Olfactory navigation versus olfactory activation: a controversy revisited

Abstract

In the early 1970s, Floriano Papi and colleagues proposed the olfactory-navigation hypothesis, which explains the homing ability of pigeons by the existence of an odor-based map acquired through learning. This notion, although supported by some observations, has also generated considerable controversy since its inception. As an alternative, Paulo Jorge and colleagues formulated in 2009 the olfactory-activation hypothesis, which states that atmospheric odorants do not provide navigational information but, instead, activate a non-olfactory path integration system. However, this hypothesis is challenged by an investigation authored by Anna Gagliardo and colleagues and published in the current issue of the Journal of Comparative Physiology A. In this editorial, the significance of the findings of this study is assessed in the broader context of the role of olfaction in avian navigation and homing, and experiments are suggested that might help to finally resolve the olfactory-navigation versus olfactory-activation controversy.

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When Fathers are Perceived to Share in the Maternal Decision to Breastfeed: Outcomes from the Infant Feeding Practices Study II

Abstract

Objectives The present study investigates the influence of joint feeding preferences of both the mother and father on initiation and duration of breastfeeding. Methods Data from the Infant Feeding Practices Study II was analyzed. Female participants in a national consumer opinion panel were followed from pregnancy through 1 year postpartum, and were asked about infant feeding practices. We examined the association between maternal prenatal perception of the expectant father's breastfeeding preferences and breastfeeding outcomes (initiation, duration of exclusive breastfeeding and any breastfeeding) and whether concordance between the parents' infant feeding preferences influenced breastfeeding. Results Mothers who perceived that the father preferred exclusive breastfeeding (vs. no preference) were more likely to initiate breastfeeding [adjusted odds ratio (aOR) = 1.9; 95% confidence interval (95% CI) 1.0–3.7], and they had a lower hazard of stopping exclusive and any breastfeeding at any given time [exclusive breastfeeding: adjusted hazard ratio (aHR) = 0.8; 95% CI 0.6–0.9; any breastfeeding: aHR = 0.6; 95% CI 0.5–0.7]. When both the mother and the father preferred exclusive breastfeeding, the hazard of breastfeeding cessation at any given time was lowest (exclusive breastfeeding: aHR = 0.4; 95% CI 0.3–0.5; any breastfeeding: aHR = 0.4; 95% CI 0.3–0.5). The risk of breastfeeding cessation remained lower even when only the father preferred exclusive breastfeeding. Conclusions for Practice Mothers tend to breastfeed for a longer duration when they perceive that the expectant father prefers exclusive breastfeeding and, even more so, when both parental preferences for exclusive breastfeeding concur. Efforts are needed to involve expectant fathers in breastfeeding decision-making and education to achieve breastfeeding success.

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Social Competence Treatment after Traumatic Brain Injury: A Multicenter, Randomized, Controlled Trial of Interactive Group Treatment versus Non-Interactive Treatment

Publication date: Available online 30 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Cynthia Harrison-Felix, Jody K. Newman, Lenore Hawley, Clare Morey, Jessica M. Ketchum, William C. Walker, Kathleen R. Bell, Scott R. Millis, Cynthia Braden, James Malec, Flora M. Hammond, C.B. Eagye, Laura Howe
ObjectiveTo evaluate the effectiveness of a replicable group treatment program for improving social competence after traumatic brain injury (TBI).DesignMulticenter randomized controlled trial comparing two methods of conducting a social competency skills program, an interactive group format versus a classroom lecture.SettingCommunity and Veteran rehabilitation centers.Participants179 civilian, military, and veteran adults with TBI and social competence difficulties, at least 6 months post-injury.Experimental InterventionThirteen weekly group interactive sessions (1.5 hours) with structured and facilitated group interactions to improve social competence.Alternative (Control) InterventionThirteen traditional classroom sessions using the same curriculum with brief supplemental individual sessions but without structured group interaction.Primary Outcome MeasureProfile of Pragmatic Impairment in Communication (PPIC), an objective behavioral rating of social communication impairments following TBI.Secondary OutcomesLaTrobe Communication Questionnaire (LCQ), Goal Attainment Scale (GAS), Satisfaction with Life Scale (SWLS), Post-Traumatic Stress Disorder Checklist – (PCL-C), Brief Symptom Inventory 18 (BSI-18), Scale of Perceived Social Self Efficacy (PSSE).ResultsSocial competence goals (GAS) were achieved and maintained for most participants regardless of treatment method. Significant improvements in the primary outcome (PPIC) and two of the secondary outcomes (LCQ and BSI) were seen immediately post-treatment and at 3 months post-treatment in the AT arm only, however these improvements were not significantly different between the GIST and AT arms. Similar trends were observed for PSSE and PCL-C.ConclusionsSocial competence skills improved for persons with TBI in both treatment conditions. The group interactive format was not found to be a superior method of treatment delivery in this study.



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A systematic critical appraisal of evidence-based clinical practice guidelines for the rehabilitation of children with moderate or severe acquired brain injury

Publication date: Available online 30 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Sarah Knight, Michael Takagi, Elizabeth Fisher, Vicki Anderson, Natasha A. Lannin, Emma Tavender, Adam Scheinberg
ObjectiveThe aim of this review was to critically appraise the quality of evidence-based clinical practice guidelines (CPGs) for the rehabilitation of children with moderate or severe acquired brain injury (ABI).Data SourcesA systematic search of MEDLINE, PsycINFO, Embase, CINAHL, and the Cochrane Library was conducted and an extensive website search of prominent professional rehabilitation society websites.Study SelectionCPGs were eligible for inclusion if they incorporated recommendation statements for inpatient and/or community rehabilitation for children with ABI and they were based on a systematic evidence search.Data ExtractionMethodological quality of eligible CPGs were appraised by three independent reviewers using the AGREE II instrument. Characteristics of eligible CPGs and strength of supporting evidence for included recommendations were extracted.Data Synthesis Of the nine included guidelines, two covered all ABIs, five focused specifically on traumatic brain injury (TBI) and two on stroke. Five of the CPGs were classified as High quality and four were of Average quality. In general, CPGs scored better for scope and purpose, rigor of development, and clarity of presentation. They scored most poorly in applicability, involvement of target users, and procedures for updating the guidelines. Inter-rater reliability for the AGREE II was generally high across domains. Very few of the 445 recommendations included across the nine CPGs were evidence-based.ConclusionsDespite variability in quality of the guideline development process, the included CPGs generally provided clear descriptions of their overall objectives, scope and purpose, employed systematic methods for searching, selecting and appraising research evidence, and produced unambiguous, clearly identifiable recommendations for children with ABI. Overall, existing CPGs focusing on rehabilitation for children with ABI are based on low quality evidence or expert consensus. Future work should focus on addressing the limitations of most of the current CPGs, particularly related to supporting implementation and integrating stakeholder involvement.



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Understanding health-related quality of life in caregivers of civilians and service members/veterans with traumatic brain injury: Reliability and validity data for the TBI-CareQOL measurement system

Publication date: Available online 30 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Noelle E. Carlozzi, Rael T. Lange, Louis M. French, Angelle M. Sander, Phillip A. Ianni, David S. Tulsky, Jennifer A. Miner, Michael A. Kallen, Tracey A. Brickell
ObjectivesTo establish the reliability and validity of the newly developed TBI-CareQOL patient reported outcomes measures in caregivers of civilians and service members/veterans (SMVs) with traumatic brain injury (TBI) so that they can be used with confidence in clinical research and practice.DesignComputer-based surveys delivered through an on-line data capture platform.Setting: Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility.ParticipantsFive hundred and sixty caregivers of individuals with TBI; this included two different study samples: 344 caregivers of civilians with TBI and 216 caregivers of SMVs with TBI.InterventionNot ApplicableMain Outcome Measures5 TBI-CareQOL item banksResultsReliabilities for the TBI-CareQOL measures were excellent (all Cronbach's α > .88); three-week test-retest reliability ranged from .75 to .90 across the two samples. Convergent validity was supported by moderate to high associations among the TBI-CareQOL measures and moderate correlations between the TBI-CareQOL measures and other measures of health-related quality of life (HRQOL) and caregiver burden. Discriminant validity was supported by low correlations between the TBI-CareQOL measures and less-related constructs (e.g., caregiver satisfaction). Known groups validity was supported: caregivers of individuals that were low functioning had worse HRQOL than caregivers of high functioning individuals.ConclusionsResults provide psychometric support for the new TBI-CareQOL item banks. As such, these measures fill a significant gap in the caregiver literature where sensitive patient-reported outcomes (PRO) measures that capture changes in HRQOL are needed to detect improvements for interventions designed to assist family caregivers.



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Diagnostic and clinical utility of the GAD-2 for screening anxiety symptoms in individuals with multiple sclerosis

Publication date: Available online 30 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Abbey J. Hughes, Katherine M. Dunn, Trisha Chaffee, Jagriti (Jackie) Bhattarai, Meghan Beier
ObjectiveTo assess the diagnostic and clinical utility of the two-item Generalized Anxiety Disorder Scale (GAD-2) for screening anxiety symptoms in individuals with multiple sclerosis (MS).DesignCross-sectional.SettingUniversity-affiliated MS neurology and rehabilitation center.ParticipantsThe sample was comprised of 99 adults (ages 19 to 72; M = 46.2; SD = 13.0; 75% female) with a physician-confirmed MS diagnosis who were receiving care in a university-affiliated MS center. Disease durations ranged from 1 to 37 years (M = 10.7; SD = 8.4).InterventionsNot applicable.Main Outcome MeasuresParticipants completed the GAD-7 and GAD-2. Internal consistency was calculated for both measures. Area under the receiver operating characteristics curve (AUC), the 95% confidence interval for the AUC, and Youden's J were calculated to determine the optimal GAD-2 cut-off score for identifying clinically significant anxiety symptoms, as defined by the previously validated GAD-7 cut-off score of ≥ 8.ResultsInternal consistency was excellent for the GAD-7 (Cronbach α = .91) and acceptable for the GAD-2 (α = .77), and the measures were highly correlated (r = .94). The GAD-2 had excellent overall accuracy for identifying clinically significant anxiety symptoms (AUC = 0.97, 95% CI 0.94 – 1.00). A GAD-2 cut-off score of ≥ 3 provided an optimal balance of good sensitivity (0.87) and excellent specificity (0.92) for detecting clinically significant anxiety symptoms. Alternatively, a cut-off score of ≥ 2 provided excellent sensitivity (1.00) and fair specificity (0.76).ConclusionsThe GAD-2 is a clinically useful and psychometrically valid tool for screening anxiety symptoms in MS rehabilitation and neurology care settings. Importantly, this tool has the potential to identify individuals with MS who are at risk for anxiety disorders and who may benefit from rehabilitation psychology interventions to ultimately improve functioning and quality of life.



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Cumulative Stress and Trauma from the Migration Process as Barriers to HIV Testing: A Qualitative Study of Latino Immigrants

Abstract

Immigrants are at increased risk for late HIV testing; however, there is limited understanding of how migration to the United States shapes HIV testing behaviors. This study examined the relationship between the migration process and HIV testing among Latino immigrants. Semi-structured, in-depth interviews were conducted in March and April 2017 with 34 Latino immigrants in New York City. Grounded theory guided analysis of the qualitative data. Results indicated that Latino immigrants experienced cumulative stress and trauma throughout the migration process that contributed to significant emotional and psychological consequences. Stress and trauma accumulated from the migration process posed barriers to HIV testing as Latino immigrants sought to avoid activities perceived as stressful, including learning one's HIV status. Targeted interventions that ameliorate the stressful effects of migration may facilitate preventive health behaviors among Latino immigrants.

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An assessment of the effectiveness of UK building regulations for new homes in Radon Affected Areas

Publication date: December 2018
Source:Journal of Environmental Radioactivity, Volume 192
Author(s): Antony R. Denman, Robin G.M. Crockett, Christopher J. Groves-Kirkby
Radon, a naturally occurring radioactive gas generated underground by radioactive decay of nuclides contained in certain types of rocks, can concentrate inside buildings, where it poses the second-largest risk factor for lung cancer, after smoking. The highest concentrations of domestic radon in the UK occur in the south-western counties of Devon and Cornwall, but certain areas in Northamptonshire and surrounding counties in the English Midlands also have high levels. It has been shown that it is possible both to reduce the radon concentrations in existing houses and to build new homes with appropriate protection. Since 1999, the UK's Building Regulations have specified that all new homes should be built with a combined radon-proof/damp-proof membrane plus, in Radon Affected Areas, a sump under the building. However, the building regulations do not require that the radon level is measured once the house is built and so there is little information on the effectiveness of these measures. Builders generally do not mention radon, and when asked, just confirm that their houses are built to current standards.To better understand the efficacy or otherwise of the currently mandated radon-protection measures, a cross-sectional investigation was carried out in 26 new housing developments in high-radon areas in Northamptonshire. In a targeted mail-shot, 1056 householders were invited to apply for a free radon test; 124 replied (11.7%). In total, 94 pairs of detectors were returned (70.1% of responders), of which two were spoiled, giving a total of 92 results.Following processing and seasonal correction, the arithmetic mean radon concentration in the target houses was 45% of the arithmetic mean radon concentration in existing houses in the postcode sectors where the houses were built and were approximately log-normally distributed. No results exceeded the UK Action Level of 200 Bq. m⁻³ but three were above the Target Level of 100 Bq. m⁻³.The results suggest that the radon-proof membranes in general ensure that radon concentrations in new homes constructed in accordance with the Building Regulations in Radon Affected Areas (RAAs) are satisfactorily low. However, there is a very small statistical probability that levels in a small number of homes will be close to or above the Action Level, particularly in areas of high radon potential. As a result, the Public Health England (PHE) recommendation for testing in the first year of occupation should be adopted as a legal requirement.



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Six-year monitoring of the vertical distribution of radiocesium in three forest soils after the Fukushima Dai-ichi Nuclear Power Plant accident

Publication date: December 2018
Source:Journal of Environmental Radioactivity, Volume 192
Author(s): Junko Takahashi, Yuichi Onda, Daichi Hihara, Kenji Tamura
After the Fukushima Dai-ichi Nuclear Power Plant accident on March 2011, several studies showed that the downward migration of ¹³⁷Cs from litter to mineral soil is more rapid in forests in Fukushima than in forests affected by the Chernobyl accident. Therefore, the downward migration within mineral soil layers is more important for predicting long-term dynamics of ¹³⁷Cs in forest ecosystems in Fukushima. In the present study, we monitored the detailed vertical distribution of ¹³⁷Cs in litter and soil layers for 6 y (2011–2017) following the previous study (2011–2012), and found that temporal changes in those distributions were different among mixed forest (MF), mature cedar (MC) and young cedar (YC) forests. The ¹³⁷Cs concentrations and inventories in the litter layer exponentially decreased with time for all sites, with more than 80–95% of the deposited ¹³⁷Cs on the forest floor distributed in mineral soil layers by 2017. The percentage of ¹³⁷Cs inventory in the litter layer to the total ¹³⁷Cs inventory in litter and mineral soil layers was well fitted by a single exponential equation with decreasing rate of 0.22–0.44 y⁻¹. The slower migration was observed in the YC site, probably because of higher initial interception of ¹³⁷Cs fallout by dense canopy. As the downward migration from litter to mineral soil progressed, the ¹³⁷Cs concentration in the first few cm of mineral soil surface gradually increased and became higher than the ¹³⁷Cs concentration in the litter within 2–3 y of the accident. The ¹³⁷Cs concentration in mineral soil layers exponentially decreased with depth throughout survey period, and an exponential equation fitted well. The relaxation depth of ¹³⁷Cs concentration in mineral soil layers estimated by the exponential equation were constantly increasing in the MC and YC sites with 0.08 cm y⁻¹. In contrast, there was no temporal increase in the relaxation depth in the MF site, indicating little migration to subsurface soil layer from not only litter layer but also surface soil layer. Further studies are necessary to identify the forests prone to the downward migration of ¹³⁷Cs and its factors regarding both forest and soil characteristics.



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Evolutionary dynamics of transposable elements during silkworm domestication

Abstract

Although there are some documented examples on population dynamics of transposable elements (TEs) in model organisms, the evolutionary dynamics of TEs in domesticated species has not been systematically investigated. The objective of this study is to understand population dynamics of TEs during silkworm domestication. In this work, using transposon-display we examined the polymorphism of seven TE families [they represent about 59% of silkworm (Bombyx mori) total TE content] in four domesticated silkworm populations and one wild silkworm population. Maximum likelihood (ML) was used to estimate selection pressure. Population differentiation and structure were performed by using AMOVA analysis and program DISTRUCT, respectively. The results of transposon-display showed that significant differentiation occurred between the domesticated silkworm and wild silkworm. These TEs have experienced expansions and fixation in the domesticated silkworm but not in wild silkworm. Furthermore, the ML results indicated that purifying selection of TEs in the domesticated silkworm were significantly weaker than that in the wild silkworm. Interestingly, an adaptation insertion induced by BmMITE-2 was found, and this insertion can reduce the polymorphism of the flanking regions of its neighboring COQ7 gene. Our results suggested that TEs expanded and were fixed in the domesticated silkworm might result from demographic effects and artificial selection during domestication. We concluded that the data presented in this study have general implication in animal and crop improvements as well as in domestication of new species.

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Oral Health Challenges in Refugees from the Middle East and Africa: A Comparative Study

Abstract

The aim was to explore and compare oral health and need for dental treatment in newly arrived refugees from the Middle East and Africa to Norway. Oral examination and structured interviews were performed with attending interpreters. Associations between origin and measures for oral health were studied with multiple linear regression. Half of the refugees (n = 132) reported oral impacts on daily performances (OIDP) and mean number of decayed teeth (DT) was 4.3 (SD 3.5). Refugees from the Middle East had more DT (1.38, p = 0.044), higher sum of decayed, missing and filled teeth (DMFT) (3.93, p = 0.001) and lower OIDP-score (− 3.72, p = 0.026) than refugees from Africa. Refugee oral health is generally poor, with more extensive challenges in refugees from the Middle East. However, few missing teeth, and manageable caries-gradient at the time of registration indicate that most refugees have the prerequisites for a good dentition, provided they get the necessary treatment.

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Novel Application of 32P Brachytherapy: Treatment of Angiolymphoid Hyperplasia with Eosinophilia in the Right Auricle with 8-Year Follow-Up

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


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The NBA and Youth Basketball: Recommendations for Promoting a Healthy and Positive Experience

Abstract

Participation in sports offers both short-term and long-term physical and psychosocial benefits for children and adolescents. However, an overemphasis on competitive success in youth sports may limit the benefits of participation, and could increase the risk of injury, burnout, and disengagement from physical activity. The National Basketball Association and USA Basketball recently assembled a group of leading experts to share their applied research and practices to address these issues. This review includes the group's analysis of the existing body of research regarding youth sports participation and the related health, performance, and psychosocial outcomes. Based upon this, age-specific recommendations for basketball participation are provided that aim to promote a healthy and positive experience for youth basketball players.

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Are the Mechanical or Material Properties of the Achilles and Patellar Tendons Altered in Tendinopathy? A Systematic Review with Meta-analysis

Abstract

Background

Changes in the mechanical behaviour of the Achilles and patellar tendons in tendinopathy could affect muscle performance, and have implications for injury prevention and rehabilitation strategies.

Objectives

To determine the effect of clinically diagnosed tendinopathy on the mechanical and material properties of the Achilles tendon (AT) and patellar tendon (PT).

Design

Systematic review with meta-analysis.

Methods

A search of electronic databases (SPORTDiscus, CINAHL, PubMed, ScienceDirect and Google Scholar) was conducted to identify research articles that reported local and global in vivo mechanical (e.g. strain, stiffness) and/or material properties (e.g. modulus) of the AT and/or PT in people with and without tendinopathy. Effect sizes and corresponding 95% confidence intervals for individual studies were calculated for tendon strain, stiffness, modulus and cross-sectional area.

Results

Eighteen articles met the inclusion criteria (AT only = 11, PT only = 5, AT and PT = 2). There was consistent evidence that the reported AT strain was higher in people with tendinopathy, compared to asymptomatic controls. People with Achilles tendinopathy had a lower AT global stiffness, lower global modulus and lower local modulus, compared to asymptomatic controls. In contrast, there was no clear and consistent evidence that the global or local mechanical or material properties of the PT are altered in tendinopathy.

Conclusions

The in vivo mechanical and material properties of the Achilles tendon-aponeurosis are altered in tendinopathy, compared to asymptomatic tendons. Despite a similar clinical presentation to Achilles tendinopathy, patellar tendinopathy does not appear to alter the tensile behaviour of the PT in vivo.

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Metabolic Disorders and Critically Ill Patients

No abstract available

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Epidural Analgesia and Subcutaneous Heparin 3 Times Daily in Cancer Patients With Acute Postoperative Pain

The use of epidural analgesia in conjunction with subcutaneous administration of unfractionated heparin 3 times per day could increase the risk of spinal epidural hematoma, but insufficient patient experience data exist to determine this. We retrospectively reviewed the incidence of spinal epidural hematoma in 3705 cases at our institution over a 7-year period of patients receiving acute postoperative epidural analgesia and heparin 3 times per day. No cases of spinal epidural hematoma were reported (95% CI, 0–0.0009952). Accepted for publication May 23, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Jackson Su, MD, Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Unit 409, 1515 Holcombe Blvd, Houston, TX 77030. Address e-mail to jsu@mdanderson.org. © 2018 International Anesthesia Research Society

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Proceedings From the Society for Advancement of Blood Management Annual Meeting 2017: Management Dilemmas of the Surgical Patient—When Blood Is Not an Option

Vigilance is essential in the perioperative period. When blood is not an option for the patient, especially in a procedure/surgery that normally holds a risk for blood transfusion, complexity is added to the management. Current technology and knowledge has made avoidance of blood transfusion a realistic option but it does require a concerted patient-centered effort from the perioperative team. In this article, we provide suggestions for a successful, safe, and bloodless journey for patients. The approaches include preoperative optimization as well as intraoperative and postoperative techniques to reduce blood loss, and also introduces current innovative substitutes for transfusions. This article also assists in considering and maneuvering through the legal and ethical systems to respect patients' beliefs and ensuring their safety. Accepted for publication April 20, 2018. Funding:None. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Gee Mei Tan, MMED, MBBS, Department of Anesthesiology, University of Colorado, School of Medicine, 13123 E 16th Ave, B090, Aurora, CO 80045. Address e-mail to Geemei.tan@childrenscolorado.org. © 2018 International Anesthesia Research Society

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Prospective Observational Investigation of Capnography and Pulse Oximetry Monitoring After Cesarean Delivery With Intrathecal Morphine

BACKGROUND: Intrathecal morphine provides excellent analgesia after cesarean delivery; however, respiratory events such as apnea, bradypnea, and hypoxemia have been reported. The primary study aim was to estimate the number of apneas per subject, termed "apnea alert events" (AAEs) defined by no breath for 30–120 seconds, using continuous capnography in women who underwent cesarean delivery. METHODS: We performed a prospective, observational study with institutional review board approval of women who underwent cesarean delivery with spinal anesthesia containing 150-µg intrathecal morphine. A STOP-Bang obstructive sleep apnea assessment was administered to all women. Women were requested to use continuous capnography and pulse oximetry for 24 hours after cesarean delivery. Nasal sampling cannula measured end-tidal carbon dioxide (EtCO2) and respiratory rate (RR), and oxygen saturation (SpO2) as measured by pulse oximetry. Capnography data were defined as "valid" when EtCO2 >10 mm Hg, RR >5 breaths per minute (bpm), SpO2 >70%, or during apnea (AAE) defined as "no breath" (EtCO2, 30 kg/m2/weight >90 kg, and 11% with suspected obstructive sleep apnea (known or STOP-Bang score >3). The duration of normal capnography and pulse oximetry data was mean (SD) (range) 8:28 (7:51) (0:00–22:32) and 15:08 (6:42) (1:31–23:07) hours:minutes, respectively; 6 women did not use the capnography. There were 198 AAEs, mean (SD) duration 57 (27) seconds experienced by 39/74 (53%) women, median (95% confidence interval for median) (range) 1 (0–1) (0–29) per subject. Observation of RR by nurses was ≥14 bpm at all time-points for all women, r = 0.05 between capnography and nurse RR (95% confidence interval, −0.04 to 0.14). There were no clinically relevant adverse events for any woman. Sixty-five women (82%) had complaints with the capnography device, including itchy nose, nausea, interference with nursing baby, and overall inconvenience. CONCLUSIONS: We report 198 AAEs detected by capnography among women who underwent cesarean delivery after receiving intrathecal morphine. These apneas were not confirmed by the intermittent hourly nursing observations. Absence of observer verification precludes distinction between real, albeit nonclinically significant alerts with capnography versus false apneas. Discomfort with the nasal sampling cannula and frequent alerts may impact capnography application after cesarean delivery. No clinically relevant adverse events occurred. Accepted for publication April 26, 2018. Funding: This study was supported by an Investigator Research Grant (VT ID# ISR-2013–10323) from Medtronic, which provided financial support and the capnography equipment. The funding body had no role in the study design, raw data extraction and processing, data analysis or interpretation, writing of the manuscript, or manuscript submission for publication. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). This study was conducted at the Lucile Packard Children's Hospital, Stanford, California. Clinical trial number: clinicaltrials.gov (NCT02417038; April 10, 2015). Institutional review board: Shana Stolarczyk, Research Compliance Office, Stanford University, 3000 El Camino Real, Five Palo Alto Sq, 4th Floor, Palo Alto, CA 94306. E-mail: irbeducation@lists.stanford.edu; Shana.Stolarczyk@stanford.edu. Reprints will not be available from the authors. Address correspondence to Carolyn F. Weiniger, MBChB, Division of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Address e-mail to carolynfweiniger@gmail.com. © 2018 International Anesthesia Research Society

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Opioids for Acute Pain Management in Patients With Obstructive Sleep Apnea: A Systematic Review

The intrinsic nature of opioids to suppress respiratory function is of particular concern among patients with obstructive sleep apnea (OSA). The association of OSA with increased perioperative risk has raised the question of whether patients with OSA are at higher risk for opioid-induced respiratory depression (OIRD) compared to the general population. The aims of this systematic review were to summarize current evidence with respect to perioperative OIRD, changes in sleep-disordered breathing, and alterations in pain and opioid sensitivity in patients with OSA. A systematic literature search of studies published between 1946 and October 2017 was performed utilizing the following databases: Medline, ePub Ahead of Print/Medline In-process, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PubMed—NOT-Medline and ClinicalTrials.Gov. Of 4321 initial studies, 40 met the inclusion criteria. The Oxford level of evidence was assessed. Overall, high-quality evidence on the comparative impact of acute opioid analgesia in OSA versus non-OSA patients is lacking. The current body of evidence is burdened by significant limitations including risk of bias and large heterogeneity among studies with regard to OSA severity, perioperative settings, outcome definitions, and the presence or absence of various perioperative drivers. These factors complicate an accurate interpretation and robust analysis of the true complication risk. Nevertheless, there is some consistency among studies with regard to a detrimental effect of opioids in the presence of OSA. Notably, the initial 24 hours after opioid administration appear to be most critical with regard to life-threatening OIRD. Further, OSA-related increased pain perception and enhanced opioid sensitivity could predispose patients with OSA to a higher risk for OIRD without overdosing. While high-quality evidence is needed, retrospective analyses indicate that critical, life-threatening OIRD may be preventable with a more cautious approach to opioid use, including adequate monitoring. Accepted for publication May 8, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Stavros G. Memtsoudis, MD, PhD, Departments of Anesthesiology, Critical Care, and Pain Management and Public Health, Hospital for Special Surgery, Weill Cornell Medical College, 535 E 70th St, New York, NY 10021. Address e-mail to memtsoudiss@hss.edu. © 2018 International Anesthesia Research Society

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Practice of Ultrasound-Guided Palpation of Neck Landmarks Improves Accuracy of External Palpation of the Cricothyroid Membrane

BACKGROUND: Ultrasonography can accurately identify the cricothyroid membrane; however, its impact on the subsequent accuracy of external palpation is not known. In this study, we tested the ability of anesthesia participants to identify the midpoint of the cricothyroid membrane using external palpation with and without ultrasound (US)-guided practice. METHODS: Following institutional ethics approval and informed consent, anesthesia participants consisting of anesthesia residents, fellows, and practicing anesthesia assistants underwent didactic teaching on neck landmarks. The participants were then randomized to practice palpation of neck landmarks with US guidance (US group) or without ultrasonography (non-US [NUS] group). After the practice session, each participant identified the cricothyroid membrane using external palpation on the neck of 10 volunteers and marked the anticipated entry point for device insertion (palpation point [PT]). The midpoint of the cricothyroid membrane of each volunteer had been premarked with invisible ink using ultrasonography (US point) by a separate member of the research team. The primary outcome was the accuracy rate defined as the percentage of the attempts with the distance ≤5 mm measured from the PT to US point for the participant. The primary outcome was compared between NUS and US groups using Wilcoxon rank sum test. A mixed-effect logistic regression or mixed-effect linear model was also conducted for outcomes accounting for the clustering and adjusting for potential confounders. RESULTS: Fifteen anesthesia participants were randomized to US (n = 8) and NUS (n = 7) groups. A total of 80 and 61 attempts were performed by the US and NUS groups, respectively. The median accuracy rate in the US group was higher than the NUS group (65% vs 30%; P = .025), and the median PT-US distance in the US group was shorter than in the NUS group (4.0 vs 8.0 mm; P = .04). The adjusted mean PT-US distance in the US group was shorter compared to the NUS group (adjusted mean [95% CI], 3.6 [2.9–4.6] vs 6.8 [5.2–8.9] mm; P

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Dexmedetomidine Versus Remifentanil for Monitored Anesthesia Care During Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Randomized Controlled Trial

BACKGROUND: We hypothesized that, compared to remifentanil, dexmedetomidine used for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) performed under monitored anesthesia care (MAC) in nonintubated patients would result in fewer episodes of major respiratory adverse events (number of episodes of bradypnea, apnea or desaturation) but no difference in satisfaction with perioperative conditions. METHODS: Sixty (American Society of Anesthesiologists physical status I–III) patients scheduled to undergo EBUS-TBNA under MAC were randomized to receive either remifentanil (0.5 µg/kg IV bolus) in 10 minutes, followed by 0.05–0.25 µg/kg/min, or dexmedetomidine (0.4 µg/kg IV bolus) in 10 minutes, followed by 0.5–1.0 µg/kg/h. The primary outcome was the number of major respiratory adverse events (bradypnea, apnea, or hypoxia). The secondary outcomes included hemodynamic variables, discharge time from the postanesthesia care unit, endotracheal lidocaine use, patient's sedation using the Observer Assessment of Alertness/Sedation Scale, operative conditions, operator and patient satisfaction, pain, coughing, vocal cord mobility, recall, and nausea/vomiting. RESULTS: Dexmedetomidine produced significantly fewer episodes of major respiratory events (bradypnea, apnea, or desaturation), with 0 [0–0.5] episodes versus 2 [0–5] (median [interquartile range]) (P = .001), than did remifentanil. Fewer episodes of bradypnea or apnea (dexmedetomidine: 0 [0–0] versus remifentanil: 0 [0–0.5]; P = .031), and fewer episodes of desaturation (dexmedetomidine: 0 [0–0.5] versus remifentanil: 1 [0–4]; P = .039) were recorded in the dexmedetomidine group. The time needed for patients to meet postanesthesia care unit discharge criteria (Aldrete score: 9) after EBUS-TBNA was longer in the dexmedetomidine group (10 [3–37.5] minutes) versus the remifentanil group (3 [3–5] minutes) (P

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Potent Inactivation-Dependent Inhibition of Adult and Neonatal NaV1.5 Channels by Lidocaine and Levobupivacaine

BACKGROUND: Cardiotoxic effects of local anesthetics (LAs) involve inhibition of NaV1.5 voltage-gated Na+ channels. Metastatic breast and colon cancer cells also express NaV1.5, predominantly the neonatal splice variant (nNaV1.5) and their inhibition by LAs reduces invasion and migration. It may be advantageous to target cancer cells while sparing cardiac function through selective blockade of nNaV1.5 and/or by preferentially affecting inactivated NaV1.5, which predominate in cancer cells. We tested the hypotheses that lidocaine and levobupivacaine differentially affect (1) adult (aNaV1.5) and nNaV1.5 and (2) the resting and inactivated states of NaV1.5. METHODS: The whole-cell voltage-clamp technique was used to evaluate the actions of lidocaine and levobupivacaine on recombinant NaV1.5 channels expressed in HEK-293 cells. Cells were transiently transfected with cDNAs encoding either aNaV1.5 or nNaV1.5. Voltage protocols were applied to determine depolarizing potentials that either activated or inactivated 50% of maximum conductance (V½ activation and V½ inactivation, respectively). RESULTS: Lidocaine and levobupivacaine potently inhibited aNaV1.5 (IC50 mean [SD]: 20 [22] and 1 [0.6] µM, respectively) and nNaV1.5 (IC50 mean [SD]: 17 [10] and 3 [1.6] µM, respectively) at a holding potential of −80 mV. IC50s differed significantly between lidocaine and levobupivacaine with no influence of splice variant. Levobupivacaine induced a statistically significant depolarizing shift in the V½ activation for aNaV1.5 (mean [SD] from −32 [4.6] mV to −26 [8.1] mV) but had no effect on the voltage dependence of activation of nNaV1.5. Lidocaine had no effect on V½ activation of either variant but caused a significantly greater depression of maximum current mediated by nNaV1.5 compared to aNaV1.5. Similar statistically significant shifts in the V½ inactivation (approximately −10 mV) occurred for both LAs and NaV1.5 variants. Levobupivacaine (1 µM) caused a significantly greater slowing of recovery from inactivation of both variants than did lidocaine (10 µM). Both LAs caused approximately 50% tonic inhibition of aNaV1.5 or nNaV1.5 when holding at −80 mV. Neither LA caused tonic block at a holding potential of either −90 or −120 mV, voltages at which there was little steady-state inactivation. Higher concentrations of either lidocaine (300 µM) or levobupivacaine (100 µM) caused significantly more tonic block at −120 mV. CONCLUSIONS: These data demonstrate that low concentrations of the LAs exhibit inactivation-dependent block of NaV1.5, which may provide a rationale for their use to safely inhibit migration and invasion by metastatic cancer cells without cardiotoxicity. Accepted for publication May 21, 2018. Funding: This study was supported by a BJA/RCoA grant awarded to T.G.H. via the National Institute of Academic Anaesthesia, UK. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). T. Elajnaf and D. T. Baptista-Hon contributed equally and share first authorship. Reprints will not be available from the authors. Address correspondence to Tim G. Hales, PhD, The Institute of Academic Anaesthesia, Division of Neuroscience, School of Medicine, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, United Kingdom. Address e-mail to t.g.hales@dundee.ac.uk. © 2018 International Anesthesia Research Society

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Monitoring Depth of Hypnosis: Mid-Latency Auditory Evoked Potentials Derived aepEX in Children Receiving Desflurane-Remifentanil Anesthesia

BACKGROUND: The aepEXplus monitoring system, which uses mid-latency auditory evoked potentials to measure depth of hypnosis, was evaluated in pediatric patients receiving desflurane-remifentanil anesthesia. METHODS: Seventy-five patients, 1–18 years of age (stratified for age; 1–3, 3–6, 6–18 years, for subgroup analyses), were included in this prospective observational study. The aepEX and the bispectral index (BIS) were recorded simultaneously, the latter serving as a reference. The ability of the aepEX to detect different levels of consciousness, defined according to the University of Michigan Sedation Scale, investigated using prediction probability (Pk), and receiver operating characteristic (ROC) analysis, served as the primary outcome parameter. As a secondary outcome parameter, the relationship between end-tidal desflurane and the aepEX and BIS values were calculated by fitting in a nonlinear regression model. RESULTS: The Pk values for the aepEX and the BIS were, respectively, .68 (95% CI, 0.53–0.82) and .85 (95% CI, 0.73–0.96; P = .02). The aepEX and the BIS had an area under the ROC curve of, respectively, 0.89 (95% CI, 0.80–0.95) and 0.76 (95% CI, 0.68–0.84; P = .04). The maximized sensitivity and specificity were, respectively, 81% (95% CI, 61%–93%) and 86% (95% CI, 74%–94%) for the aepEX at a cutoff value of >52, and 69% (95% CI, 56%–81%) and 70% (95% CI, 57%–81%) for the BIS at a cutoff value of >65. The age-corrected end-tidal desflurane concentration associated with an index value of 50 (EC50) was 0.59 minimum alveolar concentration (interquartile range: 0.38–0.85) and 0.58 minimum alveolar concentration (interquartile range: 0.41–0.70) for, respectively, the aepEX and BIS (P = .69). Age-group analysis showed no evidence of a difference regarding the area under the ROC curve or EC50. CONCLUSIONS: The aepEX can reliably differentiate between a conscious and an unconscious state in pediatric patients receiving desflurane-remifentanil anesthesia. Accepted for publication May 8, 2018. Funding: This study was funded by Fonds NutsOhra, Amsterdam, the Netherlands (grant reference number: 1103-060) with an unrestricted project grant and departmental funding. The authors declare no conflicts of interest. Trial registration: https://ift.tt/2tH82DK, NTR2983. Reprints will not be available from the authors. Address correspondence to Yuen M. Cheung, MD, Department of Anesthesiology, Erasmus University Medical Center, Room H-1273, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Address e-mail to y.m.cheung@erasmusmc.nl. © 2018 International Anesthesia Research Society

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Can STOP-Bang and Pulse Oximetry Detect and Exclude Obstructive Sleep Apnea?

BACKGROUND: Obstructive sleep apnea (OSA) is related to postoperative complications and is a common disorder. Most patients with sleep apnea are, however, undiagnosed, and there is a need for simple screening tools. We aimed to investigate whether STOP-Bang and oxygen desaturation index can identify subjects with OSA. METHODS: In this prospective, observational multicenter trial, 449 adult patients referred to a sleep clinic for evaluation of OSA were investigated with ambulatory polygraphy, including pulse oximetry and the STOP-Bang questionnaire in 4 Swedish centers. The STOP-Bang score is the sum of 8 positive answers to Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index >35 kg/m2, Age >50 years, Neck circumference >40 cm, and male Gender. RESULTS: The optimal STOP-Bang cutoff score was 6 for moderate and severe sleep apnea, defined as apnea-hypopnea index (AHI) ≥15, and the sensitivity and specificity for this score were 63% (95% CI, 0.55–0.70) and 69% (95% CI, 0.64–0.75), respectively. A STOP-Bang score of 15 and a STOP-Bang score of ≥6 had a specificity of 91% (95% CI, 0.87–0.94) for an AHI >15. The items contributing most to the STOP-Bang were the Bang items. There was a positive correlation between AHI versus STOP-Bang and between AHI versus oxygen desaturation index, Spearman ρ 0.50 (95% CI, 0.43–0.58) and 0.96 (95% CI, 0.94–0.97), respectively. CONCLUSIONS: STOP-Bang and pulse oximetry can be used to screen for sleep apnea. A STOP-Bang score of

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Impact of Regional Anesthesia on Gastroesophageal Cancer Surgery Outcomes: A Systematic Review of the Literature

Regional anesthesia may play a beneficial role in long-term oncological outcomes. Specifically, it has been suggested that it can prolong recurrence-free survival and overall survival after gastrointestinal cancer surgery, including gastric and esophageal cancer, by modulating the immune and inflammatory response. However, the results from human studies are conflicting. The goal of this systematic review was to summarize the evidence on the impact of regional anesthesia on immunomodulation and cancer recurrence after gastric and esophageal surgery. We conducted a literature search of 5 different databases. Two independent reviewers analyzed the quality of the selected manuscripts according to prespecified inclusion and exclusion criteria. Randomized controlled trials were assessed for potential sources of bias by using the Cochrane Risk of Bias tool. A total of 6 studies were included in the quality analysis and systematic review. A meta-analysis was not conducted for several reasons, including high heterogeneity among studies, low quality of the reports, and lack of standardized outcomes definitions. Although the literature suggests that regional anesthesia has some modulatory effects on the inflammatory and immunological response in the studied patient population, our systematic review indicates that there is no evidence to support or refute the use of epidural anesthesia or analgesia with the goal of reducing cancer recurrence after gastroesophageal cancer surgery. Accepted for publication May 23, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Juan P. Cata, MD, Department of Anaesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Centre, 1515 Holcombe Blvd, Unit 409, Houston, TX 77005. Address e-mail to jcata@mdanderson.org. © 2018 International Anesthesia Research Society

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Observation and Experiment: An Introduction to Causal Inference

No abstract available

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Remifentanil Stability

No abstract available

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Cervical Spine Motion During Tracheal Intubation Using an Optiscope Versus the McGrath Videolaryngoscope in Patients With Simulated Cervical Immobilization: A Prospective Randomized Crossover Study

BACKGROUND: In patients with an unstable cervical spine, maintenance of cervical immobilization during tracheal intubation is important. In McGrath videolaryngoscopic intubation, lifting of the blade to raise the epiglottis is needed to visualize the glottis, but in patients with an unstable cervical spine, this can cause cervical spine movement. By contrast, the Optiscope, a rigid video-stylet, does not require raising of the epiglottis during tracheal intubation. We therefore hypothesized that the Optiscope would produce less cervical spine movement than the McGrath videolaryngoscope during tracheal intubation. The aim of this study was to compare the Optiscope with the McGrath videolaryngoscope with respect to cervical spine motion during intubation in patients with simulated cervical immobilization. METHODS: The primary outcome of the study was the extent of cervical spine motion at the occiput–C1, C1–C2, and C2–C5 segments. In this randomized crossover study, the cervical spine angle was measured before and during tracheal intubation using either the Optiscope or the McGrath videolaryngoscope in 21 patients with simulated cervical immobilization. Cervical spine motion was defined as the change in angle at each cervical segment during tracheal intubation. RESULTS: There was significantly less cervical spine motion at the occiput–C1 segment using the Optiscope rather than the McGrath videolaryngoscope (mean [98.33% CI]: 4.7° [2.4–7.0] vs 10.4° [8.1–12.7]; mean difference [98.33% CI]: −5.7° [−7.5 to −3.9]). There were also fewer cervical spinal motions at the C1–C2 and C2–C5 segments using the Optiscope (mean difference versus the McGrath videolaryngoscope [98.33% CI]: −2.4° [−3.7 to −1.2]) and −3.7° [−5.9 to −1.4], respectively). CONCLUSIONS: The Optiscope produces less cervical spine motion than the McGrath videolaryngoscope during tracheal intubation of patients with simulated cervical immobilization. Accepted for publication May 31, 2018. Funding: None. The authors declare no conflicts of interest. Clinical trial number: ClinicalTrials.gov (NCT03120546). Reprints will not be available from the authors. Address correspondence to Tae Kyong Kim, MD, PhD, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno, Seoul 03080, Republic of Korea. Address e-mail to ktkktk@gmail.com. © 2018 International Anesthesia Research Society

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Preoperative High-Dose Methylprednisolone and Glycemic Control Early After Total Hip and Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial

BACKGROUND: To evaluate the effect of a single preoperative dose of 125 mg methylprednisolone (MP) on glycemic homeostasis early after fast-track total hip and knee arthroplasty. METHODS: One-hundred thirty-four patients undergoing elective unilateral total hip arthroplasty and total knee arthroplasty were randomized (1:1) to preoperative intravenous MP 125 mg (group MP) or isotonic saline intravenous (group C). All procedures were performed under spinal anesthesia, using a standardized multimodal analgesic regime. The primary outcome was the change in plasma glucose 2 hours postoperatively, and secondary outcomes included plasma C-peptide concentrations, homeostatic model assessment (HOMA), HOMA-IR (insulin resistance), and HOMA-B (β-cell function). Fasting blood samples were collected at baseline and 2, 6 (nonfasting), 24, and 48 hours after surgery with complete samples from 122 patients (group MP = 62, group C = 60) for analyses. RESULTS: MP patients had increased plasma glucose levels at 2 hours (adjusted mean [95% CI], 7.4 mmol·L−1 [7.2–7.5] vs 6.0 mmol·L−1 [5.9–6.2]; P = .023) and 6 hours (13.9 mmol·L−1 [13.3–14.5] vs 8.4 mmol·L−1 [7.8–9.0]; P

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Prevalence and Molecular Epidemiology of Clinical Isolates of Escherichia coli and Klebsiella pneumoniae Harboring Extended-Spectrum Beta-Lactamase and Carbapenemase Genes in Bangladesh

Microbial Drug Resistance, Ahead of Print.


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Characterization of Clinical Vancomycin-Resistant Enterococcus faecium Isolated in Eastern Hungary

Microbial Drug Resistance, Ahead of Print.


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Prevalence and Characteristics of Sequence Type 131 Escherichia coli Isolated from Children with Bacteremia in 2000–2015

Microbial Drug Resistance, Ahead of Print.


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The peregrine falcon’s rapid dive: on the adaptedness of the arm skeleton and shoulder girdle

Abstract

During a dive, peregrine falcons (Falco peregrinus) can reach a velocity of up to 320 km h^− 1. Our computational fluid dynamics simulations show that the forces that pull on the wings of a diving peregrine can reach up to three times the falcon's body mass at a stoop velocity of 80 m s^− 1 (288 km h^− 1). Since the bones of the wings and the shoulder girdle of a diving peregrine falcon experience large mechanical forces, we investigated these bones. For comparison, we also investigated the corresponding bones in European kestrels (Falco tinnunculus), sparrow hawks (Accipiter nisus) and pigeons (Columba livia domestica). The normalized bone mass of the entire arm skeleton and the shoulder girdle (coracoid, scapula, furcula) was significantly higher in F. peregrinus than in the other three species investigated. The midshaft cross section of the humerus of F. peregrinus had the highest second moment of area. The mineral densities of the humerus, radius, ulna, and sternum were highest in F. peregrinus, indicating again a larger overall stability of these bones. Furthermore, the bones of the arm and shoulder girdle were strongest in peregrine falcons.

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Salubrinal Enhances Doxorubicin Sensitivity in Human Cholangiocarcinoma Cells Through Promoting DNA Damage

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


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Antimicrobial Peptides: Features, Action, and Their Resistance Mechanisms in Bacteria

Microbial Drug Resistance, Ahead of Print.


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Maternal Socioeconomic Mobility and Preterm Delivery: A Latent Class Analysis

Abstract

Objective Growing evidence suggests that maternal socioeconomic mobility (SM) is associated with pregnancy outcomes. Our study investigated the association between maternal SM from childhood to adulthood and the risk of preterm delivery (PTD), and examined heterogeneity of associations by race/ethnicity. Methods In this study, 3019 pregnant women enrolled from 5 Michigan communities at 16–27 weeks' gestation (1998–2004) provided their parents' socioeconomic position (SEP) indicators (education, occupation, receipt of public assistance) and their own and child's father's SEP indicators (education, occupation, Medicaid status, and household income) at the time of enrollment. Latent class analysis was used to identify latent classes of childhood SEP indicators, adulthood SEP indicators, and SM from childhood to adulthood, respectively. A model-based approach to latent class analysis with distal outcome assessed relations between latent class and PTD, overall and within race/ethnicity groups. Results Three latent classes (low, middle, high) were identified for childhood SEP indicators and adulthood SEP indicators, respectively; while four latent classes (static low, upward, downward, and static high) best described SM. Women with upward SM had decreased odds of PTD (Odds ratio = 0.60, 95% confidence interval: 0.42, 0.87), compared to those with static low SEP. This SM advantage was true for all women and most pronounced in white/others women. Conclusions Maternal experiences of upward SM may be important considerations when assessing PTD risk. Our results support the argument that policies and programs aimed at improving women's SEP could lower PTD rates.

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Differences in Self-Reported Health and Unmet Health Needs Between Government Assisted and Privately Sponsored Syrian Refugees: A Cross-Sectional Survey

Abstract

Between November 2015 and January 2017, the Government of Canada resettled over 40,000 Syrian refugees through different sponsorship programs (GAR and PSR). Timely access to healthcare is essential for good health and successful integration. However, refugee support differs depending on sponsorship program, which may lead to differences in healthcare service access and needs. A cross-sectional study with a sample of Syrian refugees was conducted to assess healthcare access, and perceived physical and mental health status. Results indicate demographic and healthcare access differences between GARs and PSRs. GARs reported significantly lower perceived physical and mental health, as well as, higher unmet healthcare needs than PSRs. GARs are among the most vulnerable refugees; they report higher needs, more complex medical conditions and tend to have more difficulty re-settling. These factors likely combine to help explain lower self-reported health and higher health needs in our sample compared to PSRs.

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Mitigating the bilateral deficit: reducing neural deficits through residual force enhancement and activation reduction

Abstract

Purpose

The bilateral deficit (BLD) is characterized by a reduction in maximal voluntary torque during a bilateral contraction relative to the sum of left and right unilateral contractions. The BLD has been attributed to interhemispheric inhibition as a result of unilateral torque differences between limbs. If the BLD is the result of interhemispheric inhibition, lowering activation for a torque matching task, as shown in residual force enhancement (RFE), may help overcome the decrease in neural drive during bilateral contractions. Therefore, the purpose of the present study was to determine whether RFE could reduce the BLD.

Methods

Participants (n = 12) performed both isometric and RFE MVCs of the elbow flexors under three conditions: (1) unilateral-left; (2) unilateral-right; and (3) bilateral. To directly address the purpose of the study, a sub-group of participants that displayed both RFE and a BLD ("Responders", n = 6) were selected from the participant pool.

Results

"Responders" displayed RFE (7.1 ± 5.3%) and an isometric BLD (BI: − 9.9 ± 3.2%). In the RFE state, the BLD was no longer significant (− 5.8 ± 7.9%), accompanied by the elimination of differences in biceps brachii EMG between arms (left: − 11.7 ± 10.3%; right: − 11.5 ± 13.2%), as seen during isometric contractions (left: − 12.0 ± 23.2%; right: − 21.1 ± 16.6%).

Conclusion

Residual force enhancement appears to mitigate the BLD, alleviating the effects of a decrease in neural drive by allowing more force for a given level of muscle activation when compared to a purely isometric contraction.

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Highly efficient genome editing using oocyte-specific zcas9 transgenic zebrafish

Publication date: Available online 28 June 2018
Source:Journal of Genetics and Genomics
Author(s): Yuanyuan Liu, Chong Zhang, Yanjun Zhang, Siyao Lin, De-Li Shi, Ming Shao




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Change in maximal fat oxidation in response to different regimes of periodized high-intensity interval training (HIIT)

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In vivo identification of novel TGIF2LX target genes in colorectal adenocarcinoma using the cDNA-AFLP method

Publication date: Available online 28 June 2018
Source:Arab Journal of Gastroenterology
Author(s): Gholam Reza Mobini, Arefeh Ghafari, Saeid Amanpour, Roohollah Fateh, Mohammad Hossein Ghahremani, Samad Muhammadnejad, Ahmad Reza Dehpour, Abolfazl Akbari, Seyed Mojtaba Hoseiniharouni, Elham Kazemirad, Manzar Bolhassani, Mansour Heidari
Background and study aimsHomeobox-containing genes are composed of a group of regulatory genes encoding transcription factors involved in the control of developmental processes. The homeodomain proteins could activate or repress the expression of downstream target genes. This study was conducted to in vivo identify the potential target gene(s) of TGIF2LX in colorectal adenocarcinoma.MethodsA human colorectal adenocarcinoma cell line, SW48, was transfected with the recombinant pEGFPN1-TGIF2LX. The cells were injected subcutaneously into the flank of the three groups of 6-week-old female athymic C56BL/6 nude mice (n = 6 per group). The transcript profiles in the developed tumours were investigated using the cDNA amplified fragment length polymorphism (cDNA-AFLP) technique.ResultsThe real-time RT-PCR and DNA sequencing data for the identified genes indicated that the N-terminal domain-interacting receptor 1 (Nir1) gene was suppressed whereas Nir2 and fragile histidine triad (FHIT) genes were upregulated followed by the overexpression of TGIF2LX gene.ConclusionDownregulation of Nir1 and upregulation of Nir2 and FHIT genes due to the overexpression of TGIF2LX suggests that the gene plays an important role as a suppressor in colorectal adenocarcinoma.



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Socioeconomic Position and Reproduction: Findings from the Australian Longitudinal Study on Women’s Health

Abstract

Objective: To investigate the association of socioeconomic position (SEP) with reproductive outcomes among Australian women. Methods: Data from the Australian Longitudinal Study on Women's Health's (population-based cohort study) 1973–1978 cohort were used (N = 6899, aged 37–42 years in 2015). The association of SEP (childhood and own, multiple indicators) with age at first birth, birth-to-pregnancy (BTP) intervals and total number of children was analysed using multinomial logistic regression. Results: 14% of women had their first birth aged < 24 years. 29% of multiparous women had a BTP interval within the WHO recommendation (18–27 months). Women with a low SEP had increased odds of a first birth < 24 years: low (OR 7.0: 95% C.I. 5.3, 9.3) or intermediate education (OR 3.8: 2.8, 5.1); living in rural (OR 1.8: 1.5, 2.2) or remote (OR 2.1: 1.7, 2.7) areas; who found it sometimes (OR 1.8: 1.5, 2.2) or always difficult (OR 2.0: 1.6, 2.7) to manage on their income; and did not know their parent's education (OR 4.5: 3.2, 6.4). Low SEP was associated with having a much longer than recommended BTP interval. Conclusion: As the first Australian study describing social differences in reproductive characteristics, these findings provide a base for reducing social inequalities in reproduction. Assisting adequate BTP spacing is important, particularly for women with existing elevated risks due to social disadvantage; including having a first birth < 24 years of age and a longer than recommended BTP interval. This includes reviewing services/access to postnatal support, free family planning/contraception clinics, and improved family policies.

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Association between pre-operative biological phenotypes and postoperative pulmonary complications: An unbiased cluster analysis

BACKGROUND Biological phenotypes have been identified within several heterogeneous pulmonary diseases, with potential therapeutic consequences. OBJECTIVE To assess whether distinct biological phenotypes exist within surgical patients, and whether development of postoperative pulmonary complications (PPCs) and subsequent dependence of intra-operative positive end-expiratory pressure (PEEP) differ between such phenotypes. SETTING Operating rooms of six hospitals in Europe and USA. DESIGN Secondary analysis of the 'PROtective Ventilation with HIgh or LOw PEEP' trial. PATIENTS Adult patients scheduled for abdominal surgery who are at risk of PPCs. INTERVENTIONS Measurement of pre-operative concentrations of seven plasma biomarkers associated with inflammation and lung injury. MAIN OUTCOME MEASURES We applied unbiased cluster analysis to identify biological phenotypes. We then compared the proportion of patients developing PPCs within each phenotype, and associations between intra-operative PEEP levels and development of PPCs among phenotypes. RESULTS In total, 242 patients were included. Unbiased cluster analysis clustered the patients within two biological phenotypes. Patients with phenotype 1 had lower plasma concentrations of TNF-α (3.8 [2.4 to 5.9] vs. 10.2 [8.0 to 12.1] pg ml−1; P 

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RAD Sequencing and a Hybrid Antarctic Fur Seal Genome Assembly Reveal Rapidly Decaying Linkage Disequilibrium, Global Population Structure and Evidence for Inbreeding

Recent advances in high throughput sequencing have transformed the study of wild organisms by facilitating the generation of high quality genome assemblies and dense genetic marker datasets. These resources have the potential to significantly advance our understanding of diverse phenomena at the level of species, populations and individuals, ranging from patterns of synteny through rates of linkage disequilibrium (LD) decay and population structure to individual inbreeding. Consequently, we used PacBio sequencing to refine an existing Antarctic fur seal (Arctocephalus gazella) genome assembly and genotyped 83 individuals from six populations using restriction site associated DNA (RAD) sequencing. The resulting hybrid genome comprised 6,169 scaffolds with an N50 of 6.21 Mb and provided clear evidence for the conservation of large chromosomal segments between the fur seal and dog (Canis lupus familiaris). Focusing on the most extensively sampled population of South Georgia, we found that LD decayed rapidly, reaching the background level by around 400 kb, consistent with other vertebrates but at odds with the notion that fur seals experienced a strong historical bottleneck. We also found evidence for population structuring, with four main Antarctic island groups being resolved. Finally, appreciable variance in individual inbreeding could be detected, reflecting the strong polygyny and site fidelity of the species. Overall, our study contributes important resources for future genomic studies of fur seals and other pinnipeds while also providing a clear example of how high throughput sequencing can generate diverse biological insights at multiple levels of organisation.

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Genetic Analysis of Signal Generation by the Rgt2 Glucose Sensor of Saccharomyces cerevisiae

The yeast S. cerevisiae senses glucose through Snf3 and Rgt2, transmembrane proteins that generate an intracellular signal in response to glucose that leads to inhibition of the Rgt1 transcriptional repressor and consequently to derepression of HXT genes encoding glucose transporters. Snf3 and Rgt2 are thought to be glucose receptors because they are similar to glucose transporters. In contrast to glucose transporters, they have unusually long C-terminal tails that bind to Mth1 and Std1, paralogous proteins that regulate function of the Rgt1 transcription factor. We show that the C-terminal tail of Rgt2 is not responsible for its inability to transport glucose. To gain insight into how the glucose sensors generate an intracellular signal, we identified RGT2 mutations that cause constitutive signal generation. Most of the mutations alter evolutionarily-conserved amino acids in the transmembrane spanning regions of Rgt2 that are predicted to be involved in maintaining an outward-facing conformation or to be in the substrate binding site. Our analysis of these mutations suggests they cause Rgt2 to adopt inward-facing or occluded conformations that generate the glucose signal. These results support the idea that Rgt2 and Snf3 are glucose receptors that signal in response to binding of extracellular glucose and inform the basis of their signaling.

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Oxytocinergic modulation of brain activation to cues related to reproduction and attachment: Differences and commonalities during the perception of erotic and fearful social scenes

Publication date: Available online 28 June 2018
Source:International Journal of Psychophysiology
Author(s): Carina Sauer, Christian Montag, Martin Reuter, Peter Kirsch
In animal research, the neuropeptide oxytocin (OT) has been known for its role in reproduction and attachment for a longer time. There is strong evidence for an involvement of the mesolimbic dopaminergic system for these effects of OT. In contrast, human research rather concentrated on more human concepts of social cognition and behavior (e.g. trust or processing of fearful faces) and mainly focused on the amygdala as the main neurobiological substrate. To extend this view, we wanted to gain more insight into the neurobiological effects of OT in the context of reproduction and attachment in humans and compare these effects to its well-known effects on fear processing.In a double-blind placebo-controlled fMRI study, we investigated 55 healthy young men using intranasal OT administration. During fMRI, participants saw attachment-related erotic scenes and fearful social scenes.Over all participants, OT had a differential effect on processing of erotic and fearful scenes. While OT administration led to a relative increase of neural activation in mesolimbic structures during processing of erotic stimuli, it decreased amygdala activation for fearful stimuli. On the individual level, we observed significant positive correlations between OT induced activation changes across different brain regions and under different stimulus conditions.Our findings extend the already existing animal literature and provide evidence for a similar involvement of the mesolimbic dopaminergic system for OT effects in the context of reproduction and attachment in humans.



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The psychophysiology of stress and adaptation: Models, pathways, and implications

Publication date: Available online 28 June 2018
Source:International Journal of Psychophysiology
Author(s): Brian M. Hughes, Patrick R. Steffen, Julian Thayer




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Oxytocin for learning calm and safety

Publication date: Available online 28 June 2018
Source:International Journal of Psychophysiology
Author(s): Monika Eckstein, Ana C. Almeida de Minas, Dirk Scheele, Ann-Kathrin Kreuder, René Hurlemann, Valery Grinevich, Beate Ditzen
The appropriate discrimination between safe and dangerous situations and the subsequent decrease of fear expression in the presence of safety signals are crucial for survival and mental health.Learning of safety associations is often studied in terms of fear extinction, that is re-learning of a previously conditioned stimulus which is now no longer positively associated with danger. Numerous studies investigated neurobiological processes of fear extinction and provide a valid picture of the underlying neural structures and endocrine processes involved.However, a formerly neutral conditioned stimulus (CS) can also predict the non-occurrence of an aversive, potentially dangerous, unconditioned stimulus (US) from the very beginning and thus can serve as a safety stimulus. This process has been termed safety learning. Although safety learning has been known for almost a century, there has been little research on its underlying neurobiological mechanisms, in contrast to the more prominent Pavlovian fear conditioning and fear extinction.In this review, we propose that the well-known action of the hypothalamic neuropeptide oxytocin (OXT) in the regulation of fear and stress responses is complementary to safety learning. We summarize the literature focused on OXT signaling and safety learning in animals and humans, from the first studies of fear extinction and conditioned inhibition of fear to the most recent findings in molecular and behavioral research on initial social safety stimuli. At the end, we discuss the application of OXT as a therapeutic agent to psychopathologies related to deficits in safety learning.



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Assisting hand function after spinal cord injury with a fabric-based soft robotic glove

Spinal cord injury is a devastating condition that can dramatically impact hand motor function. Passive and active assistive devices are becoming more commonly used to enhance lost hand strength and dexterity....

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Association between STAT4 polymorphisms and risk of primary biliary cholangitis: a meta-analysis

Abstract

Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease. Several studies reported that SATA4 (signal transducer and activator of transcription 4) polymorphisms were significantly associated with PBC susceptibility. In order to derive a more comprehensive estimation of the association between STAT4 and PBC risk, this meta-analysis was conducted. Thirteen eligible studies from 8 articles with a total number of 11,310 cases and 27,844 controls were included in this meta-analysis. Pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated with fixed effects model or random effects model. The results showed statistically significant association between polymorphisms of rs7574865, rs3024921, rs6752770, rs7601754 and rs10168266 in STAT4 and PBC risk under the allelic effect model (rs7574865, T vs. G, OR = 1.24, 95% CI 1.14–1.35; rs3024921, T vs. A, OR = 1.65, 95% CI 1.44–1.91; rs6752770, G vs. A, OR = 1.24, 95% CI 1.11–1.39; rs7601754, A vs. G, OR = 1.35, 95% CI 1.17–1.55; and rs10168266, T vs. C, OR = 1.31, 95% CI 1.22–1.41). Furthermore, the rs7574865 polymorphism was significantly associated with PBC risk under all genotype genetic models (dominant effect model: TT + TG vs. GG, OR = 1.43, 95% CI 1.19–1.71; recessive effect: TT vs. TG + GG, OR = 1.40, 95% CI 1.24–1.58; and co-dominant effect: TT vs. GG, OR = 1.67, 95% CI 1.37–2.02). The sensitivity analysis by omitting one study at a time showed that the results were stable. No publication bias was indicated from both Begg's test and Egger's weighted regression. This meta-analysis suggested that polymorphisms of rs7574865, rs3024921, rs6752770, rs7601754 and rs10168266 in STAT4 were significantly associated with the risk of PBC.

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Correlation Between Pharyngeal Residue and Aspiration In Fiberoptic Endoscopic Evaluation of Swallowing – An Observational Study

Publication date: Available online 27 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Yael Shapira-Galitz, Hagit Shoffel-Havakuk, Doron Halperin, MHA Yonatan Lahav
ObjectivesTo examine the correlation between pharyngeal residue severity and clearance to penetration-aspiration on FEES.DesignRetrospective cohort.SettingKaplan Medical Center dysphagia clinic.Participants110 patients visiting a dysphagia clinic between 2014-2016 undergoing FEES.InterventionsFEES were scored for penetration-aspiration with the penetration-aspiration scale (PAS), for residue severity using the Yale Pharyngeal Residue Severity Rating Scale, YPR-SRS. The numbers of swallows required to clear the pharynx were recorded. The first and the worst bolus challenge for each consistency (liquid, purée and solid) were analyzed.Main Outcome MeasuresYPR-SRS and number of clearing swallows were correlated with the PAS of the same bolus challenge.ResultsThe study population's mean age was 67±13.4 years; 54% were males (n=58). A significant correlation was found between the YPR-SRS and the PAS for all consistencies tested, in each anatomical site (vallecula or pyriform sinus) and for both the first and worst bolus challenge (p<0.001 for all). The correlation of residue with aspiration was stronger when vallecula and pyriform sinuses scores were summated (Pearson's correlation coefficient=0.573/0.631/0.446 for liquid/purée/solid for worst bolus challenge). Incorporating the number of clearing swallows to the YPR-SRS strengthened the correlation with PAS.ConclusionsResidue severity and clearance correlate with penetration/aspiration on FEES. The YPR-SRS can be applied to standardize description of residue in FEES and to aid in dysphagia evaluation.



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Characterization and development of EST-SSR markers to study the genetic diversity and populations analysis of Jerusalem artichoke ( Helianthus tuberosus L.)

Abstract

In recent years, Jerusalem artichoke has received widespread attention as a novel source of sugar, biofuel, and animal feed. Currently, only few gDNA-SSRs derived from sunflower were verified in the Jerusalem artichoke; therefore, it is particularly important to develop SSR primer markers that belonged to Jerusalem artichoke resources. Using EST data to develop EST-SSR markers is simple and effective. In order to understand the general characteristics of SSR markers in Jerusalem artichoke EST sequences and accelerate the use of SSR markers in Jerusalem artichoke research. This study used 40,370 sequenced unigene fragments and MISA software to identify SSR loci. The 48 pairs of EST-SSR primers assessed for the identification of 45 varieties of Jerusalem artichoke. Cluster, genetic diversity parameters and AMOVA analysis was conducted using the genetic similarity coefficient, revealing genetic differences between 48 genetic material. A total of 1204 SSR loci were identified with 13 different types of repeats, distributed among 1020 EST sequences, of which trinucleotide repeats were the most common, accounting for 38.21% of the total SSR loci. Among the 44 repeat motifs, AG/CT, AAG/CTT, and ATC/ATG motifs had the highest frequencies, accounting for 22.45, 14.71, and 7.84% of all motifs, respectively. From these sequences, 48 pairs of EST-SSR primers were designed, and 22 primer pairs for loci with high polymorphism were selected to analyze the genetic diversity of 45 Jerusalem artichoke germplasm sources. The results indicated that the variation range of the effective number of alleles for 22 primers ranged between 1.7502 and 4.5660. The Shannon's information index ranged between 0.6200 and 1.6423. The variation range of PIC ranged between 0.3121 and 0.6662 with an average of 0.5184. Cluster analysis was conducted using the genetic similarity coefficient, revealing significant genetic differences between Asian and European genetic material. Cluster analysis revealed a relationship between the genotypes and geographic origins of the Jerusalem artichoke. The results of AMOVA as well as the genetic identity and genetic distance in the Jerusalem artichoke population showed that there presented certain genetic heterogeneity in Jerusalem artichoke genetic structure of 45 samples from seven different geographic populations. The Jerusalem artichoke EST-SSR marker system established in this study provides an effective molecular marker system for future research focused on Jerusalem artichoke genetic diversity and the breeding of new varieties.

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Radionuclide observables of underwater nuclear explosive tests

Publication date: December 2018
Source:Journal of Environmental Radioactivity, Volume 192
Author(s): Jonathan L. Burnett, Brian D. Milbrath
There remain technical challenges for an On-site Inspection (OSI) in the high seas environment, which gathers evidence of a violation of the Comprehensive Nuclear-Test-Ban Treaty (CTBT). For terrestrial nuclear explosions, the radionuclide observables are well defined and States Parties have chosen 17 particulate radionuclides that allow discrimination from other nuclear events. However, an underwater nuclear explosion generates induced radionuclides from the neutron activation of seawater, which has the potential to interfere with the measurement of the radionuclide observables using gamma-spectrometry techniques. To understand these effects the inventory of OSI relevant (6.0 × 10¹⁶ Bq) and activation (1.6 × 10¹⁹ Bq) radionuclides has been calculated for a 1 kT underwater nuclear explosion. The activation products consist predominantly of ³⁸Cl and ²⁴Na, which decay to 5.56% and 0.0007% of their initial activity within 1 and 14 days. Monte Carlo techniques have been used to assess spectral interferences within this timeframe. It is demonstrated that during this period they do not interfere with the measurement of the existing radionuclide observables. Additionally, ²⁴Na has been identified as useful for inspection purposes.



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Inequality and Innovation: Barriers and Facilitators to 17P Administration to Prevent Preterm Birth among Medicaid Participants

Abstract

Objectives Strategies to prevent preterm birth are limited. 17 Alpha-Hydroxyprogesterone Caproate (17P) injections have been shown to be effective, but the intervention is under-used. This mixed methods study investigates barriers and facilitators to 17P administration among Medicaid and CHIP participants enrolled in Strong Start for Mothers and Newborns, a federal preterm birth prevention program. Methods Twenty-seven awardees with more than 200 sites in 30 states, the District of Columbia, and Puerto Rico enrolled approximately 46,000 women in Strong Start from 2013 to 2016. Participant data, including data on preterm birth and 17P, was collected for each woman. Intensive interviews (n = 211) conducted with Strong Start program staff and providers (n = 314) included questions about 17P provision. Results Of women whose data included a valid response regarding 17P initiation, 3919 had a prior preterm birth and current singleton pregnancy; 14.95% received 17P. Barriers to 17P administration include late entry to prenatal care, administrative burden of preauthorization, cost risks to providers, limits in scope of practice for non-physician providers, and social barriers among participants. Facilitators for provision include streamlined work flows and the option of home administration. Conclusions for Practice A universal insurance authorization process could mitigate many barriers to 17P use. Providers need continuing education regarding the effectiveness of 17P, and expanding scope of practice for non-physician prenatal care providers would increase access. Targeted program interventions can help to overcome social barriers Medicaid participants face in accessing care. Streamlined work processes and the option of home health services are two effective program-based facilitators for providing 17P to a Medicaid population.

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De novo variants in GREB1L are associated with non-syndromic inner ear malformations and deafness

Abstract

Congenital inner ear malformations affecting both the osseous and membranous labyrinth can have a devastating impact on hearing and language development. With the exception of an enlarged vestibular aqueduct, non-syndromic inner ear malformations are rare, and their underlying molecular biology has thus far remained understudied. To identify molecular factors that might be important in the developing inner ear, we adopted a family-based trio exome sequencing approach in young unrelated subjects with severe inner ear malformations. We identified two previously unreported de novo loss-of-function variants in GREB1L [c.4368G>T;p.(Glu1410fs) and c.982C>T;p.(Arg328*)] in two affected subjects with absent cochleae and eighth cranial nerve malformations. The cochlear aplasia in these affected subjects suggests that a developmental arrest or problem at a very early stage of inner ear development exists, e.g., during the otic pit formation. Craniofacial Greb1l RNA expression peaks in mice during this time frame (E8.5). It also peaks in the developing inner ear during E13–E16, after which it decreases in adulthood. The crucial function of Greb1l in craniofacial development is also evidenced in knockout mice, which develop severe craniofacial abnormalities. In addition, we show that Greb1l^−/− zebrafish exhibit a loss of abnormal sensory epithelia innervation. An important role for Greb1l in sensory epithelia innervation development is supported by the eighth cranial nerve deficiencies seen in both affected subjects. In conclusion, we demonstrate that GREB1L is a key player in early inner ear and eighth cranial nerve development. Abnormalities in cochleovestibular anatomy can provide challenges for cochlear implantation. Combining a molecular diagnosis with imaging techniques might aid the development of individually tailored therapeutic interventions in the future.

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Effects of Ethnic Identity on the Relationship Between Mental Health and Perceived Discrimination Among Ethnic Return Migrants: The Case of Korean Chinese Return-Migrated to South Korea

Abstract

This study examined the relationship among mental health, perceived discrimination and ethnic identity among Korean Chinese (Joseonjok) who have return-migrated to South Korea. A survey was conducted with 399 Joseonjok adults (≥ 19 years) residing in the capital city Seoul or nearby. Depression was measured using the (self-report) Center for Epidemiologic Studies Depression Scale-Korean (CES-D-K) version (n = 292, mean age = 42.6, female = 56.5%). Perceived discrimination and ethnic identity were assessed with single-item questions. The mean CES-D-K total score was 9.3 (SD = 8.4) and 20.6% had clinical depression (cut-off score: 16). Perceived discrimination was positively associated with CES-D-K scores (regression coefficient = 2.09, p = 0.04). This association was stronger in those identifying themselves more strongly as 'Korean' than 'Chinese'. Discrimination by 'co-ethnic hosts' can have a greater impact on mental health among those ethnic return migrants with a stronger ethnic identity. More efforts are needed to help them better integrate into South Korean society.

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Barriers Faced by the Health Workers to Deliver Maternal Care Services and Their Perceptions of the Factors Preventing Their Clients from Receiving the Services: A Qualitative Study in South Sudan

Abstract

Objective The study objective was to explore challenges and barriers confronted by maternal and child healthcare providers to deliver adequate quality health services to women during antenatal care visits, facility delivery and post-delivery care. Methods We conducted 18 in-depth-interviews with maternal and child health professionals including midwives/nurses, trained traditional birth attendants (TBAs), gynecologists, and pediatricians in three public health facilities in Juba, South Sudan. We purposively selected these health professionals to obtain insights into service delivery processes. We analyzed the data using thematic analysis. Results Limited support from the heath system, such as poor management and coordination of staff, lack of medical equipment and supplies and lack of utilities such as electricity and water supply were major barriers to provision of health services. In addition, lack of supervision and training opportunity, low salary and absence of other forms of non-financial incentives were major elements of health workers' de-motivation and low performance. Furthermore, security instability as a result of political and armed conflicts further impact services delivery. Conclusions for Practice This study highlighted the urgent need for improving maternal and child healthcare services such as availability of medical supplies, equipment and utilities. The necessity of equal training opportunities for maternal and child healthcare workers at different levels were also stressed. Assurance of safety of health workers, especially at night, is essential for providing of delivery services.

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Context Matters: Revisiting the First Step of the ‘Sequence of Prevention’ of Sports Injuries

Abstract

It is possible to prevent sports injuries. Unfortunately, the demonstrated efficacy and effectiveness of injury prevention approaches are not translated into lasting real-world effects. Contemporary views in sports medicine and injury prevention suggest that sports injuries are 'complex' phenomena. If the problem we aim to prevent is complex, then the first step in the 'sequence of prevention' that defines the 'injury problem' already needs to have considered this. The purpose of this paper is to revisit the first step of the 'sequence of prevention', and to explore new perspectives that acknowledge the complexity of the sports injury problem. First, this paper provides a retrospective of the 'sequence of prevention', acknowledging contemporary views on sports injuries and their prevention. Thereafter, from the perspective of the socioecological model, we demonstrate the need for taking into account the complex nature of sports injuries in the first step. Finally, we propose an alternative approach to explore and understand injury context through qualitative research methods. A better understanding of the injury problem in context will guide more context-sensitive studies, thus providing a new perspective for sports injury prevention research.

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Molecular characterization of microtubule-associated protein 1-light chain 3B in Megalobrama amblycephala fed with high fat/berberine diets

Abstract

This study tested the effect of berberine on autophagy-related protein of Megalobrama amblycephala fed with high fat diet under different feeding modes. The full-length complementary DNA (cDNA) of microtubule-associated protein 1-light chain 3B (LC3B) was 1871 bp with an open reading frame of 378 bp encoding 125 amino acids. High homology at nucleotide and amino acid sequences to carp LC3B was revealed though sequence analysis. LC3B was mainly (P < 0.05) expressed in hepatopancreas but lower in several peripheral tissues, including gill, intestine, kidney, and spleen. The fish (average initial weight 4.70 ± 0.02 g) were fed with eight experiment diets containing two lipid levels (5 and 10%) or four berberine-feeding modes (without berberine, supplementing 50 mg/kg berberine at 2-week intervals, 4-week intervals, or continuous) for 8 weeks. The results showed that the numbers of autophagosomes and hepatopancreas LC3B messenger RNA (mRNA) expression levels were significantly (P < 0.05) affected both by dietary lipid level and beberine feeding mode, and the highest (P < 0.05) numbers of autophagosomes and LC3B expression levels were observed in fish at berberine continuous feeding mode groups. The findings may provide the molecular mechanisms underlying lipid metabolism and immune effect of berberine, which was associated with enhanced autophagy in fish.

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Editorial Board

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Improvement During Inpatient Rehabilitation Among Older Adults with Guillain-Barré Syndrome, Multiple Sclerosis, Parkinson Disease, and Stroke

Objective To quantify the improvement in independence experienced by patients with the following diagnoses: Guillain-Barré Syndrome (GBS), Multiple Sclerosis (MS), Parkinson Disease (PD), and stroke following inpatient rehabilitation. Design Subjects who were admitted to inpatient rehabilitation hospitals in 2012-2013 with an incident diagnosis of: GBS (n = 1079), MS (n = 1438), PD (n = 11,834), or stroke (n = 131,313) were included. The main outcome measure was improvement in Functional Independence Measure® (FIM) scores on self-care, mobility, and cognition during inpatient rehabilitation. We estimated percent improvement from a linear mixed-effects model adjusted for patients' age, sex, race/ethnicity, comorbidity count, diagnostic group (GBS, MS, PD, and stroke), and admission score. Results All patient diagnostic groups receiving inpatient rehabilitation improved across all three domains. The largest adjusted percent improvements were observed in the mobility domain and the smallest in the cognition domain for all groups. Percent improvement in mobility ranged from 84.9% (MS) to 144.0% (GBS), self-care from 49.5% (MS) to 84.1% (GBS), and cognition from 34.0% (PD) to 51.7% (GBS). Patients with GBS demonstrated the greatest percent improvement across all three domains. Conclusions Patients with GBS, MS, PD, and stroke should improve during inpatient rehabilitation but anticipated outcomes for patients with GBS should be even higher. Author Disclosures: The study was supported by funding secured by Kenneth J. Ottenbacher, PhD, OTR through the National Institutes of Health (grant numbers R01 HD069443, P2C HD065702, and K12 HD055929) and the National Institute on Disability, Independent Living, and Rehabilitation Research (grant number 90AR5009). This work was also supported by the National Institute on Aging (grant number P30 AG024832) and the Foundation for Physical Therapy's Center of Excellence in Physical Therapy Health Services and Health Policy Research and Training Grant. We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated and we certify that all financial and material support for this research (eg, NIH or NIA grants) and work are clearly identified here in the title page of the manuscript. Neither author has financially benefitted from this research project or its dissemination. The results of this study are accepted as an abstract for the 2018 Combined Sections Meeting of the American Physical Therapy Association. To date, the results of this study have not been presented or published elsewhere. Corresponding author: A. Williams Andrews, Campus Box 2085, Elon, NC 27244. 336-278-6351. andrewsb@elon.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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