Background Traditionally, the delivery of dedicated neurocritical care (NCC) occurs in distinct NCC units and is associated with improved outcomes. Institution-specific logistical challenges pose barriers to the development of distinct NCC units; therefore, we developed a consultancy NCC service coupled with the implementation of invasive multimodal neuromonitoring, within a medical-surgical intensive care unit. Our objective was to evaluate the effect of a consultancy NCC program on neurologic outcomes in severe traumatic brain injury patients. Methods: We conducted a single-center quasi-experimental uncontrolled pre- and post-NCC study in severe traumatic brain injury patients (Glasgow Coma Scale ≤8). The NCC program includes consultation with a neurointensivist and neurosurgeon and multimodal neuromonitoring. Demographic, injury severity metrics, neurophysiologic data, and therapeutic interventions were collected. Glasgow Outcome Scale (GOS) at 6 months was the primary outcome. Multivariable ordinal logistic regression was used to model the association between NCC implementation and GOS at 6 months. Results: A total of 113 patients were identified: 76 pre-NCC and 37 post-NCC. Mean age was 39 years (standard deviation [SD], 2) and 87 of 113 (77%) patients were male. Median admission motor score was 3 (interquartile ratio, 1-4). Daily mean arterial pressure was higher (95 mmHg [SD, 10]) versus (88 mmHg [SD, 10], p<0.001) and daily mean core body temperature was lower (36.6°C [SD, 0.90]) versus (37.2°C [SD, 1.0], p=0.001) post-NCC compared with pre-NCC, respectively. Multivariable regression modelling revealed the NCC program was associated with a 2.5 increased odds (odds ratios, 2.5; 95% confidence interval, 1.1-5.3; p=0.022) of improved 6-month GOS. Conclusions: Implementation of a NCC program is associated with improved 6 month GOS in severe TBI patients.

Determining what external stimuli influence cell differentiation, morphology, and growth continues to be a focus on many research groups to meet the healthcare Grand Challenges. While prior work has shown the influence of stiffness, surface chemistry and topography, these parameters often change in tandem, making it difficult to delineate the role of an individual component. This study examined the possible incorporation of microelectronic processing to produce reusable substrates for cell guidance studies. Subsequent plating of substrates cleaned with methods common in a microelectronic fabrication process showed complex responses including migration. Optical characterization of surfaces after cleaning showed remaining cellular debris that could be removed through the incorporation of a piranha solution. The micro patterned substrates did allow controlled comparison between dental pulp stem cells and osteoblast cells. The dental pulp cells did not show any cell alignment or cell proliferation (as indicated by cell density) with the isotropic or anisotropic micropatterns on the initial plating. The osteoblast cells (control) only aligned with the lines and not any of the other patterns (dots, holes or hexagons).

Objectives: To summarize the clinical characteristics and outcomes of pediatric sports-related concussion (SRC) patients who were evaluated and managed at a multidisciplinary pediatric concussion program and examine the healthcare resources and personnel required to meet the needs of this patient population. Methods: We conducted a retrospective review of all pediatric SRC patients referred to the Pan Am Concussion Program from September 1st, 2013 to May 25th, 2015. Initial assessments and diagnoses were carried out by a single neurosurgeon. Return-to-Play decision-making was carried out by the multidisciplinary team. Results: 604 patients, including 423 pediatric SRC patients were evaluated at the Pan Am Concussion Program during the study period. The mean age of study patients was 14.30 years (SD: 2.32, range 7-19 years); 252 (59.57%) were males. Hockey (182; 43.03%) and soccer (60; 14.18%) were the most commonly played sports at the time of injury. Overall, 294 (69.50%) of SRC patients met the clinical criteria for concussion recovery, while 75 (17.73%) were lost to follow-up, and 53 (12.53%) remained in active treatment at the end of the study period. The median duration of symptoms among the 261 acute SRC patients with complete follow-up was 23 days (IQR: 15, 36). Overall, 25.30% of pediatric SRC patients underwent at least one diagnostic imaging test and 32.62% received referral to another member of our multidisciplinary clinical team. Conclusion: Comprehensive care of pediatric SRC patients requires access to appropriate diagnostic resources and the multidisciplinary collaboration of experts with national and provincially-recognized training in TBI.

The use of different imaging modalities provides the clinician and researcher with different views of anatomy and physiology at unprecedented levels of detail. Multimodal imaging allows for noninvasive measurement of structure and function in humans during complex behavior, and thus provides information about the inner workings of the brain previously unavailable. The present paper examines the various imaging techniques available, and describes their application to the clinic—in the case of epilepsy—and to research—in the case of schizophrenia. Because the electroen-cephalogram has a dynamic response in milliseconds, it provides the best temporal sensitivity of functional measures of brain activity. When coupled with high-resolution magnetic resonance imaging measures of brain structure, this multimodal approach provides a powerful tool for understanding brain activity. Clinically, the use of multimodal imaging has provided greater precision in localization of the epileptogenic focus. For researchers attempting to determine the underlying causes of schizophrenia, the use of multimodal imaging has helped lead the field away from a specific lesion view to a more distributed system abnormality view of this disorder.

Synchrotron X rays were used to perform nondestructive transmission diffraction and fluorescence experiments on a group of 24 European and Islamic astrolabes dated between 1350–1720 A.D. in order to determine their compositions. A group of six astrolabes produced in Lahore between 1601–1662 A.D. were found to contain a mixed α+β brass microstructure, proving that the brass was produced by a comelting technique rather than the traditional cementation process. The results also show evidence of dezincification, attributed to heavy annealing of the brass during astrolabe manufacture. This effect was so severe that an accurate analysis of the bulk Zn composition could not be determined from the fluorescence results alone; transmission X-ray diffraction gives a more accurate measurement of the bulk Zn composition.

Ninety-eight men aged 25–50, who were unemployed because of involuntary redundancy and out of work for 2–18 months, completed the Beck Depression Inventory (BDI) and the General Health Questionnaire (GHQ–30). Their scores were compared with those of a group of employed men matched for age and social class. The mean GHQ score for the redundant men was 13–0, compared with 4·0 for the employed group. The mean BDI score was 11·1 for the redundant group and 5·6 for the employed group. Eighteen per cent of the redundant men, compared with 6% of the employed group, scored 18 or more which are scores corresponding to those in depressive illness. We conclude that the prevalence of depressive illness may be increased among redundant men.

This study evaluated cognitive set-shifting in 12 patients with focal lesions in the lateral prefrontal cortex (LPC) by examining their performance on the Trail Making Test from the Delis-Kaplan Executive Function System (D-KEFS). Patients with LPC lesions performed significantly worse than controls on the D-KEFS Trail Making Test on the Letter Sequencing, Number-Letter Switching (set-shifting), and Motor Speed conditions. Patients with LPC lesions performed significantly more slowly on the Number-Letter Switching condition even after controlling for performance on the four baseline conditions of the test. In addition, patients with LPC lesions exhibited significantly elevated error rates on the Number-Letter Switching condition. Results suggest that LPC lesions can lead to impaired cognitive set-shifting on a visual-motor sequencing task. (JINS, 2007, 13, 704–709.)