Measuring the speed of the conscious components of recognition memory: Remembering is faster than knowing.

Three experiments investigated response times (RTs) for remember and know responses in recognition memory. RTs to remember responses were faster than RTs to know responses, regardless of whether the remember–know decision was preceded by an old/new decision (two-step procedure) or was made without a preceding old/new decision (one-step procedure). The finding of faster RTs for R responses was also found when remember–know decisions were made retrospectively. These findings are inconsistent with dual-process models of recognition memory, which predict that recollection is slower and more effortful than familiarity. Word frequency did not influence RTs, but remember responses were faster for words than for nonwords. We argue that the difference in RTs to remember and know responses reflects the time taken to make old/new decisions on the basis of the type of information activated at test

Fit Into College II: Physical Activity and Nutrition Behavior Effectiveness and Programming Recommendations

Purpose: To determine whether residency (living on campus versus off campus) was related to the effects of Fit into College on students’ health behaviors, and to understand interns’ perceptions of their roles in mentoring their trainees. Design: Pre-experimental, one-group, pretest-posttest design and a posttest focus group interview. Setting: University-offered health and internship courses. Subjects: Twenty-four students (trainees) participated in the intervention, nine of whom lived on campus. Five student-interns served as their mentors. Intervention: Fit into College was a 14-week intervention in which trainees teamed up with an intern to improve and/or maintain healthy nutrition and physical activity behaviors. Measures: Trainees’ nutrition and physical activity behaviors and perceptions were quantitatively assessed through surveys at preintervention and postintervention. Interns’ mentoring perceptions were qualitatively assessed through a focus group interview after the intervention. Analysis: Two-factor repeated measure ANOVAs and qualitative theme identification. Results: Regardless of their residency location, the trainees’ perceptions of the health benefits of eating fruits and vegetables improved during the intervention. However, for trainees living on campus, the intervention was not effective in increasing the number of fruits and vegetables consumed or the planning for food preparation. The interns perceived that they did not have adequate access to healthy foods, the knowledge or skills to prepare healthy foods, or the competency to teach food preparation strategies to their trainees. For trainees living on campus, the intervention was more effective in decreasing perceived exercise barriers than trainees living off campus. Conclusion: Future iterations of Fit into College may focus on 1) improving college students’ planning and preparation of healthy foods, 2) segmenting trainees into more homogeneous groups for the interns to tailor their areas of expertise (campus vs. off-campus and/or freshman vs. upperclass students), and 3) collaborating with university-partners to improve environmental conditions to promote physical activity and healthy nutrition

Inclusive leadership : realizing positive outcomes through belongingness and being valued for uniqueness

We introduce a theoretically-grounded conceptualization of inclusive leadership and present a framework for understanding factors that contribute to and follow from inclusive leadership within work groups. We conceptualize inclusive leadership as a set of positive leader behaviors that facilitate group members perceiving belongingness in the work group while maintaining their uniqueness within the group as they fully contribute to group processes and outcomes. We propose that leader pro-diversity beliefs, humility, and cognitive complexity increase the propensity of inclusive leader behaviors. We identify five categories of inclusive leadership behaviors that facilitate group members' perceptions of inclusion, which in turn lead to member work group identification, psychological empowerment, and behavioral outcomes (creativity, job performance, and reduced turnover) in the pursuit of group goals. This framework provides theoretical grounding for the construct of inclusive leadership while advancing our understanding of how leaders can increase diverse work group effectiveness

Who doesn't receive carotid endarterectomy when appropriate?

AbstractObjectiveThe purpose of this study was to identify clinical and nonclinical factors associated with failure to perform carotid endarterectomy (CEA) in patients with clinically appropriate indications. We analyzed data from a prospective cohort study performed at five Veterans Affairs medical centers. Patients were referred for carotid artery evaluation if they had at least 50% stenosis in one carotid artery, had no history of CEA, and were independently classified preoperatively as appropriate candidates for CEA, according to clinical criteria. The primary outcome was receipt of CEA within 6 months of evaluation. Data were collected by medical record review and interview regarding clinical status, and patient and physician perception of the risks and benefits of CEA.ResultsAmong clinically appropriate candidates for CEA, 66.8% (n = 233) did not undergo the operation. Compared with patients who did undergo CEA, a greater proportion of these patients had no symptoms (68.7% vs 45.7%; P < .001). A twofold greater proportion of patients who did not undergo CEA were in the highest quartile of reported aversion to surgery. Moreover, a fourfold greater proportion were perceived by their physicians to be at less than 5% risk for future stroke without the operation, and more than a twofold greater proportion were believed to experience less than 5% efficacy from the operation by their providers (P < .01). In multivariable analyses, four characteristics were significantly associated with whether an appropriate candidate did not receive CEA: asymptomatic disease, less than 70% stenosis, high expressed aversion to surgery score, and low (<5%) provider-perceived efficacy of the operation.ConclusionAmong patients in the Veterans Affairs health care system who are clinically appropriate candidates for CEA, those who did not receive the operation were less likely to have symptomatic disease or high-grade carotid artery stenosis, but were more likely to report high aversion to surgery and to have a provider who believed CEA would not be efficacious

Development of the Paranormal and Supernatural Beliefs Scale using classical and modern test theory

Background: This study describes the construction and validation of a new scale for measuring belief in paranormal phenomena. The work aims to address psychometric and conceptual shortcomings associated with existing measures of paranormal belief. The study also compares the use of classic test theory and modern test theory as methods for scale development. Method: We combined novel items and amended items taken from existing scales, to produce an initial corpus of 29 items. Two hundred and thirty-one adult participants rated their level of agreement with each item using a seven-point Likert scale. Results: Classical test theory methods (including exploratory factor analysis and principal components analysis) reduced the scale to 14 items and one overarching factor: Supernatural Beliefs. The factor demonstrated high internal reliability, with an excellent test–retest reliability for the total scale. Modern test theory methods (Rasch analysis using a rating scale model) reduced the scale to 13 items with a four-point response format. The Rasch scale was found to be most effective at differentiating between individuals with moderate-high levels of paranormal beliefs, and differential item functioning analysis indicated that the Rasch scale represents a valid measure of belief in paranormal phenomena. Conclusions: The scale developed using modern test theory is identified as the final scale as this model allowed for in-depth analyses and refinement of the scale that was not possible using classical test theory. Results support the psychometric reliability of this new scale for assessing belief in paranormal phenomena, particularly when differentiating between individuals with higher levels of belief.Peer reviewe

Obscured by administrative data? Racial disparities in occupational injury

Objectives: Underreporting of occupational injuries is well documented, but underreporting patterns may vary by worker characteristics, obscuring disparities. We tested for racial and ethnic differences in injury reporting patterns by comparing injuries reported via research survey and administrative injury database in the same group of healthcare workers in the US. Methods: We used data from a cohort of 1568 hospital patient-care workers who were asked via survey whether they had been injured at work during the year prior (self-reported injury; N=244). Using the hospital’s injury database, we determined whether the same workers had reported injuries to the hospital’s occupational health service during that year (administratively reported injury; N=126). We compared data sources to test for racial and ethnic differences in injury reporting practices. Results: In logistic regression models adjusted for demographic and occupational characteristics, black workers’ odds of injury as measured by self-report data were 1.91 [95% confidence interval (95% CI) 1.04–3.49] compared with white workers. The same black workers’ odds of injury as measured by administrative data were 1.22 (95% CI 0.54–2.77) compared with white workers. Conclusions: The undercount of occupational injuries in administrative versus self-report data may be greater among black compared to white workers, leading to underestimates of racial disparities in workplace injury

RVX-208, a BET-inhibitor for treating atherosclerotic cardiovascular disease, raises ApoA-I/HDL and represses pathways that contribute to cardiovascular disease

AbstractHigh density lipoproteins (HDL), through activity of the main protein component apolipoprotein A-I (ApoA-I), can reduce the risk of cardiovascular disease (CVD) by removing excess cholesterol from atherosclerotic plaque. In this study, we demonstrate that the bromodomain and extraterminal domain (BET) inhibitor RVX-208 increases ApoA-I gene transcription and protein production in human and primate primary hepatocytes. Accordingly, RVX-208 also significantly increases levels of ApoA-I, HDL-associated cholesterol, and HDL particle number in patients who received the compound in recently completed phase 2b trials SUSTAIN and ASSURE. Moreover, a post-hoc analysis showed lower instances of major adverse cardiac events in patients receiving RVX-208. To understand the effects of RVX-208 on biological processes underlying cardiovascular risk, we performed microarray analyses of human primary hepatocytes and whole blood treated ex vivo. Overall, data showed that RVX-208 raises ApoA-I/HDL and represses pro-inflammatory, pro-atherosclerotic and pro-thrombotic pathways that can contribute to CVD risk

X-Ray Computed Tomography Inspection of the Stardust Heat Shield

The "Stardust" heat shield, composed of a PICA (Phenolic Impregnated Carbon Ablator) Thermal Protection System (TPS), bonded to a composite aeroshell, contains important features which chronicle its time in space as well as re-entry. To guide the further study of the Stardust heat shield, NASA reviewed a number of techniques for inspection of the article. The goals of the inspection were: 1) to establish the material characteristics of the shield and shield components, 2) record the dimensions of shield components and assembly as compared with the pre-flight condition, 3) provide flight infonnation for validation and verification of the FIAT ablation code and PICA material property model and 4) through the evaluation of the shield material provide input to future missions which employ similar materials. Industrial X-Ray Computed Tomography (CT) is a 3D inspection technology which can provide infonnation on material integrity, material properties (density) and dimensional measurements of the heat shield components. Computed tomographic volumetric inspections can generate a dimensionally correct, quantitatively accurate volume of the shield assembly. Because of the capabilities offered by X-ray CT, NASA chose to use this method to evaluate the Stardust heat shield. Personnel at NASA Johnson Space Center (JSC) and Lawrence Livermore National Labs (LLNL) recently performed a full scan of the Stardust heat shield using a newly installed X-ray CT system at JSC. This paper briefly discusses the technology used and then presents the following results: 1. CT scans derived dimensions and their comparisons with as-built dimensions anchored with data obtained from samples cut from the heat shield; 2. Measured density variation, char layer thickness, recession and bond line (the adhesive layer between the PICA and the aeroshell) integrity; 3. FIAT predicted recession, density and char layer profiles as well as bondline temperatures Finally suggestions are made as to future uses of this technology as a tool for non-destructively inspecting and verifying both pre and post flight heat shields

What Good Is EMG to the Patient and Practitioner?

ABSTRACT Electromyography (EMG) and nerve conduction studies (NCS) are not only tests to be performed in isolation and reported without consideration of the clinical context, but rather form part of what has been referred to as the electrodiagnostic consultation. Using all of the pertinent information available to the electromyographer performing the test, the electrodiagnostic consultation strives toward the goal of helping the patient and the referring physician to establish a correct diagnosis. Although not without limitations, EMG as an extension of the clinical history and physical examination can be a powerful and sensitive diagnostic tool. Like any tool, however, the final result depends on the skill and expertise with which it is wielded. KEYWORDS: Electromyography (EMG), nerve conduction studies (NCS), electrodiagnosis, neuromuscular disease, diagnostic testing Electromyography (EMG) is the part of electrodiagnostic medicine consisting of recording the variations of electric potential or voltage detected by a needle electrode inserted into skeletal muscle. This electric activity is displayed on a monitor and played over a loudspeaker for simultaneous visual and auditory analysis. In normal resting muscle little or no electric activity is detected, but during voluntary contraction the action potentials of motor units appear. In disorders of the motor unit, electric activity of various types may appear in resting muscle, and the action potentials of the motor units may have abnormal forms and patterns of activity. Abnormalities of the EMG serve as objective criteria of dysfunction of the motor unit. These abnormalities may characterize the nature of the disease process and its localization in the neuron, neuromuscular junction, or muscle fibers. Critical to understanding the role of electrodiagnostic testing in clinical medicine is a clear realization that EMG is an extension of the neurologic examination. SEMINARS IN NEUROLOGY/VOLUME 23, NUMBER 3 2003 Electromyography Terms Motor unit: The anatomic element consisting of an anterior horn cell, its axon, the neuromuscular junctions, and all the muscle fibers innervated by the axon. Insertion activity: Electric activity caused by insertion or movement of a needle electrode within a muscle. Spontaneous activity: Electric activity recorded from muscle at rest after insertion activity has subsided and when there is not voluntary contraction or an external stimulus. Fibrillation potential: The action potential of a single muscle fiber occurring spontaneously or after movement of a needle electrode. Usually fires at a constant rate. Fasciculation potential: The electric activity associated with a fasciculation that has the configuration of a motor unit action potential but occurs spontaneously. Voluntary activity: In EMG, the electric activity recorded from a muscle with consciously controlled contraction. Motor unit action potential (MUAP or MUP): The compound action potential of a single motor unit whose muscle fibers lie within the recording range of an electrode. The following measures may be specified after the recording electrode is placed in the muscle: configuration (including amplitude, duration, number of phases, polarity of each phase, number of turns, variation of shape with consecutive discharges, presence of satellite potentials, spike duration, and rise time) and recruitment characteristics (including threshold of activation, onset frequency, and recruitment frequency-allowing classification into normal, reduced, or rapid recruitment categories). Activation: The process of motor unit action potential firing, with the force of muscle contraction being determined by the number of motor units firing and their firing rate. Nerve Conduction Study Terms Nerve conduction studies: Recording and analysis of electric waveforms of biologic origin elicited in response to electric stimuli. In a patient with weakness, is there evidence of disease of the neuromuscular junction? Routine NCS are often normal in postsynaptic defects of neuromuscular transmission, such as autoimmune myasthenia gravis, whereas presynaptic disorders such as the LambertEaton myasthenic syndrome often show low-amplitude CMAPs in a patient with global hyporeflexia. Special techniques such as slow (typically 2 to 3 Hz) repetitive stimulation of distal and proximal muscle nerves often demonstrate a characteristic abnormal pattern of amplitude and area decrement that correlates with defective neuromuscular transmission. One group of patients that has caused confusion for electromyographers and referring clinicians alike is the cohort with symptoms and often signs of apparent weakness in whom the EMG and NCS are normal. Some of these individuals have poor activation because of pain in the region being tested; a few simple questions and observations of the patient&apos;s behavior help the examiner determine whether this is likely to be the case. A second group with poor activation is those who have central nervous system disorders such as stroke, myelopathy, or multiple sclerosis. These individuals invariably have physical findings and other symptoms to corroborate these central disorders that may be interfering with voluntary activation due to upper motor neuron or extrapyramidal pathway dysfunction. Others may not be able to activate fully because of disuse, malnutrition, or prolonged corticosteroid use. A fourth category is those who do not fully activate voluntary muscle for psychological reasons; the absence of pain, lack of central nervous system signs and symptoms, and dearth of other physical factors can lead to their identification. Similarly, the few individuals who are consciously feigning weakness or other deficits for secondary gain usually have no severe pain, spasticity, or other findings that provide a reasonable medical explanation for their lack of voluntary muscle activation. Muscle Wasting In a patient with muscle wasting, EMG can assist in determining whether there may be a neuromuscular explanation. Remembering that electrodiagnostic testing extends the reach of the clinical history and examination; the presence, pace of acquisition, and distribution of neurologic deficits can aid the electromyographer in characterizing which elements of the motor unit, if any, may be involved in the wasted patient at hand. As discussed before, patterns of abnormal findings on NCS and EMG suggest either myopathy, neuromuscular junction disease, neuropathy or motor neuronopathy, or, alternatively, that there is no convincing evidence of disease of muscle, nerve, neuromuscular junction, or anterior horn cell. In the latter case, historical and physical examination clues often point the clinician toward either disuse as an explanation of the muscle wastingwhich may be physical, psychological, or a combination-or toward weight loss associated with underlying medical disease such as cancer, infection (human immunodeficiency virus being one example), diabetic cachexia, or malnutrition associated with anorexia. Fixed Sensory Loss Another category of patient that is effectively interrogated by NCS techniques is that of sensory loss or other persistent sensory symptoms. Sensory NCS can indicate whether or not there is evidence of large-diameter dorsal root ganglion cell or large-caliber sensory axon disease in a particular nerve territory or in a widespread distribution throughout the body. 9 One important observation regarding the individual with clinical sensory loss and normal sensory NCS results is that either the neuropathy affects only small-diameter fibers (so-called small fiber sensory neuropathy), the lesion is central (affecting the dorsal column pathway, for example), 10 or the process is nonorganic. QUESTIONS NOT LIKELY TO BE ANSWERED BY EMG AND NCS Although EMG and NCS can often pinpoint and characterize disease of the peripheral nervous system with clarity and quantitative precision, there are times when the electrodiagnostic methods do not provide a specific answer to the question posed by the referring physician. There are a number of situations that fall into this category. The first is that the referral question is too general, such as &quot;neurologic disease?,&quot; &quot;gait disorder?,&quot; &quot;weakness?,&quot; &quot;fatigue?,&quot; or &quot;total body pain?&quot; Part of the reason that some referring physicians make such general requests of electrodiagnostic medicine is lack of familiarity with the testing procedures. To use an example familiar to the majority of physicians, in electrocardiography (ECG), the testing procedures are very uniform, with standardized electrode placement and recording techniques that are virtually identical for every patient undergoing an ECG test. For NCS, on the other hand, the breadth of techniques as well as nerves and muscles capable of being tested is staggering. More than 30 nerves in the face, neck, thorax, upper limb, and lower limb can be assessed using NCS techniques, some with SEMINARS IN NEUROLOGY/VOLUME 23, NUMBER 3 2003 multiple different methods of stimulation and recording. Another reason that EMG may not help the referring provider is that the symptoms may be too recent. In many acute neurogenic processes, for example, NCS abnormalities and all but the most subtle EMG changes are not apparent until 10 to 14 days after the inciting event. In this situation, it is usually more useful to wait at least 2 weeks after onset of acute neurologic symptoms before considering EMG. EXPERIENCING ELECTROMYOGRAPHY AND NERVE CONDUCTION STUDIES Nerve Conduction Studies Perhaps the best way to understand the procedures that patients undergo during EMG and NCS is to experience the testing first hand. During motor NCS, metal electrode disks are taped to the skin overlying the motor point of the muscle being examined. Graded electric stimuli are then delivered first to the proximal limb site of the nerve and then, after several seconds, to the distal limb site of the nerve. The responses are recorded at each site and then measured either manually on paper or by computer for amplitude, latency, and other factors. The NCV is calculated dividing the distance between the two stimulation sites by the time required for the response to traverse the path between them (velocity = distance/time). For sensory NCS, both the stimulation and recording sites overlie the sensory nerve trunk being investigated. A special case arises when the electrodiagnostic medicine specialist is asked to evaluate for the possibility of a neuromuscular junction defect a patient who is currently taking an anticholinesterase medication such as pyridostigmine. In this case, testing is best postponed until the subject can suspend the anticholinesterase agent for at least 8 and preferably 12 hours (if the subject can do so without compromising bulbar function, which is usual for individuals being evaluated for possible myasthenia gravis) so as to avoid a false-negative test result. Electromyography Needle EMG is typically performed by inserting a fine single-use concentric needle electrode (some practitioners prefer monopolar electrodes) just under the surface of the skin into a skeletal muscle. With the muscle at rest, insertional activity is assessed by making multiple tiny advances of the electrode, each a fraction of a millimeter in distance, through the muscle. What are the unintended consequences of performing EMG and NCS? The only recognized general effects of percutaneous NCS are the transient discomfort and apprehension associated with delivery of brief electric shocks to the skin. These stimuli, which are typically 0.01 to 1 msec in duration and between 0 and 100 mA in current strength, are felt as surprising, make the stimulated limb jerk slightly because of activation of innervated and nearby muscles, and are felt as uncomfortable to slightly painful, especially in proximal sites such as the popliteal fossa, supraclavicular fossa, neck, and mastoid region. Although most patients do not regard NCS as more than a minor discomfort, the average 10-point visual analog scale rating of 300 consecutive patients being 3, a few individuals cannot tolerate the procedure and request that testing be discontinued. With the theoretical exception that proximal upper limb stimulation in patients with indwelling central venous catheters or other artificial current paths to the heart might induce malignant cardiac dysrhythmias or activate an implanted defibrillator, there are no known longterm complications of percutaneous NCS. Although infection precautions are the customary practice in modern electrodiagnostic laboratories, there are few if any data regarding the incidence of infection associated with EMG. In most clinical settings disposable electrodes are used for all routine EMG studies. Platinum single-fiber EMG electrodes are sterilized by gas or autoclave employing the same methods used for surgical instruments. In addition, special precautions, including use of disposable NCS electrodes, are taken with patients known to be infected with agents such as hepatitis B virus, hepatitis C virus, CreutzfeldtJakob disease, and human immunodeficiency virus. EMG REPORTING After having read hundreds of EMG reports written at scores of laboratories throughout North America over the last two decades, it is apparent that many electromyographers have difficulty putting together succinct, clearly written summaries and interpretations. Some of this problem may stem from a desire to report on every finding in order to be complete. Another possible reason may be that some electromyographers are uncertain whether a given result is or is not clinically significant and therefore conclude that if every tidbit of information is cataloged in laundry list fashion, no important observation will be excluded even if several superfluous or unimportant details end up cluttering the report. The EMG report should be terse, to the point, and emphasize clinically relevant findings. SEMINARS IN NEUROLOGY/VOLUME 23, NUMBER 3 2003 Here are the EMG results. It is up to you to decide whether they make sense or not.&quot; A far more useful approach is to summarize the abnormalities concisely, list any pertinent additional history or physical findings that the electromyographer elicits or observes at the time of the EMG, and finally make a determination of whether or not the findings explain the patient&apos;s symptoms and signs. What follow are a few examples of pairs of EMG reports. Each pair consists of a suboptimally crafted summary and interpretation (reports 1A, 2A, and 3A) and then a revised, more useful summary and interpretation of the same patient&apos;s EMG visit (reports 1B, 2B, and 3B). Example 1:The Cluttered Noncommittal Report Referral indication: paresthesia and pain. REPORT 1A Summary The left median antidromic sensory response amplitude was 10 µV (normal greater than 15 µV) with a conduction velocity of 53 m/s (normal greater than 54 m/s) and a distal latency of 4.5 ms (normal less than 3.6 ms). The left ulnar antidromic sensory response was 5 µV in amplitude (normal greater than 10 µV) with a conduction velocity of 51 m/s (normal less than 53 ms) and a distal latency of 3.3 ms (normal less than 3.2 ms). The left median/APB motor amplitude was 4.2 mV (normal greater than 4 mV) with conduction velocity of 49 m/s (normal greater than 48 m/s), a motor distal latency of 5.2 msec, and an F wave latency of 30 ms (normal less than 32 ms). The left ulnar/ADM motor amplitude was 6.1 mV (normal greater than 6 mV) with a conduction velocity of 47 m/s (normal greater than 51 m/s), a motor distal latency of 3.4 ms (normal less than 3.6 ms), and an F wave latency of 29.7 ms (normal less than 33 ms). The left fibular/EDB motor response was 1.0 mV in amplitude (normal greater than 2.0 mV) with a conduction velocity of 38 m/s (normal greater than 41 m/s), a motor distal latency of 5.0 ms (normal less than 6.6 ms), and no elicitable F waves. The left sural sensory response was 2.2 µV in amplitude (normal greater than 6 µV) with a distal latency of 4.6 ms (normal less than 4.5 ms). Concentric needle examination showed large motor unit potentials in the left first dorsal interosseous, abductor pollicis brevis, tibialis anterior, and medial gastrocnemius muscles with fibrillation potentials in the abductor hallucis muscles on both sides and a single train of positive sharp waves in the left low lumbar paraspinal muscles. Interpretation The EMG findings suggest either median ulnar, fibular, and tibial mononeuropathies (multiple mononeuropathies), polyneuropathy with su