High Levels Of Stimulation Research Articles

The relationship between mental stimulation level of life events and suicide attempt of rural residents in Shandong Province

Objective: To explore the relationship between the level of mental stimulation and the suicide attempts of rural residents in Shandong Province. Methods: A 1:1 matched case-control study was designed to collect 1 200 cases from a survey of three suicide attempts in rural areas of Shandong Province. Controls were selected according to the following matched factors: age difference within 3 years, same gender, same village or neighboring village, no blood relationship, no suicide history. The basic characteristics of all subjects were collected through the questionnaire, and the level of mental stimulation of life events was measured. Multivariate conditional logistic regression model was used to analyze the relationship between the level of mental stimulation of life events and suicide attempts. Results: The mean age of the case group and the control group was both (36.6±0.3) years old, and 35.8% (430/1 200) were males in each group. The low-medium level of mental stimulation of negative life events in the case group was 16.7% (200/1 200) and 61.7% (740/1 200), respectively, which was higher than that in the control group, about 2.5% (30/1 200) and 29.3% (352/1 200) (all P values <0.05), respectively. A total of 11.1% (133/1 200) of the case group had positive life events, which was lower than that of the control group [16.8% (201/1 200)] (all P values<0.05). Multivariate logistic regression model analysis showed that after the adjustment of gender, age, place of residence, education level, marital status, occupation, family income, somatic disease, mental disorders, family history of suicide, and opposite life events, the low-medium and high level of mental stimulation of negative life events were risk factors for suicide attempts, with OR (95%CI) as 5.88 (4.53-7.64) and 13.94 (8.15-23.86), respectively. Mental stimulation of positive life events was protective factor of suicide attempts, with OR (95%CI) as 0.58 (0.41-0.82). Conclusion: Mental stimulation of negative and positive life events were risk and protective factors for suicide attempts.

Combining TruCulture and OptiMAP to Profile Human Immune Immunity

Abstract TruCulture® is a whole blood collection and culture system designed for use at clinical sites. TruCulture outperforms traditional peripheral blood mononuclear cell (PBMC) culturing methods, with improved reproducibility and higher levels of stimulation (Duffy et. al. Clinical Immunology 2017). The TruCulture proprietary culture medium ensures minimal non-specific immune activation, delivering a steady baseline and decreased variation during stimulating parameters. OptiMAP is a multiplex immunoassay panel that measures 13 cytokines of the major immune response pathways (TH1, TH2, TH17, and monocyte/macrophage). Using TruCulture and OptiMAP, we analyzed healthy donor whole blood responses to common stimulants: T cell activators, TLR agonists, and superantigens. The subjects ranged from 24 to 70 years old and consisted of 48% males and 52% females. The results indicated that healthy donors responded similarly to stimulation with anti-CD3/CD28 and Staphylococcal enterotoxin type B (SEB) in production of T cell cytokines (IFN-γ, IL-2, and IL-17). Response to SEB is positively correlated to the monocyte population in whole blood. T cell responses to SEB and CytoStim (an antibody based alternative to SEB) are similar in production of IFN-γ and IL-17, but CytoStim had a reduced stimulation of IL-2. All healthy donors responded to a TLR-4 agonist (LPS) by producing high levels of TNF-α, IL- 6, and IL-1β. LPS stimulated production of IFN-γ was similar to SEB, most likely due to bystander activation. The TLR-7 agonist (gardiquimod, GDQ) stimulated IL-10 levels at a level comparable to LPS. These data illustrate the utility of combining TruCulture and OptiMAP to investigate human immune stimulation pathways for clinical research.

Levels of mathematical performance in preschoolers [Nivel de rendimiento matemático en preescolares

The objective of this research was to determine the level of Mathematical Thought Development that children of five years present. The focus of the research was quantitative of basic type, the simple descriptive method with a non-experimental cross-sectional design was used. The population consisted of 80 children where non-probabilistic sampling was carried out. For data collection, an observation form used as an instrument was applied. The validity of the instrument was made through expert judgments with an approved - applicable result and the reliability was determined through Cronbach alpha. Subsequently, the collected data were processed in the database of the SPSS program. Finally, the results were 64.10% of the children of 5 years are in a process level, while 20.51% is in a level of initiation and 15.38% in the level of achievement, consequently, the predominant level is the process level, which implies raising a higher level of stimulation and reinforcement in order to develop mathematical thinking in the vast majority of children.

Auditory brainstem response (ABR) findings in males and females with comparable head sizes at supra-threshold and threshold levels

Background and purposeGender disparities in auditory brainstem response (ABR) results have been reported but the exact reasons remain controversial. Difference in head size between genders has been suggested but the literature is lacking, particularly at threshold levels. In this short communication, we compared ABR results between males and females with comparable head sizes at supra-threshold and threshold levels. Materials and methodsIn this comparative study, of 58 healthy young adults, 30 of them (17 females and 13 males) with comparable head sizes underwent the standard ABR testing. Wave V latencies and ABR thresholds were determined and analyzed accordingly. ResultsAt the supra-threshold level, significantly shorter wave V latencies were found in females than in males (p = 0.029). This difference was substantive (d = 0.86) and persisted even when the head size was included in the analysis (p = 0.032). In contrast, no significant differences in ABR thresholds were found between genders (p > 0.05). ConclusionsSignificant gender differences in ABR results among young adults were only found at the supra-threshold level, which were not related to the head size. Based on the study outcomes, gender-specific normative data for ABR are still beneficial for clinical applications, particularly when recording ABR at high stimulation levels.

Noradrenergic α1-Adrenoceptor Actions in the Primate Dorsolateral Prefrontal Cortex.

Noradrenergic (NE) α1-adrenoceptors (α1-ARs) contribute to arousal mechanisms and play an important role in therapeutic medications such as those for the treatment of posttraumatic stress disorder (PTSD). However, little is known about how α1-AR stimulation influences neuronal firing in the dorsolateral prefrontal cortex (dlPFC), a newly evolved region that is dysfunctional in PTSD and other mental illnesses. The current study examined the effects of α1-AR manipulation on neuronal firing in dlPFC of rhesus monkeys performing a visuospatial working memory task, focusing on the "delay cells" that maintain spatially tuned information across the delay period. Iontophoresis of the α1-AR antagonist HEAT (2-{[β-(4-hydroxyphenyl)ethyl]aminomethyl}-1-tetralone) had mixed effects, reducing firing in a majority of neurons but having nonsignificant excitatory effects or no effect in remaining delay cells. These data suggest that endogenous NE has excitatory effects in some delay cells under basal conditions. In contrast, the α1-AR agonists phenylephrine and cirazoline suppressed delay cell firing and this was blocked by coadministration of HEAT. These results indicate an inverted-U dose response for α1-AR actions, with mixed excitatory actions under basal conditions and suppressed firing with high levels of α1-AR stimulation such as with stress exposure. Immunoelectron microscopy revealed α1-AR expression presynaptically in axons and axon terminals and postsynaptically in spines, dendrites, and astrocytes. It is possible that α1-AR excitatory effects arise from presynaptic excitation of glutamate release, whereas postsynaptic actions suppress firing through calcium-protein kinase C opening of potassium channels on spines. The latter may predominate under stressful conditions, leading to loss of dlPFC regulation during uncontrollable stress.SIGNIFICANCE STATEMENT Noradrenergic stimulation of α1-adrenoceptors (α1-ARs) is implicated in posttraumatic stress disorder (PTSD) and other mental disorders that involve dysfunction of the prefrontal cortex, a brain region that provides top-down control. However, the location and contribution of α1-ARs to prefrontal cortical physiology in primates has received little attention. This study found that α1-ARs are located near prefrontal synapses and that α1-AR stimulation has mixed effects under basal conditions. However, high levels of α1-AR stimulation, as occur with stress, suppress neuronal firing. These findings help to explain why we lose top-down control under conditions of uncontrollable stress when there are high levels of noradrenergic release in brain and why blocking α1-AR, such as with prazosin, may be helpful in the treatment of PTSD.

Could the high consumption of high glycaemic index carbohydrates and sugars, associated with the nutritional transition to the Western type of diet, be the common cause of the obesity epidemic and the worldwide increasing incidences of Type 1 and Type 2 diabetes?

The globally increasing incidences of Type 1 diabetes (T1DM) and Type 2 diabetes (T2DM) can have a common background. If challenged by the contemporary high level of nutritional glucose stimulation, the β-cells in genetically predisposed individuals are at risk for damage which can lead to the diseases. The fat to carbohydrate dietary shift can also contribute to the associated obesity epidemic.

Differential involvement of D2 and D3 receptors during reinstatement of cocaine-seeking behavior in the Roman high- and low-avoidance rats.

Roman high- (RHA) and low-avoidance (RLA) rats have been used as a model for drug-addiction, showing, respectively, high- and low-responding to psychostimulants, and low versus high dopamine D2/3 receptors (D2/3R) striatal density. Previous studies indicated a major involvement of D2/3R on reinstatement of cocaine seeking, although the respective role of the two receptor subtypes is not clear. Here, we investigated sensitivity to cocaine self-administration (SA) through a dose-response protocol in RHAs and RLAs, and reinstatement of drug-seeking behavior at 15 days and 5 weeks following withdrawal. Compared to RLAs, RHAs confirmed a higher vulnerability to cocaine SA that was not related to a difference in sensitivity to the drug, as highlighted by the dose-response analysis. Both at early and late withdrawal, RHAs showed higher susceptibility than RLAs to reinstatement of drug-seeking when cocaine was used as a primer, but the two sublines did not differ when primed with the D2/3R agonist quinpirole. Moreover, while the specific D2R antagonist L741,626 blocked, the specific D3R antagonist SB-277011A failed to impair cocaine-primed relapse. The higher vulnerability of RHA versus RLA rats to cocaine-primed relapse, which contrasts with their similar vulnerability to quinpirole-primed relapse, suggests that the different propensity of both sublines to relapse likely relies on presynaptic rather than postsynaptic mechanisms. Moreover, our study challenges the involvement of D3R in the mechanisms underlying relapse to cocaine addiction, at least in conditions that may involve high levels of dopaminergic stimulation, and supports a major role of postsynaptic D2R over D3R in the vulnerability to relapse. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Air-Conducted Vestibular Evoked Myogenic Potential Testing in Children, Adolescents, and Young Adults: Thresholds, Frequency Tuning, and Effects of Sound Exposure.

Pediatric vestibular evaluations incorporate cervical and ocular vestibular evoked myogenic potential (c- and oVEMP, respectively) testing; however, in children, c- and oVEMP thresholds have been minimally investigated and frequency tuning is unknown. Children are also at risk for unsafe sound exposure secondary to VEMP. While it is unknown if VEMP threshold testing leads to cochlear changes, it is possible that this risk increases due to the increased number of trials needed to obtain a threshold. Obtaining VEMP thresholds at various frequencies in children provides further information for pediatric normative VEMP data. Assessing for cochlear changes after VEMP threshold testing would provide information on the safety of threshold VEMP testing in children. The objectives of this study were to (1) characterize c- and oVEMP thresholds in children, adolescents, and young adults with normal hearing using 500 and 750 Hz tone burst (TB) stimuli, (2) compare frequency tuning of 500 and 750 Hz TB, and (3) assess whether cochlear changes exist after VEMP threshold testing. It is hypothesized that children, adolescents, and young adults would not show age-related changes to the vestibular system. Therefore, reliable VEMP thresholds would be seen below maximum acoustical stimulation levels (e.g., <125 dB SPL) and frequency tuning will be similar for 500 and 750 Hz TB stimuli. Ten children (age 4-9), 10 adolescents (age 10-19), and 10 young adults (age 20-29) with normal hearing and tympanometry participated. All subjects received c- and oVEMP testing at maximum stimulation and threshold. To address frequency tuning, but not exceed recommended sound exposure allowance, subjects received a 500 Hz TB stimulus in one ear and a 750 Hz TB stimulus in the other ear. Subjects completed tympanometry pre-VEMP, and audiometric threshold testing, distortion product otoacoustic emission testing, and subjective questionnaire pre- and post-VEMP to study the effect of VEMP exposure on cochlear function for each stimulus frequency. (1) cVEMP thresholds were determined for both stimulus frequencies for children (500 Hz = 106 dB SPL; 750 Hz = 106 dB SPL), adolescents (500 Hz = 107.5 dB SPL; 750 Hz = 109.5 dB SPL), and young adults (500 Hz = 111.5 dB SPL; 750 Hz = 112 dB SPL). oVEMP thresholds were also obtained in response to both stimulus frequencies for children (500 Hz = 111.1 dB SPL; 750 Hz = 112.2 dB SPL), adolescents (500 Hz = 112.5 dB SPL; 750 Hz = 114.5 dB SPL), and young adults (500 Hz = 116 dB SPL; 750 Hz = 117 dB SPL). Similar thresholds were found between groups except for children who had significantly lower thresholds compared with adults for cVEMP (500 Hz: p = 0.002; 750 Hz: p = 0.004) and oVEMP (500 Hz: p = 0.01; 750 Hz: p = 0.02). In addition, equivalent ear-canal volume and VEMP thresholds were linearly correlated. (2) There was no significant effect of stimulus frequency on VEMP response rates, latencies, peak to peak amplitudes, or thresholds, suggesting similar frequency tuning for 500 and 750 Hz. (3) There were no significant effects of VEMP threshold testing on cochlear function for either stimulus frequency. Children, adolescents, and young adults show VEMP thresholds below high stimulation levels and had similar frequency tuning between 500 and 750 Hz. Use of 750 Hz could be regarded as the safer stimuli due to its shorter duration and thus reduced sound exposure. Children with smaller ear-canal volume had present responses at maximum stimulation and lower thresholds, suggesting that VEMP testing could be initiated at lower acoustic levels to minimize sound exposure and optimize testing.

Wrist tremor suppression based on repetitive control with multi-muscle electrical stimulation

Tremor is a rhythmic, alternating swing motion caused by involuntary repetition of muscle contraction and relaxation. Although it does not endanger life, it will make the work and daily life of patients difficult. Functional electrical stimulation (FES) has been shown as a promising technique for tremor suppression. Wrist motion is produced by a group of muscles in a collective and coordinate way. However, existing FES-based design methods mostly aim at one pair of muscles associated with the wrist motion, thus limiting the performance of tremor suppression. Furthermore, the possible high level of stimulation required for a single muscle pair can also accelerate muscle fatigue of the patients. To address these problems, this paper uses multiple muscles FES to suppress tremor by fully considering the properties of wrist motion. This paper develops a wrist musculoskeletal model with Hammerstein structure, identifies its parameters, and proposes repetitive controllers based on frequency modified inverse algorithm to suppress tremor. Experimental results are presented to demonstrate its advantages over single muscle stimulation based tremor suppression.

Effect of exit location on flow of mice under emergency condition**Project supported by the National Key Research and Development Program of China (Grant No. 2016YFB1200404).

The evacuation of crowds in a building has always emerged as a vital issue in many accidents. The geometrical structure of a room, especially the exit design has a great influence on crowd evacuation under emergency conditions. In this paper, the effect of exit location of a room on crowd evacuation in an emergency is investigated with mice. Two different exits are set in a rectangular chamber. One is located in the middle of a wall (middle-exit) and the other is at the corner of the chamber (corner-exit). Arching and clogging are observed in the flow of mice. The result based on the escape trajectories of mice shows a dynamic balance in the arch near the exit wherever the exit is located. We demonstrate that the occupant position in the arch has an effect on the escape sequence of mice. At a low stimulation level, the narrow middle-exit is more effective in increasing the flow rate of mice than the narrow corner-exit. However, the opposite result appears when the exit becomes wider. At a high stimulation level, the effect of exit location on flow of mice tends to be weakened. The results suggest that the specific level of stimulation needs to be taken into account when optimizing the evacuation efficiency of a crowd through the geometrical structure of a room.

Effects of altered pyruvate dehydrogenase activity on contracting skeletal muscle bioenergetics.

During aerobic exercise (>65% of maximum oxygen consumption), the primary source of acetyl-CoA to fuel oxidative ATP synthesis in muscle is the pyruvate dehydrogenase (PDH) reaction. This study investigated how regulation of PDH activity affects muscle energetics by determining whether activation of PDH with dichloroacetate (DCA) alters the dynamics of the phosphate potential of rat gastrocnemius muscle during contraction. Twitch contractions were induced in vivo over a broad range of intensities to sample submaximal and maximal aerobic workloads. Muscle phosphorus metabolites were measured in vivo before and after DCA treatment by phosphorus nuclear magnetic resonance spectroscopy. At rest, DCA increased PDH activation compared with control (90 ± 12% vs. 23 ± 3%, P < 0.05), with parallel decreases in inorganic phosphate (Pi) of 17% (1.4 ± 0.2 vs. 1.7 ± 0.1 mM, P < 0.05) and an increase in the free energy of ATP hydrolysis (ΔGATP) (-66.2 ± 0.3 vs. -65.6 ± 0.2 kJ/mol, P < 0.05). During stimulation DCA increased steady-state phosphocreatine (PCr) and the magnitude of ΔGATP, with concomitant reduction in Pi and ADP concentrations. These effects were not due to kinetic alterations in PCr hydrolysis, resynthesis, or glycolytic ATP production and altered the flow-force relationship between mitochondrial ATP synthesis rate and ΔGATP. DCA had no significant effect at 1.0- to 2.0-Hz stimulation because physiological mechanisms at these high stimulation levels cause maximal activation of PDH. These data support a role of PDH activation in the regulation of the energetic steady state by altering the phosphate potential (ΔGATP) at rest and during contraction.

Combined effects of sound and illuminance on indoor environmental perception

Cross-modal effects of sound and illuminance were investigated in an indoor environmental chamber with 60 university students (30 men and 30 women) aged 18–26 years. A within-subject factorial design was employed with four independent variables: noise level (45, 55, 65, and 75 dBA), noise type (Music, Water, Babble, and Fan), illuminance level (150, 500, and 1000 lx), and sex (female or male). The test conditions represented daily indoor environments, which was moderately noisy and did not present severe lighting conditions. Acoustic (loudness, annoyance, pleasantness, and naturalness) and visual (brightness and relaxation) semantic attributes were assessed using an 11-point numeric scale. The illuminance level of the ambient lighting system did not affect acoustic perception. Brightness was not altered by sound, but relaxation was affected by sound. Cross-modal interactions were asymmetric between sound and illuminance in indoor environmental settings. Women were more sensitive to the perception of both acoustic and illuminance stimuli than men, at high level of stimulation.

Abstract P-485: THE STRUGGLE FOR A SNOOZE IN PICU

Aims & Objectives: The primary objective was to examine overnight patient stimulation and current rest promotion practices in a tertiary care PICU. The secondary objective was to engage nurses in devising plausible strategies to optimize sleep and rest with the goal of developing a Clinical Guideline for our unit. Methods A 17-item bedside observational tool was devised with questions relating to patient demographics, acuity and presence of stimuli (lights, noise, procedures). On seven convenient nights over a six-week period, data were collected on every patient in PICU at three defined time points. Two focus groups concentrated on how PICU patients could be given the best opportunity to rest and experience restorative sleep. Results One hundred and thirty three overnight observations were collected. Most patients (70%) were infants, with an even split between cardiac and medical-surgical diagnoses. In a multivariate regression model, stimulation was associated with acuity (p<0.001) and younger age (p=0.001). Sleep promotion strategies were utilized most in high acuity patients, but still only rarely (20%). Nineteen nurses of varied experience participated in two focus groups. Themes that emerged included safety, unit culture, environment and family involvement. Conclusions All PICU patients are exposed to high levels of unprotected stimulation overnight, with younger and higher acuity patients at greatest risk. A Clinical Guideline is needed to standardize the way sleep and rest is promoted in PICU.

Hypoxia, cytokines and stromal recruitment: parallels between pathophysiology of encapsulating peritoneal sclerosis, endometriosis and peritoneal metastasis.

Peritoneal response to various kinds of injury involves loss of peritoneal mesothelial cells (PMC), danger signalling, epithelial-mesenchymal transition and mesothelial-mesenchymal transition (MMT). Encapsulating peritoneal sclerosis (EPS), endometriosis (EM) and peritoneal metastasis (PM) are all characterized by hypoxia and formation of a vascularized connective tissue stroma mediated by vascular endothelial growth factor (VEGF). Transforming growth factor-β1 (TGF-β1) is constitutively expressed by the PMC and plays a major role in the maintenance of a transformed, inflammatory micro-environment in PM, but also in EPS and EM. Persistently high levels of TGF-β1 or stimulation by inflammatory cytokines (interleukin-6 (IL-6)) induce peritoneal MMT, adhesion formation and fibrosis. TGF-β1 enhances hypoxia inducible factor-1α expression, which drives cell growth, extracellular matrix production and cell migration. Disruption of the peritoneal glycocalyx and exposure of the basement membrane release low molecular weight hyaluronan, which initiates a cascade of pro-inflammatory mediators, including peritoneal cytokines (TNF-α, IL-1, IL-6, prostaglandins), growth factors (TGF-α, TGF-β, platelet-derived growth factor, VEGF, epidermal growth factor) and the fibrin/coagulation cascade (thrombin, Tissue factor, plasminogen activator inhibitor [PAI]-1/2). Chronic inflammation and cellular transformation are mediated by damage-associated molecular patterns, pattern recognition receptors, AGE-RAGE, extracellular lactate, pro-inflammatory cytokines, reactive oxygen species, increased glycolysis, metabolomic reprogramming and cancer-associated fibroblasts. The pathogenesis of EPS, EM and PM shows similarities to the cellular transformation and stromal recruitment of wound healing.

Home- and center-based learning opportunities for preschoolers in low- and middle-income countries

Recent international development efforts have emphasized the importance of supporting early childhood development, yet little is known about the availability of early learning opportunities in low- and middle-income countries (LMICs). The present study uses nationally representative data from >163,000 three- and four-year-olds living in 63 countries to estimate the availability of in- and out-of-home early learning opportunities in LMICs. Results suggest that 71.9% of preschool-aged children experience high levels of at-home stimulation (e.g., reading, counting, drawing), 33.6% attend center-based early childhood care and education (ECCE) programming, 29.1% experience both, and 22.9% experience neither. Large geographical and socioeconomic disparities in learning opportunities were found both across and within countries, particularly for ECCE.

High STAP1 expression in DUX4-rearranged cases is not suitable as therapeutic target in pediatric B-cell precursor acute lymphoblastic leukemia

Approximately 25% of the pediatric B-cell precursor acute lymphoblastic leukemia (BCP-ALL) cases are genetically unclassified. More thorough elucidation of the pathobiology of these genetically unclassified (‘B-other’) cases may identify novel treatment options. We analyzed gene expression profiles of 572 pediatric BCP-ALL cases, representing all major ALL subtypes. High expression of STAP1, an adaptor protein downstream of the B-cell receptor (BCR), was identified in BCR-ABL1-like and non-BCR-ABL1-like B-other cases. Limma analysis revealed an association between high expression of STAP1 and BCR signaling genes. However, STAP1 expression and pre-BCR signaling were not causally related: cytoplasmic Igμ levels were not abnormal in cases with high levels of STAP1 and stimulation of pre-BCR signaling did not induce STAP1 expression. To elucidate the role of STAP1 in BCP-ALL survival, expression was silenced in two human BCP-ALL cell lines. Knockdown of STAP1 did not reduce the proliferation rate or viability of these cells, suggesting that STAP1 is not a likely candidate for precision medicines. Moreover, high expression of STAP1 was not predictive for an unfavorable prognosis of BCR-ABL1-like and non-BCR-ABL1-like B-other cases. Remarkably, DUX4-rearrangements and intragenic ERG deletions, were enriched in cases harboring high expression of STAP1.

Maternal and fetal outcomes associated with vagus nerve stimulation during pregnancy

ObjectiveTo access the effect of vagus nerve stimulation (VNS) on the outcome of pregnancy. MethodsWe used the International Registry of Antiepileptic Drugs and Pregnancy (EURAP) and its network to search for women receiving adjunctive VNS during pregnancy. Data on maternal and fetal outcomes were extracted from the registry databases and outcomes were evaluated. ResultsTwenty-six pregnancies were identified in 25 women. All women were exposed to a relative high VNS stimulation level (mean duty cycle 18%, range 5%–51%). Most women had seizures during pregnancy and almost 70% were on antiepileptic drug (AED) polytherapy. The proportion of women with obstetrical interventions was 53.9% (95% confidence interval [CI] 33.4%–73.4%) which was higher compared to the EURAP average (48.2%; 95% CI 47.2%–49.1%).One infant (3.9%; 95% CI 0.1%–19.6%) was born with a major malformation (unilateral congenital glaucoma), which is within the range expected among offspring of AED-treated women. ConclusionAlthough the present series of VNS-exposed pregnancies is the largest reported to date, the sample size is insufficient to draw any firm conclusions on the safety of VNS in pregnancy but the findings suggest an increased rate of obstetrical interventions, and no clear signal of VNS-related teratogenicity.

Regulation of Hypothalamo-Pituitary-Adrenocortical Responses to Stressors by the Nucleus of the Solitary Tract/Dorsal Vagal Complex.

Hindbrain neurons in the nucleus of the solitary tract (NTS) are critical for regulation of hypothalamo-pituitary-adrenocortical (HPA) responses to stress. It is well known that noradrenergic (as well as adrenergic) neurons in the NTS send direct projections to hypophysiotropic corticotropin-releasing hormone (CRH) neurons and control activation of HPA axis responses to acute systemic (but not psychogenic) stressors. Norepinephrine (NE) signaling via alpha1 receptors is primarily excitatory, working either directly on CRH neurons or through presynaptic activation of glutamate release. However, there is also evidence for NE inhibition of CRH neurons (possibly via beta receptors), an effect that may occur at higher levels of stimulation, suggesting that NE effects on the HPA axis may be context-dependent. Lesions of ascending NE inputs to the paraventricular nucleus attenuate stress-induced ACTH but not corticosterone release after chronic stress, indicating reduction in central HPA drive and increased adrenal sensitivity. Non-catecholaminergic NTS glucagon-like peptide 1/glutamate neurons play a broader role in stress regulation, being important in HPA activation to both systemic and psychogenic stressors as well as HPA axis sensitization under conditions of chronic stress. Overall, the data highlight the importance of the NTS as a key regulatory node for coordination of acute and chronic stress.

Filling a significant gap in the cardiac ICU: implementation of individualised developmental care.

Mortality rates among children with CHD have significantly declined, although the incidence of neurological abnormalities and neurodevelopmental impairment has increased. Research has focussed on outcomes, with limited attention on prevention and intervention. Although some developmental differences and challenges seen in children with CHD are explained by the cumulative effect of medical complications associated with CHD, many sequelae are not easily explained by medical complications alone. Although cardiac intensive care is lifesaving, it creates high levels of environmental and tactile stimulation, which potentially contribute to adverse neurodevelopmental outcomes. The therapeutic method of individualised developmental care, such as the Newborn Individualized Developmental Care and Assessment Program, provides early support and preventive intervention based on each child's behavioural signals of stress, comfort, and strength. Implementing developmental care practices in a cardiac ICU requires a thoughtful and well-planned approach to ensure successful adoption of practice changes. This paper reviews how developmental care was introduced in a paediatric inpatient cardiac service through multidisciplinary collaborative staff education, clinician support, child neurodevelopment assessment, parent support, and research initiatives. Given the known risk for children with CHD, cardiac medical professionals must shift their focus to not only assuring the child's survival but also optimising development through individualised developmental care in the cardiac ICU.

The role of cognitive stimulation at home in low-income preschoolers\u2019 nutrition, physical activity and body mass index

BackgroundEarly childhood obesity disproportionately affects children of low socioeconomic status. Children attending Head Start are reported to have an obesity rate of 17.9%.This longitudinal study aimed to understand the relationship between cognitive stimulation at home and intake of junk food, physical activity and body size, for a nationally representative sample of 3- and 4-year old children entering Head Start.MethodsWe used The Family and Child Experiences Survey 2006. Cognitive stimulation at home was measured for 1905 children at preschool entry using items from the Home Observation Measurement of the Environment Short Form. Junk food consumption and physical activity were obtained from parent interviews at kindergarten entry. BMI z scores were based on CDC national standards. We analyzed the association between early cognitive stimulation and junk food consumption, physical activity and BMI, using multinomial and binary logistic regression on a weighted sample.ResultsChildren who received moderate levels of cognitive stimulation at home had a 1.5 increase in the likelihood of consuming low amounts of junk food compared to children from low cognitive stimulation environments. Children who received moderate and high levels of cognitive stimulation were two and three times, respectively, more likely to be physically active than those in low cognitive stimulation homes. No direct relationship was identified between cognitive stimulation and BMI.ConclusionPrevention and treatment efforts to address early childhood obesity may consider strategies that support parents in providing cognitively stimulating home environments. Existing evidence-based programs can guide intervention in pediatric primary care.