Brain Vital Signs in Elite Ice Hockey: Towards Characterizing Objective and Specific Neurophysiological Reference Values for Concussion Management.

Background: Prior concussion studies have shown that objective neurophysiological measures are sensitive to detecting concussive and subconcussive impairments in youth ice-hockey. These studies monitored brain vital signs at rink-side using a within-subjects design to demonstrate significant changes from pre-season baseline scans. However, practical clinical implementation must overcome inherent challenges related to any dependence on a baseline. This requires establishing the start of normative reference data sets. Methods: The current study collected specific reference data for N = 58 elite, youth, male ice-hockey players and compared these with a general reference dataset from N = 135 of males and females across the lifespan. The elite hockey players were recruited to a select training camp through CAA Hockey, a management agency for players drafted to leagues such as the National Hockey League (NHL). The statistical analysis included a test-retest comparison to establish reliability, and a multivariate analysis of covariance to evaluate differences in brain vital signs between groups with age as a covariate. Findings: Test-retest assessments for brain vital signs evoked potentials showed moderate-to-good reliability (Cronbach's Alpha > 0.7, Intraclass correlation coefficient > 0.5) in five out of six measures. The multivariate analysis of covariance showed no overall effect for group (p = 0.105), and a significant effect of age as a covariate was observed (p < 0.001). Adjusting for the effect of age, a significant difference was observed in the measure of N100 latency (p = 0.022) between elite hockey players and the heterogeneous control group. Interpretation: The findings support the concept that normative physiological data can be used in brain vital signs evaluation in athletes, and should additionally be stratified for age, skill level, and experience. These can be combined with general norms and/or individual baseline assessments where appropriate and/or possible. The current results allow for brain vital sign evaluation independent of baseline assessment, therefore enabling objective neurophysiological evaluation of concussion management and cognitive performance optimization in ice-hockey.

Brain Vital Signs Detect Information Processing Differences When Neuromodulation Is Used During Cognitive Skills Training.

Background: Neuromodulation through translingual neurostimulation (TLNS) has been shown to initiate long-lasting processes of neuronal reorganization with a variety of outcomes (i.e., neuroplasticity). Non-invasive TLNS is increasingly accessible through the Portable Neuromodulation Stimulator (PoNS®), a medical device that delivers electrical stimulation to the tongue to activate the trigeminal (V) and facial (VII) cranial nerves. Anecdotal reports from previous clinical studies have suggested incidental improvements in cognitive function. To objectively explore this observation, we examined TLNS-related effects on the semantic N400 brain vital sign cognitive response during cognitive skills training in healthy individuals. Methods: Thirty-seven healthy volunteers were randomized to receive simultaneous TLNS (treatment) or no TLNS (control) while undergoing cognitive skills training. Cognitive training was conducted for two 20-min sessions (morning and afternoon/evening) over 3 consecutive days. Brain vital signs were evaluated at baseline, Day 1, and Day 3. Analyses focused on cognitive processing as measured by N400 changes in amplitude and latency. Results: Over the 3-day course of cognitive training, the N400 amplitude decreased significantly in the control group due to habituation (p = 0.028). In contrast, there was no significant change in the TLNS treatment group. Conclusion: TLNS led to a sustained N400 response during cognitive skills training, as measured by the brain's vital signs framework. The study findings suggest differential learning effects due to neuromodulation, consistent with increased attention and cognitive vigilance.

Practical strategies and perceptions from community pharmacists following their experiences with conducting pharmacy practice research: a qualitative content analysis.

OBJECTIVES: While prior research identified barriers to conducting research in community pharmacies, there remains a need to better understand facilitators to ensure successful collaborations between academic researchers and pharmacists. Our objective was to determine the experiences and perspectives of community pharmacists who have recently conducted a pharmacy practice-based research study to gain in-depth understanding of challenges as well as facilitators and identify strategies and solutions. METHODS: We conducted a qualitative study involving one-on-one semi-structured telephone interviews with community pharmacists following the completion of a practice-based research study in their pharmacies. Interview transcripts were analysed using inductive content analysis involving open coding, creating categories and abstraction into final themes. KEY FINDINGS: Eleven pharmacists participated in the qualitative interviews. We identified six major themes including: (1) barriers (e.g. time constraints); (2) facilitators (e.g. ideal pharmacy layout); (3) support and resources from academic researchers (e.g. helpfulness of training, easy-to-use study materials); (4) pharmacist-initiated strategies for conducting research (beyond prior suggestions from researchers); (5) suggestions for future pharmacy practice research; and (6) motivation for conducting pharmacy practice research. These findings informed practical strategies targeted at academic researchers and pharmacists, respectively, to facilitate the conduct of research in community pharmacists across various stages of the research process. CONCLUSIONS: Our study adds to better understanding of community pharmacists' perspectives on conducting research and identifies practical solutions that can be readily implemented by academic researchers and pharmacists participating in research.

The Duality of Economic Issues With Medication Non-adherence in Patients With Inflammatory Arthritis.

PURPOSE OF REVIEW: In this review, we synthesize current data on non-adherence across inflammatory arthritides and explore (1) the effects of economic factors on non-adherence and (2) the impacts of non-adherence on economic outcomes. RECENT FINDINGS: Recent evidence demonstrates medication non-adherence rates as high as 74% in ankylosing spondylitis (AS), 90% in gout, 50% in psoriatic arthritis (PsA), 75% in systemic lupus erythematosus (SLE), and 82% in rheumatoid arthritis (RA). The effects of socioeconomic factors have been studied most in RA and SLE but with inconsistent findings. Nonetheless, the evidence points to having prescription coverage and costs of treatment as important factors in RA and education as an important factor in SLE. Limited data in AS and gout, and no studies of the effects of socioeconomic factors in PsA, show knowledge gaps for future research. Finally, there is a dearth of data with respect to the impacts of non-adherence on economic outcomes.

Placebo Trends across the Border: US versus Canada.

BACKGROUND: Physicians around the world report to using placebos in a variety of situations and with varying degrees of frequency. Inconsistent methodologies, however, complicate interpretation and prevent direct comparisons across studies. While US- and Canada-based physicians share similar professional standards, Canada harbours a less-litigious universal healthcare model with no formal placebo-related policy-factors that may impact how physicians view and use placebos. METHODS: To compare American and Canadian data, we circulated an online survey to academic physicians practicing in Canada, collected anonymous responses, and extracted those of internists and rheumatologists for comparison to US data obtained through parallel methodologies. RESULTS: Whereas our data show overall concordance across the border-from definitions to ethical limitations and therapeutic potential-differences between American- and Canadian-based placebo practices merit acknowledgement. For example, compared to 45%-80% among US-based respondents, only 23±7% of Canada-based respondents reported using placebos in clinical practice. However, 79±7% of Canada-respondents-a figure comparable to US data-professed to prescribing at least one form of treatment without proven or expected efficacy. Placebo interventions including unwarranted vitamins and herbal supplements (impure placebos) as well as sugar pills and saline injections (pure placebos) appear more common in Canada, where more doctors described placebos as "placebos" (rather than "medications") and used them as a "diagnostic" tool (rather than a means of placating patient demands for treatment). INTERPRETATION: Cross-border variation in the use of clinical placebos appears minor despite substantial differences in health care delivery system, malpractice climate, and placebo-related policy. The prevalence of impure placebos in both Canadian and US clinics raises ethical and practical questions currently unaddressed by policy and warranting investigation.

Suggestion overrides automatic audiovisual integration.

Cognitive scientists routinely distinguish between controlled and automatic mental processes. Through learning, practice, and exposure, controlled processes can become automatic; however, whether automatic processes can become deautomatized - recuperated under the purview of control - remains unclear. Here we show that a suggestion derails a deeply ingrained process involving involuntary audiovisual integration. We compared the performance of highly versus less hypnotically suggestible individuals (HSIs versus LSIs) in a classic McGurk paradigm - a perceptual illusion task demonstrating the influence of visual facial movements on auditory speech percepts. Following a posthypnotic suggestion to prioritize auditory input, HSIs but not LSIs manifested fewer illusory auditory perceptions and correctly identified more auditory percepts. Our findings demonstrate that a suggestion deautomatized a ballistic audiovisual process in HSIs. In addition to guiding our knowledge regarding theories and mechanisms of automaticity, the present findings pave the road to a more scientific understanding of top-down effects and multisensory integration.

Can suggestion obviate reading? Supplementing primary Stroop evidence with exploratory negative priming analyses.

Using the Stroop paradigm, we have previously shown that a specific suggestion can remove or reduce involuntary conflict and alter information processing in highly suggestible individuals (HSIs). In the present study, we carefully matched less suggestible individuals (LSIs) to HSIs on a number of factors. We hypothesized that suggestion would influence HSIs more than LSIs and reduce the Stroop effect in the former group. As well, we conducted secondary post hoc analyses to examine negative priming (NP) - the apparent disruption of the response to a previously-ignored item. Our present findings indicate that suggestion reduces Stroop effects in HSIs. Secondary analyses show that LSIs had an NP effect at baseline (i.e., without suggestion) and that suggestion influenced the NP condition. Thus, at least in this experimental context, suggestion seems to dampen a deeply-engrained and largely automatic process - reading - by wielding a larger influence on HSIs relative to comparable LSIs.