Microstates and power envelope hidden Markov modeling probe bursting brain activity at different timescales.

State modeling of whole-brain electroencephalography (EEG) or magnetoencephalography (MEG) allows to investigate transient, recurring neurodynamical events. Two widely-used techniques are the microstate analysis of EEG signals and hidden Markov modeling (HMM) of MEG power envelopes. Both reportedly lead to similar state lifetimes on the 100 ms timescale, suggesting a common neural basis. To investigate whether microstates and power envelope HMM states describe the same neural dynamics, we used simultaneous MEG/EEG recordings at rest and compared the spatial signature and temporal activation dynamics of microstates and power envelope HMM states obtained separately from EEG and MEG. Results showed that microstates and power envelope HMM states differ both spatially and temporally. Microstates reflect sharp events of neural synchronization, whereas power envelope HMM states disclose network-level activity with 100-200 ms lifetimes. Further, MEG microstates do not correspond to the canonical EEG microstates but are better interpreted as split HMM states. On the other hand, both MEG and EEG HMM states involve the (de)activation of similar functional networks. Microstate analysis and power envelope HMM thus appear sensitive to neural events occurring over different spatial and temporal scales. As such, they represent complementary approaches to explore the fast, sub-second scale bursting electrophysiological dynamics in spontaneous human brain activity.

Changes in electrophysiological static and dynamic human brain functional architecture from childhood to late adulthood.

This magnetoencephalography study aimed at characterizing age-related changes in resting-state functional brain organization from mid-childhood to late adulthood. We investigated neuromagnetic brain activity at rest in 105 participants divided into three age groups: children (6-9 years), young adults (18-34 years) and healthy elders (53-78 years). The effects of age on static resting-state functional brain integration were assessed using band-limited power envelope correlation, whereas those on transient functional brain dynamics were disclosed using hidden Markov modeling of power envelope activity. Brain development from childhood to adulthood came with (1) a strengthening of functional integration within and between resting-state networks and (2) an increased temporal stability of transient (100-300 ms lifetime) and recurrent states of network activation or deactivation mainly encompassing lateral or medial associative neocortical areas. Healthy aging was characterized by decreased static resting-state functional integration and dynamic stability within the primary visual network. These results based on electrophysiological measurements free of neurovascular biases suggest that functional brain integration mainly evolves during brain development, with limited changes in healthy aging. These novel electrophysiological insights into human brain functional architecture across the lifespan pave the way for future clinical studies investigating how brain disorders affect brain development or healthy aging.

A systematic review of the validity of dietary assessment methods in children when compared with the method of doubly labelled water.

Assessing energy intake (EI) in children and adolescents is essential for monitoring population nutrition trends and interpreting clinical outcomes. The aim of this review was to examine the validity of dietary assessment methods for estimating EI in children and adolescents when compared with total energy expenditure (TEE) measured using doubly labelled water (DLW). Six online databases were searched to identify articles published in English. Studies were included if they were conducted in participants aged ≤18 years, if they estimated EI via a dietary assessment method, and if they compared this estimate to TEE measured using the DLW method. The search strategy identified 345 articles, of which 13 articles (12 studies) (n = 306 children) met the selection criteria. Five studies were carried out in children aged 5-11 years with dietary intake of children reported by parents/caregivers. The most common dietary assessment methods used were food frequency questionnaires (n = 5) and weighed food records (n = 4). All methods were found to have some level of misreporting. Child characteristics including weight status, age, and sex were not found to consistently influence the accuracy of reported EI. Five studies employing technology-assisted approaches for assessing dietary intake in children were identified and reported mixed findings. Validity studies using DLW remain sparse in the literature. Studies including participants less than 5 years or older than 11 years, and from diverse ethnicities and socioeconomic backgrounds are warranted to explore other demographic differences that may affect the accuracy of dietary assessment methods. While reported in few studies, technology-assisted methods were found to perform equally well in estimating intakes when compared to DLW and other traditional forms of dietary assessment.

Essential tremor in twins: an assessment of genetic vs environmental determinants of etiology.

OBJECTIVE: To determine the relative contribution of genetics and environment to essential tremor using a twin study method. METHODS: Twins with postural or kinetic tremor were identified by movement disorders specialists during the conduct of a study investigating PD in members of the National Academy of Sciences and National Research Council World War II Veteran Twins Registry. The diagnosis of essential tremor was made by consensus using established diagnostic criteria. RESULTS: A total of 196 twins had postural or kinetic tremor on examination. Of these, 137 had PD or had a twin with PD and were excluded from this study. Thirty-three others were excluded because of incomplete data for their twin. Sixteen twin pairs were identified in which at least one twin had essential tremor. Pairwise concordance in monozygotic twins was approximately two times that in dizygotic twins (0.60 monozygotic, 0.27 dizygotic). CONCLUSION: This pattern is consistent with a genetic cause of essential tremor. Because monozygotic concordance is not 100%, environmental factors may also play a role in the cause of the disease.

UCSD Performance-Based Skills Assessment: development of a new measure of everyday functioning for severely mentally ill adults.

Instruments to assess everyday functioning have utilized self-report, proxy report, clinician ratings, or direct observation of performance. Each of these methods has strengths and weaknesses. In this article we argue for the inclusion of performance-based measures of functional capacity in studies of severely mentally ill persons and describe a new measure, the UCSD Performance-Based Skills Assessment (UPSA). We administered the UPSA to 50 middle-aged and older outpatients with schizophrenia or schizoaffective disorder, and 20 normal comparison subjects. Participants' performance in five domains of functioning (Household Chores; Communication; Finance; Transportation; and Planning Recreational Activities) was assessed in standardized role-play situations. Administration of the UPSA required an average of 30 minutes to complete. Interrater reliability of ratings was excellent. Patients' performance was significantly more impaired than that of normal subjects. Among patients, the UPSA performance correlated significantly with severity of negative symptoms and of cognitive impairment but not with that of positive or depressive symptoms. The UPSA scores correlated highly with those on another performance-based measure. We believe that UPSA would be useful for assessing everyday functioning in severely mentally ill adults.

Prophylactic coronary artery revascularization for elective vascular surgery: study design. Veterans Affairs Cooperative Study Group on Coronary Artery Revascularization Prophylaxis for Elective Vascular Surgery.

This article describes the design of an ongoing randomized trial intended to test whether patients who require elective vascular surgery would benefit from preoperative coronary artery revascularization prior to the vascular procedure. The primary objective is to determine whether coronary artery revascularization reduces long-term mortality (mean 3.5 years) in patients undergoing vascular surgery. The study design calls for 620 patients to be randomized and followed for a mean of 3.5 years following vascular surgery. Secondary endpoints include measures of quality of life and cost-effectiveness. Patients with coronary artery disease in need of an elective vascular operation are considered candidates for the study. Anatomic exclusion criteria include ejection fraction <20%, severe aortic stenosis (valve area <1.0 cm2), left main stenosis > or =50%, nonobstructive coronary artery disease (stenosis <70%), and coronary arteries that are not amenable to revascularization. Prior to the vascular surgery, the trial randomizes eligible patients to coronary artery revascularization (either bypass surgery or angioplasty) versus medical therapy. The trial stratifies the randomization by hospital and type of vascular surgery (intraabdominal versus infrainguinal) because of differences in long-term prognosis in those patients. A 1-year feasibility trial involving five Veterans Affairs (VA) medical centers of variable vascular surgical loads has been completed. The results showed that over 90% of expected patients could be randomized. As a result, a larger VA Cooperative Study involving 18 centers will begin recruitment of patients. The findings should help determine the best strategy for managing patients with coronary artery disease in need of elective vascular surgery.

Assessment of coronary flow reserve by transesophageal echocardiography in cardiac transplant recipients.

This study investigated the feasibility of dipyridamole Doppler transesophageal echocardiography to assess coronary flow reserve in 26 patients with orthotopic heart transplantation and compared it with positron emission tomography. We found an 85% success rate in obtaining Doppler flow signals in the proximal left anterior descending coronary artery. Our data also showed that the correlation between transesophageal echocardiography and dipyridamole N-13 ammonia positron emission tomography increases when respective resting rate-pressure products are taken into account. However, comparison between the two methods should be made with caution because coronary flow reserve derived from transesophageal echocardiography tends to be higher than that obtained with positron emission tomography.

[Minilaparotomy is a careful method in right colon tumor surgery]. / Minilaparotomin skonsam vid tumörkirurgi på högerkolon.

In a series of 47 patients, right colon tumours were treated surgically with a minilaparotomy approach, entailing a skin incision of less than 10 centimetres. The procedure allows appropriate oncological management of the tumour, and is associated with a mild postoperative course and a rapid recovery and resumption of normal life. The short-term outcome in this series has been promising, and the minilaparotomy approach would thus appear to be an attractive alternative to traditional open surgery of the right colon.

Attitudes to and use of a modified prescription form by general practitioners and pharmacists.

OBJECTIVE: To evaluate the rate of use and acceptance of a new prescription form designed to provide more information to pharmacists and patients. DESIGN: Prospective descriptive study. SETTING: A semi-rural community outside Melbourne, Victoria, in November 1994. PARTICIPANTS: GPs and pharmacists working three or more sessions per week in the locality, and 21 consumers who formed two consumer focus groups. INTERVENTION: An education session for GPs and pharmacists, followed by a one-month trial of new prescription forms which included notations to facilitate interprofessional communication. MAIN OUTCOME MEASURES: Rate of use and acceptability of the new prescription notations. RESULTS: Eighteen GPs and 10 pharmacists participated; 3600 forms were issued and 2521 prescriptions, including 3464 prescription items, were analysed. GPs and pharmacists used at least one of the new prescription notations in 45% (1559) of prescription items; 35% of prescription items (1222) were notated with the general purpose of the medication. Qualitative findings suggested that GPs, pharmacists and consumers considered the new prescription form to be beneficial and useful. CONCLUSIONS: A modified prescription form to increase communication between GPs and pharmacists is acceptable in clinical practice.

Limitations and strengths of spontaneous reports data.

US Food and Drug Administration (FDA) monitoring of the continued safety of marketed medical products depends greatly on spontaneous reporting of serious adverse events by health professionals. Despite its inherent limitations, the national postmarketing surveillance system provides vital information of clinical importance.

Bone marrow transplantation in children. Imaging assessment of complications.

As the use of BMT increases for the treatment of a variety of malignant and nonmalignant diseases in children, awareness of the complications that can occur in these children is important. The imaging appearance of the complications that may occur in the central nervous system, paranasal sinus, lungs, abdomen, and pelvis in children following BMT have been reviewed. CT and MR imaging examination with the use of contrast material as indicated is important for defining pathology in the brain. Plain films should be supplemented with CT examination as needed to identify and characterize disease in the paranasal sinuses and lungs. Finally, the use of ultrasound and CT is crucial for defining complications that may occur in the abdomen and pelvis.

Core Assessment Program for Intracerebral Transplantation in Huntington's Disease (CAPIT-HD).

Studies in Parkinson's disease using the Core Assessment Program for Intracerebral Transplantation (CAPIT) protocol have demonstrated that grafts of embryonic mesencephalic cells into striatum can survive, grow, and exert useful clinical effects. Attention in now being directed toward neural grafting in other conditions, such as Huntington's disease. As a precondition for grafting of embryonic striatal cells into diseased striatum in this complex motor and psychiatric disorder, not only is further basic research needed, but also a thorough and wide-ranging assessment protocol is essential. This article presents such a CAPIT-HD assessment protocol.

The effects of race, household income, and parental education on nutrient intakes of 9- and 10-year-old girls. NHLBI Growth and Health Study.

Nutrient intakes of 2149 black and white, 9- and 10-year-old girls varied by race, household income, and parental education. Of the three variables, higher education was most consistently associated with more desirable levels of nutrient intakes, that is, lower percentage of dietary fat and higher levels of vitamin C, calcium, and potassium. Higher income was related to higher intakes of vitamin C, but lower intakes of calcium and iron. Higher income was associated with lower percentage of dietary fat. After adjustment for income and education, race was associated with intakes of calcium, vitamin C, and to a lesser extent, percentages of kilocalories from total fat and polyunsaturated fat, and potassium. Black girls had a significantly lower intake of calcium (720 versus 889 mg) and a higher intake of vitamin C (91 versus 83 mg). Proportions of the cohort with inadequate or excessive intakes of micronutrients and macronutrients were also estimated. A high proportion of girls exceeded the recommended intake level of 30% of kilocalories from total fat (90% of black girls; 84% of white girls) and 10% of kilocalories from saturated fat (92 and 93%, respectively). Low intakes of calcium (40% of black girls and and 20% og white girls) and zinc (36 and 38%, respectively) commonly were found for girls of both names.

Implications of the Health Security Act for mental health services for children and adolescents.

Lack of adequate insurance coverage is one reason that the percentage of children who currently utilize mental health services is significantly lower than the estimated percentage of children with serious mental disorders. Principles of a reformed health care system with particular relevance for children's mental health services include coverage of a broad array of home- and community-based services, provision of organized systems of care for children with serious and persistent mental illness, mechanisms to ensure appropriate utilization of services, and provision of mental health services on the same terms and conditions as other health services. The Clinton Administration's proposed Health Security Act embodied many of these principles. In addition, its call for universal coverage and for elimination of insurance exclusions for preexisting conditions would extend mental health coverage to children who are currently uninsured or underinsured; the plan would also expand the range of services covered to include state-of-the-art approaches such as intensive nonresidential services and other alternatives to hospitalization. Implementation of the proposed plan would require developing the service and workforce capacity to provide a full continuum of services, ensuring availability of existing services, integrating existing and new systems of care, guarding against underserving children with serious mental illness, and planning for the role of Medicaid funding in the reformed health care system.

The impact of parental trait anxiety on the utilization of health care services in infancy: a prospective study.

Used a prospective approach to examine the relation of prenatal parental anxiety to pediatric utilization in the first year. 31 firstborn children and their parents participated in the study. These families were primarily Caucasian, college-educated, middle-class couples who had been married an average of 4.3 years at the prenatal time period. They were first seen in their home during the second trimester of pregnancy. At that time, each parent independently completed the Life Events Survey and the Speilberger Trait Anxiety Inventory. At 12 months, each parent completed the Marital Relationship Inventory. Data on pediatric services utilization were derived from complete medical records when the child reached 12 months of age. Frequency counts for unscheduled acute care and well baby care visits were used as the primary dependent variables. As expected, prenatal reports of high maternal anxiety predicted an increased incidence of unscheduled acute care visits in the infancy period. The findings implicate physiological mechanisms and extend earlier work on psychosocial influences of pediatric services utilization to the infancy period, a time when children experience their greatest incidence of illness and patterns of medical care use become established.

Meeting the information system demands of the future through outsourcing.

As managed care organizations work to meet the rigorous data and information requirements of a rapidly evolving health care system, many are recognizing the need to out-source their computer operations. Developing a cost-effective, efficient approach to outsourcing is a challenge to many organizations. This article offers an in-depth view of outsourcing as it relates to the managed health care industry as well as criteria for selecting an outsourcing consultant or vendor.