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It is well known that providing care for a loved one with memory problems puts a person at risk for both mental and physical health problems. In the last several decades, research on chronic stress suggests that the body's physical response to stress becomes severely dysregulated as a result of chronic stress lifestyles such as caregiving. This dysregulation may be the causal factor in caregivers' increased physical and mental health risks. This paper attempts to outline the mechanisms of one major physiologic system involved in the body's stress response, explaining how it can be used to monitor the efficacy of stress management interventions. The research leads to the conclusion that well-planned stress management interventions can effectively reduce the effects of chronic stress among caregivers. (Contains 1 table and 1 figure.)

Competing Interests: Disclosure None of the authors reported any disclosures.

Background: Injections using buffered lidocaine may decrease discomfort, have a quicker onset, and be a more efficacious local anesthetic. Previous studies have been inconclusive in the oral context., Purpose: To address if bicarbonate buffered 2% lidocaine can decrease pain from the use of local anesthesia, has a quicker onset time, and is more efficacious., Study Design: The design was a single-center double-blinded randomized control trial, set in an outpatient oral and maxillofacial clinic housed in the University of Cincinnati Medical Center. Inclusion criteria for the study were patients requiring a single tooth extraction due either to caries or periodontal disease., Predictor Variable: The predictor variable was the local anesthetic used either nonbuffered 2% lidocaine with 1:100,000 epinephrine (control) or bicarbonate buffered 2% lidocaine with 1:100,000 epinephrine (study) was randomly assigned., Main Outcome Variables: Primary outcome variables were injection pain score, and postoperative pain, time to anesthetic onset, and the number of rounds of injections required to achieve adequate anesthesia., Covariates: The covariates were jaw involved, age, sex, and race, American Society of Anesthesiologists score, body mass index, current tobacco use, history of psychiatric illness, chronic pain, and preoperative pain score., Analyses: Test statistics were calculated using Wilcoxon rank-sum test, Kruskal-Wallis test, Spearman rank correlation test, χ 2 test for bivariate analyses, and Fisher's exact test. P values ≤ .05 were considered statistically significant., Results: The final sample was 114 subjects. The mean age of the sample was 42.97 years, standard deviation ±13.43 years. The sample was 39.47% male. The racial demographics were Caucasian (62.28%) and African American (33.33%). Buffered lidocaine did not have a statistically significant relationship with any of the outcomes. The jaw involved had a statistically significant association to the injection pain score (P value = .006), and the number of rounds of anesthetic required (P value = .047). Age showed a statistically significant association to injection pain score (P value = .032), and the number of rounds of anesthetic required (P value = .027). Finally, preoperative pain had a statistically significant relationship with injection pain score (P value = < .001)., Conclusion and Relevance: In this study, bicarbonate buffered lidocaine did not exhibit any discernible advantages over nonbuffered lidocaine for any study outcomes., (Copyright © 2024 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

In this issue of Neuron, Kim et al. 1 demonstrate that theta oscillations between the right ACC and BLA are critical for observational fear and identify a role for the hippocampus in modulating these oscillations. They further show that theta oscillations are specifically involved in vicarious rather than directly experienced fear., Competing Interests: Declaration of interests G.B.C. serves on the advisory board of Neuron., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Recent studies demonstrate that after classical conditioning the conditioned stimulus (CS) triggers a delayed complex spike. This new finding revolutionizes our view on the role of complex spike activity. The classical view of the complex spike as an error signal has been replaced by a signal that encodes for expectation, prediction and reward. In this brief perspective, we review some of these works, focusing on the characteristic delay of the response (~80 ms), its independence on the time interval between CS and the unconditioned stimulus (US) and its relationship to movement onset. In view of these points, we suggest that the generation of complex spike activity following learning, encodes for timing of movements onset. We then provide original data recorded from Purkinje and cerebellar nuclei neurons, demonstrating that delayed complex spike activity is an intrinsic property of the cerebellar circuit. We, therefore, suggest that learning of classical conditioning involves modulation of cerebellar circuitry where timing is provided by the inferior olive and the movement kinematic is delivered by the cerebellar nuclei projection neurons., (Copyright © 2019 Yarden-Rabinowitz and Yarom.)

The inferior olive (IO) is an evolutionarily conserved brain stem structure and its output activity plays a major role in the cerebellar computation necessary for controlling the temporal accuracy of motor behavior. The precise timing and synchronization of IO network activity has been attributed to the dendro-dendritic gap junctions mediating electrical coupling within the IO nucleus. Thus, the dendritic morphology and spatial arrangement of IO neurons governs how synchronized activity emerges in this nucleus. To date, IO neuron structural properties have been characterized in few studies and with small numbers of neurons; these investigations have described IO neurons as belonging to two morphologically distinct types, "curly" and "straight". In this work we collect a large number of individual IO neuron morphologies visualized using different labeling techniques and present a thorough examination of their morphological properties and spatial arrangement within the olivary neuropil. Our results show that the extensive heterogeneity in IO neuron dendritic morphologies occupies a continuous range between the classically described "curly" and "straight" types, and that this continuum is well represented by a relatively simple measure of "straightness". Furthermore, we find that IO neuron dendritic trees are often directionally oriented. Combined with an examination of cell body density distributions and dendritic orientation of adjacent IO neurons, our results suggest that the IO network may be organized into groups of densely coupled neurons interspersed with areas of weaker coupling.

Key Points: Cerebellar nuclei (CN) neurons can be classified into four groups according to their action potential (AP) waveform, corresponding to four types of neurons previously characterized. Half of the APs are generated by excitatory events, suggesting that excitatory inputs play a key role in generating CN outputs. Analysis of post-synaptic potentials reveals that the probability of excitatory inputs generating an AP is 0.1. The input from climbing fibre collaterals is characterized by a pair of synaptic potentials with a distinct interpair interval of 4.5 ms. The probability of climbing fibre collaterals initiating an AP in CN neurons is 0.15., Abstract: It is commonly agreed that the main function of the cerebellar system is to provide well-timed signals used for the execution of motor commands or prediction of sensory inputs. This function is manifested as a temporal sequence of spiking that should be expressed in the cerebellar nuclei (CN) projection neurons. Whether spiking activity is generated by excitation or release from inhibition is still a hotly debated issue. In an attempt to resolve this debate, we recorded intracellularly from CN neurons in anaesthetized mice and performed an analysis of synaptic activity that yielded a number of important observations. First, we demonstrate that CN neurons can be classified into four groups. Second, shape-index plots of the excitatory events suggest that they are distributed over the entire dendritic tree. Third, the rise time of excitatory events is linearly related to amplitude, suggesting that all excitatory events contribute equally to the generation of action potentials (APs). Fourth, we identified a temporal pattern of spontaneous excitatory events that represent climbing fibre inputs and confirm the results by direct stimulation and analysis on harmaline-evoked activity. Finally, we demonstrate that the probability of excitatory inputs generating an AP is 0.1 yet half of the APs are generated by excitatory events. Moreover, the probability of a presumably spontaneous climbing fibre input generating an AP is higher, reaching a mean population value of 0.15. In view of these results, the mode of synaptic integration at the level of the CN should be re-considered., (© 2017 Hebrew University in Jerusalem. The Journal of Physiology © 2017 The Physiological Society.)

The purpose of this project was to assess the detecting deception efficacy of three well-validated "detecting deception" methods - i.e., forced choice testing (FCT), modified cognitive interviewing (MCI) and autobiographical implicit association testing (aIAT) - when applied to the issue of bio-threat. The detecting deception accuracies of FCT and MCI were 81% and 75%, respectively. Although the aIAT mean response times in block 5 differed significantly between deceptive and truthful persons, the classification accuracy was low. FCT alone reduced the group of 64 persons to 11 and detected 50% of the liars; the false positive rate was 9%. MCI alone reduced the group of 64 to 24 and detected 92% of the liars; the false positive rate was 54%. When FCT was paired with MCI, 75% of liars were detected and the false positive rate was 13%. Forced choice testing and MCI show promise as methods for detecting deception related to bio-threat under low-base-rate conditions. These methods took little time, enhanced the odds of detecting deceptive individuals and exhibited high positive likelihood ratios, suggesting that they have merit as screening tools. The aIAT required more time and was less accurate but may still serve as a useful screening tool., (Copyright © 2014 John Wiley & Sons, Ltd.)

Purpose: To evaluate the thickness and diameter accuracy of the IntraLase femtosecond laser in harvesting corneal discs for lamellar keratoplasty. The stromal bed quality of resected corneas was evaluated by scanning electron microscopy., Methods: Two IntraLase units were used to create corneal discs at 225-, 300-, 400-, and 500-microm thickness settings and 7-, 8-, 8.5-, and 9-mm diameter settings (n = 28). Achieved thickness was measured using a digital caliper and achieved diameter was measured using imaging software. Samples were preserved and processed for scanning electron microscopy to observe stromal bed quality., Results: On both units, the mean deviation from attempted thickness was -9.5 +/- 8.6 microm (range: +6 to -28 microm). All of the obtained corneal discs were circular (horizontal versus vertical diameters, P > .05). The raster pattern produced a smoother stromal bed compared to the spiral pattern., Conclusions: The IntraLase femtosecond laser keratome provides depth and diameter accuracy even at increased depth settings. Stromal bed was smooth with the raster pattern and can further be smoothed by excimer phototherapeutic keratectomy treatment. Femtosecond laser lamellar keratoplasty is a promising procedure and clinical data are needed to determine effectiveness.

Objective: The purpose of this study was to compare the relative effectiveness of three recruitment modalities for enrolling Chinese-American and white family caregivers into research studies to evaluate intervention strategies., Methods: A total of 116 Chinese Americans and 134 whites were screened for eligibility to participate in one of two clinical intervention trials. Participants were recruited using: 1) media sources; 2) nonprofessional referral sources; or 3) professional referrals. Each participant was asked an open-ended question about how they became aware of the programs offered., Results: A smaller proportion of Chinese Americans (39%) than whites (50%) who responded to recruiting strategies actually enrolled as subjects. There was a significant interaction between ethnicity and recruitment strategy. Chinese-American caregivers who were recruited by nonprofessional sources were less likely to enroll in the intervention studies than those who were recruited through media sources or professional referrals. Whites, on the other hand, were more likely to be recruited through nonprofessional sources than the other two., Conclusions: A consumer-oriented approach, which included direct face-to-face contact with key community leaders, generated the highest number of Chinese-American participants. Culture-specific factors such as trust-building with social service agencies, demonstrating genuine commitment to the well-being of the target community, and linguistic and ethnic matching between research staff and potential participants appear helpful to successful research recruitment in this rapidly increasing segment of dementia caregivers.

Objective: The authors sought to determine the effect of kinship status (daughters versus wives) and ethnicity (Hispanic/Latino versus Caucasian) on self-efficacy to perform tasks relevant to caregiving in a sample of family caregivers for people with memory problems., Methods: Baseline data were collected from 238 female caregivers who participated in an intervention program. Ethnic and kin relationship groups were compared on measures of caregiver self-efficacy, acculturation within the Hispanic/Latino sample, and the relationship of self-efficacy to key outcome variables., Results: Hispanics/Latinos reported higher self-efficacy on two of three self-efficacy subscales (Responding to Disruptive Behaviors and Controlling Negative Thoughts About Caregiving). Daughters reported higher self-efficacy on all three self-efficacy scales. Among Hispanics/Latinos, acculturation did not relate strongly to self-efficacy. Caucasian and spousal caregivers appeared to make more generalized appraisals about caregiving., Conclusion: Higher self-efficacy among Hispanic/Latino caregivers may relate to cultural values about caregiving and/or ethnic differences in appraisal. Wives may be more at risk for low self-efficacy, which may relate to greater role frustration and distress. This study highlights the heterogeneity among caregivers in their experience of caregiving.

We describe a patient who had recurrent life-threatening episodes of isolated macroglossia due to the use of an angiotensin-converting enzyme (ACE) inhibitor. No associated facial, labial, pharyngeal, or laryngeal edema was noted. Aggressive treatment with epinephrine, steroids, and antihistamines resulted in rapid resolution of the tongue swelling and respiratory distress. Recurrent isolated angioedema of the tongue is an extremely rare variant of ACE inhibitor-related angioneurotic edema. The widespread use of ACE inhibitors mandates a special awareness by physicians of this potentially life-threatening yet treatable side effect.

Keratoconus (KC) is a noninflammatory corneal thinning disorder and the major cause of cornea transplantation in the Western world. Genetic factors have been suggested in the cause of KC. We conducted a family study to investigate genetic contributions to the development of KC by evaluating familial aggregation and testing genetic models with segregation analysis. KC was diagnosed based on clinical criteria. Familial aggregation of KC was evaluated using both clinical status and three videokeratography indices generated by the Topographic Modeling System (TMS-1). The estimated KC prevalence in first-degree relatives was 3.34% (41/1,226, 95% CI: 3. 22-3.46%), which is 15 to 67 times higher than that in the general population (0.23-0.05%). For all three videokeratography indices, CK, IS, and KISA, KC propositi had significantly higher mean values than controls (all P < 0.0001). Clinically unaffected parents also had significantly higher values for these indices than controls (all P < 0.016). The correlation of KISA in sib and parent-offspring pairs (r = 0.30 and 0.22, respectively, both P < 0.0005) was significantly greater than that in marital pairs (r = 0.14), and the latter was not significantly different from zero. We performed segregation analysis on KISA in 95 families ascertained through KC propositi. Hypotheses of both sporadic and environmental models were rejected (P < 0.001); a major gene model was not rejected (P > 0.1). Additionally, the most parsimonious model was autosomal recessive. In conclusion, we observed strong evidence of familial aggregation in KC and its subclinical indices and this aggregation is likely due to a major gene effect., (Copyright 2000 Wiley-Liss, Inc.)

Purpose: To illustrate a good visual outcome following penetrating keratoplasty in a patient with Sly disease, a rare mucopolysaccharidosis (MPS) caused by a deficiency of beta-glucuronidase., Methods: A 15-year-old male with progressive bilateral corneal opacification had a complete medical, genetic, and ophthalmic evaluation followed by a penetrating keratoplasty., Results: The cornea has remained clear for two years following surgery. Histopathology of the corneal button demonstrated vacuoles and granular inclusions consistent with this lysosomal storage disease., Conclusion: While research is ongoing in the fields of enzyme replacement and bone marrow transplantation, these treatments may not alleviate or reverse the corneal clouding. This case illustrates that cornea transplantation may be a valuable treatment option for visually rehabilitating such patients.

Keratoconus is an ectatic corneal dystrophy associated with stromal thinning and disruption of Bowman's layer. The purpose of this study was to explore a possible association between keratocyte apoptosis and keratoconus. Keratocyte apoptosis was evaluated in corneas of patients with keratoconus, corneas of patients with stromal dystrophies, and normal donor corneas using the transferase-mediated dUTP-digoxigenin nick and labeling (TUNEL) assay. Keratocyte apoptosis was also studied in keratoconus and normal corneas using transmission electron microscopy. TUNEL-stained keratocytes were detected in 60% of corneas with keratoconus, but only 35% of corneas with stromal dystrophies (P =0.03). The number of TUNEL-positive keratocytes detected in the keratoconus, stromal dystrophy, and normal corneas was 7+/-1 (mean+/-standard error, range 0-20), 2+/-0. 8 (range 0-9), and 0+/-0 (range 0-0) TUNEL-positive cells per section, respectively. The differences between the keratoconus and the stromal dystrophy (P =0.0097) or the normal cornea (P =0.01) groups were statistically significant. The difference between the stromal dystrophy and normal cornea groups was not statistically significant (P =0.45). The stromal dystrophy group was included to account for surgery-associated keratocyte apoptosis. No TUNEL-stained keratocytes were detected in normal corneas. Cell morphologic changes consistent with apoptosis were detected by transmission electron microscopy (TEM) in keratocytes of keratoconus corneas, but not in keratocytes in normal corneas. Chronic keratocyte apoptosis associated with ongoing epithelial injury may link risk factors associated with keratoconus such as chronic eye rubbing, contact lens wear, or atopic eye disease. Similarly, increases that have been detected in several different degradative enzymes in keratoconus corneas could be associated with chronic keratocyte apoptosis and less than perfect control of release of intracellular contents., (Copyright 1999 Academic Press.)

Purpose: To formulate and test an algorithm using minimal topographic criteria for accurately diagnosing clinical keratoconus., Setting: Subspecialty cornea practice and Keratoconus Genetic Research Project., Methods: Both eyes of 86 keratoconic patients who had never worn contact lenses and 195 normal participants were studied with the TMS-1 videokeratoscope to evaluate the KISA% index, an algorithm that topographically quantifies the phenotypic features of keratoconus. The diagnostic efficacy of the KISA% index was compared with that of the modified Rabinowitz/McDonnell (K- and I-S values) and the Maeda/Klyce (KCI% and KPI) indices. The same indices were calculated for an additional 8 eyes with keratoconus-suspect topography and 12 eyes with early keratoconus., Results: The mean KISA% was significantly greater in the keratoconus group (10,382%) than in the normal control group (20.44%) with minimal overlap. At a cutoff point for KISA% of 100, 280 of 281 participants (99.6%) were correctly classified. In contrast, the correct classification rate for the other indices were KCI%, 274 of 281 (97.5%); KPI, 249 of 281 (88.6%); K, 272 of 281 (96.8%); I-S, 269 of 281 (95.7%). Six of the 8 eyes with keratoconus-suspect topography had a KISA% between 60% and 100%, and 11 of the 12 eyes with early keratoconus had a KISA% greater than 100%., Conclusions: The KISA% index set at 100 was highly sensitive and specific for diagnosing keratoconus; a range of 60% to 100% may be useful for designating suspects. This index is more useful than any of the other currently available tools for classifying patients with keratoconus for computerized segregation analysis and for distinguishing eyes with keratoconus from normal eyes in topographic screening of refractive surgical candidates.

Corneal haze is a recognized complication of excimer laser photorefractive keratectomy. When severe, it can result in the formation of a dense corneal scar, with a reduction in best corrected visual acuity. In extreme cases, medical treatment and repeated phototherapeutic excimer ablations may fail to restore corneal transparency. In these patients, penetrating keratoplasty (PKP) has been used to restore visual function. We describe a technique for excising a superficial corneal scar using an automated microkeratome. The resultant corneal surface is quite smooth, and good visual acuity may be restored without resorting to PKP.

In eyes with low scleral rigidity, penetrating keratoplasty (PKP) is a high-risk procedure because forward movement of the lens-iris diaphragm can result in prolapse of intraocular contents, expulsive choroidal hemorrhage, and damage to the crystalline lens. We developed a method for safer PKP in eyes with low scleral rigidity. In this technique, the host cornea is incompletely excised and remains attached at the 6 and 12 o'clock positions while the cardinal sutures to secure the donor button over the host are placed. Donor endothelium is protected by an intervening layer of viscoelastic material. After the first 3 cardinal sutures are placed, the host button is completely excised and removed and the donor cornea is sutured. This technique prevents the unopposed forward movement of the lens-iris diaphragm and may reduce the risk of expulsive choroidal hemorrhage and spontaneous extrusion or damage to the crystalline lens during PKP in patients with low scleral rigidity.

Purpose: To report a technique for detecting striae in the corneal flap after laser in situ keratomileusis., Methods: Fluorescein dye was instilled in the eye, and the patient was asked to blink. The tear film was examined at the slit lamp with the cobalt filter 1 or 2 seconds after blinking., Results: The uneven pattern of pooling in the tear film was a sensitive indicator of the presence of striae in the flap., Conclusion: This technique may be useful in detecting minimal striae in the corneal flap in patients with unexplained suboptimal visual acuity after laser in situ keratomileusis.

Three children were born with partial corneal opacity and anterior segment anomalies but no cataract (Peter's anomaly type 1). In each affected eye, the corneal scar was off center and encroached on the visual axis. Glaucoma (if present) was controlled medically or surgically, after which an optical iridectomy was performed in each eye (in lieu of a penetrating keratoplasty). After surgery, in all patients the pupil extended beyond the corneal opacity and the corneal opacity decreased slightly. All could fixate and follow around the opacity. Optical iridectomy should be considered in selected cases of congenital corneal opacities.

We sought firsthand data on the extent of perceived mental health needs and on patterns of use of mental health services among Israelis aged 22 and over. The data are from a national survey conducted in 1995. A random sample of phone numbers from the telephone company's computerized listings yielded 1,395 completed questionnaires (response rate, 81%). At some point in their lives, 27% had experienced emotional distress or mental health problems with which they had difficulty coping alone; 13.4% reported that they had such an experience during 1995. According to multivariate analysis, those more likely to report mental health problems were women, those with a chronic disease, Russian immigrants, divorced or widowed adults, those with a low level of education, and members of the Clalit sick fund. 38% of those who had ever had emotional or mental health problems had asked for help. The proportion of those seeking help was high among respondents aged 35-55, Hebrew speakers (compared to speakers of Russian or Arabic), and city dwellers, and the rate was low among members of the Clalit sick fund. Of those who did seek help, 39% went to a psychologist or a psychiatrist, 25% to their family doctor, 19% to a family member or friend, 7% to a social worker or social service agency, 6% to other medical personnel, and 4% to a psychiatric hospital. 30% turned for assistance to the private sector and 70% to the public sector. These findings have special significance in view of the impending reform of the mental health services. As mandated by the new National Health Insurance Law, mental health services are to be included in the basket of health services provided by the sick funds. The data can be of use in the management of sick funds and for physicians working in the community, as they prepare for this change. In addition, the data will be of aid to national policy makers in planning services suited to the needs of different population groups and to allocate resources more rationally.