Functional connectivity changes associated with fMRI neurofeedback of right inferior frontal cortex in adolescents with ADHD.

Attention Deficit Hyperactivity Disorder (ADHD) is associated with poor self-control, underpinned by inferior fronto-striatal deficits. We showed previously that 18 ADHD adolescents over 11 runs of 8.5 min of real-time functional magnetic resonance neurofeedback of the right inferior frontal cortex (rIFC) progressively increased activation in 2 regions of the rIFC which was associated with clinical symptom improvement. In this study, we used functional connectivity analyses to investigate whether fMRI-Neurofeedback of rIFC resulted in dynamic functional connectivity changes in underlying neural networks. Whole-brain seed-based functional connectivity analyses were conducted using the two clusters showing progressively increased activation in rIFC as seed regions to test for changes in functional connectivity before and after 11 fMRI-Neurofeedback runs. Furthermore, we tested whether the resulting functional connectivity changes were associated with clinical symptom improvements and whether they were specific to fMRI-Neurofeedback of rIFC when compared to a control group who had to self-regulate another region. rIFC showed increased positive functional connectivity after relative to before fMRI-Neurofeedback with dorsal caudate and anterior cingulate and increased negative functional connectivity with regions of the default mode network (DMN) such as posterior cingulate and precuneus. Furthermore, the functional connectivity changes were correlated with clinical improvements and the functional connectivity and correlation findings were specific to the rIFC-Neurofeedback group. The findings show for the first time that fMRI-Neurofeedback of a typically dysfunctional frontal region in ADHD adolescents leads to strengthening within fronto-cingulo-striatal networks and to weakening of functional connectivity with posterior DMN regions and that this may be underlying clinical improvement.

Distance learning: health education for ninth-grade students.

A telehealth programme for schools was established by staff at the East Carolina University schools of nursing, health education, social work, nutrition, education and medicine, in conjunction with the Eastern Area Health Education Center. A health education curriculum was developed for rural high schools using the North Carolina Information Highway for delivery. A Web page provided additional resources for teachers, teenagers and health professionals. Four telehealth sessions were conducted over three years: two with the pilot school and two with a second school on-line simultaneously. A total of 76 ninth-grade students completed the courses. Evaluation indicated successful outcomes in student learning. Respondents to a follow-up survey of members of the first telehealth class had positive comments about the experience. Utilization of the Web page increased steadily from 1997.

A required, combined ACLS/ATLS provider course for senior medical students at East Carolina University.

A course that combines advanced cardiac life support (ACLS) training with advanced trauma life support (ATLS) training for senior medical students was evaluated for its ability to integrate concepts of students' prior clinical experience and to stimulate achievement of provider certification. Since initiation of this program in 1982, students have uniformly praised the combined ACLS/ATLS provider course in anonymous, post-course evaluations. The experience was judged to integrate significantly concepts and principles acquired in students' previous 18 months of clinical training. The opportunity to apply these concepts in unique and challenging clinical simulations was noted by students. Evaluation of pretest and post-test data for the class of 1984 (n = 39) using a t test for matched pairs indicates a significant improvement in post-test examination performance (P less than .001). These data are supported by skills stations testing and achievement of provider certification. Ninety-five percent of student participants achieved provider certification in ACLS; 92% achieved provider certification in ATLS.