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Motor Skill Learning Between Selection And Execution., Jörn Diedrichsen, Katja Kornysheva

Brain and Mind Institute Researchers' Publications

Learning motor skills evolves from the effortful selection of single movement elements to their combined fast and accurate production. We review recent trends in the study of skill learning which suggest a hierarchical organization of the representations that underlie such expert performance, with premotor areas encoding short sequential movement elements (chunks) or particular component features (timing/spatial organization). This hierarchical representation allows the system to utilize elements of well-learned skills in a flexible manner. One neural correlate of skill development is the emergence of specialized neural circuits that can produce the required elements in a stable and invariant fashion. We discuss …

The Human Motor System Alters Its Reaching Movement Plan For Task-Irrelevant, Positional Forces., Joshua G A Cashaback, Heather R Mcgregor, Paul L Gribble

Brain and Mind Institute Researchers' Publications

The minimum intervention principle and the uncontrolled manifold hypothesis state that our nervous system only responds to force perturbations and sensorimotor noise if they affect task success. This idea has been tested in muscle and joint coordinate frames and more recently using workspace redundancy (e.g., reaching to large targets). However, reaching studies typically involve spatial and or temporal constraints. Constrained reaches represent a small proportion of movements we perform daily and may limit the emergence of natural behavior. Using more relaxed constraints, we conducted two reaching experiments to test the hypothesis that humans respond to task-relevant forces and ignore task-irrelevant …

Clinical Challenges In Isolation Care, Elizabeth L. Beam, Shawn G. Gibbs, Angela L. Hewlett, Peter C. Iwen, Suzanne L. Nuss, Philip W. Smith

Journal Articles: College of Nursing

OVERVIEW: In 2014, the authors published the results of a study investigating nurses' use of personal protective equipment (PPE) in the care of a live simulated patient requiring contact and airborne precautions. The 24 participants were video-recorded as they donned and doffed PPE. Variations in practices that had the potential to cause contamination were noted. In this article, the authors comment on those variations, analyzing each element of proper PPE protocols and examining why the behaviors are a safety concern for the nurse and a potential risk for disease transmission in the hospital or other clinical area. The authors note …

Early Lessons Learned In Implementing A Women's Health Educational And Virtual Consultation Program In Va, Kristina M. Cordasco, Jessica L. Zuchowski, Alison B. Hamilton, Susan Kirsh, Laure Veet, Joann O. Saavedra, Lisa Altman, Herschel Knapp, Mark Canning, Donna L. Washington

Project ECHO Bibliography

BACKGROUND: Many Veterans Health Administration primary care providers (PCPs) have small female patient caseloads, making it challenging for them to build and maintain their women's health (WH) knowledge and skills. To address this issue, we implemented a longitudinal WH-focused educational and virtual consultation program using televideo conferencing.

OBJECTIVE: To perform a formative evaluation of the program's development and implementation.

RESEARCH DESIGN: We used mixed methods including participant surveys, semi-structured interviews, stakeholder meeting field notes, and participation logs. We conducted qualitative content analysis for interviews and field notes, and quantitative tabulation for surveys and logs.

SUBJECTS: Veterans Health Administration WH PCPs. …

True Durability: Hiv Virologic Suppression In An Urban Clinic And Implications For Timing Of Intensive Adherence Efforts And Viral Load Monitoring., Debra A Benator, Angelo Elmi, Manuel D Rodriguez, Howard B Gale, Virginia L. Kan, Heather J. Hoffman, Susan Tramazzo, Karen Hall, Angela Mcknight, Leah Squires

Medicine Faculty Publications

Although the majority of HIV-infected patients who begin potent antiretroviral therapy should expect long-term virologic suppression, the realities in practice are less certain. Durability of viral suppression was examined to define the best timing of targeted adherence strategies and intensive viral load monitoring in an urban clinic population with multiple challenges to ART adherence. We examined the risk of viral rebound for patients who achieved two consecutive viral loads lower than the lower limit of quantification (LLOQ) within 390 days. For 791 patients with two viral loads below the LLOQ, viral rebound >LLOQ from the first viral load was 36.9 …

Evaluation And Nonsurgical Management Of Rotator Cuff Calcific Tendinopathy., Ari C. Greis, Stephen M. Derrington, Matthew Mcauliffe

Rothman Institute Papers

Rotator cuff calcific tendinopathy is a common finding that accounts for about 7% of patients with shoulder pain. There are numerous theories on the pathogenesis of rotator cuff calcific tendinopathy. The diagnosis is confirmed with radiography, MRI or ultrasound. There are numerous conservative treatment options available and most patients can be managed successfully without surgical intervention. Nonsteroidal anti-inflammatory drugs and multiple modalities are often used to manage pain and inflammation; physical therapy can help improve scapular mechanics and decrease dynamic impingement; ultrasound-guided needle aspiration and lavage techniques can provide long-term improvement in pain and function in these patients.

Narcotic-Induced Pain, Sudeep Thapa, Jason Schairer

Gastroenterology Articles

No abstract provided.

Point-Of-Care Ultrasonography By Pediatric Emergency Medicine Physicians., Jennifer R. Marin, Resa E. Lewiss, American Academy Of Pediatrics, Committee On Pediatric Emergency Medicine, Society For Academic Emergency Medicine, Academy Of Emergency Ultrasound, American College Of Emergency Physicians, Pediatric Emergency Medicine Committee, World Interactive Network Focused On Critical Ultrasound, Gregory P. Conners

Manuscripts, Articles, Book Chapters and Other Papers

Emergency physicians have used point-of-care ultrasonography since the 1990 s. Pediatric emergency medicine physicians have more recently adopted this technology. Point-of-care ultrasonography is used for various scenarios, particularly the evaluation of soft tissue infections or blunt abdominal trauma and procedural guidance. To date, there are no published statements from national organizations specifically for pediatric emergency physicians describing the incorporation of point-of-care ultrasonography into their practice. This document outlines how pediatric emergency departments may establish a formal point-of-care ultrasonography program. This task includes appointing leaders with expertise in point-of-care ultrasonography, effectively training and credentialing physicians in the department, and providing ongoing …

Inpatient Management Of Migraine, Michael J. Marmura, Stephanie Wrobel Goldberg

Department of Neurology Faculty Papers

Migraine is a frequently disabling disorder which may require inpatient treatment. Admission criteria for migraine include intractable migraine, nausea and/or vomiting, severe disability, and dependence on opioids or barbiturates. The inpatient treatment of migraine is based on observational studies and expert opinion rather than placebo-controlled trials. Well-established inpatient treatments for migraine include dihydroergotamine, neuroleptics/antiemetics, lidocaine, intravenous aspirin, and non-pharmacologic treatment such as cognitive-behavioral therapy. Short-acting treatments possibly associated with medication overuse, such as triptans, opioids, or barbiturate-containing compounds, are generally avoided. While the majority of persons with migraine are admitted on an emergency basis for only a few days, outcome …

Transcatheter Aortic Valve Implantation Despite Challenging Vascular Access, Angelo Nascimbene, Federico Azpurua, James J Livesay, R David Fish, Zvonimir Krajcer

The Texas Heart Institute Journal

We describe transcatheter aortic valve implantation in a patient who had severe peripheral artery disease. The patient's vascular condition required additional preliminary peripheral intervention to enable adequate vascular access.

A 78-year-old man with severe aortic stenosis, substantial comorbidities, and severe heart failure symptoms was referred for aortic valve replacement. The patient's 20-mm aortic annulus necessitated the use of a 23-mm Edwards Sapien valve inserted through a 22F sheath, which itself needed a vessel diameter of at least 7 mm for percutaneous delivery. The left common femoral artery was selected for valve delivery. The left iliac artery and infrarenal aorta underwent …

Antibody-Mediated Targeting Of Iron Oxide Nanoparticles To The Folate Receptor Alpha Increases Tumor Cell Association In Vitro And In Vivo, Christian Ndong, Seiko Toraya-Brown, Katsiaryna Kekalo, Ian Baker, Tillman U. Gerngross, Steven N. Fiering, Karl E. Griswold

Dartmouth Scholarship

Active molecular targeting has become an important aspect of nanoparticle development for oncology indications. Here, we describe molecular targeting of iron oxide nanoparticles (IONPs) to the folate receptor alpha (FOLRα) using an engineered antibody fragment (Ffab). Compared to control nanoparticles targeting the non-relevant botulinum toxin, the Ffab-IONP constructs selectively accumulated on FOLRα-overexpressing cancer cells in vitro, where they exhibited the capacity to internalize into intracellular vesicles. Similarly, Ffab-IONPs homed to FOLRα-positive tumors upon intraperitoneal administration in an orthotopic murine xenograft model of ovarian cancer, whereas negative control particles showed no detectable tumor accumulation. Interestingly, Ffab-IONPs built with custom 120 nm …

Regression Of Left Ventricular Mass After Implantation Of The Sutureless 3f Enable Aortic Bioprosthesis, Giovanni Concistrè, Antonio Miceli, Federica Marchi, Francesca Chiaramonti, Mattia Glauber, Marco Solinas

The Texas Heart Institute Journal

Left ventricular hypertrophy in aortic stenosis is considered a compensatory response for the maintenance of systolic function but a risk factor for cardiac morbidity and death. We investigated the degree of left ventricular mass regression after implantation of the sutureless Medtronic 3f Enable® Aortic Bioprosthesis.

We studied 19 patients who, from May 2010 through July 2011, underwent isolated aortic valve replacement with the 3f Enable bioprosthetic valve, with clinical and echocardiographic follow-up at 6 months. The mean age was 77.1 ± 5.1 years (range, 68–86 yr); 14 patients were women (73.7%); and the mean logistic EuroSCORE was 15.4% ± 11.8%. …

When The Chief Complaint Tells It All, Herbert L Fred

The Texas Heart Institute Journal

No abstract provided.

Prenatal Diagnosis Of Left Pulmonary Artery-To-Pulmonary Vein Fistula And Its Successful Surgical Repair In A Neonate, Oleksii Ostras, Andrii Kurkevych, Lyubomyr Bohuta, Tetyana Yalynska, Tammo Raad, Mark Lewin, Illya Yemets

The Texas Heart Institute Journal

Pulmonary arteriovenous fistula is a rare disease. To the best of our knowledge, prenatal diagnosis of a fistula between the left pulmonary artery and the left pulmonary vein has not been described in the medical literature. We report a case of the prenatal diagnosis of a left pulmonary artery-to-pulmonary vein fistula, followed by successful neonatal surgical repair.

An Approach For Determining And Measuring Network Hierarchy Applied To Comparing The Phosphorylome And The Regulome, Chao Cheng, Erik Andrews, Koon-Kiu Yan, Matthew Ung, Daifeng Wang, Mark Gerstein

Dartmouth Scholarship

Many biological networks naturally form a hierarchy with a preponderance of downward information flow. In this study, we define a score to quantify the degree of hierarchy in a network and develop a simulated-annealing algorithm to maximize the hierarchical score globally over a network. We apply our algorithm to determine the hierarchical structure of the phosphorylome in detail and investigate the correlation between its hierarchy and kinase properties. We also compare it to the regulatory network, finding that the phosphorylome is more hierarchical than the regulome.

Focused Ultrasound For Treatment Of Bone Tumours., Dario B. Rodrigues, Paul R. Stauffer, David Vrba, Mark Hurwitz, Md

Department of Radiation Oncology Faculty Papers

PURPOSE: Focused ultrasound (FUS) is a modality with rapidly expanding applications across the field of medicine. Treatment of bone lesions with FUS including both benign and malignant tumours has been an active area of investigation. Recently, as a result of a successful phase III trial, magnetic resonance-guided FUS is now a standardised option for treatment of painful bone metastases. This report reviews the clinical applications amenable to treatment with FUS and provides background on FUS and image guidance techniques, results of clinical studies, and future directions.

METHODS: A comprehensive literature search and review of abstracts presented at the recently completed …

Preliminary Analysis Of In Utero Low-Level Arsenic Exposure And Fetal Growth Using Biometric Measurements Extracted From Fetal Ultrasound Reports, Matthew A. Davis, John Higgins, Zhigang Li, Diane Gilbert-Diamond, Emily R. Baker, Amar Das, Margaret R. Karagas

Dartmouth Scholarship

Background: Early life exposure to arsenic is associated with decreased birth weight in highly exposed populations but little is known about effects of low-level arsenic exposure on growth in utero.

Methods: Using a sample of 272 pregnancies from New Hampshire we obtained biometric measurements directly from fetal ultrasound reports commonly found in electronic medical records. We used information extraction methods to develop and validate an automated approach for mining biometric measurements from the text of clinical reports. As a preliminary analysis, we examined associations between in utero low-level arsenic exposure (as measured by maternal urinary arsenic concentration) and fetal growth …

G9a Is Essential For Emt-Mediated Metastasis And Maintenance Of Cancer Stem Cell-Like Characters In Head And Neck Squamous Cell Carcinoma, Shuli Liu, Dongxia Ye, Wenzheng Guo, Wenwen Yu, Yue He, Jingzhou Hu, Yanan Wang, Ling Zhang, Yueling Liao, Hongyong Song, Shuangshuang Zhong, Dongliang Xu, Huijing Yin, Beibei Sun, Xiaofei Wang, Jingyi Liu, Yadi Wu, Binhua P. Zhou, Zhiyuan Zhang, Jiong Deng

Markey Cancer Center Faculty Publications

Head and neck squamous cell carcinoma (HNSCC) is a particularly aggressive cancer with poor prognosis, largely due to lymph node metastasis and local recurrence. Emerging evidence suggests that epithelial-to-mesenchymal transition (EMT) is important for cancer metastasis, and correlated with increased cancer stem cells (CSCs) characteristics. However, the mechanisms underlying metastasis to lymph nodes in HNSCC is poorly defined. In this study, we show that E-cadherin repression correlates with cancer metastasis and poor prognosis in HNSCC. We found that G9a, a histone methyltransferase, interacts with Snail and mediates Snail-induced transcriptional repression of E-cadherin and EMT, through methylation of histone H3 lysine-9 …

Effects Of Periodontal Therapy On White Blood Cell Count And Levels Of Transforming Growth Factor Beta In Serum Of Subjects With Severe Periodontitis, A. C. E. Leite, V. M. A. Carneiro, Ana Carolina Morandini, Erivan Schnaider Ramos-Junior, M. C. M. Guimarães

All Dugoni School of Dentistry Faculty Articles

This study aimed to investigate the effects of nonsurgical periodontal therapy on white blood cell (WBC) count and levels of transforming growth factor beta (TGF—β) in serum from subjects with severe periodontitis. Serum from 28 subjects with periodontitis (mean age: 34.36±6.24; 32% men) and 27 healthy controls (mean age: 33.18±6.42; 33% men) were collected prior to therapy. Blood samples were obtained from 23 subjects who completed therapy (9—12 months). A well—controlled periodontal treatment protocol was established in three stages: mechanical periodontal therapy (scaling and root planning), reinstrumentation of dental sites, and supportive periodontal therapy. Periodontal and systemic parameters such as …

Development And Pilot Feasibility Study Of A Health Information Technology Tool To Calculate Mortality Risk For Patients With Asymptomatic Carotid Stenosis: The Carotid Risk Assessment Tool (Carat), Adrienne E. Faerber, Rebecca Horvath, Carey Stillman, Melissa L. O'Connell, Amy L. Hamilton, Karina A. Newhall, Donald S. Likosky, Philip P. Goodney

Dartmouth Scholarship

Patients with no history of stroke but with stenosis of the carotid arteries can reduce the risk of future stroke with surgery or stenting. At present, a physicians’ ability to recommend optimal treatments based on an individual’s risk profile requires estimating the likelihood that a patient will have a poor peri-operative outcomes and the likelihood that the patient will survive long enough to gain benefit from the procedure. We describe the development of the CArotid Risk Assessment Tool (CARAT) into a 2-year mortality risk calculator within the electronic medical record, integrating the tool into the clinical workflow, training the clinical …

Review Of Nanomaterials In Dentistry: Interactions With The Oral Microenvironment, Clinical Applications, Hazards, And Benefits., Alexandros Besinis, Peralta T De, Christopher J. Tredwin, Richard D. Handy

School of Engineering, Computing and Mathematics

Interest in the use of engineered nanomaterials (ENMs) as either nanomedicines or dental materials/devices in clinical dentistry is growing. This review aims to detail the ultrafine structure, chemical composition, and reactivity of dental tissues in the context of interactions with ENMs, including the saliva, pellicle layer, and oral biofilm; then describes the applications of ENMs in dentistry in context with beneficial clinical outcomes versus potential risks. The flow rate and quality of saliva are likely to influence the behavior of ENMs in the oral cavity, but how the protein corona formed on the ENMs will alter bioavailability, or interact with …

Kalkitoxin Inhibits Angiogenesis, Disrupts Cellular Hypoxic Signaling, And Blocks Mitochondrial Electron Transport In Tumor Cells, J B. Morgan, Yang Liu, Veena Coothankandaswamy, Fakhri Mahdi, Mika B. Jekabsons, William H. Gerwick, Frederick A. Valeriote, Yu-Dong Zhou, Dale G. Nagle

Hematology/Oncology Articles

The biologically active lipopeptide kalkitoxin was previously isolated from the marine cyanobacterium Moorea producens (Lyngbya majuscula). Kalkitoxin exhibited N-methyl-D-aspartate (NMDA)-mediated neurotoxicity and acted as an inhibitory ligand for voltage-sensitive sodium channels in cultured rat cerebellar granule neurons. Subsequent studies revealed that kalkitoxin generated a delayed form of colon tumor cell cytotoxicity in 7-day clonogenic cell survival assays. Cell line- and exposure time-dependent cytostatic/cytotoxic effects were previously observed with mitochondria-targeted inhibitors of hypoxia-inducible factor-1 (HIF-1). The transcription factor HIF-1 functions as a key regulator of oxygen homeostasis. Therefore, we investigated the ability of kalkitoxin to inhibit hypoxic signaling in human tumor …

Association Of Early Imaging For Back Pain With Clinical Outcomes In Older Adults, Jeffrey G. Jarvik, Laura S. Gold, Bryan A. Comstock, Patrick J. Heagerty, Sean D. Rundell, Judith A. Turner, Andrew L. Avins, Zoya Bauer, Brian W. Bresnahan, Janna L. Friedly, Kathryn James, Larry Kessler, Srdjan S. Nedeljkovic, David R. Nerenz, Xu Shi, Sean D. Sullivan, Leighton Chan, Jason M. Schwalb, Richard A. Deyo

Center for Health Policy and Health Services Research Articles

IMPORTANCE: In contrast to the recommendations for younger adults, many guidelines allow for older adults with back pain to undergo imaging without waiting 4 to 6 weeks. However, early imaging may precipitate interventions that do not improve outcomes.

OBJECTIVE: To compare function and pain at the 12-month follow-up visit among older adults who received early imaging with those who did not receive early imaging after a new primary care visit for back pain without radiculopathy.

DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort of 5239 patients 65 years or older with a new primary care visit for back pain (2011-2013) in 3 …

Predicted Protein-Protein Interactions In The Moss Physcomitrella Patens: A New Bioinformatic Resource., Scott Schuette, Brian Piatkowski, Aaron Corley, Daniel Lang, Matt Geisler

Publications

BACKGROUND: Physcomitrella patens, a haploid dominant plant, is fast becoming a useful molecular genetics and bioinformatics tool due to its key phylogenetic position as a bryophyte in the post-genomic era. Genome sequences from select reference species were compared bioinformatically to Physcomitrella patens using reciprocal blasts with the InParanoid software package. A reference protein interaction database assembled using MySQL by compiling BioGrid, BIND, DIP, and Intact databases was queried for moss orthologs existing for both interacting partners. This method has been used to successfully predict interactions for a number of angiosperm plants.

RESULTS: The first predicted protein-protein interactome for a bryophyte …

Sparcoc: A New Framework For Molecular Pattern Discovery And Cancer Gene Identification, Shiqian Ma, Daniel Johnson, Cody Ashby, Donghai Xiong, Carole L. Cramer, Jason H. Moore, Shuzhong Zhang, Xiuzhen Huang

Dartmouth Scholarship

It is challenging to cluster cancer patients of a certain histopathological type into molecular subtypes of clinical importance and identify gene signatures directly relevant to the subtypes. Current clustering approaches have inherent limitations, which prevent them from gauging the subtle heterogeneity of the molecular subtypes. In this paper we present a new framework: SPARCoC (Sparse-CoClust), which is based on a novel Common-background and Sparse-foreground Decomposition (CSD) model and the Maximum Block Improvement (MBI) co-clustering technique. SPARCoC has clear advantages compared with widely-used alternative approaches: hierarchical clustering (Hclust) and nonnegative matrix factorization (NMF). We apply SPARCoC to the study of lung …

Prolonged-Acting, Multi-Targeting Gallium Nanoparticles Potently Inhibit Growth Of Both Hiv And Mycobacteria In Co-Infected Human Macrophages., Prabagaran Narayanasamy, Barbara L. Switzer, Bradley E. Britigan

Journal Articles: Pathology and Microbiology

Human immunodeficiency virus (HIV) infection and Mycobacterium tuberculosis (TB) are responsible for two of the major global human infectious diseases that result in significant morbidity, mortality and socioeconomic impact. Furthermore, severity and disease prevention of both infections is enhanced by co-infection. Parallel limitations also exist in access to effective drug therapy and the emergence of resistance. Furthermore, drug-drug interactions have proven problematic during treatment of co-incident HIV and TB infections. Thus, improvements in drug access and simplified treatment regimens are needed immediately. One of the key host cells infected by both HIV and TB is the mononuclear phagocyte (MP; monocyte, …

Characteristics Of Clinical Shoulder Research Over The Last Decade: A Review Of Shoulder Articles In The Journal Of Bone & Joint Surgery From 2004 To 2014, Gary M. Gartsman, Brent J. Morris, R. Zackary Unger, Mitzi S. Laughlin, Hussein A. Elkousy, T. Bradley Edwards

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: The purpose of this study was to determine characteristics and trends in published shoulder research over the last decade in a leading orthopaedic journal.

Methods: We examined all clinical shoulder articles published in The Journal of Bone & Joint Surgery from 2004 to 2014. The number of citations, authorship, academic degrees of the authors, country and institution of origin, topic, level of evidence, positive or nonpositive outcome, and inclusion of validated patient-reported outcome measures were assessed for each article.

Results: Shoulder articles that included an author with an advanced research degree (MD [Doctor of Medicine] with a PhD …

Microscale Magnetic Field Modulation For Enhanced Capture And Distribution Of Rare Circulating Tumor Cells, Peng Chen, Yu-Yen Huang, Kazunori Hoshino, John X.J Zhang

Dartmouth Scholarship

Immunomagnetic assay combines the powers of the magnetic separation and biomarker recognition and has been an effective tool to perform rare Circulating Tumor Cells detection. Key factors associated with immunomagnetic assay include the capture rate, which indicates the sensitivity of the system, and distributions of target cells after capture, which impact the cell integrity and other biological properties that are critical to downstream analyses. Here we present a theoretical framework and technical approach to implement a microscale magnetic immunoassay through modulating local magnetic field towards enhanced capture and distribution of rare cancer cells. Through the design of a two-dimensional micromagnet …

Unlocking The Mysteries Of Tdp-43, Keith A. Josephs, Peter T. Nelson

Sanders-Brown Center on Aging Faculty Publications

No abstract provided.

Metabolic Reprogramming Of Cancer-Associated Fibroblasts By Idh3Α Downregulation, Daoxiang Zhang, Yongbin Wang, Zhimin Shi, Jingyi Liu, Pan Sun, Xiaodan Hou, Jian Zhang, Shimin Zhao, Binhua P. Zhou, Jun Mi

Markey Cancer Center Faculty Publications

Cancer-associated fibroblasts (CAFs) provide critical metabolites for tumor growth and undergo metabolic reprogramming to support glycolysis. However, the molecular mechanisms responsible for this change remain unclear. Here, we report that TGF-β1- or PDGF-induced CAFs switch from oxidative phosphorylation to aerobic glycolysis. We identify downregulation of isocitrate dehydrogenase 3α (IDH3α) as a marker for this switch. Furthermore, miR-424 downregulates IDH3α during CAF formation. Downregulation of IDH3α decreases the effective level of α-ketoglutarate (α-KG) by reducing the ratio of α-KG to fumarate and succinate, resulting in PHD2 inhibition and HIF-1α protein stabilization. The accumulation of HIF-1α, in turn, promotes glycolysis by increasing …