Search

Low frequency oscillations in the hippocampus emerge during by both spatial navigation and episodic memory function in humans. We have recently shown that in humans, memory-related processing is a stronger driver of low frequency oscillations than navigation. These findings and others support the idea that low-frequency oscillations are more strongly associated with a general memory function than with a specific role in spatial navigation. However, whether the low-frequency oscillations that support episodic memory and those during navigation could still share some similar functional roles remains unclear. In this study, patients undergoing intracranial electroencephalography (iEEG) monitoring performed a navigation task in which they navigated and performed internally directed route replay, similar to episodic memory. We trained a random forest classification model to use patterns in low-frequency power (2-12 Hz) to learn the position during navigation and subsequently used the same model to successfully decode position during mental simulation. We show that removal of background differences in power between navigation and mental simulation is critical to detecting the overlapping patterns. These results suggest that the low-frequency oscillations that emerge during navigation are more associated with a role in memory than specifically with a navigation related function.

Background: Gunshot wounds (GSW) to the heart are lethal, and most patients die before they arrive to the hospital. Survival decreases with number of cardiac chambers involved. We report a case of a 17-year-old male who survived a GSW injury involving two cardiac chambers with acute severe tricuspid regurgitation (TR) who subsequently developed cardiogenic shock requiring extracorporeal membrane oxygenation (ECMO) support., Case Presentation: A 17-year-old male sustained a single gunshot wound to the left chest, resulting in pericardial tamponade and right hemothorax. Emergency sternotomy revealed injury to the right ventricle and inferior cavoatrial junction with the adjacent pericardium contributing to a right hemothorax. The cardiac injuries were repaired primarily. Tricuspid regurgitation was confirmed immediately postoperatively. Five days after presentation, the patient developed cardiogenic shock secondary to TR requiring emergent stabilization with ECMO. He subsequently underwent successful tricuspid valve replacement., Conclusions: This is the first report to our knowledge of successful ECMO support of severe TR due to gunshot injury to the heart., (© 2024. The Author(s).)

Background: Valve-in-valve (VIV) transcatheter aortic valve implantation (TAVI) is a less invasive therapeutic option compared with redo surgical valve replacement for high-risk patients. Relative to procedures within stented surgical valves, VIV-TAVI within stentless valves is associated with a higher complication rate due to challenging underlying anatomy and absence of fluoroscopic landmarks., Aims: We share a single-center experience with VIV-TAVI in stentless valves, discussing our procedural insights and associated outcomes., Methods: Our institutional database was queried, and 25 patients who had undergone VIV-TAVI within a stentless bioprosthesis, homograft, or valve-sparing aortic root replacement between 2013 and 2022 were found. Outcome endpoints were based on the Valve Academic Research Consortium-3 criteria., Results: The mean age of the cohort was 69.5 ± 13.6 years. VIV implantation was performed within a homograft in 11 patients, a stentless bioprothesis in 10 patients, and a valve-sparing aortic root replacement in 4 patients. Nineteen (76%) balloon-expandable valves, 5 (20%) self-expanding valves, and one mechanically-expandable (4%) valve were implanted with 100% procedural success, with no instances of significant paravalvular leak, coronary occlusion, or device embolization. There was one (4%) in-hospitality mortality after an emergency procedure; one (4%) patient experienced a transient ischemic attack; and two (8%) patients required permanent pacemaker implantation. The median length of hospital stay was 2 days. After a median follow-up time of 16.5 months, valve function was acceptable in all patients with available data., Conclusion: VIV-TAVI within stentless valves can be safely performed with methodical procedural technique and can provide clinical benefit in patients at high reoperation risk., (© 2023 Wiley Periodicals LLC.)

Background: The onset of the coronavirus disease 2019 (COVID-19) pandemic has forced our cardiac surgery program and hospital to enact drastic measures that has forced us to change how we care for cardiac surgery patients, assist with COVID-19 care, and enable support for the hospital in terms of physical resources, providers, and resident training., Methods: In this review, we review the cardiovascular manifestations of COVID-19 and describe our system-wide adaptations to the pandemic, including the use of telemedicine, how a severe reduction in operative volume affected our program, the process of redeployment of staff, repurposing of residents into specific task teams, the creation of operation room intensive care units, and the challenges that we faced in this process., Results: We offer a revised set of definitions of surgical priority during this pandemic and how this was applied to our system, followed by specific considerations in coronary/valve, aortic, heart failure and transplant surgery. Finally, we outline a path forward for cardiac surgery for the near future., Conclusions: We recognize that individual programs around the world will eventually face COVID-19 with varying levels of infection burden and different resources, and we hope this document can assist programs to plan for the future., (Copyright © 2020 Jointly between The American Association for Thoracic Surgery, The Society of Thoracic Surgeons, and the European Association for Cardio-Thoracic Surgery. Published by Elsevier Inc. Published by Elsevier Inc. All rights reserved.)

Background: The integrated healthcare of patients with support needs in primary healthcare in Austria has insufficient structural and procedural features in terms of the quality and security of care. The aim is therefore to develop solution- and patient-oriented services that take into account both the patients' requirements as well as the medical, nursing, therapeutic and economic perspectives. The question arises: What relevant levers can support the active participation of social work in the primary healthcare of patients with support needs in Austria?, Methods: An adapted Analytic Hierarchy Process (AHP) was used to investigate the levers for integrating social work into primary healthcare networks in Austria. In addition to a semi-structured literature search, subjective expert and user priorities were surveyed, cause-and-effect relationships were visualized, an extended cycle of success was developed and relevant control levers were identified by means of a pair comparison matrix and an effectiveness front., Results: This results in the targeted development and optimization of the complex integration of social work into primary healthcare in Austria, the relevant levers being the professionalization of social work, competences of social work, communication and cooperation of stakeholders., Conclusion: The identified levers have to be processed conceptually and operationally. For this purpose, an integrated concept has to be developed, which, in addition to innovative organizational instruments, includes special communication approaches as well as inter-professional process and knowledge management., (Copyright © 2019 Elsevier B.V. All rights reserved.)

In-patient care of the elderly is currently being put to the test in all developed industrial nations. The aim is to make the resident-centered and nursing-related care more professional. In addition to the organizational and interdisciplinary orientation, the use of socially assistive robot technologies and artificial intelligence is increasingly coming to the fore. By means of literature research, expert interviews and an online survey of Upper Austrian nursing home directors, current and future challenges and challenges for the use of socially assistive robots (SAR) in in-patient care for the elderly were identified and prioritized. It becomes clear that the technological and application-oriented maturity of SAR as well as the modular adaptation of the hybrid SAR services to the existing structures and processes from the point of view of the nursing home management are in the foreground. In the future, it will be increasingly important to bring the process-related and technological support of human-machine interaction through SAR to a value-adding level.

Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repetitive mild brain trauma. CTE, previously termed "dementia pugilistica," has been identified in American football, ice hockey, baseball, rugby and soccer players, boxers, wrestlers, and military personnel exposed to blast and other traumatic brain injuries. There is often a long latency period between an individual's exposure to repetitive brain trauma and the clinical symptoms of CTE. The pathology of CTE is characterized by a progression from isolated focal perivascular hyperphosphorylated tau lesions in the cerebral cortex to a widespread tauopathy that involves diffuse cortical and medial temporal lobe regions. We hypothesize that the spread of tau from focal perivascular lesions to a widespread tauopathy occurs as a result of intraneuronal and intrasynaptic prion-like protein templating, as well as tau secretion and propagation along glymphatic and cerebrospinal fluid pathways., (Copyright © 2018 Cold Spring Harbor Laboratory Press; all rights reserved.)

The primary health care in rural areas in Austria is currently determined by challenges such as ageing of the population, the shift towards chronic and age-related illnesses, the specialist medical and hospital-related education and training of physicians' as well growing widespread difficulty of staffing doctor's office. The objective is to realize a general practitioner centered and team-oriented primary health care (PHC) approach by establishing networked primary health care in rural areas of Austria. Using literature research, online survey, expert interviews and expert workshops, we identified different challenges in terms of primary health care in rural areas. Further, current resources and capacities of primary health care in rural areas were identified using the example of the district of Rohrbach. Twelve design dimensions and 51 relevant measurement indicators of a PHC network were delineated and described. Based on this, 12 design approaches of PHC concept for the GP-centered and team-oriented primary health care in rural areas have been developed.

Introduction: African Americans' (AAs) late-onset Alzheimer's disease (LOAD) genetic risk profile is incompletely understood. Including clinical covariates in genetic analyses using informed conditioning might improve study power., Methods: We conducted a genome-wide association study (GWAS) in AAs employing informed conditioning in 1825 LOAD cases and 3784 cognitively normal controls. We derived a posterior liability conditioned on age, sex, diabetes status, current smoking status, educational attainment, and affection status, with parameters informed by external prevalence information. We assessed association between the posterior liability and a genome-wide set of single-nucleotide polymorphisms (SNPs), controlling for APOE and ABCA7, identified previously in a LOAD GWAS of AAs., Results: Two SNPs at novel loci, rs112404845 (P = 3.8 × 10 -8 ), upstream of COBL, and rs16961023 (P = 4.6 × 10 -8 ), downstream of SLC10A2, obtained genome-wide significant evidence of association with the posterior liability., Discussion: An informed conditioning approach can detect LOAD genetic associations in AAs not identified by traditional GWAS., (Copyright © 2016 the Alzheimer's Association. All rights reserved.)

Primary health care (PHC) is currently being improved in all developed industries. The aim is to make healthcare more patient-centered and close to the patient's place of residence. In addition to the organizational and interdisciplinary reorientation, the use of digital media is increasingly being emphasized. Through literature research and an online survey among Austrian doctors and general practitioners, the current and future challenges for the use of digital media in networked and regional primary health care were identified and prioritized. It becomes clear that basic functions like documentation, communication and coordination in the individual medical practice are at the forefront. In the future it will be necessary to support regional and interprofessional networking through digital media.

The development of eHealth and AAL (Ambient Assisted Living) services with the aim to reduce the complexity of living environments for the elderly often does not lead to the desired results on the market. The design of an eHealth/AAL specific framework for continuous New Service Development is presented in this paper. Our research addresses this challenge with a new Service Excellence Model (SEM) and outlines the benefits of this specific approach. The research is based on the data of the DALIA project (Assistant for DAily LIfe Activities at Home) and the PenAAL project (Performance Measurement Index for AAL solutions), parts of which the projects were the classification of relevant business dimensions and the development of a related scoring tool for continuous benchmarking and improvement.

Current and projected general practitioner (GP) and primary care in Austria shows structural and process inadequacies in the quality as well as assurance of healthcare supply. The aim is therefore to develop solution- and patient-oriented measures that take patient-related requirements and medical perspectives into account. Using an effect matrix, subjective expert and user priorities were ascertained, cause and effect relationships were examined, and an expanded circle of success for the optimization of GP and primary care in Upper Austria was developed. Through this, the relevant levers for target-oriented development and optimization of the complex system of GP and primary care in Upper Austria were identified; these are training to become general practitioners, entrepreneurs as well as management and coordination. It is necessary to further adapt the identified levers conceptually and operationally in a targeted approach. This is to be achieved by means of the primary health care (PHC) concept as well as management tools and information and communication technologies (ICT) associated with it., (© Georg Thieme Verlag KG Stuttgart · New York.)

Unlabelled: The living environments of senior citizens are gaining in complexity with regard to health, mobility, information, support and behaviour. The development of Ambient Assisted Living (AAL) services in order to reduce this complexity is becoming increasingly important. The question is: What relevant criteria support the development, measurement and evaluation of business models of hybrid AAL services which have to be considered in an appropriate Performance Measurement Set? Within the EU funded research project DALIA (Assistant for Daily Life Activities at Home) a Service Performance Measurement Criteria (SPMC) Set has been developed and described. With the help of literature review and expert interviews relevant performance criteria were identified and described in the context of Analytic Hierarchy Process (AHP). In conjunction with an AAL business models scanning, a set of performance measurement criteria could be created., Discussion: The development and application of a specific AAL SPMC Set offers the possibility in a targeted and conceptual way advance the development of marketable AAL services. Here it will be important to integrate with software support the SPMC Set in the service development process of future marketable AAL applications. With the application of an adjusted AAL Service Performance Measurement Cube, the conceptual development of marketable AAL services can be maintained and relevant decisions can be supported.

Introduction: Chronic traumatic encephalopathy (CTE) is a progressive neurodegeneration associated with repetitive head impacts. Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) is a U01 project recently funded by the National Institute of Neurological Disorders and Stroke and the National Institute of Biomedical Imaging and Bioengineering. The goal of the UNITE project is to examine the neuropathology and clinical presentation of brain donors designated as "at risk" for the development of CTE based on prior athletic or military exposure. Here, we present the rationale and methodology for UNITE., Methods: Over the course of 4 years, we will analyze the brains and spinal cords of 300 deceased subjects who had a history of repetitive head impacts sustained during participation in contact sports at the professional or collegiate level or during military service. Clinical data are collected through medical record review and retrospective structured and unstructured family interviews conducted by a behavioral neurologist or neuropsychologist. Blinded to the clinical data, a neuropathologist conducts a comprehensive assessment for neurodegenerative disease, including CTE, using published criteria. At a clinicopathological conference, a panel of physicians and neuropsychologists, blinded to the neuropathological data, reaches a clinical consensus diagnosis using published criteria, including proposed clinical research criteria for CTE., Results: We will investigate the validity of these clinical criteria and sources of error by using recently validated neuropathological criteria as a gold standard for CTE diagnosis. We also will use statistical modeling to identify diagnostic features that best predict CTE pathology., Conclusions: The UNITE study is a novel and methodologically rigorous means of assessing clinicopathological correlation in CTE. Our findings will be critical for developing future iterations of CTE clinical diagnostic criteria.

Background: Hybrid percutaneous coronary intervention offers an alternative method of revascularization for high-risk surgical populations. We report the outcomes of a single-stage hybrid strategy in valvular cardiac surgery and explore its effects on operative risk and bleeding., Methods: In a hybrid operating room, 26 patients underwent hybrid surgery consisting of femoral arterial access, then coronary stenting followed by valve surgery, with appropriate heparin dosing. Clopidogrel (300 mg) was given on anesthesia induction in nonreoperative cases, or at the time of cross clamping (after stenting) for reoperative cases., Results: Mean follow-up was 680 ± 277 days. The planned coronary stenting and surgery was successful in all patients. Major cardiovascular and cerebrovascular adverse events occurred in 1 patient, with no inhospital deaths observed. No vascular complication or stent thrombosis was observed with the described antiplatelet regimen. Outcomes were comparable to those of standard bypass valve replacement surgery., Conclusions: This study demonstrates the feasibility and early safety of a single-stage hybrid strategy with coronary stenting followed by valvular surgery in patients at increased surgical risk. Hybrid procedures may lower operative risk by eliminating or reducing the need for bypass grafting., (Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

The Ambient Assisted Living (AAL) market is still in an early stage of development. Previous approaches of comprehensive AAL services are mostly supply-side driven and focused on hardware and software. Usually this type of AAL solutions does not lead to a sustainable success on the market. Research and development increasingly focuses on demand and customer requirements in addition to the social and legal framework. The question is: How can a systematic performance measurement strategy along a service development process support the market-ready design of a concrete business model for AAL service? Within the EU funded research project DALIA (Assistant for Daily Life Activities at Home) an iterative service development process uses an adapted Osterwalder business model canvas. The application of a performance measurement index (PMI) to support the process has been developed and tested. Development of an iterative service development model using a supporting PMI. The PMI framework is developed throughout the engineering of a virtual assistant (AVATAR) as a modular interface to connect informal carers with necessary and useful services. Future research should seek to ensure that the PMI enables meaningful transparency regarding targeting (e.g. innovative AAL service), design (e.g. functional hybrid AAL service) and implementation (e.g. marketable AAL support services). To this end, a further reference to further testing practices is required. The aim must be to develop a weighted PMI in the context of further research, which supports both the service engineering and the subsequent service management process.

We describe our experience using the Edwards Sapien transfemoral Retroflex 3 catheter delivery system for transcatheter aortic valve replacement through the transapical and transaortic approaches. Transthoracic transcatheter valve replacement by the transapical and transaortic approaches can be safely and effectively performed with the Retroflex 3 delivery catheter, which affords several advantages over other available delivery devices., (Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)