People with cognitive impairments show deficits during physical performances such as gait, in particular during cognitively challenging conditions (i.e. dual‐task gait DTG). However, it is unclear if ...people at risk of dementia, such as those with subjective memory complaints (SMC), also display gait and central deficits associated with DTG. In this study, we investigated the effects of single‐ and dual‐task gait (STG and DTG), on left prefrontal cortex (PFC) activation in elderly people with subjective memory complaints (SMC) and Dementia. A total of 58 older adults (aged 65–94 years; 26 Healthy; 23 SMC; 9 Dementia) were recruited. Gait spatiotemporal characteristics (i.e. stride velocity and length) were assessed using an instrumented walkway during STG and DTG. Single‐channel functional near‐infrared spectroscopy over the left PFC was used to measure changes in oxyhaemoglobin (O2Hb) during gait. Stride velocity and length during STG (all p < .05) and DTG (all p < .000) were significantly impaired in people with Dementia compared to Healthy and SMC individuals. No differences were observed between Healthy and SMC. For STG, a greater increase in O2Hb (p < .05) was observed in those with Dementia compared to the Healthy and SMC, while no differences were observed between Healthy and SMC. A significant increase and decline in O2Hb was observed during DTG in the SMC and Dementia groups, respectively, compared to Healthy. Our findings indicate an altered pattern of cerebral haemodynamic response of the left PFC in DTG in people with SMC and Dementia, which may suggest that central changes precede functional impairments in people with SMC.
No difference in single‐ and dual‐task gait (STG/DTG) was observed between controls and participants with subjective memory complaints (SMC). Participants with Dementia showed lower STG/DTG performance compared to controls and SMC.
Participants with Dementia had greater left prefrontal cortex (PFC) activation during STG compared to controls and SMC. DTG resulted in higher and lower left PFC activation in SMC and Dementia, respectively, compared to controls.
Heart rate has natural fluctuations that are typically ascribed to autonomic function. Recent evidence suggests that conscious processing can affect the timing of the heartbeat. We hypothesized that ...heart rate is modulated by conscious processing and therefore dependent on attentional focus. To test this, we leverage the observation that neural processes synchronize between subjects by presenting an identical narrative stimulus. As predicted, we find significant inter-subject correlation of heart rate (ISC-HR) when subjects are presented with an auditory or audiovisual narrative. Consistent with our hypothesis, we find that ISC-HR is reduced when subjects are distracted from the narrative, and higher ISC-HR predicts better recall of the narrative. Finally, patients with disorders of consciousness have lower ISC-HR, as compared to healthy individuals. We conclude that heart rate fluctuations are partially driven by conscious processing, depend on attentional state, and may represent a simple metric to assess conscious state in unresponsive patients.
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•Narrative stimuli can synchronize fluctuations of heart rate between individuals•This interpersonal synchronization is modulated by attention and predicts memory•These effects on heart rate cannot be explained by modulation of respiratory patterns•Synchrony is lower in patients with disorders of consciousness
Stories affect our hearts and bind us together. Pérez et al. show that attention to narratives can synchronize fluctuations of heart rate between individuals. Heart synchronization predicts memory and cannot be explained by respiration. Finally, synchrony is lower in patients with disorders of consciousness and might inform prognosis.
Use of daily controller medications is a critical task in management of persistent asthma. Study aims were to examine (1) the association between child age and extent of daily controller-medication ...responsibility in a sample aged 4 to 19 years, (2) parent, child, and disease predictors of child daily controller-medication responsibility and overall daily controller-medication adherence, and (3) the association between child daily controller-medication responsibility and overall daily controller-medication adherence.
We conducted a cross-sectional telephone survey of 351 parents of children who were prescribed daily controller medication. Children's mean age was 10.4 years; 61.5% were male, and 88.1% were white. Parents provided all data, including an estimate of the percentage of child and parent daily controller-medication responsibility. Daily controller-medication adherence was measured as parents' report of percentage of daily doses taken per doses prescribed in a typical week. We used multivariate linear regression to determine associations between parent race/ethnicity, education, income, number of dependents, child age, gender, years since diagnosis, parent perception of symptom severity and control, and dependent variables (child daily controller-medication responsibility and daily controller-medication adherence). We also examined associations between child daily controller-medication responsibility and daily controller-medication adherence.
Child daily controller-medication responsibility increased with age. By age 7, children had assumed, on average, almost 20% of daily controller-medication responsibility; by age 11, approximately 50%; by age 15, 75%; and by age 19, 100%. In multivariate models, child age and male gender remained significantly associated with child daily controller-medication responsibility, and child's age and parents' race/ethnicity remained significantly associated with daily controller-medication adherence.
Clinicians may need to screen for child daily controller-medication management and include even young children when educating families on the use of asthma medications and other key asthma-management tasks.
Background
There are many interventions to facilitate seamless continuity of care for patients in transition from hospital back to primary care; however, disparities remain in readmission rates for ...vulnerable populations, especially African-Americans.
Objectives
We set out to investigate the association of race and ethnicity with 30-day readmission in our urban academic setting and to identify factors that could be leveraged in primary care to address disparities in hospitalizations.
Methods/Approach
Using data originally collected for quality improvement purposes, we evaluated 30-day readmission rates for our primary care patients (January 1, 2013–September 30, 2014) by race and ethnicity, adjusting for demographic and clinical characteristics. Then, using inductive and deductive methods, we coded semi-structured interviews with 24 African-American primary care patients who were discharged from the Medicine or Cardiology service at our tertiary care hospital during the study period.
Key Results
African-Americans had the highest readmission rate (21.7%) and a higher adjusted odds of readmission (1.37; 95% CI 1.04–1.81) compared to Whites. Five major themes emerged as having potential to be leveraged in primary care to help prevent multiple hospitalizations: (1) dependable patient-physician relationships, (2) healthcare coordination across settings, (3) continuity with one primary care provider (PCP), (4) disease self-management, and (5) trust in resident physicians. Participants also made several recommendations to keep patients like themselves from returning to the hospital: increased time to tell their story during their primary care visit, more direct patient-physician communication during the visit, and improved access between visits.
Conclusions
While African-American patients in our practice experience higher rates of hospital readmissions than their White counterparts, they emphasize the significance of their PCP relationship and communication to enhance disease management and prevent hospitalizations. Ongoing efforts are needed to establish and implement best practice communication trainings for patients at increased risk of hospitalization, particularly for resident physicians.
The transcriptional regulator c-MYC is abnormally overexpressed in many human cancers. Evasion from apoptosis is critical for cancer development, particularly c-MYC-driven cancers. We explored which ...anti-apoptotic BCL-2 family member (expressed under endogenous regulation) is essential to sustain c-MYC-driven lymphoma growth to reveal which should be targeted for cancer therapy. Remarkably, inducible Cre-mediated deletion of even a single Mcl-1 allele substantially impaired the growth of c-MYC-driven mouse lymphomas. Mutations in p53 could diminish but not obviate the dependency of c-MYC-driven mouse lymphomas on MCL-1. Importantly, targeting of MCL-1 killed c-MYC-driven human Burkitt lymphoma cells, even those bearing mutations in p53. Given that loss of one allele of Mcl-1 is well tolerated in healthy tissues, our results suggest that therapeutic targeting of MCL-1 would be an attractive therapeutic strategy for MYC-driven cancers.
As a popular food snack rich in protein, fiber, unsaturated fatty acids, antioxidants and phytonutrients, almond nut consumption is widely associated with improvements in cardiometabolic health. ...However, limited data exists regarding the role of almond consumption in improving exercise recovery. Accordingly, we aimed to investigate the impact of chronic almond snacking on muscle damage and cardiometabolic health outcomes during acute eccentric exercise recovery in mildly overweight, middle-aged, adults.
Using a randomized cross-over design, 25 mildly overweight (BMI: 25.8 ± 3.6 kg/m
), middle-aged (35.1 ± 4.7 y) males (
= 11) and females (
= 14) performed a 30-min downhill treadmill run after 8-weeks of consuming either 57 g/day of whole almonds (ALMOND) or an isocaloric amount (86 g/day) of unsalted pretzels (CONTROL). Muscle soreness (visual analogue scale), muscle function (vertical jump and maximal isokinetic torque) and blood markers of muscle damage (creatine kinase (CK) concentration) and inflammation (c-reactive protein concentration) were measured pre and post (24, 48, and 72 h) exercise. Blood biomarkers of cardiometabolic health (total cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol), body composition and psycho-social assessments of mood (POMS-2 inventory), appetite and well-being were measured pre and post intervention.
Downhill running successfully elicited muscle damage, as evidenced by a significant increase in plasma CK concentration, increased perception of muscle soreness, and impaired vertical jump performance (all
< 0.05) during acute recovery. No effect of trial order was observed for any outcome measurement. However, expressed as AUC over the cumulative 72 h recovery period, muscle soreness measured during a physical task (vertical jump) was reduced by ~24% in ALMOND vs. CONTROL (
< 0.05) and translated to an improved maintenance of vertical jump performance (
< 0.05). However, ALMOND did not ameliorate the CK response to exercise or isokinetic torque during leg extension and leg flexion (
> 0.05). No pre-post intervention changes in assessments of cardiometabolic health, body composition, mood state or appetite were observed in ALMOND or CONTROL (all
> 0.05).
Chronic almond supplementation alleviates task-specific perceived feelings of muscle soreness during acute recovery from muscle damaging exercise, resulting in the better maintenance of muscle functional capacity. These data suggest that almonds represent a functional food snack to improve exercise tolerance in mildly overweight, middle-aged adults.
Lipid peroxidation of marine fish diets can affect the nutritional value of the diet and consequently fish health, especially in the absence of adequate amounts of anti-oxidants. In this study, diets ...with different levels of oxidized oil and dietary vitamin E were fed to juvenile Atlantic halibut for 16 weeks and the effects on the acute stress response were investigated after this period. Fish were fed diets containing either non-oxidized (POV=0.6 meq kg−1, diet A, control) or oxidized fish oil (POV=7.5 meq kg−1, diets B and C; 15 meq kg−1, diets D and E). Diets A, C and E were supplemented with vitamin E (300 IU kg−1). Following this period, Atlantic halibut were subjected to a 1-h heat shock (HS; from 12 to 18 °C). Plasma cortisol and glucose, and red blood cells (RBC) heat shock protein 70 (hsp70) levels were measured prior to, 0 (immediately after), 6, 12, and 24 h after stress. Two-way ANOVA, using dietary treatment and sampling point as main factors, was performed. In all experimental groups, Atlantic halibut showed increased plasma cortisol levels immediately after (0 h) heat shock, however these returned to pre-stress levels by 6 h. Similarly, plasma glucose level increased significantly immediately after heat shock and decreased to pre-stress levels by 6 h. Dietary treatment had a significant effect on plasma glucose levels. Fish fed the highly oxidized diet (diet E) showed lower overall plasma glucose levels than fish fed less or non-oxidized diets (diets A, B, and C). RBC hsp70 was detected in all treatment groups. However, no significant changes in hsp70 levels were observed after exposure to heat shock. The overall results indicate that juvenile halibut fed diets containing oxidized fish oil up to a peroxide value of 15 meq kg−1 were able to cope with temperature stress, regardless of dietary vitamin E content. The glucose results, however, suggest that highly oxidized diets decrease the overall glucose levels. Furthermore, plasma cortisol and glucose, but not hsp70, seemed to be adequate indicators of heat shock stress in juvenile halibut.
Injuries, the leading cause of death in children 1-17 years old, are often preventable. Injury patterns are impacted by changes in the child's environment, shifts in supervision, and caregiver ...stressors. The objective of this study was to evaluate the incidence and proportion of injuries, mechanisms, and severity seen in Pediatric Emergency Departments (PEDs) during the COVID-19 pandemic.
This multicenter, cross-sectional study from January 2019 through December 2020 examined visits to 40 PEDs for children < 18 years old. Injury was defined by at least one International Classification of Disease-10th revision (ICD-10) code for bodily injury (S00-T78). The main study outcomes were total and proportion of PED injury-related visits compared to all visits in March through December 2020 and to the same months in 2019. Weekly injury visits as a percentage of total PED visits were calculated for all weeks between January 2019 and December 2020.
The study included 741,418 PED visits for injuries pre-COVID-19 pandemic (2019) and during the COVID-19 pandemic (2020). Overall PED visits from all causes decreased 27.4% in March to December 2020 compared to the same time frame in 2019; however, the proportion of injury-related PED visits in 2020 increased by 37.7%. In 2020, injured children were younger (median age 6.31 years vs 7.31 in 2019), more commonly White (54% vs 50%, p < 0.001), non-Hispanic (72% vs 69%, p < 0.001) and had private insurance (35% vs 32%, p < 0.001). Injury hospitalizations increased 2.2% (p < 0.001) and deaths increased 0.03% (p < 0.001) in 2020 compared to 2019. Mean injury severity score increased (2.2 to 2.4, p < 0.001) between 2019 and 2020. Injuries declined for struck by/against (- 4.9%) and overexertion (- 1.2%) mechanisms. Injuries proportionally increased for pedal cycles (2.8%), cut/pierce (1.5%), motor vehicle occupant (0.9%), other transportation (0.6%), fire/burn (0.5%) and firearms (0.3%) compared to all injuries in 2020 versus 2019.
The proportion of PED injury-related visits in March through December 2020 increased compared to the same months in 2019. Racial and payor differences were noted. Mechanisms of injury seen in the PED during 2020 changed compared to 2019, and this can inform injury prevention initiatives.
Specific concerns from 706 parents regarding their children's (M age = 8.0, SD = 3.9) use of daily asthma medications were systematically identified and organized. 270 (38.2%) of 706 parents ...expressed a total of 470 concerns (M = 1.74, SD = 0.93; Range 1-5), including concerns about side effects (48.9%; e.g., growth retardation); aspects of the regimen (29.3%; e.g., medication amount); and "steroid" use (10.4%). Independent predictors of parental concern included use of inhaled corticosteroids (OR = 1.60, 95% CI 1.07-2.40), nasal corticosteroids (OR = 1.70, 95% CI 1.21-2.38), and alternative therapies (OR = 1.84, 95% CI 1.32-2.56). Providers should be prepared to address a wide range of medication concerns, especially those related to side effects.
The present study represents a content analysis, of 1,133 articles published between 1977 and 1998 in Child Abuse & Neglect, Child Maltreatment, and Journal of Child Sexual Abuse was performed. ...Although there were indications of increased attention to ethnicity in child maltreatment research published between 1977 and 1998, the improvements were modest. Of the 1,133 articles examined, 6.7% focused on ethnicity. The percentage of studies that provided information on the ethnic composition of samples increased across time; however, only half of the studies published in the most recent years examined (1995-1998) reported information on the ethnicity of the participants. Although the percentage of articles that used ethnicity in analyses or as a control variable increased across time, three quarters of the articles published in the most recent years examined (1995-1998) did not include ethnicity in their analyses or design.
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