Vaccination uptake for pertussis and influenza vaccines in pregnancy among different practices at a single institution.

OBJECTIVE: The authors investigated tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) and influenza vaccination during pregnancy following Advisory Committee on Immunization Practices' (ACIP's) recommendation for antenatal pertussis vaccination. METHODS: A retrospective chart review was performed in 2019 of women receiving prenatal care at our institution between January 1, 2014 and December 31, 2018. Receipt of ACIP-recommended vaccines were examined using Current Procedural Terminology codes to identify initiation of prenatal care, then administration of Tdap and influenza vaccines. Data were examined by individual practice (university faculty, community physicians, obstetrics and gynecology (OBGYN) residents, and family medicine residents, practice staff composition, vaccination protocol use, and insurance status. Statistical analyses were performed using χ2 testing and χ2 testing of linear trend. RESULTS: Within our cohort (n = 17 973), highest vaccination uptake occurred in the university-based OBGYN faculty practice (Tdap = 58.2%, influenza = 56.5%) with lowest uptake in the OBGYN resident practice (Tdap = 28.6%, influenza = 18.5%). Higher uptake occurred in practices with standing orders, more advanced practice providers, lower provider to nursing ratios, and lower rates of Medicaid insurance. CONCLUSION: These data demonstrated higher vaccination uptake with standing orders, more advanced practice providers, and lower provider to nurse ratios. Future work optimizing practice staff composition and vaccination protocols may increase vaccine uptake.

Group singing for health and wellbeing in the Republic of Ireland: the first national map.

AIMS: (1) To catalogue and map all singing for health and wellbeing groups in the Republic of Ireland (ROI); (2) determine how they prioritise health outcomes; (3) understand what they consider success; and (4) identify gaps in provision. METHODS: A novel mixed-methods survey was distributed electronically through SING Ireland (the Choir Association of Ireland), artsandhealth.ie, and to 2736 potential stakeholders with links to singing for health and wellbeing and singing on social prescription (SSP) from October 2020 to April 2021. Thematic analysis was used to analyse four open-ended survey questions. RESULTS: A total of 185 singing for health and wellbeing groups were identified, with varied representation in each of the ROI's 26 counties. 35 groups were noted to have links to SSP. Gaps in provision for clinical and individual populations and for SSP were identified. Six themes related to the success of group singing for health and wellbeing programmes were determined: fostering and funding social and community connections; the people and the approach; enjoyment and atmosphere; musical and personal growth, programmatic structure and musical content; and the impact of Covid. CONCLUSION: The first-ever national mapping of group singing for health and wellbeing in the ROI, and one of few internationally, this study may serve as a roadmap for gathering information about existing singing for health and wellbeing provision and identifying geographical and clinical gaps internationally. Recommendations are included for future research to address gaps in provision, explore the feasibility of integrating SSP more widely and for further public health investment.

Pilot Study on Music in the Waiting Room of Outpatient Pain Clinics.

BACKGROUND: This study explores live and recorded music listening in the outpatient pain clinic. There is evidence demonstrating the effectiveness of live and recorded music in a hospital setting but a comparison study of this kind has yet to be conducted. METHODS: A multimethod survey study design was used. A questionnaire utilizing rating scales was self-administered across two outpatient pain clinic waiting rooms. Patients were included through convenience sampling. In one clinic, a playlist of recorded music curated by two of the authors was provided. In the second clinic, a music therapy student played live music using guitar, flute, and voice. The questionnaire gathered data on music's impact on pain and emotional states, as well as attitudes toward music in the waiting room. Quantitative data was analyzed using descriptive statistics and qualitative data, gathered in the questionnaires open ended question, was analyzed using thematic analysis. RESULTS: The questionnaire was completed by 200 adult patients. Patients reported lowered levels of anxiety, stress, and pain in both clinics, as well as a shorter waiting time and more caring experience. Patients in the live music clinic reported that music lowered levels of stress, nervousness, agitation, and pain more than in the recorded music clinic. CONCLUSIONS: Participants in this study identified that music is a useful tool in the pain clinic waiting room. This study contributes to evidence that music should be considered as a complimentary treatment for people living with pain and in the wider hospital setting. Additional research is warranted with a control group, pre- and posttesting, and studies of music in hospitals in a range of cultural contexts.

Quantitative Diffusion and Spectroscopic Neuroimaging Combined with a Novel Early-Developmental Assessment Improves Models for 1-Year Developmental Outcomes.

BACKGROUND AND PURPOSE: Preterm infants are at risk for overt and silent CNS injury, with developmental consequences that are difficult to predict. The novel Specific Test of Early Infant Motor Performance, administered in preterm infants at term age, is indicative of later developmental gross motor and cognitive scores at 12 months. Here, we assessed whether functional performance on this early assessment correlates with CNS integrity via MR spectroscopy or diffusional kurtosis imaging and whether these quantitative neuroimaging methods improve predictions for future 12-month developmental scores. MATERIALS AND METHODS: MR spectroscopy and quantitative diffusion MR imaging data were acquired in preterm infants (n = 16) at term. Testing was performed at term and 3 months using the Specific Test of Early Infant Motor Performance and the Bayley Scales of Infant and Toddler Development, Third Edition, at 12 months. We modeled the relationship of MR spectroscopy and diffusion MR imaging data with both test scores via multiple linear regression. RESULTS: MR spectroscopy NAA ratios at a TE of 270 ms in the frontal WM and basal ganglia and kurtosis metrics in major WM tracts correlated strongly with total Specific Test of Early Infant Motor Performance scores. The addition of MR spectroscopy and diffusion separately improved the functional predictions of 12-month outcomes. CONCLUSIONS: Microstructural integrity of the major WM tracts and metabolism in the basal ganglia and frontal WM strongly correlate with early developmental performance, suggesting that the Specific Test of Early Infant Motor Performance reflects CNS integrity after preterm birth. This study demonstrates that combining quantitative neuroimaging and early functional movement improves the prediction of 12-month outcomes in premature infants.

The Perception of Art among Patients and Staff on a Renal Dialysis Unit.

This study investigated the purpose and effectiveness of giving outpatients an opportunity to engage in art activities while receiving dialysis treatment. A mixed method study was conducted. 21 semi-structured interviews were conducted with outpatients attending the dialysis unit and 13 surveys of clinicians were completed. The principle reasons to partake in the art activity programme included: to pass time, to relieve boredom, to be creative, to try something new, distraction from concerns, to stay positive and to achieve something new. Patients who did not participate in the programme pass their time primarily by watching TV or sleeping. All staff who partook in the survey were satisfied with the programme and wanted it to continue. Our findings indicate that the creative arts programme is viewed positively by staff and patients alike, and might be useful in other hospital departments. Further in depth qualitative research would be useful to interrogate the potential effect of engagement in art on positive mental health and quality of life for patients with chronic conditions.

Post-mortem skeletal surveys in suspected non-accidental injury.

AIM: To evaluate potential differences between live (LSS) and post-mortem skeletal surveys (PMSS) in cases of non-accidental injury (NAI). MATERIALS AND METHODS: All skeletal surveys (SS) performed for suspected NAI over a 5 year period were retrospectively reviewed. Demographic details, injuries obtained, artefacts, and radiographic difficulties encountered during LSS and PMSS were recorded. RESULTS: Of 195 surveys performed, there were significantly fewer positive PMSS (11/128; 8.6%) than LSS (16/67; 23.8%), but no difference between the actual injuries encountered. Of those who had a positive SS, dead children were significantly younger (mean age 2.6 ± 3.4 months old) than live children (7.8 ± 6.9 months old; p < 0.05). Thirty-six percent of all contemporary digital radiographs contained artefacts, particularly in PMSS (599/1504; 39.8%) compared to LSS (269/904: 29.7%; p < 0.001), which were mostly patient identification labels (55.1 versus 21.6%; p < 0.001). PMSS demonstrated death-related radiographic complications in 10.6% of cases. CONCLUSION: Radiographic imaging in deceased children is not easy, and yields significant artefacts, which may hamper image interpretation. A technique for obtaining multiple views of a limb in fixed flexion deformity to maximize the diagnostic potential is described. Careful consideration of these factors would maximize the diagnostic yield in this unique patient population.

Recognition and management of odontogenic referred pain.

There are times when referred pain makes it difficult to locate the source of odontogenic pain. In those situations, additional evaluation or referral is needed to determine the cause of the chief complaint. This article presents two cases that illustrate the difficulty and frustrations of referred pain for both patients and dentists. After a thorough evaluation and diagnosis, the true sources of the patients' chief complaints were identified and treated, leading to complete resolution of their symptoms. These cases emphasize the importance of listening to the patient, obtaining a detailed dental history, collecting comprehensive diagnostic data, and developing an accurate diagnosis before initiating treatment. When a definitive diagnosis cannot be determined, referral may be necessary to provide the best treatment possible.

Complementary hemispheric asymmetries in object naming and recognition: a voxel-based correlational study.

Cognitive neuroscientific research proposes complementary hemispheric asymmetries in naming and recognising visual objects, with a left temporal lobe advantage for object naming and a right temporal lobe advantage for object recognition. Specifically, it has been proposed that the left inferior temporal lobe plays a mediational role linking conceptual information with word forms and vice versa, while the right inferior temporal lobe supports the retrieval of conceptual knowledge from visual input. To test these hypotheses, we administered four behavioural tasks to fifteen patients with temporal lobe brain damage, and correlated their behavioural scores with voxel-based measures of neuronal integrity (signal intensities) in whole-brain analyses. The behavioural paradigms included four tasks. Two were verbal tasks: (a) picture naming requiring the mapping of conceptual knowledge to word forms, (b) semantic categorisation of words requiring the reverse mapping of word forms to conceptual knowledge, and two were visual object tasks with no verbal component, both of which required the retrieval of conceptual information from visual objects, i.e., (c) visual object categorisation and (d) normal and chimera object decisions. Performance on the verbal tasks correlated with the neural integrity of partially overlapping left inferior and anterior temporal lobe regions, while performance on the object tasks correlated with the neural integrity of overlapping regions in right inferior and anterior temporal lobe. These findings support the notion of complementary hemispheric advantages for object naming and recognition, and further suggest that the classical language model emphasising posterior regions in the mapping between word forms and conceptual knowledge should be extended to include left inferior temporal lobe.

What training do artists need to work in healthcare settings?

Given the increased attention paid to the development of arts in healthcare settings, the need for a formalised training framework to enable artists to work comfortably and safely in healthcare settings has become pressing. This paper sets out a review of literature and best practice regarding the training of professional artists wishing to work in healthcare settings. The authors' research confirms the gap in the arts sector with regard to such training. Very little formal training is currently available internationally for artists wishing to work in healthcare settings outside of the arts therapies professions. There is a need for the health sector to formalise a currently ad hoc approach to employing artists in healthcare settings. There are a number of best-practice models of arts and health practice from which we can learn but relatively scant literature on course development. The arts therapies are relatively expert in the domain of using the arts in healthcare and while there are different aims and intentions to this work, it is important that any establishment of arts and health training recognises the contribution and expertise of arts therapists in the healthcare arena. A culture of mutual learning between the arts therapies and the arts and health specialists is recommended.

Longitudinal studies of semantic dementia: the relationship between structural and functional changes over time.

The pattern of brain atrophy in semantic dementia and its associated cognitive effects have attracted a considerable body of research, but the nature of core impairments remains disputed. A key issue is whether the disease encompasses one neurocognitive network (semantics) or two (language and semantics). In order to address these conflicting perspectives, we conducted a longitudinal investigation of two semantic dementia patients, in which behavioural performance across a range of measures of language and semantic performance was assessed and interpreted in the context of annually acquired MRI scans. Our results indicated a core semantic impairment in early stages of the disease, associated with atrophy of the inferior, anterior temporal cortex. Linguistic impairments emerged later, and were contingent on atrophy having spread into areas widely believed to subserve core language processes (left posterior perisylvian, inferior frontal and insular cortex). We claim, therefore, that phonological, syntactic and morphological processing deficits in semantic dementia reflect damage to core language areas. Further, we propose that much of the current controversy over the nature of deficits in semantic dementia reflect a tendency in the literature to adopt a static perspective on what is a progressive disease. An approach in which the relationship between progressive neural changes and behavioural change over time is carefully mapped, offers a more constraining data-set from which to draw inferences about the relationship between language, semantics and the brain.

A cure for the soul? The benefit of live music in the general hospital.

From 2005 to 2006 a professional orchestra (the Irish Chamber Orchestra) performed in a university teaching hospital with the aims of bringing live music to patients who could not access traditional concert venues and of improving quality of life for patients and staff. This was the first time an orchestra was resident in a hospital in the Republic of Ireland. An independent contemporaneous evaluation was carried out to assess the benefit of live music for patients. Live music in hospital was found to enhance the quality of the aesthetic environment of the hospital, with both patients and staff stating that listening to live music helped them to relax, feel happier and more positive. Patients' perception of the hospital was affected positively by live music in waiting areas. Music was found to have strong emotional effect and the individual preferences and experiences of patients need to be carefully taken into account when programming music in hospital. Listening to live music while in hospital has positive benefits with few negative effects.

Repetition suppression and semantic enhancement: an investigation of the neural correlates of priming.

The priming of a stimulus by another has become an important tool for exploring the neural underpinnings of conceptual representations. However, priming effects can derive from many different types of relationships and it is important to distinguish between them in order to be able to develop theoretical accounts of the representation of conceptual knowledge. While it is well known that repetition priming (the repeated presentation of the same stimulus) is associated with a reduced neural response, called repetition suppression (RS), the neural correlates of semantic priming (when two stimuli are related in meaning but not identical) are not so well established. We compared the neural correlates of repetition and semantic priming using written words, independently manipulating form and meaning. In an fMRI study, subjects saw single words and made a concrete-abstract decision. Two consecutive words were identical (town-town) or varied along a continuum of semantic relatedness, from highly related (cord-string) to unrelated (face-sail). We found distinct patterns of activation for repetition and semantic priming. Repetition priming was associated with RS in LIFG, bilateral parahippocampal gyrus and R fusiform gyrus. We also observed increased activation for word repetition in the RMFG and RMTG/STG, which may reflect recognition of item's earlier presentation. There was no evidence of suppression for semantic relatedness. Semantic priming was associated with enhanced activation in multiple bilateral fronto-temporal areas, i.e. semantic enhancement. The results suggest that repetition and semantic priming in visual word recognition depend on distinct cognitive processes and neural substrates.

Semantic processing of living and nonliving concepts across the cerebral hemispheres.

Studies of patients with category-specific semantic deficits suggest that the right and left cerebral hemispheres may be differently involved in the processing of living and nonliving domains concepts. In this study, we investigate whether there are hemisphere differences in the semantic processing of these domains in healthy volunteers. Based on the neuropsychological findings, we predicted a disadvantage for nonliving compared to living concepts in the right hemisphere. Our prediction was supported, in that semantic decisions to nonliving concepts were significantly slower and more error-prone when presented to the right hemisphere. In contrast there were no hemisphere differences for living concepts. These findings are consistent with either differential representation or processing of concepts across right and left hemispheres. However, we also found a disadvantage for nonliving things compared to living things in the left hemisphere, which is not consistent with a simple representation account. We discuss these findings in terms of qualitatively different semantic processing in right and left hemispheres within the framework of a distributed model of conceptual representation.

Relaxation and complementary therapies: an alternative approach to managing dental anxiety in clinical practice.

Dental anxiety is a widespread problem and has a significant impact on the provision of dental care for the general population. Anxiety leads to avoidance of dental treatment and increased stress for dental practitioners. Traditionally, dental anxiety has been managed using pharmacological techniques. This article reviews alternative treatment approaches, including psychological and complementary therapies which can be used in managing dental anxiety and facilitating dental treatment. Many of these approaches are currently being used within the dental profession. Others are gaining a wider acceptance as to their usage. Where available, the evidence of their efficacy will be reviewed.

Selecting among competing alternatives: selection and retrieval in the left inferior frontal gyrus.

It has been widely argued that the left inferior frontal gyrus (LIFG) is involved in the control of retrieval of information from long-term memory. Recent claims that the LIFG is involved in selecting among semantic alternatives have been challenged on the grounds that the manipulation of selection demands may have been confounded with controlled retrieval. The current study used an event-related functional magnetic resonance paradigm to re-examine the possibility that LIFG activation is involved in selection processes. In order to minimize potential confounding effects of controlled retrieval, we used an automatic retrieval task (picture naming) and held retrieval demands constant, while varying selection demands by way of competitor priming from earlier semantically related trials. We found significant activation in LIFG as a function of increased selection demands; activation centred on two peaks, one in anterior LIFG and a second more superior and posterior region. These data support the view that LIFG plays a role in selection among semantic information, even in the absence of controlled retrieval processes.

Anteromedial temporal cortex supports fine-grained differentiation among objects.

Patients with damage to left anteromedial temporal cortex often show a striking deficit: they fail to recognize animals and other living things. This failure of recognition presents an important challenge to theories of the neural representation of conceptual knowledge. Here we propose that this lesion-behaviour association arises because polymodal neurons in anteromedial temporal cortex integrate simple features into complex feature conjunctions, providing the neural infrastructure for differentiating among objects.