Psychological, Physical, and Heat Stress Indicators Prior to and after a 15-Minute Structural Firefighting Task

Firefighters work in strenuous conditions for prolonged periods wearing up to 20 kg of personal protective equipment. This often contributes to significant heat and cardiovascular strain. This study examined the relationships between psychological and physical measures taken prior to undertaking a 15 min firefighting task, and the occurrence of heat stress and high levels of fatigue following the task. Nine qualified firefighters completed a 15 min “live burn” scenario designed to mimic a fire started by a two-seater couch in a lounge room and completed simulated tasks throughout the duration. Logical reasoning, speed and accuracy, general motivation and fatigue, and physical and mental effort were recorded pre-scenario, and at 0- and 20-min post-scenario. General motivation and fatigue scores at 0- and 20-min post-scenario were highly correlated with each other (rs = 0.90; p = 0.001). The general motivation and fatigue scores, at 0- and 20-min post-scenario, were also strongly related to pre-task logic/reasoning test scores (Post 0 rs = −0.77, p = 0.016; Post 20 rs = −0.87, p = 0.002). Firefighters with lower logical reasoning and speed and accuracy scores were more susceptible to fatigue and impaired cognition when exposed to rises in core temperature and heat stress.

Effects of Cued and Uncued Swallowing in Patients With Dementia

Purpose: Parameters such as bolus location at swallow onset (BLSO), stage transition duration (STD), pharyngeal transition duration (PTD), pharyngeal response duration (PRD), and pharyngeal phase duration (PPD) often vary between cued and uncued swallowing conditions. Research has demonstrated that cued swallows may offer functional benefits that mitigate pathophysiological processes. However, there are limited data assessing differences between cued and uncued swallows in disordered populations, such as dementia. The purpose of this study was to evaluate if cued swallowing alters swallowing biomechanics in patients living with dementia. Method: Through a retrospective analysis of videofluoroscopic swallow studies (VFSS), 105 swallows from 26 participants living with dementia ( M age = 81 years; 14 women) were analyzed in duplicate by blinded raters using the Analysis of Swallowing Physiology, Events, Kinematics, and Timing method. Only VFSS with at least one cued and one uncued swallow were included in the analysis. Chi-square tests were used to explore differences in BLSO. Repeated-measures analyses of variance (ANOVAs) were used to explore differences in STD, PTD, PRD, and PPD. Results: Results revealed no significant differences in BLSO between cued and uncued swallows for patients living with dementia ( p = .934). Repeated-measures ANOVAs revealed no significant differences between the two types of swallows for STD ( p = .995), PTD ( p = .864), PRD ( p = .807), or PPD ( p = .660). Conclusions: This study suggests that there may be limited benefit to providing cued swallows to individuals living with dementia. Further research should investigate if this is due to impaired cognition and/or changes in motor control to volitionally complete the cued swallow.

Pain Assessment in Impaired Cognition (PAIC15) Instrument: Cutoffs Against Three Standards

Observational pain scales can help identify pain in persons with impaired cognition including dementia who may have difficulty expressing pain verbally. The Pain Assessment in Impaired Cognition-15 (PAIC15) observational pain scale covers 15 important items that are indicative of pain, but it is unclear how likely pain is for persons with each summed score (theoretical range 0-45). The goal of our study was to determine sensitivity and specificity of cut offs for probable pain on the PAIC15 against three possible standards. We determined cut offs against (1) self report when able, (2) the established Pain Assessment in Advanced Dementia (PAINAD) cut off of 2, and (3) observer’s overall estimate based on a series of systematic observations. We used data of 238 nursing home residents with dementia who were observed by their physician in training or nursing staff in the context of an evidence-based medicine (EBM) training study, with 137 residents assessed twice. The area under the ROC curve was excellent against the PAINAD cut off (□ 0.8) at both assessments, but acceptable or less than acceptable for the other two standards. Across standards and criteria for optimal sensitivity and specificity, cut offs at the PAIC15 could be 3 or 4. Guided by self report we recommend PAIC15 scores of 3 and higher to represent probable pain with sensitivity and specificity in the 0.5 to 0.7 range.

A Case Report on Korean Medical Treatment for a Patient with Quadriplegia and Impaired Cognition as Neurological Sequelae after Ingestion of Herbicides

This study is a case report of Korean medicine treatment for a patient with quadriplegia and impaired cognition as neurological sequelae after ingestion of herbicides. A 59-year-old man with toxic encephalopathy and hypoxic encephalopathy after the ingestion of herbicides was treated with acupuncture, Hyulbuchuko-tang mixed with Ondam-tang-gami (血府逐瘀湯合溫膽湯加味), cupping, moxibustion, and rehabilitation. Clinical symptoms were measured with the Manual Muscle Test (MMT), Korean Mini Mental Status Exam (K-MMSE), Functional Independence Measure (FIM), and Modified Barthel Index (MBI). After three months of treatment, clinical symptoms improved. The motor function improved (MMT on both sides, Gr. 3+F/4G →Gr. 4-G~4G/4+G), cognition improved (K-MMSE, 13→21), and ADL (Activities of Daily Living) scores also improved (FIM 41→74; MBI 20→63). Korean medical treatment could effectively treat neurological sequelae after ingestion of herbicides in this case.

The Genetics and Learning Disorders of the Syndromes Involving Craniosynostosis

Prenatal genetic vehicles that lead to facial and cranial dysmorphias, specifically craniosynostosis, are seen in a spectrum of synostotic syndromes that include apert, crouzon, Kleeblattschadel deformity, saethre-chotzen, muenke, cranio-fronto-nasal syndrome, Robinow-Sorauf syndrome and beare-stevenson-cutis-gyrata syndrome. Specific genes involved in cranio-synostotic syndromes include: TWIST1, EFNB1, GLI2, DMD, YWHAE, IRAK2, FGFR1, FGFR2, FGFR3, CNTNAP2, ADAMTS18, SKI, MECP2, KIFBP, TCF12, H2AL1P, GAGE12D and possibly HDAC9. Regarding protein expression, conserved domains found in rpsblast for craniosynostosis using the NCBI homologene tool show IGc2 (smart00408) immunoglobulin C-2 Type, PKc_like (cl09925) Protein Kinases, catalytic domain, Ig (cl11960) Immunoglobulin domain. A discussion of all the syndromes involving craniosynostosis is beyond the scope of this paper. We will discuss the clinical features, genetics, cognitive development and associated psychiatric conditions of the more common syndromes involving craniosynostosis. We theorize that the clinical features and genetics of craniosynostosis involve a spectrum of syndromes on which there is variable severity and involvement of impaired cognition and developmental disorders.

Gene-Specific DNA Methylation Linked to Postoperative Cognitive Dysfunction in Apolipoprotein E3 and E4 Mice

Background: Geriatric surgical patients are at higher risk of developing postoperative neurocognitive disorders (NCD) than younger patients. The specific mechanisms underlying postoperative NCD remain unknown, but they have been linked to genetic risk factors, such as the presence of APOE4, compared to APOE3, and epigenetic modifications caused by exposure to anesthesia and surgery. Objective: To test the hypothesis that compared to E3 mice, E4 mice exhibit a more pronounced postoperative cognitive impairment associated with differential DNA methylation in brain regions linked to learning and memory. Methods: 16-month-old humanized apolipoprotein-E targeted replacement mice bearing E3 or E4 were subjected to surgery (laparotomy) under general isoflurane anesthesia or sham. Postoperative behavioral testing and genome-wide DNA methylation were performed. Results: Exposure to surgery and anesthesia impaired cognition in aged E3, but not E4 mice, likely due to the already lower cognitive performance of E4 prior to surgery. Cognitive impairment in E3 mice was associated with hypermethylation of specific genes, including genes in the Ephrin pathway implicated in synaptic plasticity and learning in adults and has been linked to Alzheimer’s disease. Other genes, such as the Scratch Family Transcriptional Repressor 2, were altered after surgery and anesthesia in both the E3 and E4 mice. Conclusion: Our findings suggest that the neurocognitive and behavioral effects of surgery and anesthesia depend on baseline neurocognitive status and are associated with APOE isoform-dependent epigenetic modifications of specific genes and pathways involved in memory and learning.

Faces of Pain during Dental Procedures: Reliability of Scoring Facial Expressions in Print Art

Background: Observational tools have been developed to assess pain in cognitively impaired individuals. It is not known, however, whether these tools are universal enough so that even pain depicted in print art can be assessed reliably. Therefore, the aim of this study was to assess the reliability in scoring facial expressions of pain in dental print art from the 17th, 18th, and 19th century, using a Short Form of the 15-item Pain Assessment in Impaired Cognition (PAIC15-SF) tool. Methods: Seventeen prints of patients undergoing dental procedures were scored twice by two inexperienced observers and an expert and once by a Gold Standard observer. Results: All observers achieved high intra-observer reliability for all four items of the category “facial expressions” and for three items of the category “body movements” (ICC: 0.748–0.991). The remaining two items of the category “body movements”, viz., “rubbing” and “restlessness”, were excluded from further research because it was not possible to calculate a reliable ICC. Overall, the intra-observer reliability of the expert was higher than that of the inexperienced observers. The inter-observer reliability scores varied from poor to excellent (ICC: 0.000–0.970). In comparison to the Gold Standard, the inter-observer reliability of the expert was higher than that of the inexperienced observers. Conclusion: The PAIC15-SF tool is universal enough even to allow reliable assessment of facial expressions of pain depicted in dental print art.