
Source: Journal of Human Evolution, Volume 126
Author(s): Rebecca Rogers Ackermann
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