Exploring Changes in Functional Connectivity Associated with the Development of Cognitive Flexibility During Middle Childhood

Cognitive flexibility is a subset of executive function that involves flexibly adapting one’s behavior to meet the demands of a changing environment. In a cognitive task, this often entails shifts of attention between dimensions of a stimulus or flexibly changing response sets. This skill improves greatly throughout middle childhood and is supported by a frontal-parietal neural network. The level of synchrony in activation, or functional connectivity, between frontal and parietal regions has been reported to increase over development even after cognitive flexibility has stabilized. The current study aims to assess changes in functional connectivity across the age range when this ability most rapidly develops. fNIRS was used to measure synchrony in hemodynamic activation of the frontal and parietal cortices in children at age 5, 7 and 9. Functional connectivity was measured at a resting state and while children performed three tasks requiring cognitive flexibility. Task performance and connectivity strength were compared across age groups. Cognitive flexibility improved greatly with age, aligning with previous literature. Evidence was found for refinement of local connectivity within the frontal cortex, such that weaker connections decreased in strength with age and stronger connections increased in strength. Further, connectivity between frontal and parietal regions was greater for 9-year-olds when task demands increased, reflecting greater synchrony of this network with age. Understanding the neural dynamics associated with the development of flexibility promotes a better understanding of the brain-behavior relationship. This line of research can also allow us to make comparisons with atypically developing populations, such as those with Autism, who have impairments in this skill. By understanding how neural architecture develops to support executive function in typical populations, we can better understand how deficits arise from atypical trajectories

Web-based Monitoring of Pain Management in Adolescent and Young Adult Sickle Cell Patients Through Daily Self-Assessment

There is a wide range of variability in the clinical phenotype of Sickle Cell Disease (SCD), resulting in a vast array of clinical presentations ranging from acute, recurrent vaso-occlusive pain episodes to chronic pain, increased risk of strokes, acute chest syndromes and osteonecrosis. Historically, pain crises have been defined by whether or not the patient seeks medical attention. Previous studies have shown that while patients with SCD are in pain 54.5% of the time, they are only seeking medical attention during 3.5% of these episodes. This has led to a gross underestimation of the prevalence of pain episodes, due to discrepancies in both the definition and reporting of these episodes. There is currently no utility available to accurately assess and manage pain levels in Sickle Cell patients who are not utilizing medical facilities. The implementation of a web-based application to monitor daily pain levels is relevant to public health because it is likely to provide medical teams with the tools necessary to track patient pain levels more precisely. This will also enable healthcare providers to be more proactive with regard to pain management in patients with SCD. Twenty-nine patients were asked to record their level of pain three times daily for six months via a web-based application. The application asked patients to appraise their pain level by use of a Visual Analog Scale (VAS), ranging from 0 (no pain) to 10 (extreme pain). Each patient was assigned a non-specific identifier that enabled him or her to log into the system without referencing any personal health information. Pain measurements were electronically time stamped and all information was filtered to ensure the protection of patient sensitive information. Authorized team members were alerted of pain episodes by email (pain levels of 5- 7) or text message (pain levels of 8-10). The patient was then contacted and information was gathered regarding the location and duration of pain, the presence of other symptoms and social factors that influenced a patient’s decision to seek medical intervention. Of the 29 patients enrolled in the study, 21 patients accessed the web-based application and provided a total of 4,981 pain data entries over a six month time period. Patients reported that they were in no pain (pain score of 0) 23.4% of the days logged, in pain (pain score of 1-7) 76.6% of the days logged and in pain crisis (pain score of 8-10) 12.2% of the days logged. This data provides proof of the principle that adolescents with SCD will provide electronic reports of their pain multiple times a day over an extended period of time. This preliminary data also suggests that the prevalence of pain in adolescents is much greater than previously reported

Autistic Traits and Executive Functioning

Autism Spectrum Disorder is a term used to encompass all of the varying degrees of the developmental disorder known as Autism. Individuals with Autism Spectrum Disorder struggle with areas of executive functioning such as cognitive flexibility, planning, visual/visuo-spatial working memory, and verbal fluency compared to typically-developing individuals. This research project seeks to measure the amount of Autistic-like traits/tendencies of individuals who are not diagnosed with Autism Spectrum disorder and compare their level of Autistic tendencies to their ability to perform various cognitive tasks. Participants will first take the Autism Quotient--a questionnaire determining their level of autistic-like traits. Following this, participants will perform a number of cognitive tasks including fluency, Tower of Hanoi, working memory tasks, and the Rey Osterrieth Complex Figure (ROCF). These tasks measure various aspects of an individuals executive functioning capabilities including working memory, planning, organization and complex problem solving. It is hypothesized that individuals with higher scores on the Autism Quotient will have a greater number of errors on the executive function tasks than individuals with lower Autism Quotient scores

“You don’t see them on the streets of your town”: challenges and strategies for serving unstably housed veterans in rural areas

Research on policy and programmatic responses to homelessness has focused largely on urban areas, with comparatively little attention paid to the rural context. We conducted qualitative interviews with a nationwide sample of rural-serving agencies receiving grants through the U.S. Department of Veterans Affairs’ Supportive Services for Veteran Families program to better understand the housing needs, available services, needed resources, and challenges in serving homeless and unstably housed veterans in rural areas. Respondents discussed key challenges—identifying unstably housed veterans, providing services within the rural resource context, and leveraging effective collaboration—and strategies to address these challenges. Unmet needs identified included emergency and subsidized long-term housing options, transportation resources, flexible financial resources, and additional funding to support the intensive work required in rural areas. Our findings identify promising programmatic innovations and highlight the need for policy remedies that are responsive to the unique challenges of addressing homelessness and housing instability in rural areas.Accepted manuscrip

It’s all about timing: The involvement of kir4.1 channel regulation in acute ischemic stroke pathology

An acute ischemic stroke is characterized by the presence of a blood clot that limits blood flow to the brain resulting in subsequent neuronal loss. Acute stroke threatens neuronal survival, which relies heavily upon proper function of astrocytes. Neurons are more susceptible to cell death when an astrocyte is unable to carry out its normal functions in supporting the neuron in the area affected by the stroke (Rossi et al., 2007; Takano et al., 2009). For example, under normal conditions, astrocytes initially swell in response to changes in extracellular osmotic pressure and then reduce their regulatory volume in response to volume-activated potassium (K+) and chloride channels (Vella et al., 2015). This astroglial swelling may be overwhelmed, under ischemic conditions, due to the increased levels of glutamate and extracellular K+ (Lai et al., 2014; Vella et al., 2015). The increase in extracellular K+ contributes to neuronal damage and loss through the initiation of harmful secondary cascades (Nwaobi et al., 2016). Reducing the amount of extracellular K+ could, in theory, limit or prevent neuronal damage and loss resulting in an improved prognosis for individuals following ischemic stroke. Kir4.1, an inwardly rectifying K+ channel, has demonstrated an ability to regulate the rapid reuptake of this ion to return the cell to basal levels allowing it to fire again in rapid transmission (Sibille et al., 2015). Despite growing interest in this area, the underlying mechanism suggesting that neuroprotection could occur through modification of the Kir4.1 channel’s activity has yet to be described. The purpose of this reviewis to examine the current literature and propose potential underlying mechanisms involving Kir4.1, specially the mammalian target of rapamycin (mTOR) and/or autophagic pathways, in the pathogenesis of ischemic stroke. The hope is that this review will instigate further investigation of Kir4.1 as a modulator of stroke pathology

Prevalence of and Factors Associated with Negative Microscopic Diagnosis of Cutaneous Leishmaniasis in Rural Peru.

Cutaneous leishmaniasis is endemic to South America where diagnosis is most commonly conducted via microscopy. Patients with suspected leishmaniasis were referred for enrollment by the Ministry of Health (MoH) in Lima, Iquitos, Puerto Maldonado, and several rural areas of Peru. A 43-question survey requesting age, gender, occupation, characterization of the lesion(s), history of leishmaniasis, and insect-deterrent behaviors was administered. Polymerase chain reaction (PCR) was conducted on lesion materials at the Naval Medical Research Unit No. 6 in Lima, and the results were compared with those obtained by the MoH using microscopy. Factors associated with negative microscopy and positive PCR results were identified using