"I must do this!": A latent profile analysis approach to understanding the role of irrational beliefs and motivation regulation in mental and physical health.

In the research concerning rational emotive behaviour therapy (REBT) in sport and exercise, irrational beliefs are proposed as a risk factor for health. Concurrent to this, researchers have also indicated that autonomous and controlled motivation, as proposed in organismic integration theory could, together with irrational beliefs, determine individual health. However, research is yet to align irrational beliefs and motivation, and explore how this alignment relates to mental health. The present two study paper identifies individual subgroups, drawn from data concerning irrational beliefs, motivation, and health (psychological distress, and physical health), in a sample of exercisers (study 1) and student athletes (study 2). We examined the latent profile structure of irrational beliefs and motivation, and how these latent profiles relate to psychological distress (studies 1 and 2), and physical health (study 2). Results indicate a two class profile whereby class 1 is characterised by high irrational beliefs, low self-determined motivation, and poor health outcomes. Class 2 is characterised by low irrational beliefs, high self-determined motivation, and better health outcomes. The findings are discussed in relation to the theoretical implications for REBT and organismic integration theory, and the practical implications for key stakeholders in the health of exercise participants and athletes.

Exploring perceptions of factors aiding the development of critical thinking in adult dysphagia: A study among fourth-year speech-language pathology students.

BACKGROUND: The assessment and management of adult dysphagia in South Africa is complex as appropriate intervention requires a balance of theoretical knowledge and critical thinking to ensure service delivery is appropriate within a resource-constrained health care system. Critical thinking involves the skilful evaluation of information to make informed decisions for effective assessment and intervention. It is imperative for Speech-Language Pathologists (SLPs) to cultivate these skills from an early stage in their careers. This study therefore aims to investigate the factors perceived to enhance critical thinking to shed light on how students transition theory into clinical decision-making. This is vital to inform future practice in the realm of dysphagia and to enhance Speech Therapy education. METHODS: A qualitative research design was utilised to identify what facilitators assist SLP students to develop critical thinking skills in adult dysphagia. Data were gathered from students across three universities. Fifteen participants answered a self-developed online survey, and of those, four participated in a follow-up focus group. The data were analysed using a top-down approach and reflexive thematic analysis. RESULTS AND DISCUSSION: The results revealed that viewing videos on instrumental assessment measures, case studies and peer learning were perceived to expand critical thinking theoretically. Similarly, critical thinking was best supported in clinical contexts, which provided opportunities to observe expert clinicians at the bedside, obtain individual feedback and access supervision. CONCLUSION: The findings yielded recommendations for clinical educators involved in dysphagia training. This is necessary to better prepare SLP students to provide contextually relevant and responsive dysphagia services.

Long term experience of robotic retroperitoneal partial nephrectomy as the default approach in the management of renal masses: should the paradigm shift?

Although retroperitoneal surgery has demonstrated a better quality of recovery compared to transperitoneal routes, Retroperitoneal Robot Assisted Partial Nephrectomy (RRAPN) remains proportionally infrequent. As the boundaries of what is achievable robotically continue to be pushed, we present our experience at a high-volume tertiary referral centre that specialises in retroperitoneal surgery, exploring its feasibility as standard of care in the management of small renal masses. A prospective database of 784 RAPNs (2009-2020) was reviewed and 721 RRAPNs (92%) were performed at our centre. In our practice, we utilise a four-port approach to RRAPN. Patient, tumour and operative characteristics were assessed and both oncological outcomes and trifecta and pentafecta achievements were determined. Pentafecta was defined as achieving trifecta (negative surgical margin, no post-operative complications and WIT of < 25 min) plus over 90% estimated GFR preservation and no CKD stage upgrading at 1 year. Multivariate analysis was conducted to predict peri-operative factors which may prevent achieving a trifecta/pentafecta outcome. From 784 cases, 112 RAPNs were performed for imperative reasons, whilst the remainder were elective. Mean BMI ± s.d amongst our cohort was 28.6 ± 5.7. Mean tumour size was 3.1 cm (range 0.8-10.5 cm) and 47% of cases were stratified as intermediate/high risk using R.E.N.A.L nephrometry scoring. Forty-six patients had lesions in a hilar location, and 31% were anterior. Median blood loss was 30mls, with an open conversion rate of 1% and transfusion rate of 1.6%. Median warm ischaemic time (WIT) was 21 min, positive surgical margins were found in 4% and our post-operative Clavien 3/ > complication rate was 2.6%. We had a 1-day median length of stay with a 30 day readmission rate of 2%. Of 631 patients (80%) with a definitive histological diagnosis of cancer, 23% had T1b/ > disease. Over a mean 15 month follow-up period (range 1-125 months), 2% of patients developed recurrences and our cohort demonstrated a 99% 5 year cancer specific survival. Trifecta was achieved in 67% of cases and pentafecta in 47%. Age (p = 0.05), operative time (p = 0.008), pT1b tumours (p = 0.03), R.E.N.A.L score and blood loss (p = 0.001) were found to statistically significantly influence achievement of trifecta. Pentafecta achievement was influenced by R.E.N.A.L score (p = 0.008), operative time (p = 0.001) and blood loss (p = 0.001). We demonstrate the retroperitoneal approach in RAPN is feasible and safe irrespective of lesion location and complexity. In the hands of high-volume centres that are skilled in the retroperitoneal approach the benefits of retroperitoneal surgery can be extended even to challenging cohorts of patients without compromising their oncological or functional outcomes.

The impact of a fellow on a regional robotic-assisted partial nephrectomy service.

INTRODUCTION: Training a fellow has a cost in time and effort for the surgeon and their team. Their relative inexperience may also negatively affect the patient. The aim of this study was to determine and quantify the impact of a fellow on a regional robotic-assisted partial nephrectomy service and on perioperative outcomes. MATERIALS AND METHODS: We reviewed the prospectively collected data for 522 patients who had undergone robotic-assisted partial nephrectomy since 2015 during the tenure of six fellows. Perioperative outcomes for three groups were compared: group A (no fellow participation), group B (some participation) and group C (fellow completed entire operation). We also reviewed progression over 12 months. RESULTS: Demographics were similar in all groups apart from the percentage of men, which was lower in group C (p < 0.05). Operative time was 27 minutes longer for group B (p < 0.001). Warm ischaemia time was significantly shorter for group A but the difference was only four minutes (p < 0.001). Length of stay was slightly shorter for group C compared with the other groups (p < 0.01). Trifecta achievement was greatest for group A (p < 0.001). There were no perioperative deaths in any group and positive margins, complications and readmissions were low and similar in all groups. Towards the end of their fellowship, fellows performed more operations independently. CONCLUSION: There is a measurable, but small, negative impact of a fellow on a robotic-assisted partial nephrectomy service, which reduces with experience. With appropriate supervision and patient selection, a fellow can be taught robotic-assisted partial nephrectomy without affecting patient safety or treatment outcome.

Mapping stakeholders for system evaluation - the case of the Electronic Prescription Service in England.

This paper discusses the process of identifying stakeholders for the evaluation of health information systems through a map. Defining the multiplicity of stakeholders associated with a new system as well as the nature of their relationships is an important aspect of evaluating any intervention. We report a study of the Electronic Prescription Service (EPS) in primary care in England. We describe the complexity associated with the process of identifying stakeholders and illustrating their dynamic relationships. Reflecting upon our experience of map-making and map-using, we discuss the role of a stakeholder map to generate and communicate knowledge. The EPS stakeholder map - in its variety of possible alternative representations - reveals the complexity of the electronic prescribing scenario and the challenge of its evaluation. Recognising the drawbacks of a static two dimensional representation, we argue that a dynamic use of a stakeholder map and a reflective map-making practice is useful and important for the evaluation of IT programmes in healthcare.

Does the placement of a FRECA gastrostomy at the time of laparoscopic fundoplication impact on outcome?

AIM: To assess the performance of a paediatric cohort having a FRECA PEG (FP) placed at the time of laparoscopic fundoplication. METHODS: This is retrospective study of a single surgeon's experience of laparoscopic fundoplications over a decade. Patient details were retrieved form a Microsoft Excel database and demographic, operative, and performance measures analysed. RESULTS: Of a series of 67 laparoscopic fundoplications, 20 with neurological compromise underwent FP placement at the time of surgery. Mean age was 3.37 years with a male to female ratio of 1.1:1. A size 9 French FRECA was placed in patients less than 10 kg (12) with larger patients (8) having a size 15 device. A Watson anterior wrap was performed in 16 cases with the rest having a Nissen fundoplication. Seven of these cases had pre-existing FPs which were taken down before replacement post fundoplication. Feeding was resumed the next morning except in three with delayed gastric emptying. Other complications (3) were seen but were not PEG related. The median stay for the series was 4 days (SD 3) and patients were followed up for a mean of 684 days. Over this period four patients relapsed and resumed medical treatment. A single mortality occurred in a syndromic 3-year-old a year later from problems unrelated to surgery. FPs were changed to a button device under general anaesthetic 3-24 months following placement. CONCLUSION: FP placement at the time of laparoscopic fundoplication does not appear to compromise the outcome of surgery. Neither the size of patient nor the type of wrap is an impediment to its placement and the device can be used shortly after surgery in the majority allowing for an early discharge. Complications are infrequent; however, change to a button device within 2 years of initial placement requires general anaesthetic.

Strong and recurring seasonality revealed within stream diatom assemblages.

Improving stream water quality in agricultural landscapes is an ecological priority and a legislative duty for many governments. Ecosystem health can be effectively characterised by organisms sensitive to water quality changes such as diatoms, single-celled algae that are a ubiquitous component of stream benthos. Diatoms respond within daily timescales to variables including light, temperature, nutrient availability and flow conditions that result from weather and land use characteristics. However, little consideration has been given to the ecological dynamics of diatoms through repeated seasonal cycles when assessing trajectories of stream function, even in catchments actively managed to reduce human pressures. Here, six years of monthly diatom samples from three independent streams, each receiving differing levels of diffuse agricultural pollution, reveal robust and repeated seasonal variation. Predicted seasonal changes in climate-related variables and anticipated ecological impacts must be fully captured in future ecological and water quality assessments, if the apparent resistance of stream ecosystems to pollution mitigation measures is to be better understood.

Evaluation of ideal irrigation fluid in 'Greenlight' photoselective vapourization of the prostate.

Although many anecdotal opinions are available that water gives a better visual quality, no studies have analysed the differences in the visual quality of the operative field with the use of either saline or sterile water. As part of a prospective audit we wished to assess the effect of differing irrigant fluids on intraoperative visibility during Greenlight photoselective vapourization of prostate (PVP). Twenty-nine consecutive patients with prostates less than 100 cm(3) who underwent PVP were studied. The irrigation fluid used was randomly connected on a bag-by-bag basis, with the surgeon blinded to the bag's contents. Towards the end of each bag the surgeon gave a score to the quality of vision. All surgeons were familiarized with the vision scoring system in advance. The scores were analysed in two ways. The mean scores for water and saline were compared. In addition, a mean score for each fluid in each patient where both fluids were used (n=24) was separately calculated and the means for each fluid compared. One hundred and twenty-four bags of fluid in 29 operative cases were analysed. The mean overall vision scores were 3.94% for saline and 4.01% for water (P=0.62). The paired data were analysed using the Student's t-test and there was no statistically significant difference (P=0.34). We showed no significant difference in visual quality between water and saline during PVP. Although fluid absorption is almost unknown with PVP, there seems to be no justification for using water irrigation if saline is available, particularly with a theoretical risk of absorption.

Lycopene inhibits DNA synthesis in primary prostate epithelial cells in vitro and its administration is associated with a reduced prostate-specific antigen velocity in a phase II clinical study.

Interest in lycopene has focused primarily on its use in the chemoprevention of prostate cancer (CaP); there are few clinical trials involving men with established disease. In addition, most data examining its mechanism of action have been obtained from experiments using immortal cell lines. We report the inhibitory effect(s) of lycopene in primary prostate epithelial cell (PEC) cultures, and the results of a pilot phase II clinical study investigating whole-tomato lycopene supplementation on the behavior of established CaP, demonstrating a significant and maintained effect on prostate-specific antigen velocity over 1 year. These data reinforce the justification for a large, randomized, placebo-controlled study.

Unresolved priapism secondary to tamsulosin.

Tamsulosin is the most potent adrenergic alpha-1 antagonist used for the treatment of benign prostatic hyperplasia. Priapism has been reported rarely in patients taking Prazosin, Doxazosin and Terazosin. We describe an otherwise healthy man with recurrent and then persistent unresolved priapism after the use of tamsulosin. Initial treatment consisted of aspiration and intracavernosal irrigation of iced saline and vasoconstrictive agent, but in vain. We then performed Winters procedure but that too failed and the priapism persisted. Health-care professionals should inform all patients taking such medications about rare but possible serious adverse effects.

Increased activity and phase delay in circadian motility rhythms in geriatric depression. Preliminary observations.

Locomotor activity levels and rhythms of eight hospitalized geriatric unipolar depressed patients (DSM-III criteria) were compared with those of eight healthy elderly controls in a similar environment. Activity was measured using a wrist-worn electronic activity monitor with solid-state memory. Depressed patients had a 29% higher mean total 24-hour activity level, with no change in circadian amplitude or frequency. Daily peak activity (acrophase) averaged 2.05 hours later in depressed patients, with no overlap between the groups. The degree of phase delay correlated significantly with the 4 PM postdexamethasone serum cortisol level. These tentative findings suggest that elderly unipolar depressed patients have prominent chronobiological disturbances in the modulation of activity levels and possibly other physiological processes. These differ strikingly from reported disturbances in younger or bipolar depressed patients.

Conspecific and Heterospecific Aboveground Herbivory Both Reduce Preference by a Belowground Herbivore.

Insect herbivores damage plants both above- and belowground, and interactions in each realm can influence the other via shared hosts. While effects of leaf damage on aboveground interactions have been well-documented, studies examining leaf damage effects on belowground interactions are limited, and mechanisms for these indirect interactions are poorly understood. We examined how leaf herbivory affects preference of root-feeding larvae [Acalymma vittatum F. (Coleoptera: Chrysomelidae)] in cucumber (Cucumis sativus L.). We manipulated leaf herbivory using conspecific adult A. vittatum and heterospecific larval Spodoptera frugiperda Smith (Lepidoptera: Noctuidae) herbivores in the greenhouse and the conspecific only in the field, allowing larvae to choose between roots of damaged and undamaged plants. We also examined whether leaf herbivory induced changes in defensive cucurbitacin C in leaves and roots. We hypothesized that induced changes in roots would deter larvae, and that effects would be stronger for damage by conspecifics than the unrelated caterpillar because the aboveground damage could be a cue to plants indicating future root damage by the same species. In both the greenhouse and field, plants with damaged leaves recruited significantly fewer larvae to their roots than undamaged plants. Effects of conspecific and heterospecific damage did not differ. Leaf damage did not induce changes in leaf or root cucurbitacin C, but did reduce root biomass. While past work has suggested that systemic induction by aboveground herbivory increases resistance in roots, our results suggest that decreased preference by belowground herbivores in this system may be because of reduced root growth.

Developmental differences in acute nigrostriatal and mesocorticolimbic system response to haloperidol.

Dose-dependent effects of haloperidol (2.66 nmol/kg to 79.8 mmol/kg, IP) on levels of dopamine, homovanillic acid (HVA) and dihydroxyphenylacetic acid (DOPAC) were assessed in the corpus striatum, nucleus accumbens, and medial prefrontal cortex (PFCTX) of 18-, 30-, and 110-day-old rats. Eighteen-day-old rats were 35% and 63% more sensitive than adults to the effects of haloperidol on striatal and accumbens turnover and had steeper dose-response curves. The dose-response function in the PFCTX was similar to striatum at 18 days, but became shallower and nonsigmoidal with age. Maximally effective doses of haloperidol produced, at all ages, a comparable percent rise in DOPAC levels in all regions. With maturation, the percent rise in HVA progressively outstripped DOPAC response in nucleus accumbens and striatum. Overall, prominent developmental differences emerged in these regions in their sensitivity and response to haloperidol, which are consistent with previously reported differences in behavioral sensitivity.

Influence of apolipoproteins on the anatomical distribution of arterial disease.

The association of raised triglyceride levels with peripheral arterial disease has indicated that different interactions of environmental, biochemical and genetic risk factors promote atherosclerosis in particular sites. This hypothesis was investigated in patients presenting with atherosclerotic disease in the carotid (n = 23) or peripheral arteries (n = 94) before the age of 50 years; symptomatic coronary artery disease was also present in some patients (n = 35). Patients presenting with carotid disease had the highest levels of cholesterol (mean 7.6 mmol/l, P less than 0.05), apolipoproteins B (mean 1.02 g/l) and CIII (median 22.8 mg/dl, P less than 0.05) but normal levels of apolipoprotein AI. Patients presenting with peripheral arterial disease were the heaviest smokers and this was the only group where hypertriglyceridaemia was observed. Patients with coronary artery disease had the lowest levels of apolipoprotein AI (mean 1.15 g/l, P less than 0.05). Although polymorphic variation in the apolipoprotein genes did not appear to influence the distribution of symptomatic disease, genetic variation at two polymorphic sites in the apolipoprotein AI-CIII-AIV gene cluster was associated with differences in triglyceride levels. The control of the metabolism of triglyceride rich particles by apolipoproteins may predispose to atherosclerosis in specific sites, low levels of apolipoprotein AI selectively promoting coronary artery atherosclerosis and high levels of apolipoprotein CIII selectively promoting carotid artery atherosclerosis.

Comparison of the actions of centrally and peripherally administered clonidine and guanfacine in the rabbit: investigation of the differences.

1 Guanfacine was administered intravenously to rabbits and produced a dose-dependent lowering of blood pressure. 2 Clonidine and guanfacine, administered to rabbits intravenously (30 micrograms/kg and 300 micrograms/kg respectively) and intracisternally (3 micrograms/kg and 12 micrograms/kg respectively) caused a similar degree of hypotension, apparently of central origin. 3 Saliva flow in vivo was estimated. Clonidine (30 micrograms/kg, i.v.) caused a significant decrease in salivation (P less than 0.05) for the first 50 min after injection. Guanfacine caused a significant fall (P less than 0.05) only at 50 and 180 min after injection. 4 Apparent partition coefficients for an octanol/buffer system at pH 7.4 for clonidine and guanfacine were 5.4 and 21.2 respectively. 5 Measurement of guanfacine levels concurrently in both plasma and brain showed that guanfacine had higher brain than plasma levels and that the brain levels were fairly constant over the 3 h measured. Brain:plasma ratios were 2.1:1, 5.3:1 and 13.6:1 after 15, 90 and 180 min respectively. 6 These results suggest that the long duration of action of guanfacine is due to its persistence at its central site of action.

Effects of selective monoaminergic reuptake blockade on activity rhythms in developing rats.

Developing rats display prominent ultradian rhythms of locomotor activity when separated from the litter. A pharmacological analysis was undertaken to provide preliminary data on the role of monoaminergic neurotransmitter systems in the modulation or manifestation of this fundamental biological rhythm. Twenty-four hour activity profiles were monitored in 15-day-old rats, tested in darkness, after intraperitoneal treatment with desipramine (DMI), zimelidine (ZMI), or GBR-13069 (GBR), selective uptake inhibitors of norepinephrine, serotonin, and dopamine, respectively. Time series data were analyzed by low-resolution variance spectral analysis. DMI significantly diminished ultradian (greater than 1 cycle per day; cpd) rhythmicity, and enhanced the circadian rhythm. Equimolar doses of ZMI had little effect on the ultradian band (7-15 cpd), but slightly reduced the circadian peak. The effects of acute GBR administration were complex, as this agent produced prominent effects on basal activity. In a second study these agents were administered continuously over a 5-day period, using subcutaneously implanted Alzet osmotic minipumps, to avoid the confounding effects of acute administration. Continuously-infused DMI virtually eliminated characteristic ultradian rhythms in the 9-15 cpd bandwidth. ZIM diminished ultradian oscillations only in the 14-15 cpd range, and GBR-12909 had little effect on ultradian rhythms throughout the usually prominent 7-16 cpd domain. All three reuptake inhibitors increased the prominence of slow ultradian rhythms with frequencies of 3-4 cpd. Continuous reuptake blockade had no significant effects on circadian amplitude or phase, as determined by cosinor analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Objective measurement of hyperactivity and attentional problems in ADHD.

OBJECTIVE: To precisely describe movement abnormalities in seated children with attention-deficit hyperactivity disorder (ADHD) while they were engaged in a continuous performance task (CPT). METHOD: Diagnoses were made by using structured interviews (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version) and DSM-IV criteria. Movement patterns of 18 boys with ADHD (9.3 +/- 2.4 years) and 11 normal controls (8.6 +/- 1.8 years) were recorded using an infrared motion analysis system that tracked the position of four markers 50 times per second to a resolution of 0.04 mm. RESULTS: Boys with ADHD moved their head 2.3 times more often than normal children (p < .002), moved 3.4 times as far (p < .01), covered a 3.8-fold greater area (p < .001), and had a more linear and less complex movement pattern (p < .00004). They responded more slowly and with greater variability on the CPT. Complexity of head movement and variability in response latency significantly correlated with teacher ratings. A predefined composite of movement and attention discriminated 16 of 18 patients from 11 of 11 controls. CONCLUSIONS: The relative inability of boys with ADHD to sit still can be objectively verified, and "fidgeting" appears to consist of more frequent, larger amplitude, whole body movements.

Selective depletion of cerebral norepinephrine with 6-hydroxydopamine and GBR-12909 in neonatal rat.

Specific and extensive neonatal depletions of norepinephrine were produced in 3-day-old rats by combined administration of GBR-12909 (40 mg/kg, i.p.), a specific inhibitor of dopamine uptake, and the neurotoxin 6-hydroxydopamine (125 micrograms, i.c.). Norepinephrine concentrations in prefrontal cortex and hippocampus were reduced by more than 95%, and hypothalamic concentrations were reduced by 57%. Concentrations of dopamine, serotonin, and their respective metabolites were not affected in these regions or in the striatum.