State-dependent long lasting modulation of leg motoneuron membrane potential during stick insect walking.

The basis of locomotion is the rhythmic activity of locomotor organs. During walking, rhythmic alternating bursts occur in leg motoneurons which result from the integration of signals from central pattern generators, sense organs and coordinating signals from neighboring segments. The rhythmic bursting pattern is shaped by rhythmic excitatory and inhibitory drive, as well as a long lasting (tonic) depolarizing modulation. This dissertation investigates the mechanisms that underlie the tonic modulation of neuronal activity, which is the basis of the rhythmic activity. A single-legged preparation of the stick insect was used, that allows the analysis of neuronal activity in mesothoracic motoneurons during front leg stepping, without the influence of local sense organs. Intracellular recordings of the membrane potential in flexor motoneurons ipsilateral and contralateral to the stepping front leg revealed a mean tonic membrane depolarization of 1.8 ±1.1 mV that could outlast the stepping sequence by several seconds. Furthermore, a phasic modulation of membrane potential occurred on top of the tonic depolarization, which was variably coupled to front leg steps. The tonic depolarization was associated with a decrease in input resistance, its amplitude depended on membrane potential and its mean reversal potential was found to be -41 mV. These properties of the tonic depolarization indicate that it is based on a nonselective cation conductance or a mixed inward and outward current through different channels. Furthermore, the tonic depolarization increased the excitability of the membrane to depolarizing input and was found to have long repolarization time constants (tau=800 ms). Pharmacological experiments were performed to identify the participating transmitter(s) and to test for a possible involvement of second messengers. Flexor motoneurons were recorded intracellularly while superfusing pharmacological agents, which were restricted to the mesothoracic ganglion. The muscarinic antagonist atropine decreased the tonic depolarization amplitude, thus indicating a role for acetylcholine in mediating the tonic depolarization via metabotropic receptors. Other transmitters/receptors might be involved too, as octopamine increased the tonic depolarization amplitude. This was supported by the reduction of the tonic depolarization amplitude by an octopaminergic antagonist (mianserin). Serotonin had an opposing effect on the tonic depolarization amplitude. It was shown that serotonin increased, but also decreased the tonic depolarization amplitude in different experiments. Several second messenger pathways might be involved in mediating the tonic depolarization, one of which seems to include calcium in the flexor motoneurons. Furthermore, the increase of the tonic depolarization amplitude by 8-Br-cAMP suggests a role for cAMP in mediating the tonic depolarization. An involvement of an IP3/DAG pathway was indicated by the increase in tonic depolarization in the presence of neomycin and U-73122. Additional experiments addressed the role of the brain (supraesophageal ganglion) in controlling neuronal activity in the mesothoracic ganglion induced by front leg stepping. Especially the relevance of the brain for generating the tonic depolarization was tested in lesion experiments. Brain removal decreased the tonic depolarization amplitude, thus indicating a role for descending pathways in influencing the tonic depolarization. Another preparation was used to investigate the neuronal activity in neck connectives during front leg stepping. The neuronal activity increased and was correlated to front leg stepping velocity. In brainless animals, however, the increased activity in neck connectives was diminished

Establishing a Review Process to Evaluate Research Guides

Springshare\u27s LibGuide platform has become synonymous with online library pathfinders or research guides and instruction support. However, without oversight of the collection of guides and standards for their creation, unwieldy numbers and lack of uniformity prevail. The McGoogan Library of Medicine at the University of Nebraska Medical Center created a review process that not only governed the creation and approval of guides, but analyzed the usage and scope of guides that had already been created. This paper will outline the creation of standards and application of a review process to increase the value and relevance of guides

Elevating Librarian-Mediated Search Services: When 2nd Best Isn\u27t Good Enough

Objective: To optimize librarian-mediated search services, librarians must consider all aspects of their search service that affect service utilization and efficacy. The library literature provides little information concerning the format in which libraries are providing literature search results and even less on the effect of format on search service utilization.  At our academic health science library, the number of search requests received rose dramatically after we began providing results in RefShare format. RefShare is the collaboration tool available in ProQuest’s RefWorks®.  We wanted to know how other libraries were providing results and whether they had seen format affect search service utilization. Methods: A survey created using Springshare’s LibWizard® was distributed to the MEDLIB-L listserv, the expertsearching listserv, and through direct email to AAHSL reference and education librarians. The survey was sent out on March 31st, 2019 and closed on April 30th, 2019. We asked about the audience that the librarian/library served and requested basic information about the librarian-mediated search services offered -- with a special focus on formats used to send literature search results to the requester. Results and Conclusion: We have analyzed the survey results, and we share our findings here

The Cost-Effectiveness of Chin Tuck Against Resistance Compared to Usual Care in Citizens with Oropharyngeal Dysphagia – An Economic Evaluation

Purpose: This study aims to evaluate the cost-effectiveness of chin tuck against resistance (CTAR) for citizens suffering from dysphagia compared to the standard municipal treatment in Denmark.Patients and Methods: A cost-utility analysis, employing a municipal perspective, was conducted using cost data collected alongside clinical data of a randomized controlled trial evaluating the effect of CTAR training for citizens with dysphagia. The composition of the clinical randomized controlled trial, which included citizens with different diagnoses, means that participants had different disease courses. Ninety-two citizens from seven different Danish municipalities were enrolled, of whom 43 received standard care, and 49 received CTAR in addition to standard care. The effect outcome of the economic evaluation was quality-adjusted life years (QALY), estimated using the EQ-5D-5L questionnaire. Individual resource consumption of each citizen was determined based on the use of home care, home nursing care, physio- and occupational therapy, dietitian guidance, and hospital admissions. The incremental costs and QALYs between the intervention group (CTAR in addition to standard care) and standard care group were estimated using regression analysis, and sensitivity analyses were performed to investigate the robustness of the results.Results: The base case analysis showed that the intervention group was dominant compared to the standard care group, with a decrease in incremental costs of £ 542.38 and an increase in incremental QALYs of 0.0118. All sensitivity analyses demonstrated similar findings as the base case analysis, supporting the robustness of the results.Conclusion: This study found that the intervention group was the dominant alternative, hence being more effective and cost-saving, compared to the standard care group in a Danish municipality perspective with a three-month time horizon. This study adds to the scarce evidence on the cost-effectiveness of CTAR in a Danish clinical setting, but further studies should focus on estimating long-term cost-effectiveness

Primary healthcare professionals experience of transfer and meaning according to screening for dysphagia

Transfer is a well-known theory about learning in practice contexts. This concept, combined with the need to implement screening for dysphagia in the nursing homes, has led to this project describing the experienced transfer effect and meaning among healthcare professionals after participation in a practice-orientated workshop focusing on implementing the Minimal Eating Observation Form-II (MEOF-II). Fifty-eight healthcare professionals participated in a 2.5-h facilitated practice-orientated workshop in the period from March to September, 2018. Before and after the workshop, they filled out a questionnaire that focused on the healthcare professional’s experience of skills related to dysphagia. The study documented that, after the workshop, more healthcare professionals felt competent to perform the MEOF-II to identify signs of dysphagia and know their role in screening for dysphagia. Nine months after the workshop, 80% of the residents in the nursing home had been screened for dysphagia by using the MEOF-II. This study documented that practice-orientated workshops and systematic follow-up encouraged the healthcare professionals to use the MEOF-II to contribute to the early detection of dysphagia in the nursing home. Workshops based on the transfer theory may also be relevant for implementation and application of other new skills in similar settings