Voluntary reaction time and long-latency reflex modulation.

Stretching a muscle of the upper limb elicits short (M1) and long-latency (M2) reflexes. When the participant is instructed to actively compensate for a perturbation, M1 is usually unaffected and M2 increases in size and is followed by the voluntary response. It remains unclear if the observed increase in M2 is due to instruction-dependent gain modulation of the contributing reflex mechanism(s) or results from voluntary response superposition. The difficulty in delineating between these alternatives is due to the overlap between the voluntary response and the end of M2. The present study manipulated response accuracy and complexity to delay onset of the voluntary response and observed the corresponding influence on electromyographic activity during the M2 period. In all active conditions, M2 was larger compared with a passive condition where participants did not respond to the perturbation; moreover, these changes in M2 began early in the appearance of the response (∼ 50 ms), too early to be accounted for by voluntary overlap. Voluntary response latency influenced the latter portion of M2, with the largest activity seen when accuracy of limb position was not specified. However, when participants aimed for targets of different sizes or performed movements of various complexities, reaction time differences did not influence M2 period activity, suggesting voluntary activity was sufficiently delayed. Collectively, our results show that while a perturbation applied to the upper limbs can trigger a voluntary response at short latency (<100 ms), instruction-dependent reflex gain modulation remains an important contributor to EMG changes during the M2 period.

Much Ado About Fried Chicken: Abetting Aspiration or Respecting Autonomy?

Purpose Palliative care is a philosophy of care that encompasses holistic, patient-centric care involving patients and their family members and loved ones. Palliative care patients often have complex needs. A common challenge in managing patients near their end of life is the complexity of navigating clinical decisions and finding achievable and realistic goals of care that are in line with the values and wishes of patients. This often results in differing opinions and conflicts within the multidisciplinary team. Conclusion This article describes a tool derived from the biopsychosocial model and the 4-quadrant ethical model. The authors describe the use of this tool in managing a patient who wishes to have fried chicken despite aspiration risk and how this tool was used to encourage discussions and reduce conflict and distress within the multidisciplinary team.

Cost analysis of implementing a telegeriatrics ecosystem with nursing homes: panel data analysis.

Our study analyzed the economicimpact of a telegeriatrics programme on care of nursing homeresidents, from the healthcare system provider's perspective. Thisis a retrospective, archival data analysis of multiple data sourcesin 4 nursing homes of Singapore from 2010 to 2015. Individualsadmitted to nursing homes and have undergone telemedicineconsultations (N=859) from 2010 to 2015 were recruited. Weconducted a cost analysis of the programme by reviewing pasthospital admissions' and specialist outpatient clinic (SOC) visits'billing records, nurse training records, and key performanceindicators' reports. A significant relationship was observed betweenteleconsultations and SOC visit cost (ß1 = -83.366, p-value<0.01) and between teleconsultations and inpatient cost (ß1 =-470.971, p-value <0.05). Remote video consultations could reduceunnecessary SOC visits and hospital admissions, and thereforelead to cost savings. Training of nursing home nurses couldtranslate to cost savings as a result of decreased ED transfers.