The timing and precision of action prediction in the aging brain

Action Prediction in the Aging Brai

Follow-up analysis of federal process of care data reported from three acute care hospitals in rural Appalachia

BACKGROUND: This investigation evaluated standardized process of care data collected on selected hospitals serving a remote rural section of westernmost North Carolina. METHODS: Centers for Medicare and Medicaid Services data were analyzed retrospectively for multiple clinical parameters at Fannin Regional Hospital, Murphy Medical Center, and Union General Hospital. Data were analyzed by paired t-test for individual comparisons among the three study hospitals to compare the three facilities with each other, as well as with state and national average for each parameter. RESULTS: Centers for Medicare and Medicaid Services "Hospital Compare" data from 2011 showed Fannin Regional Hospital to have significantly higher composite scores on standardized clinical process of care measures relative to the national average, compared with Murphy Medical Center (P = 0.01) and Union General Hospital (P = 0.01). This difference was noted to persist when Fannin Regional Hospital was compared with Union General Hospital using common state reference data (P = 0.02). When compared with national averages, mean process of care scores reported from Murphy Medical Center and Union General Hospital were both lower but not significantly different (-3.44 versus -6.07, respectively, P = 0.54). CONCLUSION: The range of process of care scores submitted by acute care hospitals in western North Carolina is considerable. Centers for Medicare and Medicaid Services "Hospital Compare" information suggests that process of care measurements at Fannin Regional Hospital are significantly higher than at either Murphy Medical Center or Union General Hospital, relative to state and national benchmarks. Further investigation is needed to determine what impact these differences in process of care may have on hospital volume and/or market share in this region. Additional research is planned to identify process of care trends in this demographic and geographically rural area

A feasibility study of signed consent for the collection of patient identifiable information for a national paediatric clinical audit database

Objectives: To investigate the feasibility of obtaining signed consent for submission of patient identifiable data to a national clinical audit database and to identify factors influencing the consent process and its success. Design: Feasibility study. Setting: Seven paediatric intensive care units in England. Participants: Parents/guardians of patients, or patients aged 12-16 years old, approached consecutively over three months for signed consent for submission of patient identifiable data to the national clinical audit database the Paediatric Intensive Care Audit Network (PICANet). Main outcome measures: The numbers and proportions of admissions for which signed consent was given, refused, or not obtained (form not returned or form partially completed but not signed), by age, sex, level of deprivation, ethnicity (South Asian or not), paediatric index of mortality score, length of hospital stay (days in paediatric intensive care). Results: One unit did not start and one did not fully implement the protocol, so analysis excluded these two units. Consent was obtained for 182 of 422 admissions (43%) (range by unit 9% to 84%). Most (101/182; 55%) consents were taken by staff nurses. One refusal (0.2%) was received. Consent rates were significantly better for children who were more severely ill on admission and for hospital stays of six days or more, and significantly poorer for children aged 10-14 years. Long hospital stays and children aged 10-14 years remained significant in a stepwise regression model of the factors that were significant in the univariate model. Conclusion: Systematically obtaining individual signed consent for sharing patient identifiable information with an externally located clinical audit database is difficult. Obtaining such consent is unlikely to be successful unless additional resources are specifically allocated to training, staff time, and administrative support

Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients

BACKGROUND: During in vitro fertilization (IVF), fertility patients are expected to self-administer many injections as part of this treatment. While newer medications have been developed to substantially reduce the number of these injections, such agents are typically much more expensive. Considering these differences in both cost and number of injections, this study compared patient preferences between GnRH-agonist and GnRH-antagonist based protocols in IVF. METHODS: Data were collected by voluntary, anonymous questionnaire at first consultation appointment. Patient opinion concerning total number of s.c. injections as a function of non-reimbursed patient cost associated with GnRH-agonist [A] and GnRH-antagonist [B] protocols in IVF was studied. RESULTS: Completed questionnaires (n = 71) revealed a mean +/- SD patient age of 34 +/- 4.1 yrs. Most (83.1%) had no prior IVF experience; 2.8% reported another medical condition requiring self-administration of subcutaneous medication(s). When out-of-pocket cost for [A] and [B] were identical, preference for [B] was registered by 50.7% patients. The tendency to favor protocol [B] was weaker among patients with a health occupation. Estimated patient costs for [A] and [B] were $259.82 +/- 11.75 and$654.55 +/- 106.34, respectively (p < 0.005). Measured patient preference for [B] diminished as the cost difference increased. CONCLUSIONS: This investigation found consistently higher non-reimbursed direct medication costs for GnRH-antagonist IVF vs. GnRH-agonist IVF protocols. A conditional preference to minimize downregulation (using GnRH-antagonist) was noted among some, but not all, IVF patient sub-groups. Compared to IVF patients with a health occupation, the preference for GnRH-antagonist was weaker than for other patients. While reducing total number of injections by using GnRH-antagonist is a desirable goal, it appears this advantage is not perceived equally by all IVF patients and its utility is likely discounted heavily by patients when nonreimbursed medication costs reach a critical level

Development and Validation of the Wheelchair Imagery Ability Questionnaire (WIAQ) for Use in Wheelchair Sports

Objectives: Appropriate tools to measure psychological skills in wheelchair athletes seldom exist within the sport psychology literature. Given the benefits of imagery on performance, and the lack of an appropriate wheelchair specific measure, the aim of this multi-study research programme was to develop a new psychometric tool to measure the vividness of movement imagery in wheelchair athletes. We used the Vividness of Movement Imagery Questionnaire–2 (VMIQ-2; Roberts, Callow, Hardy, Markland & Bringer, 2008) as a conceptual framework for item creation and subsequent development of a new tool known as the Wheelchair Imagery Ability Questionnaire (WIAQ). Method: Study 1 focused on item creation for the WIAQ for the scale with a purposeful sample of wheelchair athletes using focus groups. Study 2 tested the factor structure of the WIAQ using a Bayesian Structural Equation Modelling (BSEM) approach. Study 3 provided concurrent validity of the WIAQ. Results: Study 1 resulted in the development of the initial 24 item WIAQ. Study 2 refined the scale through the use of BSEM to a 15 item measure. Study 3 provided support for the WIAQ evidence for the concurrent validity of the measure. Conclusion: The WIAQ is the first known measure specifically created to measure imagery ability in wheelchair athletes and has scope to be used in a broader rehabilitation context for individuals and practitioners making use of imagery as a tool to support various physical recovery strategies

Deep-C storage: Biological, chemical and physical strategies to enhance carbon stocks in agricultural subsoils

Due to their substantial volume, subsoils contain more of the total soil carbon (C) pool than topsoils. Much of this C is thousands of years old, suggesting that subsoils offer considerable potential for long-term C sequestration. However, knowledge of subsoil C behaviour and manageability remains incomplete, and subsoil C storage potential has yet to be realised at a large scale, particularly in agricultural systems. A range of biological (e.g. deep-rooting), chemical (e.g. biochar burial) and physical (e.g. deep ploughing) C sequestration strategies have been proposed, but are yet to be assessed. In this review, we identify the main factors that regulate subsoil C cycling and critically evaluate the evidence and mechanistic basis of subsoil strategies designed to promote greater C storage, with particular emphasis on agroecosystems. We assess the barriers and opportunities for the implementation of strategies to enhance subsoil C sequestration and identify 5 key current gaps in scientific understanding. We conclude that subsoils, while highly heterogeneous, are in many cases more suited to long-term C sequestration than topsoils. The proposed strategies may also bring other tangible benefits to cropping systems (e.g. enhanced water holding capacity and nutrient use efficiency). Furthermore, while the subsoil C sequestration strategies we reviewed have large potential, more long-term studies are needed across a diverse range of soils and climates, in conjunction with chronosequence and space-for-time substitutions. Also, it is vital that subsoils are more consistently included in modelled estimations of soil C stocks and C sequestration potential, and that subsoil-explicit C models are developed to specifically reflect subsoil processes. Finally, further mapping of subsoil C is needed in specific regions (e.g. in the Middle East, Eastern Europe, South and Central America, South Asia and Africa). Conducting both immediate and long-term subsoil C studies will fill the knowledge gaps to devise appropriate soil C sequestration strategies and policies to help in the global fight against climate change and decline in soil quality. In conclusion, our evidence-based analysis reveals that subsoils offer an untapped potential to enhance global C storage in terrestrial ecosystems

Molecular cloning and genetic mapping of perennial ryegrass casein protein kinase 2 α-subunit genes

The α-subunit of the casein protein kinase CK2 has been implicated in both light-regulated and circadian rhythm-controlled plant gene expression, including control of the flowering time. Two putative CK2α genes of perennial ryegrass (Lolium perenne L.) have been obtained from a cDNA library constructed with mRNA isolated from cold-acclimated crown tissue. The genomic organisation of the two genes was determined by Southern hybridisation analysis. Primer designs to the Lpck2a-1 and Lpck2a-2 cDNA sequences permitted the amplification of genomic products containing large intron sequences. Amplicon sequence analysis detected single nucleotide polymorphisms (SNPs) within the p150/112 reference mapping population. Validated SNPs, within diagnostic restriction enzyme sites, were used to design cleaved amplified polymorphic sequence (CAPS) assays. The Lpck2a-1 CAPS marker was assigned to perennial ryegrass linkage group (LG) 4 and the Lpck2a-2 CAPS marker was assigned to LG2. The location of the Lpck2a-1 gene locus supports the previous conclusion of conserved synteny between perennial ryegrass LG4, the Triticeae homoeologous group 5L chromosomes and the corresponding segment of rice chromosome 3. Allelic variation at the Lpck2a-1 and Lpck2a-2 gene loci was correlated with phenotypic variation for heading date and winter survival, respectively. SNP polymorphism may be used for the further study of the role of CK2α genes in the initiation of reproductive development and winter hardiness in grasses