413 S Loop Rd
Edgewood KY 41017
Medical School: Other - Unknown
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License #: R3171
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Word-finding impairment in veterans of the 1991 Persian Gulf War. - Brain and cognition
Approximately one quarter of 1991 Persian Gulf War Veterans experience cognitive and physiological sequelae that continue to be unexplained by known medical or psychological conditions. Difficulty coming up with words and names, familiar before the war, is a hallmark of the illness. Three Gulf War Syndrome subtypes have been identified and linked to specific war-time chemical exposures. The most functionally impaired veterans belong to the Gulf War Syndrome 2 (Syndrome 2) group, for which subcortical damage due to toxic nerve gas exposure is the suspected cause. Subcortical damage is often associated with specific complex language impairments, and Syndrome 2 veterans have demonstrated poorer vocabulary relative to controls. 11 Syndrome 1, 16 Syndrome 2, 9 Syndrome 3, and 14 age-matched veteran controls from the Seabees Naval Construction Battalion were compared across three measures of complex language. Additionally, functional magnetic resonance imaging (fMRI) was collected during a covert category generation task, and whole-brain functional activity was compared between groups. Results demonstrated that Syndrome 2 veterans performed significantly worse on letter and category fluency relative to Syndrome 1 veterans and controls. They also exhibited reduced activity in the thalamus, putamen, and amygdala, and increased activity in the right hippocampus relative to controls. Syndrome 1 and Syndrome 3 groups tended to show similar, although smaller, differences than the Syndrome 2 group. Hence, these results further demonstrate specific impairments in complex language as well as subcortical and hippocampal involvement in Syndrome 2 veterans. Further research is required to determine the extent of language impairments in this population and the significance of altered neurologic activity in the aforementioned brain regions with the purpose of better characterizing the Gulf War Syndromes.Copyright Â© 2015 Elsevier Inc. All rights reserved.
Quality of Care for Chronic Conditions Among Disabled Medicaid Enrollees: An Evaluation of a 1915 (b) and (c) Waiver Program. - Medical care
Examining the impact of Medicaid-managed care home-based and community-based service (HCBS) alternatives to institutional care is critical given the recent rapid expansion of these models nationally.We analyzed the effects of STAR+PLUS, a Texas Medicaid-managed care HCBS waiver program for adults with disabilities on the quality of chronic disease care.We compared quality before and after a mandatory transition of disabled Medicaid enrollees older than 21 years from fee-for-service (FFS) or primary care case management (PCCM) to STAR+PLUS in 28 counties, relative to enrollees in counties remaining in the FFS or PCCM models.Person-level claims and encounter data for 2006-2010 were used to compute adherence to 6 quality measures. With county as the independent sampling unit, we employed a longitudinal linear mixed-model analysis accounting for administrative clustering and geographic and individual factors.Although quality was similar among programs at baseline, STAR+PLUS enrollees experienced large and sustained improvements in use of Î²-blockers after discharge for heart attack (49% vs. 81% adherence posttransition; P<0.01) and appropriate use of systemic corticosteroids and bronchodilators after a chronic obstructive pulmonary disease event (39% vs. 68% adherence posttransition; P<0.0001) compared with FFS/PCCM enrollees. No statistically significant effects were identified for quality measures for asthma, diabetes, or cardiovascular disease.In 1 large Medicaid-managed care HCBS program, the quality of chronic disease care linked to acute events improved while that provided during routine encounters appeared unaffected.
Executive functioning in attention-deficit/hyperactivity disorder: questioning the notion of planning deficits with heart rate reactivity. - Attention deficit and hyperactivity disorders
This study employed a paired stimulus paradigm to compare phasic changes in heart rate among children (age categories 6-8, 9-10, and 11-12) and adults (age categories 18-19 and 20-22) with attention-deficit/hyperactivity disorder (ADHD) and age-matched controls. A sample of 95 participants (19 ADHD-diagnosed children, 34 controls, 20 ADHD-diagnosed adults, and 22 controls) solved a planning task, the Tower of London, through 4 levels of difficulty. It was hypothesized that groups with ADHD would show greater heart rate acceleration and less final deceleration than would controls, and that these heart rate responses would change with age and difficulty level as well. Though heart rate differences were found among age categories and difficulty levels, none were found between participants with ADHD and controls. The lack of ADHD differences are not consistent with the behavioral evidence that planning by itself is one of the marked executive function deficits in ADHD. Because ADHD differences were not evident, the effects either were not present or were smaller than that of difficulty level and age. Possible explanations for this lack of difference and future directions are discussed.
Planning: fixed-foreperiod event-related potentials during the Tower of London task. - Neuropsychologia
Slow wave ERPs were recorded from 28 young adults as they generated plans for various difficulty levels of a fixed-foreperiod version of the Tower of London task. The resulting waveform included three segments: (1) a left-lateralized negative early-interval wave, which was frontally maximal but not sensitive to difficulty, (2) a right-lateralized frontally maximal mid-interval wave, which was more positive for more difficult problems, and (3) a left lateralized centrally maximal negative-ramping contingent negative variation (CNV) late wave, which was more negative for more difficult problems. The current study adds to the current literature in that it finds that the frontal and central neural utilization with difficulty changes across plan generation. This suggests that plan generation should be considered in terms of when component processes of planning are differentially utilized as plan generation unfolds.Copyright Â© 2011 Elsevier Ltd. All rights reserved.
Structural connectivity of Broca's area and medial frontal cortex. - NeuroImage
Despite over 140 years of research on Broca's area, the connections of this region to medial frontal cortex remain unclear. The current study investigates this structural connectivity using diffusion-weighted MRI tractography in living humans. Our results show connections between Broca's area and Brodmann's areas (BA) 9, 8, and 6 (both supplementary motor area (SMA) in caudal BA 6, and Pre-SMA in rostral BA 6). Trajectories follow an anterior-to-posterior gradient, wherein the most anterior portions of Broca's area connect to BA 9 and 8 while posterior Broca's area connects to Pre-SMA and SMA. This anterior-posterior connectivity gradient is also present when connectivity-based parcellation of Broca's area is performed. Previous studies of language organization suggest involvement of anterior Broca's area in semantics and posterior Broca's area in syntax/phonology. Given corresponding patterns of functional and structural organization of Broca's area, it seems well warranted to investigate carefully how anterior vs. posterior medial frontal cortex differentially affect semantics, syntax and phonology.Copyright 2010 Elsevier Inc. All rights reserved.
Deconstructing the tower: parameters and predictors of problem difficulty on the Tower of London task. - Brain and cognition
The Tower of London (TOL) task has been widely used in both clinical and research realms. In the current study, 104 healthy participants attempted all possible moderate- to high-difficulty TOL problems in order to determine: (1) optimal measures of problem solving performance, (2) problem characteristics, other than the minimum moves necessary to solve the problem, that determine participants' difficulty in solving problems successfully, quickly, and efficiently, and (3) effects of increased task experience on which problem characteristics determine problem difficulty. A factor analysis of six performance measures found that, regardless of task experience, problem difficulty could be captured well either by a single factor corresponding to general quality of solution or possibly by three subordinate factors corresponding to solution efficiency, solution speed, and initial planning speed. Regression analyses predicting these performance factors revealed that in addition to a problem's minimum moves three problem parameters were critical in determining the problem difficulty: goal position hierarchy, start position hierarchy, and number of solution paths available. The relative contributions of each of the characteristics strongly depended on which performance factor defined performance. We conclude that TOL problem performance is multifaceted, and that classifying problem difficulty using only the minimum moves necessary to solve the problem is inadequate.Copyright 2010 Elsevier Inc. All rights reserved.
Predictors of mortality following symptomatic pulmonary embolism in patients undergoing noncardiac surgery. - Canadian journal of anaesthesia = Journal canadien d'anestheÌsie
To determine 30-day mortality and predictors of mortality following perioperative pulmonary embolism (PE).We searched both the Mayo Clinic electronic medical records and Autopsy Registry, between January 1, 1998 and December 31, 2001, for patients who developed PE within 30 days after noncardiac surgery performed under general or neuraxial anesthesia. Medical records of all identified patients were reviewed using standardized data collection forms. The association between risk factors for PE and 30-day post-PE mortality was assessed using t tests, exact binomial tests, and logistic regression.We identified 158 patients with probable or definite perioperative PE. The overall 30-day mortality from the day of PE was 25.3%, i.e., 40 patients died. Hypotension requiring treatment, need for mechanical ventilation, and intensive care unit admission were the prominent univariate predictors of 30-day mortality (all P
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