Electronic Curriculum Implementation at North American Dental Schools

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153722/1/jddj0022033720046810tb03851x.pd

Experimental Treatments for Spinal Cord Injury: What you Should Know

Experiencing a spinal cord injury (SCI) is extremely distressing, both physically and psychologically, and throws people into a complex, unfamiliar world of medical procedures, terminology, and decision making. You may have already had surgery to stabilize the spinal column and reduce the possibility of further damage. You are understandably distressed about the functions you may have lost below the level of spinal injury. You wish to recover any lost abilities as soon as possible. You, your family, or friends may have searched the Internet for treatments and cures

Relative judgement is relatively difficult: evidence against the role of relative judgement in absolute identification

A variety of processes have been put forward to explain absolute identification performance. One difference between current models of absolute identification is the extent to which the task involves accessing stored representations in long-term memory (e.g. exemplars in memory, Kent & Lamberts, Journal of Experimental Psychology: Learning Memory and Cognition, 31, 289–305, 2005) or relative judgement (comparison of the current stimulus to the stimulus on the previous trial, Stewart, Brown & Chater, Psychological Review, 112, 881–911, 2005). In two experiments we explored this by tapping into these processes. In Experiment 1 participants completed an absolute identification task using eight line lengths whereby a single stimulus was presented on each trial for identification. They also completed a matching task aimed at mirroring exemplar comparison in which eight line lengths were presented in a circular array and the task was to report which of these matched a target presented centrally. Experiment 2 was a relative judgement task and was similar to Experiment 1 except that the task was to report the difference (jump-size) between the current stimulus and that on the previous trial. The absolute identification and matching data showed clear similarities (faster and more accurate responding for stimuli near the edges of the range and similar stimulus-response confusions). In contrast, relative judgment performance was poor suggesting relative judgement is not straightforward. Moreover, performance as a function of jump-size differed considerably between the relative judgement and absolute identification tasks. Similarly, in the relative judgement task, predicting correct stimulus identification based on successful relative judgement yielded the reverse pattern of performance observed in the absolute identification task. Overall, the data suggest that relative judgement does not underlie absolute identification and that the task is more likely reliant on an exemplar comparison process

A prospective, multicenter, phase I matched-comparison group trial of safety, pharmacokinetics, and preliminary efficacy of riluzole in patients with traumatic spinal cord injury.

A prospective, multicenter phase I trial was undertaken by the North American Clinical Trials Network (NACTN) to investigate the pharmacokinetics and safety of, as well as obtain pilot data on, the effects of riluzole on neurological outcome in acute spinal cord injury (SCI). Thirty-six patients, with ASIA impairment grades A-C (28 cervical and 8 thoracic) were enrolled at 6 NACTN sites between April 2010 and June 2011. Patients received 50 mg of riluzole PO/NG twice-daily, within 12 h of SCI, for 14 days. Peak and trough plasma concentrations were quantified on days 3 and 14. Peak plasma concentration (Cmax) and systemic exposure to riluzole varied significantly between patients. On the same dose basis, Cmax did not reach levels comparable to those in patients with amyotrophic lateral sclerosis. Riluzole plasma levels were significantly higher on day 3 than on day 14, resulting from a lower clearance and a smaller volume of distribution on day 3. Rates of medical complications, adverse events, and progression of neurological status were evaluated by comparison with matched patients in the NACTN SCI Registry. Medical complications in riluzole-treated patients occurred with incidences similar to those in patients in the comparison group. Mild-to-moderate increase in liver enzyme and bilirubin levels were found in 14-70% of patients for different enzymes. Three patients had borderline severe elevations of enzymes. No patient had elevated bilirubin on day 14 of administration of riluzole. There were no serious adverse events related to riluzole and no deaths. The mean motor score of 24 cervical injury riluzole-treated patients gained 31.2 points from admission to 90 days, compared to 15.7 points for 26 registry patients, a 15.5-point difference (p=0.021). Patients with cervical injuries treated with riluzole had more-robust conversions of impairment grades to higher grades than the comparison group

Reducible connections and non-local symmetries of the self-dual Yang-Mills equations

We construct the most general reducible connection that satisfies the self-dual Yang-Mills equations on a simply connected, open subset of flat $\mathbb{R}^4$. We show how all such connections lie in the orbit of the flat connection on $\mathbb{R}^4$ under the action of non-local symmetries of the self-dual Yang-Mills equations. Such connections fit naturally inside a larger class of solutions to the self-dual Yang-Mills equations that are analogous to harmonic maps of finite type.Comment: AMSLatex, 15 pages, no figures. Corrected in line with the referee's comments. In particular, restriction to simply-connected open sets now explicitly stated. Version to appear in Communications in Mathematical Physic

Interventions to Optimize Spinal Cord Perfusion in Patients With Acute Traumatic Spinal Cord Injury: An Updated Systematic Review

STUDY DESIGN: Systematic review update. OBJECTIVES: Interventions that aim to optimize spinal cord perfusion are thought to play an important role in minimizing secondary ischemic damage and improving outcomes in patients with acute traumatic spinal cord injuries (SCIs). However, exactly how to optimize spinal cord perfusion and enhance neurologic recovery remains controversial. We performed an update of a recent systematic review (Evaniew et al, J. Neurotrauma 2020) to evaluate the effects of Mean Arterial Pressure (MAP) support or Spinal Cord Perfusion Pressure (SCPP) support on neurological recovery and rates of adverse events among patients with acute traumatic SCI. METHODS: We searched PubMed/MEDLINE, EMBASE and ClinicalTrials.gov for new published reports. Two reviewers independently screened articles, extracted data, and evaluated risk of bias. We implemented the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach to rate confidence in the quality of the evidence. RESULTS: From 569 potentially relevant new citations since 2019, we identified 9 new studies for inclusion, which were combined with 19 studies from a prior review to give a total of 28 studies. According to low or very low quality evidence, the effect of MAP support on neurological recovery is uncertain, and increased SCPP may be associated with improved neurological recovery. Both approaches may involve risks for specific adverse events, but the importance of these adverse events to patients remains unclear. Very low quality evidence failed to yield reliable guidance about particular monitoring techniques, perfusion ranges, pharmacological agents, or durations of treatment. CONCLUSIONS: This update provides an evidence base to support the development of a new clinical practice guideline for the hemodynamic management of patients with acute traumatic SCI. While avoidance of hypotension and maintenance of spinal cord perfusion are important principles in the management of an acute SCI, the literature does not provide high quality evidence in support of a particular protocol. Further prospective, controlled research studies with objective validated outcome assessments are required to examine interventions to optimize spinal cord perfusion in this setting

GG-Strands

A $G$-strand is a map $g(t,{s}):\,\mathbb{R}\times\mathbb{R}\to G$ for a Lie group $G$ that follows from Hamilton's principle for a certain class of $G$-invariant Lagrangians. The SO(3)-strand is the $G$-strand version of the rigid body equation and it may be regarded physically as a continuous spin chain. Here, $SO(3)_K$-strand dynamics for ellipsoidal rotations is derived as an Euler-Poincar\'e system for a certain class of variations and recast as a Lie-Poisson system for coadjoint flow with the same Hamiltonian structure as for a perfect complex fluid. For a special Hamiltonian, the $SO(3)_K$-strand is mapped into a completely integrable generalization of the classical chiral model for the SO(3)-strand. Analogous results are obtained for the $Sp(2)$-strand. The $Sp(2)$-strand is the $G$-strand version of the $Sp(2)$ Bloch-Iserles ordinary differential equation, whose solutions exhibit dynamical sorting. Numerical solutions show nonlinear interactions of coherent wave-like solutions in both cases. ${\rm Diff}(\mathbb{R})$-strand equations on the diffeomorphism group $G={\rm Diff}(\mathbb{R})$ are also introduced and shown to admit solutions with singular support (e.g., peakons).Comment: 35 pages, 5 figures, 3rd version. To appear in J Nonlin Sc

Establishing Diagnostic Criteria for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 3].

STUDY DESIGN: Narrative review. OBJECTIVES: To discuss the importance of establishing diagnostic criteria in Degenerative Cervical Myelopathy (DCM), including factors that must be taken into account and challenges that must be overcome in this process. METHODS: Literature review summarising current evidence of establishing diagnostic criteria for DCM. RESULTS: Degenerative Cervical Myelopathy (DCM) is characterised by a degenerative process of the cervical spine resulting in chronic spinal cord dysfunction and subsequent neurological disability. Diagnostic delays lead to progressive neurological decline with associated reduction in quality of life for patients. Surgical decompression may halt neurologic worsening and, in many cases, improves function. Therefore, making a prompt diagnosis of DCM in order to facilitate early surgical intervention is a clinical priority in DCM. CONCLUSION: There are often extensive delays in the diagnosis of DCM. Presently, no single set of diagnostic criteria exists for DCM, making it challenging for clinicians to make the diagnosis. Earlier diagnosis and subsequent specialist referral could lead to improved patient outcomes using existing treatment modalities

Timing of Decompressive Surgery in Patients With Acute Spinal Cord Injury: Systematic Review Update

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: Surgical decompression is a cornerstone in the management of patients with traumatic spinal cord injury (SCI); however, the influence of the timing of surgery on neurological recovery after acute SCI remains controversial. This systematic review aims to summarize current evidence on the effectiveness, safety, and cost-effectiveness of early (≤24 hours) or late (\u3e24 hours) surgery in patients with acute traumatic SCI for all levels of the spine. Furthermore, this systematic review aims to evaluate the evidence with respect to the impact of ultra-early surgery (earlier than 24 hours from injury) on these outcomes. METHODS: A systematic search of the literature was performed using the MEDLINE database (PubMed), Cochrane database, and EMBASE. Two reviewers independently screened the citations from the search to determine whether an article satisfied predefined inclusion and exclusion criteria. For all key questions, we focused on primary studies with the least potential for bias and those that controlled for baseline neurological status and specified time from injury to surgery. Risk of bias of each article was assessed using standardized tools based on study design. Finally, the overall strength of evidence for the primary outcomes was assessed using the GRADE approach. Data were synthesized both qualitatively and quantitively using meta-analyses. RESULTS: Twenty-one studies met inclusion and exclusion criteria and formed the evidence base for this review update. Seventeen studies compared outcomes between patients treated with early (≤24 hours from injury) compared to late (\u3e24 hours) surgical decompression. An additional 4 studies evaluated even earlier time frames: CONCLUSIONS: This review provides an evidence base to support the update on clinical practice guidelines related to the timing of surgical decompression in acute SCI. Overall, the strength of evidence was moderate that early surgery (≤24 hours from injury) compared to late (\u3e24 hours) results in clinically meaningful improvements in neurological recovery. Further studies are required to delineate the role of ultra-early surgery in patients with acute SCI

Developing Peri-Operative Rehabilitation in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 6]: An Unexplored Opportunity?

Study Design Narrative review. Objective Degenerative cervical myelopathy is one of the most frequent impairments of the spinal cord encountered internationally in adults. Currently, surgical decompression is the recommended treatment for people with DCM (PwCM) presenting with moderate to severe symptoms or neurological deficits. However, despite surgical intervention, not all patients make a complete recovery due to the irreversible tissue damage within the spinal cord. The objective of this review is to describe the state and gaps in the current literature on rehabilitation for PwCM and possible innovative rehabilitation strategies. Methods Literature search. Results In other neurological disorders such as stroke and acute traumatic spinal cord injury (SCI), timely and strategic rehabilitation has been shown to be indispensable for maximizing functional outcomes, and it is imperative that appropriate perioperative rehabilitative interventions accompany surgical approaches in order to enable the best outcomes. In this review, the current state of knowledge regarding rehabilitation for PwCM is described. Additionally, various therapies that have shown to improve outcomes in comparable neurological conditions such as stroke and SCI which may be translated to DCM will be reviewed. Conclusions We conclude that locomotor training and arm/hand therapy may benefit PwCM. Further, we conclude that body weight support, robotic assistance, and virtual/augmented reality therapies may be beneficial therapeutic analogs to locomotor and hand therapies