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Issue Addressed: Physical inactivity is a leading risk factor for disease burden and premature mortality. Interventions to increase physical activity are common, though few examples of multi-strategy, wide-scale community programs exist. Active Launceston is a community-wide program aimed at improving health and well-being through physical activity. We report on the process evaluation of Active Launceston and changes in community physical activity participation between 2008 and 2015, as a measure of program effectiveness., Methods: Mixed-method evaluation of Active Launceston combined process evaluation-consisting of participant numbers, socio-demographic characteristics, campaign awareness, focus groups and stakeholder interviews-with impact evaluation consisting of a random-sample cross-sectional serial telephone survey., Results: Active Launceston attracted 11 887 attendees, participating in 30 342 sessions, amounting to 38 088 hours of physical activity between 2008 and 2015. Participant focus groups highlighted benefits including increased engagement in exercise, better health and social connectedness. While telephone surveys found the proportion of people participating in any physical activity in the last 12 months to be similar between the 3 years (2008, 77.7%; 2012, 77.1%; 2015, 73.6%), a higher proportion participated in vigorous physical activity in 2012 and 2015 compared to 2008 (P < 0.01), when adjusting for age and gender differences. A higher proportion also achieved sufficient activity for health in 2015 compared to 2008 (P = 0.01)., Conclusions: Mixed-method evaluation suggests Active Launceston is an effective community-wide program supporting community members to engage in regular physical activity and increase levels of social engagement. SO WHAT?: This work provides a model for implementing high-reach, community-wide interventions that improve physical activity outcomes., (© 2019 Australian Health Promotion Association.)

Objectives: The aim of the study was to summarize short-term effectiveness, safety, and cost of using infliximab biosimilar (IFX-B) drugs, (Inflectra [Hospira] and Remsima [NAAP]) compared to originator infliximab (IFX-O) (Remicade [MSD]) in biologic naive pediatric inflammatory bowel disease in the United Kingdom., Methods: Prospective audit of patients starting anti-tumour necrosis factor (TNF) therapy. Disease severity, response to treatment, and remission rate was measured by Pediatric Crohn's Disease Activity Index (PCDAI) and/or Physician Global Assessment., Results: Between March 2015 and February 2016, 278 patients (175 IFX-O, 82 IFX-B, and 21 Adalimumab) were started on anti-TNF therapy. This was compared with collected data on 398 patients started on IFX-O from 2011 to 2015. At initiation, median PCDAI was 36 (20,48) (n = 42) in the IFX-O group and 28 (20,40) (n = 29) in the IFX-B group, (P = 0.08). Immunosuppression rates were similar: 150/175 (86%) for IFX-O and 65/82 (79%) for IFX-B (P > 0.05). Post induction, median PCDAI score was 5 (0,11) (n = 19) and 0 (0,8) (n = 15) in the IFX-O and IFX-B groups, respectively (P = 0.35). There was no difference in response to treatment using Physician Global Assessment 85% (n = 28) in IFX-O group and 86% (n = 19) in IFX-B group (P > 0.05). Adverse events at initiation and post induction were not different between both groups (P > 0.05). Using conservative calculations, £875,000 would have been saved for a 1-year period with universal adoption of biosimilars in patients who were instead treated with IFX-O., Conclusions: IFX-B is likely as effective as IFX-O in treating IBD in comparable pediatric populations. Sites should adopt infliximab biosimilar for new starts due to cost reduction with no difference in other parameters.

Background: Deep brain stimulation (DBS) of the human entorhinal area using 50 Hz pulses has revealed conflicting results regarding memory performance. Moreover, its impact on memory-related hippocampal potentials has not yet been investigated., Methods: We recorded data from seven epilepsy patients implanted with depth electrodes in the entorhinal cortex, hippocampus, amygdala, and parahippocampal cortex. Entorhinal DBS (bipolar, biphasic 50 Hz pulses, on- and off-cycles of 15 s) was applied with low amplitude (0.1 mA) to resemble physiologic conditions. During DBS on- and off-periods, patients learned noun-color associations that were later tested., Results: During entorhinal DBS we observed more positive deflections of event-related potentials (ranging from 700 to 950 ms) in the anterior hippocampus for the on- vs. off-condition. We detected no effects in the amygdala, mid hippocampus and parahippocampal cortex. On the behavioral level, no differences in memory performance (item and source memory) were apparent in the on- vs. off-condition, neither across all trials nor across patients., Discussion: Our findings indicate that entorhinal DBS with low amplitude has an impact on memory encoding-related potentials within the anterior hippocampus, but not on memory performance per se., (© 2017 Wiley Periodicals, Inc.)

The incidence of Crohn disease (CD) has been increasing and surgery needs to be contemplated in a substantial number of cases. The relevant advent of biological treatment has changed but not eliminated the need for surgery in many patients. Despite previous publications on the indications for surgery in CD, there was a need for a comprehensive review of existing evidence on the role of elective surgery and options in pediatric patients affected with CD. We present an expert opinion and critical review of the literature to provide evidence-based guidance to manage these patients. Indications, surgical options, risk factors, and medications in pre- and perioperative period are reviewed in the light of available evidence. Risks and benefits of surgical options are addressed. An algorithm is proposed for the management of postsurgery monitoring, timing for follow-up endoscopy, and treatment options.

Drawing inferences from past experiences enables adaptive behavior in future situations. Inference has been shown to depend on hippocampal processes. Usually, inference is considered a deliberate and effortful mental act which happens during retrieval, and requires the focus of our awareness. Recent fMRI studies hint at the possibility that some forms of hippocampus-dependent inference can also occur during encoding and possibly also outside of awareness. Here, we sought to further explore the feasibility of hippocampal implicit inference, and specifically address the temporal evolution of implicit inference using intracranial EEG. Presurgical epilepsy patients with hippocampal depth electrodes viewed a sequence of word pairs, and judged the semantic fit between two words in each pair. Some of the word pairs entailed a common word (e.g., "winter-red," "red-cat") such that an indirect relation was established in following word pairs (e.g., "winter-cat"). The behavioral results suggested that drawing inference implicitly from past experience is feasible because indirect relations seemed to foster "fit" judgments while the absence of indirect relations fostered "do not fit" judgments, even though the participants were unaware of the indirect relations. A event-related potential (ERP) difference emerging 400 ms post-stimulus was evident in the hippocampus during encoding, suggesting that indirect relations were already established automatically during encoding of the overlapping word pairs. Further ERP differences emerged later post-stimulus (1,500 ms), were modulated by the participants' responses and were evident during encoding and test. Furthermore, response-locked ERP effects were evident at test. These ERP effects could hence be a correlate of the interaction of implicit memory with decision-making. Together, the data map out a time-course in which the hippocampus automatically integrates memories from discrete but related episodes to implicitly influence future decision making., (© 2015 Wiley Periodicals, Inc.)

Recent findings suggest that repetition effects interact with episodic memory processes that are putatively supported by the hippocampus. Thus, the formation or refinement of episodic memories may be related to a modulating signal from the hippocampus to the neocortex which leads to sparser or more extended stimulus representations (repetition suppression or enhancement), depending on the type of stimulus and the brain site. This framework suggests that hippocampal activity during the initial presentation of a stimulus correlates with the magnitude of repetition effects. Here, we tested this hypothesis in an fMRI study in which associations between faces and buildings were presented twice. BOLD responses showed repetition suppression in fusiform face area (FFA) and parahippocampal place area (PPA), most likely due to a refinement of existing category representations. Hippocampal activity during the first presentations was correlated with the amount of repetition suppression, in particular in the FFA. Repetition enhancement effects were observed on BOLD responses in posterior parietal cortex, possibly related to the formation of new representations of associative stimuli. The magnitude of parietal BOLD repetition effects depended on successful memory formation. These findings suggest that both repetition enhancement and repetition suppression effects are influenced by a modulating signal from the hippocampus., (© 2014 Wiley Periodicals, Inc.)

Combined immunosuppression by immunomodulators and biological therapy has become standard in the medical management of moderate-to-severe inflammatory bowel disease (IBD) because of clearly demonstrated efficacy. Clinical studies, registries, and case reports warn of the increased risk of infections, particularly opportunistic infections; however, already in the steroid monotherapy era, patients are at risk because it is accepted that a patient should be considered immunosuppressed when receiving a daily dose of 20 mg of prednisone for 2 weeks. Prescriptions increasingly involve azathioprine, methotrexate, and various biological agents. The TREAT registry evaluated safety in >6000 adult patients, half of them treated with infliximab (IFX) for about 1.9 years. IFX-treated patients had an increased risk of infections and this was associated with disease severity and concomitant prednisone use. The REACH study, evaluating the efficacy of IFX in children with moderate-to-severe Crohn disease, refractory to immunomodulatory treatment, reports serious infections as the major adverse events and their frequency is higher with shorter treatment intervals. The combination of immunosuppressive medications is a risk factor for opportunistic infections. Exhaustive guidelines on prophylaxis, diagnosis, and management of opportunistic infections in adult patients with IBD have been published by a European Crohn's and Colitis Organization working group, including clear evidence-based statements. We have reviewed the literature on infections in pediatric IBD as well as the European Crohn's and Colitis Organization guidelines to present a commentary on infection prophylaxis for the pediatric age group.

Objective: To systematically review the evidence base for the medical (pharmaceutical and nutritional) treatment of paediatric inflammatory bowel disease., Methods: Key clinical questions were formulated regarding different treatment modalities used in the treatment of paediatric (not adult-onset) IBD, in particular the induction and maintenance of remission in Crohn disease and ulcerative colitis. Electronic searches were performed from January 1966 to December 2006, using the electronic search strategy of the Cochrane IBD group. Details of papers were entered on a dedicated database, reviewed in abstract form, and disseminated in full for appraisal. Clinical guidelines were appraised using the AGREE instrument and all other relevant papers were appraised using Scottish Intercollegiate Guidelines Network methodology, with evidence levels given to all papers., Results: A total of 6285 papers were identified, of which 1255 involved children; these were entered on the database. After critical appraisal, only 103 publications met our criteria as evidence on medical treatment of paediatric IBD. We identified 3 clinical guidelines, 1 systematic review, and 16 randomised controlled trials; all were of variable quality, with none getting the highest methodological scores., Conclusions: This is the first comprehensive review of the evidence base for the treatment of paediatric IBD, highlighting the paucity of trials of high methodological quality. As a result, the development of clinical guidelines for managing children and young people with IBD must be consensus based, informed by the best-available evidence from the paediatric literature and high-quality data from the adult IBD literature, together with the clinical expertise and multidisciplinary experience of paediatric IBD experts.

Successful information processing requires the focusing of attention on a certain stimulus property and the simultaneous suppression of irrelevant information. The Stroop task is a useful paradigm to study such attentional top-down control in the presence of interference. Here, we investigated the neural correlates of an auditory Stroop task using fMRI. Subjects focused either on tone pitch (relatively high or low; phonetic task) or on the meaning of a spoken word (high/low/good; semantic task), while ignoring the other stimulus feature. We differentiated between task-related (phonetic incongruent vs. semantic incongruent) and sensory-level interference (phonetic incongruent vs. phonetic congruent). Task-related interference activated similar regions as in visual Stroop tasks, including the anterior cingulate cortex (ACC) and the presupplementary motor-area (pre-SMA). More specifically, we observed that the very caudal/posterior part of the ACC was activated and not the dorsal/anterior region. Because identical stimuli but different task demands are compared in this contrast, it reflects conflict at a relatively high processing level. A more conventional contrast between incongruent and congruent phonetic trials was associated with a different cluster in the pre-SMA/ACC which was observed in a large number of previous studies. Finally, functional connectivity analysis revealed that activity within the regions activated in the phonetic incongruent vs. semantic incongruent contrast was more strongly interrelated during semantically vs. phonetically incongruent trials. Taken together, we found (besides activation of regions well-known from visual Stroop tasks) activation of the very caudal and posterior part of the ACC due to task-related interference in an auditory Stroop task., (2009 Wiley-Liss, Inc.)

One of the most important factors controlling material specific processing in the human brain is language dominance, i.e. hemispheric specialization in semantic processes. Although previous studies have shown that lateralized long-term memory processes in the medial temporal lobes are modified in subjects with atypical (right) language dominance, the effect of language dominance on the neural basis of working memory (WM) has remained unknown. Here, we used functional MRI (fMRI) to study the impact of language dominance on the neural representation of WM. We conducted an n-back task in three different load conditions and with both verbal and nonverbal (spatial) material in matched groups of left and right language dominant subjects. This approach allowed us to investigate regions showing significant interactions between language dominance and material. Overall, right dominant subjects showed an increased inter-individual variability of WM-related activations. Verbal WM involved more pronounced activation of the left fusiform cortex in left dominant subjects and of the right inferior parietal lobule in the right dominant group. Spatial WM, on the other hand, induced activation of right hemispheric regions in left dominant subjects, but no specific activations in right dominant subjects. Taken together, these findings indicate that the neural basis of verbal WM processes depends on language dominance and is more mutable in right dominant subjects. The increased variability in right dominant subjects strongly suggests that a standard network of material-dependent WM processes exists in left dominant subjects, and that right dominant subjects use variable alternative networks., (Copyright 2009 Wiley-Liss, Inc)

Hippocampal DC shifts have been observed under various physiological and pathological conditions. Here, we studied the interconnection of slow shifts (0.01 Hz high-pass) in surface EEG and hippocampal shifts as emerging in an event-related EEG biofeedback paradigm. Hippocampal EEG activity was monitored by depth electrodes implanted in four epilepsy patients for presurgical evaluation. Trials were sorted according to the near-DC shifts occurring at the surface position Cz, which was the feedback electrode, into positive, indistinct (i.e., small or biphasic) and negative shifts. We found significant hippocampal near-DC shifts being positively or negatively correlated to the shifts in surface EEG in all four patients. The amplitudes of the hippocampal near-DC shifts were several times larger than the surface shifts. The polarity of the shifts appears to depend on the location of the electrode contacts with respect to the hippocampal subfields. The finding that neocortical and hippocampal near-DC shifts are interconnected may open new perspectives for the prediction and control of mediotemporal lobe seizures., ((c) 2007 Wiley-Liss, Inc.)

We analyzed intracranial electroencephalographic (EEG) recordings from the medial temporal lobes of 12 epilepsy patients during a continuous word recognition paradigm, contrasting trials of correctly recognized repeated words (hits) and correctly identified new words (correct rejections). Using a wavelet-based analysis, we investigated how power changes and phase clustering in different frequency bands contribute to the averaged event-related potentials (ERPs). In addition, we analyzed the actual mean phases of the different oscillations. Our analyses yielded the following results: (1) power changes contributed significantly only to the late components of the ERPs (>400 ms) (2) earlier ERP components were produced by a stimulus-related broad-band phase and amplitude reset of ongoing oscillatory activity about 190 ms after stimulus onset that involved not only the theta band, but also covered alpha and lower beta band frequencies (3) phase and amplitude reset occurred during an epoch of increased phase entrainment over time that lasted for about two oscillation periods for all involved frequencies and was more pronounced for correct rejections than for hits. The broad-band phase and amplitude reset was observed for both hits and correct rejections, and therefore, did not appear to support a specific cognitive function, but rather to act as a general facilitating factor for the processes involved in this memory task. Further analyses of synchronization between oscillations and power changes in different frequency bands revealed a task-dependent modulation of gamma activity by the entrained theta cycle, a mechanism potentially related to memory encoding and retrieval in the rhinal cortex and hippocampus, respectively., (Copyright 2005 Wiley-Liss, Inc.)

Although the hippocampal formation is essential for verbal memory, it is not fully understood how it contributes to language comprehension. We recorded event-related potentials (ERPs) directly from two substructures of the medial temporal lobe (MTL), the rhinal cortex and the hippocampus proper, while epilepsy patients listened to sentences that either were correct or contained semantic or syntactic violations. Semantic violations elicited a large negative ERP response peaking at approximately 400 ms in the rhinal cortex. In contrast, syntactically incorrect sentences elicited a negative deflection of 500-800 ms in the hippocampus proper. The results suggest that functionally distinct aspects of integration in language comprehension are supported by different MTL structures: the rhinal cortex is involved in semantic integration, whereas the hippocampus proper subserves processes of syntactic integration. An analysis of phase synchronization within the gamma band between rhinal and hippocampal recording sites showed that both of the above-mentioned ERP components were preceded by an increase of phase synchronization. In contrast to these short phasic increases of phase synchronization in both violation conditions, correct sentences were associated with a long-lasting synchronization in a late time window, possibly reflecting the integration of semantic and syntactic information as required for normal comprehension., ((c) 2005 Wiley-Liss, Inc)

Concrete words, whose meanings are readily imagined, are better remembered than abstract words. However, the neural correlates of this effect are poorly understood. Here, we investigated the effect of imageability on brain activity in the medial temporal lobe (MTL) processes underlying recognition memory. We recorded event-related potentials (ERPs) via depth electrodes from within the MTL in 14 patients with drug-resistant epilepsy. Patients performed a continuous word recognition task with words of high and low imageability (controlled for word frequency). Behaviorally, recognition performance was better for high, compared to low, imageable words. Two ERP components associated with recognition memory, the AMTL-N400 and the hippocampal late negative component, showed an old/new effect, but only the hippocampal P600 showed a main effect of imageability. We suggest that the hippocampal effect of imageability in recognition memory may be associated with conceptual or pictorial information processing of concrete words., ((c) 2005 Wiley-Liss, Inc.)

The medial temporal lobe (MTL) is the core structure of the declarative memory system, but which specific operation is performed by anatomically defined MTL substructures? One hypothesis proposes that the hippocampus carries out an exclusively mnemonic operation during declarative memory formation that is insensitive to content, whereas the rhinal cortex carries out an operation supporting memory formation indirectly. To explore the interaction between a salient item feature and memory formation, we contrasted neural correlates of memory formation of high- and low-frequency words. Event-related potentials (ERPs) were recorded via depth electrodes from within the MTL in nine epilepsy patients while they memorized single words. To assess memory formation, ERPs to words subsequently recalled in a free recall test were contrasted with ERPs to forgotten words. More high- than low-frequency words were remembered. High-frequency words led to distinct ERP subsequent memory effects in rhinal cortex and hippocampus. Low-frequency words, however, were only associated with the hippocampal ERP effect. The anatomically restricted interaction between word frequency and memory formation might indicate a semantically affected operation in the parahippocampal region supporting memory formation indirectly. By contrast, the missing interaction in hippocampal recordings might suggest a direct correlate of declarative memory formation that is insensitive to item properties.

Functional magnetic resonance imaging (fMRI) and magnetoencephalography (MEG) were used to study the relationships between lateralized auditory perception in humans and the contralaterality of processing in auditory cortex. Subjects listened to rapidly presented streams of short FM-sweep tone bursts to detect infrequent, slightly deviant tone bursts. The stimulus streams consisted of either monaural stimuli to one ear or the other or binaural stimuli with brief interaural onset delays. The onset delay gives the binaural sounds a lateralized auditory perception and is thought to be a key component of how our brains localize sounds in space. For the monaural stimuli, fMRI revealed a clear contralaterality in auditory cortex, with a contralaterality index (contralateral activity divided by the sum of contralateral and ipsilateral activity) of 67%. In contrast, the fMRI activations from the laterally perceived binaural stimuli indicated little or no contralaterality (index of 51%). The MEG recordings from the same subjects performing the same task converged qualitatively with the fMRI data, confirming a clear monaural contralaterality, with no contralaterality for the laterally perceived binaurals. However, the MEG monaural contralaterality (55%) was less than the fMRI and decreased across the several hundred millisecond poststimulus time period, going from 57% in the M50 latency range (20-70 ms) to 53% in the M200 range (170-250 ms). These data sets provide both quantification of the degree of contralaterality in the auditory pathways and insight into the locus and mechanism of the lateralized perception of spatially lateralized sounds.

Using a new prototype (Olympus XPGIF 5.2/ N30) gastroscope, upper gastrointestinal endoscopy was safely performed under sedation on 99 infants (weights 0.9 to 10.1 kg). No complications occurred. Macroscopic and microscopic abnormalities were found in 60%, including abnormal duodenal biopsies in 47% of cases with protracted diarrhoea. Duodenal biopsy material was, however, of suboptimal standard for histologic assessment in 25% of the cases. In 52% of those under 3.5 kg diagnoses were made that would not have otherwise been possible and, in 75% of those in the Intensive Care Unit, abnormalities were found. The use of this new endoscope represents a significant advance in clinical practice.