Patients with neurological or neurosurgical disease can suffer from impaired cough, which may result in life-threatening retention of tracheobronchial secretions, atelectasis, pneumonia and finally ...death. Due to a lack of alternatives and pathophysiological plausibility, the application of mechanical insufflation-exsufflation (MI-E) has already become international standard care in neuromuscular disease and spinal cord injury although a lack of evidence for efficacy. High-quality studies to support the use of MI-E in neurological and neurosurgical patients during weaning from mechanical ventilation are missing. The goal of this exploratory study is to display the effect size of MI-E intervention on the duration of mechanical ventilation and additional outcomes.
One hundred adult patients with a cough deficiency or retention of secretion admitted to a neurological intensive care unit (ICU) are planned to be recruited for this randomised controlled trial. Patients are randomised 1:1 to receive either MI-E or best standard care. Observation will take place until discharge from the hospital, death or end of the study period. The primary endpoint of this trial is the duration of mechanical ventilation from randomisation until successful weaning. The outcome will be analysed with Kaplan-Meier estimation and competing risks analyses. Secondary endpoint is the proportion of patients with successful weaning. Further outcomes will include the incidence of hospital-acquired pneumonia, mortality, decannulation rate, length of stay on the ICU and the total score of the Glasgow Coma Scale.
The study was approved by the Medical Ethics Committee of the University of Oldenburg. The findings of this study will be submitted for publication in a peer-reviewed journal.
DRKS00020981.
Various music interventions can evoke favorable behavioral responses or physiological reactions in people with disorders of consciousness (DOC), such as coma, unresponsive wakefulness syndrome (UWS), ...and minimally conscious state (MCS). However, it appears that no study thus far has investigated the effects of music on the endocrine system of people with DOC.
This explorative study aimed to investigate the effects of biographical music and biographical language on the physiological and endocrine systems of people with UWS and MCS.
A cohort of 20 people with DOC (10 women, 10 men; age range 19-77) received 20 min of biographical music and biographical language. Before and afterward, they were exposed to silence. Physiological and hormonal measurements were conducted before, during, and after the interventions.
Paired
-tests showed a significant decrease of salivary cortisol in the condition with biographical language interventions.
Biographical interventions can modulate reactions in the endocrine system in people with DOC. Further studies are needed to establish whether and how individuals living with DOC show psychoneuroendocrine responses to music and other arts-based interventions.
The effects of music interventions including active and receptive music therapy for people living with neurogenic disorders of consciousness (DOC) have been subject to empirical studies in the past. ...The aim of this systematic review was to find and analyse the current research about the effects of musical interventions on people with DOC.
For this purpose, studies with music interventions and patients with DOC from the year 1900 to 2017 were searched in English, German, and French in different databases. Risk-of-bias-analyses were conducted for each study that fulfilled the inclusion criteria.
Twenty-two quantitative studies (three randomised controlled trials with more than 10 participants) were found eligible for review. They include a total of 329 participants living with either coma, unresponsive wakefulness syndrome, or minimally conscious state. Music interventions were associated with favourable behavioural and physiological responses in several studies, but methodological quality and outcomes were heterogeneous.
More studies with a larger number of participants are needed as well as a consensus on key characteristics of effective short-term and long-term music interventions for DOC.
•Music interventions and music therapy can enhance quality of life in people with disorders of consciousness (DOC).•Qualitative studies and case reports shed light on music-related response patterns ...at behavioural and physiological levels.•Music therapists use small, non-verbal signals like the breathing rhythm to establish contact with their clients.•Social support and information of biographic music experiences are important to guide music-based therapies.
Previous studies suggest that music interventions and music therapy can enhance wellbeing, improve quality of life, and stimulate cognitive functions in people with disorders of consciousness (DOC), including coma, unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS). This systematic review was designed to identify patterns of both short- and long-term changes in response to music interventions and music therapy for people living with DOC on the basis of a qualitative meta-summary. The results indicate that music intervention and music therapy often lead to behavioural changes in, for example, breathing cycles, visual fixation and eye contact. However, the details of the data collection procedures are incomplete in some cases. Nonetheless, the results complement and extend the quantitative work on music interventions for people with DOC by revealing the importance of environmental factors, such as the roles of the relatives and friends of patients with respect to informing and guiding music therapeutic interventions.
The occurrence of obstructive and central sleep apnea syndromes, ventilator pump failure and reduced hypercapnic ventilatory drive in myotonic dystrophy type 1 (DM1) is well established, and there ...are indications for an impairment of the hypoxic ventilator drive, too. Yet, it is still unknown, to which extent the respiratory rhythm is affected by DM1, thus if a central bradypnea, cluster breathing or ataxic ("Biot's") breathing can occur. Additionally, the causes of the impairment of the central respiratory drive in DM1 are not known.
We present the case of a tracheotomized female patient with DM1 with central bradypnea and ataxic breathing. A 57-year-old woman with DM1 was admitted to our Neurointensive Care Unit (NICU) due to refractory tracheobronchial retention of secretions resulting from aspiration of saliva. Due to a combination of chronic hypercapnic respiratory failure, severe central bradypnea with a minimal breathing frequency of 3 per minute and ataxic breathing a pressure-controlled home ventilation was initiated.
In our patient central bradypnea and ataxic breathing possibly were respiratory sequale of DM1, that may have been caused by pontine white matter lesions affecting the pontine respiratory nuclei. From a clinical viewpoint, polygraphy is a suitable tool to objectify disorders of the respiratory rhythm in DM1 even in tracheotomized patients. Clinical studies combining respiratory diagnostics as polygraphy, transcutaneous capnometry and blood gas analysis with brain magnetic resonance imaging (MRI) are required to better understand disorders of respiratory regulation in DM1, and to identify their anatomical correlates.
This research examined the Pride Program (1991 and 1992)--a residential, summer-school program for at-risk middle-school students. It was conducted with subjects from two large, urban middle schools ...for the purpose of determining if, after five school years, differences existed among three selected groups (treatment, control and comparison) of at-risk students in the areas of academic achievement, attendance and conduct. Treatment-group self-esteem was examined over a three-year period. Furthermore, this study provided a qualitative program evaluation of the Pride Program for the first two years of its existence. The results are as follows: The qualitative evaluation indicated that all participants were generally satisfied with the program, although it needed some corrections, particularly in the academic component. Primary quantitative findings at the end of tenth grade were that there were no significant differences between groups in mean English grades, mathematics grades, grade-point average, number of absences and discipline referrals. At the end of middle school (eighth grade), the treatment group was found to have significantly better math grades in school than the other two groups and significantly lower ITBS Total Language scores than the control group. No significant difference was found in Total Self-esteem over the three-year period. Secondary finding were that mathematics grades declined for all groups between the first semester and the fourth semester of high school; the three groups combined mean numbers of absences and discipline referrals increased significantly between Grades 6 and 10; positive significant differences in Total Self-esteem were found between the pre-treatment scores and the ninth grade scores; a positive time effect was found on the subscales of General Self, Social Self-Peers and Home-Parents. Quantitative analysis of academic achievement, attendance and conduct demonstrated no statistically significant impact based on a student's attendance in the Pride Program. The only area which demonstrated significant results was self-esteem in the three subareas of General Self, Social Self-Peers and Home-Parents. Various recommendations for program improvement are discussed.
The rhodamine system is a flexible framework for building small‐molecule fluorescent probes. Changing N‐substitution patterns and replacing the xanthene oxygen with a dimethylsilicon moiety can shift ...the absorption and fluorescence emission maxima of rhodamine dyes to longer wavelengths. Acylation of the rhodamine nitrogen atoms forces the molecule to adopt a nonfluorescent lactone form, providing a convenient method to make fluorogenic compounds. Herein, we take advantage of all of these structural manipulations and describe a novel photoactivatable fluorophore based on a Si‐containing analogue of Q‐rhodamine. This probe is the first example of a “caged” Si‐rhodamine, exhibits higher photon counts compared to established localization microscopy dyes, and is sufficiently red‐shifted to allow multicolor imaging. The dye is a useful label for super‐resolution imaging and constitutes a new scaffold for far‐red fluorogenic molecules.
In the red zone: Caged Si‐Q‐rhodamine, a new red‐shifted label for localization microscopy, exhibits superior photon counts and is sufficiently red‐shifted to allow multicolor imaging. This dye is a useful label for advanced imaging experiments and constitutes a new scaffold for red fluorogenic molecules.
Older adult physical activity (PA) levels obtained from the International Physical Activity Questionnaire-Short Form (IPAQ) and accelerometry (ACC) were compared. Mean difference scores between ...accumulated or bout ACC PA and the IPAQ were computed. Spearman rank-order correlations were used to assess relations between time spent in PA measured from ACC and self-reported form of the IPAQ, and percentage agreement across measures was used to classify meeting or not meeting PA recommendations. The IPAQ significantly underestimated sitting and overestimated time spent in almost all PA intensities. Group associations across measures revealed significant relations in walking, total PA, and sitting for the whole group (r = .29-.36, p < .05). Significant relationships between bout ACC and IPAQ walking (r = .28-.39, p < .05) were found. There was 40-46% agreement between measures for meeting PA recommendations. The IPAQ appears not to be a good indicator of individual older adult PA behavior but is better suited for larger population-based samples.
Fruit of tomato (Solarium lycopersicum), like those from many species, have been characterized to undergo a shift from partially photosynthetic to truly heterotrophic metabolism. While there is ...plentiful evidence for functional photosynthesis in young tomato fruit, the rates of carbon assimilation rarely exceed those of carbon dioxide release, raising the question of its role in this tissue. Here, we describe the generation and characterization of lines exhibiting a fruit-specific reduction in the expression of glutamate 1-semialdehyde aminotransferase (GSA). Despite the fact that these plants contained less GSA protein and lowered chlorophyll levels and photosynthetic activity, they were characterized by few other differences. Indeed, they displayed almost no differences in fruit size, weight, or ripening capacity and furthermore displayed few alterations in other primary or intermediary metabolites. Although GSA antisense lines were characterized by significant alterations in the expression of genes associated with photosynthesis, as well as with cell wall and amino acid metabolism, these changes were not manifested at the phenotypic level. One striking feature of the antisense plants was their seed phenotype: the transformants displayed a reduced seed set and altered morphology and metabolism at early stages of fruit development, although these differences did not affect the final seed number or fecundity. Taken together, these results suggest that fruit photosynthesis is, at least under ambient conditions, not necessary for fruit energy metabolism or development but is essential for properly timed seed development and therefore may confer an advantage under conditions of stress.
The recent completion of the inaugural virtual interview season has triggered calls for the permanency of virtual interviews in the radiology resident selection process. We designed a study to assess ...the inaugural 2020-2021 virtual interview season and inform the anticipated debate on the future of radiology residency interviews.
Forty-four and 39-question survey instruments developed for program directors (PDs) and applicants, respectively, were distributed through the Radiology Residency Education Research Alliance to measure the demographics, experiences with technology, attitudes toward the virtual interview season and attitudes about proposed changes to the interview process. Comparisons were made between demographics and survey queries.
PD and applicant response rates were 74% (25/34) and 45% (84/186), respectively. Eighty percent (20/25) of PDs and 76% (64/84) of applicants described the virtual interview season as excellent or very good. Sixty percent of PDs agreed or strongly agreed with the statement "The benefits of the virtual interview season outweighed the drawbacks," while 24% disagreed or strongly disagreed, and 16% were neutral. Among applicants, 80% agreed or strongly agreed, 10% disagreed or strongly disagreed, and 10% were neutral toward the same statement. Ninety-two percent of PDs noted that their rank order list performed the same or better than in years prior. Both PDs and applicants identified applicant equity and wellness as major benefits of virtual interviews, while identifying over-application and interview hoarding as significant detriments.
The virtual interview provides an adequate substitute for the conventional in-person residency interview, with real and perceived benefits to applicant wellness, equity, and financial well-being. The downsides of virtual interviews, namely over-application and interview hoarding, have workable solutions.
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