The relationship between sustained attention and parasympathetic functioning

Sustained attention (SA) is an important cognitive ability that plays a crucial role in successful cognitive control. Resting vagally-mediated heart rate variability (vmHRV) has emerged as an informative index of parasympathetic nervous system activity and a sensitive correlate of individual differences in cognitive control. However, it is unclear how resting vmHRV is associated with individual differences in sustained attention. The primary aim of the current study was to assess if resting vmHRV was associated with individual differences in performance on a neuropsychological assessment of sustained attention. We further aimed to characterize the relationship between resting vmHRV and dispositional factors related to sustained attention, specifically attentional errors in daily life, self-regulation, mindfulness and media-multitasking. Based on previous work, we hypothesized higher resting vmHRV would be associated with better sustained attention across task-based and self-report measures. We did not find resting vmHRV to be significantly associated with performance measures on a task-based assessment of sustained attention. Further, resting vmHRV was not significantly associated with attention errors, self-regulation, mindfulness, or media-multitasking. This work stands to expand the current understanding between parasympathetic functioning, cognition, and behavior, investigating the unexplored domain of sustained attention and related dispositional factors.

Balancing Act: Acute and Contextual Vestibular Sensations of Cranial Electrotherapy Stimulation Using Survey and Sensor Outcomes in a Non-Clinical Sample

Cranial electrotherapy stimulation (CES) delivers low-intensity electrical currents to the brain to treat anxiety, depression, and pain. Though CES is considered safe and cost-effective, little is known about side effects emerging across different contexts. Our objective was to investigate how varying physical and cognitive demands impact the frequency and intensity of CES vestibular sensations in a sample of healthy young adults. We used a 2 (stimulation: sham, active) × 2 (physical demand: static sway, dynamic sit-to-stand) × 2 (cognitive demand: single-task remain silent, dual-task count backward) repeated measures design. Vestibular sensations were measured with surveys and wearable sensors capturing balance changes. Active stimulation did not influence reported vestibular sensations. Instead, high physical demand predicted more sensation reports. High cognitive demand, but not active stimulation, predicted postural sway unsteadiness. Significant effects of active stimulation on balance were observed only during the dynamic sit-to-stand transitions. In summary, CES induces vestibular sensations only for a specific outcome under certain circumstances. Our findings imply that consumers can safely maximize the benefits of CES while ensuring they are taking steps to minimize any potential side effects by considering their context and circumstances.

Pharmacokinetics and effect on renal function and average daily gain in lambs after castration and tail docking, of firocoxib and meloxicam

AIMS

To evaluate and compare the pharmacokinetics of IM and oral firocoxib, and IM meloxicam, and detect their effect on renal function and average daily gain (ADG) in lambs undergoing tail docking and castration.

METHODS

Seventy-five male Romney lambs, aged 3-6 weeks, were randomised into five treatment groups (n = 15 per group): IM firocoxib (1 mg/kg); oral firocoxib (1 mg/kg); IM meloxicam (1 mg/kg); normal saline (approximately 2 mL, oral); or sham. Following the treatment administration, hot-iron tail docking and rubber ring castration were performed in all groups except the sham group, which did not undergo the procedures, but the animals were handled in the same manner as castrated and tail docked lambs. Blood samples were collected before and 1, 2, 4, 6, 8, 24, 48, 72, 96 and 120 hours after treatment administration, and drug concentrations in plasma were quantified by liquid chromatography and mass spectrometry. Plasma urea and creatinine concentrations were determined at a commercial laboratory. Lamb body weights were recorded before and 2, 4 and 8 weeks after tail docking and castration. The pharmacokinetic analysis was carried out using a non-compartmental approach. Between-group and between-time-point differences were compared using mixed model analyses.

RESULTS

There was no evidence for a difference in plasma elimination half-life between firocoxib given IM (LSM 18.6 (SE 1.4) hours), firocoxib given orally (LSM 18.2 (SE 1.4) hours), and meloxicam given IM (LSM 17. 0 (SE 1.4) hours). Firocoxib (IM) had a significantly greater volume of distribution (LSM 3.7 (SE 0.2) L/kg) than IM meloxicam (LSM 0.2 (SE 0.2) L/kg). Lambs in the meloxicam group had higher (p < 0.05) plasma urea and creatinine concentrations than those in the firocoxib, saline and sham groups. Lambs' ADG was decreased (p < 0.01) compared to the other treatment groups in the 0-2 week period following meloxicam administration.

CONCLUSIONS AND CLINICAL RELEVANCE

Both formulations of firocoxib had a long plasma elimination half-life and large volume of distribution. There was a transient reduction in ADG in the meloxicam group, possibly due to mild renal toxicity. Comparative studies on dose-response effects of firocoxib and meloxicam in lambs following the procedures are required.Abbreviations: ADG: Average daily gain; Cmax: Maximum concentration; COX: Cyclooxygenase; LOD: Limit of detection; NSAID: Non-steroidal anti-inflammatory drugs; CL: Plasma clearance; T1/2el: Plasma elimination half-life; Tmax: Time to achieve Cmax; Vd: Volume of distribution.

Abstract 2161: Quinolinic acid phosphoribosyl transferase (QPRT) is an essential liability of non-small cell lung cancer

Lung cancer is the second most diagnosed type of cancer and the leading cause of cancer-related mortality. 85% of all lung cancer cases are non-small cell lung cancer (NSCLC), a large proportion of which are only diagnosed at advanced stages (II-IV) due to lack of early diagnostic techniques. Standard first-line treatment for late-stage inoperable NSCLC still is chemotherapy regiments. However, most NSCLC patients fail to respond to these regimens or relapse upon treatment. Thus, there is a pressing need to identify novel therapeutic targets that can more effectively treat NSCLC. Quinolinic acid phosphoribosyl transferase (QPRT) is a rate-limiting enzyme in the tryptophan catabolic pathway which fuels de novo NAD+ production, whose expression as previously been shown to have a prognostic value in certain cancers. Here, we demonstrate that high QPRT levels is a feature of a large proportion of NSCLC cell lines and that QPRT induction occurs in genetically engineered models of NSCLC (KP and KL) when compared to the normal lung. Considering the critical role of NAD+ levels to enable high rates of proliferation, we hypothesized that QPRT induction enables lung cancer cells to thrive. Strikingly, QPRT knockdown in a panoply of NSCLC cell lines results in pronounced suppression of tumor cells both in 2D and 3D conditions. Interestingly, we observe that QPRT suppression does not affect proliferation or cell cycle progression but rather due to pronounced induction of cell death. Surprisingly, while we observed DNA damage upon QPRT suppression, NAD+ levels were not affected by QPRT suppression indicating that QPRT’s effects in NSCLC are independent of its contribution to the NAD+ pools. Together, our results point for QPRT as a novel and effective therapeutic target for NSCLC.

Citation Format: Hossein Kashfi, Nathan Ward, Didem Ilter, Stanislav Drapela, Aimee Falzone, Stephen Gardell, Gina M. DeNicola, Ana P. Gomes. Quinolinic acid phosphoribosyl transferase (QPRT) is an essential liability of non-small cell lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2161.

Web-based physical activity promotion in young people with CF: a randomised controlled trial

BACKGROUND

Physical activity levels are known to decline following hospitalisation for people with cystic fibrosis (pwCF). However, optimal physical activity promotion strategies are unclear. This study investigated the effect of a web-based application (ActivOnline) in promoting physical activity in young pwCF.

METHODS

Multicentre randomised controlled trial with assessor blinding and qualitative evaluation. People with CF (12-35 years) admitted to hospital for a respiratory cause were eligible and randomised to the 12-week ActivOnline intervention (AO) or usual care (UC). The primary outcome was change in device-based time spent in moderate-to-vigorous physical activity (MVPA) from baseline to post-intervention. Follow-up was at 6 months from hospital discharge when qualitative evaluation was undertaken.

RESULTS

107 participants were randomised to AO (n=52) or UC (n=55). Sixty-three participants (59%) contributed to the intention-to-treat analysis. Mean (SD) age was 21 (6) years (n=46, <18 years). At baseline, physical activity levels were high in both groups (AO 102 (52) vs UC 127 (73) min/day). There was no statistically significant difference in MVPA between groups at either timepoint (post-intervention mean difference (95% CI) -14 mins (-45 to 16)). Uptake of the intervention was low with only 40% (n=21) of participants accessing the web application.

CONCLUSION

A web-based application, including individualised goal setting, real-time feedback and motivation for behavioural change, was no better than usual care at promoting physical activity in young pwCF following hospital discharge. High levels of baseline physical activity levels in both groups, and limited engagement with the intervention, suggest alternative strategies may be necessary to identify and support young pwCF who would benefit from enhanced physical activity.

TRIAL REGISTRATION NUMBER

ACTRN12617001009303, 13 July 13 2017.

The influence of context representations on cognitive control states

Cognitive control operates via two distinct mechanisms, proactive and reactive control. These control states are engaged differentially, depending on a number of within-subject factors, but also between-group variables. While research has begun to explore if shifts in control can be experimentally modulated, little is known about whether context impacts which control state is utilized. Thus, we test if contextual factors temporarily bias the use of a particular control state long enough to impact performance on a subsequent task. Our methodology involves two parts: first participants are exposed to a context manipulation designed to promote proactive or reactive processing through amount or availability of advanced preparation within a task-switching paradigm. Then, they complete an AX-CPT task, where we assess immediate transfer on preferential adoption of one control mode over another. We present results from a Pilot Study that revealed anecdotal evidence of proactive versus reactive processing for a context manipulation using long and short preparation times. We also present data from a follow-up Registered Experiment that implements a context manipulation using long or no preparation times to assess if a more extreme context leads to pronounced differences on AX-CPT performance. Together, the results suggest that contextual representations do not impact the engagement of a particular control state, but rather, there is a general preference for the engagement of proactive control.

The mediating role of inhibitory control in the relationship between prefrontal cortex hemodynamics and exercise performance in adults with overweight or obesity

Physical inactivity has been suggested to impair physical performance, cognitive functions and facilitate weight gain. One hypothesis is that long periods of physical inactivity could impair oxygen delivery to the prefrontal cortex (PFC), impairing one's cognitive ability to inhibit unhealthy automated behaviors and, therefore, reduce exercise tolerance. The present study sought to further understand the relationship among PFC hemodynamics, inhibitory control, and exercise tolerance in individuals with low physical fitness levels who are overweight or obese. Thirty-four participants were asked to perform a series of inhibitory control tests (i.e., Stroop task) in one testing session and complete an incremental cycling exercise test with hemodynamic fluctuations of the PFC measured with functional near-infrared spectroscopy in another session. Our results indicate that exercise performance varied with PFC oxygenation. We also found that inhibitory control played a key role mediating the relationship between PFC oxygenation and exercise performance, suggesting that the cognitive ability to inhibit automated responses has an impact on exercise behavior in adults with overweight and obesity.

Factors Influencing Barriers and Facilitators to In-home Video Telehealth for Dementia Management

OBJECTIVES

Quality dementia care, which recognizes caregivers as vital care partners, is a scarce resource. Innovative solutions like video telehealth may increase the reach of extant clinicians; however, little is known about perceived barriers and facilitators to in-home video telehealth for dementia management from the perspectives of caregivers.

METHODS

Twenty-four caregivers of community-dwelling Veterans with dementia participated in semi-structured interviews. Questions gathered perceived facilitators and barriers to in-home video telehealth for dementia management through experience with related technology. Transcripts were analyzed using directed content analysis which was guided by factors previously identified as influencing older adults' adoption of technology.

RESULTS

Caregiver experience with related technology was mostly facilitative to video telehealth, which was thought best suited for follow-up care. Increased access and decreased patient-caregiver stress were potential benefits. Barriers included perceived limitations of video and the belief that persons with dementia would have limited ability to manage technological aspects and to engage in video telehealth on their own.

CONCLUSIONS

This study improves our understanding of the factors that caregivers perceive as barriers and facilitators to in-home video telehealth for dementia management.

CLINICAL IMPLICATIONS

Strategies to optimize video telehealth include capitalizing on caregivers' social network and providing targeted training.

Modulating Cognitive–Motor Multitasking with Commercial-off-the-Shelf Non-Invasive Brain Stimulation

One growing area of multitasking research involves a focus on performing cognitive and motor tasks in tandem. In these situations, increasing either cognitive or motor demands has implications for performance in both tasks, an effect which is thought to be due to competing neural resources. Separate research suggests that non-invasive brain stimulation may offer a means to mitigate performance decrements experienced during multitasking. In the present study, we investigated the degree to which a commercially available non-invasive brain stimulation device (Halo Sport) alters balance performance in the presence of different types of cognitive demands. Specifically, we tested if performing a secondary cognitive task impacts postural sway in healthy young adults and if we could mitigate this impact using transcranial direct current stimulation (tDCS) applied over the primary motor cortex. Furthermore, we included conditions of unstable and stable surfaces and found that lower surface stability increased postural sway. In addition, we found that cognitive load impacted postural sway but in the opposite pattern we had anticipated, with higher sway found in the single-task control condition compared to executive function conditions. Finally, we found a small but significant effect of tDCS on balance with decreased sway for active (compared to sham) tDCS.

The Specificity of Cognitive-Motor Dual-Task Interference on Balance in Young and Older Adults

Standing upright on stable and unstable surfaces requires postural control. Postural control declines as humans age, presenting greater risk of fall-related injury and other negative health outcomes. Secondary cognitive tasks can further impact balance, which highlights the importance of coordination between cognitive and motor processes. Past research indicates that this coordination relies on executive function (EF; the ability to control, maintain, and flexibly direct attention to achieve goals), which coincidentally declines as humans age. This suggests that secondary cognitive tasks requiring EF may exert a greater influence on balance compared to non-EF secondary tasks, and this interaction could be exaggerated among older adults. In the current study, we had younger and older adults complete two Surface Stability conditions (standing upright on stable vs. unstable surfaces) under varying Cognitive Load; participants completed EF (Shifting, Inhibiting, Updating) and non-EF (Processing Speed) secondary cognitive tasks on tablets, as well as a single task control scenario with no secondary cognitive task. Our primary balance measure of interest was sway area, which was measured with an array of wearable inertial measurement unit sensors. Replicating prior work, we found a main effect of Surface Stability with less sway on stable surfaces compared to unstable surfaces, and we found an interaction between Age and Surface Stability with older adults exhibiting significantly greater sway selectively on unstable surfaces compared to younger adults. New findings revealed a main effect of Cognitive Load on sway, with the single task condition having significantly less sway than two of the EF conditions (Updating and Shifting) and the non-EF condition (Processing Speed). We also found an interaction of Cognitive Load and Surface Stability on postural control, where Surface Stability impacted sway the most for the single task and two of the executive function conditions (Inhibition and Shifting). Interestingly, Age did not interact with Cognitive Load, suggesting that both age groups were equally impacted by secondary cognitive tasks, regardless the presence or type of secondary cognitive task. Taken together, these patterns suggest that cognitive demands vary in their impact on posture control across stable vs. unstable surfaces, and that EF involvement may not be the driving mechanism explaining cognitive-motor dual-task interference on balance.

TP1.2.7The stuck colonoscope

Background

With the increased awareness and push for earlier diagnosis of colorectal cancer, the number of patients undergoing colonoscopy is increasing. Being a common condition, a number of these patients will have herniae. We describe a rare complication during a Sigmoidoscopy in a patient with an Inguinal hernia.

The case

A 75-year-old man was booked for a flexible sigmoidoscopy for rectal bleeding. The scope was successfully inserted to the Splenic flexure. During withdrawal, the scope stopped moving. It was still possible to advance the scope, but not to withdraw. The patient confirmed the presence of a left inguinal hernia. Physical examination and the position on magnetic scope imager confirmed the loop in the hernia.

Various manoeuvres to withdraw the scope were unsuccessful. A colleague was called for a second opinion. We came up with a plan to maintain a ‘long loop‘ position in the hernia, by holding the scope through the scrotum and allowing it to slide on withdrawal. This was successful and the patient was discharged.

Discussion

Incarceration of the scope in the hernia occurs when the hernial defect permits entry and exit of the scope, leaving a loop in the hernia, in a long loop position. During withdrawal, the configuration changes to a short loop, crowding the hernial defect, preventing the scope from sliding. On searching literature, we found that this technique has been described by Koltun et al and is known as the “Pulley” technique. We suggest that colonoscopists are familiar with this technique.

EP.WE.453Impact of COVID 19 pandemic on colorectal rapid access investigations

Aim

The impact of the COVID-19 pandemic on delays in diagnosis of cancer has been highlighted at a national level. Such a delay represents an ongoing source of mortality and morbidity missing from the COVID-19 statistics. This study examines the delay in investigation of patients referred to the urgent colorectal cancer referral service at a single centre.

Method

Retrospective data was collated from prospective database for all 1,894 referrals to the urgent colorectal cancer referral service for the period 21 January to 24 December 2020. The time to appointment (TTA) was compared by date of referral and outcome type (endoscopy, CT abdomen pelvis (CT-AP), CT colonography (CT-C), clinic appointment).

Results

Across 2020, fewer than 25% of patients met the NICE recommendation of appointment within 14 days (median TTA 30 days, first quartile 19). TTA increased dramatically in the first months of the pandemic (February median: 19; March: 80.5). TTA remained high, not falling below a median wait of 28 days until November. CT-C tests were particularly delayed (median TTA: 86) due to concerns regarding aerosol generation and COVID-19 transmission. Patients were offered CT-AP tests while awaiting their delayed CT-C, as CT-AP had a significantly better wait of 15 days.

Conclusion

COVID-19 was a major disruptor of colorectal cancer diagnosis in 2020, with patients waiting more than twice as long as NICE recommends. This will likely continue into 2021, with further research required to assess the impact of this disruption on mortality and morbidity.

Cognitive Motor Dual Task Costs in Older Adults with Motoric Cognitive Risk Syndrome

The purpose of this study was to characterize Cognitive Motor Dual Task (CMDT) costs for a community-based sample of older adults with Motoric Cognitive Risk Syndrome (MCR), as well as investigate associations between CMDT costs and cognitive performance. Twenty-five community-dwelling older adults (ages 60-89 years) with MCR performed single and dual task complex walking scenarios, as well as a computerized cognitive testing battery. Participants with lower CMDT costs had higher scores on composite measures of Working Memory, Processing Speed, and Shifting, as well as an overall cognitive composite measure. In addition, participants with faster single task gait velocity had higher scores on composite measures of Working Memory, Processing Speed, and overall cognition. Taken together, these results suggest that CMDT paradigms can help to elucidate the interplay between cognitive and motor abilities for older adults with MCR.

508 Conservative Management of Small Bowel Obstruction: A Local Experience

Introduction

Post-operative intra-abdominal adhesions remain the leading cause of small bowel obstruction (SBO) representing one of the main diagnoses warranting emergency laparotomies. The National Audit in Small Bowel Obstruction advocates the use of water-soluble contrast agents (WSCA) as initial management of SBO. We aim to assess the role and outcomes of WSCA and its rate in successfully managing SBO non-operatively.

Method

We conducted a 2-year retrospective analysis including all patients admitted with adhesive SBO. Outcomes of patients who received WSCA were compared to those who hadn’t.

Results

118 patients were included, 27(23%) of which required immediate surgery while 91(77%) were initially managed conservatively. From the latter group, 53(58.2%) received WSCA whilst 38(41.8%) didn’t. Of the group that received WSCA, 36(39.5%) were successfully managed non-operatively, compared to 26(28.5%) that didn’t, this however lacked statistical significance. LOS didn’t differ between these two groups (5 days vs. 5.5 days, p = 0.805). 32% of the patients required eventual surgical intervention needing longer LOS regardless of receiving WSCA (6.6 days vs. 13.6 days p &lt; 0.001).

Conclusions

Adhesive SBO can be managed conservatively in up to two-thirds of patients. WSCA usage has a positive impact but needs further assessment in larger studies.

Underload on the Road: Measuring Vigilance Decrements During Partially Automated Driving

Partially automated vehicle technology is increasingly common on-road. While this technology can provide safety benefits to drivers, it also introduces new concerns about driver attention. In particular, during partially automated driving (PAD), drivers are expected to stay vigilant so they can readily respond to important events in their environment. However, using partially automated vehicles on the highway places drivers in monotonous situations and requires them to do very little. This can place the driver in a state of cognitive underload in which they experience a very small amount of cognitive demand. In this situation, drivers can exhibit vigilance decrements which impact their ability to respond to on-road threats. This is of particular concern in situations when the partially automated vehicle fails to respond to a potentially critical situation and leaves all responsibility to safely navigate to the driver. This paper reviews situations that lead to vigilance decrements and characterizes the different methodologies of measuring driver vigilance during PAD, highlighting their advantages and limitations. Based on our reading of the literature, we summarize several factors future research on vigilance decrements in PAD should consider.

Video Telehealth Occupational Therapy Services for Older Veterans: National Survey Study

Background

Occupational therapy (OT) is a vital service that supports older adults’ ability to age in place. Given the barriers to accessing care, video telehealth is a means of providing OT. Even within Veterans Health Administration (VHA), a pioneer in telehealth, video telehealth by OT practitioners to serve older adults is not well understood.

Objective

This study examines VHA OT practice using video telehealth with older veterans using an implementation framework.

Methods

A web-based national survey of VHA OT practitioners conducted between September and October 2019 contained a mix of mostly closed questions with some open-text options. The questions were developed using the Promoting Action on Research Implementation in Health Services model with input from subject matter experts. The questions gathered the extent to which VHA OT practitioners use video telehealth with older veterans; are comfortable with video telehealth to deliver specific OT services; and, for those using video telehealth with older veterans, the barriers, facilitators of change, and perceived benefits of video telehealth.

Results

Of approximately 1455 eligible VHA OT practitioners, 305 participated (21.0% response rate). Most were female (196/259, 75.7%) occupational therapists (281/305, 92.1%) with a master’s degree (147/259, 56.8%) and 10 years or fewer (165/305, 54.1%) of VHA OT practice. Less than half (125/305, 41.0%) had used video telehealth with older veterans, and users and nonusers of video telehealth were demographically similar. When asked to rate perceived comfort with video telehealth to deliver OT services, participants using video telehealth expressed greater comfort than nonusers, which was significant for 9 of the 13 interventions: activities of daily living (P<.001), instrumental activities of daily living (P=.004), home safety (P<.001), home exercise or therapeutic exercise (P<.001), veteran or caregiver education (P<.001), durable medical equipment (P<.001), assistive technology (P<.001), education and work (P=.04), and wheelchair clinic or seating and positioning (P<.001). More than half (74/125, 59.2%) of those using video telehealth reported at least one barrier, with the most frequently endorsed being Inadequate space, physical locations and related equipment. Most (92/125, 73.6%) respondents using video telehealth reported at least one facilitator, with the most frequently endorsed facilitators reflecting respondent attitudes, including the belief that video telehealth would improve veteran access to care (77/92, 84%) and willingness to try innovative approaches (76/92, 83%).

Conclusions

Most VHA OT survey respondents had not used video telehealth with older veterans. Users and nonusers were demographically similar. Differences in the percentages of respondents feeling comfortable with video telehealth for specific OT interventions suggest that some OT services may be more amenable to video telehealth. This, coupled with the primacy of respondent beliefs versus organizational factors as facilitators, underscores the need to gather clinicians’ attitudes to understand how they are driving the implementation of video telehealth.

Driver Rehabilitation Utilization and Need Among Community-Dwelling Older Adults

IMPORTANCE

Driving is one of the most important instrumental activities of daily living. As adults age, many face challenges with maintaining independent driving, leading to risk for decreased occupational engagement and quality of life. The extent to which occupational therapy services meet the driver rehabilitation needs of older adults is unknown.

OBJECTIVE

To characterize driver rehabilitation service utilization among a nationally representative sample of community-dwelling older adults.

DESIGN

Exploratory, descriptive cross-sectional study using the National Health and Aging Trends Study 2016 wave.

PARTICIPANTS

Community-dwelling adults age 65 and older who received rehabilitation services in the past year (N = 1,173).

OUTCOMES AND MEASURES

Sociodemographic information, comorbidities, rehabilitation use, community mobility, and participation restrictions were collected using self-report and performance-based measures.

RESULTS

Of this sample of older adults, 63.0% reported driving as their primary mode of transportation, 25.8% reported limitations in community participation related to transportation, and 9.2% reported having received rehabilitation focused on driving or other transportation goals in the past year. Findings from this study suggest a discrepancy between utilization of driver rehabilitation and self-reported need.

CONCLUSIONS AND RELEVANCE

Many older adults reported limitations in community participation for transportation-related reasons, yet driver rehabilitation represented only a small proportion of services used. As experts in driver rehabilitation, occupational therapy practitioners should lead the way in advocating for increased utilization of driver rehabilitation and development of innovative, accessible transportation options to promote community mobility and participation among older adults.

WHAT THIS ARTICLE ADDS

The results of this study illustrate an important discrepancy between self-reported need for and utilization of driver rehabilitation services. Occupational therapy practitioners can play an important role in meeting older adults' driving and transportation needs to enable them to fully participate in their community and daily routines.

Age-related effects on a novel dual-task Stroop paradigm

The Stroop task is a traditional measure of cognitive control processes, yet results remain mixed when it comes to assessing age-related differences perhaps in part due to strategies participants use to reduce inhibitory control demands required for success on the task. Thirty-three older adults and 34 younger adults completed a Baseline (traditional, single-task) version of Stroop, followed by two, novel dual-task Stroop variants: Color-Dual (maintain secondary count of prespecified font color regardless the lexical content) and Lexical-Dual (maintain secondary count of prespecified word regardless the font color). With regard to Baseline performance, we predicted an Age x Trial Type interaction in which older adults would be selectively impaired on Incongruent trials compared to younger adults, and this prediction was supported. When we added secondary task demands, we predicted a Trial Type x Dual-Task Type interaction in which performance in the Lexical-Dual condition would be worse than performance in the Color-Dual condition. This prediction was also supported, suggesting that having a secondary task that activated the irrelevant stream of information required more inhibitory control. Finally, we also predicted that Age would interact with Trial Type and Dual-Task Type, which was partially supported in response latencies and more definitively supported in error rates. Overall, our results indicate that Stroop performance is differentially influenced by additional dual-task demands that potentially minimize strategy usage, which has implications for both young and older adult Stroop performance.

Exercise as a substitute for traditional airway clearance in cystic fibrosis: a systematic review

BACKGROUND

Exercise and traditional airway clearance techniques (ACTs) are both routinely recommended for people with cystic fibrosis (CF), with some people using exercise as a substitute for traditional ACTs. The effectiveness of this is unclear. We systematically reviewed the evidence for using exercise as a substitute for traditional ACTs in people with CF.

METHODS

A systematic database and literature search were undertaken of studies comparing exercise to rest or traditional ACTs. Primary outcomes were respiratory function, respiratory exacerbations and health-related quality of life. Secondary outcomes included mucociliary clearance (MCC), sputum weight and ease of expectoration. Data are mean difference (95% CI).

RESULTS

A total of 12 studies (15 reports) were included, all of short duration (single session to 2 weeks). In crossover trials, exercise did not improve forced expiratory volume in one second in comparison to rest, but peak expiratory flow was increased during treadmill exercise (mean difference (MD) range 1.00-1.16 L/s) and cycle ergometry (1.19 (0.96 to 1.42) L/s). Treadmill exercise improved MCC (2.6 (1.6 to 3.6)%) and ease of expectoration (MD range 1.3-1.8 cm) compared with rest. No consistent differences in respiratory function were evident when exercise was compared with traditional ACTs (four crossover studies). There was no significant difference in MCC or sputum weight in studies where forced expirations were included in the exercise intervention.

CONCLUSIONS

Exercise improves ease of expectoration and sputum clearance compared with rest. Exercise, incorporating forced expirations, may have similar effects to traditional ACTs over the short term. There are no data comparing exercise to traditional ACTs over the longer term.

PROSPERO REGISTRATION NUMBER

CRD42018102780.

Prefrontal Cortex Hemodynamics During Exercise in Older Adults With Motoric Cognitive Risk Syndrome

The motoric cognitive risk syndrome (MCR) is a recently described pre-dementia syndrome in older adults characterized by slow gait coupled with subjective cognitive complaints. While previous studies have demonstrated the benefits of exercise on cerebral hemodynamics in healthy older adults, to date, no study has characterized the effects of exercise on these parameters among more vulnerable older persons with MCR. To address this knowledge gap, we investigated how the brain area responsible for high-order cognitive function (i.e., prefrontal cortex) is affected during acute cycling exercise in 19 older adults with MCR (Age (mean ± SD): 73.7 ± 7.1 years; BMI: 32.1 ± 5.5 kg/m2; gait speed: 0.55 ± 0.1 m/s; Modified Mini-Mental score: 91.8 ± 6.8; 74% female). Participants performed an incremental submaximal cycling test and we used functional near-infrared spectroscopy to assess changes in concentrations of Oxyhemoglobin (O2Hb), Deoxyhemoglobin (dHb) and total hemoglobin (Hbt) during exercise. Results showed that participants cycled for 4.9 ± 0.5 minutes, achieved a submaximal load of 54.7 ± 17.3 watts, a peak exercise heart rate of 95.7 ± 14.7 beats/min and a rate of perceived exertion (13.8 ± 2.0). Compared to baseline, there was an increase of 97.3 % in the O2Hb, 86 % on the Hbt and an 87.9 decrease of dHb while exercising. Our findings suggest that acute exercise at light through moderate intensity increases prefrontal cortex oxygenation in older adults with MCR. Additional studies are also warranted to characterize the effects of chronic exercise on cerebral hemodynamics in at-risk older adults.

Development of a device to measure adherence and pressure characteristics of positive expiratory pressure therapies used by adults with cystic fibrosis

Introduction: Positive expiratory pressure (PEP) and oscillating positive expiratory pressure (OscPEP) therapies are often used by people with cystic fibrosis (CF) to facilitate airway clearance. However, suboptimal adherence and poor technique may reduce their effectiveness.Objective: To develop a device (PEPtrac) to accurately measure and provide preliminary clinical data of adherence and technique characteristics when airway clearance is performed using PEP/OscPEP devices.Methods: This study comprised two distinct phases: 1) a benchtop validation study; and 2) clinical study. Benchtop study: Accuracy of PEPtrac was measured by comparing it to video analysis for five different PEP/OscPEP devices. Clinical study: Clinical data were then collected for 18 adults with CF using one of three PEP/OscPEP devices (PariPEP S®, Acapella DH® or Aerobika®) unsupervised.Results: There was 100% agreement between PEPtrac and video analysis data. Clinical data revealed significant variability in expiratory duration and pressure properties between the three PEP/OscPEP devices and between participants. For example, expiratory duration with PariPEP S® (mean [SD] = 4.8 [1.2] sec) was longer (p < .001) than Acapella DH® (3.7 [0.8] sec) and Aerobika® (2.9 [1.1] sec) and Aerobika® had a higher oscillation amplitude than Acapella DH® (6.4 [1.7] vs 5.3 [1.5] cmH₂O, p < .001).Discussion: Accurate measurement of PEP/OscPEP adherence and technique using a device such as PEPtrac was possible. Further research is required to investigate the clinical importance of the variability in technique seen in our clinical data.

Caregiver Satisfaction with a Video Telehealth Home Safety Evaluation for Dementia

Family caregivers are vital to telehealth-delivered dementia care. The objective of this mixed methods descriptive study conducted in the VA Bedford Healthcare System was to examine caregiver satisfaction with a video telehealth dementia home safety occupational therapy evaluation. Ten caregivers of Veterans with dementia participated. Ratings of caregiver satisfaction, measured by nine Likert scale items including ability to see and hear, were examined in relation to person and visit-related contextual factors extracted from research assistants' field notes, to develop an in-depth understanding of caregiver experience. Person factors included caregiver age and gender and Veteran cognitive status. Visit-related contextual factors included occurrence of technical glitches. Caregiver visit satisfaction was overall positive, with exceptions related to technological glitches and the presence of the person with dementia during the visit. Veteran cognitive status appeared to influence caregiver satisfaction. Implications of the study are that proactively addressing technical glitches and incorporating dementia stage-specific approaches may optimize caregivers' telehealth experience.

Effects of Cognitive Over Postural Demands on Upright Standing Among Young Adults

A growing body of research has shown that static stance control (e.g., body sway) is influenced by cognitive demands (CD), an effect that may be related to competition for limited central resources. Measures of stance control have also been impacted by postural demands (PD) (e.g., stable vs. unstable stances). However, less is known of any possible interactions between PD and CD on static stance control in populations with intact balance control and ample cognitive resources, like young healthy adults. In this study, among the same participants, we factorially compared the impact of PD with and without CD on static stance control. Thirty-four healthy young adults wore inertial measurement units (IMU) while completing static stance tasks for 30 seconds in three different PD positions: feet apart, feet together, and tandem feet. After completing these tasks alone, participants performed these tasks with CD by concurrently completing verbal serial seven subtractions from a randomly selected three-digit number. For two dependent measures, path length and jerk, there were main effects of CD and PD but no interaction effect between these factors. For all other stance control parameters, there was only a PD main effect. Thus, adding a cognitive demand to postural demands, while standing upright, may have an independent impact on stance control, but CD does not seem to interact with PD. These results suggest that young healthy adults may be less sensitive to simple PD and CD due to their greater inherent balance control and available cognitive resources. Future work might explore more complex PD and CD combinations to determine the boundaries under which young adults' resources are taxed.

Use of Video Telehealth to Serve Geriatric Veterans: A National Survey of Veterans Health Administration OT Practitioners

Date Presented 03/27/20

Little is known about utilization of video telehealth with older clients by OT practitioners. Of 322 OT practitioners at the Veterans Health Administration participating in a web-based survey, 41% use video telehealth with older clients. The primary facilitator reflected practitioner attitudes, while the primary barrier was institutional. Findings highlight key person-level and system-level factors in implementation of video telehealth for older clients.

Primary Author and Speaker: Megan Gately

Additional Authors and Speakers: Tickle-Degnen Linda, Keren Ladin, Lauren Moo

Contributing Authors: Ward Nathan

Exploring Utilization and Need of Driving Rehabilitation Among a National Sample of Community-Dwelling Older Adults

Date Presented 03/26/20

This descriptive, cross-sectional study aims to characterize current need and utilization of driver rehabilitation services among a nationally representative sample of community-dwelling older adults. Overall findings suggest that the need for driver rehabilitation services is unmet within this population. Results from this study provide empirical evidence to support future OT practice and policy recommendations to improve older adult community mobility and participation.

Primary Author and Speaker: Elizabeth Marfeo

Contributing Authors: Amelia Coffey, Nathan Ward

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

NUTRITIONAL RISK STATUS, DIETARY INTAKE AND COGNITIVE PERFORMANCE IN OLDER ADULTS WITH MOTORIC COGNITIVE RISK SYNDROME

Background

Modifiable lifestyle factors such as diet are associated with cognitive decline and dementia. Greater understanding of the nutritional intake of older adults who are at increased risk for cognitive decline may allow for the development of more effective dietary interventions to prevent or delay the onset of dementia.

Objectives

The purpose of this study was to characterize the nutritional status, diet quality and individual nutritional components of older adults with motoric cognitive risk syndrome (MCR). MCR is a pre-dementia syndrome classified by slow gait speed and subjective memory impairments.

Design

Cross-sectional analysis.

Setting

A community-based senior center located in an urban setting.

Participants

Twenty-five community-dwelling older adults with MCR aged 60-89 yrs.

Measurements

Nutritional risk status was determined using the Nestle Mini Nutritional Assessment (MNA). A food frequency questionnaire was used to quantify: overall dietary quality using the Healthy Eating Index (HEI); adherence to the Mediterranean-DASH for Neurodegenerative Delay (MIND) dietary pattern; and intake of individual nutritional components shown to be protective or harmful for cognitive function in older adults. Participants completed a computerized cognitive testing battery to assess cognitive abilities.

Results

More than one third (36%) of participants were at increased risk for malnutrition. Participants at lower risk for malnutrition had better working memory (r = 0.40, p = 0.04), executive functioning (r = 0.44, p = 0.03), and overall cognition (r = 0.44, p = 0.03). While participants generally consumed a reasonable quality diet (HEI = 65.15), 48% of participants had poor adherence to a neuroprotective MIND dietary pattern. Higher intake of B-complex vitamins was associated with better task switching (r = 0.40, p ≤ 0.05) and faster processing speeds (r = 0.39, p ≤ 0.05). Higher vitamin C intake was associated with better executive functioning (r = 0.40, p ≤ 0.05).

Conclusions

Our findings suggest that a significant proportion of older adults with MCR may be at increased risk for malnutrition. While the diet quality of older adults with MCR appeared to need improvement, future studies should investigate the effects of more specific nutritional interventions, including the MIND diet, on cognition in at-risk older adults.

A web-based intervention to promote physical activity in adolescents and young adults with cystic fibrosis: protocol for a randomized controlled trial

BACKGROUND

Regular participation in physical activity by people with cystic fibrosis (CF) promotes positive clinical and health outcomes including reduced rate of decline in lung function, fewer hospitalizations and greater wellbeing. However adherence to exercise and activity programs is low, in part due to the substantial daily therapy burden for young people with CF. Strict infection control requirements limit the role of group exercise programs that are commonly used in other clinical groups. Investigation of methods to promote physical activity in this group has been limited. The Active Online Physical Activity in Cystic fibrosis Trial (ActionPACT) is an assessor-blinded, multi-centre, randomized controlled trial designed to compare the efficacy of a novel web-based program (ActivOnline) compared to usual care in promoting physical activity participation in adolescents and young adults with CF.

METHODS

Adolescents and young adults with CF will be recruited on discharge from hospital for a respiratory exacerbation. Participants randomized to the intervention group will have access to a web-based physical activity platform for the 12-week intervention period. ActivOnline allows users to track their physical activity, set goals, and self-monitor progress. All participants in both groups will be provided with standardised information regarding general physical activity recommendations for adolescents and young adults. Outcomes will be assessed by a blinded assessor at baseline, after completion of the intervention, and at 3-months followup. Healthcare utilization will be assessed at 12 months from intervention completion. The primary outcome is change in moderate-to-vigorous physical activity participation measured objectively by accelerometry. Secondary outcomes include aerobic fitness, health-related quality of life, anxiety and depression and sleep quality.

DISCUSSION

This trial will establish whether a web-based application can improve physical activity participation more effectively than usual care in the period following hospitalization for a respiratory exacerbation. The web-based application under investigation can be made readily and widely available to all individuals with CF, to support physical activity and exercise participation at a time and location of the user's choosing, regardless of microbiological status.

TRIAL REGISTRATION

Clinical trial registered on July 13, 2017 with the Australian and New Zealand Clinical Trials Register at (ACTRN12617001009303).

Building the multitasking brain: An integrated perspective on functional brain activation during task-switching and dual-tasking

Multitasking behavior is associated with well-known performance costs, but the question of why individuals falter when attempting to manage multiple streams of information remains difficult to answer. One reason for this difficulty may be that multitasking costs are often characterized by isolating component processes that are studied largely independently. In this study, we instead integrate two commonly studied substrates of multitasking, task-switching and dual-tasking, within the same procedural context. This method allows not only a direct comparison of performance costs associated with different demand types but also examination of their interaction. We measured functional brain activation in thirty healthy young adults as they completed a block-design version of the task, observing consistent and separable patterns of frontoparietal activation as a function of demand type. Broadly, task-switching was associated with activation of left premotor and inferior parietal regions, and dual-tasking was associated with activation in regions of right prefrontal and inferior parietal cortex. In the interaction condition, we observed a distributed bilateral pattern of activation across the areas associated with each demand in isolation. These results provide both behavioral and neuroimaging evidence that task-switching and dual-tasking demands can be dissociated and contribute to multitasking costs in unique and separable ways.

Modulating Applied Task Performance via Transcranial Electrical Stimulation

Basic and applied research are increasingly adopting transcranial electrical stimulation (tES) for modulating perceptual, cognitive, affective, and motor processes. Industry and defense applications of tES hold potential for accelerating training and knowledge acquisition and sustaining work-related performance in the face of fatigue, workload, and stress. This mini-review article describes the promises and perils of tES, and reviews research testing its influence on two broad applied areas: sustaining and dividing attention, and operating in virtual environments. Also included is a discussion of challenges related to viable mechanistic explanations for tES effectiveness, attempts at replication and consideration of null results, and the potential importance of individual differences in predicting tES influences on human performance. Finally, future research directions are proposed to address these challenges and help develop a fuller understanding of tES viability for enhancing real-world performance.

Exercise as a therapeutic intervention for people with cystic fibrosis

INTRODUCTION

The complex multisystem nature of cystic fibrosis (CF) commonly results in reduced exercise tolerance, which is independently associated with poor clinical outcomes. Exercise is routinely recommended as part of the therapeutic regimen in CF to improve both respiratory and non-respiratory impairments. Areas covered: This article summarises the most recent evidence regarding the use of exercise as a therapeutic intervention in CF and discusses some of the practical considerations for exercise prescription in this setting. Clinical trials in progress and future research priorities are outlined. Expert opinion: On the balance of available evidence, exercise is likely to assist in improving physical fitness and health-related quality of life (HRQOL) and may be associated with a slower rate of decline in respiratory function in CF. Limitations to current studies include small sample sizes, study durations insufficient to achieve a training effect and difficulty distinguishing the effects of exercise training from that of other interventions implemented as part of a package of care. Larger, multi-centred trials are required to clarify the role of exercise in CF in improving physical fitness, respiratory function, HRQOL, as a substitute for traditional airway clearance techniques and in the management of common CF-related comorbidities.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Exercise is commonly used as a substitute for traditional airway clearance techniques by adults with cystic fibrosis in Australia: a survey

QUESTIONS

What airway clearance techniques and exercise regimens are used by adults with cystic fibrosis (CF) in Australia when well or unwell? What proportion of these adults believe that exercise can be used as a substitute for traditional airway clearance techniques, and how have they come to this belief? What type of exercise is used as a substitute for traditional airway clearance techniques?

DESIGN

Cross-sectional survey at 13 CF centres in Australia, using a purpose-designed questionnaire.

PARTICIPANTS

Six hundred and ninety-two adults with CF completed the questionnaire.

OUTCOME MEASURES

The questionnaire included questions about: the participants' current use of traditional airway clearance techniques and exercise, when well and unwell; and beliefs regarding the use of exercise as a substitute for traditional airway clearance techniques.

RESULTS

Coughing, huffing and positive expiratory pressure were the most commonly used airway clearance techniques. Walking, jogging and lifting weights were the most commonly used forms of exercise. Overall, 43% of participants believed that exercise could be used as a substitute for traditional airway clearance techniques, with 44% having substituted exercise for traditional airway clearance techniques in the previous 3 months. Personal experience was the most commonly reported factor influencing participants' beliefs about the use of exercise as a substitute for traditional airway clearance techniques.

CONCLUSION

Exercise is commonly used as a substitute for traditional airway clearance techniques. Physiotherapists should advise patients that whilst there is some research suggesting a possible mechanism for exercise as a form of airway clearance, there are currently no medium-term to long-term data supporting exercise as a stand-alone form of airway clearance. These results suggest that future research to investigate the clinical effectiveness of exercise as a substitute for traditional airway clearance techniques should be a priority.

REGISTRATION

ACTRN12616000994482.