Mccallumyilmaz8605
Background Cocaine use disorder (CUD) is a public health problem with limited treatment options and a significant relapse rate. Neuroimaging studies have identified abnormal functional connectivity in individuals with substance use disorders. Neuromodulation has been proposed to target this altered neurocircuitry. Combining TMS with neuroimaging has the potential to inform identification of biomarkers, diagnosis, and treatment. Objectives We review the literature of transcranial magnetic stimulation (TMS) with neuroimaging for CUD and outline a research path forward whereby TMS can be used to identify brain network features as diagnostic or prognostic biomarkers for treatment. Methods We reviewed the literature for primary research studies of TMS with neuroimaging for CUD. We searched PubMed using search terms of "cocaine," "transcranial magnetic stimulation," and "neuroimaging." Identified studies were screened by title and abstract. Full-text studies were reviewed for inclusion. Results In our initial search, we identified 73 studies. Six studies met our inclusion criteria. These studies used rTMS (n = 3) and single or paired pulse TMS (n = 3) and included a total of 289 participants. All studies used fMRI as the neuroimaging modality. The most common outcome measure was craving and cue-reactivity (n = 3). Conclusion The literature combining TMS with neuroimaging is small and heterogeneous. We propose that combining TMS with neuroimaging will accelerate our understanding of substance use disorder neurobiology and treatment. Once network biomarkers of substance use have been identified, TMS can be used to manipulate the dysfunctional circuits in order to identify a causal relationship between connectivity and psychopathology.Background Robotic Rives-Stoppa ventral hernia repair (rRS-VHR) is a minimally invasive technique that incorporates extraperitoneal mesh placement, using either transabdominal or totally extraperitoneal access. An understanding of its learning curve and technical challenges may guide and encourage its adoption. We aim at evaluating the rRS-VHR learning curve based on operative times while accounting for adverse outcomes. Materials and Methods We conducted a retrospective analysis of patients undergoing rRS repair for centrally located ventral and incisional hernias. A single surgeon operative time-based cumulative sum (CUSUM) analysis learning curve was created, and a composite outcome was used for risk-adjusted CUSUM (RA-CUSUM). Results Eighty-one patients undergoing rRS-VHR were included. A learning curve was created by using skin-to-skin times. Accordingly, patients were grouped into three phases. The mean skin-to-skin time was 72.2 minutes, and there was a significant decrease in skin-to-skin times throughout the learning curve (Phase-I 86.4 minutes versus Phase-III 63.8 minutes; P = .001), with a gradual decrease after 29 cases. Eleven patients experienced adverse composite outcomes, which were used to create a RA-CUSUM graph. Results showed the highest adverse outcome rates in Phase-II, with a gradual decrease in risk-adjusted operative times after 51 cases. Conclusions Consistently decreasing operative times and adverse outcome rates in rRS-VHR was observed after the completion of 29 and 51 cases, respectively. Future studies that provide group learning curves for this procedure can deliver more generalizable results in terms of its performance rates.
Powered wheelchairs promote participation for people with mobility limitations. For older adults with cognitive impairment, existing training methods may not address learning needs, leading to difficulty with powered wheelchair skills. Error-minimized training, facilitated by shared control technology, may provide learning opportunities more suited to this population.
The objective of this study was to evaluate the feasibility of an error-minimized approach to powered wheelchair skills training using shared control in residential care. Feasibility indicators were hypothesized a priori to be feasible for use in a definitive RCT.
A 2 × 2 factorial RCT compared an error-minimized powered wheelchair skills training program (Co-pilot) to a control intervention at two doses (6 sessions vs. 12 sessions). Data were collected on the feasibility of study processes (e.g., recruitment), resources (e.g., participant time), management (e.g., technology reliability), and training outcomes (e.g., adverse events, clinicarch. Individuals with cognitive impairment are able to learn the required skills for operation of a powered wheelchair.
Individuals with mild to moderate cognitive impairment are able to learn the skills required to drive a powered wheelchair in as few as six training sessions. Further evaluation of the Co-pilot training program is required. IMPLICATIONS FOR REHABILITATION Shared control teleoperation technology may be used to augment learning in older adults with cognitive impairments. Evaluation of the feasibility of use of novel rehabilitation technologies is critical prior to engaging in large-scale clinical research. Individuals with cognitive impairment are able to learn the required skills for operation of a powered wheelchair.In 2008 the National Institutes of Health established the Research, Condition and Disease Categorization Database (RCDC) that reports the amount spent by NIH institutes for each disease. Its goal is to allow the public "to know how the NIH spends their tax dollars," but it has been little used. The RCDC for 2018 was used to assess 428 schizophrenia-related research projects funded by the National Institute of Mental Health. Three senior psychiatrists independently rated each on its likelihood ("likely", "possible", "very unlikely") of improving the symptoms and/or quality of life for individuals with schizophrenia within 20 years. At least one reviewer rated 386 (90%), and all three reviewers rated 302 (71%), of the research projects as very unlikely to provide clinical improvement within 20 years. Reviewer agreement for the "very unlikely" category was good; for the "possible" category was intermediate; and for the "likely" category was poor. At least one reviewer rated 30 (7%) of the research projects as likely to provide clinical improvement within 20 years. The cost of the 30 projects was 5.5% of the total NIMH schizophrenia-related portfolio or 0.6% of the total NIMH budget. Study results confirm previous 2016 criticisms that the NIMH schizophrenia-related research portfolio disproportionately underfunds clinical research that might help people currently affected. Although the results are preliminary, since the RCDC database has not previously been used in this manner and because of the subjective nature of the assessment, the database would appear to be a useful tool for disease advocates who wish to ascertain how NIH spends its public funds.
To assess outcomes of a low-profile thoracic stent-graft in the treatment of thoracic aortic pathologies.
A retrospective analysis of all consecutive patients with aortic thoracic pathologies treated with the RelayPro device in two university hospitals between October 2018 and July 2019.
23 patients (65% men; mean age 63.4 ± 15 years) were treated. Pathologies included aortic dissections (n = 10), 5 residual type A (22%) and 5 type B (22%), 6 degenerative aortic aneurysms (26%), 4 penetrating aortic ulcers (17%), and aortic erosion, intramural hematoma and aortic rupture (n = 1 and 4% in each case). click here Two cases (9%) were emergent and two urgent. Proximal landing was achieved in zones 0 (4%), 1 (4%), 2 (43%), and 3 (26%). Five grafts were frozen elephant trunk extensions. Technical success was 100% with accurate device deployment in the intended landing zone of the aortic arch in all 23 patients and with no Ia/III endoleaks and three (13%) type II endoleaks. Apposition was adequate in 96%. Two patients had post-implantation syndromes (one fever, one leukocytosis). Mean follow-up was 11.6 ± 3.7 months (range, 2-16) with no other complications, secondary interventions or conversions to open surgery. There was no 30-day mortality and no aortic-related mortality; all-cause mortality was 4% during follow-up.
A 3-4 French reduced profile in the current generation of stent-grafts facilitates TEVAR particularly in patients with smaller vessels access. Early safety and effectiveness outcomes are favorable, even in endpoints such as deployment accuracy and apposition which may be surrogates for longer-term clinical success and durability.
A 3-4 French reduced profile in the current generation of stent-grafts facilitates TEVAR particularly in patients with smaller vessels access. Early safety and effectiveness outcomes are favorable, even in endpoints such as deployment accuracy and apposition which may be surrogates for longer-term clinical success and durability.
Cervical cancer is among the most common preventable cancers with the highest morbidity and mortality. The World Health Organization (WHO) recommends visual inspection of the cervix with acetic acid (VIA) as cervical cancer screening strategy in resource-poor settings. However, there are barriers to the sustainability of VIA programs including declining providers' VIA competence without mentorship and quality assurances and challenges of integration into primary healthcare. This study seeks to evaluate the impact of smartphone-based strategies in improving reliability, reproducibility, and quality of VIA in humanitarian settings.
We implemented smartphone-based VIA that included standard VIA training, adapted refresher, and 6-month mHealth mentorship, sequentially, in the rural Shiselweni region of Eswatini. A remote expert reviewer provided diagnostic and management feedback on patients' cervical images, which were reviewed weekly by nurses. Program's outcomes, VIA image agreement rates, and Kappa statisviders, and tertiary centers; and capacity building through low-tech high-yield screening are promising strategies for scale-up of VIA programs.
Our findings suggest that smartphone mentorship provided experiential learning to improve nurses' competencies and VIA reliability and reproducibility, reduced false positive, and introduced peer-to-peer education and quality control services. Local collaboration; extending services to remote populations; decreasing unnecessary burden to screened women, providers, and tertiary centers; and capacity building through low-tech high-yield screening are promising strategies for scale-up of VIA programs.Xanthium strumarium is native to North America and now has become one of the invasive alien species (IAS) in China. In order to detect the effects of the invader on biodiversity and evaluate its suitable habitats and ecological distribution, we investigated the abundance, relative abundance, diversity indices, and the number of the invasive and native plants in paired invaded and non-invaded quadrats in four locations in North and Northeast China. We also analyzed the effects of monthly mean maximum and minimum temperatures, relative humidity (%), and precipitations (mm). Strong positive significant (P less then 0.01) correlation and maximum interspecific competition (41%) were found in Huailai between invaded and non-invaded quadrats. Shannon's Diversity Index showed that non-invaded plots had significantly (P less then 0.05) more diversified species than invaded ones. The significant (P less then 0.05) Margalef's Richness Index was found in Huailai and Zhangjiakou in non-invaded recorded heterogeneous nature of plant communities.
