Migraineurs during interictal periods showed hyperxcitability of the visual cortex with a wider photoresponsive area, the underlying mechanism probably being dual: constitutional-defensive and acquired-sensitizating.

Project ECHO (Extension for Community Healthcare Outcomes) is an evidence-based model that provides high-quality medical education for common and complex diseases through telementoring and comanagement of patients with primary care clinicians. In a one to many knowledge network, the ECHO model helps to bridge the gap between primary care clinicians and specialists by enhancing the knowledge, skills, confidence, and practice of primary care clinicians in their local communities. As a result, patients in rural and urban underserved areas are able to receive best practice care without long waits or having to travel long distances. The ECHO model has been replicated in 43 university hubs in the United States and five other countries. A new replication tool was developed by the Project ECHO Pain team and U.S. Army Medical Command to ensure a high-fidelity replication of the model. The adoption of the tool led to successful replication of ECHO in the Army Pain initiative. This replication tool has the potential to improve the fidelity of ECHO replication efforts around the world.

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Multiresolution analysis of fMRI studies using wavelets is a new approach, previously reported to yield higher sensitivity in the detection of activation areas. No data are available, however, in the literature on the analytic approach and wavelet bases that produce optimum results. The present study was undertaken to assess the performance of different wavelet decomposition schemes by making use of a "gold standard," a realistic computer-simulated phantom. As activation areas are then known "a priori," accurate assessments of sensitivity, specificity, ROC curve area and spatial resolution can be obtained. This approach has allowed us to study the effect of different factors: the size of the activation area, activity level, signal-to-noise ratio (SNR), use of pre-smoothing, wavelet base function and order and resolution level depth. Activations were detected by performing t-tests in the wavelet domain and constructing the final image from those coefficients that passed the significance test at a given P-value threshold. In contrast to previously reported data, our simulation study shows that lower wavelet orders and resolution depths should be used to obtain optimum results (in terms of ROC curve area). The Gabor decomposition offers the maximum fidelity in preserving activation area shapes. No major differences were found between other wavelet bases functions. Data pre-smoothing increases ROC area for all but very small activation region sizes.

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