Heart Failure Knowledge among CNAs in a Skilled Nursing Facility: A Pilot Project

Heart failure (HF) is one of the leading causes of hospitalization among patients over the age of 65 years. Many are transitioned to skilled nursing facilities (SNF) following hospital discharge. HF-specific SNF staff education was designed for early detection of changes and improved management of this patient population. Computer-based education modules and hands on skill demonstration stations were created to provide basic HF knowledge and specific guideline recommended care measures for the SNF environment. A pretest, post-test, and skill demonstration were implemented and included weight assessment, application of compression stockings, volume status monitoring, and low sodium diet recommendations. Pretest scores ranged from 4 to 10 (M = 7.8, SD 1.4) and post-test scores ranged from 6 to 10 (M = 8.9, SD 1.0). This demonstrated a significant improvement in knowledge (p \u3c .000). This pilot study demonstrated that a sustainable staff education intervention will improve knowledge based on current guidelines and skill in the SNF environment. This is necessary for quality care delivery and decreased HF related rehospitalization. Further study is warranted that explores implementation of this educational program in other SNFs and assessment of long-range outcomes

Vacuum Extraction of Cataracts

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Brainstem networks construct threat probability and prediction error from neuronal building blocks

When faced with potential threat we must estimate its probability, respond advantageously, and leverage experience to update future estimates. Threat estimation is the proposed domain of the forebrain, while behaviour is elicited by the brainstem. Yet, the brainstem is also a source of prediction error, a learning signal to acquire and update threat estimates. Neuropixels probes allowed us to record single-unit activity across a 21-region brainstem axis in rats receiving probabilistic fear discrimination with foot shock outcome. Against a backdrop of diffuse behaviour signaling, a brainstem network with a dorsal hub signaled threat probability. Neuronal function remapping during the outcome period gave rise to brainstem networks signaling prediction error and shock on multiple timescales. The results reveal brainstem networks construct threat probability, behaviour, and prediction error signals from neuronal building blocks

Motor Affordance for Grasping a Handrail

Mere observation of objects around us can potentiate motor action by priming specific areas in the brain. This concept, referred to as the affordance effect, suggests that humans put viewed objects into motor terms automatically. Such automated linking of observations to action offers potential advantages to interact with our environment quickly and efficiently when producing goal-directed movements. One possible application of this affordance effect includes the rapid balance reactions needed to avoid a fall. In reactive balance control, movements must be extremely fast yet simultaneously appropriate for a given environment (e.g. quickly grasping a nearby handrail to avoid a fall). The present study was conducted to test if viewing a wall-mounted handrail – the type of handle commonly used to regain balance – results in activation of motor cortical networks

Age-related loss of early grasp affordance when viewing a safety handle

Age-related loss of early grasp affordance when viewing a safety handle Author: D.W. McDannald1, , M. Mansour2, G. Rydalch3, D.A.E. Bolton1 Mere observation of objects in our surroundings can potentiate movement, a fact reflected by visually-primed activation of motor cortical networks. This mechanism holds potential value for reactive balance control where recovery actions of the arms or legs must be targeted to a new support base to avoid a fall. The present study was conducted to test if there was a difference in activation of motor cortical networks when viewing a wall-mounted safety handle in older adults versus young adults. Here, we used transcranial magnetic stimulation (TMS) to measure corticospinal excitability in hand muscles directly following access to vision while participants performed a seated reach-grasp task. Vision was controlled using liquid crystal lenses and TMS pulses were time-locked to occur shortly after the goggles opened but prior to any cue for movement. Between trials, the response environment was unpredictably altered to present either a handle or no handle (i.e. covered). We hypothesized that the modulation pattern of hand muscle activity following visual access to the safety handle would be attenuated in older adults when compared with young adults. Our results demonstrated that older adults failed to show an affordance effect when viewing the safety handle, in contrast to the clear affordance effect observed in young adults. These findings suggest that aging diminishes our ability to quickly put our visual world into automatic motor terms. If indeed the affordance effect does play a role in allowing for efficient, and timely postural responses to avoid a fall, this would suggest that older adults have a specific deficit in this regard. By failing to prepare arm reactions older adults may be less capable of adapting their actions to avoid a fall in complex, and cluttered (i.e. real-world) settings

Human-In-the-Loop for Bayesian Autonomous Materials Phase Mapping

Autonomous experimentation (AE) combines machine learning and research hardware automation in a closed loop, guiding subsequent experiments toward user goals. As applied to materials research, AE can accelerate materials exploration, reducing time and cost compared to traditional Edisonian studies. Additionally, integrating knowledge from diverse sources including theory, simulations, literature, and domain experts can boost AE performance. Domain experts may provide unique knowledge addressing tasks that are difficult to automate. Here, we present a set of methods for integrating human input into an autonomous materials exploration campaign for composition-structure phase mapping. The methods are demonstrated on x-ray diffraction data collected from a thin film ternary combinatorial library. At any point during the campaign, the user can choose to provide input by indicating regions-of-interest, likely phase regions, and likely phase boundaries based on their prior knowledge (e.g., knowledge of the phase map of a similar material system), along with quantifying their certainty. The human input is integrated by defining a set of probabilistic priors over the phase map. Algorithm output is a probabilistic distribution over potential phase maps, given the data, model, and human input. We demonstrate a significant improvement in phase mapping performance given appropriate human input

Motor Affordance for Grasping a Safety Handle

Mere observation of objects in our surroundings can potentiate movement, a fact reflected by visually-primed activation of motor cortical networks. This mechanism holds potential value for reactive balance control where recovery actions of the arms or legs must be targeted to a new support base to avoid a fall. The present study was conducted to test if viewing a wall-mounted safety handle – the type of handle commonly used to regain balance – results in activation of motor cortical networks. We hypothesized that the hand area of the primary motor cortex would be facilitated shortly after visual access to a safety handle versus when no handle was visible. Here, we used transcranial magnetic stimulation (TMS) to measure corticospinal excitability in hand muscles directly following access to vision while participants performed a seated reach-grasp task. Vision was controlled using liquid crystal lenses and TMS pulses were time-locked to occur shortly after the goggles opened but prior to any cue for movement. Between trials the response environment was unpredictably altered to present either a handle or no handle (i.e. covered). Our results demonstrated a rapid motor facilitation in muscles of the right hand when participants viewed a handle versus trials where this handle was covered. This effect was selective both in terms of the muscles activated and the timing at which it emerged. The First Dorsal Interosseus and Opponens Pollicus muscles (synergists in closing the hand) were facilitated 120 ms after viewing the handle. Interestingly, this effect was absent at earlier (80 ms) and later (160 ms) points. Conversely, Abductor Digiti Minimi, which moves the little finger out from the rest of the hand, tended to diminish when viewing the handle. These findings suggest a rapid engagement of muscles suitable for grasping a handle based on vision. This is consistent with the concept of affordances where vision automatically translates viewed objects into appropriate motor terms. The fact that this affordance effect was present for a wall-mounted safety handle commonly used to regain balance has implications for automatically priming recovery actions with upper limbs suited to our surroundings, even before postural perturbation is detected

Normal Aging does Not Impair Orbitofrontal-Dependent Reinforcer Devaluation Effects

Normal aging is associated with deficits in cognitive flexibility thought to depend on prefrontal regions such as the orbitofrontal cortex (OFC). Here, we used Pavlovian reinforcer devaluation to test whether normal aging might also affect the ability to use outcome expectancies to guide appropriate behavioral responding, which is also known to depend on the OFC. Both young and aged rats were trained to associate a 10-s conditioned stimulus (CS+) with delivery of a sucrose pellet. After training, half of the rats in each age group received the sucrose pellets paired with illness induced by LiCl injections; the remaining rats received sucrose and illness explicitly unpaired. Subsequently, responding to the CS+ was assessed in an extinction probe test. Although aged rats displayed lower responding levels overall, both young and aged rats conditioned to the CS+ and developed a conditioned taste aversion following reinforcer devaluation. Furthermore, during the extinction probe test, both young and aged rats spontaneously attenuated conditioned responding to the cue as a result of reinforcer devaluation. These data show that normal aging does not affect the ability to use expected outcome value to appropriately guide Pavlovian responding. This result indicates that deficits in cognitive flexibility are dissociable from other known functions of prefrontal – and particularly orbitofrontal – cortex

Nucleus Accumbens Core and Shell are Necessary for Reinforcer Devaluation Effects on Pavlovian Conditioned Responding

The nucleus accumbens (NA) has been hypothesized to be part of a circuit in which cue-evoked information about expected outcomes is mobilized to guide behavior. Here we tested this hypothesis using a Pavlovian reinforcer devaluation task, previously applied to assess outcome-guided behavior after damage to regions such as the orbitofrontal cortex and amygdala that send projections to NA. Rats with sham lesions or neurotoxic lesions of either the core or shell subdivision of NA were trained to associate a 10-s CS+ with delivery of three food pellets. After training, half of the rats in each lesion group received food paired with illness induced by LiCl injections; the remaining rats received food and illness unpaired. Subsequently, responding to the CS+ was assessed in an extinction probe test. Both sham and lesioned rats conditioned to the CS+ and formed a conditioned taste aversion. However only sham rats reduced their conditioned responding as a result of reinforcer devaluation; devalued rats with lesions of either core or shell showed levels of responding that were similar to lesioned, non-devalued rats. This impairment was not due to the loss of motivational salience conferred to the CS+ in lesioned rats as both groups responded similarly for the cue in conditioned reinforcement testing. These data suggest that NA core and shell are part of a circuit necessary for the use of cue-evoked information about expected outcomes to guide behavior