An adapting auditory-motor feedback loop can contribute to generating vocal repetition

Consecutive repetition of actions is common in behavioral sequences. Although integration of sensory feedback with internal motor programs is important for sequence generation, if and how feedback contributes to repetitive actions is poorly understood. Here we study how auditory feedback contributes to generating repetitive syllable sequences in songbirds. We propose that auditory signals provide positive feedback to ongoing motor commands, but this influence decays as feedback weakens from response adaptation during syllable repetitions. Computational models show that this mechanism explains repeat distributions observed in Bengalese finch song. We experimentally confirmed two predictions of this mechanism in Bengalese finches: removal of auditory feedback by deafening reduces syllable repetitions; and neural responses to auditory playback of repeated syllable sequences gradually adapt in sensory-motor nucleus HVC. Together, our results implicate a positive auditory-feedback loop with adaptation in generating repetitive vocalizations, and suggest sensory adaptation is important for feedback control of motor sequences

Circadian Rhythms in Anesthesia and Critical Care Medicine

The rotation of the earth and associated alternating cycles of light and dark—the basis of our circadian rhythms—are fundamental to human biology and culture. However, it was not until 1971 that researchers first began to describe the molecular mechanisms for the circadian system. During the past few years, groundbreaking research has revealed a multitude of circadian genes affecting a variety of clinical diseases, including diabetes, obesity, sepsis, cardiac ischemia, and sudden cardiac death. Anesthesiologists, in the operating room and intensive care units, manage these diseases on a daily basis as they significantly affect patient outcomes. Intriguingly, sedatives, anesthetics, and the intensive care unit environment have all been shown to disrupt the circadian system in patients. In the current review, we will discuss how newly acquired knowledge of circadian rhythms could lead to changes in clinical practice and new therapeutic concepts

Sofosbuvir, Velpatasvir, and Voxilaprevir for Treatment of Recurrent Hepatitis C Virus Infection After Liver Transplantation.

There are limited data on direct-acting antiviral (DAA) treatment options for previously treated patients with recurrent genotype 3 (GT3) hepatitis C virus (HCV) after liver transplantation. Sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) is currently approved for treatment of HCV in patients with prior treatment with DAAs. We report the first published experience using SOF/VEL/VOX after liver transplantation for a DAA-experienced patient with severe hepatitis due to early recurrent GT3 HCV. The patient was treated with SOF/VEL/VOX that was extended to a total duration of 16 weeks and was intensified with ribavirin (RBV) starting at week 8 due to persistent viremia during treatment. Sustained virologic response at 12 weeks (SVR12) after treatment completion was achieved. SOF/VEL/VOX was well tolerated, and immediate drug-drug interaction (DDI) with tacrolimus (TAC) was not evident. Due to improvement in liver metabolic function with increasing TAC clearance, TAC dose adjustment was required throughout the treatment course

Monitoring stream stage, channel profile, and aqueous conductivity with time domain reflectometry (TDR).

Time domain reflectometry (TDR) operates by propagating a radar frequency electromagnetic pulse down a transmission line while monitoring the reflected signal. As the electromagnetic pulse propagates along the transmission line, it is subject to impedance by the dielectric properties of the media along the transmission line (e.g., air, water, sediment), reflection at dielectric discontinuities (e.g., air-water or water-sediment interface), and attenuation by electrically conductive materials (e.g., salts, clays). Taken together, these characteristics provide a basis for integrated stream monitoring; specifically, concurrent measurement of stream stage, channel profile and aqueous conductivity. Here, we make novel application of TDR within the context of stream monitoring. Efforts toward this goal followed three critical phases. First, a means of extracting the desired stream parameters from measured TDR traces was required. Analysis was complicated by the fact that interface location and aqueous conductivity vary concurrently and multiple interfaces may be present at any time. For this reason a physically based multisection model employing the S11 scatter function and Cole-Cole parameters for dielectric dispersion and loss was developed to analyze acquired TDR traces. Second, we explored the capability of this multisection modeling approach for interpreting TDR data acquired from complex environments, such as encountered in stream monitoring. A series of laboratory tank experiments were performed in which the depth of water, depth of sediment, and conductivity were varied systematically. Comparisons between modeled and independently measured data indicate that TDR measurements can be made with an accuracy of {+-}3.4x10{sup -3} m for sensing the location of an air/water or water/sediment interface and {+-}7.4% of actual for the aqueous conductivity. Third, monitoring stations were sited on the Rio Grande and Paria rivers to evaluate performance of the TDR system under normal field conditions. At the Rio Grande site (near Central Bridge in Albuquerque, New Mexico) continuous monitoring of stream stage and aqueous conductivity was performed for 6 months. Additionally, channel profile measurements were acquired at 7 locations across the river. At the Paria site (near Lee's Ferry, Arizona) stream stage and aqueous conductivity data were collected over a 4-month period. Comparisons drawn between our TDR measurements and USGS gage data indicate that the stream stage is accurate within {+-}0.88 cm, conductivity is accurate within {+-}11% of actual, and channel profile measurements agree within {+-}1.2 cm

Remdesivir for 5 or 10 Days in Patients With Severe Covid-19

Background: Remdesivir is an RNA polymerase inhibitor with potent antiviral activity in vitro and efficacy in animal models of coronavirus disease 2019 (Covid-19). Methods: We conducted a randomized, open-label, phase 3 trial involving hospitalized patients with confirmed SARS-CoV-2 infection, oxygen saturation of 94% or less while they were breathing ambient air, and radiologic evidence of pneumonia. Patients were randomly assigned in a 1:1 ratio to receive intravenous remdesivir for either 5 days or 10 days. All patients received 200 mg of remdesivir on day 1 and 100 mg once daily on subsequent days. The primary end point was clinical status on day 14, assessed on a 7-point ordinal scale. Results: In total, 397 patients underwent randomization and began treatment (200 patients for 5 days and 197 for 10 days). The median duration of treatment was 5 days (interquartile range, 5 to 5) in the 5-day group and 9 days (interquartile range, 5 to 10) in the 10-day group. At baseline, patients randomly assigned to the 10-day group had significantly worse clinical status than those assigned to the 5-day group (P = 0.02). By day 14, a clinical improvement of 2 points or more on the ordinal scale occurred in 64% of patients in the 5-day group and in 54% in the 10-day group. After adjustment for baseline clinical status, patients in the 10-day group had a distribution in clinical status at day 14 that was similar to that among patients in the 5-day group (P = 0.14). The most common adverse events were nausea (9% of patients), worsening respiratory failure (8%), elevated alanine aminotransferase level (7%), and constipation (7%). Conclusions: In patients with severe Covid-19 not requiring mechanical ventilation, our trial did not show a significant difference between a 5-day course and a 10-day course of remdesivir. With no placebo control, however, the magnitude of benefit cannot be determined. (Funded by Gilead Sciences; GS-US-540-5773 ClinicalTrials.gov number, NCT04292899.)

Association Between Neuromuscular Blocking Agents and Outcomes of Emergency Tracheal Intubation: A Secondary Analysis of Randomized Trials

Study objective: To examine the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt and severe complications during tracheal intubation of critically ill adults in an emergency department (ED) or ICU. Methods: We performed a secondary analysis of data from 2 multicenter randomized trials in critically ill adults undergoing tracheal intubation in an ED or ICU. Using a generalized linear mixed-effects model with prespecified baseline covariates, we examined the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt (primary outcome) and severe complications during tracheal intubation (secondary outcome). Results: Among the 2,440 patients in the trial data sets, 2,339 (95.9%) were included in the current analysis; 475 patients (20.3%) received succinylcholine and 1,864 patients (79.7%) received rocuronium. Successful intubation on the first attempt occurred in 375 patients (78.9%) who received succinylcholine and 1,510 patients (81.0%) who received rocuronium (an adjusted odds ratio of 0.87; 95% CI 0.65 to 1.15). Severe complications occurred in 67 patients (14.1%) who received succinylcholine and 456 patients (24.5%) who received rocuronium (adjusted odds ratio, 0.88; 95% CI 0.62 to 1.26). Conclusion: Among critically ill adults undergoing tracheal intubation, the incidences of successful intubation on the first attempt and severe complications were not significantly different between patients who received succinylcholine and patients who received rocuronium

fMRI Evidence for a Dual Process Account of the Speed-Accuracy Tradeoff in Decision-Making

Background: The speed and accuracy of decision-making have a well-known trading relationship: hasty decisions are more prone to errors while careful, accurate judgments take more time. Despite the pervasiveness of this speed-accuracy tradeoff (SAT) in decision-making, its neural basis is still unknown. Methodology/Principal Findings: Using functional magnetic resonance imaging (fMRI) we show that emphasizing the speed of a perceptual decision at the expense of its accuracy lowers the amount of evidence-related activity in lateral prefrontal cortex. Moreover, this speed-accuracy difference in lateral prefrontal cortex activity correlates with the speedaccuracy difference in the decision criterion metric of signal detection theory. We also show that the same instructions increase baseline activity in a dorso-medial cortical area involved in the internal generation of actions. Conclusions/Significance: These findings suggest that the SAT is neurally implemented by modulating not only the amount of externally-derived sensory evidence used to make a decision, but also the internal urge to make a response. We propose that these processes combine to control the temporal dynamics of the speed-accuracy trade-off in decisionmaking

Identifying Vulnerable Populations through an Examination of the Association Between Multipollutant Profiles and Poverty

Recently, concerns have centered on how to expand knowledge on the limited science related to the cumulative impact of multiple air pollution exposures and the potential vulnerability of poor communities to their toxic effects. The highly intercorrelated nature of exposures makes application of standard regression-based methods to these questions problematic due to well-known issues related to multicollinearity. Our paper addresses these problems by using, as its basic unit of inference, a profile consisting of a pattern of exposure values. These profiles are grouped into clusters and associated with a deprivation outcome. Specifically, we examine how profiles of NO(2)-, PM(2.5)-, and diesel- (road and off-road) based exposures are associated with the number of individuals living under poverty in census tracts (CT's) in Los Angeles County. Results indicate that higher levels of pollutants are generally associated with higher poverty counts, though the association is complex and nonlinear. Our approach is set in the Bayesian framework, and as such the entire model can be fit as a unit using modern Bayesian multilevel modeling techniques via the freely available WinBUGS software package, (1) though we have used custom-written C++ code (validated with WinBUGS) to improve computational speed. The modeling approach proposed thus goes beyond single-pollutant models in that it allows us to determine the association between entire multipollutant profiles of exposures with poverty levels in small geographic areas in Los Angeles County