Reorganization of the Neurobiology of Language After Sentence Overlearning.

It is assumed that there are a static set of "language regions" in the brain. Yet, language comprehension engages regions well beyond these, and patients regularly produce familiar "formulaic" expressions when language regions are severely damaged. These suggest that the neurobiology of language is not fixed but varies with experiences, like the extent of word sequence learning. We hypothesized that perceiving overlearned sentences is supported by speech production and not putative language regions. Participants underwent 2 sessions of behavioral testing and functional magnetic resonance imaging (fMRI). During the intervening 15 days, they repeated 2 sentences 30 times each, twice a day. In both fMRI sessions, they "passively" listened to those sentences, novel sentences, and produced sentences. Behaviorally, evidence for overlearning included a 2.1-s decrease in reaction times to predict the final word in overlearned sentences. This corresponded to the recruitment of sensorimotor regions involved in sentence production, inactivation of temporal and inferior frontal regions involved in novel sentence listening, and a 45% change in global network organization. Thus, there was a profound whole-brain reorganization following sentence overlearning, out of "language" and into sensorimotor regions. The latter are generally preserved in aphasia and Alzheimer's disease, perhaps explaining residual abilities with formulaic expressions in both.

Improving Delirium Care in Hospitalized Older Adults: Impact of Education on Hospital Aides as Sitters.

As one of several hospital team members involved in the management of care for older adults with delirium, hospital aides (HAs) are often relied on to provide direct patient care in the role of a sitter. Yet, many HAs have not received training about delirium, its associated behaviors, or appropriate interventions. As a consequence, there are gaps in quality of care for older adults with delirium and potential missed opportunities for HA sitters to contribute to the interdisciplinary team (IDT) care of these patients. In the current study, a quality improvement project at an urban hospital provided an educational session on delirium to HAs. Accuracy of HA delirium knowledge, delirium behavior recognition, and delivery of care to patients with delirium significantly increased across three postintervention measures (p = <0.001 to 0.016). HAs also reported increased confidence in caring for patients with delirium and in their perceived role on the IDT. [Journal of Gerontological Nursing, 47(6), 20-26.].

Fall Ascertainment and Development of a Risk Prediction Model Using Electronic Medical Records.

OBJECTIVES: To examine the use of electronic medical record (EMR) data to ascertain falls and develop a fall risk prediction model in an older population. DESIGN: Retrospective longitudinal study using 10 years of EMR data (2004-2014). A series of 3-year cohorts included members continuously enrolled for a minimum of 3 years, requiring 2 years pre-fall (no previous record of a fall) and a 1-year fall risk period. SETTING: Kaiser Permanente Hawaii, an ambulatory setting. PARTICIPANTS: A total of 57 678 adults, age 60 years and older. MEASUREMENTS: Initial EMR searches were guided by current literature and geriatricians to understand coding sources of falls as our outcome. Falls were captured by two coding sources: International Classification of Diseases, Ninth Revision (ICD-9) codes (E880-889) and/or a fall listed as a "primary reason for visit." A comprehensive list of EMR predictors of falls were included into prediction models enabling statistical subset selection from many variables and modeling by logistic regression. RESULTS: Although 72% of falls in the training data set were coded as "primary reason for visit," 22% of falls were coded as ICD-9 and 6% coded as both. About 80% were reported in face-to-face encounters (eg, emergency department). A total of 2164 individuals had a fall in the risk period. Using the 13 key predictors (age, comorbidities, female sex, other mental disorder, walking issues, Parkinson's disease, urinary incontinence, depression, polypharmacy, psychotropic and anticonvulsant medications, osteoarthritis, osteoporosis) identified through LASSO regression, the final model had a sensitivity of 67%, specificity of 69%, positive predictive value of 8%, negative predictive value of 98%, and area under the curve of .74. CONCLUSION: This study demonstrated how the EMR can be used to ascertain falls and develop a fall risk prediction model with moderate sensitivity/specificity. Concurrent work with clinical providers to enhance fall documentation will improve the ability of the EMR to capture falls and consequently may improve the model to predict fall risk.

Suboptimal osteoporosis evaluation and treatment in older men with and without additional high-risk factors for fractures.

We compared osteoporosis case-finding, evaluation and treatment in groups of Older Men and Older Women with age alone as a significant risk for fracture and Older Men with Higher Risk (older men additionally having previous hip fracture, corticosteroid use or androgen deprivation therapy). We studied 13,704 older men and women (≥70 years old) receiving care at a Veterans Affairs medical center from January 2000 to August 2010 whose 10-year hip fracture risk was assessed by limited FRAX score. The main outcome measures were the proportion of patients who had bone mineral density (by dual-energy X-ray absorptiometry [DXA]) and serum 25-hydroxy vitamin D (25-OH D) measurements performed, and calcium/vitamin D or bisphosphonates prescribed. The proportion of men with a 10-year hip fracture risk ≥3% with age alone as a risk was 48% and 88% in men aged 75-79 and ≥80 years, respectively. Compared with Older Women, fewer Older Men underwent DXA (12% vs 63%, respectively) and 25-OH D measurements (18% vs 39%), and fewer received calcium/vitamin D (20% vs 63%) and bisphosphonate (5% vs 44%) prescriptions. In Older Men with Higher Risk category, the proportion of men with 10-year hip fracture risk ≥3% ranged from 69% to 95%. Despite a higher risk and expectation that this group would have greater case detection and screening, few Older Men with Higher risk underwent DXA screening (27%-36%) and 25-OH D measurements (23%-28%), and received fewer calcium/vitamin D (40%-50%) and bisphosphonate (13%-24%) prescriptions. Considering the known morbidity and mortality, our findings underscore the need for improved evaluation and management of osteoporosis in older men at high risk for fracture.

Rationale, Procedures, and Response Rates for the 2015 Administration of NCI's Health Information National Trends Survey: HINTS-FDA 2015.

The National Cancer Institute (NCI) developed the Health Information National Trends Survey (HINTS) to monitor population trends in cancer communication practices, information preferences, health risk behaviors, attitudes, and cancer knowledge. The U.S. Food and Drug Administration (FDA) recognized HINTS as a unique data resource for informing its health communication endeavors and partnered with NCI to field HINTS-FDA 2015. HINTS-FDA 2015 was a self-administered paper instrument sent by mail May 29 to September 8, 2015, using a random probability-based sample of U.S. postal addresses stratified by county-level smoking rates, with an oversampling of high and medium-high smoking strata to increase the yield of current smokers responding to the survey. The response rate for HINTS-FDA 2015 was 33% (N = 3,738). The yield of current smokers (n = 495) was lower than expected, but the sampling strategy achieved the goal of obtaining more former smokers (n = 1,132). Public-use HINTS-FDA 2015 data and supporting documentation have been available for download and secondary data analyses since June 2016 at http://hints.cancer.gov . NCI and FDA encourage the use of HINTS-FDA for health communication research and practice related to tobacco-related communications, public knowledge, and behaviors as well as beliefs and actions related to medical products and dietary supplements.

Total and differential white blood cell counts predict eight-year incident coronary heart disease in elderly Japanese-American men: the Honolulu Heart Program.

BACKGROUND: Previous studies have reported an association between total and differential white blood cell (WBC) counts and incident coronary heart disease (CHD), but data from elderly populations are scarce. The purpose of this study was to examine the association between total and differential WBC counts and incident CHD in an elderly Japanese-American population. METHODS: Total and differential WBC counts were examined at a baseline examination from 1991 to 1993 in the Honolulu Heart Program. Subjects were Japanese-American men aged 71-93 years free of CHD at baseline (N = 2879), who were divided into quartiles of total and differential WBC counts for analysis, and were followed for incident CHD for 8 years. RESULTS: During the follow up period, 279 men developed CHD. Hazard ratio for incident CHD for each quartile of total and differential WBC counts were obtained by Cox regression using the lowest quartile as the reference group. After full adjustment including age, cardiovascular risk factors, chronic diseases and medication use, the hazard ratios in the highest quartiles of total WBC, granulocyte and neutrophil counts were 1.75 (95% confidence interval [CI], 1.18-2.62; P = 0.006), 1.66 (95%CI, 1.11-2.48; P = 0.01), and 1.57 (95%CI, 1.06-2.34; P = 0.03), respectively. No significant associations were found between lymphocyte or monocyte counts and incident CHD. CONCLUSIONS: Higher total WBC, granulocyte and neutrophil counts were associated with higher risk of incident CHD in a population of elderly Japanese-American men. Further studies are needed to establish cut-points and treatment options with anti-inflammatory medications.

Single-larger-portion-size and dual-column nutrition labeling may help consumers make more healthful food choices.

BACKGROUND: The Food and Drug Administration is considering changes to the Nutrition Facts label to help consumers make more healthful choices. OBJECTIVE: To examine the effects of modifications to the Nutrition Facts label on foods that can be listed as having 1 or 2 servings per container, but are reasonably consumed at a single eating occasion. DESIGN: Participants were randomly assigned to study conditions that varied on label format, product, and nutrition profile. Data were collected via an online consumer panel. PARTICIPANTS/SETTING: Adults aged 18 years and older were recruited from Synovate's online household panel. Data were collected during August 2011. A total of 32,897 invitations were sent for a final sample of 9,493 interviews. INTERVENTION: Participants were randomly assigned to one of 10 label formats classified into three groups: listing 2 servings per container with a single column, listing 2 servings per container with a dual column, and listing a single serving per container. Within these groups there were versions that enlarged the font size for "calories," removed "calories from fat," and changed the wording for serving size declaration. MAIN OUTCOME MEASURES: The single product task measured product healthfulness, the amount of calories and various nutrients per serving and per container, and label perceptions. The product comparison task measured ability to identify the healthier product and the product with fewer calories per container and per serving. STATISTICAL ANALYSES PERFORMED: Analysis of covariance models with Tukey-Kramer tests were used. Covariates included general label use, age, sex, level of education, and race/ethnicity. RESULTS: Single-serving and dual-column formats performed better and scored higher on most outcome measures. CONCLUSIONS: For products that contain 2 servings but are customarily consumed at a single eating occasion, using a single-serving or dual-column labeling approach may help consumers make healthier food choices.

Cultural beliefs, partner characteristics, communication, and sexual risk among Latino MSM.

This study examined factors associated with communication about condom use and unprotected anal intercourse (UAI) in a U.S. sample of immigrant Latino MSM (N = 356), with a focus on culturally based beliefs. Logistic regression analysis revealed that communication about condom use at participants' most recent encounter was associated with a lower likelihood of UAI during that encounter. UAI was more likely when the partner was a main partner and there was seroconcordance. A separate logistic regression indicated that communication about condom use was less likely when the most recent encounter involved a main partner, greater sexual desire, and intoxication due to substance use. Although cultural beliefs were not predictive of communication about condom use or UAI at the most recent encounter, they were related to the occurrence of UAI in the previous three months. There is a need for more research on the interplay of culture, safer sex communication, and sexual risk.

Effectiveness of kukui nut oil as a topical treatment for psoriasis.

BACKGROUND: No cure for psoriasis exists for the 1-3% of the American population who suffer from it; however, anecdotal reports from patients with psoriasis visiting Hawaii who purchased kukui nut oil, claim it helped reduce the severity of their lesions. OBJECTIVE: This pilot study was a double-blind, placebo-controlled clinical trial to determine the effectiveness of kukui nut oil as a topical treatment for psoriasis. METHODS: Thirty adult subjects (18-78 year) were recruited from the community for a 12-week randomized, double-blind, placebo-controlled pilot study. Subjects were previously diagnosed with mild, stable plaque psoriasis (less than 15% of total body surface area [TBSA]) and agreed to abstain from other treatments during the course of the study. Following a 4-week washout period the subjects were randomized into a treatment group (15 subjects applying kukui nut oil) or a control group (15 applying the mineral oil placebo). Patients were seen every 2 weeks (seven visits at 0, 2, 4, 6, 8, 10, and 12 weeks) by a dermatological nurse practitioner under the general supervision of a board certified dermatologist. Measurable outcomes included evaluation of one targeted lesion and of the overall severity of their psoriasis using clinical evaluation, Psoriasis Area and Sensitivity Index (PASI), Global Severity of Psoriasis Scale, and photographs. Each patient also evaluated their own lesions daily using the Global Severity of Psoriasis Scale, and noted any side-effects or other treatments used. RESULTS: Although both groups improved, we found no significant difference between the treatment (kukui nut oil) and the placebo (mineral oil) among the 24 out of 30 subjects (80%) who completed the study. No side-effects or adverse events were reported. CONCLUSION: Kukui nut oil did not significantly reduce symptoms of psoriasis; however, this was a small pilot study, and the use of this oil cannot be dismissed without using a larger study population of patients with psoriasis.