Virtual dissection and comparative connectivity of the superior longitudinal fasciculus in chimpanzees and humans.

Many of the behavioral capacities that distinguish humans from other primates rely on fronto-parietal circuits. The superior longitudinal fasciculus (SLF) is the primary white matter tract connecting lateral frontal with lateral parietal regions; it is distinct from the arcuate fasciculus, which interconnects the frontal and temporal lobes. Here we report a direct, quantitative comparison of SLF connectivity using virtual in vivo dissection of the SLF in chimpanzees and humans. SLF I, the superior-most branch of the SLF, showed similar patterns of connectivity between humans and chimpanzees, and was proportionally volumetrically larger in chimpanzees. SLF II, the middle branch, and SLF III, the inferior-most branch, showed species differences in frontal connectivity. In humans, SLF II showed greater connectivity with dorsolateral prefrontal cortex, whereas in chimps SLF II showed greater connectivity with the inferior frontal gyrus. SLF III was right-lateralized and proportionally volumetrically larger in humans, and human SLF III showed relatively reduced connectivity with dorsal premotor cortex and greater extension into the anterior inferior frontal gyrus, especially in the right hemisphere. These results have implications for the evolution of fronto-parietal functions including spatial attention to observed actions, social learning, and tool use, and are in line with previous research suggesting a unique role for the right anterior inferior frontal gyrus in the evolution of human fronto-parietal network architecture.

Incidence, nature, and temporal trends of adverse events associated with noncardiac procedures among veterans with drug-eluting coronary artery stents.

BACKGROUND: The incidence of adverse events with noncardiac procedures (NCP) after the use of drug eluting stents (DES) is not well studied. We sought to determine the incidence and temporal trends of adverse events in patients undergoing NCP after coronary DES. METHODS: We performed a retrospective review of patients receiving DES during percutaneous coronary intervention (PCI) in the Lexington VAMC between January 1, 2004 and December 31, 2010 to determine the circumstances and the results of their NCP. RESULTS: We identified 1,092 patients who underwent at least one PCI with DES who were followed for at least 3 years. Of those, 452 patients (41%) had a NCP at a median of 534 days after PCI with 1,081 procedures (894 low-, 160 Intermediate-, and 27 high-risk) performed. Clinically relevant NCP-related complications were defined as significant bleeding or stent thrombosis and occurred in 13 individuals (nine perioperative bleeding and four probable/possible stent thrombosis including two mortalities). Five adverse events occurred within the first year at a rate of 0.014 event/patient-year. During the remainder of follow-up (up to 9 years), eight events were documented at a rate of 0.0004 event/patient-years. During the first year of follow-up, there was no significant increase in risk of recurrent myocardial infarction (MI) or target vessel revascularization (TVR) in patients undergoing NCP but higher risk of all-cause mortality in those who did not undergo NCP. However, in patients who underwent NCP, there was a statistically significant increase in myocardial infarction (MI), target vessel revascularization (TVR), and rehospitalization for cardiac reasons compared with those without NCP during long term follow-up (median of 5.6 years). CONCLUSION: NCP after DES requiring management of DAT are relatively common among veterans following PCI using DES. The risk of bleeding and stent thrombosis is concentrated in the first year but remains very low.

The effect of virtual reality gaming on dynamic balance in older adults.

BACKGROUND: physical therapy interventions that increase functional strength and balance have been shown to reduce falls in older adults. AIM: this study compared a virtual reality group (VRG) and a control group (CG). DESIGN: randomised controlled 6-week intervention with pre- and post-test evaluations. SETTING: outpatient geriatric orthopaedic and balance physical therapy clinic. POPULATION: forty participants were randomised into two groups. METHOD: the VRG received three different Nintendo® Wii FIT balance interventions three times per week for 6 weeks and the CG received no intervention. RESULTS: compared with the CG, post-intervention measurements showed significant improvements for the VRG in the 8-foot Up & Go test [median decrease of 1.0 versus -0.2 s, (P=0.038) and the Activities-specific Balance Confidence Scale (6.9 versus 1.3%) (P=0.038)]. CONCLUSION: virtual reality gaming provides clinicians with a useful tool for improving dynamic balance and balance confidence in older adults.

Improved balance in middle-aged adults after 8 weeks of a modified version of Otago Exercise Program: A randomized controlled trial.

OBJECTIVE: The objective of this randomized controlled trial was to examine dynamic balance changes (reach distance) in middle-aged adults using the Y Balance Test (YBT) following 8 weeks of home-based exercise program adapted from the Otago Exercise Program (OEP). METHODS: Fifty-two healthy middle-aged adults with mean age of 54.4±5.4 years and body mass index of 27.7±5.7 kg/m2 were randomly assigned into either the exercise group (a modification of the Otago Exercise Program, that consisted of home-based balance and strength exercises) or the non-exercise group (continuation of usual lifestyle) by having the participants select a paper from a sealed envelope. The YBT was used to measure participants' dynamic balance in the right and left anterior (RA, LA), posteromedial (RPM, LPM), and posterolateral (RPL, LPL) directions. RESULTS: The outcome in this trial was reach distance (cm). There was a significant group by time interaction in terms of reach distance for all directions (p<0.05, η2 ranged from 0.06 to 0.20). In the exercise group, results of the repeated measures analysis of variance (ANOVA) showed significant improvements in the reach distance in all the directions (p<0.001). In contrast, the non-exercise group had significant difference only in the left posterolateral direction (p = 0.009). Participants in the exercise group achieved significantly greater reach distance (cm) (95% confidence interval (CI)) for RA[(2.8, 0.4 to 5.2), p = 0.023]; LA[(3.2, 0.9 to 5.6), p = 0.008]; RPM[(4.0, 1.0 to 7.9), p = 0.046]; LPM[(5.8,1.3 to 10.3), p = 0.013]; RPL[(7.6, 2.6 to 12.6), p = 0.003]; and LPL[(4.2, 0.3 to 8.2), p = 0.035]. CONCLUSION: The modified version of OEP appears to be effective in improving parameters of dynamic balance in the middle-aged adult population. The improvements in YBT reach distance in the exercise group are indicative of the significance of performing balance and strength exercises regularly for this population.

Effect of a static calf muscle-tendon unit stretching program on ankle dorsiflexion range of motion of older women.

BACKGROUND AND PURPOSE: While there has been considerable research on stretching, a paucity of research has focused on stretching of the calf muscle-tendon unit (MTU) in older women. Because limited ankle dorsiflexion range of motion (ROM) is associated with gait abnormalities and increases the risk of falls in the elderly, we investigated the effect of static stretching on flexibility of the calf MTU of healthy elderly adults. METHODS: Twenty healthy female volunteers, 76 to 91 years of age, were recruited from Linda Valley Villa, an independent living center. Subjects performed a static stretching program 5 days a week for 6 weeks. Passive ankle dorsiflexion ROM was taken prior to beginning the stretching program and 3 days after the last stretching day. RESULTS: Mean increase in passive ankle dorsiflexion ROM was 12.3 degrees (SD= 4.4 degrees ) (p < .001). CONCLUSION: A 6-week stretching program is capable of provoking a significant increase in ankle dorsiflexion ROM for elderly women.

Hepatic encephalopathy for the hospitalist.

The care of patients with advanced liver disease is often complicated by episodes of acute decline in alertness and cognition, termed hepatic encephalopathy (HE). Hospitalists must be familiar with HE, as it is a common reason for hospitalization in this population and is associated with significantly increased mortality. This narrative review addresses common issues related to diagnosis and classification, precipitants, inpatient management, and transitions of care for patients with HE. The initial presentation can be variable, and HE remains a clinical diagnosis. The spectrum of HE manifestations spans from mild, subclinical cognitive deficits to overt coma. The West Haven scoring system is the most widely used classification system for HE. Various metabolic insults may precipitate HE, and providers must specifically seek to rule out infection and bleeding in cirrhotic patients presenting with altered cognition. This is consistent with the 4-pronged approach of the American Association for the Study of Liver Disease practice guidelines. Patients with HE are typically treated primarily with nonabsorbable disaccharide laxatives, often with adjunctive rifaximin. The evidence for these agents is discussed, and available support for other treatment options is presented. Management issues relevant to general hospitalists include those related to acute pain management, decisional capacity, and HE following transjugular intrahepatic portosystemic shunt placement. These issues are examined individually. Successfully transitioning patients recovering from HE to outpatient care requires open communication with multiple role players including patients, caregivers, and outpatient providers. Journal of Hospital Medicine 2016;11:591-594. © 2016 Society of Hospital Medicine.

Cognitive demands of lower paleolithic toolmaking.

Stone tools provide some of the most abundant, continuous, and high resolution evidence of behavioral change over human evolution, but their implications for cognitive evolution have remained unclear. We investigated the neurophysiological demands of stone toolmaking by training modern subjects in known Paleolithic methods ("Oldowan", "Acheulean") and collecting structural and functional brain imaging data as they made technical judgments (outcome prediction, strategic appropriateness) about planned actions on partially completed tools. Results show that this task affected neural activity and functional connectivity in dorsal prefrontal cortex, that effect magnitude correlated with the frequency of correct strategic judgments, and that the frequency of correct strategic judgments was predictive of success in Acheulean, but not Oldowan, toolmaking. This corroborates hypothesized cognitive control demands of Acheulean toolmaking, specifically including information monitoring and manipulation functions attributed to the "central executive" of working memory. More broadly, it develops empirical methods for assessing the differential cognitive demands of Paleolithic technologies, and expands the scope of evolutionary hypotheses that can be tested using the available archaeological record.

The manipulative complexity of Lower Paleolithic stone toolmaking.

BACKGROUND: Early stone tools provide direct evidence of human cognitive and behavioral evolution that is otherwise unavailable. Proper interpretation of these data requires a robust interpretive framework linking archaeological evidence to specific behavioral and cognitive actions. METHODOLOGY/PRINCIPAL FINDINGS: Here we employ a data glove to record manual joint angles in a modern experimental toolmaker (the 4(th) author) replicating ancient tool forms in order to characterize and compare the manipulative complexity of two major Lower Paleolithic technologies (Oldowan and Acheulean). To this end we used a principled and general measure of behavioral complexity based on the statistics of joint movements. CONCLUSIONS/SIGNIFICANCE: This allowed us to confirm that previously observed differences in brain activation associated with Oldowan versus Acheulean technologies reflect higher-level behavior organization rather than lower-level differences in manipulative complexity. This conclusion is consistent with a scenario in which the earliest stages of human technological evolution depended on novel perceptual-motor capacities (such as the control of joint stiffness) whereas later developments increasingly relied on enhanced mechanisms for cognitive control. This further suggests possible links between toolmaking and language evolution.

Crossroads in quality.

Expanding insurance coverage is a critical step in health reform, but we argue that to be successful, reforms must also address the underlying problems of quality and cost. We identify five fundamental building blocks for a high-performance health system and urge action to create a national center for effectiveness research, develop models of accountable health care entities capable of providing integrated and coordinated care, develop payment models to reward high-value care, develop a national strategy for performance measurement, and pursue a multistakeholder approach to improving population health.

Tissue Iodine in Sheep Fed Diets Containing Ethylenediamine Dihydriodide.

Twenty-four male lambs, produced by crossing commercial blackfaced ewes with purebred Suffolk rams and averaging 40.1 kg body wt., were fed one of two ethylenediamine dihydriodide (EDDI)-supplemented diets. A total of eight pens (four pens per treatment) containing three animals each were assigned at random to the two diets. Dietary treatments consisted of a basal diet containing 0.79 ppm I as EDDI and EDDI-supplemented diets providing an additional 12 mg of EDDI/head/d. The diets were fed for 42 d, after which the animals were slaughtered and various tissues collected for I analysis. Iodine concentration in the serum of sheep fed the EDDI-supplemented diet increased fivefold (62 vs. 12 µg/dl) over the control animals within a week and this difference was maintained throughout the experiment. There was a trend toward increased I in semimembranosus, psoas major, longissimus and trapezius muscles, although this was statistically nonsignificant. Increases (P<0.01) in the I concentration in liver (0.085 vs. 0.166 µg/g) and kidney (0.143 vs. 0.409 µg/g) were observed. Analysis of thyroid tissue indicated no increase in I concentration (1732 vs. 2166 µg/g). Based on these results, it is concluded that feeding EDDI to sheep at 12 mg/head/d until slaughter increased I in edible tissues. The rate at which iodine depletes from these tissues is unknown.