Chronic Deep Brain Stimulation of the Human Nucleus Accumbens Region Disrupts the Stability of Intertemporal Preferences.

When choosing between rewards that differ in temporal proximity (intertemporal choice), human preferences are typically stable, constituting a clinically relevant transdiagnostic trait. Here we show, in female and male human patients undergoing deep brain stimulation (DBS) of the anterior limb of the internal capsule/NAcc region for treatment-resistant obsessive-compulsive disorder, that long-term chronic (but not phasic) DBS disrupts intertemporal preferences. Hierarchical Bayesian modeling accounting for temporal discounting behavior across multiple time points allowed us to assess both short-term and long-term reliability of intertemporal choice. In controls, temporal discounting was highly reliable, both long-term (6 months) and short-term (1 week). In contrast, in patients undergoing DBS, short-term reliability was high, but long-term reliability (6 months) was severely disrupted. Control analyses confirmed that this effect was not because of range restriction, the presence of obsessive-compulsive disorder symptoms or group differences in choice stochasticity. Model-agnostic between- and within-subject analyses confirmed this effect. These findings provide initial evidence for long-term modulation of cognitive function via DBS and highlight a potential contribution of the human NAcc region to intertemporal preference stability over time.SIGNIFICANCE STATEMENT Choosing between rewards that differ in temporal proximity is in part a stable trait with relevance for many mental disorders, and depends on prefrontal regions and regions of the dopamine system. Here we show that chronic deep brain stimulation of the human anterior limb of the internal capsule/NAcc region for treatment-resistant obsessive-compulsive disorder disrupts the stability of intertemporal preferences. These findings show that chronic stimulation of one of the brain's central motivational hubs can disrupt preferences thought to depend on this circuit.

The determination of intercultural sensitivity and ethnocentrism levels among nurses and nursing students: A border of city, Turkey.

AIM: The current study is a descriptive-comparative study and aims to determine intercultural sensitivity and ethnocentrism levels among nurses and nursing students. METHOD: The study was conducted with 207 nurses working at a State Hospital and 211 nursing students studying at a University between November 30, 2019, and January 20, 2020. The data were collected using a descriptive characteristics form, the Intercultural Sensitivity Scale, and the Ethnocentrism Scale. FINDINGS: It was found that both nurses and nursing students (73.4% and 60.7%, respectively) struggled to communicate with foreign patients and experienced problems with cultural differences (49.8% and 22.7%, respectively). A statistically significant negative correlation was found for the nurses and nursing students in terms of their intercultural sensitivity and ethnocentrism scores (p < .05). PRACTICAL IMPLICATION: Nurses and student nurses should interact with people from different cultures to improve refugee health care.

Nucleus Accumbens Deep Brain Stimulation in Patients with Substance Use Disorders and Delay Discounting.

Deep brain stimulation (DBS) of the nucleus accumbens (NAc) shows first promising results in patients with severe substance use disorder (SUD), a patient group known to have deficits in self-control. One facet of self-control is the ability to forego smaller sooner rewards in favor of larger later rewards (delay discounting, DD). The NAc has been suggested to integrate motivational information to guide behavior while the consequences of NAc-DBS on DD are unknown. To this end, nine patients with SUD performed a DD task with DBS on and after a 24 h DBS off period. Furthermore, 18 healthy controls were measured to assess possible alterations in DD in patients with SUD. Our findings implicate that DD was not significantly modulated by NAc-DBS and also that patients with SUD did not differ from healthy controls. While null results must be interpreted with caution, the commonly observed association of impaired DD in SUD might suggest a long-term effect of NAc-DBS that was not sufficiently modulated by a 24 h DBS off period.

Patterns of medical management of overactive bladder (OAB) and benign prostatic hyperplasia (BPH) in the United States.

AIMS: Overactive bladder (OAB) and benign prostatic hyperplasia (BPH) are highly prevalent conditions that place a large burden on the United States (US) health care system. We sought to analyze patterns of prescription medication usage for incident OAB in men and women, and for incident BPH in men using US health insurance claims data. MATERIALS AND METHODS: This study used Truven Health MarketScan® Commercial and Medicare Supplemental Research databases. The data were pooled from diverse points of care. BPH subjects included men age 18+ with the first and last two diagnoses of BPH ≥30 days apart and no BPH diagnosis for 1 year prior. OAB subjects included men and women age 18+, who were diagnosed similarly with incident OAB. The type of medication, medication continuation (persistence), and switching to a different medication were analyzed through September 30, 2013. RESULTS: Medication persistence was much higher overall for BPH than OAB (56% vs 34%, respectively, P < 0.0001), and was highest among men with BPH age 65+ (62%). Patients age 18-64 were less likely to continue medication than older adults (age 65+) for both BPH and OAB. A 9.4% of patients in the OAB cohort and 6.9% of men with BPH switched from one medication to another. CONCLUSIONS: Persistence was higher with BPH than OAB medications overall, whereas switching rates were higher in the OAB group. The lower persistence of OAB medication may be due to less efficacy or tolerability. The possibility of under treatment of OAB also warrants future investigations.

An approach to improve the care of mid-life women through the implementation of a Women's Health Assessment Tool/Clinical Decision Support toolkit.

The objectives of this study are to describe the implementation process of the Women's Health Assessment Tool/Clinical Decision Support toolkit and summarize patients' and clinicians' perceptions of the toolkit. The Women's Health Assessment Tool/Clinical Decision Support toolkit was piloted at three clinical sites over a 4-month period in Washington State to evaluate health outcomes among mid-life women. The implementation involved a multistep process and engagement of multiple stakeholders over 18 months. Two-thirds of patients (n = 76/110) and clinicians (n = 8/12) participating in pilot completed feedback surveys; five clinicians participated in qualitative interviews. Most patients felt more prepared for their annual visit (69.7%) and that quality of care improved (68.4%) while clinicians reported streamlined patient visits and improved communication with patients. The Women's Health Assessment Tool/Clinical Decision Support toolkit offers a unique approach to introduce and address some of the key health issues that affect mid-life women.

Patterns of Care for Newly Diagnosed Benign Prostatic Hyperplasia in the United States.

PURPOSE: We examined diagnostic tests and treatment patterns in men with new onset benign prostatic hyperplasia using consolidated national electronic health record data. MATERIALS AND METHODS: The Humedica® electronic health record database consists of de-identified patient records from approximately 25 million patients in the United States. Using this database, men with a new benign prostatic hyperplasia diagnosis (benign prostatic hyperplasia, bladder neck obstruction, urinary retention and incomplete bladder emptying) between July 1, 2009 and June 30, 2012 were included in study. Exclusion criteria included conditions such as genitourinary cancers, radiation cystitis, neurogenic bladder and urological pain diagnoses. Diagnostic tests and treatments were summarized and stratified by age (less than 65 vs 65 years or greater) and serum prostate specific antigen level. RESULTS: A total of 38,252 men met inclusion criteria. Mean followup was 1,020 days. Serum creatinine in 92% of patients, serum prostate specific antigen in 76% and urinalysis in 52% were the most common tests. Invasive testing was obtained in less than 20% of patients. Treatments included watchful waiting in 40% of patients, pharmacological therapy in 59.4% and surgery in 2.2%. α-Blockers were prescribed in 50.7% of men. Men older than 65 years and with higher prostate specific antigen levels were less likely to be treated with watchful waiting. Therapy with a 5-ARI (5-α reductase inhibitor) was prescribed in 23% to 29% of men across all prostate specific antigen categories. CONCLUSIONS: The majority of clinical care for new onset benign prostatic hyperplasia was in concordance with guideline recommendations. Based on prostate specific antigen values, 5-ARI therapy was underutilized in men with large prostates and was over utilized in men with small prostates.

Real-World Patterns of Care for the Overactive Bladder Syndrome in the United States.

OBJECTIVE: To examine the "real-world" overactive bladder (OAB) practice patterns using national data in the United States. MATERIALS AND METHODS: The Humedica EHR database was queried. This database consists of de-identified patient records from a network of organizations treating approximately over 30 million patients across states in the United States. The entire study period was from July 1, 2008, to September 30, 2013. Patients with a diagnosis of OAB between July 1, 2009, and June 30, 2012 were included and followed. Patient comorbidities, demographics, diagnostic testing, and medication usage were analyzed. RESULTS: Of 19,309,600 subjects enrolled during the study period, 46,648 adults had a diagnosis of OAB, with follow-up of at least 6 months, and met the inclusion criteria. There were 35,315 women and 11,333 men. Compared with women, men with OAB were more likely to undergo post-void residual measurement (32% vs 22%) and diagnostic cystoscopy (10% vs 7%). Women were more likely than men to undergo urodynamics (7% vs 3%). Overall, 34% of women and 19% of men diagnosed with OAB were prescribed medication. CONCLUSION: Few patients with OAB underwent invasive diagnostic testing. Anticholinergic medication was prescribed to a minority of patients diagnosed with OAB, indicating possible underuse of a potentially effective therapy. Men were less likely than women to receive medical therapy, despite the fact that OAB is common in both sexes.

Compliance with the North American Guidelines for Children's Agricultural Tasks (NAGCAT) work practice recommendations for youth working with large animals.

The North American Guidelines for Children's Agricultural Tasks (NAGCAT) were developed to reduce the risk of childhood agricultural injury. The purpose of this study was to evaluate compliance with NAGCAT-recommended work practices (WPs) when youth work with large animals. On a daily basis, over a period of 10 weeks, youth self-reported the number of minutes they worked with a large animal and whether they followed the associated NAGCAT WP guidelines. Statistical analyses were conducted to compare boys to girls and to consider the effect of factors such as youth age, farm residence status, and selected parental characteristics. A high proportion of youth exhibited relatively low compliance for most of the five WPs evaluated. Respirators were rarely worn, but checking for people and obstacles in the area while working with large animals was commonly reported. In general, boys, especially the older boys, exhibited higher compliance than did girls. The results of our study demonstrate, in general, that youth are not following recommended NAGCAT WPs when working with large animals, identifying an area in agricultural safety and health requiring focused attention.

Compliance with NAGCAT work practices recommendations for youth cleaning service alleys in stall barns.

Unintentional injury is the leading cause of death in the U.S. among persons 1 to 44 years of age. Over one million children and adolescents in the U.S. live, work, and/or play on farms, where injury risk is relatively high compared to other settings. In an attempt to reduce the number of childhood agricultural injuries occurring on farms, the North American Guidelines for Children's Agricultural Tasks (NAGCAT) was developed to assist parents or other caregivers in assigning developmentally appropriate chores to youth exposed to agricultural hazards. The results presented here are from a longitudinal study in which we obtained (self-reported) daily chore, injury, and safety behavior data from children and adolescents. We focused on one NAGCAT chore, cleaning a service alley in a stall barn, in order to estimate the extent of compliance with specific work practice recommendations contained in the NAGCAT. Our results indicated that among the four NAGCAT-recommended safety practices for cleaning service alleys in stall barns (wearing nonskid shoes, leather gloves, a respirator, and eye protection), wearing non-skid shoes was the only safety practice reported with any degree of regularity. Overall, boys were more likely to wear non-skid shoes compared to girls. In addition, older youth were generally more likely to report higher work practice compliance compared to younger youth.

Aphid fecundity and grassland invasion: invader life history is the key.

Loss or gain of pathogens can determine the trajectory of biological invasions, and invasion by novel hosts also can alter pathogen dynamics to facilitate invasion. Recent empirical and theoretical work has implicated infection by barley and cereal yellow dwarf viruses (B/CYDV), a group of generalist pathogens of the Poaceae family (grasses), as a necessary precursor to the invasion of over 9 million hectares of California's perennial grasslands by exotic annual grasses. The mechanism underlying this pathogen-mediated invasion hypothesis is elevated vector fecundity on exotic annual grasses. While empirical evidence supports this hypothesis, the links between aphid fecundity, host identity, and host resource supply have not been thoroughly assessed. We performed field and laboratory experiments to examine the fecundity and preference responses of three of the most common aphid vectors of B/CYDV, Rhopalosiphum padi (L.), R. maidis (Fitch), and Sitobion avenae (Fab.), to a combination of host life history (annual and perennial), host provenance (native and exotic), and nutrient supply (mineral N and P fertilization), controlling for host phylogenetic lineage. Aphids consistently had higher fecundity on annual grasses than perennials, regardless of host provenance, age, or nutrient fertilization. In addition, aphids preferentially colonized annual hosts when offered a choice among host species. Multi-generation studies have found that nutrient addition affects both host quality and composition in natural communities; our experimental results indicate that the indirect effects of nutrient fertilization in determining host community composition are of more importance than are the direct effects on host quality to aphid population dynamics. To summarize the applications of our results, we demonstrate that, in contrast to the current focus on the qualitative differences between invaders and natives, the impact of invasive exotic grasses is not due to host provenance, per se, but arises because the annual invaders differ qualitatively from the native species in interactions with shared pathogen vectors. More generally, our work demonstrates the importance of isolating whether the fate and impacts of an invader are, at their root, due to the provenance of the invader, or due to other characteristics that determine its functional uniqueness in the context of the native community.

Man alpha1-2 Man alpha-OMe-concanavalin A complex reveals a balance of forces involved in carbohydrate recognition.

We have determined the crystal structure of the methyl glycoside of Man alpha1-2 Man in complex with the carbohydrate binding legume lectin concanavalin A (Con A). Man alpha1-2 Man alpha-OMe binds more tightly to concanavalin A than do its alpha1-3 and alpha1-6 linked counterparts. There has been much speculation as to why this is so, including a suggestion of the presence of multiple binding sites for the alpha1-2 linked disaccharide. Crystals of the Man alpha1-2 Man alpha-OMe-Con A complex form in the space group P2(1)2(1)2(1) with cell dimensions a = 119.7 A, b = 119.7 A, c = 68.9 A and diffract to 2. 75A. The final model has good geometry and an R factor of 19.6% (Rfree= 22.8%). One tetramer is present in the asymmetric unit. In three of the four subunits, electron density for the disaccharide is visible. In the fourth only a monosaccharide is seen. In one subunit the reducing terminal sugar is recognized by the monosaccharide site; the nonreducing terminal sugar occupies a new site and the major solution conformation of the inter-sugar glycosidic linkage conformation is adopted. In contrast, in another subunit the non reducing terminal sugar sits in the so called monosaccharide binding site; the reducing terminal sugar adopts a different conformation about its inter-sugar glycosidic linkage in order for the methyl group to access a hydrophobic pocket. In the third subunit, electron density for both binding modes is observed. We demonstrate that an extended carbohydrate binding site is capable of binding the disaccharide in two distinct ways. These results provide an insight in to the balance of forces controlling protein carbohydrate interactions.

Effect of high-frequency vibration on experimental pain threshold in young women when applied to areas of different size.

The purpose of this study was to compare the effects of high-frequency vibration when applied to two areas of different size. Subjects were 30 right-handed Caucasian women, aged 19-38 years, with a negative history of upper extremity dysfunction. The experimental cutaneous pain threshold was determined by stimulating the skin over the pisiform bone on the palmar surface of the hand. Pain threshold measurements were taken before, during, and 2 and 5 min after vibration. Group A received vibration to an area 12.5 cm2 on the ulnar aspect of the palm of the hand 1 cm distal to the pisiform bone. Group B received vibration to an area 25 cm2, also on the ulnar aspect of the palm of the hand. Results of the mixed design analysis of variance performed on the mean pain thresholds indicate that there was no significant main effect for group (size of area vibrated), p greater than 0.05, or interaction effect between group by trial (size of area vibrated and time of pain threshold measurement), p greater than 0.05. There was a significant main effect for trial (time of pain threshold measurement), p less than 0.001. Pain threshold values were greatest for both groups during the period of vibration.

Selected primitive reflexes in children with cerebral palsy: consistency of response.

The purpose of this study was to determine the consistency of reflex responses of subjects in varying behavioral states. The following selected primitive reflexes were examined in children with spastic quadriplegic cerebral palsy: tonic labyrinthine, asymmetrical tonic neck, symmetrical tonic neck, crossed extension, and Moro. Our hypothesis was that a subject's reflex responses would vary as a function of his behavioral state. Ten children, ages 3 to 6 years, participated in the study. Reflex responses were elicited using a specified protocol. A behavioral-state scale was defined, and the subject's behavioral state was noted before each reflex stimulus was applied. Each subject completed eight test sessions. Test sessions were videotaped with portable video equipment. Results of the study indicated a significant inverse relationship between progression on the behavioral-state scale and consistency of reflex responses; the higher the numerical rating, the less the consistency of response. Findings of our study support those who recommend optimal states for testing and indicate that caution should be used when interpreting test results based on a single examination.