Differential effects of theta-gamma tACS on motor skill acquisition in young individuals and stroke survivors: A double-blind, randomized, sham-controlled study.

BACKGROUND: Theta-gamma transcranial alternating current stimulation (tACS) was recently found to enhance thumb acceleration in young, healthy participants, suggesting a potential role in facilitating motor skill acquisition. Given the relevance of motor skill acquisition in stroke rehabilitation, theta-gamma tACS may hold potential for treating stroke survivors. OBJECTIVE: We aimed to examine the effects of theta-gamma tACS on motor skill acquisition in young, healthy participants and stroke survivors. METHODS: In a pre-registered, double-blind, randomized, sham-controlled study, 78 young, healthy participants received either theta-gamma peak-coupled (TGP) tACS, theta-gamma trough-coupled (TGT) tACS or sham stimulation. 20 individuals with a chronic stroke received either TGP or sham. TACS was applied over motor cortical areas while participants performed an acceleration-dependent thumb movement task. Stroke survivors were characterized using standardized testing, with a subgroup receiving additional structural brain imaging. RESULTS: Neither TGP nor TGT tACS significantly modified general motor skill acquisition in the young, healthy cohort. In contrast, in the stroke cohort, TGP diminished motor skill acquisition compared to sham. Exploratory analyses revealed that, independent of general motor skill acquisition, healthy participants receiving TGP or TGT exhibited greater peak thumb acceleration than those receiving sham. CONCLUSION: Although theta-gamma tACS increased thumb acceleration in young, healthy participants, consistent with previous reports, it did not enhance overall motor skill acquisition in a more complex motor task. Furthermore, it even had detrimental effects on motor skill acquisition in stroke survivors.

Colorectal carcinoma with dome-like phenotype: an under-recognised subset of colorectal carcinoma?

BACKGROUND: The term dome carcinoma has been applied to a variant of colorectal carcinoma, thought to derive from M-cells of the gut-associated lymphoid tissue. Its distinguishing morphological features include a non-polypoid plaque-like lesion composed of closely apposed cystically dilated glands lined by a single layer of non-mucinous cells, intensely PAS-positive intraluminal material, and a close spatial relation to lymphoid stroma. AIMS AND METHODS: A search in the literature for such cases and the authors' experience with carcinomas sharing morphological details with dome carcinoma are presented to direct focus on this unique phenotype of colorectal carcinoma and to expand on its morphology. RESULTS: Four such examples, all stage pT1, pN0 have been previously reported. Here two additional cases, with several features of dome carcinoma, stage pT1 and pT2, respectively, are added. An extensive intramucosal component, unassociated with adenomatous growth, a pink quality of the lesional cells, low grade budding, absence of cytoplasmic pseudofragments, and absence of necrosis characterised the present cases as well as intact MMR-proteins and loss of APC. As opposed to two of the previously reported cases, intraepithelial lymphocytes were unapparent in these cases and the lymphoid stroma was effaced along with tumour progression in one of the present cases. Hence, a range of appearances is encompassed by the dome carcinoma. The uncommon reporting of dome carcinoma may be due to lack of awareness of this particular subset of colorectal carcinoma. Indeed, one of the current cases was signed out as a conventional carcinoma, despite the comment in the pathology report of an unusual morphology. CONCLUSION: Dome carcinoma may be more under-recognised than rare. The reporting of variants of colorectal carcinoma, displaying histological features suggestive of dome carcinoma, is encouraged in order to obtain more exact knowledge on its putative clinical significance.

Use of the child health questionnaire in a sample of moderate and low-income inner-city children with asthma.

The Child Health Questionnaire (CHQ-PF50) is one of several recent efforts to gauge pediatric, health-related quality of life from the patient's (or parent's) perspective. Although tested extensively with healthy children, more information is needed about CHQ performance among children with chronic conditions such as asthma. The current study extends previous work by examining the CHQ's psychometric performance in a sample of children with asthma, overrepresenting those at high risk for poor outcomes. Seventy-four adult caregivers of children with asthma completed the CHQ. Internal consistency reliability was consistently high for all but one scale. Intraclass correlation coefficients ranged from a low of 0.37 to a high of 0.84. Tests of validity found CHQ scales better at distinguishing levels of disease severity as defined by symptom activity than medication use or pulmonary function tests. Performance of the CHQ-PF50 in a sample of low-income to moderate income inner-city parents of children with asthma presented mixed results. The instrument addresses a broad range of concepts but some scales may be more salient than others in assessing health status of children at highest risk for asthma morbidity. Future efforts must compare condition-specific and generic instruments to evaluate their relative strengths and weakness, as well as potential links between them.

Reliability and validity of the Children's Health Survey for Asthma.

OBJECTIVE: Describe the psychometric properties of the Children's Health Survey for Asthma (CHSA)- a condition-specific, self-report, functional health measure for parents of children 5 to 12 years of age with chronic asthma. METHOD: Data from two cross-sectional and one longitudinal study were used to assess internal consistency reliability, test-retest reliability, and validity of the CHSA. Over 275 parents and guardians of children with asthma completed the CHSA in one of three studies. The combined samples included a heterogenous mix of respondents by child age and race/ethnicity and parental marital and socioeconomic status. Five domain scores were computed: physical health, activity (child), activity (family), emotional health (child), and emotional health (family). Raw scale scores were transformed from 0 to 100 with higher scores indicating better or more positive outcomes. RESULTS: Across the three samples, mean scale scores ranged from a low of 61.5 (emotional health of the child) to a high of 86.1 (activity [family]). Internal consistency reliability for each of the scales was high (Cronbach's alpha =.81-. 92), and test-retest reliability (correlation between forms) ranged from.62 to.86. Significant differences in mean scores for four of five scales were noted between those with low versus moderate to high recent symptom activity. CONCLUSION: In three tests, the CHSA displays strong reliability and validity. Descriptive statistics demonstrate a range of scale scores. Internal consistency is good to excellent and short-term test-retest reliability is good for each of the five scales. Construct validity is demonstrated by the ability of CHSA to distinguish levels of disease severity, defined by symptom activity.

The influence of provider behavior, parental characteristics, and a public policy initiative on the immunization status of children followed by private pediatricians: a study from Pediatric Research in Office Settings.

OBJECTIVES: To determine the relative impact of parental characteristics, provider behavior, and the provision of free vaccines through state-sponsored vaccine volume programs (VVPs) on the immunization status of children followed by private pediatricians. STUDY DESIGN: Retrospective and cross-sectional surveys of immunization data. SETTING: The offices of 15 private pediatricians, from 11 states, who were members of the Pediatric Research in Office Settings network. Seven of these physicians used vaccines provided through VVPs. PATIENTS: Children 2 to 3 years old followed by the participating physicians. METHODS: The immunization status of children was assessed from two separate samples. For sample 1, immunization data were abstracted from the medical records of 60 consecutive eligible children seen in each office. Parents of the selected children indicated the method of payment for immunizations and the education levels of the mothers. Because this cross-sectional survey might have oversampled frequent health care users, a retrospective chart review of up to 75 randomly selected children in each pediatrician's practice was also conducted (sample 2). Additional data were collected from the parents of children in sample 2 by telephone interviews. For both samples, patients were considered to be fully immunized if they had received four diphtheria-tetanus-pertussis/diphtheria-tetanus vaccines, three oral poliovirus/inactivated poliovirus vaccines, and one measles-mumps-rubella vaccine before their second birthdays. Before collecting vaccination data, pediatricians completed a survey detailing their immunization beliefs and practices. Logistic regression was used to identify factors that were independently associated with a child being fully immunized. RESULTS: For sample 1, 81.7% of the 857 children surveyed were fully immunized. Practitioner-specific immunization rates varied widely, ranging from 51% to 97%. The immunization rate of children who received vaccines provided by VVPs was similar to that of children whose immunizations were not provided by VVPs (81.2% vs 82.2%; odds ratio [OR] for a VVP as a predictor for being fully immunized, 0.94, 95% confidence interval [CI], 0.66 to 1.32). In addition, parents who paid for immunizations out of pocket were as likely to have fully immunized children as those who had little or no out-of-pocket expenditures for vaccines (OR, 1.13; 95% CI, 0.75 to 1.13). In the logistic model, only individual pediatrician and size of the metropolitan area in which the pediatrician's practice was located were significant predictors of a child's immunization status. The results from sample 2 were similar; 82.1% of the 772 surveyed patients were fully immunized. With sample 2, individual pediatrician and age of the child at the time of the survey were the only predictors of immunization status. The OR of a VVP as a predictor of a child being fully immunized was 1.37 (95% CI, 0.65 to 2.90). CONCLUSIONS: Individual provider behavior may be the most important determinant of the immunization status of children followed by private pediatricians. In our samples, the effect of parental characteristics was limited. State-sponsored VVPs were not associated with higher immunization rates, perhaps because cost of vaccines did not seem to be a significant barrier to immunization in this population.

Methodological issues in determining rates of childhood immunization in office practice. A study from pediatric research in office settings (PROS).

OBJECTIVE: To compare 3 methods for measuring pediatric office immunization rates. DESIGN: Retrospective and prospective cross-sectional surveys. PATIENTS: Children 2 and 3 years old from 15 pediatric practices in 11 states. METHODS: Immunization rates were determined for each practice using 3 methods. The Consecutive method used data from the practice's medical records of patients seen consecutively in the office; the Chart method used data from randomly selected practice medical records; and the Active method (reference standard) used a combination of medical record data with a telephone interview to collect additional immunization data and current patient status, using data only on current patients. Analyses were based on a mean of 57, 62, and 51 (Consecutive, Chart, and Active method, respectively) patients per practice. Patients were considered fully immunized if they had received 4 doses of DTP/DT vaccine, 3 doses of OPV/IPV, and 1 dose of MMR vaccine by their second birthday Comparisons were made using the paired t test. RESULTS: The mean immunization rate by method was Consecutive, 81.5% (range, 51%-97%); Chart, 71.6% (range, 42%-94%); and Active, 79.6% (range, 53%-96%). Within a given practice, the differences between methods varied considerably (0 to 28 percentage points). The mean difference from the reference standard Active method was 8 percentage points (P < .001) for the Chart method and -1.9 percentage points (P = .36) for the Consecutive method. The largest difference was between the Consecutive and Chart methods (mean difference, 9.9 percentage points; P = .003). Practitioners uniformly found the Consecutive method easiest to implement. CONCLUSIONS: Practice-specific immunization rates are one of the few objective measures of the quality of preventive pediatric care. Pediatric practices monitoring their immunization rates should consider using the Consecutive method, a simple, acceptable, and valid measure of practice immunization rate.

A developmental approach to sexuality education: implications for medical practice.

Medical professionals are increasingly expected to address issues of sexuality and acquired immunodeficiency syndrome (AIDS) with young patients and their parents. Focus group interviews were conducted with parents (n = 43) and adolescents (n = 800) to determine the preferred physician role regarding families and sexual development. Parents believed that a physician was an appropriate expert to assist in preventing negative risk behaviors (e.g., drugs, alcohol, sexual intercourse) and emphasized the importance of the physician developing a comfortable relationship early on with parents and youth to allow for reciprocal dialogue about sensitive topics. Parents also commented that physicians generally appeared uncomfortable when discussing personal issues (viz., sexuality) and frequently lacked communication skills (e.g., use of open-ended questions or statements) to foster conversation. Youth identified physicians as a logical source of information about sexuality but felt hesitant to ask questions that might prompt value-based discussion. Youth also expressed concern about confidentiality in the doctor-patient relationship. Adolescents desired physicians to be more "askable" than they are perceived to be. Guidelines are offered for strengthening office interactions and improving communication skills.

Intraperitoneal chemotherapy: introduction of a new "single use" delivery system--a preliminary report.

Intraperitoneal administration of chemotherapy in ovarian cancer is currently under investigation. In this preliminary report we introduce the "Veress-needle" as a "single-use" delivery system of intraperitoneal chemotherapy. A total of 22 infusions in 7 patients revealed no major complications, and during 4 infusions only minor side effects were noted. The technique described seems to fulfill the need for a safe, reliable, and acceptable delivery system of intraperitoneal chemotherapy.