The cortical organization of audio-visual sentence comprehension: an fMRI study at 4 Tesla

Neuroimaging studies of written and spoken sentence processing report greater left hemisphere than right hemisphere activation. However, a large majority of our experience with language is face-to-face interaction, which is much richer in information. The current study examines the neural organization of audio-visual (AV) sentence processing using functional magnetic resonance imaging (fMRI) at 4 Tesla. Participants viewed the face and upper body of a speaker via a video screen while listening to her produce, in alternating blocks, English sentences and sentences composed of pronounceable non-words. Audio-visual sentence processing was associated with activation in the left hemisphere in Broca's area, dorsolateral prefrontal cortex, the superior precentral sulcus, anterior and middle portions of the lateral sulcus, middle superior portions of the temporal sulcus, supramarginal gyrus and angular gyrus. Further, AV sentence processing elicited activation in the right anterior and middle lateral sulcus. Between-hemisphere analyses revealed a left hemisphere dominant pattern of activation. The findings support the hypothesis that the left hemisphere may be biased to process language independently of the modality through which it is perceived. These results are discussed in the context of previous neuroimaging results using American Sign Language (ASL).     

Endogenous facilitation: from molecular mechanisms to persistent pain

It is well documented that sensory transmission, including pain, is subject to endogenous inhibitory modulatory influences at dorsal horn of the spinal cord. Recent results, from behavioral to molecular studies, demonstrate that endogenous modulatory systems are bi-phasic, including inhibitory as well as new facilitatory systems. In this review, we propose the existence of endogenous facilitatory systems in the brain, and review evidence supporting the hypothesis. We believe that understanding molecular and cellular mechanisms of endogenous facilitatory systems hold the hope for better future treatment of patients with chronic pain.     

Fetal exposure to alcohol as evidenced by fatty acid ethyl esters in meconium in the absence of maternal drinking history in pregnancy

The detection of fatty acid ethyl esters (FAEE) in neonatal meconium has been proposed as a novel screening method for intrauterine exposure to alcohol. We investigated the potential use of meconium FAEE screening in a high-risk neonatal population in the absence of maternal drinking history. One hundred forty-two meconium samples of neonates suspected of intrauterine illicit substance exposure and referred to the Motherisk Laboratory were analyzed for the existence of drugs by enzyme-linked immunosorbent assay (ELISA) and FAEE by gas chromatography-flame ionization detection (GC-FID). A positive FAEE test was previously defined as a cumulative measurement of 7 individual FAEE > or = 2 nmol/g. Seventy-one percent of the samples tested positive for at least 1 illicit drug, with cannabis being the most prevalent (52.3%). Fourteen percent of all samples tested positive for prenatal alcohol exposure, as evidenced by cumulative meconium FAEE > or = 2 nmol/g. Ethyl oleate, linoleate, palmitate, and arachidonate were detected most often and at the highest levels. At least 3 individual FAEE were detected in 95% of all positive samples, and none could be identified by the use of 1 selected FAEE. Significantly elevated levels of FAEE above the baseline and the presence of multiple FAEE species in meconium are exclusive to neonates who have likely been exposed to excessive amounts of alcohol in utero. Babies born to mothers who are suspected to use illicit drugs in pregnancy are at elevated risk for exposure also to alcohol in utero. Meconium FAEE are emerging biologic markers that can potentially facilitate earlier diagnosis and intervention for less apparent forms of alcohol-related disabilities that cannot be confirmed in the absence of maternal drinking history.     

Cost-utility analysis of osteopathy in primary care: results from a pragmatic randomized controlled trial

BACKGROUND: Spinal pain is common and costly to health services and society. Management guidelines have encouraged primary care referral for spinal manipulation, but the evidence base is weak. More economic evaluations alongside pragmatic trials have been recommended. OBJECTIVE: Our aim was to assess the cost-utility of a practice-based osteopathy clinic for subacute spinal pain. METHODS: A cost-utility analysis was performed alongside a pragmatic single-centre randomized controlled trial in a primary care osteopathy clinic accepting referrals from 14 neighbouring practices in North West Wales. Patients with back pain of 2-12 weeks duration were randomly allocated to treatment with osteopathy plus usual GP care or usual GP care alone. Costs were measured from a National Health Service (NHS) perspective. All primary and secondary health care interventions recorded in GP notes were collected for the study period. We calculated quality adjusted life year (QALY) gains based on EQ-5D responses from patients in the trial, and then cost per QALY ratios. Confidence intervals (CIs) were estimated using non-parametric bootstrapping. RESULTS: Osteopathy plus usual GP care was more effective but resulted in more health care costs than usual GP care alone. The point estimate of the incremental cost per QALY ratio was 3560 pounds (80% CI 542 pounds-77,100 pounds). Sensitivity analysis examining spine-related costs alone and total costs excluding outliers resulted in lower cost per QALY ratios. CONCLUSION: A primary care osteopathy clinic may be a cost-effective addition to usual GP care, but this conclusion was subject to considerable random error. Rigorous multi-centre studies are needed to assess the generalizability of this approach.     

Physical activity, social support, and family structure as determinants of mood among European-American and African-American women

The literature indicates that mood is an important predictor of physical and psychological well-being. Mood influences a person's health perceptions, treatment compliance, and recovery. Given the importance of mood as an outcome, it is important to identify predictors of mood. The current study examined physical activity, social support, and family structure as determinants of mood among women who had recently begun a walking program. Two hundred and fifty-nine European-American and African-American women between the ages of 30 and 60 participated in the study. A significant positive relation was found between physical activity, social support, and mood, while a negative relation was found between number of children and mood. Hierarchical regression revealed that physical activity, social support of friends, mari- tal status, and number of children were significant predictors of women's mood. Race moderated the relation between number of children and mood. This study suggests that physical activity, social support, and family may be important factors in the psychological well-being of women.