Sleep to learn after stroke: Implicit and explicit off-line motor learning

After stroke, many individuals experience persistent motor impairments as well as altered patterns of sleep. Therefore, examining the role of sleep in motor skill learning following stroke is a critical issue. Other learning variables, such as type of instruction, may interact with sleep to influence sleep-dependent motor learning. Forty individuals with stroke and 40 control participants practiced a continuous motor tracking task and then either slept (sleep condition) or stayed awake (no-sleep condition) between practice and retention testing. Half were provided explicit information regarding the presence of a repeating sequence (explicit condition), while the other half were not (implicit condition). After stroke, individuals demonstrated sleep-dependent off-line motor learning of both the implicit and explicit version of the continuous tracking task; however, individuals with stroke who stayed awake between practice and retention testing did not demonstrate an improvement in motor performance at retention. Neither sleep nor instruction differentiated the performance of the healthy control participants. These data suggest that aspects of motor recovery after stroke may be modulated by sleep.     

The Woman’s Body (Not the Man’s One) Is Used to Evaluate Sexual Desire: An Eye-Tracking Study of Automatic Visual Attention

Introduction

Vision of the human body has been shown to be key in eliciting sexual desire. However, whether the visual pattern characterizing sexual desire is different in women and men is still unclear.

How do statistical properties influence findings of tracking (maintenance) in epidemiologic studies? An example of research in tracking of obesity⋆

There is great interest in studying the tracking (maintenance) of health conditions and risk factors over the life span. Tracking is often defined as the maintenance of a distribution position (e.g., quintile or percentile) in a study population over time. This study investigated how statistical properties might influence research findings of tracking with a special attention on the tracking of extreme ranking. Our results show that when repeated measures over time were positively correlated, the probability of tracking in extreme rankings was greater than other rankings and this was closely influenced by the overall correlation (r) and by the categorization. For example, when r = 0.4, 38% remained in the bottom and upper quintile (Q1, Q5) respectively, while only 22% remained in the middle quintile (Q3); when r = 0.8, the figure became 65% vs. 32%. When r = 0.4 and 0.8, 19 and 50% remained in the upper 95th percentile (or under the 5th percentile), respectively. Our real data show that children in the upper body mass index (= weight(kg)/height(m)²) quintile were more likely to maintain their ranking (54%) than others (about 30%), but not significantly higher than the expected (47%, p > 0.05). In conclusion, the overall correlation should be considered when studying tracking. Our proposed methods and predicted probabilities of tracking can help test whether one's observed tracking patterns are different from the statistically predicted ones.     

Provider networks and primary‐care signups: do they restrict the use of medical services?

This article analyzes the effect of gatekeeper and network restrictions on use of health‐care services using simulation‐based estimation methods. Data from the Community Tracking Survey (1996–1997) show significant evidence of selection into plans with gatekeeper and/or network restrictions. Enrollees in plans with networks of physicians have fewer office‐based visits to non‐physician medical professionals, but more emergency room visits and hospital stays. Individuals in plans that require signups with a primary‐care provider have more visits to non‐physician providers of care, more surgeries and hospital stays but substantially fewer emergency room visits. Enrollees of plans that do not pay for out‐of‐network services have more office‐based and emergency room visits, but less surgeries and hospitalizations. Copyright © 2008 John Wiley & Sons, Ltd.     

Effectiveness of pediatric practice consultation on missed opportunities for immunization

Objective To evaluate the effectiveness of pediatric practice consultation in reducing missed-opportunity rates at eight pediatric sites in Baltimore, Maryland. The overarching goal was to decrease the occurrence of missed opportunities from 33% to 15% for the first, second, and third diphtheria and tetanus toxoids and pertussis vaccines during visits at which children were eligible for the vaccines. Design The effect of an in-office educational program alone at four sites is compared with the educational program and a consultation on office vaccination practices at four matched sites. All eight sites received a small grant ($2,000) to fund practice changes. The medical records of children making visits before and after the interventions were audited to determine missed-opportunity rates. The policies and operations and the knowledge, attitudes, and practices of physicians and nurse practitioners at each site were also assessed. Results The four education-consultation sites experienced a statistically significant 14% net reduction in the missed-opportunity rate relative to the education-only sites. This positive effect, however, was largely due to an increase in missed opportunities at one education-only site. There was a 10% increase in the missed-opportunity rate among the education-only sites and a 4% decrease among the education-consultation sites; neither change was statistically significant. Two of the three sites that reduced missed opportunities were matched health maintenance organizations (HMOs). Shortly after the interventions, both HMOs implemented tracking and follow-up information systems, which were planned before the interventions. Conclusions There is no evidence that either the educational program alone or the educational program and consultation combination reduced missed opportunities. The findings suggest that improved tracking and follow-up data systems and vaccination of children at sick visits may reduce missed opportunities. This study was funded by the Centers for Disease Control and Prevention, contract number 200-90-0850.     

Left Ventricular Diastolic Function of Children in High Blood Pressure Tracking Group.

The purpose of this study was to determine whether left ventricular (LV) diastolic function in children with high blood pressure (BP) is abnormal. We measured the corrected LV isovolumic relaxation time (IRT), peak velocity of increase in LV dimension (dD/dt) and the LV muscle volume in a high systolic BP tracking group (10 boys and 22 girls) and a low BP tracking group (22 boys and 11 girls) at 3-year intervals from the ages of 6 to 15. The corrected IRT of the high BP tracking group was significantly longer than the low BP tracking group. Left ventricular dD/dt/D of the high BP tracking group was significantly lower than the low BP tracking group from the ages of 12 in boys and 9 in girls. The left ventricular muscle volume index of both groups, however, was not significantly different. Both corrected IRT and dD/dt/D were well correlated with diastolic BP. These data suggest that children in the high BP tracking group might have LV diastolic abnormalities from age 12 or 15, in contrast to children of the low BP tracking group, without increased LV muscle volume. Therefore, it might be useful to examine BP and LV function of children from ages 12 or 15 for prevention of hypertension.     

吉林省长春市朝阳区结核病人发现模式初探

目的抓住提高就诊率、确诊率和网络直报追踪到位率三个环节,提高肺结核病人发现率。方法通过全面推行结核病控制策略(DOTS),充分发挥结防所作用,与综合性医院配合协作,政府职能部门督导,三位一体,各尽其责,做好病人发现工作。结果朝阳区自项目实施以来,发现新发涂阳登记率2002年20.48/10万、2003年24.75/10万、2004年42.65/10万。2004年实施朝阳区结核病人发现模式研究项目以来,新发现涂阳274例,项目任务数254例,完成率107.87%。结论加强结防所、综合性医院、卫生行政部门三位一体协作,采取综合性措施后,切实有效地提高了病人的发现率,因此,充分发挥各自职能,共享医院资源,有效提高就诊率,提高确诊率和网络直报追踪到位率是做好结核病控制工作最为有效途径。     

Increased Utilization of Virtual Visits and Electronic Approaches in Clinical Research During the COVID-19 Pandemic and Thereafter

ObjectivesTo assess the impact of the COVID-19 pandemic on clinical research and the use of electronic approaches to mitigate this impact.MethodsWe compared the utilization of electronic consenting, remote visits, and remote monitoring by study monitors in all research studies conducted at Mayo Clinic sites (Arizona, Florida, and Minnesota) before and during the COVID-19 pandemic (ie, between May 1, 2019 and December 31, 2020). Participants are consented through a participant-tracking system linked to the electronic health record.ResultsBetween May 2019, and December 2020, there were 130,800 new consents across every modality (electronic and paper) to participate in a non-trial (107,176 [82%]) or a clinical trial (23,624 [18%]). New consents declined from 5741 in February 2020 to 913 in April 2020 but increased to 11,864 in November 2020. The mean (standard deviation [SD]) proportion of electronic consent increased from 22 (2%) before to 45 (20%) during the pandemic (P=.001). Mean (SD) remote electronic consenting increased from 0.3 (0.5%) to 29 (21%) (P<.001). The mean (SD) number of patients with virtual visits increased from 3.5 (2.4%) to 172 (135%) (P=.003) per month between pre-COVID (July 2019 to February 2020) and post-COVID (March to December 2020) periods. Virtual visits used telemedicine (68%) or video (32%). Requests for remote monitor access to complete visits increased from 44 (17%) per month between May 2019 and February 2020 to 111 (74%) per month between March and December 2020 (P=.10).ConclusionAfter a sharp early decline, the enrollment of new participants and ongoing study visits recovered during the COVID-19 pandemic. This recovery was accompanied by the increased use of electronic tools.