bluuebunny/crossref_metadata_2025 huggingface dataset:
The applicability of generalisability and bias to health professions education's research
Authors: Varpio Lara , O'Brien Bridget , Rees Charlotte E. , Monrouxe Lynn , Ajjawi Rola , Paradis Elise
Published: August 2020

Context

Research in health professions education (HPE) spans an array of topics and draws from a diversity of research domains , which brings richness to our understanding of complex phenomena and challenges us to appreciate different approaches to studying them. To fully appreciate and benefit from this diversity, scholars in HPE must be savvy to the hallmarks of rigour that differ across research approaches. In the absence of such recognition, the valuable contributions of many high‐quality studies risk being undermined.

Methods

In this article, we delve into two constructs‐‐‐generalisability and bias‐‐that are commonly invoked in discussions of rigour in health professions education research. We inspect the meaning and applicability of these constructs to research conducted from different paradigms (i.e., positivist and constructivist) and orientations (i.e., objectivist and subjectivist) and then describe how scholars can demonstrate rigour when these constructs do not align with the assumptions underpinning their research.

Conclusions

A one‐size‐fits‐all approach to evaluating the rigour of HPE research disadvantages some approaches and threatens to reduce the diversity of research in our field. Generalisability and bias are two examples of problematic constructs within paradigms that embrace subjectivity; others are equally problematic. As a way forward, we encourage HPE scholars to inspect their assumptions about the nature and purpose of research—both to defend research rigour in their own studies and to ensure they apply standards of rigour that align with research they read and review.
Extracellular matrix remodelling is associated with muscle force increase in overloaded mouse plantaris muscle
Authors: Stantzou A. , Relizani K. , Morales‐Gonzalez S. , Gallen C. , Grassin A. , Ferry A. , Schuelke M. , Amthor H.
Published: August 2020

Aims

Transforming growth factor‐β (TGF‐β) signalling is thought to contribute to the remodelling of extracellular matrix (ECM) of skeletal muscle and to functional decline in patients with muscular dystrophies. We wanted to determine the role of TGF‐β‐induced ECM remodelling in dystrophic muscle.

Methods

We experimentally induced the pathological hallmarks of severe muscular dystrophy by mechanically overloading the plantaris muscle in mice. Furthermore, we determined the role of TGF‐β signalling on dystrophic tissue modulation and on muscle function by (i) overloading myostatin knockout (Mstn−/−) mice and (ii) by additional pharmacological TGF‐β inhibition via halofuginone.

Results

Transcriptome analysis of overloaded muscles revealed upregulation predominantly of genes associated with ECM, inflammation and metalloproteinase activity. Histology revealed in wild‐type mice signs of severe muscular dystrophy including myofibres with large variation in size and internalized myonuclei, as well as increased ECM deposition. At the same time, muscle weight had increased by 208% and muscle force by 234%. Myostatin deficiency blunted the effect of overload on muscle mass (59% increase) and force (76% increase), while having no effect on ECM deposition. Concomitant treatment with halofuginone blunted overload‐induced muscle hypertrophy and muscle force increase, while reducing ECM deposition and increasing myofibre size.

Conclusions

ECM remodelling is associated with an increase in muscle mass and force in overload‐modelled dystrophic muscle. Lack of myostatin is not advantageous and inhibition of ECM deposition by halofuginone is disadvantageous for muscle plasticity in response to stimuli that induce dystrophic muscle.
Duration of symptoms and manometric parameters offer clues to diagnosis of pseudoachalasia
Authors: Gergely Maté , Mello Michael D. , Rengarajan Arvind , Gyawali C. Prakash
Published: August 2020

Background

Pseudoachalasia manifests high‐resolution manometry (HRM) findings of achalasia but results from a secondary process. We analyzed clinical and HRM characteristics of pseudoachalasia, including malignant and non‐malignant subtypes.

Methods

High‐resolution manometry was retrospectively reviewed in patients with confirmed pseudoachalasia, and corroborated with endoscopic and radiographic studies. A control cohort of idiopathic achalasia patients was identified. Clinical characteristics, Eckardt score, and HRM metrics were extracted from institutional records. Grouped data and medians (interquartile range) were compared between pseudoachalasia and idiopathic achalasia, and between malignant and non‐malignant pseudoachalasia, using parametric and non‐parametric statistical tests.

Key Results

Of 28 pseudoachalasia patients (62.2 ± 2.5 years, 60.7% female), 18 (64.3%) had malignancy, and 10 (35.7%) had non‐malignant obstruction. Although Eckardt score did not differentiate pseudoachalasia from 58 achalasia patients (55.9 ± 2.5 years, 53.4% female), weight loss was greater (median 9.1 [5.0‐18.5] vs 3.6 [0‐9.1] kg, P < .02) with shorter duration of symptoms (median 12.9 [8.0‐38.6] vs 36.0 [25.7‐45.0] weeks, P < .001] in pseudoachalasia. Esophagogastric junction (EGJ) metrics demonstrated lower mean IRP values and lower EGJ contractile integral in pseudoachalasia (P < .04 for each comparison with idiopathic achalasia). Type 1 pattern was more frequent in pseudoachalasia (39.3% vs 13.8%, P < .008). Pseudoachalasia demonstrated incomplete HRM patterns, with lower rates of lack of peristalsis (79.6%, vs 93.1% in achalasia, P < .05). Despite higher Eckardt scores in malignant vs non‐malignant pseudoachalasia (median 8.0 [7.0‐9.0] vs 6.0 [3.5‐7.8], P < .03], no significant HRM differences were noted.

Conclusions and Inferences

Pseudoachalasia manifests with a shorter history, greater weight loss, and incomplete HRM achalasia patterns compared to achalasia.
Phytophthora infestans RXLR effector PITG20303 targets a potato MKK1 protein to suppress plant immunity
Authors: Du Yu , Chen Xiaokang , Guo Yalu , Zhang Xiaojiang , Zhang Houxiao , Li Fangfang , Huang Guiyan , Meng Yuling , Shan Weixing
Published: August 2020

Pathogens secret a plethora of effectors into the host cell to modulate plant immunity. Analysing the role of effectors in altering the function of their host target proteins will reveal critical components of the plant immune system.

Here we show that Phytophthora infestans RXLR effector PITG20303, a virulent variant of AVRblb2 (PITG20300) that escapes recognition by the resistance protein Rpi‐blb2, suppresses PAMP‐triggered immunity (PTI) and promotes pathogen colonization by targeting and stabilizing a potato MAPK cascade protein, StMKK1. Both PITG20300 and PITG20303 target StMKK1, as confirmed by multiple in vivo and in vitro assays, and StMKK1 was shown to be a negative regulator of plant immunity, as determined by overexpression and gene silencing.

StMKK1 is a negative regulator of plant PTI, and the kinase activities of StMKK1 are required for its suppression of PTI and effector interaction. PITG20303 depends partially on MKK1, PITG20300 does not depend on MKK1 for suppression of PTI‐induced reactive oxygen species burst, while the full virulence activities of nuclear targeted PITG20303 and PITG20300 are dependent on MKK1.

Our results show that PITG20303 and PITG20300 target and stabilize the plant MAPK cascade signalling protein StMKK1 to negatively regulate plant PTI response.
Roles for the chloroplast‐localized pentatricopeptide repeat protein 30 and the ‘mitochondrial’ transcription termination factor 9 in chloroplast quality control
Authors: Alamdari Kamran , Fisher Karen E. , Sinson Andrew B. , Chory Joanne , Woodson Jesse D.
Published: August 2020

Chloroplasts constantly experience photo‐oxidative stress while performing photosynthesis. This is particularly true under abiotic stresses that lead to the accumulation of reactive oxygen species (ROS) which oxidize DNA, proteins and lipids. Reactive oxygen species can also act as signals to induce acclimation through chloroplast degradation, cell death and nuclear gene expression. To better understand the mechanisms behind ROS signaling from chloroplasts, we have used the Arabidopsis thaliana mutant plastid ferrochelatase two (fc2) that conditionally accumulates the ROS singlet oxygen (1O2) leading to chloroplast degradation and eventually cell death. Here we have mapped mutations that suppress chloroplast degradation in the fc2 mutant and demonstrate that they affect two independent loci (PPR30 and mTERF9) encoding chloroplast proteins predicted to be involved in post‐transcriptional gene expression. These mutants exhibited broadly reduced chloroplast gene expression, impaired chloroplast development and reduced chloroplast stress signaling. Levels of 1O2, however, could be uncoupled from chloroplast degradation, suggesting that PPR30 and mTERF9 are involved in ROS signaling pathways. In the wild‐type background, ppr30 and mTERF9 mutants were also observed to be less susceptible to cell death induced by excess light stress. While broad inhibition of plastid transcription with rifampicin was also able to suppress cell death in fc2 mutants, specific reductions in plastid gene expression using other mutations was not always sufficient. Together these results suggest that plastid gene expression, or the expression of specific plastid genes by PPR30 and mTERF0, is a necessary prerequisite for chloroplasts to activate the 1O2 signaling pathways to induce chloroplast quality control pathways and/or cell death.
Comparative Study on a Straight and Helical Capillary Tube for CO2 and R22 Refrigerant
Authors: Jadhav Pravin , Agrawal Neeraj
Published: August 2020

A comparative study has been carried out on the adiabatic straight and helical capillary tube, using a CO2 and R22 refrigerant. The numerical model for CO2 and R22 is developed using the basic principles of conservation of mass, momentum, and energy. The effect of coiling in the helical capillary tube is compared with a straight capillary tube for CO2 and R22 refrigerant. Compared with the straight capillary tube, the percentage reduction in mass flowrate in the helical capillary tube is calculated with a change in coil diameter, tube diameter, and length. As the coil diameter increases from 30 mm to 150 mm, the percentage reduction in mass is from 5.8% to 2.2% in CO2, and 5% to 1.6% in R22. For helical capillary tube with 50 mm coil diameter, as the tube diameter increases from 1 to 1.5 mm, the percentage reduction in mass flowrate with CO2 refrigerant is from 2.65% to 4.96%, however, for R22 it is from 2.43% to 4.24%. Similarly, as the capillary tube length increases from 1.3 m to 1.8 m, the percentage reduction in mass with CO2, with 50 mm coil diameter is 4.44–4.55%. However, the percentage reduction in mass with R22 is 3.71–3.85%. Moreover, compared with the straight capillary tube, the percentage reduction in length in a helical capillary tube with coil diameter 50 mm is 16% for CO2 and 9% for R22 refrigerant.
Comodulation masking release with random variations of flanking-band center frequencies
Authors: Doleschal Florian , Verhey Jesko L.
Published: August 2020

Comodulation masking release (CMR) is an effect that is associated with auditory sensitivity to coherent amplitude modulations in different frequency regions. The present study investigated if this comodulation is detected by a direct comparison of auditory filter outputs, or if common masker fluctuations are first extracted by a broadly tuned stage that integrates information across a large spectral range. To this end, a modified flanking-band experiment with a narrowband noise masker at the signal frequency (on-frequency masker), and two flanking bands (FBs), one centered below and one above the signal frequency, were used. The center frequencies (CFs) of FBs changed whenever the masker had a local envelope minimum. The center frequencies were randomly chosen from a range of frequencies around the average CF of each FB. A CMR was measured even for large CF variations of FBs, where the envelopes at the off-frequency auditory filters were no longer the same as the masker envelope at the on-frequency auditory filter. This supports the hypothesis of a broadly tuned stage to determine masker comodulation. For two experimental settings, CMR deteriorated for very large variations of CFs of FBs, suggesting a spectral weighting of the off-frequency auditory filters in this broadly tuned stage.
Effects of High-Intensity Interval Training in Hypoxia on Taekwondo Performance
Authors: Chacón Torrealba Tomás , Aranda Araya Jaime , Benoit Nicolas , Deldicque Louise
Published: August 2020

Purpose: To evaluate the effects of a 6-week taekwondo-specific high-intensity interval training (HIIT) in simulated normobaric hypoxia on physical fitness and performance in taekwondoists. Methods: Eighteen male and female black-belt taekwondoists trained twice a week for 6 weeks in normoxia or in hypoxia (FiO2 = 0.143 O2). The HIIT was composed of specific taekwondo movements and simulated fights. Body composition analyses and a frequency speed of kick test during 10 seconds (FSKT10s) and 5 × 10 seconds (FSKTmult), countermovement jump (CMJ) test, Wingate test, and an incremental treadmill test were performed before and after training. Blood lactate concentrations were measured after the FSKTmult and Wingate tests, and a fatigue index during the tests was calculated. Results: A training effect was found for FSKT10s (+35%, P < .001), FSKTmult (+32%, P < .001), and fatigue index (−48%, P = .002). A training effect was found for CMJ height (+5%, P = .003) during the CMJ test. After training, CMJ height increased in hypoxia only (+7%, P = .005). No effect was found for the parameters measured during Wingate test. For the incremental treadmill test, a training effect was found for peak oxygen consumption (P = .002), the latter being 10% lower after than before training in normoxia only (P = .002). Conclusions: In black-belt taekwondoists, hypoxic HIIT twice a week for 6 weeks provides tiny additional gains on key performance parameters compared with normoxic HIIT. Whether the trivial effects reported here might be of physiological relevance to improve performance remains debatable and should be tested individually.
Evidence on Physical Activity and the Prevention of Frailty and Sarcopenia Among Older People: A Systematic Review to Inform the World Health Organization Physical Activity Guidelines
Authors: Oliveira Juliana S. , Pinheiro Marina B. , Fairhall Nicola , Walsh Sarah , Chesterfield Franks Tristan , Kwok Wing , Bauman Adrian , Sherrington Catherine
Published: August 2020

Background: Frailty and sarcopenia are common age-related conditions associated with adverse outcomes. Physical activity has been identified as a potential preventive strategy for both frailty and sarcopenia. The authors aimed to investigate the association between physical activity and prevention of frailty and sarcopenia in people aged 65 years and older. Methods: The authors searched for systematic reviews (January 2008 to November 2019) and individual studies (January 2010 to March 2020) in PubMed. Eligible studies were randomized controlled trials and longitudinal studies that investigated the effect of physical activity on frailty and/or sarcopenia in people aged 65 years and older. The Grading of Recommendations Assessment, Development and Evaluation approach was used to rate certainty of evidence. Results: Meta-analysis showed that physical activity probably prevents frailty (4 studies; frailty score pooled standardized mean difference, 0.24; 95% confidence interval, 0.04–0.43; P = .017, I2 = 57%, moderate certainty evidence). Only one trial investigated physical activity for sarcopenia prevention and did not provide conclusive evidence (risk ratio 1.08; 95% confidence interval, 0.10–12.19). Five observational studies showed positive associations between physical activity and frailty or sarcopenia prevention. Conclusions: Physical activity probably prevents frailty among people aged 65 years and older. The impact of physical activity on the prevention of sarcopenia remains unknown, but observational studies indicate the preventive role of physical activity.
Redesigned TetR-Aptamer System To Control Gene Expression in Plasmodium falciparum
Authors: Rajaram Krithika , Liu Hans B. , Prigge Sean T.
Published: August 2020

Malaria elimination efforts have been repeatedly hindered by the evolution and spread of multidrug-resistant strains of
Plasmodium falciparum
. The absence of a commercially available vaccine emphasizes the need for a better understanding of
Plasmodium
biology in order to further translational research. This has been partly facilitated by targeted gene deletion strategies for the functional analysis of parasite genes. However, genes that are essential for parasite replication in erythrocytes are refractory to such methods, and require conditional knockdown or knockout approaches to dissect their function. One such approach is the TetR-DOZI system that employs multiple synthetic aptamers in the untranslated regions of target genes to control their expression in a tetracycline-dependent manner. Maintaining modified parasites with intact aptamer copies has been challenging since these repeats can be lost by recombination. By interspacing the aptamers with unique sequences, we created a stable genetic system that remains effective at controlling target gene expression.
Use of oximetry to screen for paediatric obstructive sleep apnoea: is one night enough and is 6 hours too much?
Authors: Galway Niamh Catherine , Maxwell Barbara , Shields Michael , O'Donoghue Dara
Published: August 2020

Introduction

Nocturnal pulse oximetry can be used to screen for obstructive sleep apnoea (OSA) using the McGill Oximetry Score (MOS). The MOS has a time threshold for a technically adequate study of 6 hours. It has been suggested that one night of oximetry is sufficient to screen for OSA using the MOS.

Aims

(1) To evaluate night-to-night variation of the MOS. (2) To determine the impact of recording three nights of oximetry on the screening yield for OSA. (3) To explore whether useful MOS data are discarded when a threshold of 6 hours of oximetry recording is used.

Methods

A retrospective study of nocturnal pulse oximetry done at home over three consecutive nights in paediatric patients with suspected OSA. Studies were scored (MOS) using thresholds of ≥6 and ≥4 hours of recording.

Results

A total of 329 patients were studied. MOS scores over three nights showed only fair to moderate agreement. On the first night 126 patients (38%) screened positive for OSA. When three nights of oximetry were done 195 patients (59%) screened positive on at least one of the nights. There were 48 patients with studies of between 4 and 6 hours duration on one or more nights. If these studies are scored 20 patients (42%) would screen positive for OSA on at least one night based on scoring these studies alone.

Conclusion

One night of oximetry screening may not be sufficient to screen for OSA. Lowering the time threshold to ≥4 hours may increase the screening capability of nocturnal oximetry.
Proposal and validation of a new grading system for pterygium (SLIT2)
Authors: Ting Darren Shu Jeng , Liu Yu-Chi , Patil Moushmi , Ji Angel Jung Se , Fang Xiao Ling , Tham Yih Chung , Lee Yi-Fang , Htoon Hla M , Mehta Jodhbir S.
Published: August 2020

Background/aims

To propose and validate a new pterygium grading system based on slit-lamp evaluation.

Methods

This prospective cross-sectional study included 217 patients with pterygium. All patients underwent slit-lamp examination, and slit-lamp photographs were independently graded by two graders twice. A total of eight parameters were evaluated and all parameters were assigned with a score of 1–4 (normal–severe). Intra-rater and inter-rater reliability as determined by weighted Cohen’s kappa analysis.

Results

A total of 868 independent assessment, based on 217 slit-lamp images, were performed by two graders. For conjunctival assessment, the intra-rater reliability was excellent for body thickness (κ=0.81–0.89) and size at limbus (κ=0.87–0.92), substantial-to-excellent for body vascularity (κ=0.72–0.86), and moderate-to-excellent for body length (κ=0.57–0.81), whereas the inter-rater reliability was excellent for size at limbus (κ=0.86), substantial for body thickness (κ=0.72–0.73) and body vascularity (κ=0.66–0.75), and moderate for body length (κ=0.54–0.57). For corneal assessment, the intra-rater reliability was excellent for all four parameters (κ=0.84–0.90) whereas the inter-rater reliability was excellent for head length (κ=0.86–0.87), substantial-to-excellent for head vascularity (κ=0.78–0.82), substantial for Stocker’s line (κ=0.79–0.80) and head thickness (κ=0.67–0.69). The grading system was named SLIT2, which included Stocker’s line, Size at limbus, Length of head/body, Injection/vascularity of body/head, and Thickness of body/head.

Conclusion

The proposed SLIT2 grading system, consisting of eight components, may serve as a reliable tool to standardise the reporting of pterygium severity and disease recurrence for clinical and research applications.
Focal choroidal excavation: review of literature
Authors: Verma Saurabh , Kumar Vinod , Azad Shorya , Bhayana Amber Amar , Surve Abhidnya , Kumar Suneel , Agarwal Pulak , Chawla Rohan , Venkatesh Pradeep
Published: August 2020

Focal choroidal excavation (FCE) is defined as an area of concavity in choroid detected on optical coherence tomography. These are mostly present in macular region without evidence of accompanying scleral ectasia or posterior staphyloma. Though initially considered to be congenital, increasing number of cases have been identified in association with other choroidal pathologies such as central serous choroidopathy, choroidal neovascularisation, polypoidal choroidal vasculopathy, choroiditis, choroidal tumours. In this review article, we aim to elaborate on the morphology, pathogenesis and differential diagnosis of FCE and specifically discuss the spectrum of diseases with known association along with the impact of their treatment on FCE
Trends in excess mortality associated with atrial fibrillation over 45 years (Framingham Heart Study): community based cohort study
Authors: Vinter Nicklas , Huang Qiuxi , Fenger-Grøn Morten , Frost Lars , Benjamin Emelia J , Trinquart Ludovic
Published: August 2020

Objective

To assess temporal trends in the association between newly diagnosed atrial fibrillation and death.

Design

Community based cohort study.

Setting

Framingham Heart Study cohort, in 1972-85, 1986-2000, and 2001-15 (periods 1-3, respectively), in Framingham, MA, USA.

Participants

Participants with no atrial fibrillation, aged 45-95 in each time period, and identified with newly diagnosed atrial fibrillation (or atrial flutter) during each time period.

Main outcome measures

The main outcome was all cause mortality. Hazard ratios for the association between time varying atrial fibrillation and all cause mortality were calculated with adjustment for time varying confounding factors. The difference in restricted mean survival times, adjusted for confounders, between participants with atrial fibrillation and matched referents at 10 years after a diagnosis of atrial fibrillation was estimated. Meta-regression was used to test for linear trends in hazard ratios and restricted mean survival times over the different time periods.

Results

5671 participants were selected in time period 1, 6177 in period 2, and 6174 in period 3. Adjusted hazard ratios for all cause mortality between participants with and without atrial fibrillation were 1.9 (95% confidence interval 1.7 to 2.2) in time period 1, 1.4 (1.3 to 1.6) in period 2, and 1.7 (1.5 to 2.0) in period 3 (Ptrend=0.70). Ten years after diagnosis of atrial fibrillation, the adjusted difference in restricted mean survival times between participants with atrial fibrillation and matched referents decreased by 31%, from −2.9 years (95% confidence interval −3.2 to −2.5) in period 1, to −2.1 years (−2.4 to −1.8) in period 2, to −2.0 years (−2.3 to −1.7) in period 3 (Ptrend=0.03).

Conclusions

No evidence of a temporal trend in hazard ratios for the association between atrial fibrillation and all cause mortality was found. The mean number of life years lost to atrial fibrillation at 10 years had improved significantly, but a two year gap compared with individuals without atrial fibrillation still remained.
Rod phototransduction and light signal transmission during type 2 diabetes
Authors: Becker Silke , Carroll Lara S , Vinberg Frans
Published: August 2020

Introduction

Diabetic retinopathy is a major complication of diabetes recently associated with compromised photoreceptor function. Multiple stressors in diabetes, such as hyperglycemia, oxidative stress and inflammatory factors, have been identified, but systemic effects of diabetes on outer retina function are incompletely understood. We assessed photoreceptor physiology in vivo and in isolated retinas to better understand how alterations in the cellular environment compared with intrinsic cellular/molecular properties of the photoreceptors, affect light signal transduction and transmission in the retina in chronic type 2 diabetes.

Research design and methods

Photoreceptor function was assessed in BKS.Cs-Dock7m+/+Lepr db/J mice, using homozygotes for Leprdb as a model of type 2 diabetes and heterozygotes as non-diabetic controls. In vivo electroretinogram (ERG) was recorded in dark-adapted mice at both 3 and 6 months of age. For ex vivo ERG, isolated retinas were superfused with oxygenated Ames’ media supplemented with 30 mM glucose or mannitol as iso-osmotic control and electrical responses to light stimuli were recorded.

Results

We found that both transduction and transmission of light signals by rod photoreceptors were compromised in 6-month-old (n=9–10 eyes from 5 animals, ***p<0.001) but not in 3-month-old diabetic mice in vivo (n=4–8 eyes from 2 to 4 animals). In contrast, rod signaling was similar in isolated retinas from 6-month-old control and diabetic mice under normoglycemic conditions (n=11). Acutely elevated glucose ex vivo increased light-evoked rod photoreceptor responses in control mice (n=11, ***p<0.001), but did not affect light responses in diabetic mice (n=11).

Conclusions

Our data suggest that long-term diabetes does not irreversibly change the ability of rod photoreceptors to transduce and mediate light signals. However, type 2 diabetes appears to induce adaptational changes in the rods that render them less sensitive to increased availability of glucose.
The contribution of grandmother involvement to child growth and development: an observational study in rural Pakistan
Authors: Chung Esther O , Hagaman Ashley , LeMasters Katherine , Andrabi Nafeesa , Baranov Victoria , Bates Lisa M , Gallis John A , O'Donnell Karen , Rahman Atif , Sikander Siham , Turner Elizabeth L , Maselko Joanna
Published: August 2020

Introduction

Early childhood interventions primarily focus on the mother–child relationship, but grandmothers are often critical in childcare in low-resource settings. Prior research is mixed on how grandmother involvement influences child outcomes and there is a paucity of research on grandmother caregiving in low-income and middle-income countries. We examined the role of grandmother involvement on child growth and development in the first 2 years of life cross sectionally and longitudinally in rural Pakistan.

Methods

We used data from the Bachpan Cohort, a longitudinal birth cohort in rural Pakistan. Maternally reported grandmother involvement in daily instrumental and non-instrumental caregiving was collected at 3 and 12 months. A summed score was created and categorised into non-involved, low and high. Outcomes included 12-month and 24-month child growth, 12-month Bayley Scales of Infant and Toddler Development and 24-month Ages and Stages Questionnaire—Socioemotional. We used multivariable generalised linear models to estimate mean differences (MD) at 12 months (n=727) and 24 months (n=712). Inverse probability weighting was used to account for missingness and sampling.

Results

In our sample, 68% of children lived with a grandmother, and most grandmothers were involved in caregiving. Greater 3-month grandmother involvement was positively associated with 12-month weight z-scores; however, greater involvement was associated with lower 24-month weight z-scores. High 12-month grandmother involvement was associated with improved 12-month cognitive (MD=0.38, 95% CI −0.01 to 0.76), fine motor skills (MD=0.45, 95% CI 0.08 to 0.83) and 24-month socioemotional development (MD=−17.83, 95% CI −31.47 to –4.19). No meaningful associations were found for length z-scores or language development.

Conclusion

In rural Pakistan, grandmothers provide caregiving that influences early child development. Our findings highlight the complex relationship between grandmother involvement and child weight, and suggest that grandmothers may positively promote early child cognitive, fine motor and socioemotional development. Understanding how grandmother involvement affects child outcomes in early life is necessary to inform caregiving interventions.
Severe mental illness and palliative care: patient semistructured interviews
Authors: Knippenberg Inge , Zaghouli Nasira , Engels Yvonne , Vissers Kris C P , Groot Marieke M
Published: August 2020

Objectives

To explore perceptions, experiences and expectations with respect to palliative care of patients with severe mental illness (SMI) and an incurable, life-limiting chronic illness.

Methods

Face-to-face semistructured interviews were conducted with 12 patients (10 of them living in a mental healthcare institution) with severe mental and physical health issues in the Netherlands. A semistructured interview guide was used to elicit perceptions of, experiences with and expectations regarding palliative care. Data were analysed using inductive content analysis.

Results

Analysis of the data revealed eight categories: perceptions on health and health issues, coping with illness and symptoms, experiences with and wishes for current healthcare, contact with relatives and coresidents, experiences with end of life of relatives and coresidents, willingness to discuss end of life and death, wishes and expectations regarding one’s own end of life and practical aspects relating to matters after death. These categories were clustered into two separate themes: current situation and anticipation of end of life. Interviewees with SMI appeared not accustomed to communicate about end-of-life issues, death and dying due to their life-threatening illness. They tended to discuss only their current situation and, after further exploration of the researcher, the terminal phase of life. They seemed not engaged in their future palliative care planning.

Conclusions

Findings of this study highlight inadequacies in advance care planning for patients with SMI. Results suggest using values, current and near wishes, and needs as a starting point for establishing a gradual discussion concerning goals and preferences for future medical and mental treatment and care.
Outcomes and biomarker analyses among patients with COVID-19 treated with interleukin 6 (IL-6) receptor antagonist sarilumab at a single institution in Italy
Authors: Montesarchio Vincenzo , Parella Roberto , Iommelli Chiara , Bianco Antonella , Manzillo Elio , Fraganza Fiorentino , Palumbo Cristiana , Rea Gaetano , Murino Patrizia , De Rosa Rosanna , Atripaldi Luigi , D’Abbraccio Maurizio , Curvietto Marcello , Mallardo Domenico , Celentano Egidio , Grimaldi Antonio Maria , Palla Marco , Trojaniello Claudia , Vitale Maria Grazia , Million-Weaver Samuel Lewis , Ascierto Paolo Antonio
Published: August 2020

Background

The inflammatory pathology observed in severe COVID-19 disease caused by the 2019 novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterized by elevated serum levels of C reactive protein (CRP) and cytokines, including interferon gamma, interleukin 8 (IL-8), and interleukin 6 (IL-6). Initial reports from the outbreak in Italy, China and the USA have provided anecdotal evidence of improved outcomes with the administration of anti-IL-6 agents, and large-scale trials evaluating these therapies are ongoing.

Study description

In this retrospective case series, clinical outcomes and correlates of response to treatment with the IL-6 receptor antagonist sarilumab are described for 15 patients with COVID-19 from a single institution in Southern Italy. Among 10 patients whose symptoms improved after sarilumab treatment, rapid decreases in CRP levels corresponded with clinical improvement. Lower levels of IL-6 at baseline as well as lower neutrophil to lymphocyte ratio as compared with patients whose COVID-19 did not improve with treatment were associated with sarilumab-responsive disease.

Conclusions

This observation may reflect a possible clinical benefit regarding early intervention with IL-6-modulatory therapies for COVID-19 and that CRP could be a potential biomarker of response to treatment.
Gut feelings: depression as an embodied and affective phenomenon in Houellebecq’sSerotonin
Authors: Slatman Jenny , van de Ven Inge
Published: August 2020

Current debates about the possible causes of depression reinforce the age-old body–mind dualism: while some claim that depression is caused by psychological or societal stress, others underline that it results from a shortage of the neurotransmitter serotonin in the central nervous system. This paper shows that Michel Houellebecq’s latest novelSerotonincan be read as an account of depression that goes beyond this body–mind dualism. Moreover, we will argue that his way of narrating invites us to reconsider the restorative power of narrative in ‘pathography,’ a genre that is a primary focus within medical humanities. The first section of the paper discusses, while drawing on Wilson’s work on new materialism, that although the title of the novelSerotoninmay suggest that Houellebecq takes sides with those who believe that depression is a brain disease, the protagonist of the novel suffers mainly from his gut feelings, which affects his entire embodied existence. Against the background of Merleau-Ponty’s philosophy, the second section specifies this existential disruption in terms of an embodied ‘I cannot.’ In the third section, we make clear how Houellebecq’s way of narrating—plotless and episodic—reinforces these embodied feelings of incapacity. The final section, then, traces how Houellebecq, by means of his style of writing and his choice of themes, succeeds in transferring gut feelings onto the reader. If illness narratives aim at sharing experiences of illness, the ‘narrative’ of depression, so we argue, had better take the form of an anti-narrative or a chaos story. Indeed, Houellebecq’s anti-narrative succeeds in passing on to the reader the experience of a debilitating gut feeling, and a gradual loss of grip that manifests itself as a temporal and spatial disorientation.
eCLIPs bifurcation remodeling system for treatment of wide neck bifurcation aneurysms with extremely low dome-to-neck and aspect ratios: a multicenter experience
Authors: De Vries Joost , Boogaarts Hieronymus D , Sørensen Leif , Holtmannspoetter Markus , Benndorf Goetz , Turowski Bernd , Bohner Georg , Derakhshani Shahram , Navasa Chema , van Zwam Wim H , Söderman Michael , Rautio Riitta , Mathys Christian , Riina Howard , Marotta Thomas R
Published: August 2020

Background

Wide necked bifurcation aneurysms (WNBA) are among the most difficult aneurysms to treat. Very low dome-to-neck (DTN) and aspect ratios provide an even greater challenge in the management of WNBAs. We present the safety and efficacy profile for endovascular clip system (eCLIPs) device in the treatment of this subset of WNBAs with very unfavorable morphologies.

Methods

In our case series, 24 patients treated at 12 international centers were taken from a larger prospective voluntary post-marketing registry of 65 patients treated with the eCLIPs device and coiling. Those who had WNBAs at either the carotid or basilar terminus with a DTN ratio <1.6 and aspect ratio <1.2 were included. Radiologic and clinical outcomes were assessed immediately after the procedure and at the latest follow-up.

Results

The eCLIPs device was successfully deployed in 23 cases (96%). One patient (4.2%) died due to guidewire perforation distal to the implant site. No other complications were documented. After a mean follow-up of 15.8 months (range 3–40 months), good radiologic outcomes (modified Raymond–Roy classification (MRRC) scores of 1 or 2) were documented in 20 of 21 patients (95%) with follow-up data. The lone patient with an MRRC score of 3 showed coiled compaction after incomplete neck coverage with the device.

Conclusion

Our series of patients with aneurysms having adverse DTN and aspect ratios demonstrated that the eCLIPs device has a safety and efficacy profile comparable with currently available devices in the treatment of WNBAs.
The professional and personal impact of the coronavirus pandemic on US neurointerventional practices: a nationwide survey
Authors: Fargen Kyle M , Leslie-Mazwi Thabele M , Klucznik Richard P , Wolfe Stacey Q , Brown Patrick , Ansari Sameer A , Dabus Guilherme , Spiotta Alejandro M , Mokin Maxim , Hassan Ameer E , Liebeskind David , Welch Babu G , Siddiqui Adnan H , Hirsch Joshua A
Published: August 2020

Background

Little is currently known about the effects of the coronavirus (COVID-19) pandemic on neurointerventional (NI) procedural volumes or its toll on physician wellness.

Methods

A 37-question online survey was designed and distributed to physician members of three NI physician organizations.

Results

A total of 151 individual survey responses were obtained. Reduced mechanical thrombectomy procedures compared with pre-pandemic were observed with 32% reporting a greater than 50% reduction in thrombectomy volumes. In concert with most (76%) reporting at least a 25% reduction in non-mechanical thrombectomy urgent NI procedures and a nearly unanimous (96%) cessation of non-urgent elective cases, 68% of physicians reported dramatic reductions (>50%) in overall NI procedural volume compared with pre-pandemic. Increased door-to-puncture times were reported by 79%. COVID-19-positive infections occurred in 1% of physician respondents: an additional 8% quarantined for suspected infection. Sixty-six percent of respondents reported increased career stress, 56% increased personal life/family stress, and 35% increased career burnout. Stress was significantly increased in physicians with COVID-positive family members (P<0.05).

Conclusions

This is the first study designed to understand the effects of the COVID-19 pandemic on NI physician practices, case volumes, compensation, personal/family stresses, and work-related burnout. Future studies examining these factors following the resumption of elective cases and relaxing of social distancing measures will be necessary to better understand these phenomena.
Adult outcomes after preterm birth
Authors: Prior Emily , Modi Neena
Published: August 2020

Extremely preterm birth reflects global disruption of the third trimester environment. Young adults born preterm have an adverse cardiovascular and metabolic health profile, together with molecular evidence of accelerated ageing and a reduced life expectancy. The underlying mechanism for these observations is unknown. This review summarises recent evidence of the lifetime effects of preterm birth and highlights the risks survivors face.
Prevalence and factors associated with advanced care directives in a motor neuron disease multidisciplinary clinic in Australia
Authors: Phua Chun Seng , Ng Aloysius , Brooks Christopher , Harrington Zinta , Vedam Hima , Huynh Thang , Seccombe Desi , Aouad Patrick , Cordato Dennis
Published: August 2020

Objectives

Motor neuron disease (MND) is a neurodegenerative disorder leading to functional decline and death. Multidisciplinary MND clinics provide an integrated approach to management and facilitate discussion on advanced care directives (ACDs). The study objectives are to analyse (1) the prevalence of ACD in our MND clinic, (2) the relationship between ACD and patient demographics and (3) the relationship between ACD decision-making and variables such as NIV, PEG, hospital admissions and location of death.

Methods

Using clinic records, all patients who attended the MND clinic in Liverpool Hospital between November 2014 and November 2019 were analysed. Data include MND subtypes, symptom onset to time of diagnosis, time of diagnosis to death, location and reason of death. ACD prevalence, non-invasive ventilation (NIV) and percutaneous endoscopic gastrostomy (PEG) requirements were analysed.

Results

There were 78 patients; M:F=1:1. 44 (56%) patients were limb onset, 28 (36%) bulbar onset, 4 primary lateral sclerosis and 2 flail limb syndrome presentations. 27% patients completed ACDs, while 32% patients declined ACDs. Patients born in Australia or in a majority English-speaking country were more likely to complete ACDs compared to those born in a non-English-speaking country. There was no significant correlation between ACD completion and age, gender, MND subtype, symptom duration, NIV, PEG feeding, location of death.

Conclusion

One-quarter of patients completed ACDs. ACDs did not correlate with patient age, gender, MND subtype and symptom duration or decision-making regarding NIV, PEG feeding or location of death. Further studies are needed to address factors influencing patients’ decisions regarding ACDs.
Physiological and functional responses of water-cooled versus traditional radiofrequency ablation of peripheral nerves in rats
Authors: Zachariah Christa , Mayeux Jacques , Alas Guillermo , Adesina Sherry , Mistretta Olivia Christine , Ward Patricia Jill , Chen Antonia , English Arthur William , Washington Alencia V
Published: August 2020

Background and objectives

Several clinical studies have focused on assessing the effectiveness of different radiofrequency ablation (RFA) modalities in pain management. While a direct head-to-head clinical study is needed, results from independent studies suggest that water-cooled RFA (CRFA) may result in longer lasting pain relief than traditional RFA (TRFA). The primary purpose of this study was, therefore, to investigate in a preclinical model, head-to-head differences between the two RFA technologies.

Methods

RFA was performed in a rat sciatic nerve model (n=66) in two groups: (1) TRFA or (2) CRFA. The surgeon was not blinded to the treatment; however, all the physiological endpoints were assessed in a blinded fashion which include histological, MRI, and nerve function assessment via electromyography.

Results

The energy delivered by the generator for CRFA was significantly higher compared with TRFA. Histological staining of nerves harvested immediately following CRFA exhibited extended length and multiple zones of thermal damage compared with TRFA-treated nerves. MRI scans across 4 weeks following treatment showed edematous/inflammatory zones present for longer times following CRFA. Finally, there was greater attenuation and prolonged loss of nerve function measured via electromyography in the CRFA group.

Conclusions

This study shows that CRFA has greater energy output, as well as more pronounced structural and functional changes elicited on the peripheral nerves compared with TRFA. While these preclinical data will need to be confirmed with a large clinical randomized controlled trial, we are encouraged by the direction that they may have set for those trials.
Pregnancy in lymphangioleiomyomatosis: clinical and lung function outcomes in two national cohorts
Authors: Taveira-DaSilva Angelo M , Johnson Simon R , Julien-Williams Patricia , Johnson Jan , Stylianou Mario , Moss Joel
Published: August 2020

Pregnancy in women with lymphangioleiomyomatosis (LAM) has been associated with increased complications and worsening lung function although objective data to advise patients are not available. We assessed lung function and CT scans before and after pregnancy in 16 women with LAM. During the pregnancy, pneumothorax was frequent and mean forced expiratory volume in 1 s (FEV1) fell from 77%±19% prepregnancy to 64%±25% predicted and DLCOfrom 66±26 to 57±26 (both p<0.01). After pregnancy, rates of FEV1decline were high and 10 patients required sirolimus. Women with LAM, especially with moderate or advanced disease should be counselled regarding adverse events and loss of lung function during the pregnancy.
Bearing capacity mechanisms for pipes buried in sand
Authors: Wu Jinbiao , Kouretzis George , Suwal Laxmi
Published: August 2020

This paper presents results of scaled physical model tests performed to measure the reaction developing on a rigid pipe buried in dry sand when the pipe is subjected to vertical downwards movement relative to its surrounding soil. The aim of this experimental study is to evaluate the efficacy of methods used to determine the properties of vertical bearing springs, an integral part of beam-on-nonlinear Winkler spring models used for the analysis of buried pipelines subjected to permanent ground displacements. We show that bearing capacity formulas used in practice to estimate the ultimate reaction developing on buried pipes may provide reasonably accurate estimates, provided that they are used together with sand friction angle values that account for the fact that granular materials do not obey an associative flow rule, and with bearing capacity factors compatible with the mode of sand failure observed in the tests. We also provide evidence suggesting that laying pipes in loose sand backfills does not have a beneficial effect on the reaction developing on the pipe, compared to medium dense sand, and we recommend against using loose sand material properties for the estimation of the properties of vertical bearing springs.
Parametric study of multi-story, perforated, partially grouted masonry walls subjected to in-plane cyclic actions
Authors: Medeiros Klaus A.S. , Chavez Kyle H. , Fonseca Fernando S. , Parsekian Guilherme A. , Shrive Nigel G.
Published: August 2020

Finite element models were developed to assess the influence of several parameters on the load capacity, deflection, and initial stiffness of multi-story, partially grouted masonry walls with openings. The base model was validated with experimental data from three walls. The analyses indicated that the load capacity of masonry walls was considerably sensitive to the ungrouted and grouted masonry strengths and mortar shear strength; moderately sensitive to the vertical reinforcement ratio and aspect ratio; slightly sensitive to the axial stress; and almost insensitive to the opening size, reinforcement spacing, and horizontal reinforcement ratio. The deflection of the walls had well-defined correlations with the masonry strength, vertical reinforcement, axial stress, and aspect ratio. The initial stiffness was especially sensitive to the axial stress and the aspect ratio, but weakly correlated with the opening size, and the spacing and size of the reinforcement.