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This study measured the effectiveness of an in-house designed, cast silicone airway model in addressing the lack of easily accessible, validated transoral laser microsurgery simulation models.
Methods
Participants performed resection of two marked vocal fold lesions on the model. The model underwent face, content and construct validation assessment using a five-point Likert scale questionnaire measuring the mean resection time for each lesion and the completeness of lesion excision. Comparative analyses were performed for these measures.
Results
Thirteen otolaryngologists participated in this study. The model achieved validation threshold on all face and content measures (median, ≥4). Construct validation was demonstrated by the improvement in mean resection time between lesions one and two (86 vs 54 seconds, W = 11, p = 0.017). The mean resection time was lower amongst more senior otolaryngologists (61.5 vs 107.1 seconds, W = 11, p = 0.017).
Conclusion
This synthetic silicone model is a low-cost, easily reproducible, high-fidelity synthetic airway model, demonstrating face, content and construct validity.
In the decades immediately following the Vietnam War, there were no significant conflicts with free speech resulting from major policy or military action. In contrast, the global war on terror following the events of September 11, 2001, mirror in many ways where prior conflicts and government action clashed with Free Speech. Forty-five days after the worst attack on American soil since Pearl Harbor, Congress enacted the USA PATRIOT Act. In the months and years that followed, American forces fought abroad and opponents of and advocates for the Act fought at home. This article will review the implementation of the Patriot Act and two provisions, section 215 and 805, to follow the actions of the executive, legislative, and judicial branches of the federal government and those of civil liberties advocacy groups to review America’s efforts to meet the challenges of providing security for the homeland and protecting Free Speech.
An extracurricular clinical communication course called PsychED Up, with a focus on Psychiatry, met with challenges during the COVID-19 pandemic and the associated social distancing requirements. The course is usually delivered face-to-face by a small team of doctors, medical students, actors and lived-experience practitioners, and consists of large-group teaching on a weekly topic, followed by small group simulations. A small-scale study was performed to evaluate whether conducting clinical communication teaching and simulation online was acceptable, effective and feasible.
Methods
Twelve students and ten faculty members participated in the online session, performing live clinical scenarios with simulated patients, over a two-hour period. Pre-and post-course questionnaires were designed with quantitative measures of confidence and qualitative questions about participants’ experience. Eight students completed both questionnaires. Questionnaire answers were analysed using a mixed-methods approach, with themes identified from the qualitative long answers, and statistical analysis of quantitative answers was also performed.
Results
Students found the session beneficial, with all indicating that they would sign up for a full online course. Based on answers to the quantitative questions, 50% of students felt more prepared for their clinical examinations. (p = 0.046). However, all participants noted a reduction in their ability to read non-verbal cues and body language. Returning students found they were less attentive during the session compared with the original face-to-face teaching (p = 0.05). Actors and faculty members found that the online course was feasible, acceptable and effective. However, most agreed that it was not preferable to teaching clinical communication skills face to face. Technological issues were minimal.
Conclusion
The majority of students and faculty found the session both beneficial and enjoyable, but felt face to face sessions would be more helpful in teaching clinical communication. Student attentiveness and awareness of non-verbal cues were highlighted as concerns. However, students generally responded positively to the online course, particularly the quality and diversity of peer feedback. Teaching clinical communication virtually has the potential to be successful, and has implications for future undergraduate medical teaching.
Neonates undergoing surgery for congenital heart disease are vulnerable to adverse events. Conventional quality improvement processes centring on mortality and significant morbidity leave a gap in the identification of systematic processes that, though not directly linked to an error, may still contribute to adverse outcomes. Implementation of a multidisciplinary “flight path” process for surgical patients may be used to identify modifiable threats and errors and generate action items, which may lead to quality improvement.
Methods:
A retrospective review of our neonatal “flight path” initiative was performed. Within 72 hours of a cardiac surgery, a meeting of the multidisciplinary patient care team occurs. A “flight path” is generated, graphically illustrating the patient’s hospital course. Threats, errors, or unintended consequences are identified. Action items are generated, and a working group is formed to address the items. A patient’s flight path is updated weekly until discharge. The errors and action items are logged into a database, which is analysed quarterly to identify trends.
Results:
Thirty one patients underwent flight path review over a 1-year period; 22.5% (N = 7) of patients had an error-free “flight.” Eleven action items were generated – four from identified errors and seven from identified threats. Nine action items were completed.
Conclusions:
Flight path reviews of congenital cardiac patients can be generated with few resources and aid in the detection of quality improvement opportunities. The regular multidisciplinary meetings that occur as a part of the flight path review process can promote inter-professional teamwork.
The foci of this book are on the social determinants of health, and the importance to our health of our social connectedness and social support that turn on shared social identities. In Chapter 23, Reicher surveys these matters and makes three important concluding points. First, shared social identity in groups creates bonds between people and converts those bonds into social capital. Second, he asserts that the key to a new social model of mental and physical health lies in understanding how to support people in building and consolidating their own social groups. But, importantly, he also points out that social identity can work for good outcomes but also for those that are seen as less positive.
This chapter rounds off Section 2. In it, one of the authors, Jonathan Montgomery, begins by highlighting his view of the recurrent themes that arise from all eight chapters in this section.
Then, one of the editors, Alex Haslam, responds by substantially agreeing with Jonathan Montgomery. However, Haslam takes the opportunity to clarify one of the points that Montgomery makes with the intention of drawing attention to a key issue that runs like an artery through the body of this book. This concerns the nature of personalised healthcare and how this should best be understood and delivered. Haslam cautions that, in the process of developing personalised care, we should avoid the temptation to reduce peoples’ maladies to their individual conditions.
I feel that the best tribute I can pay to the memory of Louis Massignon is to set down some of my personal memories of this great man. I first met him in Cambridge in 1954 at the International Congress of Orientalists. I was then a very junior Islamologist. We spoke about various things but not, so far as I remember, about my book Muhammad at Mecca, which had come out the previous year. What specially stands out in my memory is that, when he learnt I was from Scotland, he told me he was hoping to make a kind of pilgrimage to the birthplace of his friend Duncan Black Macdonald, which was in or near the island of Mull off [the] west coast of Scotland. I was able to give him details of trains, ferries and buses, and I put him in touch with Eric Bishop, then Lecturer in Arabic in Glasgow, who helped him with the ‘transfer’ across that city. I believe that he did in fact reach his goal and was well satisfied with having achieved this. I thought it was very typical of the man that he should be so interested in the particular geographical localities associated with some of the deep experiences of particular human beings. This is in line with the importance for him of the chapel in Brittany dedicated to the Seven Sleepers, and indeed with the importance of Mecca for Muslims and of the ‘holy places’ in Jerusalem for Jews, Christians and Muslims. I notice that Jacques Waardenburg in Le Miroir says that Macdonald was born in Glasgow. If this is correct and Macdonald was not born in Mull, then the place Massignon wanted to visit must have had a formative influence on him in some other respect.
At Cambridge Louis Massignon invited me to call on him in Paris, and I did so several times in the following years. I gather that my visits did not differ greatly in character from those of other scholarly acquaintances. I would ring him up and he would give me a time, usually ten or eleven o’clock in the morning. There seemed to be an understanding that the visit would last for an hour.
The Coneybury ‘Anomaly’ is an Early Neolithic pit located just south-east of Stonehenge, Wiltshire. Excavations recovered a faunal assemblage unique in its composition, consisting of both wild and domestic species, as well as large quantities of ceramics and stone tools, including a substantial proportion of blades/bladelets. We present a suite of new isotope analyses of the faunal material, together with ancient DNA sex determination, and reconsider the published faunal data to ask: What took place at Coneybury, and who was involved? We argue on the basis of multiple lines of evidence that Coneybury represents the material remains of a gathering organised by a regional community, with participants coming from different areas. One group of attendees provided deer instead of, or in addition to, cattle. We conclude that the most likely scenario is that this group comprised local hunter-gatherers who survived alongside local farmers.
While our fascination with understanding the past is sufficient to warrant an increased focus on synthesis, solutions to important problems facing modern society require understandings based on data that only archaeology can provide. Yet, even as we use public monies to collect ever-greater amounts of data, modes of research that can stimulate emergent understandings of human behavior have lagged behind. Consequently, a substantial amount of archaeological inference remains at the level of the individual project. We can more effectively leverage these data and advance our understandings of the past in ways that contribute to solutions to contemporary problems if we adapt the model pioneered by the National Center for Ecological Analysis and Synthesis to foster synthetic collaborative research in archaeology. We propose the creation of the Coalition for Archaeological Synthesis coordinated through a U.S.-based National Center for Archaeological Synthesis. The coalition will be composed of established public and private organizations that provide essential scholarly, cultural heritage, computational, educational, and public engagement infrastructure. The center would seek and administer funding to support collaborative analysis and synthesis projects executed through coalition partners. This innovative structure will enable the discipline to address key challenges facing society through evidentially based, collaborative synthetic research.
Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990–1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.
A trend toward greater body size in dizygotic (DZ) than in monozygotic (MZ) twins has been suggested by some but not all studies, and this difference may also vary by age. We analyzed zygosity differences in mean values and variances of height and body mass index (BMI) among male and female twins from infancy to old age. Data were derived from an international database of 54 twin cohorts participating in the COllaborative project of Development of Anthropometrical measures in Twins (CODATwins), and included 842,951 height and BMI measurements from twins aged 1 to 102 years. The results showed that DZ twins were consistently taller than MZ twins, with differences of up to 2.0 cm in childhood and adolescence and up to 0.9 cm in adulthood. Similarly, a greater mean BMI of up to 0.3 kg/m2 in childhood and adolescence and up to 0.2 kg/m2 in adulthood was observed in DZ twins, although the pattern was less consistent. DZ twins presented up to 1.7% greater height and 1.9% greater BMI than MZ twins; these percentage differences were largest in middle and late childhood and decreased with age in both sexes. The variance of height was similar in MZ and DZ twins at most ages. In contrast, the variance of BMI was significantly higher in DZ than in MZ twins, particularly in childhood. In conclusion, DZ twins were generally taller and had greater BMI than MZ twins, but the differences decreased with age in both sexes.
For over 100 years, the genetics of human anthropometric traits has attracted scientific interest. In particular, height and body mass index (BMI, calculated as kg/m2) have been under intensive genetic research. However, it is still largely unknown whether and how heritability estimates vary between human populations. Opportunities to address this question have increased recently because of the establishment of many new twin cohorts and the increasing accumulation of data in established twin cohorts. We started a new research project to analyze systematically (1) the variation of heritability estimates of height, BMI and their trajectories over the life course between birth cohorts, ethnicities and countries, and (2) to study the effects of birth-related factors, education and smoking on these anthropometric traits and whether these effects vary between twin cohorts. We identified 67 twin projects, including both monozygotic (MZ) and dizygotic (DZ) twins, using various sources. We asked for individual level data on height and weight including repeated measurements, birth related traits, background variables, education and smoking. By the end of 2014, 48 projects participated. Together, we have 893,458 height and weight measures (52% females) from 434,723 twin individuals, including 201,192 complete twin pairs (40% monozygotic, 40% same-sex dizygotic and 20% opposite-sex dizygotic) representing 22 countries. This project demonstrates that large-scale international twin studies are feasible and can promote the use of existing data for novel research purposes.
Painful physical symptoms (PPS) are prevalent among elderly patients with depression. We describe the impact of PPS on depression outcomes and quality of life (QOL) of elderly Asian patients with major depressive disorder (MDD).
Methods:
This post hoc analysis of data from a three-month prospective observational study of East Asian MDD in- or out-patients focused on elderly patients aged ≥60 years. Depression severity was evaluated using the Hamilton depression (HAMD-17) and clinical global impression of severity (CGI-S) scales, while QOL was measured using EuroQOL (EQ-5D and EQ-VAS) instruments. PPS were rated using the modified somatic symptom inventory (SSI).
Results:
At baseline, depression was moderate to severe and 49% of the 146 elderly patients were painful physical symptom positive (PPS+). Bivariate analysis showed significant correlations between PPS and depression severity and QOL at baseline. Linear regression models showed the baseline factor most significantly associated with depression severity at three months was baseline PPS status. PPS+ patients had a mean increase of 2.87 points in their HAMD-17 rating and 0.77 points in their CGI-S score. Response and remission were significantly lower in PPS+ patients; response was 60% and remission was 40% in PPS+ patients while 82% and 66% in painful physical symptom negative (PPS−) patients. QOL at endpoint was lower in PPS+ patients.
Conclusions:
PPS are common in elderly Asian patients with MDD and negatively influence depression outcomes and QOL. Patients with PPS had lower QOL at baseline, lower response and remission rates, higher severity of depression, and lower QOL after three months of treatment.
Recent studies have proposed the existence of three distinct subgroups of bipolar 1 disorder based on age at onset (AAO). The present study aims to investigate potential clinical and functional differences between these subgroups in an Australian sample.
Methods:
Participants (n = 239) were enrolled in the Bipolar Comprehensive Outcomes Study (BCOS), a 2-year longitudinal, observational, cross-sectional study. Assessment measures included the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAMD21), Clinical Global Impressions Scale (CGI-BP), SF-36, SLICE/Life Scale, and the EuroQol (EQ-5D). Participants were also asked about their age at the first major affective episode.
Results:
Three AAO groups were compared: early (AAO < 20, mean = 15.5 ± 2.72; 44.4% of the participants); intermediate (AAO 20–39, mean = 26.1 ± 4.8; 48.14% of the participants) and late (AAO > 40, mean = 50.6 ± 9.04; 7.4% of the participants). Higher rates of depression, suicidal ideation and binge drinking were reported by the early AAO group. This group also reported poorer quality of life in a number of areas. The early AAO group had a predominant depressive initial polarity and the intermediate group had a manic predominance.
Post hoc analyses were conducted to evaluate the efficacy of levomilnacipran extended-release (ER) in subgroups of patients with major depressive disorder (MDD).
Methods
Data were pooled from 5 completed Phase II/III studies. Patients were categorized by sex, age, MDD duration, recurrence of MDD, current episode duration, number of prior episodes, and baseline Montgomery–Åsberg Depression Rating Scale (MADRS) score. Efficacy was evaluated by MADRS least squares (LS) mean change from baseline, response (MADRS improvement ≥50%), and remission (MADRS ≤10).
Results
In the pooled population, treatment with levomilnacipran ER versus placebo resulted in greater improvement in MADRS score (−15.8 versus −12.9; LS mean difference, −2.9; P < .001) and higher response rates (44.7% versus 34.5%; P < .001). Comparable treatment effects were found in most subgroups. Remission rates in the overall population were higher for levomilnacipran ER versus placebo (27.7% versus 21.5%; P < .05); notably high remission rates were seen in patients with baseline MADRS score < 30 (48.8% versus 28.9%; P < .001).
Discussion
Clinically meaningful improvements in depressive symptoms were found across subgroups, including statistically significant outcomes for both response and remission.
Conclusion
Levomilnacipran ER was efficacious across a wide range of MDD patients, including men and women, ages 18–78, with varying histories and symptom severity.
A method for determining the sex of live adult Laricobius nigrinus Fender (Coleoptera: Derodontidae) is described. Beetles were briefly chilled and positioned ventral-side-up under a dissecting microscope. Two forceps with blunted ends were used to gently brace the beetle and press on the centre of the abdomen to extrude its terminal segments. Male beetles were distinguished by a sclerotised, reticulate ninth abdominal sternite. In females, the distinct ovipositor (tergite, valvifers (ninth sternite), and laterotergites of the ninth abdominal segment) was visible. The procedure was rapid and harmed only a small number of individuals (fewer than 5%).
NADPH diaphorase has recently been discovered to be responsible for neuronal nitric oxide (NO) synthase activity in mammals. It thus serves as a histochemical marker for the localization of NO synthase in the nervous system. The histochemical technique was used to map out potential NO-producing neurones in the nervous system of the parasitic nematode, Ascaris suum. Positive staining for NADPH diaphorase was present in various parts of the central nervous system, in particular within selective cell bodies and fibres in the ventral ganglion, the retrovesicular ganglion, ventral and dorsal cords and sublateral lines. Intense staining was also present in the motorneurone commissures, indicating a potential role for NO as a neurotransmitter at the neuromuscular junction. NADPH disphorase-positive neurones were not confined to the central nervous system. Selective staining was also present in the enteric nervous system, in particular the pharynx and in the peripheral nervous system innervating the sensory organs.
The histochemical marker for nitric oxide synthase, NADPH diaphorase, is known to co-localize in mammalian neurones with various classical neurotransmitters and neuropeptides. The nervous system of the parasitic nematode Ascaris suum has previously been shown to contain both NADPH diaphorase activity and neuropeptide immunoreactivity. This study examined the possibility that NADPH diaphorase and neuropeptide immunoreactivity may co-exist in the same neurones. Two antisera were used, one raised to KYSALMFamide, a C-terminal synthetic analogue of SALMFamide 1 (GFNSALMFamide), and another that recognizes calcitonin-gene-related peptide (CGRP). We provide evidence that in a distinct subset of neurones in the ventral, dorsal and lateral ganglia NADPH diaphorase staining and SALMFamide- like immunoreactivity are co-localized, suggesting a possible role for nitric oxide in modulating neuropeptide activity in these regions. CGRP-like immunoreactivity was less widely distributed, and was not consistently co-localized with NADPH diaphorase.