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Cognitive aging is associated with widespread neural reorganization processes in the human brain. However, the behavioral impact of such reorganization is not well understood. The current neuroimaging study investigated age differences in the functional network architecture during semantic word retrieval in young and older adults. Combining task-based functional connectivity, graph theory and cognitive measures of fluid and crystallized intelligence, our findings show age-accompanied large-scale network reorganization even when older adults have intact word retrieval abilities. In particular, functional networks of older adults were characterized by reduced decoupling between systems, reduced segregation and efficiency, and a larger number of hub regions relative to young adults. Exploring the predictive utility of these age-related changes in network topology revealed high, albeit less efficient, performance for older adults whose brain graphs showed stronger dedifferentiation and reduced distinctiveness. Our results extend theoretical accounts on neurocognitive aging by revealing the compensational potential of the commonly reported pattern of network dedifferentiation when older adults can rely on their prior knowledge for successful task processing. However, we also demonstrate the limitations of such compensatory reorganization and show that a youth-like network architecture in terms of balanced integration and segregation is associated with more economical processing.
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Envelhecimento Cognitivo , Semântica , Adulto Jovem , Adolescente , Humanos , Idoso , Cognição , Encéfalo/diagnóstico por imagem , Envelhecimento/psicologia , Imageamento por Ressonância Magnética , Mapeamento EncefálicoRESUMO
Human cognition is organized in distributed networks in the brain. Although distinct specialized networks have been identified for different cognitive functions, previous work also emphasizes the overlap of key cognitive domains in higher level association areas. The majority of previous studies focused on network overlap and dissociation during resting states whereas task-related network interactions across cognitive domains remain largely unexplored. A better understanding of network overlap and dissociation during different cognitive tasks may elucidate flexible (re-)distribution of resources during human cognition. The present study addresses this issue by providing a broad characterization of large-scale network dynamics in three key cognitive domains. Combining prototypical tasks of the larger domains of attention, language, and social cognition with whole-brain multivariate activity and connectivity approaches, we provide a spatiotemporal characterization of multiple large-scale, overlapping networks that differentially interact across cognitive domains. We show that network activity and interactions increase with increased cognitive complexity across domains. Interaction patterns reveal a common core structure across domains as well as dissociable domain-specific network activity. The observed patterns of activation and deactivation of overlapping and strongly coupled networks provide insight beyond region-specific activity within a particular cognitive domain toward a network perspective approach across diverse key cognitive functions.
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Encéfalo , Imageamento por Ressonância Magnética , Humanos , Encéfalo/fisiologia , Mapeamento Encefálico , Cognição/fisiologia , Atenção/fisiologia , Rede Nervosa/fisiologiaRESUMO
The Great Lakes Areas of Concern (AOC) program was created through amendments to the Great Lakes Water Quality Agreement (GLWQA) in 1987 to restore contaminated sites using an ecosystem-based approach. This program represents one of the first instances of ecosystem-based management (EBM) in the Great Lakes region with a specific focus on the inclusion of the public and local stakeholders in the process. Despite official language incorporating EBM in the AOC program, implementation of these practices has not been consistent across AOCs given differences in local arrangements of Public Advisory Councils (PACs), approaches to community engagement, and environmental problems. To better understand community engagement in these complex AOCs, this research investigated community, PAC, and state agency perspectives in three AOCs in Michigan: the Kalamazoo River, Saginaw River and Bay, and Rouge River AOCs. We gathered data through interviews, focus groups, and participatory observations with community members, PAC members, and state officials in each AOC. Findings indicate that communities in these areas have minimal connection to the AOC program and PACs. Community members tended to have greater connection to local organizations that provide a variety of opportunities for community members to engage with their environment in ways they value. To better connect the public to the AOC program, PACs may benefit from intentional partnerships with community organizations to increase community engagement. To consistently bolster community engagement in AOCs, we further recommend that state agencies provide additional resources to improve connection to local communities.
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The Great Lakes region was once a hub of industry and innovation that provided wealth and identity to the region. Economic upheavals have left the region trying to recreate economies and cleanup degraded environments. There have been multiple, overlapping efforts to change these conditions and create a new narrative for the region through environmental remediation, habitat restoration, and community revitalization on the path towards resilience. The elements that contribute to success are organized differently in different places, and are not always identified or characterized in the environmental literature. Trying to fill this conceptual gap is critical because landscape-scale environmental cleanup has been delivered at the local scale through various partnerships and arrangements. Thus, this special collection of articles in the Journal of Great Lakes Research explores how individuals, organizations, and communities are engaging in the complex process of environmental cleanup and revitalization throughout the region. This collection of articles represents a range of approaches to unpack how people are navigating and contributing to this regenerative process from quantitative studies at the regional scale that characterize global patterns to in-depth qualitative studies that identify and characterize the processes that unfold in specific places to change our environments both ecologically and socially. These articles represent the broad experience unfolding in the region to understand these activities through research and navigate them through practice. This collection will add new dimensions to Great Lakes research by including the individuals, organizations, and agencies as components of the ecosystem.
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Increasing recognition of the complexity of environmental problems and the need to understand social processes and human values is leading environmental management agencies in many nations, including the USA, to integrate more research from the social sciences through the inclusion of social scientists on interdisciplinary teams. For this study we conducted focus groups at three research laboratories within the U.S. Environmental Protection Agency's Office of Research and Development to better understand how inclusion of social sciences influenced the research process and outcomes, and the barriers to and facilitators of integration. The focus groups identified effects on the research process including improved problem framing, the introduction of new methodologies, and greater stakeholder and public inclusion, while research outcomes included the inclusion or refinement of social and environmental perspectives and systems thinking, increased translatability of research, and new partnerships. Barriers identified included lack of familiarity with social sciences which affected perceptions of social sciences and organizational capacity to absorb and apply social science expertise. Facilitators included receptivity of team members, intentional communication strategies, and project structures and organizational commitment that support interdisciplinary work. Finding a key barrier to be lack of clarity about the different roles social sciences play in translational research, we present a conceptual model defining the roles and contributions of social scientists that clarifies the distinction between "integration" of social sciences in research and "application" of skills and knowledge from the social sciences which play distinct but equally important roles in translational research approaches and solutions-driven research. These insights on the ways social sciences contribute to translational research efforts advance integration of social and natural sciences in environmental science research, particularly in applied contexts.
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BACKGROUND: Community-driven projects that aim to address public concerns about health risks from H. pylori infection in Indigenous Arctic communities (estimated H. pylori prevalence = 64%) show frequent failure of treatment to eliminate the bacterium. Among project participants, treatment effectiveness is reduced by antibiotic resistance of infecting H. pylori strains, which in turn, is associated with frequent exposure to antibiotics used to treat other infections. This analysis compares antibiotic dispensation rates in Canadian Arctic communities to rates in urban and rural populations in Alberta, a southern Canadian province. METHODS: Project staff collected antibiotic exposure histories for 297 participants enrolled during 2007-2012 in Aklavik, Tuktoyaktuk, and Fort McPherson in the Northwest Territories, and Old Crow, Yukon. Medical chart reviews collected data on systemic antibiotic dispensations for the 5-year period before enrolment for each participant. Antibiotic dispensation data for urban Edmonton, Alberta (average population ~ 860,000) and rural northern Alberta (average population ~ 450,000) during 2010-2013 were obtained from the Alberta Government Interactive Health Data Application. RESULTS: Antibiotic dispensation rates, estimated as dispensations/person-years (95% confidence interval) were: in Arctic communities, 0.89 (0.84, 0.94); in Edmonton, 0.55 (0.55, 0.56); in rural northern Alberta, 0.63 (0.62, 0.63). Antibiotic dispensation rates were higher in women and older age groups in all regions. In all regions, the highest dispensation rates occurred for ß-lactam and macrolide antibiotic classes. CONCLUSIONS: These results show more frequent antibiotic dispensation in Arctic communities relative to an urban and rural southern Canadian population.
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Antibacterianos/uso terapêutico , Características de Residência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Regiões Árticas , Canadá , Criança , Pré-Escolar , Feminino , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , Falha de Tratamento , População Urbana/estatística & dados numéricos , Adulto JovemRESUMO
Stakeholder participation is now widely viewed as an essential component of environmental management projects, but limited research investigates how practitioners perceive the major challenges and strategies for implementing high-quality participation. In order to address this gap, we present findings from a survey and interviews conducted with managers and advisory committee leaders in a case study of United States and binational (US and Canada) Great Lakes Areas of Concern. Our findings suggest that recruiting and integrating participants and sustaining participation over the long term present distinctive ongoing challenges that are not fully recognized in existing conceptualizations of the process of implementing participation. For example, it can be difficult to recruit active stakeholders to fill vacant "slots," to integrate distinctive interests and perspectives in decision-making processes, and to keep participants involved when activity is low and less visible. We present strategies that emerged in the survey and interviews for addressing these challenges, emphasizing the building and leveraging of relationships among stakeholders themselves. Such strategies include balancing tight networks with an openness to new members, supplementing formal hearings with social gatherings, making participation socially meaningful, and dividing labor between managers and advisory committees.
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Participação dos Interessados , Canadá , Tomada de Decisões , Humanos , Lagos , Liderança , Estados UnidosRESUMO
Cleanup of Great Lakes Areas of Concern (AOCs) restores environmental benefits to waterfront communities and is an essential condition for revitalization. We define waterfront revitalization as policies or actions in terrestrial waterfront or adjacent aquatic areas that promote improvements in human socioeconomic well-being while protecting or improving the natural capital (the stocks of natural assets, biodiversity) that underlies all environmental, social, and economic benefits. Except for economic measures such as development investments, visitation rates, or commercial activity, evidence of waterfront revitalization in the Great Lakes is mostly anecdotal. We offer a perspective on waterfront revitalization that links indicators and metrics of sustainable revitalization to community goals and human beneficiaries. We compiled environmental, social, economic, and governance indicators and metrics of revitalization, many of which are based on or inspired by Great Lakes AOC case studies and community reutilization or sustainability plans. We highlight the role of indicators in avoiding unintended consequences of revitalization including environmental degradation and social inequity. Revitalization indicators can be used in planning for comparing alternative designs, and to track restoration progress. The relevancy of specific indicators and metrics will always depend on the local context.
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We previously demonstrated that oligomeric amyloid ß42 (oAß42) inhibits the mevalonate pathway impairing cholesterol synthesis and protein prenylation. Enzymes of the mevalonate pathway are regulated by the transcription factor SREBP-2. Here, we show that in several neuronal types challenged with oAß42, SREBP-2 activation is reduced. Moreover, SREBP-2 activation is also decreased in the brain cortex of the Alzheimer's disease (AD) mouse model, TgCRND8, suggesting that SREBP-2 may be affected in vivo early in the disease. We demonstrate that oAß42 does not affect enzymatic cleavage of SREBP-2 per se, but may impair SREBP-2 transport from the endoplasmic reticulum (ER) to the Golgi. Trafficking of SREBP-2 from the ER to the Golgi requires protein kinase B (Akt) activation. oAß42 significantly reduces Akt phosphorylation and this decrease is responsible for the decline in SREBP-2 activation. Overexpression of constitutively active Akt prevents the effect of oAß42 on SREBP-2 and the downstream inhibition of cholesterol synthesis and protein prenylation. Our work provides a novel mechanistic link between Aß and the mevalonate pathway, which will impact the views on issues related to cholesterol, isoprenoids, and statins in AD. We also identify SREBP-2 as an indirect target of Akt in neurons, which may play a role in the cross-talk between AD and diabetes.
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Peptídeos beta-Amiloides/farmacologia , Fragmentos de Peptídeos/farmacologia , Proteínas Proto-Oncogênicas c-akt/antagonistas & inibidores , Proteína de Ligação a Elemento Regulador de Esterol 2/metabolismo , Peptídeos beta-Amiloides/metabolismo , Animais , Apoptose/efeitos dos fármacos , Células Cultivadas , Feminino , Masculino , Neurônios/efeitos dos fármacos , Neurônios/metabolismo , Fragmentos de Peptídeos/metabolismo , Ratos , Ratos Sprague-DawleyRESUMO
Transcranial alternating current stimulation (tACS) is a promising tool for modulating brain oscillations. Combining tACS with functional magnetic resonance imaging (fMRI), we recently showed that tACS applied over the occipital cortex did not exert its strongest effect on regions below the electrodes, but mainly on more distant fronto-parietal regions. Theoretically, this effect could be explained by tACS-induced modulation of functional connectivity between directly stimulated areas and more distant but anatomically and functionally connected regions. In the present study, we aimed to characterize the effect of tACS on low frequency fMRI signal fluctuations. We employed simultaneous fMRI-tACS in 20 subjects during resting state (eyes open with central fixation for ~8min). Subjects received tACS at different frequencies (10, 16, 40Hz) and with different electrode montages (Cz-Oz, P5-P6) previously used in behavioral studies. Electric field simulations showed that tACS over Cz-Oz directly stimulates occipital cortex, while tACS over P5-P6 primarily targets parietal cortices. Group-level simulation-based functional connectivity maps for Cz-Oz and P5-P6 resembled the visual and fronto-parietal control resting-state networks, respectively. The effects of tACS were frequency and partly electrode montage dependent. In regions where frequency-dependent effects of tACS were observed, 10 and 40Hz tACS generally induced opposite effects. Most tACS effects on functional connectivity were observed between, as opposed to within, resting-state networks. The left fronto-parietal control network showed the most extensive frequency-dependent modulation in functional connectivity, mainly with occipito-parietal regions, where 10Hz tACS increased and 40Hz tACS decreased correlation values. Taken together, our results show that tACS modulates local spontaneous low frequency fluctuations and their correlations with more distant regions, which should be taken into account when interpreting tACS effects on brain function.
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Relógios Biológicos/fisiologia , Ondas Encefálicas/fisiologia , Plasticidade Neuronal/fisiologia , Lobo Occipital/fisiologia , Lobo Parietal/fisiologia , Estimulação Transcraniana por Corrente Contínua/métodos , Adulto , Mapeamento Encefálico/métodos , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Rede Nervosa/fisiologiaRESUMO
Strychnine is a neurotoxin and an active ingredient in some rodenticides which are placed in burrows to suppress pocket gopher (Thomomys talpoides) populations in range and crop land in western North America. The population level impact was modelled of the use of strychnine-based rodenticides on a non-target snake species, the Great Basin Gophersnake (Pituophis catenifer deserticola), which is a predator of pocket gopher and a Species at Risk in Canada. Using information on population density, demographics, and movement and habitat suitability for the Gophersnake living in an agricultural valley in BC, Canada, we estimated the impact of the poisoning of adult snakes on the long-term population size. To determine the area where Gophersnakes could be exposed to strychnine, we used vendor records of a rodenticide, and quantified the landcover areas of orchards and vineyards where the compound was most commonly applied. GIS analysis determined the areas of overlap between those agricultural lands and suitable habitats used by Gophersnakes. Stage-based population matrix models revealed that in a low density (0.1/ha) population scenario, a diet of one pocket gopher per year wherein 10 % of them carried enough strychnine to kill an adult snake could cause the loss of 2 females annually from the population and this would reduce the population by 35.3 % in 25 years. Under the same dietary exposure, up to 35 females could die per year in a high density (0.4/ha) population which would result in a loss of 50 % of adults in 25 years.
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Monitoramento Ambiental/métodos , Poluentes Ambientais/toxicidade , Modelos Teóricos , Rodenticidas/toxicidade , Serpentes/fisiologia , Estricnina/toxicidade , Agricultura , Animais , Canadá , Demografia , EcossistemaRESUMO
BACKGROUND: Pneumonia remains an important public health problem among elderly nursing home residents. This clinical trial sought to determine if a multicomponent intervention protocol, including manual tooth/gum brushing plus 0.12% chlorhexidine oral rinse, twice per day, plus upright positioning during feeding, could reduce the incidence of radiographically documented pneumonia among nursing home residents, compared with usual care. METHODS: This cluster-randomized clinical trial was conducted in 36 nursing homes in Connecticut. Eligible residents >65 years with at least 1 of 2 modifiable risk factors for pneumonia (ie, impaired oral hygiene, swallowing difficulty) were enrolled. Nursing homes were randomized to the multicomponent intervention protocol or usual care. Participants were followed for up to 2.5 years for development of the primary outcome, a radiographically documented pneumonia, and secondary outcome, a lower respiratory tract infection (LRTI) without radiographic documentation. RESULTS: A total of 834 participants were enrolled: 434 to intervention and 400 to usual care. The trial was terminated for futility. The number of participants in the intervention vs control arms with first pneumonia was 119 (27.4%) vs 94 (23.5%), respectively, and with first LRTI, 125 (28.8%) vs 100 (25.0%), respectively. In a multivariable Cox regression model, the hazard ratio in the intervention vs control arms, respectively, was 1.12 (95% confidence interval [CI], .84-1.50; P = .44) for first pneumonia and 1.07 (95% CI, .79-1.46, P = .65) for first LRTI. CONCLUSIONS: The multicomponent intervention protocol did not significantly reduce the incidence of first radiographically confirmed pneumonia or LRTI compared with usual care in nursing home residents. CLINICAL TRIALS REGISTRATION: NCT00975780.
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Clorexidina , Instituição de Longa Permanência para Idosos , Antissépticos Bucais , Casas de Saúde , Pneumonia/prevenção & controle , Escovação Dentária , Idoso , Idoso de 80 Anos ou mais , Connecticut/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pneumonia/diagnóstico por imagem , Pneumonia/epidemiologia , Pneumonia/mortalidade , Radiografia , Fatores de RiscoRESUMO
Background: It is an unfortunate truth that Emergency Medicine (EM) physicians will, at some point, have contact with the medicolegal system. However, most EM residency training programs lack education on the legal system in their curriculum, leaving EM physicians unprepared for litigation. To fill this gap, we designed a high-yield and succinct medical legal workshop highlighting legal issues commonly encountered by EM physicians. We aimed to determine the effectiveness of this curriculum by measuring pre and post knowledge questions. Methods: A two-hour session included a case-based discussion of common misconceptions held by physicians about the legal system, proper steps when interacting with the legal system and review of legal documents. This session was developed with the involvement of our hospital legal counsel and discussed real encounters. The effectiveness of the session was determined using pre- and post-session surveys assessing participant knowledge and comfort approaching the scenarios. Results: A total of 34 EM residents had the opportunity to complete this workshop as a part of their conference curriculum. A total of 26 participants completed the pre-survey and 19 participants completed the post-survey. No participants had previous training in the legal aspects of medicine, including handling a subpoena, serving as a witness, or giving a deposition. The pre-survey demonstrated that there was significant uncertainty surrounding the processes, definitions, and the legal system interaction. Many participants stated they would not know what to do if they received a subpoena (85.71%), were called as a witness in a trial (96.43%) or receive correspondence from a lawyer (96.43%). The post survey revealed an increased knowledge base and confidence following the session. 100% of residents reported knowing what to do after receiving a subpoena, being called as a witness and understanding the process involved in giving a deposition. All residents reported that the session was beneficial and provided crucial information. Conclusion: EM residents have limited baseline understanding of how to approach common legal scenarios. Educational materials available for this curriculum topic are limited. Based on the rapid knowledge increase observed in our residents, we believe our workshop could be adapted for use at other residency programs.
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Currículo , Medicina de Emergência , Internato e Residência , Medicina de Emergência/educação , Humanos , Inquéritos e Questionários , Educação de Pós-Graduação em MedicinaRESUMO
BACKGROUND: Cure Violence interruption programs are evidence-based interventions aimed at reducing the transmission of gun violence and its related injuries. Assessing the implementation of these programs can include the metric of "reach." This study evaluated one such program - 414LIFE - in Milwaukee, Wisconsin. The evaluation reconceptualized "reach" as a metric for reaching the individuals and neighborhoods at greatest risk for gun violence. METHODS: 414LIFE's reach was analyzed descriptively and geospatially through its program evaluation dataset from May 2019 through September 2020 using a cross-sectional design. Program referral criteria includes patients who sustained a gunshot wound, are less than 36 years old, and a resident of, or injured in, the city of Milwaukee. A choropleth map visualized location of participants' residence, which justified a global Moran's I, and then a local Moran's I calculation to identify statistically significant clustering of referrals. RESULTS: In the first 1.5 years of the program's partnership with the local level I trauma center and affiliated academic medical institution, 398 patients were referred. Three hundred referrals (75.4%) met program criteria; 53.8% were Black men. Statistically significant clusters were identified and mapped. Half of the top 10 neighborhoods with referrals were the city's identified priority neighborhoods. CONCLUSIONS: 414LIFE successfully reaches its intended population and geographic locations. Geospatial reach should be considered routinely in program evaluations of Cure Violence programs to track growth and reach over time.
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Avaliação de Programas e Projetos de Saúde , Humanos , Wisconsin , Masculino , Estudos Transversais , Feminino , Adulto , Violência com Arma de Fogo , Adolescente , Ferimentos por Arma de Fogo , Características de ResidênciaRESUMO
Complaints reflect a person's or family's experience within the aged care system and provide important insight into community expectations and consumer priorities. Crucially, when aggregated, complaints data can serve to indicate problematic trends in care provision. Our objective was to characterize the areas of medication management most frequently complained about in Australian residential aged care services from 1 July 2019 to 30 June 2020. A total of 1134 complaint issues specifically referenced medication use. Using content analysis, with a dedicated coding framework, we found that 45% of these complaints related to medicine administration processes. Three categories received nearly two thirds of all complaints: (1) not receiving medication at the right time; (2) inadequate medication management systems; and (3) chemical restraint. Half of the complaints described an indication for use. These were, in order of frequency: 'pain management', 'sedation', and 'infectious disease/infection control'. Only 13% of medication-related complaints referred to a specific pharmacological agent. Opioids were the most common medication class referred to in the complaint dataset, followed by psychotropics and insulin. When compared to complaint data composition overall, a higher proportion of anonymous complaints were made about medication use. Residents were significantly less likely to lodge complaints about medication management, probably due to limited engagement in this part of clinical care provision.
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Introduction The emergency medicine (EM) match has undergone significant shifts in 2022 and 2023. While variation in specialty fill rates is expected over time, EM programs noted a significant increase in open positions starting in 2022. Utilizing National Resident Matching Program (NRMP) data over a 10-year period, we identified significant deviations in the emergency medicine match. Methods Shewhart control charts were used to plot the match results over time. A 10-year sample was used to establish the baseline value. From this value, the upper and lower control limits were established. Residency program expansion, decreasing applicant numbers, and changing applicant types were evaluated to detect any non-random changes to the process. Results While the number of EM PGY-1 positions added over time was within the expected range, both the number of unmatched positions and the change in the number of total US MD applicants were outside of this range and are considered to be "out of control." Conclusion It is not yet clear which contributing causes may underlie this sudden change. Several potential etiologies exist, including mismatches in supply and demand for positions, changes in perceptions of the specialty, the effects of COVID-19, and changing workforce needs. Historically similar experiences affecting other specialties, including anesthesia and radiation oncology, are analyzed. Potential solutions for returning to the necessary and usual success of the emergency medicine specialty match are explored.
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Semantic knowledge is central to human cognition. The angular gyrus (AG) is widely considered a key brain region for semantic cognition. However, the role of the AG in semantic processing is controversial. Key controversies concern response polarity (activation vs. deactivation) and its relation to task difficulty, lateralization (left vs. right AG), and functional-anatomical subdivision (PGa vs. PGp subregions). Here, we combined the fMRI data of five studies on semantic processing (n = 172) and analyzed the response profiles from the same anatomical regions-of-interest for left and right PGa and PGp. We found that the AG was consistently deactivated during non-semantic conditions, whereas response polarity during semantic conditions was inconsistent. However, the AG consistently showed relative response differences between semantic and non-semantic conditions, and between different semantic conditions. A combined analysis across all studies revealed that AG responses could be best explained by separable effects of task difficulty and semantic processing demand. Task difficulty effects were stronger in PGa than PGp, regardless of hemisphere. Semantic effects were stronger in left than right AG, regardless of subregion. These results suggest that the AG is engaged in both domain-general task-difficulty-related processes and domain-specific semantic processes. In semantic processing, we propose that left AG acts as a "multimodal convergence zone" that binds different semantic features associated with the same concept, enabling efficient access to task-relevant features.
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Mapeamento Encefálico , Lobo Parietal , Humanos , Mapeamento Encefálico/métodos , Lobo Parietal/diagnóstico por imagem , Lobo Parietal/fisiologia , Cognição/fisiologia , Semântica , Neuroimagem Funcional , Imageamento por Ressonância Magnética/métodosRESUMO
BACKGROUND: Health care workers are often uncertain of the role of law enforcement personnel in the resuscitation bay. A cross-sectional, quality improvement project was designed with an educational intervention to address the knowledge gaps. METHODS: There were 2 sessions for trauma surgery and emergency medicine faculty, residents, and staff. The first was a formal presentation by hospital risk management and security focused on answering questions generated by real-life scenarios. After reviewing feedback from the first session, the second session was designed as a panel discussion led by attending physicians who reviewed various clinical scenarios. A pre/postsurvey was administered, including potential clinical scenarios with multiple-choice answers and open feedback. RESULTS: There were 64 presurvey and 31 postsurvey respondents from the first session (48.4%). Significantly more questions were answered correctly from pre to postsurvey (5.5 vs 6.7/16 questions; U = 798.0, P = .048). Of the 14 (45.2%) respondents who provided open-ended feedback, 50% indicated confusion, and 21.4% expressed strong, negative emotions. In the second session, there were 39 presurvey and 18 postsurvey respondents (46.2%). Again, significantly more questions were answered correctly after the second session (2.2 vs 4.5/7 questions; U = 115.0, P ≤ .001). Feedback highlighted that the panel format was considered more helpful than the formal didactic of the first session. CONCLUSION: Confusion about the role of law enforcement personnel in the clinical environment can be partially addressed using multidisciplinary joint conferences that should be led by clinicians to ensure real-life clinical applicability. Further education and law enforcement personnel role clarification for health care workers are critical to protect patient rights.
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Aplicação da Lei , Ressuscitação , Humanos , Estudos Transversais , Currículo , Pessoal de SaúdeRESUMO
We captured a <1-d-old male elk calf (Cervus canadensis) with a shortened neck. Postmortem examination revealed trauma, meconium aspiration syndrome, and cervical vertebral malformation (partial fusion and narrowed disc spaces). This observation is novel in a wild elk calf, although the gross lesions resembled complex vertebral malformation in neonatal cattle.
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Animais Selvagens , Doenças do Desenvolvimento Ósseo , Cervos , Animais , Masculino , Kentucky , Síndrome de Aspiração de Mecônio/veterinária , Vértebras Cervicais/anormalidades , Doenças do Desenvolvimento Ósseo/diagnóstico , Doenças do Desenvolvimento Ósseo/veterinária , Animais Recém-NascidosRESUMO
Devices capable of recording or stimulating neuronal signals have created new opportunities to understand normal physiology and treat sources of pathology in the brain. However, it is possible that the tissue response to implanted electrodes may influence the nature of the signals detected or stimulated. In this study, we characterized structural and functional changes in deep layer pyramidal neurons surrounding silicon or polyimide-based electrodes implanted in the motor cortex of rats. Devices were captured in 300 µm-thick tissue slices collected at the 1 or 6 week time point post-implantation, and individual neurons were assessed using a combination of whole-cell electrophysiology and 2-photon imaging. We observed disrupted dendritic arbors and a significant reduction in spine densities in neurons surrounding devices. These effects were accompanied by a decrease in the frequency of spontaneous excitatory post-synaptic currents, a reduction in sag amplitude, an increase in spike frequency adaptation, and an increase in filopodia density. We hypothesize that the effects observed in this study may contribute to the signal loss and instability that often accompany chronically implanted electrodes. STATEMENT OF SIGNIFICANCE: Implanted electrodes in the brain can be used to treat sources of pathology and understand normal physiology by recording or stimulating electrical signals generated by local neurons. However, a foreign body response following implantation undermines the performance of these devices. While several studies have investigated the biological mechanisms of device-tissue interactions through histology, transcriptomics, and imaging, our study is the first to directly interrogate effects on the function of neurons surrounding electrodes using single-cell electrophysiology. Additionally, we provide new, detailed assessments of the impacts of electrodes on the dendritic structure and spine morphology of neurons, and we assess effects for both traditional (silicon) and newer polymer electrode materials. These results reveal new potential mechanisms of electrode-tissue interactions.