Altered prefrontal activation during the inhibition of eating responses in women with bulimia nervosa.

BACKGROUND: The sense of 'loss of control' (LOC), or a feeling of being unable to stop eating or control what or how much one is eating, is the most salient aspect of binge eating. However, the neural alterations that may contribute to this experience and eating behavior remain poorly understood. METHODS: We used functional near-infrared spectroscopy (fNIRS) to measure activation in the prefrontal cortices of 23 women with bulimia nervosa (BN) and 23 healthy controls (HC) during two tasks: a novel go/no-go task requiring inhibition of eating responses, and a standard go/no-go task requiring inhibition of button-pressing responses. RESULTS: Women with BN made more commission errors on both tasks. BN subgroups with the most severe LOC eating (n = 12) and those who felt most strongly that they binge ate during the task (n = 12) showed abnormally reduced bilateral ventromedial prefrontal cortex (vmPFC) and right ventrolateral prefrontal cortex (vlPFC) activation associated with eating-response inhibition. In the entire BN sample, lower eating-task activation in right vlPFC was related to more frequent and severe LOC eating, but no group differences in activation were detected on either task when this full sample was compared with HC. BN severity was unrelated to standard-task activation. CONCLUSIONS: Results provide initial evidence that diminished PFC activation may directly contribute to more severe eating-specific control deficits in BN. Our findings support vmPFC and vlPFC dysfunction as promising treatment targets, and indicate that eating-specific tasks and fNIRS may be useful tools for identifying neural mechanisms underlying dysregulated eating.

Relationships of hip abductor strength, neuromuscular control, and hip width to femoral length ratio with peak hip adduction angle in healthy female runners.

A large peak hip adduction angle during running is a risk factor for several overuse injuries in women. The purpose of this study was to determine if female runners with a large peak hip adduction angle have differences in eccentric hip abductor muscle strength, hip neuromuscular control, and/or hip width to femoral length ratio (HW:FL) compared to those with a small angle. Hip adduction during running, hip strength, hip control, and HW:FL were measured in sixty healthy female runners (1.66 ± 0.06 m; 63.2 ± 8.3 kg; 27 ± 6 years). Data from twenty runners with the largest and twenty with the smallest peak hip adduction angles were analysed. Between-group differences in hip strength, control, and HW:FL were determined using independent t-tests (p < 0.05). Variables that were significantly different between groups were entered into a regression model. Runners in both groups had similar hip strength (p = 0.90) and control (p = 0.65). HW:FL was greater in the large peak angle group (p = 0.04), but only explained a small amount of peak hip adduction angle variance for all sixty runners (R2 = 0.05). Alarge peak hip adduction angle in some healthy female runners may simply be instinctive as there were no deficiencies in the strength or neuromuscular control constructs assessed.

Sedentary behavior time as a predictor of hemoglobin A1c among adults, 40 to 59 years of age, living in the United States: National Health and Nutrition Examination Survey 2003 to 2004 and 2013 to 2014.

BACKGROUND: Sedentary behavior activities have been associated with an increased risk of type 2 diabetes. Aim: Our aim was to determine whether sedentary behavior time (SBT) is predictive of hemoglobin A1c (HbA1c) ≥ 6.5% (48 mmol/mol). METHODS: We used cross-sectional data, adults 40 to 59 years of age, from the National Health and Nutrition Examination Survey (NHANES) for 2003 to 2004 and 2013 to 2014. Responses to questions on the Physical Activity Questionnaire regarding time watching television/videos, and time spent sitting in front of a computer per day were compiled into tertiles. Binary logistic regression analysis was used to determine whether SBT was a predictor of a HbA1c ≥ 6.5% adjusting for age, sex, race and ethnicity, and body mass index. RESULTS: In a univariate model, adults reporting ≥ 8 hours of SBT in NHANES 2003-2004 had 2.02 increased odds of a HbA1c ≥ 6.5% (OR = 2.02, 95% CI: 1.31, 3.13, p < 0.0001) compared to adults reporting ≤ 3 hours. After adjusting the regression model for age, sex, race and ethnicity, and body mass index, adults reporting ≥ 8 hours of SBT in NHANES 2003 to 2004 had 1.72 increased odds of HbA1c ≥ 6.5% (OR = 2.02, 95% CI: 1.10, 2.68, p < 0.0001) compared to adults reporting ≤ 3 hours of SBT. Reported SBT was not a predictor of HbA1c ≥ 6.5% for NHANES 2013 to 2014. CONCLUSION: Reported SBT was a predictor of HbA1c ≥ 6.5% among adults, 40 to 59 years of age, in NHANES 2003 to 2004, but was not a predictor in 2013 to 2014.

Changes in motor performance and mental workload during practice of reaching movements: a team dynamics perspective.

Few investigations have examined mental workload during motor practice or learning in a context of team dynamics. This study examines the underlying cognitive-motor processes of motor practice by assessing the changes in motor performance and mental workload during practice of reaching movements. Individuals moved a robotic arm to reach targets as fast and as straight as possible while satisfying the task requirement of avoiding a collision between the end-effector and the workspace limits. Individuals practiced the task either alone (HA group) or with a synthetic teammate (HRT group), which regulated the effector velocity to help satisfy the task requirements. The findings revealed that the performance of both groups improved similarly throughout practice. However, when compared to the individuals of the HA group, those in the HRT group (1) had a lower risk of collisions, (2) exhibited higher performance consistency, and (3) revealed a higher level of mental workload while generally perceiving the robotic teammate as interfering with their performance. As the synthetic teammate changed the effector velocity in specific regions near the workspace boundaries, individuals may have been constrained to learn a piecewise visuomotor map. This piecewise map made the task more challenging, which increased mental workload and perception of the synthetic teammate as a burden. The examination of both motor performance and mental workload revealed a combination of both adaptive and maladaptive team dynamics. This work is a first step to examine the human cognitive-motor processes underlying motor practice in a context of team dynamics and contributes to inform human-robot applications.

Using Mean Absolute Relative Phase, Deviation Phase and Point-Estimation Relative Phase to Measure Postural Coordination in a Serial Reaching Task.

The objectives of this communication are to present the methods used to calculate mean absolute relative phase (MARP), deviation phase (DP) and point estimate relative phase (PRP) and compare their utility in measuring postural coordination during the performance of a serial reaching task. MARP and DP are derived from continuous relative phase time series representing the relationship between two body segments or joints during movements. MARP is a single measure used to quantify the coordination pattern and DP measures the stability of the coordination pattern. PRP also quantifies coordination patterns by measuring the relationship between the timing of maximal or minimal angular displacements of two segments within cycles of movement. Seven young adults practiced a bilateral serial reaching task 300 times over 3 days. Relative phase measures were used to evaluate inter-joint relationships for shoulder-hip (proximal) and hip-ankle (distal) postural coordination at early and late learning. MARP, PRP and DP distinguished between proximal and distal postural coordination. There was no effect of practice on any of the relative phase measures for the group, but individual differences were seen over practice. Combined, MARP and DP estimated stability of in-phase and anti-phase postural coordination patterns, however additional qualitative movement analyses may be needed to interpret findings in a serial task. We discuss the strengths and limitations of using MARP and DP and compare MARP and DP to PRP measures in assessing coordination patterns in the context of various types of skillful tasks. Key pointsMARP, DP and PRP measures coordination between segments or joint anglesAdvantages and disadvantages of each measure should be considered in relationship to the performance taskMARP and DP may capture coordination patterns and stability of the patterns during discrete tasks or phases of movements within a taskPRP and SD or PRP may capture coordination patterns and stability during continuous oscillating movement tasks.

An exploration of grip force regulation with a low-impedance myoelectric prosthesis featuring referred haptic feedback.

BACKGROUND: Haptic display technologies are well suited to relay proprioceptive, force, and contact cues from a prosthetic terminal device back to the residual limb and thereby reduce reliance on visual feedback. The ease with which an amputee interprets these haptic cues, however, likely depends on whether their dynamic signal behavior corresponds to expected behaviors-behaviors consonant with a natural limb coupled to the environment. A highly geared motor in a terminal device along with the associated high back-drive impedance influences dynamic interactions with the environment, creating effects not encountered with a natural limb. Here we explore grasp and lift performance with a backdrivable (low backdrive impedance) terminal device placed under proportional myoelectric position control that features referred haptic feedback. METHODS: We fabricated a back-drivable terminal device that could be used by amputees and non-amputees alike and drove aperture (or grip force, when a stiff object was in its grasp) in proportion to a myoelectric signal drawn from a single muscle site in the forearm. In randomly ordered trials, we assessed the performance of N=10 participants (7 non-amputee, 3 amputee) attempting to grasp and lift an object using the terminal device under three feedback conditions (no feedback, vibrotactile feedback, and joint torque feedback), and two object weights that were indiscernible by vision. RESULTS: Both non-amputee and amputee participants scaled their grip force according to the object weight. Our results showed only minor differences in grip force, grip/load force coordination, and slip as a function of sensory feedback condition, though the grip force at the point of lift-off for the heavier object was significantly greater for amputee participants in the presence of joint torque feedback. An examination of grip/load force phase plots revealed that our amputee participants used larger safety margins and demonstrated less coordination than our non-amputee participants. CONCLUSIONS: Our results suggest that a backdrivable terminal device may hold advantages over non-backdrivable devices by allowing grip/load force coordination consistent with behaviors observed in the natural limb. Likewise, the inconclusive effect of referred haptic feedback on grasp and lift performance suggests the need for additional testing that includes adequate training for participants.

Do laparoscopic skills transfer to robotic surgery?

BACKGROUND: Identifying the set of skills that can transfer from laparoscopic to robotic surgery is an important consideration in designing optimal training curricula. We tested the degree to which laparoscopic skills transfer to a robotic platform. METHODS: Fourteen medical students and 14 surgery residents with no previous robotic but varying degrees of laparoscopic experience were studied. Three fundamentals of laparoscopic surgery tasks were used on the laparoscopic box trainer and then the da Vinci robot: peg transfer (PT), circle cutting (CC), and intracorporeal suturing (IS). A questionnaire was administered for assessing subjects' comfort level with each task. RESULTS: Standard fundamentals of laparoscopic surgery scoring metric were used and higher scores indicate a superior performance. For the group, PT and CC scores were similar between robotic and laparoscopic modalities (90 versus 90 and 52 versus 47; P > 0.05). However, for the advanced IS task, robotic-IS scores were significantly higher than laparoscopic-IS (80 versus 53; P < 0.001). Subgroup analysis of senior residents revealed a lower robotic-PT score when compared with laparoscopic-PT (92 versus 105; P < 0.05). Scores for CC and IS were similar in this subgroup (64 ± 9 versus 69 ± 15 and 95 ± 3 versus 92 ± 10; P > 0.05). The robot was favored over laparoscopy for all drills (PT, 66.7%; CC, 88.9%; IS, 94.4%). CONCLUSIONS: For simple tasks, participants with preexisting skills perform worse with the robot. However, with increasing task difficulty, robotic performance is equal or better than laparoscopy. Laparoscopic skills appear to readily transfer to a robotic platform, and difficult tasks such as IS are actually enhanced, even in subjects naive to the technology.

Cardiorespiratory response during physical therapist intervention for infants and young children with chronic respiratory insufficiency.

PURPOSE: To document physical therapist intervention activities and cardiorespiratory response for young children with chronic respiratory insufficiency. METHODS: Twelve children born prematurely, 6 to 30 months chronological age and admitted to inpatient pulmonary rehabilitation for oxygen and/or ventilation weaning, were included. During 3 intervention sessions, a second physical therapist recorded intervention activity and heart rate (HR), oxygen saturation (SaO2), and respiratory rate. Total time and median HR, SaO2, and respiratory rate for each activity were calculated. An analysis of variance was used to compare HR and SaO2 across activity based on intersession reliability. RESULTS: Sitting activities were most frequent and prone least frequent. Median cardiorespiratory measures were within reference standards for age. No adverse effects were seen during intervention and no significant difference was found in HR and SaO2 among intervention activities. CONCLUSION: Young children with chronic respiratory insufficiency are able to tolerate intervention with close monitoring by the physical therapist.

Differences in time-frequency characteristics between healthy controls and TBI patients during hypercapnia assessed via fNIRS.

Damage to the cerebrovascular network is a universal feature of traumatic brain injury (TBI). This damage is present during different phases of the injury and can be non-invasively assessed using functional near infrared spectroscopy (fNIRS). fNIRS signals are influenced by partial arterial carbon dioxide (PaCO2), neurogenic, Mayer waves, respiratory and cardiac oscillations, whose characteristics vary in time and frequency and may differ in the presence of TBI. Therefore, this study aims to investigate differences in time-frequency characteristics of these fNIRS signal components between healthy controls and TBI patients and characterize the changes in their characteristics across phases of the injury. Data from 11 healthy controls and 21 TBI patients were collected during the hypercapnic protocol. Results demonstrated significant differences in low-frequency oscillations between healthy controls and TBI patients, with the largest differences observed in Mayer wave band (0.06 to 0.15 Hz), followed by the PaCO2 band (0.012 to 0.02 Hz). The effects within these bands were opposite, with (i) Mayer wave activity being lower in TBI patients during acute phase of the injury (d = 0.37 [0.16, 0.57]) and decreasing further during subacute (d = 0.66 [0.44, 0.87]) and postacute (d = 0.75 [0.50, 0.99]) phases; (ii) PaCO2 activity being lower in TBI patients only during acute phase of the injury (d = 0.36 [0.15, 0.56]) and stabilizing to healthy levels by the subacute phase. These findings demonstrate that TBI patients have impairments in low frequency oscillations related to different mechanisms and that these impairments evolve differently over the course of injury.

An Examination of the Effects of Virtual Reality Training on Spatial Visualization and Transfer of Learning.

Spatial visualization ability (SVA) has been identified as a potential key factor for academic achievement and student retention in Science, Technology, Engineering, and Mathematics (STEM) in higher education, especially for engineering and related disciplines. Prior studies have shown that training using virtual reality (VR) has the potential to enhance learning through the use of more realistic and/or immersive experiences. The aim of this study was to investigate the effect of VR-based training using spatial visualization tasks on participant performance and mental workload using behavioral (i.e., time spent) and functional near infrared spectroscopy (fNIRS) brain-imaging-technology-derived measures. Data were collected from 10 first-year biomedical engineering students, who engaged with a custom-designed spatial visualization gaming application over a six-week training protocol consisting of tasks and procedures that varied in task load and spatial characteristics. Findings revealed significant small (Cohen's d: 0.10) to large (Cohen's d: 2.40) effects of task load and changes in the spatial characteristics of the task, such as orientation or position changes, on time spent and oxygenated hemoglobin (HbO) measures from all the prefrontal cortex (PFC) areas. Transfer had a large (d = 1.37) significant effect on time spent and HbO measures from right anterior medial PFC (AMPFC); while training had a moderate (d = 0.48) significant effect on time spent and HbR measures from left AMPFC. The findings from this study have important implications for VR training, research, and instructional design focusing on enhancing the learning, retention, and transfer of spatial skills within and across various VR-based training scenarios.

Combined vitamin D and magnesium supplementation does not influence markers of bone turnover or glycemic control: A randomized controlled clinical trial.

High-dose vitamin D supplementation can increase total osteocalcin concentrations that may reduce insulin resistance in individuals at risk for prediabetes or diabetes mellitus. Magnesium is a cofactor in vitamin D metabolism and activation. The purpose of this study was to determine the combined effect of vitamin D and magnesium supplementation on total osteocalcin concentrations, glycemic indices, and other bone turnover markers after a 12-week intervention in individuals who were overweight and obese, but otherwise healthy. We hypothesized that combined supplementation would improve serum total osteocalcin concentrations and glycemic indices more than vitamin D supplementation alone or a placebo. A total of 78 women and men completed this intervention in 3 groups: a vitamin D and magnesium group (1000 IU vitamin D3 and 360 mg magnesium glycinate), a vitamin D group (1000 IU vitamin D3), and a placebo group. Despite a significant increase in serum 25-hydroxyvitamin D concentrations in the vitamin D and magnesium group compared with the placebo group (difference = 5.63; CI, -10.0 to -1.21; P = .001) post-intervention, there were no differences in serum concentrations of total osteocalcin, glucose, insulin, and adiponectin or the homeostatic model assessment of insulin resistance (HOMA-IR) among groups (P > .05 for all). Additionally, total osteocalcin (ß = -0.310, P = .081), bone-specific alkaline phosphatase (ß = 0.004, P = .986), and C-terminal cross-linked telopeptide (ß = 0.426, P = .057), were not significant predictors of HOMA-IR after the intervention. Combined supplementation was not associated with short-term improvements in glycemic indices or bone turnover markers in participants who were overweight and obese in our study. This trial was registered at clinicaltrials.gov (NCT03134417).

Optical brain monitoring for operator training and mental workload assessment.

An accurate measure of mental workload in human operators is a critical element of monitoring and adaptive aiding systems that are designed to improve the efficiency and safety of human-machine systems during critical tasks. Functional near infrared (fNIR) spectroscopy is a field-deployable non-invasive optical brain monitoring technology that provides a measure of cerebral hemodynamics within the prefrontal cortex in response to sensory, motor, or cognitive activation. In this paper, we provide evidence from two studies that fNIR can be used in ecologically valid environments to assess the: 1) mental workload of operators performing standardized (n-back) and complex cognitive tasks (air traffic control--ATC), and 2) development of expertise during practice of complex cognitive and visuomotor tasks (piloting unmanned air vehicles--UAV). Results indicate that fNIR measures are sensitive to mental task load and practice level, and provide evidence of the fNIR deployment in the field for its ability to monitor hemodynamic changes that are associated with relative cognitive workload changes of operators. The methods reported here provide guidance for the development of strategic requirements necessary for the design of complex human-machine interface systems and assist with assessments of human operator performance criteria.

Childhood trauma and adult self-reported depression.

Adverse childhood experiences (ACEs) are plentiful within our society however the consequences that stem from these experiences are not often addressed particularly their impact on mental wellness. Given that ACEs have negative neurodevelopmental influences that persist over the lifespan this paper will present findings from a study that examined the relationship between ACEs and self-reported depression among low-income ethnic minority populations who live in an urban setting. Findings highlight the importance of research on the prevalence of and risks for multiple types of childhood maltreatment, particularly in the somewhat neglected area of self-reported depression. Statistical significance was found for most ACEs and clinical significance was noted for several ACEs. Efforts to mitigate and prevent depression will likely benefit from preventing ACEs and treating individuals exposed to them. Discernment that ACEs lead to risk behaviors that subsequently increase the likelihood of depression could provide insight that can improve prevention efforts.

Individual differences in skill acquisition and transfer assessed by dual task training performance and brain activity.

Assessment of expertise development during training program primarily consists of evaluating interactions between task characteristics, performance, and mental load. Such a traditional assessment framework may lack consideration of individual characteristics when evaluating training on complex tasks, such as driving and piloting, where operators are typically required to execute multiple tasks simultaneously. Studies have already identified individual characteristics arising from intrinsic, context, strategy, personality, and preference as common predictors of performance and mental load. Therefore, this study aims to investigate the effect of individual difference in skill acquisition and transfer using an ecologically valid dual task, behavioral, and brain activity measures. Specifically, we implemented a search and surveillance task (scanning and identifying targets) using a high-fidelity training simulator for the unmanned aircraft sensor operator, acquired behavioral measures (scan, not scan, over scan, and adaptive target find scores) using simulator-based analysis module, and measured brain activity changes (oxyhemoglobin and deoxyhemoglobin) from the prefrontal cortex (PFC) using a portable functional near-infrared spectroscopy (fNIRS) sensor array. The experimental protocol recruited 13 novice participants and had them undergo three easy and two hard sessions to investigate skill acquisition and transfer, respectively. Our results from skill acquisition sessions indicated that performance on both tasks did not change when individual differences were not accounted for. However inclusion of individual differences indicated that some individuals improved only their scan performance (Attention-focused group), while others improved only their target find performance (Accuracy-focused group). Brain activity changes during skill acquisition sessions showed that mental load decreased in the right anterior medial PFC (RAMPFC) in both groups regardless of individual differences. However, mental load increased in the left anterior medial PFC (LAMPFC) of Attention-focused group and decreased in the Accuracy-focused group only when individual differences were included. Transfer results showed no changes in performance regardless of grouping based on individual differences; however, mental load increased in RAMPFC of Attention-focused group and left dorsolateral PFC (LDLPFC) of Accuracy-focused group. Efficiency and involvement results suggest that the Attention-focused group prioritized the scan task, while the Accuracy-focused group prioritized the target find task. In conclusion, training on multitasks results in individual differences. These differences may potentially be due to individual preference. Future studies should incorporate individual differences while assessing skill acquisition and transfer during multitask training.

The effect of combined magnesium and vitamin D supplementation on vitamin D status, systemic inflammation, and blood pressure: A randomized double-blinded controlled trial.

OBJECTIVE: Poor vitamin D and magnesium status is observed in individuals who are overweight and obese (Owt/Ob) and is often associated with a heightened risk of cardiovascular disease. Magnesium is a cofactor that assists vitamin D metabolism. We aimed to determine the efficacy of a combined magnesium and vitamin D regimen compared with vitamin D only on increasing serum 25-hydroxyvitamin D (25OHD) concentrations and the effects of these supplements on cardiometabolic outcomes. METHODS: This 12-week double-blinded randomized controlled trial had three treatment arms: magnesium + vitamin D (MagD; 360 mg magnesium glycinate + 1000 IU vitamin D 3 × daily), vitamin D only (VitD; 1000 IU vitamin D 3 × daily), and placebo. A total of 95 Owt/Ob participants were randomized into one of these three study arms. Anthropometry, dietary intake, concentrations of serum 25OHD, serum parathyroid hormone (PTH), serum inflammatory markers, and blood pressure were obtained at baseline and week 12. RESULTS: The MagD group experienced the greatest increase in serum 25OHD concentrations (6.3 ± 8.36 ng/mL; P < 0.05). There was a decrease in systolic blood pressure (7.5 ± 8.26 mmHg; P < 0.05) for individuals who had a baseline systolic blood pressure of >132 mmHg in the MagD group. There were no statistically significant treatment effects on serum PTH concentrations and markers of inflammation. CONCLUSIONS: A combined MagD treatment may be more effective in increasing serum 25OHD concentrations compared with VitD supplementation alone in Owt/Ob individuals.

Evaluation of fNIRS signal components elicited by cognitive and hypercapnic stimuli.

Functional near infrared spectroscopy (fNIRS) measurements are confounded by signal components originating from multiple physiological causes, whose activities may vary temporally and spatially (across tissue layers, and regions of the cortex). Furthermore, the stimuli can induce evoked effects, which may lead to over or underestimation of the actual effect of interest. Here, we conducted a temporal, spectral, and spatial analysis of fNIRS signals collected during cognitive and hypercapnic stimuli to characterize effects of functional versus systemic responses. We utilized wavelet analysis to discriminate physiological causes and employed long and short source-detector separation (SDS) channels to differentiate tissue layers. Multi-channel measures were analyzed further to distinguish hemispheric differences. The results highlight cardiac, respiratory, myogenic, and very low frequency (VLF) activities within fNIRS signals. Regardless of stimuli, activity within the VLF band had the largest contribution to the overall signal. The systemic activities dominated the measurements from the short SDS channels during cognitive stimulus, but not hypercapnic stimulus. Importantly, results indicate that characteristics of fNIRS signals vary with type of the stimuli administered as cognitive stimulus elicited variable responses between hemispheres in VLF band and task-evoked temporal effect in VLF, myogenic and respiratory bands, while hypercapnic stimulus induced a global response across both hemispheres.

Examining Mental Workload in a Spatial Navigation Transfer Game via Functional near Infrared Spectroscopy.

The goal of this study was to examine the effects of task-related variables, such as the difficulty level, problem scenario, and experiment week, on performance and mental workload of 27 healthy adult subjects during problem solving within the spatial navigation transfer (SNT) game. The study reports task performance measures such as total time spent on a task (TT) and reaction time (RT); neurophysiological measures involving the use of functional near-infrared spectroscopy (fNIRS); and a subjective rating scale for self-assessment of mental workload (NASA TLX) to test the related hypotheses. Several within-subject repeated-measures factorial ANOVA models were developed to test the main hypothesis. The results revealed a number of interaction effects for the dependent measures of TT, RT, fNIRS, and NASA TLX. The results showed (1) a decrease in TT and RT across the three levels of difficulty from Week 1 to Week 2; (2) an increase in TT and RT for high and medium cognitive load tasks as compared to low cognitive load tasks in both Week 1 and Week 2; (3) an overall increase in oxygenation from Week 1 to Week 2. These findings confirmed that both the behavioral performance and mental workload were sensitive to task manipulations.

Diverse changes in microglia morphology and axonal pathology during the course of 1 year after mild traumatic brain injury in pigs.

Over 2.8 million people experience mild traumatic brain injury (TBI) in the United States each year, which may lead to long-term neurological dysfunction. The mechanical forces that are caused by TBI propagate through the brain to produce diffuse axonal injury (DAI) and trigger secondary neuroinflammatory cascades. The cascades may persist from acute to chronic time points after injury, altering the homeostasis of the brain. However, the relationship between the hallmark axonal pathology of diffuse TBI and potential changes in glial cell activation or morphology have not been established in a clinically relevant large animal model at chronic time points. In this study, we assessed the tissue from pigs subjected to rapid head rotation in the coronal plane to generate mild TBI. Neuropathological assessments for axonal pathology, microglial morphological changes, and astrocyte reactivity were conducted in specimens out to 1-year post-injury. We detected an increase in overall amyloid precursor protein pathology, as well as periventricular white matter and fimbria/fornix pathology after a single mild TBI. We did not detect the changes in corpus callosum integrity or astrocyte reactivity. However, detailed microglial skeletal analysis revealed changes in morphology, most notably increases in the number of microglial branches, junctions, and endpoints. These subtle changes were most evident in periventricular white matter and certain hippocampal subfields, and were observed out to 1-year post-injury in some cases. These ongoing morphological alterations suggest persistent change in neuroimmune homeostasis. Additional studies are needed to characterize the underlying molecular and neurophysiological alterations, as well as potential contributions to neurological deficits.

Use of simulation as a needs assessment to develop a focused team leader training curriculum for resuscitation teams.

BACKGROUND: Many inpatients experience cardiac arrest and mortality in this population is extremely high. Simulation is frequently used to train code teams with the goal of improving these outcomes. A key step in designing such a training curriculum is to perform a needs assessment. We report on the effectiveness of a simulation-based training program for residents designed using unannounced in-situ simulation cardiac arrest data as a needs assessment. METHODS: In order to develop the curriculum for training, a needs assessment was done using in-situ simulation. Prior to instruction, residents were assessed in their ability to lead a simulated resuscitation using a standardized checklist. During the intervention phase, residents participated in didactic and team training. The didactic training consisted of pharmacology review, ACLS update and TeamSTEPPS training. Residents took turns as code team leader in three simulation sessions. Rapid cycle deliberate practice (RCDP) was employed as part of simulation sessions. All residents returned, for post-intervention assessment. Mean pre-post test scores were analyzed to determine if there was a significant difference. RESULTS: Twenty-seven residents participated. Mean pre-training assessment score was 47.6 (95% CI 37.5-57.9). The mean post-training assessment score was 84.4 (95% CI 79.0-89.5). The mean time to defibrillation after pads were placed in scenario with shockable rhythm decreased from 102.2 seconds (95% CI 74.0-130.5) to 56.3 (95% CI 32.7-79.8). CONCLUSION: Using unannounced in-situ cardiac arrest simulations as a needs assessment, a simulation-based training program was developed that significantly improved resident performance as team leader. Future work is needed to determine if this improvement translates into patient benefits and is sustainable. However, in-situ simulation is a promising tool for curriculum development.

Short-Term Effects of Meditation on Sustained Attention as Measured by fNIRS.

Cognitive abilities such as attention, memory, processing time, perception, and reasoning can be augmented using some type of intervention. Within the broad range of conventional and unconventional intervention methods used in cognitive enhancement, meditation is one of those that is safe, widely practiced by many since ancient times, and has been shown to reduce stress and improve psychological health and cognitive functioning. Various neuroimaging studies using functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) have shown functional and structural changes due to meditation in different types of meditation practices and on various groups of meditators. Recently, a few studies on meditation have used functional near infrared spectroscopy (fNIRS) to study the effects of meditation on cerebral hemodynamics. In this study, we examined the short-term effects of loving-kindness (LK) meditation on sustained attention using behavioral performance measures, physiological outcomes, and cognitive activity as measured by fNIRS in first-time meditators during Stroop color word task (SCWT) performance. Our results indicated that behavioral outcomes, assessed mainly on response time (RT) during SCWT performance, showed a significant decrease after meditation. As expected, physiological measures, primarily pulse pressure (PP) measured after meditation dropped significantly as compared to the before meditation measurement. For the hemodynamic measures of oxygenated-hemoglobin (HbO2), deoxygenated-hemoglobin (Hb), and total-hemoglobin (HbT), our findings show significant differences in SCWT performance before and after meditation. Our results suggest that LK meditation can result in improvements in cognitive, physiological, and behavioral outcomes of first-time meditators after a short-term session.