Πέμπτη, 12 Ιουλίου 2018

Equity in Physical Activity: A Misguided Goal

Abstract

Rates of participation in physical activity are often not the same between groups in a given demographic category. These differences have been termed 'inequities,' and major health organizations are advocating large-scale initiatives to create 'equity' in physical activity. The aim of this paper is to explain why equity in physical activity is a misguided goal. Equity is a misguided goal because it ignores absolute rates of physical activity (i.e., it is a metric of how one group compares with another), and because it is an automated goal that ignores sizes of 'gaps' between groups. Moreover, equity initiatives incorrectly assume that groups with relatively high physical activity rates are always at lower health risk; that non-targeted groups will remain static in their levels of physical activity; that individuals are part of only one demographic category; that complete equity can be achieved; that the causal relationship between equity initiatives and their desired outcome can be known; and that differences in physical activity rates between groups are due to differences in 'opportunity.' Due to these issues, health organizations should abandon the goal of equity. Instead, they should aim to increase physical activity in groups that are most sedentary and/or at greatest health risk to a level that is as high as is feasible and possible, irrespective of how that new level compares with other groups. This goal is objective and not based on the misguided premises that underpin the current equity narrative.



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Ketamine and Electroconvulsive Therapy for Depression

No abstract available

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Can Cerebral Near-infrared Spectroscopy Predict Cerebral Ischemic Events in Neurosurgical Patients? A Narrative Review of the Literature

Cerebral near-infrared spectroscopy (NIRS) is considered a valuable noninvasive modality for cerebral oxygenation monitoring during cardiovascular surgery and cardiac arrest. We assessed the capability of cerebral NIRS to predict cerebral desaturation and the related neurological outcomes in neurosurgical patients. A literature search in different electronic medical databases was performed from inception to January 2018. A total of 286 citations were found and finally 48 studies were retrieved, only 7 of these were eligible and included for review. A meta-analysis was not feasible because of high heterogeneity of patients' groups, different NIRS techniques used in the studies and different outcome criteria selected. The qualitative assessment showed controversial data on the threshold value of cerebral near-infrared spectroscopy used for detecting cerebral ischemia in neurosurgical patients. The evidence on the selected studies is not strong enough, at the moment, to recommend cerebral NIRS as a mandatory monitor to detect cerebral deoxygenation able to predict the future neurological outcome in neurosurgical patients. Further studies are needed to validate a threshold value for cerebral ischemia and the relationship between NIRS-detected cerebral desaturation and clinical outcome in the neurosurgical population. M.L. is a scientific advisor of MASIMO Corp., Irvine, CA. The remaining authors declare that they have nothing to disclose. Address correspondence to: Andrey Khozhenko, MD, DESA, Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Sowwah Square, 112412, Abu Dhabi, UAE (e-mail: ahozhenko@gmail.com). Received December 25, 2017 Accepted May 30, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Effect of Endurance Conditioning on Insulin-mediated Glucose Clearance in Dogs

Introduction Physical activity has been shown to improve insulin sensitivity in subjects with insulin resistance, but the effect of athletic conditioning on subjects with normal insulin sensitivity has received less scrutiny. Because strenuous exercise can be limited by the availability of substrates, it is reasonable to hypothesize that conditioning would increase the capacity for muscle uptake of substrates like glucose, and to the extent that improvement in this process would include upregulation of the portions of the glucose uptake pathway in muscle, this increased capacity would also be reflected in insulin sensitivity. Therefore, we tested the hypothesis that conditioning for endurance exercise would result in increased insulin sensitivity using elite racing sled dogs. Methods A frequent sampled intravenous glucose tolerance test was performed on these dogs before and after a full 7 month season of conditioning in preparation for a 1600-km race. Results Compared to the results in unconditioned dogs, conditioned dogs rapidly cleared the intravenous glucose bolus through increases in both glucose mediated (7.6 ± 3.4%/min vs 3.0 ± 2.2%/min, p = 0.008) and insulin-mediated (36.3 ± 18.4x 10-4 L/min/mU vs 11.5 ± 8.0 x 10-4 L/min/mU, p = 0.007) mechanisms. The more modest increase in serum insulin following the intravenous glucose bolus in Conditioned dogs failed to suppress lipolysis and serum concentrations of non-esterified fatty acids remained constant in the conditioned dogs throughout the 4-hr test. Conclusion These results, in particular the increase in insulin-independent peripheral uptake of glucose, describe novel alterations in metabolism induced by athletic conditioning that arguably result in near-continuous provision of oxidizable substrates to peripheral muscle in support of sustained muscular work typical of these dogs. Corresponding Author: Michael S. Davis, 264 McElroy Hall, Stillwater, OK, 74078, Phone: 405-744-8172, Fax: 405-744-8263, Michael.davis@okstate.edu Studies were funded by the Army Research Office Division of Life Sciences (W911NF-09-1-0549). The authors affirm that they have no professional relationships with companies or manufacturers who will benefit from the results of the present study, and that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by ACSM. Submitted for publication April 2018. Accepted for publication July 2018. © 2018 American College of Sports Medicine

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Associations between Changes in Activity and Sleep Quality and Duration over Two Years

Purpose Insufficient physical activity (PA) and inadequate sleep quality (SQ) and sleep duration (SD) are highly prevalent behaviours that increase the risk of developing many chronic health conditions. Evidence regarding bi-directional relationships between PA, SQ and SD is inconsistent. As changes in one of these behaviours may impact on the other, it is important to understand the nature of the bi-directional relationship between physical activity and sleep. Therefore, the aim of this study was to examine the relationship between changes in physical activity, sleep quality and sleep duration over a 2-year period in middle-aged adults. Methods Participants were adults aged 42-72 years from Brisbane, Australia. Mail surveys were used to assess PA, SQ, SD, socio-demographic and health characteristics in 2011 and 2013 (n=3,649). Multinomial logistic regression analyses were conducted to examine the relationships between patterns of change in PA, SQ and SD over the two years. Results Improving or maintaining good SQ was associated with increasing or maintaining PA and maintaining PA was associated with maintaining or increasing SQ (p

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Tripartite Chromatin Localization of Budding Yeast Shugoshin Involves Higher-Ordered Architecture of Mitotic Chromosomes

The spindle assembly checkpoint (SAC) is key to faithful segregation of chromosomes. One requirement that satisfies SAC is appropriate tension between sister chromatids at the metaphase-anaphase juncture. Proper tension generated by poleward pulling of mitotic spindles signals biorientation of the underlying chromosome. In the budding yeast, the tension status is monitored by the conserved Shugoshin protein, Sgo1p, and the tension sensing motif (TSM) of histone H3. ChIP-seq reveals a unique TSM-dependent, tripartite domain of Sgo1p in each mitotic chromosome. This domain consists of one centromeric and two flanking peaks 3 - 4 kb away, present exclusively in mitosis. Strikingly, this trident motif coincides with cohesin localization, but only at the centromere and the two immediate adjacent loci, despite that cohesin is enriched at numerous regions throughout mitotic chromosomes. Chromosome conformation capture assays reveal apparent looping at the centromeric and pericentric regions. The TSM-Sgo1p-cohesin triad is therefore at the center stage of higher-ordered chromatin architecture for error-free segregation.



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Firefighters Against Cancer and Exposures (FACEs) non-profit launches in Texas

IRVINE, Calif. — In an effort to help firefighters cover the high cost of cancer treatment as a result of the occupational risk of experiencing higher rates of certain types of cancer than the general U.S. population, Laboratory for Advanced Medicine (LAM) today announced the launch of Firefighters Against Cancer and Exposures (FACEs), a Texas-based non-profit that provides supplemental funding ...

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Should nonviolent, convicted felons be accepted into the EMS field?

Our co-hosts discuss a recent article detailing possible legislation in California that would allow nonviolent, convicted felons to enter the EMS field

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Acculturation and Breastfeeding Among Hispanic American Women: A Systematic Review

Abstract

Introduction Hispanic immigrants are more likely to breastfeed than are Hispanics born in the US, in part due to their acculturation. This paper aims to systematically review the existing literature on the association between acculturation and Hispanics' breastfeeding behaviors. Methods The systematic search used major databases such as Medline and PubMed, and it followed the PRISMA checklist. The scientific quality of the studies was rated using the Quality Assessment Tool for Quantitative Studies. Results We identified 1943 potential citations, of which 18 studies met the eligibility criteria. Overall, while 13 studies suggested that high-acculturated Hispanics were less likely to breastfeed compared with low-acculturated, five studies did not find significant evidence of such an association. Moreover, 12 studies used a static measure or a linear scale, which is not optimal; only three studies utilized bi/multidimensional scales to assess acculturation. Intention to breastfeed was examined in six studies, but the results were inconsistent. Breastfeeding initiation was examined in 11 studies, and two out of eight studies that examined breastfeeding duration, specifically analyzed exclusive breastfeeding at 6 months. Discussion Our results agree with the general hypothesis that higher acculturation is inversely related to breastfeeding rates, independently of income. Researchers used different methodologies to study acculturation and breastfeeding practices, limiting our ability to reach more detailed conclusions. Owing to the lack of a standard methodology for measuring acculturation, future studies should utilize bi/multidimensional scales when studying breastfeeding, in particular, in relation to breastfeeding intention and exclusive breastfeeding at 6 months; preferably according to Hispanic subgroups.



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Effect of Maternal Vitamin B12 Supplementation on Cognitive Outcomes in South Indian Children: A Randomized Controlled Clinical Trial

Abstract

Objectives To examine the effects of oral maternal vitamin B12 supplementation during pregnancy and early lactation on cognitive development in children. Method We studied 218 children born to mothers enrolled in a placebo-controlled, randomized trial of vitamin B12 supplementation during pregnancy through 6 weeks post-partum. Cognitive functions were assessed at 30 months using the Bayley Scales of Infant Development- 3rd edition (BSID III). The association of maternal sociodemographic characteristics, maternal biochemical status during pregnancy, birth weight and home environment with each sub-domain of BSID-III was examined using linear regression analysis. Separate multiple linear regression analyses for each of the BSID-III sub-domains with maternal trimester specific nutritional biomarker status was conducted. Results Children of mothers who received oral vitamin B12 supplementation had significantly higher scores on expressive language compared to children of mothers who received placebo (β = 0.14, P = 0.03). Children of mothers with elevated serum total homocysteine (tHcy) in the second and third trimesters of pregnancy had significantly lower scores on expressive language (β = − 0.18, P = 0.03 and β = − 0.19, P = 0.02, respectively) and gross motor domains (β = − 0.23, P = 0.008 and β = − 0.30, P = 0.001, respectively) of BSID-III adjusted for treatment arm and multiple confounders, compared with children whose mothers did not have elevated tHcy. Conclusions for practice Maternal B12 supplementation during pregnancy was associated with higher expressive language scores in children at 30 months. Elevated maternal tHcy levels during pregnancy had negative associations with expressive language and gross motor domains of BSID-III. Larger trials of maternal B12 supplementation are needed to confirm these findings.



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Body Image Dissatisfaction, Obesity and Their Associations with Breastfeeding in Mexican Women, a Cross-Sectional Study

Abstract

Introduction In Mexico the breastfeeding rate is low and the obesity rate is high. Body image concerns, particularly prevalent in obese women, are associated with low breastfeeding rate; however, this association has never been examined in Mexican women. To fill this need, we examined the association between body image dissatisfaction (BID) and breastfeeding across levels of maternal weight status in Mexican women. Methods A cross-sectional study was used, utilizing data from the Mexican National Health and Nutrition Survey (ENSANUT) for 2012. The breastfeeding (Never or breastfed less than 30 days, Still breastfeeding, Ever breastfed) of the last child (age ≤ 3 years), BID (Stunkard Figure Rating Scale), anthropometric (Body Mass Index, BMI), and associated characteristics were collected. Weighted-multinomial logistic regression models were utilized to examine the adjusted association between BID and breastfeeding and the effect modification of maternal weight status. Results Overall, 2422 women aged 20–49 years met the eligibility criteria. Of these, 247 (10.8%) had never breastfed or breastfed less than 30 days, 826 (32%) were still breastfeeding, and 1349 (57.2%) had breastfed. A total of 38.2% were overweight (25 ≤ BMI < 30 kg m2) and 26.2% were obese (BMI ≥ 30 kg m2). In the adjusted model, while stratifying by maternal weight status levels, a greater BID was associated with a lower odds of sill breastfeeding (OR 0.58, 95% CI 0.45–0.75) and having breastfed (OR 0.65, 95% CI 0.50–0.83) only among women with BMI ≥ 30 kg m2. Discussion The results highlight the potential relationship between body image concerns and breastfeeding in Mexican women with obesity. However, the causality of such relationship needs further investigation, ideally using a longitudinal study design.



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Routine indexes for cirrhosis and significant fibrosis detection in patients with compensated chronic hepatitis B

Fibrosis index based on the four factors (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) were not well validated in patients with chronic hepatitis B (CHB). The aim of this study was to validate the performances of these indexes and construct novel indexes for liver fibrosis assessment.

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Fecal matrix metalloprotease-9 and lipocalin-2 as biomarkers in detecting endoscopic activity in patients with inflammatory bowel diseases

Journal of Clinical Gastroenterology

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Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn's disease (METRIC): A multicentre trial

The Lancet: Gastroenterology & Hepatology

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Safety and efficacy of elobixibat for chronic constipation: Results from a randomised, double-blind, placebo-controlled, phase 3 trial and an open-label, single-arm, phase 3 trial

The Lancet: Gastroenterology & Hepatology

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Evaluation of gastric emptying by transabdominal ultrasound after oral administration of semisolid cellulose-based gastric ultrasound contrast agents

Ultrasound in Medicine and Biology

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Role of cholecystectomy after endoscopic sphincterotomy in the management of choledocholithiasis in high-risk patients: a systematic review and meta-analysis

Journal of Clinical Gastroenterology

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Clinical and histopathologic features of colorectal adenocarcinoma in Crohn’s disease

Journal of Clinical Gastroenterology

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Irritable bowel syndrome on the US Mexico border: A survey in an indigent population using Rome III Criteria

Journal of Clinical Gastroenterology

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Role of esophageal motility, acid reflux, and of acid suppression in nonobstructive dysphagia

Journal of Clinical Gastroenterology

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Efficacy of pharmacologic therapy for eosinophilic esophagitis: A systematic review and network meta-analysis

Journal of Clinical Gastroenterology

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Low-dose levothyroxine reduces intrahepatic lipid content in patients with type 2 diabetes mellitus and NAFLD

Journal of Clinical Endocrinology & Metabolism

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Normal Rectal Filling Sensations in Patients with an Enlarged Rectum

Abstract

Background

Increased rectal volume is believed to be associated with diminished rectal sensation, i.e., rectal hyposensitivity.

Aims

To demonstrate that patients with increased rectal volumes do not automatically have diminished rectal filling sensations.

Methods

We, retrospectively, observed 100 adult patients with defecation problems, and 44 healthy controls who had undergone anorectal function tests. Using the balloon retention test, we analyzed the distribution of rectal volumes and pressures at different rectal filling sensation levels.

Results

We found variance in the distribution of rectal volumes at all levels, while rectal pressures showed a normal distribution. We found no correlation between rectal volumes and pressures (constant sensation, r = 0.140, P = 0.163, urge sensation, r = − 0.090, P = 0.375, and maximum tolerable volumes, r = − 0.091, P = 0.366), or when taking age and sex into account. The findings for the patient group were congruent with those for the control group.

Conclusions

Participants with increased rectal volumes do not experience increased rectal pressures at any sensation level. This finding, combined with the knowledge that rectal pressure triggers rectal filling sensation, indicates that rectal filling sensations in patients with increased rectal volumes are not diminished. Therefore, "rectal hyposensitivity" should be reserved for patients with increased rectal pressure thresholds, and not for "abnormally" increased rectal volume thresholds.



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Routine indexes for cirrhosis and significant fibrosis detection in patients with compensated chronic hepatitis B

Fibrosis index based on the four factors (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) were not well validated in patients with chronic hepatitis B (CHB). The aim of this study was to validate the performances of these indexes and construct novel indexes for liver fibrosis assessment.

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β-Blockers Improve Presinusoidal Portal Hypertension

Abstract

Background

Presinusoidal portal hypertension is a clinically important cause of gastric and gastroesophageal varices. Whereas β-blockers have an established prophylactic role against bleeding from esophageal and gastric varices in portal hypertension due to cirrhosis, the effect on presinusoidal portal hypertension is unknown.

Aims

To evaluate the hemodynamic effect of β-blockers in non-cirrhotic patients with presinusoidal portal hypertension.

Methods

We measured the blood pressure gradient from spleen pulp to free hepatic vein in 12 patients with presinusoidal portal hypertension by combined hepatic vein catheterization and spleen pulp puncture while on and off β-blocker treatment (random sequence).

Results

The β-blockers reduced the gradient from a mean off-treatment value of 32 mm Hg to a on-treatment value of 26 mm Hg (P < 0.05) with a reduction of at least 20% in five patients (42%).

Conclusions

β-blocker treatment caused a clinically significant reduction in the pressure gradient from spleen pulp to the free hepatic vein. This finding supports the recommendation for prophylactic β-blockage in patients with presinusoidal portal hypertension.



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Issue Information ‐ Editorial Board

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Clinical Genetics, Volume 94, Issue 2, Page 189-189, August 2018.


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NR4A2 haploinsufficiency is associated with intellectual disability and autism spectrum disorder

Clinical Genetics, Volume 94, Issue 2, Page 264-268, August 2018.


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Epilepsy Genetics: current knowledge, applications and future directions

Clinical Genetics, Volume 0, Issue ja, -Not available-.


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Microbial biomarkers for immune checkpoint blockade therapy against cancer

Abstract

Three major standard treatments, i.e., surgery, chemotherapy, and radiotherapy, were traditionally applied to the treatment of cancer and saved many patients. Meanwhile, clinical studies as well as basic research of immunotherapy are being actively conducted for intractable or advanced malignancies that cannot be cured by the conventional standard treatments. Remarkable therapeutic efficacies have been recently reported in clinical trials on some cancer types, and immunotherapy is now being recognized as the "fourth" standard therapy against cancer. In particular, immune checkpoint inhibitor therapy (ICI) has demonstrated the effectiveness of immunotherapy through large-scale randomized clinical trials, leading to the paradigm-shift in cancer treatment. Immune checkpoint molecules transduce co-inhibitory signals to immunocompetent cells including T cells, and crucially contribute to the formation of an immunosuppressive microenvironment in tumor tissues, which intrinsically confers the treatment resistance. Programmed death-1 (PD-1, CD279) is one of the typical immune checkpoint molecules. Anti-tumor therapies targeting PD-1 and its ligands had been developed and approved in many countries, and various studies utilizing clinical specimens are currently progressing. In this review, we provide an overview of the biomarkers based on the analysis of enteric microbiota that correlate with the clinical efficacy/inefficacy of PD-1-based therapy.



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Extracellular matrix proteins in the gastrointestinal tract: more than a supporting role

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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Diabetes‐induced microvascular complications at the level of the spinal cord: a contributing factor in diabetic neuropathic pain

The Journal of Physiology, EarlyView.


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Desensitizing mouse cardiac troponin C to calcium converts slow muscle towards a fast muscle phenotype

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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Quickly‐responding C‐fibre nociceptors contribute to heat hypersensitivity in the area of secondary hyperalgesia

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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When the neighbourhood party gets too loud

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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The negotiated equilibrium model of spinal cord function

The Journal of Physiology, EarlyView.


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Mechanisms of sarcopenia: motor unit remodeling and muscle fibre type shifts with ageing

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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Stem‐cell cardiospheres for myocardial regeneration: advancing cell therapy in myocardial infarction and heart failure

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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Redox‐regulation of haemostasis in hypoxic exercising humans; a randomised double‐blind placebo‐controlled antioxidant study

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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Bruxism in dentists’ families

Journal of Oral Rehabilitation, Volume 45, Issue 8, Page 657-658, August 2018.


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Cover Image

Journal of Oral Rehabilitation, Volume 45, Issue 8, Page i-i, August 2018.


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Issue Information

Journal of Oral Rehabilitation, Volume 45, Issue 8, Page ii-iv, August 2018.


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Mechanisms of blood pressure control following acute exercise in adolescents: Effects of exercise intensity on haemodynamics and baroreflex sensitivity

Experimental Physiology, EarlyView.


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The shape of things to come: Early life stress stunts brainstem microglia with lasting implications for cardiorespiratory control and plasticity

Experimental Physiology, Volume 0, Issue ja, -Not available-.


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Onsite EMT - Safe Site Medical

National Medical Services Company looking for skilled EMT's / Paramedics to staff medical clinic on large construction site. Responsibilities include patient triage, first aid treatment, follow-up care, case management, support and manage medical services, assist with incident investigations, & substance abuse testing. Other responsibilities include assisting site safety team with daily site walks ...

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Encouraging Parenting Behaviors That Promote Early Childhood Development Among Caregivers From Low-Income Urban Communities: A Randomized Static Group Comparison Trial of a Primary Care-Based Parenting Program

Abstract

Objectives Encouraging key parenting behaviors in early infancy may help decrease income-related developmental disparities. In this study we assessed whether a brief, primary care-based program (Sit Down and Play; SDP) could be successful in impacting key parenting behaviors that promote early childhood development. Methods An ethnically diverse group of predominantly low-income caregivers of children 2–6 months of age were enrolled, interviewed, and randomized to intervention (n = 20) or control (n = 20) groups. Intervention families received SDP at recruitment and the subsequent well-child visit. Control families were provided handouts regarding developmental milestones. One month after the second well-child visit, all families were reinterviewed (n = 34; 85% retention rate). Using open-ended questions and standardized measures (i.e., StimQ), parents were asked about parenting behaviors central to children's development: (1) participation in cognitively stimulating activities, (2) provision of learning materials, and (3) the quality of parent–child verbal interactions. Potential impact on perceived parenting confidence was also explored utilizing The Parenting Sense of Competence Scale. Analyses were conducted using chi square tests and analysis of variance. Results A significant main effect of time, and as hypothesized, an interaction between time and condition emerged that favored SDP on play behaviors (p = 0.03). Post-intervention, SDP families had significantly higher levels of interactional activities between a parent and child that promote cognitive development (p = 0.02). Conclusions for Practice Results appear promising for an accessible, low-intensity program delivered in the primary care setting. Further studies to determine the effectiveness of SDP on parenting behaviors and subsequent developmental outcomes are warranted.



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Rare case of a gallbladder neuroendocrine carcinoma

Abstract

There are no neuroectodermal cells in the gallbladder mucosa. Therefore, gallbladder neuroendocrine carcinoma (NEC) is extremely rare and has a poor prognosis. We report a case of a Japanese man in his 60s with this disease. The patient visited a family doctor for epigastralgia. Blood tests showed no abnormalities, including tumor markers, such as CEA and CA19-9. Abdominal ultrasonography (US) showed a low-echoic mass, 39 × 30 mm, with clear boundaries to the liver from the fundus of the gallbladder. Contrast-enhanced computed tomography showed that the tumor was enhanced early and washed out. Diffusion-weighted MRI showed a high signal. We suspected liver invasion of gallbladder cancer and performed a cholecystectomy, S4 and S5 hepatectomy, and lymphadenectomy. The resected whitish tumor was 29 × 22 mm. The tumor cells had honeycomb growth to the liver from the gallbladder. Tumor cells were poorly differentiated, and there was no stricture of the gland duct. Immunostaining showed that the tumor cells were positive for CD56, chromogranin A and synaptophysin, and about 30% were positive for Ki-67. Our diagnosis was gallbladder NEC with liver invasion. Although most malignant gallbladder tumors are adenocarcinomas, this case indicates that gallbladder NEC should be considered as a differential diagnosis of gallbladder tumor.



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