Submammary Implantation of Internal Pulse Generators for Deep Brain Stimulation: Long-Term Follow-up of Device Acceptance and Quality of Life in Women.

BACKGROUND: A submammary approach to implanting pulse generators is innovative and has yielded good aesthetic results in the current literature. It was our aim to make a comparison of patient device acceptance, tolerance, and complications between submammary and abdominal device locations in deep brain stimulation. METHODS: Twenty-five and 28 patients were included in the submammary and abdominal groups, respectively. Our primary criterion was patient acceptance that was calculated using total Florida Patient Acceptance Survey (FPAS) scores in each group. Secondarily, tolerance was assessed in the submammary group by means of a specific questionnaire. RESULTS: Total FPAS scores from the submammary group [total FPAS: 77.1 versus 74.7, P = 0.29] revealed no significant difference when compared with the abdominal group. The same similarities were observed regarding the 4 subscales: return to function [16.3 versus 15.8, P = 0.53], device-related distress [22.0 versus 21.3, P = 0.31], body image concerns [9.2 versus 8.6, P = 0.14], and positive appraisal [17.8 versus 17.4, P = 0.58]. Tolerance was reported as good by the majority of the women from the submammary group. There was no evidence of higher infection rates in the submammary implantation (SMI) group. CONCLUSIONS: SMI is a satisfactory alternative to other deep brain stimulation locations. SMI is a feasible option for any young woman who is eligible for deep brain stimulation.

Physical and cognitive performance during long-term cold weather operations.

BACKGROUND: Physiological responses, physical performance, and cognitive performance were measured during military cold weather survival courses to determine the effects of long-term cold exposure on training safety and potential survival ability. METHODS: There were 28 males, from 5 9-d winter survival courses, who participated. Cognitive performance was evaluated through logical reasoning, planning, and vigilance. Physical performance was evaluated with tests of hand function and arm strength. Subjective cold sensation scale (CSS), rating of perceived exertion (RPE), and mood indicators were quantified. Core temperature (T(core0) and HR were recorded continuously throughout the courses, and fingertip temperature (T(finger)) was also recorded during testing. Hematocrit values to indicate hydration status were obtained from blood samples taken on three occasions. RESULTS: Mean air temperature (T(air)) during the testing periods ranged from -24.4 to 4.4 degrees C among the five courses. Hydration level and T(core) remained normal throughout all courses while T(finger) decreased with decreasing T(air). Finger dexterity deteriorated by 23-28% when T(finger) decreased from 18 to 10 degrees C. Muscular strength was decreased by a small (4%) but significant amount over 6 d of testing. Cognitive function was unaffected by cold air or time on the course. Mood indicators were consistent with CSS and RPE scores. CONCLUSION: Under the exposure conditions and availability of basic survival equipment, including water, described herein, and in the absence of trauma, healthy fit individuals can participate in this military training without any serious decrements in cognitive and physical performance. In an actual survival situation, similarly decreased dexterity may adversely affect survival activities.

Effect of modafinil on core temperature during sustained wakefulness and exercise in a warm environment.

BACKGROUND: Previous studies have revealed that modafinil elevates resting core temperature during periods of sustained wakefulness. The purpose of this study was to examine the effects of modafinil on core temperature during rest and exercise throughout 40 h of sustained wakefulness in a warm environment. METHODS: Ten males performed a drug session (three 100 mg doses per day) and a placebo session that involved a control day, 40 h of sustained wakefulness, and a recovery sleep. For 38 h of the sustained wakefulness, subjects were exposed to 30 degrees C with 50% relative humidity. During the afternoon of both days of wakefulness and during the early morning of the second day, subjects performed 2 h of exercise at 60% VO2max while exposed to the warm environment. RESULTS: The data revealed that rectal temperature (Tre) was elevated at rest 0.15-0.2 degrees C following modafinil ingestion throughout the period of sustained wakefulness. This increase in body temperature at rest was due to an increase in heat production during the first day of wakefulness followed by a lower evaporative heat loss during the second day. During exercise, an inconsistent effect of the drug on Tre was observed throughout the 38-h period. On the first afternoon, the impact of modafinil on Tre was no longer evident after 20 min of exercise. In contrast, during the early morning and afternoon of the second day, the effects of the drug on Tre at rest remained during exercise. For seven subjects who had Tre data for 80 min during all exercise periods, Tre during the placebo session was 38.9, 38.4, and 38.7 degrees C after 80 min of exercise for periods one, two and three, respectively, whereas the corresponding values during the modafinil session were 38.8, 38.7, and 38.9 degrees C. CONCLUSION: With a greater cumulative dose of the drug, Tre remained elevated throughout the exercise period to an extent similar to the increase observed under resting conditions when compared with the placebo condition.

Effects of sleep loss on team decision making: motivational loss or motivational gain?

OBJECTIVE: To examine the effects of 30 hr of sleep loss and continuous cognitive work on performance in a distributed team decision-making environment. BACKGROUND: To date, only a few studies have examined the effect of sleep loss on distributed team performance, and only one other to our knowledge has examined the relationship between sleep loss and social-motivational aspects of teams (Hoeksema-van Orden, Gaillard, & Buunk, 1998). METHOD: Sixteen teams participated; each comprised 4 members. Three team members made threat assessments on a military surveillance task and then forwarded their judgments electronically to a team leader, who made a final assessment on behalf of the team. RESULTS: Sleep loss had an antagonistic effect on team decision-making accuracy and decision time. However, the performance loss associated with fatigue attributable to sleep loss was mediated by being part of a team, as compared with performing the same task individually - that is, we found evidence of a "motivational gain" effect in these sleepy teams. We compare these results with those of Hoeksema-van Orden et al. (1998), who found clear evidence of a "social loafing" effect in sleepy teams. CONCLUSION: The divergent results are discussed in the context of the collective effort model (Karau & Williams, 1993) and are attributable in part to a difference between independent and interdependent team tasks. APPLICATION: The issues and findings have implications for a wide range of distributed, collaborative work environments, such as military network-enabled operations.