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1.
Global Health ; 20(1): 36, 2024 Apr 26.
Article in English | MEDLINE | ID: mdl-38671505

ABSTRACT

BACKGROUND: As crises escalate worldwide, there is an increasing demand for innovative solutions to enhance humanitarian outcomes. Within this landscape, digital health tools have emerged as promising solutions to tackle certain health challenges. The integration of digital health tools within the international humanitarian system provides an opportunity to reflect upon the system's paternalistic tendencies, driven largely by Global North organisations, that perpetuate existing inequities in the Global South, where the majority of crises occur. The Participation Revolution, a fundamental pillar of the Localisation Agenda, seeks to address these inequities by advocating for greater participation from crisis-affected people in response efforts. Despite being widely accepted as a best practice; a gap remains between the rhetoric and practice of participation in humanitarian response efforts. This study explores the extent and nature of participatory action within contemporary humanitarian digital health projects, highlighting participatory barriers and tensions and offering potential solutions to bridge the participation gap to enhance transformative change in humanitarian response efforts. METHODS: Sixteen qualitative interviews were conducted with humanitarian health practitioners and experts to retrospectively explored participatory practices within their digital health projects. The interviews were structured and analysed according to the Localisation Performance Measurement Framework's participation indicators and thematically, following the Framework Method. The study was guided by the COREQ checklist for quality reporting. RESULTS: Varied participatory formats, including focus groups and interviews, demonstrated modest progress towards participation indicators. However, the extent of influence and power held by crisis-affected people during participation remained limited in terms of breadth and depth. Participatory barriers emerged under four key themes: project processes, health evidence, technology infrastructure and the crisis context. Lessons for leveraging participatory digital health humanitarian interventions were conducting thorough pre-project assessments and maintaining engagement with crisis-affected populations throughout and after humanitarian action. CONCLUSION: The emerging barriers were instrumental in shaping the limited participatory reality and have implications: Failing to engage crisis-affected people risks perpetuating inequalities and causing harm. To advance the Participation Revolution for humanitarian digital health response efforts, the major participatory barriers should be addressed to improve humanitarian efficiency and digital health efficacy and uphold the rights of crisis-affected people.


Subject(s)
Altruism , Qualitative Research , Humans , Relief Work , Retrospective Studies , Digital Health
2.
Confl Health ; 17(1): 20, 2023 Apr 15.
Article in English | MEDLINE | ID: mdl-37061703

ABSTRACT

BACKGROUND: Forced displacement is a crucial determinant of poor health. With 31 people displaced every minute worldwide, this is an important global issue. Addressing this, the Participation Revolution workstream from the World Humanitarian Summit's Localisation commitments has gained traction in attempting to improve the effectiveness of humanitarian aid. Simultaneously, digital health initiatives have become increasingly ubiquitous tools in crises to deliver humanitarian assistance and address health burdens. OBJECTIVE: This scoping review explores how the localisation agenda's commitment to participation has been adopted within digital health interventions used by displaced people in low-and-middle-income countries. METHODS: This review adopted the Arksey and O'Malley approach and searched five academic databases and three online literature repositories with a Population, Concept and Context inclusion criteria. Data were synthesised and analysed through a critical power lens from the perspective of displaced people in low-and-middle-income-countries. RESULTS: 27 papers demonstrated that a heterogeneous group of health issues were addressed through various digital health initiatives, principally through the use of mobile phones. The focus of the literature lay largely within technical connectivity and feasibility assessments, leaving a gap in understanding potential health implications. The varied conceptualisation of the localisation phenomenon has implications for the future of participatory humanitarian action: Authorship of reviewed literature primarily descended from high-income countries exposing global power dynamics leading the narrative. However, power was not a central theme in the literature: Whilst authors acknowledged the benefit of local involvement, participatory activities were largely limited to informing content adaptations and functional modifications within pre-determined projects and objectives. CONCLUSION: With over 100 million people displaced globally, effective initiatives that meaningfully address health needs without perpetuating harmful inequalities are an essential contribution to the humanitarian arena. The gap in health outcomes evidence, the limited constructions of health, and the varying and nuanced digital divide factors are all indicators of unequal power in the digital health sphere. More needs to be done to address these gaps meaningfully, and more meaningful participation could be a crucial undertaking to achieve this. Registration The study protocol was registered before the study (10.17605/OSF.IO/9D25R) at https://osf.io/9d25r .

3.
MCN Am J Matern Child Nurs ; 46(2): 76-81, 2021.
Article in English | MEDLINE | ID: mdl-33394686

ABSTRACT

PURPOSE: To determine effectiveness of a transcutaneous electrical nerve stimulation (TENS) unit to improve labor pain management and patient satisfaction with overall labor experience among women in labor at term. STUDY DESIGN: Prospective, exploratory design using convenience sampling. METHODS: Pregnant women at term, anticipating a vaginal birth at our tertiary care hospital, were invited to participate in the TENS study to help manage early labor pain. Pain level was assessed on entry into the study and 2 hours post-TENS application using the Wong-Baker FACES® Pain Rating Scale. A TENS satisfaction survey was conducted during postpartum. Pain scores were analyzed using a matched Wilcoxon signed-rank test. RESULTS: There were 272 women enrolled in the study; 255 completed the patient satisfaction survey and 263 had measured pain assessments pre- and post-TENS application. There was a significant reduction in pain scores after application of TENS, (7.09 vs. 6.74, p = 0.02). Most women 78% (199/255) agreed that TENS helped manage early labor pain, 80% (203/255) would recommend TENS for management of early labor pain, and 72% (183/255) would use TENS again. CLINICAL IMPLICATIONS: TENS therapy provides nurses with an opportunity to offer women a low-cost, low-intervention treatment for managing early labor. TENS provides a distraction from contractions and generates a sense of control to help women manage the discomforts of labor and possibly remain home longer.


Subject(s)
Labor, Obstetric , Pain Management/standards , Transcutaneous Electric Nerve Stimulation/standards , Adolescent , Adult , Female , Humans , Pain Management/methods , Pain Management/statistics & numerical data , Pain Measurement/methods , Pain Measurement/statistics & numerical data , Patient Satisfaction , Pregnancy , Prospective Studies , Transcutaneous Electric Nerve Stimulation/methods , Transcutaneous Electric Nerve Stimulation/statistics & numerical data
4.
Front Psychol ; 10: 2570, 2019.
Article in English | MEDLINE | ID: mdl-31803112

ABSTRACT

Cortisol reactivity to adrenocorticotropic hormone (ACTH) has been associated with neuropsychological processes including attention and memory in children with asthma. While cortisol reactivity to a psychological stressor is often considered a measure of current neuroendocrine functioning, this study examines the association of the cortisol reactivity and subsequent neuropsychological functioning. Using prospective data from the Childhood Asthma Management Program (CAMP), we explored the predictive ability of cortisol reactivity to ACTH and children's later attention and memory using traditional and an alternative cortisol reactivity (normalized cortisol) measures. Cortisol reactivity was assessed at study entry and 1-year follow-up, and neuropsychological functioning was assessed at 3-year follow-up. Cortisol reactivity was assessed through plasma cortisol concentrations collected at baseline (CORTBASELINE) and 30 min post-ACTH challenge (CORTPOST-A CTH). An alternative measure of cortisol reactivity was developed through post-ACTH stimulation cortisol, normalized by cortisol by baseline (CORTNORM -ACTH). CORT B ASELINE positively predicted year 3 attention, while CORTNORM -ACTH negatively predicted attention, suggesting convergence of cortisol variables in prediction of neuropsychological function. Year 1 CORTACTH positively predicted child memory at year 3; Year 1 CORTNORM-ACTH negatively predicted year 3 sustained attentions. These findings demonstrate that HPA reactivity, including the application of normalized cortisol reactivity, can predict subsequent neuropsychological functioning of children with mild to moderate asthma.

5.
Article in English | MEDLINE | ID: mdl-27383096

ABSTRACT

American Indians and Alaska Natives (AI/ANs) have a unique, traumatic, and alienating history of education in the U.S., which may be directly related to overall health and well-being. Community engagement is critical in well-being research with Native communities, especially when investigating culturally sensitive topics, such as early education experiences. This study investigates the value of a community-based participatory research approach in gaining valuable culturally sensitive information from Native people in a respectful manner. Assessment participation and feedback are analyzed and presented as indicators of Native participant engagement success in a potentially sensitive research project exploring early education experiences.


Subject(s)
Community-Based Participatory Research , Cultural Competency , Indians, North American/ethnology , Resilience, Psychological , Aged , Humans , Middle Aged
6.
J Subst Abuse Treat ; 65: 66-73, 2016 06.
Article in English | MEDLINE | ID: mdl-26710670

ABSTRACT

Few studies have investigated the impact of adolescent change language on substance use treatment outcomes and even fewer have examined how adolescents respond to normative feedback. The purpose of this study was to understand the influence normative feedback has on adolescent change language and subsequent alcohol and cannabis use 3months later. We examined how percent change talk (PCT) was associated with subsequent alcohol and drug use outcomes. Adolescents (N=48) were randomly assigned to receive brief motivational interviewing (MI) or MI plus normative feedback (NF). Audio recordings were coded with high interrater reliability. Adolescents with high PCT who received MI+NF had significantly fewer days of alcohol and binge drinking at follow up. There were no differences between groups on cannabis use or treatment engagement. Findings indicate that NF may be useful for adolescents with higher amount of change talk during sessions and may be detrimental for individuals with higher sustain talk.


Subject(s)
Adolescent Behavior/psychology , Alcohol Drinking/therapy , Feedback, Psychological , Motivational Interviewing/methods , Adolescent , Female , Humans , Male , Marijuana Smoking/therapy , Motivation , Surveys and Questionnaires , Treatment Outcome
7.
Seizure ; 32: 4-8, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26552554

ABSTRACT

PURPOSE: We set out to determine clinical and EEG features of seizures presenting with falls, epileptic drop attacks and atonia in the video EEG monitoring unit. METHODS: We searched the video EEG monitoring reports over a 5-year-period for the terms "drop", "fall" and "atonic". RESULTS: Seizures presenting as epileptic drop attacks, falls or atonia were found in 23/1112 (2%) admissions. About half of the patients suffering from these seizure types had developmental delay and learning difficulties and in half of the patients a lesion was seen on MRI which was often frontal. The presumed epileptogenic zone was frontal in many cases (43%), unclear with regards to a region or multifocal in 48% and posterior temporal/occipital in 2 patients (9%). EEG patterns recorded were paroxysmal fast activity, spike and wave discharges and EEG attenuation. Seizure related falls were seen in 8 cases (34%) with injuries recorded during Video EEG monitoring in half of those. CONCLUSION: Clinical and EEG features outlined here can help the clinician to recognise patients at risk for these devastating seizure types.


Subject(s)
Accidental Falls , Brain/physiopathology , Seizures/physiopathology , Syncope/physiopathology , Adolescent , Adult , Brain/pathology , Electroencephalography/methods , Female , Humans , Learning Disabilities/diagnosis , Learning Disabilities/epidemiology , Learning Disabilities/pathology , Learning Disabilities/physiopathology , Male , Middle Aged , Seizures/diagnosis , Seizures/epidemiology , Seizures/pathology , Syncope/diagnosis , Syncope/epidemiology , Syncope/pathology , Video Recording/methods , Young Adult
8.
Psychol Addict Behav ; 29(4): 941-9, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26415055

ABSTRACT

There is considerable evidence for motivational interviewing (MI) in changing problematic behaviors. Research on the causal chain for MI suggests influence of facilitator speech on client speech. This association has been examined using macro (session-level) and micro (utterance-level) measures; however, effects across sessions have largely been unexplored, particularly with groups. We evaluated a sample of 129 adolescent Group MI sessions, using a behavioral coding system and timing information to generate information on facilitator and client speech (CT; change talk) within 5 successive segments (quintiles) of each group session. We hypothesized that facilitator speech (open-ended questions and reflections of CT) would be related to subsequent CT. Repeated measures analysis indicated significant quadratic and cubic trends for facilitator and client speech across quintiles. Across quintiles, cross-lagged panel analysis using a zero-inflated negative binomial model showed minimal evidence of facilitator speech on client CT, but did indicate several effects of client CT on facilitator speech, and of client CT on subsequent client CT. Results suggest that session-level effects of facilitator speech on client speech do not arise from long-duration effects of facilitator speech; instead, we detected effects of facilitator speech on client speech only at the beginning and end of sessions, when open questions, respectively, suppressed and enhanced client expressions of CT. Findings suggest that clinicians must remain vigilant to client CT throughout the group session, reinforcing it when it arises spontaneously and selectively employing open-ended questions to elicit it when it does not, particularly toward the end of the session.


Subject(s)
Adolescent Behavior/psychology , Juvenile Delinquency/rehabilitation , Motivational Interviewing/methods , Professional-Patient Relations , Psychotherapeutic Processes , Psychotherapy, Group/methods , Speech , Adolescent , Female , Humans , Male
9.
J Environ Manage ; 131: 129-37, 2013 Dec 15.
Article in English | MEDLINE | ID: mdl-24161802

ABSTRACT

The relationship of eelgrass survival and habitat quality to water column nitrogen level, phytoplankton biomass, particulate matter, bottom light intensity, and light attenuation was quantified at 70 sites within 19 Massachusetts estuaries through 4 growing seasons (2007-2009, 2011). Sites included a range of eelgrass habitat quality, from stable productive eelgrass beds, to degraded beds, to areas that have lost all eelgrass coverage. Survival of transplanted eelgrass culms was used as a bio-indicator of habitat quality. Habitat quality based upon both changes in stability of eelgrass coverage and transplant survival was positively related to light intensity and percent transmittance. Transplant survival was consistent with habitat designations based upon long-term changes in eelgrass coverage, with lowest light coinciding with areas that lost eelgrass in earlier decades. Bottom light declined in proportion to increases in total nitrogen levels, phytoplankton biomass, and water column particulates determined from long-term water quality data. Field surveys indicated that eelgrass survival required bottom light ≥100 µE/m(2)/s and healthy eelgrass existed where tidally-averaged total nitrogen was less than 0.34 mg/L, equivalent to a mid-ebb tide water-column total nitrogen of <0.37 mg/L. Traditional sampling of water column nitrogen at mid-ebb tide was found to slightly overestimate the average nitrogen level over a complete tidal cycle. However, since long-term, ebb-tide and tidally-averaged total nitrogen are correlated, it is possible to use the monitoring average to guide management until tidally-averaged TN becomes available. Nitrogen thresholds that support eelgrass communities provide a fundamental tool for managing this habitat and for selection of transplant sites aimed at accelerating restoration of this resource under increasing nitrogen loading of the coastal zone.


Subject(s)
Ecosystem , Light , Nitrogen/analysis , Zosteraceae , Environmental Monitoring , Massachusetts
10.
Development ; 139(24): 4666-74, 2012 Dec.
Article in English | MEDLINE | ID: mdl-23172918

ABSTRACT

This study is the first to demonstrate that macrophage migration inhibitory factor (MIF), an immune system 'inflammatory' cytokine that is released by the developing otocyst, plays a role in regulating early innervation of the mouse and chick inner ear. We demonstrate that MIF is a major bioactive component of the previously uncharacterized otocyst-derived factor, which directs initial neurite outgrowth from the statoacoustic ganglion (SAG) to the developing inner ear. Recombinant MIF acts as a neurotrophin in promoting both SAG directional neurite outgrowth and neuronal survival and is expressed in both the developing and mature inner ear of chick and mouse. A MIF receptor, CD74, is found on both embryonic SAG neurons and adult mouse spiral ganglion neurons. Mif knockout mice are hearing impaired and demonstrate altered innervation to the organ of Corti, as well as fewer sensory hair cells. Furthermore, mouse embryonic stem cells become neuron-like when exposed to picomolar levels of MIF, suggesting the general importance of this cytokine in neural development.


Subject(s)
Ear, Inner/embryology , Intramolecular Oxidoreductases/physiology , Macrophage Migration-Inhibitory Factors/physiology , Nerve Growth Factors/physiology , Animals , Animals, Newborn , Cell Survival/drug effects , Cells, Cultured , Chick Embryo , Ear, Inner/drug effects , Ear, Inner/growth & development , Ear, Inner/metabolism , Intramolecular Oxidoreductases/genetics , Intramolecular Oxidoreductases/metabolism , Intramolecular Oxidoreductases/pharmacology , Macrophage Migration-Inhibitory Factors/genetics , Macrophage Migration-Inhibitory Factors/metabolism , Macrophage Migration-Inhibitory Factors/pharmacology , Mice , Mice, Knockout , Nerve Growth Factors/genetics , Nerve Growth Factors/metabolism , Nerve Growth Factors/pharmacology , Neurites/drug effects , Neurites/physiology , Neurons/cytology , Neurons/drug effects , Neurons/physiology , Organ of Corti/embryology , Organ of Corti/growth & development , Organ of Corti/metabolism , Spiral Ganglion/embryology , Spiral Ganglion/growth & development , Spiral Ganglion/metabolism
11.
Brain Stimul ; 5(3): 201-207, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22305346

ABSTRACT

BACKGROUND: Poor reading efficiency is the most persistent problem for adults with developmental dyslexia. Previous research has demonstrated a relationship between left posterior temporal cortex (pTC) function and reading ability, regardless of dyslexia status. OBJECTIVE/HYPOTHESIS: In this study, we tested whether enhancing left lateralization of pTC using transcranial direct current stimulation (tDCS) improves reading efficiency in adults without dyslexia. METHOD: Twenty-five right-handed adults with no history of learning disorder participated. Real and sham "Left lateralizing" tDCS were applied to the pTC in separate sessions. Standardized word and nonword reading tests were given immediately after stimulation. RESULTS: Modeling of the induced electrical field confirmed that tDCS was likely to increase left pTC excitability and reduce right pTC excitability as intended. Relative to sham, real tDCS induced improvements in word reading efficiency in below average readers. CONCLUSIONS: Enhancing left lateralization of the pTC using tDCS improves word reading efficiency in below-average readers. This demonstrates that left lateralization of the pTC plays a role in reading ability, and provides stimulation parameters that could be used for a trial of tDCS in adults with developmental dyslexia. Such short-term gains could amplify the effect of appropriate reading interventions when performed in conjunction with them.


Subject(s)
Brain/physiology , Comprehension/physiology , Comprehension/radiation effects , Functional Laterality/physiology , Reading , Transcranial Magnetic Stimulation/methods , Adult , Brain/radiation effects , Female , Functional Laterality/radiation effects , Humans , Male , Middle Aged , Young Adult
12.
PLoS One ; 7(12): e53280, 2012.
Article in English | MEDLINE | ID: mdl-23285273

ABSTRACT

Cyclodextrins are sugar compounds that are increasingly finding medicinal uses due to their ability to complex with hydrophobic molecules. One cyclodextrin in particular, 2-hydroxypropyl-ß-cyclodextrin (HPßCD), is used as a carrier to solubilize lipophilic drugs and is itself being considered as a therapeutic agent for treatment of Niemann-Pick Type C disease, due to its ability to mobilize cholesterol. Results from toxicological studies suggest that HPßCD is generally safe, but a recent study has found that it causes hearing loss in cats. Whether the hearing loss occurred via death of cochlear hair cells, rendering it permanent, was unexplored. In the present study, we examined peripheral auditory function and cochlear histology in mice after subcutaneous injection of HPßCD to test for hearing loss and correlate any observed auditory deficits with histological findings. On average, auditory brainstem response thresholds were elevated at 4, 16, and 32 kHz in mice one week after treatment with 8,000 mg/kg. In severely affected mice all outer hair cells were missing in the basal half of the cochlea. In many cases, surviving hair cells in the cochlear apex exhibited abnormal punctate distribution of the motor protein prestin, suggesting long term changes to membrane composition and integrity. Mice given a lower dose of 4,000 mg/kg exhibited hearing loss only after repeated doses, but these threshold shifts were temporary. Therefore, cyclodextrin-induced hearing loss was complex, involving cell death and other more subtle influences on cochlear physiology.


Subject(s)
Anticholesteremic Agents/adverse effects , Hair Cells, Auditory/drug effects , Hearing Loss/chemically induced , beta-Cyclodextrins/adverse effects , 2-Hydroxypropyl-beta-cyclodextrin , Animals , Anticholesteremic Agents/administration & dosage , Anticholesteremic Agents/pharmacology , Cell Death/drug effects , Dose-Response Relationship, Drug , Drug Administration Schedule , Drug Evaluation, Preclinical , Hair Cells, Auditory/physiology , Hearing Loss/pathology , Infusions, Parenteral , Mice , beta-Cyclodextrins/administration & dosage , beta-Cyclodextrins/pharmacology
13.
Cortex ; 48(9): 1179-86, 2012 Oct.
Article in English | MEDLINE | ID: mdl-21794852

ABSTRACT

Neurologists and aphasiologists have debated for over a century whether right hemisphere recruitment facilitates or impedes recovery from aphasia. Here we present a well-characterized patient with sequential left and right hemisphere strokes whose case substantially informs this debate. A 72-year-old woman with chronic nonfluent aphasia was enrolled in a trial of transcranial magnetic stimulation (TMS). She underwent 10 daily sessions of inhibitory TMS to the right pars triangularis. Brain activity was measured during picture naming using functional magnetic resonance imaging (fMRI) prior to TMS exposure and before and after TMS on the first day of treatment. Language and cognition were tested behaviorally three times prior to treatment, and at 2 and 6 months afterward. Inhibitory TMS to the right pars triangularis induced immediate improvement in naming, which was sustained 2 months later. fMRI confirmed a local reduction in activity at the TMS target, without expected increased activity in corresponding left hemisphere areas. Three months after TMS, the patient suffered a right hemisphere ischemic stroke, resulting in worsening of aphasia without other clinical deficits. Behavioral testing 3 months later confirmed that language function was impacted more than other cognitive domains. The paradoxical effects of inhibitory TMS and the stroke to the right hemisphere demonstrate that even within a single patient, involvement of some right hemisphere areas may support recovery, while others interfere. The behavioral evidence confirms that compensatory reorganization occurred within the right hemisphere after the original stroke. No support is found for interhemispheric inhibition, the theoretical framework on which most therapeutic brain stimulation protocols for aphasia are based.


Subject(s)
Aphasia/physiopathology , Functional Laterality/physiology , Recovery of Function/physiology , Aged , Brain Mapping , Female , Frontal Lobe/physiology , Frontal Lobe/physiopathology , Humans , Image Processing, Computer-Assisted , Language , Magnetic Resonance Imaging , Neuronal Plasticity/physiology , Transcranial Magnetic Stimulation/methods
14.
Brain Stimul ; 5(2): 155-62, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22037128

ABSTRACT

BACKGROUND: A limited number of studies have shown that modulation of cortical excitability using transcranial direct current stimulation (tDCS) is safe and tolerable. Few have directly evaluated whether sham and active stimulation are indistinguishable. OBJECTIVE: We aimed to demonstrate tDCS safety and tolerability in a large cohort, and to compare the occurrence and severity of side effects between sham and active stimulation sessions. METHODS: One hundred thirty-one healthy subjects undergoing 277 tDCS sessions rated on a 1 to 5 scale the perception of side effects during and after stimulation. Proportions of active and sham sessions associated with side effects were compared using Fisher exact test, and distributions of severity ratings were compared using the Kruskal-Wallis test. RESULTS: No serious adverse effects occurred. Side effects most commonly reported were tingling (76%), itching (68%), burning (54%), and pain (25%). Side effect severity was mild, with fewer than 2% of responses indicating a severity > 3 on all questions except tingling (15%), itching (20%), burning (7%), pain (5%), and fatigue (3%) during stimulation. Rates of sensory side effects were statistically significantly higher in active stimulation sessions compared with sham sessions. No other stimulation parameters had a statistically significant impact on side effect occurrence. CONCLUSIONS: TDCS is a safe well-tolerated technique with no evidence of risk for serious adverse effects. Sensory side effects are common, but the severity is typically low. Because sensory side effects are more frequent and more severe in active compared with sham tDCS, the current method of sham stimulation may not be an adequate control condition for some studies.


Subject(s)
Electric Stimulation/adverse effects , Electric Stimulation/methods , Perception/physiology , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged
15.
Hear Res ; 282(1-2): 184-95, 2011 Dec.
Article in English | MEDLINE | ID: mdl-21875659

ABSTRACT

Heterozygous mutations in the gene encoding chromodomain-DNA-binding-protein 7 (CHD7) cause CHARGE syndrome, a multiple anomaly condition which includes vestibular dysfunction and hearing loss. Mice with heterozygous Chd7 mutations exhibit semicircular canal dysgenesis and abnormal inner ear neurogenesis, and are an excellent model of CHARGE syndrome. Here we characterized Chd7 expression in mature middle and inner ears, analyzed morphological features of mutant ears and tested whether Chd7 mutant mice have altered responses to noise exposure and correlated those responses to inner and middle ear structure. We found that Chd7 is highly expressed in mature inner and outer hair cells, spiral ganglion neurons, vestibular sensory epithelia and middle ear ossicles. There were no obvious defects in individual hair cell morphology by prestin immunostaining or scanning electron microscopy, and cochlear innervation appeared normal in Chd7(Gt)(/+) mice. Hearing thresholds by auditory brainstem response (ABR) testing were elevated at 4 and 16 kHz in Chd7(Gt)(/+) mice, and there were reduced distortion product otoacoustic emissions (DPOAE). Exposure of Chd7(Gt)(/+) mice to broadband noise resulted in variable degrees of hair cell loss which inversely correlated with severity of stapedial defects. The degrees of hair cell loss and threshold shifts after noise exposure were more severe in wild type mice than in mutants. Together, these data indicate that Chd7(Gt)(/+) mice have combined conductive and sensorineural hearing loss, correlating with changes in both middle and inner ears.


Subject(s)
CHARGE Syndrome/enzymology , DNA-Binding Proteins/metabolism , Ear, Inner/enzymology , Ear, Middle/enzymology , Hearing Loss, Conductive/enzymology , Hearing Loss, Sensorineural/enzymology , Acoustic Stimulation , Age Factors , Animals , Auditory Threshold , CHARGE Syndrome/genetics , CHARGE Syndrome/pathology , CHARGE Syndrome/physiopathology , DNA-Binding Proteins/genetics , Disease Models, Animal , Ear, Inner/abnormalities , Ear, Inner/physiopathology , Ear, Inner/ultrastructure , Ear, Middle/abnormalities , Ear, Middle/physiopathology , Ear, Middle/ultrastructure , Evoked Potentials, Auditory, Brain Stem , Female , Genes, Reporter , Hearing Loss, Conductive/genetics , Hearing Loss, Conductive/pathology , Hearing Loss, Conductive/physiopathology , Hearing Loss, Sensorineural/genetics , Hearing Loss, Sensorineural/pathology , Hearing Loss, Sensorineural/physiopathology , Immunohistochemistry , Male , Mice , Mice, 129 Strain , Mice, Transgenic , Microscopy, Electron, Scanning , Molecular Motor Proteins/metabolism , Mutation , Noise , Otoacoustic Emissions, Spontaneous , Promoter Regions, Genetic , beta-Galactosidase/genetics , beta-Galactosidase/metabolism
16.
Hum Mol Genet ; 20(3): 466-81, 2011 Feb 01.
Article in English | MEDLINE | ID: mdl-21071598

ABSTRACT

Alström Syndrome is a life-threatening disease characterized primarily by numerous metabolic abnormalities, retinal degeneration, cardiomyopathy, kidney and liver disease, and sensorineural hearing loss. The cellular localization of the affected protein, ALMS1, has suggested roles in ciliary function and/or ciliogenesis. We have investigated the role of ALMS1 in the cochlea and the pathogenesis of hearing loss in Alström Syndrome. In neonatal rat organ of Corti, ALMS1 was localized to the basal bodies of hair cells and supporting cells. ALMS1 was also evident at the basal bodies of differentiating fibrocytes and marginal cells in the lateral wall. Centriolar ALMS1 expression was retained into maturity. In Alms1-disrupted mice, which recapitulate the neurosensory deficits of human Alström Syndrome, cochleae displayed several cyto-architectural defects including abnormalities in the shape and orientation of hair cell stereociliary bundles. Developing hair cells were ciliated, suggesting that ciliogenesis was largely normal. In adult mice, in addition to bundle abnormalities, there was an accelerated loss of outer hair cells and the progressive appearance of large lesions in stria vascularis. Although the mice progressively lost distortion product otoacoustic emissions, suggesting defects in outer hair cell amplification, their endocochlear potentials were normal, indicating the strial atrophy did not affect its function. These results identify previously unrecognized cochlear histopathologies associated with this ciliopathy that (i) implicate ALMS1 in planar cell polarity signaling and (ii) suggest that the loss of outer hair cells causes the majority of the hearing loss in Alström Syndrome.


Subject(s)
Alstrom Syndrome/metabolism , Alstrom Syndrome/pathology , Cochlea/ultrastructure , DNA-Binding Proteins/metabolism , Hair Cells, Auditory/metabolism , Hair Cells, Auditory/ultrastructure , Hearing Loss/genetics , Hearing Loss/pathology , Alstrom Syndrome/genetics , Animals , Cell Cycle Proteins , Cell Differentiation , Cell Polarity , Centrioles , Cilia/ultrastructure , DNA-Binding Proteins/genetics , Fluorescent Antibody Technique , Hearing Loss/metabolism , Mice , Mice, Knockout , Microscopy, Electron , Organ of Corti/ultrastructure , Rats , Rats, Sprague-Dawley , Signal Transduction , Stria Vascularis/ultrastructure
17.
Brain Lang ; 113(1): 45-50, 2010 Apr.
Article in English | MEDLINE | ID: mdl-20159655

ABSTRACT

Although evidence suggests that patients with left hemisphere strokes and non-fluent aphasia who receive 1Hz repetitive transcranial magnetic stimulation (rTMS) over the intact right inferior frontal gyrus experience persistent benefits in naming, it remains unclear whether the effects of rTMS in these patients generalize to other language abilities. We report a subject with chronic non-fluent aphasia who showed stable deficits of elicited propositional speech over the course of 5 years, and received 1200 pulses of 1Hz rTMS daily for 10 days at a site identified as being optimally responsive to rTMS in this patient. Consistent with prior studies there was improvement in object naming, with a statistically significant improvement in action naming. Improvement was also demonstrated in picture description at 2, 6, and 10 months after rTMS with respect to the number of narrative words and nouns, sentence length, and use of closed class words. Compared to his baseline performance, the patient showed significant improvement on the Western Aphasia Battery (WAB) subscale for spontaneous speech. These findings suggest that manipulation of the intact contralesional cortex in patients with non-fluent aphasia may result in language benefits that generalize beyond naming to include other aspects of language production.


Subject(s)
Aphasia, Broca/therapy , Speech , Transcranial Magnetic Stimulation/methods , Aphasia, Broca/pathology , Aphasia, Broca/physiopathology , Brain/pathology , Brain/physiopathology , Chronic Disease , Follow-Up Studies , Humans , Language Tests , Magnetic Resonance Imaging , Male , Middle Aged , Speech/physiology , Stroke/pathology , Stroke/physiopathology , Stroke/therapy , Time Factors , Treatment Outcome
18.
Ann Pharmacother ; 41(1): 79-85, 2007 Jan.
Article in English | MEDLINE | ID: mdl-17190848

ABSTRACT

OBJECTIVE: To review the efficacy and safety of botulinum toxin A (BTX) in the treatment of sialorrhea. DATA SOURCES: A PubMed search and reference list review was performed to find clinical trials on BTX in the treatment of sialorrhea. The search was limited to English-language trials involving human subjects. Articles from 1965 to October 2006 were searched, using key words botulinum, botulinum toxin, Botox, sialorrhea, saliva, salivary gland, and drooling. STUDY SELECTION AND DATA EXTRACTION: Reports of 15 studies were found on BTX in the treatment of sialorrhea in human subjects. Four controlled trials are presented in detail, and 11 uncontrolled studies are summarized. DATA SYNTHESIS: One controlled trial found that BTX caused significant reductions in patients' severity and frequency of drooling compared with placebo. Another found significant saliva reductions in the treatment group receiving the highest dose of BTX but found no subjective improvement compared with the placebo group. A third study comparing BTX with placebo found significant improvements in subjective and objective measures of drooling in the treatment group. A fourth controlled trial found significant reductions from baseline levels of drooling after patients received BTX injections. Similar efficacy was found between the BTX and scopolamine treatment groups. CONCLUSIONS: Evidence indicates that BTX is a safe and effective treatment for sialorrhea. More research is needed to determine the ideal dose, injection location, and technique of BTX injections.


Subject(s)
Botulinum Toxins, Type A/therapeutic use , Sialorrhea/drug therapy , Botulinum Toxins, Type A/pharmacology , Humans , Salivary Glands/drug effects , Salivary Glands/physiology , Sialorrhea/epidemiology , Sialorrhea/physiopathology
19.
Physiother Theory Pract ; 22(4): 207-18, 2006 Sep.
Article in English | MEDLINE | ID: mdl-16920679

ABSTRACT

The purpose of this case study was to report data from a clinical evaluation of an individual with fascioscapulohumeral muscular dystrophy (FSHMD) while using a manual wheelchair versus the same wheelchair fitted with pushrim activated power-assisted wheelchair hubs (PAPAW). An individual with FSHMD was tested for change in heart rate (HR), rate of perceived exertion (RPE), propulsion speed (PS), time to completion (TC), and qualitative observation in a community-based environment. A modified Physiological Cost Index (mPCI) was calculated post hoc. Results indicate HR and mPCI for the PAPAW trials were lower; RPE was "Hard" for manual wheelchair propulsion and "Fairly or Very Light" for the PAPAW trials; PS was twice as fast in both conditions using the PAPAW; and TC was 53% faster with PAPAW than in the manual wheelchair. Qualitatively, the manual propulsion conditions had exaggerated trunk and hip flexion with simultaneous scapula elevation and upward rotation to initiate downward force on the hand rim more so than the PAPAW conditions. The data suggest that propulsion of a wheelchair enhanced by PAPAW is more energy efficient, biomechanically advantageous, and more timesaving than a manual wheelchair for the tested individual with FSHMD in his environment.


Subject(s)
Ergonomics , Muscular Dystrophy, Facioscapulohumeral/rehabilitation , Wheelchairs , Adult , Biomechanical Phenomena , Cost-Benefit Analysis , Energy Metabolism , Equipment Design , Humans , Male , Physical Exertion , United States , Wheelchairs/economics
20.
Gerontology ; 48(2): 93-7, 2002.
Article in English | MEDLINE | ID: mdl-11867931

ABSTRACT

BACKGROUND: The comprehension of written health care information, e.g. prescription bottle labels or an informed consent form, impacts on communication with patients and their ability to understand medical procedures, as well as goals of therapy. OBJECTIVE: To determine if the problem of literacy was present in a population of affluent Albuquerque retirement community dwellers. METHODS: We administered the Test of Functional Health Literacy in Adults (TOFHL) to 93 residents (71 women and 22 men), using a one-on-one directed examination conducted by one of the authors (J.G.B.). RESULTS: The group studied had a mean age of >70 years, were not acutely ill, had no known loss of mental function, were better educated and had a high standard of living compared to national standards. However, 30% (95% confidence level) of our group were unable to adequately comprehend written information as measured by the TOFHL. The subgroup with poor comprehension (21 women and 7 men) had a mean age of 85 years (versus 82 years in the group with good comprehension) and a mean of 13 years (versus 15 years in the group with good comprehension) of formal education. Multivariate analysis was consistent with a negative effect of age (p = 0.04), a positive effect of years of formal education (p = 0.0005) and no effect of gender on the TOFHL score. CONCLUSION: Two recent studies, one in an emergency room setting and the other among Medicare enrollees, demonstrated similar results to ours. The high prevalence of poor comprehension in these groups should alert providers to the need to develop additional or different communication skills that can address the problem of poor reading comprehension across at least three diverse groups of people, with particular attention to those over the age of 65.


Subject(s)
Cognition , Educational Status , Health Education , Income , Patient Education as Topic , Reading , Retirement , Aged , Aged, 80 and over , Delivery of Health Care , Educational Measurement/methods , Female , Humans , Male , Middle Aged , Multivariate Analysis
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