Feasibility of a Multimodal Telemedical Intervention for Patients with Parkinson's Disease-A Pilot Study.

Symptoms of Parkinson's disease (PD) can be controlled well, but treatment often requires expert judgment. Telemedicine and sensor-based assessments can allow physicians to better observe the evolvement of symptoms over time, in particular with motor fluctuations. In addition, they potentially allow less frequent visits to the expert's office and facilitate care in rural areas. A variety of systems with different strengths and shortcomings has been investigated in recent years. We designed a multimodal telehealth intervention (TelePark) to mitigate the shortcomings of individual systems and assessed the feasibility of our approach in 12 patients with PD over 12 weeks in preparation for a larger randomized controlled trial. TelePark uses video visits, a smartphone app, a camera system, and wearable sensors. Structured training included setting up the equipment in patients' homes and group-based online training. Usability was assessed by questionnaires and semi-standardized telephone interviews. Overall, 11 out of 12 patients completed the trial (5 female, 6 male). Mean age was 65 years, mean disease duration 7 years, mean MoCA score 27. Adherence was stable throughout the study and 79% for a short questionnaire administered every second day, 62% for medication confirmation, and 33% for an electronic Hauser diary. Quality of life did not change in the course of the study, and a larger cohort will be required to determine the effect on motor symptoms. Interviews with trial participants identified motivations to use such systems and areas for improvements. These insights can be helpful in designing similar trials.

Chronic cough and an atypical pattern of peripheral pulmonary opacities: A case report secondary to suspected drug onset.

INTRODUCTION: Chronic eosinophilic pneumonia (CEP) is an idiopathic interstitial lung disease with nonspecific symptoms that involves a complex inflammatory cascade. CASE STUDY: A 36-year-old prisoner with a history of psoriasis presented with progressive worsening dyspnea, chest pain, and cough. His symptoms started 2-months after starting adalimumab, a tumor necrosis factor (TNF)-inhibitor, for psoriasis treatment. RESULTS: Initial workup revealed 27% eosinophils on complete blood count, elevated IgE levels on bronchoalveolar lavage, and bilateral peripheral lung opacities on imaging. The patient's symptoms and eosinophilia improved markedly after starting corticosteroids. Based on these findings, the patient was diagnosed with CEP. CONCLUSION: To our knowledge, this is the first case of asthma and CEP in a patient taking adalimumab. We suspect adalimumab unmasked the Th2 cell pathway response that was otherwise suppressed by psoriasis, a primarily Th1 cell pathway disease. The patient's pulmonary changes can be attributed to an eosinophilic asthma phenotype with adalimumab putatively indirectly causing CEP.

On the efficiency of instruction-based rule encoding.

Instructions have long been considered a highly efficient route to knowledge acquisition especially compared to trial-and-error learning. We aimed at substantiating this claim by identifying boundary conditions for such an efficiency gain, including the influence of active learning intention, repeated instructions, and working memory load and span. Our experimental design allowed us to not only assess how well the instructed stimulus-response (S-R) rules were implemented later on, but also to directly measure prior instruction encoding processes. This revealed that instruction encoding was boosted by an active learning intention which in turn entailed better subsequent rule implementation. As should be expected, instruction-based learning took fewer trials than trial-and-error learning to reach a similar performance level. But more importantly, even when performance was measured relative to the identical number of preceding correct implementation trials, this efficiency gain persisted both in accuracy and in speed. This suggests that the naturally greater number of failed attempts in the initial phase of trial-and-error learning also negatively impacted learning in subsequent trials due to the persistence of erroneous memory traces established beforehand. A single instruction trial was sufficient to establish the advantage over trial-and-error learning but repeated instructions were better. Strategic factors and inter-individual differences in WM span - the latter exclusively affecting trial-and-error learning presumably due to the considerably more demanding working memory operations - could reduce or even abolish this advantage, but only in error rates. The same was not true for response time gains suggesting generally more efficient task automatization in instruction-based learning.