A Retrospective Review of Clinical Admissions to Afghan National Security Forces Health Care Institutions.

BACKGROUND: Few published reports have examined the numbers of civilian injuries treated at Military Treatment Facilities in the Afghan Theater of Operations. However, review of Department of Defense Trauma Registry revealed a persistent percentage of civilians treated by NATO, and this study compares the proportion of civilians served by Afghan and Coalition military hospitals between 2009 and 2013. METHODS: A retrospective review of records from Department of Defense trauma Registry for Coalition data, and Afghan data from the Office of the Inspector General. We assessed changes in the proportion of civilians served between 2009 and 2013 at Afghan and Coalition hospitals. RESULTS: There was a significant percentage (≥21.55%) of civilians served at both Afghan and Coalition hospitals. Although the total population of Afghan Nationals treated remained steady, the number of total civilians decreased over this time period. To account for this, the percentage of military personnel increased at Afghan military hospitals. In Coalition hospitals, the civilian population increased between 2009 and 2011 and then decreased between 2011 and 2013. CONCLUSIONS: For all hospitals, whether Afghan or Coalition hospitals, there was a persistent level of civilian admissions. A downward trend for civilian patients in the Coalition hospitals and a similar increase in Afghan hospitals was expected. However, the numbers for Afghan hospitals instead showed a downward trend, potentially from the loss of logistical assistance provided by Coalition forces in transferring patients to Afghan hospitals. As evidenced by our data, future missions should plan to provide care for this civilian population, by allocating funding and appropriately training personnel. Additionally, logistical concerns of transferring to host-nation facilities and training host-nation providers will require foresight, planning, and diplomatic overtures, not always included in tactical decision-making.

A Retrospective Case Series of Surgical Implant Generation Network (SIGN) Placement at the Afghan National Police Hospital, Kabul, Afghanistan.

In Afghanistan, adequate and cost-effective medical care for even routine conditions is lacking; especially for complex injuries like long-bone fractures. The Surgical Implant Generation Network (SIGN) intramedullary nail is used for treatment of long-bone fractures from blunt injuries and does not require imaging. We are reporting for the first time results of the SIGN intramedullary nail at the Afghan National Police Hospital, a tertiary care facility in Kabul. 71 records from the SIGN Online Surgical Database were reviewed for gender, age, date of injury, implant date, patient's home of record, and type/ mechanism of injury. Mean age was 26.7 years, all but one being male; time from injury to implant ranged 1 to 401 days, with mean of 40.6 days. Long-bone fractures from motor vehicle accidents remained constant, and war injuries peaked in summer. Follow-up is limited because of security and financial burdens of travel. However, personal communication with Afghan National Police Hospital surgeons suggests that patients included in the current study have not experienced any adverse outcomes. While it remains to be seen if the SIGN Online Surgical Database will facilitate more comprehensive outcome studies, our results provide support for the efficacy of SIGN nails in treating long-bone fractures from war injuries.

Adult plasticity of spatiotemporal receptive fields of multisensory superior colliculus neurons following early visual deprivation.

PURPOSE: Previous work has established that the integrative capacity of multisensory neurons in the superior colliculus (SC) matures over a protracted period of postnatal life (Wallace and Stein, 1997), and that the development of normal patterns of multisensory integration depends critically on early sensory experience (Wallace et al., 2004). Although these studies demonstrated the importance of early sensory experience in the creation of mature multisensory circuits, it remains unknown whether the reestablishment of sensory experience in adulthood can reverse these effects and restore integrative capacity. METHODS: The current study tested this hypothesis in cats that were reared in absolute darkness until adulthood and then returned to a normal housing environment for an equivalent period of time. Single unit extracellular recordings targeted multisensory neurons in the deep layers of the SC, and analyses were focused on both conventional measures of multisensory integration and on more recently developed methods designed to characterize spatiotemporal receptive fields (STRF). RESULTS: Analysis of the STRF structure and integrative capacity of multisensory SC neurons revealed significant modifications in the temporal response dynamics of multisensory responses (e.g., discharge durations, peak firing rates, and mean firing rates), as well as significant changes in rates of spontaneous activation and degrees of multisensory integration. CONCLUSIONS: These results emphasize the importance of early sensory experience in the establishment of normal multisensory processing architecture and highlight the limited plastic potential of adult multisensory circuits.

Spatial receptive field organization of multisensory neurons and its impact on multisensory interactions.

Previous work has established that the spatial receptive fields (SRFs) of multisensory neurons in the cerebral cortex are strikingly heterogeneous, and that SRF architecture plays an important deterministic role in sensory responsiveness and multisensory integrative capacities. The initial part of this contribution serves to review these findings detailing the key features of SRF organization in cortical multisensory populations by highlighting work from the cat anterior ectosylvian sulcus (AES). In addition, we have recently conducted parallel studies designed to examine SRF architecture in the classic model for multisensory studies, the cat superior colliculus (SC), and we present some of the preliminary observations from the SC here. An examination of individual SC neurons revealed marked similarities between their unisensory (i.e., visual and auditory) SRFs, as well as between these unisensory SRFs and the multisensory SRF. Despite these similarities within individual neurons, different SC neurons had SRFs that ranged from a single area of greatest activation (hot spot) to multiple and spatially discrete hot spots. Similar to cortical multisensory neurons, the interactive profile of SC neurons was correlated strongly to SRF architecture, closely following the principle of inverse effectiveness. Thus, large and often superadditive multisensory response enhancements were typically seen at SRF locations where visual and auditory stimuli were weakly effective. Conversely, subadditive interactions were seen at SRF locations where stimuli were highly effective. Despite the unique functions characteristic of cortical and subcortical multisensory circuits, our results suggest a strong mechanistic interrelationship between SRF microarchitecture and integrative capacity.

Spatiotemporal architecture of cortical receptive fields and its impact on multisensory interactions.

Recent electrophysiology studies have suggested that neuronal responses to multisensory stimuli may possess a unique temporal signature. To evaluate this temporal dynamism, unisensory and multisensory spatiotemporal receptive fields (STRFs) of neurons in the cortex of the cat anterior ectosylvian sulcus were constructed. Analyses revealed that the multisensory STRFs of these neurons differed significantly from the component unisensory STRFs and their linear summation. Most notably, multisensory responses were found to have higher peak firing rates, shorter response latencies, and longer discharge durations. More importantly, multisensory STRFs were characterized by two distinct temporal phases of enhanced integration that reflected the shorter response latencies and longer discharge durations. These findings further our understanding of the temporal architecture of cortical multisensory processing, and thus provide important insights into the possible functional role(s) played by multisensory cortex in spatially directed perceptual processes.

Spatial heterogeneity of cortical receptive fields and its impact on multisensory interactions.

Investigations of multisensory processing at the level of the single neuron have illustrated the importance of the spatial and temporal relationship of the paired stimuli and their relative effectiveness in determining the product of the resultant interaction. Although these principles provide a good first-order description of the interactive process, they were derived by treating space, time, and effectiveness as independent factors. In the anterior ectosylvian sulcus (AES) of the cat, previous work hinted that the spatial receptive field (SRF) architecture of multisensory neurons might play an important role in multisensory processing due to differences in the vigor of responses to identical stimuli placed at different locations within the SRF. In this study the impact of SRF architecture on cortical multisensory processing was investigated using semichronic single-unit electrophysiological experiments targeting a multisensory domain of the cat AES. The visual and auditory SRFs of AES multisensory neurons exhibited striking response heterogeneity, with SRF architecture appearing to play a major role in the multisensory interactions. The deterministic role of SRF architecture was tightly coupled to the manner in which stimulus location modulated the responsiveness of the neuron. Thus multisensory stimulus combinations at weakly effective locations within the SRF resulted in large (often superadditive) response enhancements, whereas combinations at more effective spatial locations resulted in smaller (additive/subadditive) interactions. These results provide important insights into the spatial organization and processing capabilities of cortical multisensory neurons, features that may provide important clues as to the functional roles played by this area in spatially directed perceptual processes.

Development and plasticity of intra- and intersensory information processing.

The functional architecture of sensory brain regions reflects an ingenious biological solution to the competing demands of a continually changing sensory environment. While they are malleable, they have the constancy necessary to support a stable sensory percept. How does the functional organization of sensory brain regions contend with these antithetical demands? Here we describe the functional organization of auditory and multisensory (i.e., auditory-visual) information processing in three sensory brain structures: (1) a low-level unisensory cortical region, the primary auditory cortex (A1); (2) a higher-order multisensory cortical region, the anterior ectosylvian sulcus (AES); and (3) a multisensory subcortical structure, the superior colliculus (SC). We then present a body of work that characterizes the ontogenic expression of experience-dependent influences on the operations performed by the functional circuits contained within these regions. We will present data to support the hypothesis that the competing demands for plasticity and stability are addressed through a developmental transition in operational properties of functional circuits from an initially labile mode in the early stages of postnatal development to a more stable mode in the mature brain that retains the capacity for plasticity under specific experiential conditions. Finally, we discuss parallels between the central tenets of functional organization and plasticity of sensory brain structures drawn from animal studies and a growing literature on human brain plasticity and the potential applicability of these principles to the audiology clinic.

Functional organization of temporal frequency selectivity in primate visual cortex.

Several studies have shown that neurons with similar response properties are arranged together in domains across primary visual cortex (V1). An orderly pattern of domains has been described for preferences to ocular dominance, orientation, and spatial frequency. Temporal frequency preference, another important attribute of the visual scene, also might be expected to map into different domains. Using optical imaging and a variety of quantitative methods, we examined how temporal frequency selectivity is mapped in V1 of the prosimian primate, bush baby (Otolemur garnetti). We found that unlike other attribute maps, selectivity for different temporal frequencies is arranged uniformly across V1 with no evidence of local clustering. Global tuning for temporal frequency, based on magnitude of response, showed a good match to previous tuning curves for single neurons. A peak response was found around 2.0 Hz, with smaller attenuation at lower temporal frequencies than at higher frequencies. We also examined whether the peak temporal frequency response differed between anatomical compartments defined by cytochrome oxidase (CO). No significant differences in the preference for temporal frequency were found between these CO compartments. Our findings show that key sensory attributes that are linked in perception can be organized in quite distinct ways in V1 of primates.

Visual deprivation alters the development of cortical multisensory integration.

It has recently been demonstrated that the maturation of normal multisensory circuits in the cortex of the cat takes place over an extended period of postnatal life. Such a finding suggests that the sensory experiences received during this time may play an important role in this developmental process. To test the necessity of sensory experience for normal cortical multisensory development, cats were raised in the absence of visual experience from birth until adulthood, effectively precluding all visual and visual-nonvisual multisensory experiences. As adults, semichronic single-unit recording experiments targeting the anterior ectosylvian sulcus (AES), a well-defined multisensory cortical area in the cat, were initiated and continued at weekly intervals in anesthetized animals. Despite having very little impact on the overall sensory representations in AES, dark-rearing had a substantial impact on the integrative capabilities of multisensory AES neurons. A significant increase was seen in the proportion of multisensory neurons that were modulated by, rather than driven by, a second sensory modality. More important, perhaps, there was a dramatic shift in the percentage of these modulated neurons in which the pairing of weakly effective and spatially and temporally coincident stimuli resulted in response depressions. In normally reared animals such combinations typically give rise to robust response enhancements. These results illustrate the important role sensory experience plays in shaping the development of mature multisensory cortical circuits and suggest that dark-rearing shifts the relative balance of excitation and inhibition in these circuits.

Low-threshold Ca2+-associated bursts are rare events in the LGN of the awake behaving monkey.

It has been proposed that low-threshold Ca2+ (LT)-associated bursts in the lateral geniculate nucleus (LGN) of awake animals communicate significant or unexpected visual events to cortex. The present study investigated this hypothesis by examining the incidence of LT bursts in 146 cells recorded from the LGN of three macaque monkeys. Bursts were defined as clusters of two or more action potentials separated by not more than 4 ms and preceded by a > or = 100-ms quiescent interval. The incidence of bursts was examined in several intensive-training Go-NoGo and target selection tasks as well as in training-free tasks where natural scenes with both familiar and novel contents were shown. Our chief findings were as follows. 1) Bursts occur in the majority of cells under every condition tested, 2) burst incidence is very low (<1 burst every 10 s), 3) bursts occur in association with a receptive field stimulus on average only once every 23 times in 65% of cells tested, 4) cells responding with bursts to the stimulus also tended to exhibit higher levels of spontaneous bursting, 5) the presence of bursts did not depend on the novelty of the stimulus or its behavioral relevance. When the monkeys explored static natural scenes, 6) bursts were not correlated with short-term changes in the image sampled by the cell's receptive field during saccades. Burst incidence 7) did not increase when images were novel or when they evoked an emotional reaction, and 8) bursts did not decrease when images were familiar. 9) Bursts were not correlated with saccades in the dark, but 10) more spikes participated in bursts in the dark. Although these results confirm the occurrence of LT bursts in LGN cells of awake monkeys, they do not support the hypothesis that these bursts are a privileged means of transferring sensory information, that they signal unexpected or significant visual events, or that they are involved uniquely in the coding of natural scenes.

On the impact of attention and motor planning on the lateral geniculate nucleus.

Although the lateral geniculate nucleus (LGN) is one of the most thoroughly characterized thalamic nuclei, its functional role remains controversial. Traditionally, the LGN in primates has been viewed as the lowest level of a set of feedforward parallel visual pathways to cortex. These feedforward pathways are pictured as connected hierarchies of areas designed to construct the visual image gradually - adding more complex features as one marches through successive levels of the hierarchy. In terms of synapse number and circuitry, the anatomy suggests that the LGN can be viewed also as the ultimate terminus in a series of feedback pathways that originate at the highest cortical levels. Since the visual system is dynamic, a more accurate picture of image construction might be one in which information flows bidirectionally, through both the feedforward and feedback pathways constantly and simultaneously. Based upon evidence from anatomy, physiology, and imaging, we argue that the LGN is more than a simple gate for retinal information. Here, we review evidence that suggests that one function of the LGN is to enhance relevant visual signals through circuits related to both motor planning and attention. Specifically, we argue that major extraretinal inputs to the LGN may provide: (1) eye movement information to enhance and bind visual signals related to new saccade targets and (2) top-down and bottom-up information about target relevance to selectively enhance visual signals through spatial attention.