Comparative Effectiveness of Behavioral Interventions to Prevent or Delay Dementia: One-Year Partner Outcomes.

BACKGROUND/OBJECTIVE: Various behavioral interventions are recommended to combat the distress experienced by caregivers of those with cognitive decline, but their comparative effectiveness is poorly understood. DESIGN/SETTING: Caregivers in a comparative intervention study randomly had 1 of 5 possible interventions suppressed while receiving the other four. Caregivers in a full clinical program received all 5 intervention components. Care partner outcomes in the study group were compared to participants enrolled in a full clinical program. PARTICIPANTS: Two hundred and seventy-two dyads of persons with amnestic mild cognitive impairment (pwMCI) and care partners enrolled in the comparative intervention study. 265 dyads participated in the full clinical program. INTERVENTION: Behavioral intervention components included: memory compensation training, computerized cognitive training, yoga, support group, and wellness education. Each was administered for 10 sessions over 2 weeks. MEASUREMENTS: A longitudinal mixed-effect regression model was used to analyze the effects of the interventions on partner burden, quality of life (QoL), mood, anxiety, and self-efficacy at 12 months follow-up. RESULTS: At 12 months, withholding wellness education or yoga had a significantly negative impact on partner anxiety compared to partners in the clinical program (ES=0.55 and 0.44, respectively). Although not statistically significant, withholding yoga had a negative impact on partner burden and mood compared to partners in the full clinical program (ES=0.32 and 0.36, respectively). CONCLUSION: Our results support the benefits of wellness education and yoga for improving partner's burden, mood, and anxiety at one year. Our findings are the first to provide an exploration of the impact of multicomponent interventions in care partners of pwMCI.

Prevalence of Previously Undiagnosed Abdominal Aortic Aneurysms in Patients with Intracranial Aneurysms: From the Brain and Aortic Aneurysms Study (BAAS).

BACKGROUND: A relationship between intracranial and abdominal aortic aneurysms (AAA) has been appreciated through genome-wide association studies suggesting a shared pathophysiology. However, the actual prevalence of AAA in patients presenting with ruptured intracranial aneurysms is not known. Our aim was to estimate the prevalence of previously undiagnosed AAA in patients presenting with aneurysmal subarachnoid hemorrhage (aSAH) to see if it may be high enough to justify formally testing the utility of screening. METHODS: A prospective, observational inception cohort study of 81 consecutive patients presenting to Mayo Clinic Florida with aSAH was performed from August 14, 2011 to February 10, 2014. These individuals were then screened using an abdominal ultrasound technique for an AAA. Our primary end point was detection of AAA. Our secondary end points were 30-day good-to-fair functional status (modified Rankin scale < 4) and all-cause mortality. RESULTS: We detected an AAA in 10 patients (rate: 12%; 95% CI 6-22%) with aSAH. The mean diameter of these AAA was 3.4 ± 1.0 cm. Among these 10 patients, there was one death within the first month of aSAH hospitalization. There were no significant differences in demographic or clinical characteristics based on AAA detection status. Mean follow-up time was 4.7 years. The rate of good-to-fair functional status at 30-days was 79%. All-cause mortality during follow-up at 1-year was higher for patients with AAA (36%; 95% CI 0-61%) compared to patients without AAA (7%; 95% CI 1-14%) (log-rank p = 0.045). CONCLUSIONS: The co-prevalence of AAA in patients presenting with ruptured brain aneurysms may be sufficiently high such that screening for AAA among likely survivors of aSAH might be appropriate. Larger studies would be needed to establish a net clinical benefit from screening AAA and then treating newly identified large AAAs in this morbid population.

Randomized clinical trial of liposomal bupivacaine transverse abdominis plane block versus intrathecal analgesia in colorectal surgery.

BACKGROUND: Transverse abdominis plane (TAP) block is considered an effective alternative to neuraxial analgesia for abdominal surgery. However, limited evidence supports its use over traditional analgesic modalities in colorectal surgery. This study compared the analgesic efficacy of liposomal bupivacaine TAP block with intrathecal (IT) opioid administration in a multicentre RCT. METHODS: Patients undergoing elective small bowel or colorectal resection were randomized to receive TAP block or a single injection of IT analgesia with hydromorphone. Patients were assessed at 4, 8, 16, 24 and 48 h after surgery. Primary outcomes were mean pain scores and morphine milligram equivalents (MMEs) administered within 48 h after surgery. Secondary outcomes included duration of hospital stay, incidence of postoperative ileus and use of intravenous patient-controlled analgesia. RESULTS: In total, 209 patients were recruited and 200 completed the trial (TAP 102, IT 98). The TAP group had a 1·6-point greater mean pain score than the IT group at 4 h after surgery, and this difference lasted for 16 h after operation. The TAP group received more MMEs within the first 24 h after surgery than the IT group (median difference in MMEs 10·0, 95 per cent c.i. 3·0 to 20·5). There were no differences in MME use at 24 and 48 h, or with respect to secondary outcomes. CONCLUSION: IT opioid administration provided better immediate postoperative pain control than TAP block. Both modalities resulted in low pain scores in patients undergoing elective colorectal surgery and should be considered in multimodal postoperative analgesic plans. Registration number: NCT02356198 ( http://www.clinicaltrials.gov).

Judging the accuracy of children's recall: a statement-level analysis.

Three experiments were conducted to examine fact finders' judgments of children's answers to cued recall questions about a recent dental visit. Participants performed better than chance at judging the correctness of the children's answers in all 3 experiments, and judgment accuracy was consistently better when the children's answers were correct. Judgment performance did not decline when confidence information was removed, and when all confidence information was removed, the best performance was obtained by parents and by professionals who work with children. The findings of these experiments provide support for the use of written transcripts in presentations of child testimony and highlight the importance of child- and event-related knowledge in judgments of children's testimony.

The Drinkwater-Ross anthropometric fractionation of body mass: comparison with measured body mass and densitometrically estimated fat and fat-free masses.

The Drinkwater-Ross anthropometric fractionation of body mass (mass = sigma skeletal, residual, fat and muscle masses), lean body mass (LBM = sigma skeletal, residual and muscle masses) and fat mass (FM) were compared with the measured body mass, together with the densitometrically estimated fat-free mass (FFM) and fat mass (FM), of 205 male (mean +/- S.D.: 74.66 +/- 10.55 kg; 10.1 +/- 3.7% BF by densitometry) and 177 female (mean +/- S.D.: 59.14 +/- 8.85 kg; 18.5 +/- 5.1% BF by densitometry) South Australian State representatives in a variety of sports. Most absolute differences (d) between the measured body masses and those resultant from the sum of the four fractionated masses (male: d = 2.15 kg or 2.9%; female: d = 1.27 kg or 2.2%) were within what one would expect from random day-to-day variation. However, this was not so for the comparisons between the fractionated LBM (male: d = 2.54 kg or 3.8%; female: d = 2.45 kg or 5.2%) and FM scores (male: d = 1.67 kg or 30.0%; female: d = 2.40 kg or 20.0%) and their densitometric counterparts. These differences are probably related to a combination of the densitometric and fractionation assumptions.

A comparison of the effects of measured, predicted, estimated and constant residual volumes on the body density of male athletes.

The aim of this study was to use the measured residual volume (RV) of male athletes (n = 207) as a criterion and assess the error in their RV, body density (BD) and relative body fat (%BF) associated with using RVs predicted from regression equations, RVs estimated from vital capacity (VC) and an assumed constant RV of 1300 ml. The ventilated residual volume (RV) was determined both before and after the underwater weighing by helium dilution with the subject immersed to neck level. The mean of the absolute differences Idl and SEE between the 2 RV trials were 66 and 89 ml, respectively. These increased to values ranging 195-747 and 259-308 ml, respectively, when the means of the 2 RV trials for each subject were compared with the RVs predicted via regression equations, estimated from the VC and assumed to be a constant of 1300 ml. A similar trend emerged with variation of only the RV in the BD formula for each subject. The 2 RV trials resulted in a Idl and SEE of .00109 (.5% BF) and .00145 g.cm-3 (.6% BF), respectively, but these increased to values ranging .00306 (1.3% BF)-.01207 (5.1% BF) and .00394 (1.7% BF)-.00441 g.cm-3 (1.9% BF), respectively, for predicted, estimated and assumed constant RVs. In all cases the lowest Idl and SEE were associated with the RVs predicted by a multiple regression equation (R = .616; SEE = 259 ml) which was generated on our sample.(ABSTRACT TRUNCATED AT 250 WORDS)

The relationship of target and response complexity in coincident timing performance.

This paper reports two experiments concerned with the interaction of response and target factors in a coincident timing situation. Coincident timing involves executing a response to intercept a moving target. The target response relationship was manipulated in the first experiment by providing some targets with no structure (linear path) and others containing 1 and 2 bounce points. In the second experiment, responses required 0, 1, or 2 reversals in direction. The results provide tentative support for the notion that structure in the target path could be linked to the key temporal response dynamics for improved performance consistency, and that subjects may alter their response structure to incorporate this linkage. This can be further extended to the advantage of simply moving while perceiving movement. This paper stresses the importance of examining the perceptual and motor requirements of the coincident timing skill in unison.

A comparison of the effects of measured, predicted, estimated and constant residual volumes on the body density of female athletes.

The body density (BD), and hence the relative body fat (% BF) was measured for 182 female athletes. The residual volume (RV) was determined both before and after the underwater weighing by a multiple breath helium dilution technique with the subject immersed to neck level. The absolute mean difference (lXdl) and SEE between the two RV trials were 63 and 75 ml, respectively. These increased to values ranging 144-685 and 187-252 ml, respectively, when the mean of the two RV trials for each subject was compared with the RVs predicted via regression equations, estimated from the vital capacity (VC) and assumed to be a constant of 1000 ml. A similar trend resulted from variation of only the RV in the BD formula for each subject. The two RV trials resulted in an lXdl and SEE of .00121 (.5% BF) and .00141 g.cm-3 (.6% BF), respectively, but these increased to values ranging .00283 (1.3% BF) -.01291 (5.7% BF) and .00362 (1.6% BF) -.00527 g.cm-3 (2.5% BF), respectively, for predicted, estimated and assumed constant RVs. In all cases, the lowest lXdl and SEE were associated with the RVs predicted by a multiple regression equation (R = .725; SEE = 187 ml) which was generated on our sample while the largest lXdl values were registered by the other regression equations. These data emphasize that the use of predicted, estimated and constant RVs result in substantial errors in BD and % BF compared with those when the RV is measured.