Systematic review of multidisciplinary interventions in heart failure

OBJECTIVE

To determine the impact of multidisciplinary interventions on hospital admission and mortality in heart failure.

DESIGN

Systematic review. Thirteen databases were searched and reference lists from included trials and related reviews were checked. Trial authors were contacted if further information was required.

SETTING

Randomised controlled trials conducted in both hospital and community settings.

PATIENTS

Trials were included if all, or a defined subgroup of patients, had a diagnosis of heart failure.

INTERVENTIONS

Multidisciplinary interventions were defined as those in which heart failure management was the responsibility of a multidisciplinary team including medical input plus one or more of the following: specialist nurse, pharmacist, dietician, or social worker. Interventions were separated into four mutually exclusive groups: provision of home visits; home physiological monitoring or televideo link; telephone follow up but no home visits; and hospital or clinic interventions alone. Pharmaceutical and exercise based interventions were excluded.

MAIN OUTCOME MEASURES

All cause hospital admission, all cause mortality, and heart failure hospital admission.

RESULTS

74 trials were identified, of which 30 contained relevant data for inclusion in meta-analyses. Multidisciplinary interventions reduced all cause admission (relative risk (RR) 0.87, 95% confidence interval (CI) 0.79 to 0.95, p = 0.002), although significant heterogeneity was found (p = 0.002). All cause mortality was also reduced (RR 0.79, 95% CI 0.69 to 0.92, p = 0.002) as was heart failure admission (RR 0.70, 95% CI 0.61 to 0.81, p < 0.001). These results varied little with sensitivity analyses.

CONCLUSION

Multidisciplinary interventions for heart failure reduce both hospital admission and all cause mortality. The most effective interventions were delivered at least partly in the home.

Availability of visual and proprioceptive afferent messages and postural control in elderly adults

The ability of young and elderly adults to keep a stable upright posture while facing changes in the availability of visual and/or propriomuscular information was investigated. The two sensory sources of information were alternatively available and withdrawn, jointly and separately, during 10-s alternating sequences. Vision was modified by means of liquid-crystal goggles, and proprioception was altered by means of tendon vibration of both antagonistic ankle muscles. Elderly adults were less stable than young adults when vision was withdrawn. Both groups were greatly affected when propriomuscular inputs were altered by vibration. Under constant visual conditions and following a propriomuscular perturbation (i.e., vibration), elderly adults were unable to take advantage of the reinsertion of propriomuscular inputs. They showed a transient, decreased stability and were unable to fully recover during a 10-s period, whereas young adults were able to rapidly integrate the information to stabilize their posture. When both propriomuscular and visual inputs were withdrawn and concurrently reinserted, the elderly adults did not show a transitory increase in the velocity of the center of foot pressure. The present results extend findings on the inability of elderly adults to reconfigure rapidly the postural set following reinsertion of sensory inputs. The results also suggest that elderly adults have difficulties in taking advantage of sensory redundancy in postural control.

Timing and accuracy of visually directed movements in children: control of direction and amplitude components

The reaction times (RTs), movement times (MTs), and final accuracy of hand movements directed towards visual goals were measured in 6-, 8-, and 10-year-old children, using tasks in which direction and amplitude components of movement were distinctly required. The tasks were performed with and without visual feedback of the limb. RTs decreased with age, and were shorter in directional than in amplitude task, in all ages. MTs were the longest at age 8 in both tasks, equally short at ages 6 and 10 in the directional task, the shortest at age 10, and intermediate at age 6, when amplitude had to be regulated. In the amplitude task, the target distance generally affected MTs under both visual conditions, but to a lower degree at age 10 than in the two younger groups. Movement accuracy, which was in all cases higher with visual feedback, showed different developmental trends among the two spatial components: directional accuracy was not different among the three groups of age, whereas amplitude accuracy showed a nonmonotonic development in the nonvisual condition, with an increase between age 6 and age 10, and the lowest level at age 8. In the visual condition, amplitude accuracy did not change with age. The specification of direction seems therefore to predominantly load the preparatory stage of the response. Amplitude specification seems to be more dependent on on-going regulations and to undergo a longer and more complex development, with a critical period around age 8 when a greater propensity for a feedback-based control appears on the two components. With increasing age, amplitude tends to be specific to a greater extent by a feedforward process.

Accuracy of children on an open-loop pointing task

The accuracy of active and passive movements was measured in 4-yr.- to 11-yr.-old children and in adults performing a visuo-manual pointing task without seeing their limbs. Accuracy varied according to age and nature of movement. The younger children performed accurate movements. At age 7 the accuracy suddenly decreased while the difference between active and passive movements increased. Between 7 and 11 yr., the active performance improved progressively until attaining an adult-like level, while the passive performance remained unchanged. It is concluded that a change occurs in the manner of controlling reaching movements at age 7.

Feedforward versus feedback control in children and adults subjected to a postural disturbance

Any action performed by standing subjects is generally accompanied by compensatory postural activities, which reduce or abolish the postural disturbance generated by the movements and keep the subjects' center of gravity within the supporting base. These postural activities are triggered by either anticipatory and/or feedback-based control processes, depending on the information available and on the behavioral context. To investigate the respective involvement of these two components in postural control during development, we studied the extent to which the postural equilibrium of children (3-to 10-year-olds) and adults was disturbed by the same physical event, an unloading, depending on whether it was initiated by the subject or externally imposed. The subjects were standing on a force platform with their eyes closed, holding a load (5% of their own body weight) in their hands, with arms vertical and forearms horizontal. Two conditions were applied: (1) the subjects voluntarily released the load and (2) the load was unpredictably removed. The unloading resulted in a backward movement of the center of pressure, which was smaller with self-initiated than imposed disturbances in all age groups. This difference varied depending mainly on the age-related changes in the relative amplitude of the self-initiated disturbance, which decreased between 3- to 5-, and 6- to 8-year-olds (who showed no marked postural instability after self-initiated unloading), and increased again in the two older groups (9- to 10-year-olds and adults), in which it also became more consistent It was concluded that feedforward control. becomes more efficient as children grow up, but that its relative contribution to postural control does not show a monotonic pattern of development.

The binding of L-tryptophan to serum albumins in the presence of non-esterified fatty acids

Bovine, human and rat serum albumins were defatted and palmitic acid, oleic acid and lauric acid added in various molar ratios. The binding of L-tryptophan to these albumins was measured at 20 degrees C in a 0.138 M salt solution at pH 7.4, by using an ultrafiltration technique, and analysed in terms of n, the number of available tryptophan-binding sites per albumin molecule, with apparent association constant, k. 2. n and k were 0.90 and 2.3x10(-4)M(minus-1) respectively for defatted bovine serum albumin and 0.87 and 9.7x10(-3)M(-minus-1) for human albumin. Addition of palmitic acid did not decrease n until the molar ratio, fatty acid/bovine albumin, approached and exceeded 2. The decrease in k was small and progressive. In contrast, lauric caused a marked decrease in n and k at ratios as low as 0.5. A similar distinction between the effects on n of palmitic acid and oleic acid and those of lauric acid was seen for human albumin. k for human albumin was not significantly affected by fatty acids under the conditions studied. 3. It is concluded that primary long-chain fatty acid sites interact only weakly with the tryptophan site on albumin and that inhibition of tryptophan binding occurs when secondary long-chain sites are occupied. Primary medium-chain fatty acid sites are distinct from primary long-chain sites but may be grouped with secondary long-chain sites. 4. The relationship between free and bound tryptophan in samples of rat plasma (Stoner et al., 1975) is discussed in terms of a similar but limited study of rat albumin.

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Adloff C, Kuo CM, Lin W, Roy A, Sarkar T, Yu SS, Ceard L, Chang P, Chao Y, Chen KF, Chen PH, Hou WS, Li YY, Lu RS, Paganis E, Psallidas A, Steen A, Yazgan E, Yu PR, Asavapibhop B, Asawatangtrakuldee C, Srimanobhas N, Boran F, Damarseckin S, Demiroglu ZS, Dolek F, Dumanoglu I, Eskut E, Gokbulut G, Guler Y, Guler EG, Hos I, Isik C, Kangal EE, Kara O, Topaksu AK, Kiminsu U, Onengut G, Ozdemir K, Polatoz A, Simsek AE, Tali B, Tok UG, Turkcapar S, Zorbakir IS, Zorbilmez C, Isildak B, Karapinar G, Ocalan K, Yalvac M, Akgun B, Atakisi IO, Cekmecelioglu YC, Gülmez E, Kaya M, Kaya O, Özçelik Ö, Tekten S, Yetkin EA, Cakir A, Cankocak K, Komurcu Y, Sen S, Sen FA, Cerci S, Kaynak B, Ozkorucuklu S, Cerci DS, Grynyov B, Levchuk L, Bhal E, Bologna S, Brooke JJ, Bundock A, Clement E, Cussans D, Flacher H, Goldstein J, Heath GP, Heath HF, Kreczko L, Krikler B, Paramesvaran S, Sakuma T, Nasr-Storey SSE, Smith VJ, Stylianou N, Taylor J, Titterton A, Bell KW, Belyaev A, Brew C, Brown RM, Cockerill DJA, Ellis KV, Harder K, Harper S, Linacre J, Manolopoulos K, Newbold DM, Olaiya E, Petyt D, Reis T, Schuh T, Shepherd-Themistocleous CH, Thea A, Tomalin IR, Williams T, Bainbridge R, Bloch P, Bonomally S, Borg J, Breeze S, Buchmuller O, Cepaitis V, Chahal GS, Colling D, Dauncey P, Davies G, Negra MD, Fayer S, Fedi G, Hall G, Hassanshahi MH, Iles G, Langford J, Lyons L, Magnan AM, Malik S, Martelli A, Nash J, Palladino V, Pesaresi M, Raymond DM, Richards A, Rose A, Scott E, Seez C, Shtipliyski A, Tapper A, Uchida K, Virdee T, Wardle N, Webb SN, Winterbottom D, Zecchinelli AG, Cole JE, Khan A, Kyberd P, Mackay CK, Reid ID, Teodorescu L, Zahid S, Abdullin S, Brinkerhoff A, Caraway B, Dittmann J, Hatakeyama K, Kanuganti AR, McMaster B, Pastika N, Sawant S, Smith C, Sutantawibul C, Wilson J, Bartek R, Dominguez A, Uniyal R, Hernandez AMV, Buccilli A, Charaf O, Cooper SI, Croce DD, Gleyzer SV, Henderson C, Perez CU, Rumerio P, West C, Akpinar A, Albert A, Arcaro D, Cosby C, Demiragli Z, Gastler D, Rohlf J, Salyer K, Sperka D, Spitzbart D, Suarez I, Tsatsos A, Yuan S, Zou D, Benelli G, Burkle B, Coubez X, Cutts D, Duh YT, Hadley M, Heintz U, Hogan JM, Laird E, Landsberg G, Lau KT, Lee J, Luo J, Narain M, Sagir S, Usai E, Wong WY, Yan X, Yu D, Zhang W, Brainerd C, Breedon R, De La Barca Sanchez MC, Chertok M, Conway J, Cox PT, Erbacher R, Jensen F, Kukral O, Lander R, Mulhearn M, Pellett D, Regnery B, Taylor D, Tripathi M, Yao Y, Zhang F, Bachtis M, Cousins R, Dasgupta A, Datta A, Hamilton D, Hauser J, Ignatenko M, Iqbal MA, Lam T, Mccoll N, Nash WA, Regnard S, Saltzberg D, Schnaible C, Stone B, Valuev V, Burt K, Chen Y, Clare R, Gary JW, Hanson G, Karapostoli G, Long OR, Manganelli N, Negrete MO, Si W, Wimpenny S, Zhang Y, Branson JG, Chang P, Cittolin S, Cooperstein S, Deelen N, Duarte J, Gerosa R, Giannini L, Gilbert D, Guiang J, Kansal R, Krutelyov V, Lee R, Letts J, Masciovecchio M, May S, Padhi S, Pieri M, Narayanan BVS, Sharma V, Tadel M, Vartak A, Würthwein F, Xiang Y, Yagil A, Amin N, Campagnari C, Citron M, Dorsett A, Dutta V, Incandela J, Kilpatrick M, Marsh B, Mei H, Ovcharova A, Quinnan M, Richman J, Sarica U, Stuart D, Wang S, Bornheim A, Cerri O, Dutta I, Lawhorn JM, Lu N, Mao J, Newman HB, Ngadiuba J, Nguyen TQ, Spiropulu M, Vlimant JR, Wang C, Xie S, Zhang Z, Zhu RY, Alison J, Andrews MB, Ferguson T, Mudholkar T, Paulini M, Vorobiev I, Cumalat JP, Ford WT, MacDonald E, Patel R, Perloff A, Stenson K, Ulmer KA, Wagner SR, Alexander J, Cheng Y, Chu J, Cranshaw DJ, Mcdermott K, Monroy J, Patterson JR, Quach D, Reichert J, Ryd A, Sun W, Tan SM, Tao Z, Thom J, Wittich P, Zientek M, Albrow M, Alyari M, Apollinari G, Apresyan A, Apyan A, Banerjee S, Bauerdick LAT, Beretvas A, Berry D, Berryhill J, Bhat PC, Burkett K, Butler JN, Canepa A, Cerati GB, Cheung HWK, Chlebana F, Cremonesi M, Petrillo KFD, Elvira VD, Freeman J, Gecse Z, Gray L, Green D, Grünendahl S, Gutsche O, Harris RM, Heller R, Herwig TC, Hirschauer J, Jayatilaka B, Jindariani S, Johnson M, Joshi U, Klabbers P, Klijnsma T, Klima B, Kortelainen MJ, Kwok KHM, Lammel S, Lincoln D, Lipton R, Liu T, Lykken J, Madrid C, Maeshima K, Mantilla C, Mason D, McBride P, Merkel P, Mrenna S, Nahn S, O’Dell V, Papadimitriou V, Pedro K, Pena C, Prokofyev O, Ravera F, Hall AR, Ristori L, Schneider B, Sexton-Kennedy E, Smith N, Soha A, Spiegel L, Stoynev S, Strait J, Taylor L, Tkaczyk S, Tran NV, Uplegger L, Vaandering EW, Weber HA, Woodard A, Acosta D, Avery P, Bourilkov D, Cadamuro L, Cherepanov V, Errico F, Field RD, Guerrero D, Joshi BM, Kim M, Konigsberg J, Korytov A, Lo KH, Matchev K, Menendez N, Mitselmakher G, Rosenzweig D, Shi K, Sturdy J, Wang J, Yigitbasi E, Zuo X, Adams T, Askew A, Diaz D, Habibullah R, Hagopian S, Hagopian V, Johnson KF, Khurana R, Kolberg T, Martinez G, Prosper H, Schiber C, Yohay R, Zhang J, Baarmand MM, Butalla S, Elkafrawy T, Hohlmann M, Verma RK, Noonan D, Rahmani M, Saunders M, Yumiceva F, Adams MR, Apanasevich L, Gonzalez HB, Cavanaugh R, Chen X, Dittmer S, Evdokimov O, Gerber CE, Hangal DA, Hofman DJ, Mills C, Oh G, Roy T, Tonjes MB, Varelas N, Viinikainen J, Wang X, Wu Z, Ye Z, Alhusseini M, Dilsiz K, Durgut S, Gandrajula RP, Haytmyradov M, Khristenko V, Köseyan OK, Merlo JP, Mestvirishvili A, Moeller A, Nachtman J, Ogul H, Onel Y, Ozok F, Penzo A, Snyder C, Tiras E, Wetzel J, Amram O, Blumenfeld B, Corcodilos L, Eminizer M, Gritsan AV, Kyriacou S, Maksimovic P, Roskes J, Swartz M, Vámi T, Barrera CB, Baringer P, Bean A, Bylinkin A, Isidori T, Khalil S, King J, Krintiras G, Kropivnitskaya A, Lindsey C, Minafra N, Murray M, Rogan C, Royon C, Sanders S, Schmitz E, Takaki JDT, Wang Q, Williams J, Wilson G, Duric S, Ivanov A, Kaadze K, Kim D, Maravin Y, Mitchell T, Modak A, Nam K, Rebassoo F, Wright D, Adams E, Baden A, Baron O, Belloni A, Eno SC, Feng Y, Hadley NJ, Jabeen S, Kellogg RG, Koeth T, Mignerey AC, Nabili S, Seidel M, Skuja A, Tonwar SC, Wang L, Wong K, Abercrombie D, Andreassi G, Bi R, Brandt S, Busza W, Cali IA, Chen Y, D’Alfonso M, Ceballos GG, Goncharov M, Harris P, Hu M, Klute M, Kovalskyi D, Krupa J, Lee YJ, Maier B, Marini AC, Mironov C, Paus C, Rankin D, Roland C, Roland G, Shi Z, Stephans GSF, Tatar K, Wang J, Wang Z, Wyslouch B, Chatterjee RM, Evans A, Hansen P, Hiltbrand J, Jain S, Krohn M, Kubota Y, Lesko Z, Mans J, Revering M, Rusack R, Saradhy R, Schroeder N, Strobbe N, Wadud MA, Acosta JG, Oliveros S, Bloom K, Bryson M, Chauhan S, Claes DR, Fangmeier C, Finco L, Golf F, Fernández JRG, Joo C, Kravchenko I, Siado JE, Snow GR, Tabb W, Yan F, Agarwal G, Bandyopadhyay H, Hay L, Iashvili I, Kharchilava A, McLean C, Nguyen D, Pekkanen J, Rappoccio S, Williams A, Alverson G, Barberis E, Freer C, Haddad Y, Hortiangtham A, Li J, Madigan G, Marzocchi B, Morse DM, Nguyen V, Orimoto T, Parker A, Skinnari L, Tishelman-Charny A, Wamorkar T, Wang B, Wisecarver A, Wood D, Bhattacharya S, Bueghly J, Chen Z, Gilbert A, Gunter T, Hahn KA, Odell N, Schmitt MH, Sung K, Velasco M, Band R, Bucci R, Dev N, Goldouzian R, Hildreth M, Anampa KH, Jessop C, Lannon K, Loukas N, Marinelli N, Mcalister I, Meng F, Mohrman K, Musienko Y, Ruchti R, Siddireddy P, Wayne M, Wightman A, Wolf M, Zarucki M, Zygala L, Bylsma B, Cardwell B, Durkin LS, Francis B, Hill C, Lefeld A, Winer BL, Yates BR, Addesa FM, Bonham B, Das P, Dezoort G, Elmer P, Frankenthal A, Greenberg B, Haubrich N, Higginbotham S, Kalogeropoulos A, Kopp G, Kwan S, Lange D, Lucchini MT, Marlow D, Mei K, Ojalvo I, Olsen J, Palmer C, Stickland D, Tully C, Xie Z, Malik S, Norberg S, Bakshi AS, Barnes VE, Chawla R, Das S, Gutay L, Jones M, Jung AW, Karmarkar S, Liu M, Negro G, Neumeister N, Paspalaki G, Peng CC, Piperov S, Purohit A, Schulte JF, Stojanovic M, Thieman J, Wang F, Xiao R, Xie W, Dolen J, Parashar N, Baty A, Dildick S, Ecklund KM, Freed S, Geurts FJM, Kumar A, Li W, Padley BP, Redjimi R, Roberts J, Shi W, Leiton AGS, Bodek A, de Barbaro P, Demina R, Dulemba JL, Fallon C, Ferbel T, Galanti M, Garcia-Bellido A, Hindrichs O, Khukhunaishvili A, Ranken E, Taus R, Chiarito B, Chou JP, Gandrakota A, Gershtein Y, Halkiadakis E, Hart A, Heindl M, Hughes E, Kaplan S, Karacheban O, Laflotte I, Lath A, Montalvo R, Nash K, Osherson M, Salur S, Schnetzer S, Somalwar S, Stone R, Thayil SA, Thomas S, Wang H, Acharya H, Delannoy AG, Spanier S, Bouhali O, Dalchenko M, Delgado A, Eusebi R, Gilmore J, Huang T, Kamon T, Kim H, Luo S, Malhotra S, Mueller R, Overton D, Rathjens D, Safonov A, Akchurin N, Damgov J, Hegde V, Kunori S, Lamichhane K, Lee SW, Mengke T, Muthumuni S, Peltola T, Undleeb S, Volobouev I, Wang Z, Whitbeck A, Appelt E, Greene S, Gurrola A, Johns W, Maguire C, Melo A, Ni H, Padeken K, Romeo F, Sheldon P, Tuo S, Velkovska J, Arenton MW, Cox B, Cummings G, Hakala J, Hirosky R, Joyce M, Ledovskoy A, Li A, Neu C, Tannenwald B, Wolfe E, Karchin PE, Poudyal N, Thapa P, Black K, Bose T, Buchanan J, Caillol C, Dasu S, De Bruyn I, Everaerts P, Fienga F, Galloni C, He H, Herndon M, Hervé A, Hussain U, Lanaro A, Loeliger A, Loveless R, Sreekala JM, Mallampalli A, Mohammadi A, Pinna D, Savin A, Shang V, Sharma V, Smith WH, Teague D, Trembath-Reichert S, Vetens W. Precision luminosity measurement in proton-proton collisions at s = 13 TeV in 2015 and 2016 at CMS

The measurement of the luminosity recorded by the CMS detector installed at LHC interaction point 5, using proton-proton collisions at s = 13 TeV in 2015 and 2016, is reported. The absolute luminosity scale is measured for individual bunch crossings using beam-separation scans (the van der Meer method), with a relative precision of 1.3 and 1.0% in 2015 and 2016, respectively. The dominant sources of uncertainty are related to residual differences between the measured beam positions and the ones provided by the operational settings of the LHC magnets, the factorizability of the proton bunch spatial density functions in the coordinates transverse to the beam direction, and the modeling of the effect of electromagnetic interactions among protons in the colliding bunches. When applying the van der Meer calibration to the entire run periods, the integrated luminosities when CMS was fully operational are 2.27 and 36.3 fb - 1 in 2015 and 2016, with a relative precision of 1.6 and 1.2%, respectively. These are among the most precise luminosity measurements at bunched-beam hadron colliders.

Kinematics of aiming in direction and amplitude: a developmental study

The patterns of aimed movements to visual targets were analyzed in children aged 6, 8 and 10. Tasks with direction and/or amplitude requirements were used. The tasks were performed both with and without vision. Peak velocity, acceleration and deceleration and their relative temporal occurrence were evaluated. Overall, the 6- and 10-year-olds exhibited higher peak velocity and acceleration when performing the pure directional task than when performing tasks with an amplitude or stopping requirement. On the contrary, 8-year-olds showed similar peak acceleration and velocity across all three tasks. Similarly, when performing the pure directional task, the 6- and 10-year-olds reached their peak velocity and acceleration relatively later in time than the 8-year-olds. Vision of movement increased the peak velocity in all experimental tasks and peak acceleration was increased only in the pure directional task. Thus, movement kinematics varied according to the task requirements and age. Eight-year-olds showed greater propensity to feedback control in all tasks, suggesting an over-inhibition in their approach patterns, whereas 10-year-olds tended to use feedforward processes, with a shortened deceleration phase.

Age effects on reflex and postural responses to propriomuscular inputs generated by tendon vibration

The effects of aging on two sensorimotor levels of propriomuscular function were investigated in a young (20- to 44-year-old) and an elderly (60- to 86-year-old) population by eliciting segmental reflex and postural responses via the same muscle spindle inflow generated by applying the same pattern of tendon vibration. The latency and amplitude of the reflex responses to vibration (tonic vibration reflex) of the biceps and triceps brachii did not depend on the subjects' age. No major age-related changes were observed in the deep reflexes of the lower limbs. The postural responses to the same vibratory stimulation applied to both the soleus or the tibialis anterior muscles (vibration-induced falling) did not show any changes in latency depending on either age or the visual conditions, whereas the intensity of these responses decreased both with age and when the use of vision was possible. Our results suggest that the two levels at which the same propriomuscular messages were processed are differentially affected by aging. The lower reflex level does not undergo any noticeable impairment, whereas the higher postural control level deteriorates in the elderly, which might be partly responsible for the balance problems which tend to occur more frequently with advancing age.

The effect of amplitude and accuracy requirements on movement time in children

The object of this study was to investigate how children control their movements, through- the analysis of Fitts' Law on subjects 5, 7, 9, and 11 yr of age. Children had to perform rapid alternative pointing movements between two targets, varying in width and distance (level of difficulty of the task). The analysis of movement time showed that, as children grow up, movement speed increased and was gradually less affected by the level of difficulty of a given task; moreover the respective effects of accuracy and amplitude requirements on movement time changed with age, resulting in distinct evolutive patterns. The results are thereby discussed in relation to the respective development of both programming and guiding components of movement in children. A few observations about ocular strategies during the task were also noted.

Development of postural adaptation to arm raising

We studied the development of the coordination between posture and movement by analyzing the shifts of the center of pressure (CoP) associated with arm raising. Three groups of children aged 3-5 years, 6-8 years, and 9-10 years and an adult group were tested. The subjects were required to raise their arms to the horizontal position while standing still, with their hands free or loaded (5% of the body weight). The arm movements were recorded by a TV-image processor, and the changes in position of the CoP were measured by a force platform and analyzed before, during, and after the arm movement. The data show that the CoP moved forward during arm raising, that additional load induced a greater shift in all age groups, and that the relative amplitude of the shift decreased with age. The greatest changes occurred between ages 3-5 years and 6-8 years. The pre- and postmovement CoP shift suggests qualitative changes in the postural adaptation to movement between these two age groups: the anticipatory postural adjustments moved from a supporting function to a compensatory function, yielding an increasing functional convergence between the feedforward and the feedback modes of postural control, and an increasing rapidness in recovering postural stability after arm movement. The postural behavior shown by the 9- to 10-year-old children and by the adults in the arms-free condition suggests an increased tolerance to unbalance when postural oscillations do not jeopardize static equilibrium.

Proprioceptive Control of Goal-Directed Movements in Man, Studied by Means of Vibratory Muscle Tendon Stimulation

The purpose of this study was to investigate the role of propriomuscular feedback in the control of pluriarticular pointing movements, performed without visual feedback toward visual targets. The proprioceptive inputs were distorted during movements by applying vibration to the distal tendon of the biceps muscle. Various movement and vibration durations were imposed. The results show that vibration affects the spatial outcome of the movements. The effects of vibration were movement time-independent when the durations were shorter than 450 ms and became movement time-dependent with longer durations. Moreover, the effects of vibration became more marked when a short vibration was applied at the end rather than at the beginning of a slow movement. These studies suggest that at least two types of proprioceptive control loops may be involved in correcting this kind of movement, depending on the execution time. In slow movements, the final phase might be a privileged period for on-line, propriomuscular-based corrections. Lastly, it emerged that the regulation of a goal-directed movement on the basis of proprioceptive feedback processing can take place within at most 200 ms.

The dose-related hyper-and-hypokalaemic effects of salbutamol and its arrhythmogenic potential

1. The hypokalaemic effect of salbutamol after more than 30 min of administration has been well described. A hyper-and-hypokalaemic effect for adrenaline has been reported, but no such hyperkalaemic effect for salbutamol. 2. The possible hyper-and-hypokalaemic effects of salbutamol with the concomitant potential for pro-arrhythmia were assessed in the baboon (Papio ursinus). 3. Male and female baboons were anaesthetized with ketamine (15 mg kg-1) and maintained with 6% pentobarbitone as spontaneously breathing animals. Six baboons in each group received either 10, 100 or 500 micrograms kg-1 salbutamol i.v. Lead II of the ECG and femoral i.a. blood pressure were recorded continuously for 10 min. Arterial blood samples were collected at 0 min and then after 3 and 10 min of salbutamol administration. 4. All the animals developed sinus tachycardia (above 200 beats min-1) within 30 s of each dose of salbutamol administration and the high heart rate persisted throughout the experiment. All the animals were hyperkalaemic after 3 min and hypokalaemic after 10 min for each dose of salbutamol. Left ventricular conduction defects were seen in 3 animals during the hyperkalaemic phase. No arrhythmia was seen during the hypokalaemic phase. 5. Salbutamol has a transient hyperkalaemic and a more prolonged hypokalaemic effect in the baboon. The hypokalaemia could not be associated with arrhythmia although conduction defects were associated with the hyperkalaemia. 6. Since salbutamol is used as a bronchodilator in asthmatic patients and to treat acute hyperkalaemia, it is suggested that caution should be exercised when using salbutamol in high doses to treat acute asthma especially during the first few minutes of administration. The finding of hyperkalaemia with salbutamol questions its use in the treatment of hyperkalaemia.

Visual correction of a rapid goal-directed response

The purpose of this study was to investigate the role of dynamic and static visual cues in improvement of accuracy during a pointing movement. In the experiment, subjects were required to point finger rapidly at visual targets as accurately as possible. Movement amplitude was 15 cm, and movement times ranged from 100 to 190 msec. Three visual feedback conditions were applied: no feedback, dynamic ongoing feedback on the complete hand trajectory, and static error feedback on the movement end-point. Two spatial movement outcomes were considered, mean constant error and intraindividual dispersion of pointings. Data were analyzed with regard to effects of feedback and speed. Under the no-feedback condition, accuracy was lowest; constant error was not speed-dependent, whereas dispersion increased with speed of movement. Accuracy was highest under the complete feedback condition and was speed-dependent, as shown by both constant error and dispersion. Under error feedback, accuracy was intermediate and was also speed-dependent. The results are discussed in terms of the interchange between correcting mechanisms vs delayed control within the motor regulatory processes.

Resolving Power of the Perceptual-and Sensorimotor Systems in 6- to 10-Year-Old Children

Children aged 6 to 10 were tested on their ability to move accurately and to perceptually evaluate their motor response. Subjects performed a directional and an amplitude visuo-manual aiming task without vision of their moving limb. They were asked to correct their error, after completion of their movements, only if they felt they were not accurate. Terminal aiming errors and correction responses (adjustments) were analyzed, and threshold detection was determined relative to terminal aiming error. Action accuracy and evaluation of action accuracy are two abilities that do not develop synchronously. Moreover, the relationship between these abilities depends on whether accuracy and direction or amplitude are required. Amplitude undergoes more corrections than direction, suggesting that the spatial system of reference involved depends more upon the coding of the final position than on direction. Two spatial comparators, operating on the basis of two types of evaluation, seem to have a variably distinct contribution to movement and perception accuracy, according to age.

A portrait of the Higgs boson by the CMS experiment ten years after the discovery

In July 2012, the ATLAS and CMS collaborations at the CERN Large Hadron Collider announced the observation of a Higgs boson at a mass of around 125 gigaelectronvolts. Ten years later, and with the data corresponding to the production of a 30-times larger number of Higgs bosons, we have learnt much more about the properties of the Higgs boson. The CMS experiment has observed the Higgs boson in numerous fermionic and bosonic decay channels, established its spin-parity quantum numbers, determined its mass and measured its production cross-sections in various modes. Here the CMS Collaboration reports the most up-to-date combination of results on the properties of the Higgs boson, including the most stringent limit on the cross-section for the production of a pair of Higgs bosons, on the basis of data from proton-proton collisions at a centre-of-mass energy of 13 teraelectronvolts. Within the uncertainties, all these observations are compatible with the predictions of the standard model of elementary particle physics. Much evidence points to the fact that the standard model is a low-energy approximation of a more comprehensive theory. Several of the standard model issues originate in the sector of Higgs boson physics. An order of magnitude larger number of Higgs bosons, expected to be examined over the next 15 years, will help deepen our understanding of this crucial sector.

ECT and tardive dyskinesia

Three cases of elderly depressed patients with symptoms of tardive dyskinesia (TD) subsequently treated with electroconvulsive therapy (ECT) are presented. These cases are discussed in relation to several cases reported in the literature of ECT and TD. The possibility of improvement in symptoms of TD in certain patients is discussed.

Stability of cardiodynamic and some blood parameters in the baboon following intravenous anaesthesia with ketamine and diazepam

The stability of cardiodynamic and some blood parameters during a slow, continuous infusion of a combination of ketamine and diazepam is reported. Contractility (dP/dt), myocardial relaxation (Tln), left ventricular end-diastolic pressure (LVEDP), left ventricular systolic pressure (LVSP), arterial blood pressure and certain blood parameters were assessed in 3 male and 3 female juvenile baboons (Papio ursinus). Anaesthesia was induced with 15 mg/kg ketamine i.m. and maintained with a continuous i.v. infusion (40-60 ml/h) of ketamine and diazepam. The mixture consisted of 2 ml ketamine (100 mg/ml), 2 ml diazepam (5 mg/ml) and 50 ml saline. A period of 75 +/- 10 min was allowed for preparation of the animals, after which lead II of the ECG, femoral artery blood pressure and left ventricular pressure were recorded at 15-min intervals for a period of 2 h: the total duration of anaesthesia was 195 min. Arterial blood samples were analysed at 30-min intervals for blood gases, electrolytes, glucose and insulin. Left ventricular parameters were derived from the left ventricular pressure curve. Tln, LVSP and LVEDP showed small fluctuations. Contractility decreased (p < 0.037) at the 195-min interval. No arrhythmias or ECG changes were seen, while blood pressure decreased gradually. Serum calcium concentration decreased and blood glucose levels increased gradually over time. Anaesthesia and analgesia were sufficient and no other drugs were necessary. The animals appeared sedated and dazed 60-80 min after the procedure. A continuous infusion of a combination of ketamine and diazepam for a duration of 150 min can provide stable anaesthesia for cardiodynamic measurements.