Changes in Neural Network Connectivity of Normal Young Adults in Response to Power Wheelchair Trainer using EEG Coherence

The ability to move and explore their surrounding environment plays a critical role in the development of cognitive function in children, especially during early childhood. The lack of independent and autonomous mobility is, therefore, a clear disadvantage for the overall development of children with multiple, severe disabilities. Limited number of studies have been conducted on the impact of power mobility device on this specific population. Previous exploratory and pilot studies showed promising results regarding quantifiable and consistent changes in the electroencephalogram (EEG) of children with multiple, severe disabilities when provided with power mobility training. This study aimed to further extend our understanding of the cognitive impact of power mobility training on a different population: healthy young adults aged 18 to 24 – a well-studied neurotypical control population. The study used Magnitude-Square Coherence (MSC) derived from the electroencephalogram (EEG) recorded at resting-yet-awake state before and after power mobility training to investigate changes in the functional connectivity in the brain of seven healthy young adults in the 18-to-24-year-old age range. Neural processes invoked between different functional lobes in the brain in: delta (1-4 Hz), theta (5-7 Hz), alpha (8-13 Hz), beta (14-30 Hz), and gamma (31-100 Hz) in response to power mobility training were examined and analyzed. Statistical analyses were then performed on the change, or difference in EEG coherence between the 5-minute rest with eyes closed before and after power mobility training. Results from both the paired t-test and the Wilcoxson-signed rank test with an alpha level of 0.05 (p≤0.05) on the change in EEG coherence after mobility training showed an overall decrease in EEG coherence between the parietal and temporal regions on healthy young adults after using the Trainer in all five frequency bands. Reduced interregional EEG coherence was found in the centro-parietal region for both the delta and beta frequency. Lower EEG coherence was also noted between the frontal and temporal regions in alpha frequency. These findings help edify that power mobility training is responsible for objectively quantifiable changes in neural network connectivity that may be correlated with improvement in subjective measures of cognitive gains on children with multiple, severe disabilities

Glycoproteomic measurement of site-specific polysialylation

Polysialylation is the enzymatic addition of a highly negatively charged sialic acid polymer to the non-reducing termini of glycans. Polysialylation plays an important role in development, and is involved in neurological diseases, neural tissue regeneration, and cancer. Polysialic acid (PSA) is also a biodegradable and non-immunogenic conjugate to therapeutic drugs to improve their pharmacokinetics. PSA chains vary in length, composition, and linkages, while the specific sites of polysialylation are important determinants of protein function. However, PSA is difficult to analyse by mass spectrometry (MS) due to its high negative charge and size. Most analytical approaches for analysis of PSA measure its degree of polymerization and monosaccharide composition, but do not address the key questions of site specificity and occupancy. Here, we developed a high-throughput LC-ESI-MS/MS glycoproteomics method to measure site-specific polysialylation of glycoproteins. This method measures site-specific PSA modification by using mild acid hydrolysis to eliminate PSA and sialic acids while leaving the glycan backbone intact, together with protease digestion followed by LC-ESI-MS/MS glycopeptide detection. PSA-modified glycopeptides are not detectable by LC-ESI-MS/MS, but become detectable after desialylation, allowing measurement of site-specific PSA occupancy. This method is an efficient analytical workflow for the study of glycoprotein polysialylation in biological and therapeutic settings

The Pharmacist Discharge Care (PHARM-DC) study: A multicenter RCT of pharmacist-directed transitional care to reduce post-hospitalization utilization

BackgroundOlder adults commonly face challenges in understanding, obtaining, administering, and monitoring medication regimens after hospitalization. These difficulties can lead to avoidable morbidity, mortality, and hospital readmissions. Pharmacist-led peri-discharge interventions can reduce adverse drug events, but few large randomized trials have examined their effectiveness in reducing readmissions. Demonstrating reductions in 30-day readmissions can make a financial case for implementing pharmacist-led programs across hospitals.Methods/designThe PHARMacist Discharge Care, or the PHARM-DC intervention, includes medication reconciliation at admission and discharge, medication review, increased communication with caregivers, providers, and retail pharmacies, and patient education and counseling during and after discharge. The intervention is being implemented in two large hospitals: Cedars-Sinai Medical Center and the Brigham and Women's Hospital. To evaluate the intervention, we are using a pragmatic, randomized clinical trial design with randomization at the patient level. The primary outcome is utilization within 30 days of hospital discharge, including unforeseen emergency department visits, observation stays, and readmissions. Randomizing 9776 patients will achieve 80% power to detect an absolute reduction of 2.5% from an estimated baseline rate of 27.5%. Qualitative analysis will use interviews with key stakeholders to study barriers to and facilitators of implementing PHARM-DC. A cost-effectiveness analysis using a time-and-motion study to estimate time spent on the intervention will highlight the potential cost savings per readmission.DiscussionIf this trial demonstrates a business case for the PHARM-DC intervention, with few barriers to implementation, hospitals may be much more likely to adopt pharmacist-led peri-discharge medication management programs.Trial registrationClinicalTrials.gov Identifier: NCT04071951