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21.
Elizabeth K. Vernon Bryce Cooley William Rozum Gail B. Rattinger Stephanie Behrens Joshua Matyi Elizabeth Fauth Constantine G. Lyketsos JoAnn T. Tschanz 《The American journal of geriatric psychiatry》2019,27(4):349-359
Objective
Closer caregiver-care recipient (CG-CR) relationships are associated with better cognitive and functional abilities, activities of daily living (in persons with dementia), and lower informal care costs.Methods
Due to the difficulty in treating neuropsychiatric symptoms (NPSs) and their detrimental effects on caregivers and care recipients, we examined whether closeness of CG-CR relationships was associated with overall NPS severity or with specific NPS symptom domains in care recipients. In a longitudinal population-based study in Cache County, Utah, the 12-item Neuropsychiatric Inventory (NPI-12) was assessed in 300 CG-CR dyads. Caregivers reported current relationship closeness using the Whitlatch Relationship Closeness Scale. Linear mixed models examined associations between CG-CR closeness and NPI-12 total score or selected symptom domains over time (observation period: 2002–2012).Results
In unadjusted linear mixed models, higher closeness scores were associated with a five-point lower NPI-12 score and a one-point lesser increase in NPI-12 per year. NPI scores also showed lower affective cluster scores (two points) and lesser increase in psychosis cluster (approximately 0.5 points per year) and agitation/aggression (0.16 points per year) for each unit increase in closeness. When controlling for NPI caregiver distress, associations between closeness and NPSs diminished to a 0.5-point lesser increase in total NPI-12 score per year. Adjusted models for NPI domains/clusters showed ?0.32 points per year for the psychosis cluster, ?0.11 points per year for agitation/aggression, and ?0.67 overall for the affective cluster.Conclusion
Higher CG-CR closeness, a potentially modifiable factor, is associated with lower NPS severity and may provide a target for intervention. 相似文献22.
Shelley Ellis Andrew Callaway Bryce Dyer 《Disability and rehabilitation. Assistive technology》2018,13(6):568-574
Within the Paracanoeing discipline, it is important to ensure that appropriate control is achieved by a paddler with a disability. However, this Paralympic Games discipline has seen very little attention to date. The aims of this study were to understand the kinematic impact to a paracanoeist when not utilizing the use of a prosthetic lower-limb. A kayaker with a uni-lateral transfemoral amputation completed several 200?m maximal efforts both with and without their prosthesis. When the prosthetic limb was removed, there were significant differences found in stroke rate, stroke speed, stroke length and overall power output. Sagittal and frontal video analysis demonstrated the residual limb movements when paddling and indicated where support would be required to improve the kayak’s control. It is recommended that those with lower-limb absence wishing to paddle a kayak competitively utilize the use of a prostheses designed for the kayaking environment that supports the residual limb at both the upper and inner thigh and the distal end.
- Implications for rehabilitation
This paper is the first study to investigate both biomechanical and assistive technology-related issues in the new Paralympic Games sport of Paracanoeing.
For participants possessing lower-limb absence, a prosthetic limb that is designed specifically for the kayaking environment is recommended when Paracanoeing to maximize efficient propulsion.
Use of an ergometer and multiple 2D cameras provides practitioners the ability to optimize both the comfort and fit of a prosthetic limb.
Use of an ergometer and multiple 2D cameras provides both athletes and practitioners the ability to optimize the points of human contact within a kayak to ensure comfort and control.
23.
Jessica Leake Raphael Zinn Laura H. Corbit Michael S. Fanselow Bryce Vissel 《The Journal of neuroscience》2021,41(18):4120
Memories are rarely acquired under ideal conditions, rendering them vulnerable to profound omissions, errors, and ambiguities. Consistent with this, recent work using context fear conditioning has shown that memories formed after inadequate learning time display a variety of maladaptive properties, including overgeneralization to similar contexts. However, the neuronal basis of such poor learning and memory imprecision remains unknown. Using c-fos to track neuronal activity in male mice, we examined how these learning-dependent changes in context fear memory precision are encoded in hippocampal ensembles. We found that the total number of c-fos-encoding cells did not correspond with learning history but instead more closely reflected the length of the session immediately preceding c-fos measurement. However, using a c-fos-driven tagging method (TRAP2 mouse line), we found that the degree of learning and memory specificity corresponded with neuronal activity in a subset of dentate gyrus cells that were active during both learning and recall. Comprehensive memories acquired after longer learning intervals were associated with more double-labeled cells. These were preferentially reactivated in the conditioning context compared with a similar context, paralleling behavioral discrimination. Conversely, impoverished memories acquired after shorter learning intervals were associated with fewer double-labeled cells. These were reactivated equally in both contexts, corresponding with overgeneralization. Together, these findings provide two surprising conclusions. First, engram size varies with learning. Second, larger engrams support better neuronal and behavioral discrimination. These findings are incorporated into a model that describes how neuronal activity is influenced by previous learning and present experience, thus driving behavior.SIGNIFICANCE STATEMENT Memories are not always formed under ideal circumstances. This is especially true in traumatic situations, such as car accidents, where individuals have insufficient time to process what happened around them. Such memories have the potential to overgeneralize to irrelevant situations, producing inappropriate fear and contributing to disorders, such as post-traumatic stress disorder. However, it is unknown how such poorly formed fear memories are encoded within the brain. We find that restricting learning time results in fear memories that are encoded by fewer hippocampal cells. Moreover, these fewer cells are inappropriately reactivated in both dangerous and safe contexts. These findings suggest that fear memories formed at brief periods overgeneralize because they lack the detail-rich information necessary to support neuronal discrimination. 相似文献
24.
Dawn Peck Amy White Gisele Pino April Studinski Meghan Strenk Randi Gadea Jennifer Gannon Bryce Heese Esperanza Font-Montgomery Tracy Klug Jennifer Burton George Hoganson Devin Oglesbee Dimitar Gavrilov Dietrich Matern Kimiyo Raymond Piero Rinaldo Silvia Tortorelli 《Molecular genetics and metabolism》2021
25.
Andre M. Samuel Matthew L. Webb Adam M. Lukasiewicz Daniel D. Bohl Bryce A. Basques Glenn S. Russo Vinay K. Rathi Jonathan N. Grauer 《Clinical orthopaedics and related research》2015,473(10):3297-3306
Background
Industry payments made to physicians by drug and device manufacturers or group purchasing organizations are now reported to the Centers for Medicare and Medicaid Services (CMS) as a part of the Physician Payments Sunshine Act. Initial reports from the program show that orthopaedic surgeons lead all physician specialties in total and average industry payments. However, before further discussion of these payments and their implications can take place, it remains to be seen whether these figures are a true reflection of the field of orthopaedic surgery in general, rather than the result of a few outlier physicians in the field. In addition, the nature and sources of these funds should be determined to better inform the national dialogue surrounding these payments.Questions/Purposes
We asked: (1) How do industry payments to orthopaedic surgeons compare with payments to physicians and surgeons in other fields, in terms of median payments and the Gini index of disparity? (2) How much do payments to the highest-receiving orthopaedic surgeons contribute to total payments? (3) What kind of industry payments are orthopaedic surgeons receiving? (4) How much do the highest-paying manufacturers contribute to total payments to orthopaedic surgeons?Materials and Methods
We reviewed the most recent version of the CMS Sunshine Act Open Payments database released on December 19, 2014, containing data on payments made between August 1, 2013 and December 31, 2013. Data on total payments to individual physicians, physician specialty, the types of payments made, and the manufacturers making payments were reviewed. The Gini index of statistical dispersion was calculated for payments made to orthopaedic surgeons and compared with payments made to physicians and surgeons in all other medical specialties. A Gini index of 0 indicates complete equality of payments to everyone in the population, whereas an index of 1 indicates complete inequality, or all income going to one individual.Results
A total of 15,376 orthopaedic surgeons receiving payments during the 5-month period were identified, accounting for USD 109,846,482. The median payment to orthopaedic surgeons receiving payments was USD 121 (interquartile range, USD 34–619). The top 10% of orthopaedic surgeons receiving payments (1538 surgeons) received at least USD 4160 and accounted for 95% of total payments. Royalties and patent licenses accounted for 69% of all industry payments to orthopaedic surgeons.Conclusions
Even as a relatively small specialty, orthopaedic surgeons received substantial payments from industry (more than USD 110 million) during the 5-month study period. Whether there is a true return of value from these payments remains to be seen; however, future ethical and policy discussions regarding industry payments to orthopaedic surgeons should take into account the large disparities in payments that are present and also the nature of the payments being made. It is possible that patients and policymakers may view industry payments to orthopaedic surgeons more positively in light of these new findings.Level of Evidence
Level III, Economic and Decision Analysis. 相似文献26.
27.
28.
Kerlin BA 《American journal of hematology》2012,87(Z1):S68-S74
Venous thromboembolism (VTE) is an increasingly common complication encountered in tertiary care pediatric settings. The purpose of this review is to summarize the epidemiology, current and emerging pharmacotherapeutic options, and management of this disease. Over 70% of VTE occur in children with chronic diseases. Although they are seen in children of all ages, adolescents are at greatest risk. Pediatric VTE is associated with an increased risk of in-hospital mortality; recurrent VTE and post-thrombotic syndrome are commonly seen in survivors. In recent years, anticoagulation with low molecular weight heparin has emerged as the mainstay of therapy, but compliance is limited by its onerous subcutaneous administration route. New anticoagulants either already approved for use in adults or in the pipeline offer the possibility of improved dose stability and oral routes of administration. Current recommended anticoagulation course durations are derived from very limited case series and cohort data, or extrapolations from adult literature. However, the pathophysiologic underpinnings of pediatric VTE are dissimilar from those seen in adults and are often variable within groups of pediatric patients. Clinical studies and trials in pediatric VTE are underway which will hopefully improve the quality of evidence from which therapeutic guidelines are derived. 相似文献
30.
Jared R. Gallaher Bryce E. Haac Andrew J. Geyer Charles Mabedi Bruce A. Cairns Anthony G. Charles 《World journal of surgery》2016,40(11):2650-2657