Neuroprosthetic baroreflex controls haemodynamics after spinal cord injury.

Spinal cord injury (SCI) induces haemodynamic instability that threatens survival1-3, impairs neurological recovery4,5, increases the risk of cardiovascular disease6,7, and reduces quality of life8,9. Haemodynamic instability in this context is due to the interruption of supraspinal efferent commands to sympathetic circuits located in the spinal cord10, which prevents the natural baroreflex from controlling these circuits to adjust peripheral vascular resistance. Epidural electrical stimulation (EES) of the spinal cord has been shown to compensate for interrupted supraspinal commands to motor circuits below the injury11, and restored walking after paralysis12. Here, we leveraged these concepts to develop EES protocols that restored haemodynamic stability after SCI. We established a preclinical model that enabled us to dissect the topology and dynamics of the sympathetic circuits, and to understand how EES can engage these circuits. We incorporated these spatial and temporal features into stimulation protocols to conceive a clinical-grade biomimetic haemodynamic regulator that operates in a closed loop. This 'neuroprosthetic baroreflex' controlled haemodynamics for extended periods of time in rodents, non-human primates and humans, after both acute and chronic SCI. We will now conduct clinical trials to turn the neuroprosthetic baroreflex into a commonly available therapy for people with SCI.

Contextual constraint and lexical competition: Revisiting biased misperception during reading.

In identifying and accessing lexical items while comprehending text, readers must rapidly select a word from visually similar words before integrating it into a sentence. It has been proposed that readers are likely to misperceive a low frequency word as a highly frequent orthographically similar alternative, particularly when the alternative is supported by previous context (Gregg & Inhoff, 2016; Perea & Pollatsek, 1998; Pollatsek, Perea, & Binder, 1999; Slattery, 2009). In such cases, the misperception may not be corrected until the reader encounters incongruent information. However, many of these studies place incongruent text directly after the critical word, confounding whether readers regress backward in text to resolve their misperception or to halt forward text progression in order resolve a lexical level conflict between the word form and its competitor. In 3 eye tracking while reading experiments, we adapted materials from previous studies to include a postcritical spillover region to address this possibility. Two of these experiments were designed to permit an ex-Gaussian analysis of the distribution of first pass reading prior to disambiguating information. The evidence suggests that postlexical competition-inhibition between orthographically similar forms can delay forward movement of the eyes as a competitor is inhibited. The possibility that misperception and postlexical competition-inhibition arise from the same set of mechanisms is discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Validity and reliability of an in-training evaluation report to measure the CanMEDS roles in emergency medicine residents.

BACKGROUND: There is a question of whether a single assessment tool can assess the key competencies of residents as mandated by the Royal College of Physicians and Surgeons of Canada CanMEDS roles framework. OBJECTIVE: The objective of the present study was to investigate the reliability and validity of an emergency medicine (EM) in-training evaluation report (ITER). METHOD: ITER data from 2009 to 2011 were combined for residents across the 5 years of the EM residency training program. An exploratory factor analysis with varimax rotation was used to explore the construct validity of the ITER. A total of 172 ITERs were completed on residents across their first to fifth year of training. RESULTS: A combined, 24-item ITER yielded a five-factor solution measuring the CanMEDs role Medical Expert/Scholar, Communicator/Collaborator, Professional, Health Advocate and Manager subscales. The factor solution accounted for 79% of the variance, and reliability coefficients (Cronbach alpha) ranged from α  =  0.90 to 0.95 for each subscale and α  =  0.97 overall. The combined, 24-item ITER used to assess residents' competencies in the EM residency program showed strong reliability and evidence of construct validity for assessment of the CanMEDS roles. CONCLUSION: Further research is needed to develop and test ITER items that will differentiate each CanMEDS role exclusively.

Simulation-based training in critical resuscitation procedures improves residents' competence.

OBJECTIVE: Residents must become proficient in a variety of procedures. The practice of learning procedural skills on patients has come under ethical scrutiny, giving rise to the concept of simulation-based medical education. Resident training in a simulated environment allows skill acquisition without compromising patient safety. We assessed the impact of a simulation-based procedural skills training course on residents' competence in the performance of critical resuscitation procedures. METHODS: We solicited self-assessments of the knowledge and clinical skills required to perform resuscitation procedures from a cross-sectional multidisciplinary sample of 28 resident study participants. Participants were then exposed to an intensive 8-hour simulation-based training program, and asked to repeat the self-assessment questionnaires on completion of the course, and again 3 months later. We assessed the validity of the self-assessment questionnaire by evaluating participants' skills acquisition through an Objective Structured Clinical Examination station. RESULTS: We found statistically significant improvements in participants' ratings of both knowledge and clinical skills during the 3 self-assessment periods ( p < 0.001). The participants' year of postgraduate training influenced their self assessment of knowledge ( F = 4.91, p< 0.01) and clinical 2,25 skills ( F = 10.89, p< 0.001). At the 3-month follow-up, junior 2,25 level residents showed consistent improvement from their baseline scores, but had regressed from their posttraining measures. Senior-level residents continued to show further increases in their assessments of both clinical skills and knowledge beyond the simulation-based training course. CONCLUSION: Significant improvement in self-assessed theoretical knowledge and procedural skill competence for residents can be achieved through participation in a simulation-based resuscitation course. Gains in perceived competence appear to be stable over time, with senior learners gaining further confidence at the 3-month follow-up. Our findings support the benefits of simulation-based training for residents.