Left posterior parietal theta burst stimulation affects gestural imitation regardless of semantic content.

OBJECTIVE Neuro-imaging studies have suggested that the ability to imitate meaningless and meaningful gestures may differentially depend on superior (SPL) and inferior (IPL) parietal lobule. Therefore, we hypothesized that imaging-guided neuro-navigated continuous theta burst stimulation (cTBS) over left SPL mainly affects meaningless and over left IPL predominantly meaningful gestures. METHODS Twelve healthy subjects participated in this study. High resolution structural MRI was used for imaging guided neuro-navigation cTBS. Participants were targeted with one train of cTBS in three experimental sessions: sham stimulation over vertex and real cTBS over left SPL and IPL, respectively. An imitation task, including 24 meaningless and 24 meaningful gestures, was performed 'offline'. RESULTS cTBS over both left IPL and SPL significantly interfered with gestural imitation. There was no differential effect of SPL and IPL cTBS on gesture type (meaningless versus meaningful). CONCLUSIONS Our findings confirm that left posterior parietal cortex plays a predominant role in gestural imitation. However, the hypothesis based on the dual route model suggesting a differential role of SPL and IPL in the processing of meaningless and meaningful gestures could not be confirmed. SIGNIFICANCE Left SPL and IPL play a common role within the posterior-parietal network in gestural imitation regardless of semantic content.

Cost-effectiveness of universal prophylaxis in pregnancy with prior group B streptococci colonization.

OBJECTIVE: To estimate the costs and outcomes of rescreening for group B streptococci (GBS) compared to universal treatment of term women with history of GBS colonization in a previous pregnancy. STUDY DESIGN: A decision analysis model was used to compare costs and outcomes. Total cost included the costs of screening, intrapartum antibiotic prophylaxis (IAP), treatment for maternal anaphylaxis and death, evaluation of well infants whose mothers received IAP, and total costs for treatment of term neonatal early onset GBS sepsis. RESULTS: When compared to screening and treating, universal treatment results in more women treated per GBS case prevented (155 versus 67) and prevents more cases of early onset GBS (1732 versus 1700) and neonatal deaths (52 versus 51) at a lower cost per case prevented ($8,805 versus $12,710). CONCLUSION: Universal treatment of term pregnancies with a history of previous GBS colonization is more cost-effective than the strategy of screening and treating based on positive culture results.

Factors determining the use of universal precautions by emergency department nurses

The Health Belief Model (HBM) provided the theoretical framework for examining Universal Precautions (UP) compliance factors by Emergency Department nurses. A random sample of Emergency Nurses Association (ENA) clinical nurses (n = 900) from five states (New York, New Jersey, California, Texas, and Florida), were surveyed to explore the factors related to their decision to comply with UP. Five-hundred-ninety-eight (598) useable questionnaires were analyzed. The responders were primarily female (84.9%), hospital based (94.6%), staff nurses (66.6%) who had a mean 8.5 years of emergency nursing experience. The nurses represented all levels of hospitals from rural (4.5%) to urban trauma centers (23.7%). The mean UP training hours was 3.0 (range 0-38 hours). Linear regression was used to analyze the four hypotheses. The first hypothesis evaluating perceived susceptibility and seriousness with reported UP use was not significant (p = $>$.05). Hypothesis 2 tested perceived benefits with internal and external barriers. Both perceived benefits and internal barriers as well as the overall regression were significant (F = 26.03, p = $<$0.001). Hypothesis 3 which tested modifying factors, cues to action, select demographic variables, and the main effects of the HBM with self reported UP compliance, was also significant (F = 12.39, p = $<$0.001). The additive effects were tested by use of a stepwise regression that assessed the contribution of each of the significant variables. The regression was significant (F = 12.39, p = $<$0.001) and explained 18% of the total variance. In descending order of contribution, the significant variables related to compliance were: internal barriers (t = $-$6.267; p = $<$0.001) such as the perception that because of the nature of the emergency care environment there is sometimes inadequate time to put on UP; cues to action (t = 3.195; p = 0.001) such as posted reminder signs or verbal reminders from peers; the number of Universal Precautions training hours (t = 3.667; p = $<$0.001) meaning that as the number of training hours increase so does compliance; perceived benefits (t = 3.466; p = 0.001) such as believing that UP will provide adequate barrier protection; and perceived susceptibility (t = 2.880; p = 0.004) such as feeling that they are at risk of exposure. ^

The determinants of physician and pharmacist utilization and equity of access under Korean universal health insurance

This study examines the social and behavioral determinants of two types of primary care, seeing a physician or a pharmacist, for Koreans and evaluates the equity of the Korean national health insurance system. The study applies the Aday and Andersen access framework to cross-sectional data from the 1992 Korean National Health Interview Survey (N = 21,841).^ The study found that in Korea, the elderly were most likely, and children least likely, to have used physician services. Women, household heads, those in small families, and the less educated were more likely than their counterparts to use physician and pharmacist services. Health status and need were important determinants of Koreans seeing a doctor or a pharmacist. Differences in need substantially accounted for the original differences observed between subgroups. Resources associated with having insurance coverage, a regular source of care, and place of residence (rural/urban) ameliorated to some extent the subgroup differences in the use of physicians' and pharmacists' services among Koreans. They were also major independent predictors of access. Having insurance remains a particularly important predictor of who uses physician services. Among the insured, trade-offs in the use of physician and pharmacist services were found in the current system, i.e., uninsured and poor Koreans were more likely to use pharmacist services, while insured and rural Koreans were more likely to use doctor services. Among the insured, cost sharing rates are lower for physician than for pharmacist services. Self-employed persons were less likely than government and industrial workers to use physician services. An underlying expectation under universal health insurance was that the Korean health care system would be equitable. The research results, however, did not fully support this expectation.^ The policy implications of these findings are that measures are required to extend insurance coverage to the uninsured, to equalize differences in benefit packages between health plans, and to expand the availability of physicians in rural areas. Further research is also needed to understand those who do not currently have a regular source of care and why and the access barriers that may exist for selected demographic subgroups (those in large families and unmarried or divorced/widowed persons). ^

What is ‘wood’ – An anatomical re-definition

The technical definition of ‘wood’ is well accepted, but its botanical understanding remains vague. Different degrees and amounts of lignification in plants and their imprecise description, together with a conceptually doubtful life form catalog including trees, shrubs and herbs further complicate our understanding of ‘wood’. Here, we use permanent micro sections to demonstrate that the xylem and bark of terrestrial plants can vary from one tissue with a few lignified cells to an almost fully lignified tissue. This universal principle of plant growth and stabilization, accounting for all taxonomic units within vascular plants, suggests that the classical life form separation into herbs, shrubs and trees is not valid. An anatomical-based differentiation between ‘wood’, ‘woody’ and ‘woodiness’ is also only meaningful if supplemented by insight on the particular plant section and its lignified proportion. We therefore recommend utilizing the botanically more neutral term ‘stem anatomy’ instead of ‘wood anatomy’, which further implies integration of the xylem and bark of all terrestrial plants. Since dendrochronology considers shrubs, dwarf shrubs and perennial herbs in addition to trees, its semantic expansion toward ‘xylemchronology’ might be worthwhile considering.