Understanding Traumatic Brain Injury in the Primary Care Setting

poster abstractBackground: TBI is being re-conceptualized as a chronic disease causative agent rather than as a single, acute event. This study examined how familiar family medicine physicians (PCPs) are with TBI and their level of confidence in treating TBI sequelae likely to be seen in primary care. We also examined PCP attitudes regarding care for post-acute mild TBI and moderate/severe TBI in primary care and how recently the respondent had cared for a mild TBI and/or moderate/severe TBI patient. Methods: The study featured a mixed methods study design. A survey was administered on paper and electronically. A semi-structured qualitative interview guide was developed based upon survey responses. Descriptive statistics were calculated. Results: Most respondents associated neurological symptoms/conditions as TBI sequelae: irritability, 100.0%, fatigue, 98.0%; insomnia, 88.2%, depression, 98.0%, headaches, 98.0%, anxiety, 80.4%. Two-thirds (66.7%) identified epilepsy as a condition associated with TBI. Just over one-half associated tinnitus (51.0%) or loss of libido (52.9%) with TBI while only one-third (33.3%) associated incontinence with TBI. Most physicians felt confident treating depression (84.0%), anxiety (82.4%), headache (80.4%) and insomnia (76.0%). Physicians felt less confident in treating fatigue (68.0%), irritability (68.0%), incontinence (51.2%) and loss of libido (50.0%). The least amount of confidence was claimed in treating epilepsy (37.5%) and tinnitus (36.4%). All respondents (100.0%) believed that a PCP can manage post-acute mild TBI (concussion) care while 52.0% agreed that a PCP can manage post-acute care for moderate/severe TBI. Only one respondent (2.0%) had never cared for a mild TBI patient. Most (70.6%) had cared for a moderate/severe TBI patient within the past two years while 5.9% had cared for one of these patients more than a year ago. Nearly twenty percent (19.7%) had never cared for a moderate/severe TBI patient and 3.9% were unsure if they had

Sentence Processing in Aphasia: Dual-Task and Sentence Type Effects

Adults with aphasia or no brain damage completed a grammaticality judgment task alone and in competition with a tone discrimination task to determine whether (a) cognitive factors interact with stimulus parameters (i.e., syntactic complexity, number of propositions) known to influence sentence processing, and (b) material-specific limitations (grammaticality judgment in isolation), general cognitive abilities (cognitive test scores), or both are important predictors of dual-task outcomes. Accuracy, grammatical sensitivity, and reaction time findings were consistent with resource models of aphasia and underscore the theoretical and clinical importance of acknowledging and specifying interactions between language and cognition in normal and patient populations

Function-informed transcriptome analysis of Drosophila renal tubule

BACKGROUND: Comprehensive, tissue-specific, microarray analysis is a potent tool for the identification of tightly defined expression patterns that might be missed in whole-organism scans. We applied such an analysis to Drosophila melanogaster Malpighian (renal) tubule, a defined differentiated tissue. RESULTS: The transcriptome of the D. melanogaster Malpighian tubule is highly reproducible and significantly different from that obtained from whole-organism arrays. More than 200 genes are more than 10-fold enriched and over 1,000 are significantly enriched. Of the top 200 genes, only 18 have previously been named, and only 45% have even estimates of function. In addition, 30 transcription factors, not previously implicated in tubule development, are shown to be enriched in adult tubule, and their expression patterns respect precisely the domains and cell types previously identified by enhancer trapping. Of Drosophila genes with close human disease homologs, 50 are enriched threefold or more, and eight enriched 10-fold or more, in tubule. Intriguingly, several of these diseases have human renal phenotypes, implying close conservation of renal function across 400 million years of divergent evolution. CONCLUSIONS: From those genes that are identifiable, a radically new view of the function of the tubule, emphasizing solute transport rather than fluid secretion, can be obtained. The results illustrate the phenotype gap: historically, the effort expended on a model organism has tended to concentrate on a relatively small set of processes, rather than on the spread of genes in the genome

Factors Affecting Implementation of an Evidence-Based Practice in the VA: Illness Management and Recovery

Objective: Illness management and recovery (IMR) is an evidence-based practice that assists consumers in managing their illnesses and pursuing personal recovery goals. Although research has examined factors affecting IMR implementation facilitated by multifaceted, active roll-outs, the current study attempted to elucidate factors affecting IMR implementation outside the context of a research-driven implementation. Methods: Semi-structured interviews with 20 local recovery coordinators and 18 local IMR experts were conducted at 23 VA medical centers. Interviews examined perceived and experienced barriers and facilitators to IMR implementation. Data were analyzed via thematic inductive/deductive analysis in the form of crystallization/immersion. Results: Six factors differed between sites implementing IMR from those not providing IMR: awareness of IMR, importer-champions, autonomy-supporting leadership, veteran-centered care, presence of a sensitive period, and presence of a psychosocial rehabilitation and recovery center. Four factors were common in both groups: recovery orientation, evidence-based practices orientation, perceived IMR fit within program structure, and availability of staff time. Conclusions and Implications for Practice: IMR can be adopted in lieu of active implementation support; however, knowledge dissemination appears to be key. Future research should examine factors affecting the quality of implementation. (PsycINFO Database Record (c) 2016 APA, all rights reserved

Verbal Fluency in Aphasia and Right Hemisphere Brain damage: Qualitative Analysis Yields Relationship to General Cognitive Factors

Adults with aphasia, right hemisphere damage or no brain damage completed a verbal fluency task alone and in a dual-task paradigm. The purpose of this study was to specify further relationships between domain-specific (i.e., word-finding, fluency) and domain-general skills (i.e., attention, working memory, cognitive flexibility) by examining not only accuracy, but also the nature of subjects’ responses (e.g., word frequency, category prototypicality) within and across fluency task conditions. Preliminary analyses demonstrated significant qualitative and quantitative differences across groups, conditions, and time. Results are examined with respect to theoretical and clinical implications for adults with aphasia or right-hemisphere brain damage

Verbal Fluency in Aphasia and Right Hemisphere Brain Damage: The Effects of Dual-Task Conditions

Adults with aphasia, right hemisphere damage or no brain damage completed a verbal fluency task alone and in competition with a tone discrimination task. The study’s purpose was to specify further resource models of aphasia by examining whether (a) material-specific resource limitations (i.e., verbal fluency in isolation, naming test scores), general cognitive abilities (i.e., attention, working memory, nonverbal fluency test scores), or both are important predictors of dual-task outcomes, and (b) dual-task conditions evoke qualitative changes in naming strategy (i.e., error types; semantic cluster use). Findings relate to the strength and nature of interactions between language and cognition in normal and patient populations

Evolving Availability and Standardization of Patient Attributes for Matching

Variation in availability, format, and standardization of patient attributes across health care organizations impacts patient-matching performance. We report on the changing nature of patient-matching features available from 2010-2020 across diverse care settings. We asked 38 health care provider organizations about their current patient attribute data-collection practices. All sites collected name, date of birth (DOB), address, and phone number. Name, DOB, current address, social security number (SSN), sex, and phone number were most commonly used for cross-provider patient matching. Electronic health record queries for a subset of 20 participating sites revealed that DOB, first name, last name, city, and postal codes were highly available (\u3e90%) across health care organizations and time. SSN declined slightly in the last years of the study period. Birth sex, gender identity, language, country full name, country abbreviation, health insurance number, ethnicity, cell phone number, email address, and weight increased over 50% from 2010 to 2020. Understanding the wide variation in available patient attributes across care settings in the United States can guide selection and standardization efforts for improved patient matching in the United States

Tissue-specific study across the stem reveals the chemistry and transcriptome dynamics of birch bark.

Tree bark is a highly specialized array of tissues that plays important roles in plant protection and development. Bark tissues develop from two lateral meristems; the phellogen (cork cambium) produces the outermost stem-environment barrier called the periderm, while the vascular cambium contributes with phloem tissues. Although bark is diverse in terms of tissues, functions and species, it remains understudied at higher resolution. We dissected the stem of silver birch (Betula pendula) into eight major tissue types, and characterized these by a combined transcriptomics and metabolomics approach. We further analyzed the varying bark types within the Betulaceae family. The two meristems had a distinct contribution to the stem transcriptomic landscape. Furthermore, inter- and intraspecies analyses illustrated the unique molecular profile of the phellem. We identified multiple tissue-specific metabolic pathways, such as the mevalonate/betulin biosynthesis pathway, that displayed differential evolution within the Betulaceae. A detailed analysis of suberin and betulin biosynthesis pathways identified a set of underlying regulators and highlighted the important role of local, small-scale gene duplication events in the evolution of metabolic pathways. This work reveals the transcriptome and metabolic diversity among bark tissues and provides insights to its development and evolution, as well as its biotechnological applications.peerReviewe

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Flavonoid-rich orange juice is associated with acute improvements in cognitive function in healthy middle-aged males

Purpose: Epidemiological evidence suggests that chronic consumption of fruit-based flavonoids is associated with cognitive benefits; however, the acute effects of flavonoid-rich (FR) drinks on cognitive function in the immediate postprandial period require examination. The objective was to investigate whether consumption of FR orange juice is associated with acute cognitive benefits over 6 h in healthy middle-aged adults. Methods: Males aged 30–65 consumed a 240-ml FR orange juice (272 mg) and a calorie-matched placebo in a randomized, double-blind, counterbalanced order on 2 days separated by a 2-week washout. Cognitive function and subjective mood were assessed at baseline (prior to drink consumption) and 2 and 6 h post consumption. The cognitive battery included eight individual cognitive tests. A standardized breakfast was consumed prior to the baseline measures, and a standardized lunch was consumed 3 h post-drink consumption. Results: Change from baseline analysis revealed that performance on tests of executive function and psychomotor speed was significantly better following the FR drink compared to the placebo. The effects of objective cognitive function were supported by significant benefits for subjective alertness following the FR drink relative to the placebo. Conclusions: These data demonstrate that consumption of FR orange juice can acutely enhance objective and subjective cognition over the course of 6 h in healthy middle-aged adults