Association between changes in habitual stepping activity and cognition in older adults.

Advancing age is associated with declines in cognitive function. Although physical activity is thought to protect against this decline, it is unclear how a short-term uptake in daily steps or a decline in day-to-day step variability may contribute to cognition among older adults. We tested associations between changes in step counts, day-to-day step variability and executive cognitive functions among older adults taking part in a physical activity intervention. Thirty-seven older adults (33 females; 71.4 ± 6.3 years) completed a 10-week personalized physical activity intervention. Participants wore a Fitbit to measure daily step counts throughout the study. They also completed a computerized Stroop task before and after the intervention. Average step counts and step count variability via average-real-variability (ARV) were determined. Compared to pre-intervention, step counts increased (p < 0.001) and step variability decreased post-intervention (p = 0.04). Models describing the changes in step counts and ARV over the 10-weeks were cubic (both, p < 0.04). Reaction times during the simple (p = 0.002) and switching (p = 0.04) conditions were faster post-intervention. Change in step variability was positively associated with the change in reaction time for the switching condition (ß = 0.029, p = 0.002). On average, a reduction in day-to-day step variability was associated with improvements in cognitive flexibility.

The INSÉPArable portfolio tool to sustain continued education and the professional development of nurses for a full scope of nursing practice and enhanced patient safety competencies: An ethnographic study.

BACKGROUND: Despite widespread recognition of the undeniable impact of nurses on patient safety, important barriers relating to the organization of health systems still hinder the full expansion of the role of these professionals. In Quebec (Canada), nurses work overtime and increased adverse events are preoccupying and point to a possible lack of contemporary tools for continuous professional development. Innovative training tools should foster a more reflective practice focused on a holistic view of the patient in order to support the full scope of nursing practice and ensure continuous improvement in the quality of care. Such tools would make it possible to better understand their practice, according to their own perception, as well as its applicability in the emergence of a professional conscience which is essential to lasting safety competencies. This study's overarching goal was to propose a model and a portfolio prototype to support nurses' training. METHOD: Based on a humanistic and reflective perspective on patient care and safety competencies, a design approach was used to develop a portfolio prototype. Ethnography was used to collect and analyse data using shadowing observations of 10 nurse/patient dyads, followed by interviews about their care experience. The research was conducted in acute and long-term care settings of the Quebec City area. The iteration process resulted in a first version of the prototype that was then presented to various stakeholders during a co-design workshop aimed at better understanding the clinical applicability of this prototype. FINDINGS: The INSÉPArable project is illustrated in two interrelated figures, which reflects a complete inductive representation supporting sustainable patient safety from nursing practice experience. First, nursing practice status has been depicted as an iceberg metaphor where the essence of care, the « art of nursing ¼ is hidden. Second, a sphere illustrates the direction to the full emergence of nursing practice that helps to enhance the hidden "art of nursing" by leading nurses towards optimal conditions conscience. DISCUSSION: INSÉPArable turned out to be more than an individual reflective tool as it also highlights the need for collective awareness among nurse managers regarding their responsibility in implementing and sustaining healthy work environments, in which optimal conditions are better supported. This also implies a renewed mode of governance and the implementation of more humanistic processes that redefine the contemporary professionalism of nurses, which are closely linked to patient safety.

Pectoral I Block Does Not Improve Postoperative Analgesia After Breast Cancer Surgery: A Randomized, Double-Blind, Dual-Centered Controlled Trial.

BACKGROUND AND OBJECTIVES: General anesthesia for breast surgery may be supplemented by using a regional anesthetic technique. We evaluated the efficacy of the first pectoral nerve block (Pecs I) in treating postoperative pain after breast cancer surgery. METHODS: A randomized, double-blind, dual-centered, placebo-controlled trial was performed. One hundred twenty-eight patients scheduled for unilateral breast cancer surgery were recruited. A multimodal analgesic regimen and surgeon-administered local anesthetic infiltration were used for all patients. Ultrasound-guided Pecs I was performed using bupivacaine or saline. The primary outcome was the patient pain score (numerical rating scale [NRS]) in the recovery unit 30 minutes after admission or just before the morphine administration (NRS ≥4/10). The secondary outcomes were postoperative opioid consumption (ie, in the recovery unit and after 24 hours). RESULTS: During recovery, no significant difference in NRS was observed between the bupivacaine (n = 62, 3.0 [1.0-4.0]) and placebo (n = 65, 3.0 [1.0-5.0]) groups (P = 0.55). However, the NRS was statistically significantly different, although not clinically significant, for patients undergoing major surgeries (mastectomies or tumorectomies with axillary clearance) (n = 29, 3.0 [0.0-4.0] vs 4.0 [2.0-5.0], P = 0.04). Morphine consumption during recovery did not differ (1.5 mg [0.0-6.0 mg] vs 3.0 mg [0.0-6.0 mg], P = 0.20), except in the major surgery subgroup (1.5 mg [0.0-6.0 mg] vs 6.0 mg [0.0-12.0 mg], P = 0.016). Intraoperative sufentanil and cumulative morphine consumption up to 24 hours did not differ between the 2 groups. Three patients experienced complications related to the Pecs I. CONCLUSIONS: Pecs I is not better than a saline placebo in the presence of multimodal analgesia for breast cancer surgery. However, its role in extended (major) breast surgery may warrant further investigation. CLINICAL TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov, identifier NCT01670448.

Temporal Processing of Joyful and Disgusting Food Pictures by Women With an Eating Disorder.

The present study used the presentation of food pictures and judgements about their duration to assess the emotions elicited by food in women suffering from an eating disorder (ED). Twenty-three women diagnosed with an ED, namely anorexia (AN) or bulimia nervosa (BN), and 23 healthy controls (HC) completed a temporal bisection task and a duration discrimination task. Intervals were marked with emotionally pre-rated pictures of joyful and disgusting food, and pictures of neutral objects. The results showed that, in the bisection task, AN women overestimated the duration of food pictures in comparison to neutral ones. Also, compared to participants with BN, they perceived the duration of joyful food pictures as longer, and tended to overestimate the duration of the disgusting ones. These effects on perceived duration suggest that AN women experienced an intense reaction of fear when they were confronted to food pictures. More precisely, by having elevated the arousal level and activated the defensive system, food pictures seemed to have speeded up the rhythm of the AN participants' internal clock, which led to an overestimation of images' duration. In addition, the results revealed that, in both tasks, ED women presented a lower temporal sensitivity than HC, which was related to their ED symptomatology (i.e., BMI, restraint and concern) and, particularly, to their weaker cognitive abilities in terms of attention, processing speed and working memory. Considered all together, the findings of the present experiment highlight the role of fear and anxiety in the manifestations of AN and point out the importance of considering non-temporal factors in the interpretation of time perception performance.

An electroencephalographic investigation of the filled-duration illusion.

The study investigated how the brain activity changed when participants were engaged in a temporal production task known as the "filled-duration illusion." Twelve right-handed participants were asked to memorize and reproduce the duration of time intervals (600 or 800 ms) bounded by two flashes. Random trials contained auditory stimuli in the form of three 20 ms sounds between the flashes. In one session, the participants were asked to ignore the presence of the sounds, and in the other, they were instructed to pay attention to sounds. The behavioral results showed that duration reproduction was clearly affected by the presence of the sounds and the duration of time intervals. The filled-duration illusion occurred when there were sounds; the participants overestimated the interval in the 600-ms interval condition with sounds. On the other hand, the participants underestimated the 800-ms interval condition without sounds. During the presentation of the interval to be encoded, the contingent negative variation (CNV) appeared around the prefrontal scalp site, and P300 appeared around the parieto-central scalp site. The CNV grew larger when the intervals contained the sounds, whereas the P300 grew larger when the intervals were 800 ms and did not contain the sounds. During the reproduction of the interval to be presented, the Bereitschaftspotential (BP) appeared over the fronto-central scalp site from 1000 ms before the participants' response. The BP could refer to the decision making process associated with the duration reproduction. The occurrence of three event-related potentials (ERPs), the P300, CNV, and BP, suggests that the fronto-parietal area, together with supplementary motor area (SMA), is associated with timing and time perception, and magnitude of these potentials is modulted by the "filled-duration illusion".

Sensitivity to time interval changes in speech and tone conditions.

The main goal of the present experiment was to verify whether sensitivity to time interval changes in speech is greater than sensitivity to time interval changes between tones. The 12-syllable sentences were delivered in French (the main language of the participants) or in a foreign language (Slovenian) that was totally unfamiliar to the participants. Two types of sub-sequences were induced within the series of stimuli (sub-sequences in sentences or in tone sequences). Discrimination, as revealed by the Weber fraction in each condition, was much better in the tone conditions than in the speech conditions. Nevertheless, discrimination was excellent in all conditions: Weber fractions below 2% with tones and around 4.5% in the speech conditions. Moreover, the study revealed that familiarity with a particular language does not affect performance and that inducing internal sub-sequences within tone conditions, as opposed to using a series of equal intervals, does not lead to better discrimination. The fact that discrimination is better with tones than with sentences indicates that the extensive training provided by speech does not lead to higher sensitivity to time interval variations than simple tones do. Instead, it seems to indicate that the different acoustical variations in speech reduce the capability to discriminate time interval variations.

NCX-1000, a nitric oxide-releasing derivative of UDCA, does not decrease portal pressure in patients with cirrhosis: results of a randomized, double-blind, dose-escalating study.

OBJECTIVES: NCX-1000 (2(acetyloxy) benzoic acid-3(nitrooxymethyl)phenyl ester) is an nitric oxide (NO)-releasing derivative of ursodeoxycholic acid (UDCA), which showed selective vasodilatory effect on intrahepatic circulation in animal models of cirrhosis. This study was aimed at testing the efficacy and tolerability of this compound in patients with cirrhosis and portal hypertension. METHODS: This was a single-center, phase-2a, randomized (4:1), double-blind, parallel-group, dose-escalating study. Patients received progressive oral doses of NCX-1000 or placebo up to 2 g t.i.d. or maximum tolerated doses for 16 days. Efficacy on fasting and postprandial hepatic venous pressure gradient (HVPG) at baseline and after treatment was assessed. Hepatic blood flow (HBF) and arterial blood pressure were also measured. RESULTS: Eleven patients (nine NCX-1000 and two placebo) were enrolled and completed the trial. After NCX-1000 treatment, HVPG did not change (16.7+/-3.8 vs. 17.1+/-3.8 mm Hg; P=0.596), and HBF decreased significantly (904+/-310 vs. 1,129+/-506 ml/min; P=0.043). The postprandial increase in portal pressure and HBF was not modified by NCX-1000. There was no significant effect on diastolic blood pressure, but systolic blood pressure was reduced by the treatment in a dose-dependent manner (121+/-11 mm Hg after NCX-1000 vs. 136+/-7 mm Hg at baseline; P=0.003). Seven non-serious adverse events were experienced by four patients (one on placebo). CONCLUSIONS: In patients with cirrhosis and portal hypertension, NCX-1000 administration was safe, but it was not able to reduce portal pressure. A significant reduction of systolic blood pressure and HBF was observed in the treatment arm, suggesting that the drug had systemic effects and lacked selective release of NO at the intrahepatic circulation.

When a leak is unavoidable, preoxygenation is equally ineffective with vital capacity or tidal volume breathing.

PURPOSE: Ideally, preoxygenation is performed using a tight fitting mask either by breathing normally for three to five minutes or with four to eight vital capacity (VC) breaths in 0.5 to one minute, but in practice leaks are frequent and sometimes unavoidable. This study was designed to determine which breathing method provided the best oxygenation in the presence of leak. METHODS: Twenty volunteers were instructed to breathe from a circle circuit supplied with 6 L x min(-1) of fresh oxygen. Each subject was tested under four situations selected in random order: 1) normal breathing for three minutes without leak; 2) normal breathing for three minutes with a leak; 3) four VCs in 30 sec without a leak; and 4) four VCs in 30 sec with a leak. The leak was created by a piece of size 18 French nasogastric tube, 5 cm long, taped under the face mask. Inspired and expired O(2) and CO(2) were sampled at the nostrils. RESULTS: In the absence of a leak, the end-tidal oxygen fraction (F(EO(2)) was greater after three minutes of tidal breathing (89 +/- 3%; mean +/- SD) in comparison with the response to four VCs (76 +/- 7%; P < 0.001). Introduction of a leak decreased the F(EO(2)) significantly (P < 0.001). With a leak, the F(EO(2)) was similar with normal breathing (61 +/- 8%) and after four VCs (59 +/- 11%). CONCLUSION: Preoxygenation with tidal volume breathing for three minutes yields higher F(EO(2)) in comparison to four VCs. If a small leak (4 mm internal diameter) is introduced, the F(EO(2)) decreases significantly with both breathing methods to approximately 60%.

Acute sodium deficit triggers plasticity of the brain angiotensin type 1 receptors.

The brain renin-angiotensin system (bRAS) is involved in the control of hydromineral balance. However, little information is available on the functional regulation of the bRAS as a consequence of sodium deficit in the extracellular fluid compartments. We used a pharmacological model of acute Na+ depletion (furosemide injections) to investigate changes of a major component of the bRAS, the hypothalamic angiotensin type 1A (AT(1A)) receptors. Furosemide induced a rapid and long-lasting expression of the AT(1A) mRNA in the subfornical organ, the median preoptic nucleus (MnPO), and the parvocellular division of the paraventricular nucleus (pPVN). Na+ depletion increased the number of cells expressing AT(1A) mRNA in the pPVN, but not in the MnPO. The enhancement of AT(1A) mRNA expression was associated with an increase in AT(1) binding sites in all the regions studied. It is of interest that in the paraventricular nucleus, the majority of the neurons expressing AT(1A) mRNA also showed an increase in metabolic activity (Fos-related antigen immunoreactivity [FRA-ir]). By contrast, in the MnPO, we observe two distinct cell populations. Our data demonstrated that an acute Na+ deficit induced a functional regulation of the hypothalamic AT(1A) receptors, indicating that these receptors are subject to plasticity in response to hydromineral perturbations.