Biological, biochemical and genotoxicological alterations of Benzylamine on Biomphalaria alexandrina snails and its Schistosoma mansoni larvicidal potential.

Biomphalaria spp. snails are freshwater gastropods that responsible for Schistosoma mansoni transmission. Schistosomiasis is a chronic illness that occurred in underdeveloped regions with poor sanitation. The aim of the present study is to evaluate the molluscicidal activity of benzylamine against B. alexandrina snails and it larvicidal effects on the free larval stages of S. mansoni. Results showed that benzylamine has molluscicidal activity against adult B. alexandrina snails after 24 h of exposure with median lethal concentration (LC50) 85.7 mg/L. The present results indicated the exposure of B. alexandrina snails to LC10 or LC25 of benzylamine resulted in significant decreases in the survival, fecundity (eggs/snail/week) and reproductive rates, acetylcholinesterase, albumin, protein, uric acid and creatinine concentrations, levels of Testosterone (T) and 17ß Estradiol (E), while alkaline phosphatase levels were significantly increased in comparison with control ones. The present results showed that the sub lethal concentration LC50 (85.7 mg/L) of benzylamine has miracidial and cercaricidal activities, where the Lethal Time (LT50) for miracidiae was 17.08 min while for cercariae was 30.6 min. Also, results showed that were decreased significantly after exposure to sub lethal concentrations compared with control. The present results showed that the expression level of NADH dehydrogenase subunit 1 (ND1) genes and cytochrome oxidase subunit I (COI) in B. alexandrina snails exposed to LC10 or LC25 concentrations benzylamine were significantly decreased compared to the control groups. Therefore, benzylamine could be used as effective molluscicide to control schistosomiasis.

Functional role and epithelial to mesenchymal transition of the miR-590-3p/MDM2 axis in hepatocellular carcinoma.

BACKGROUND: There is considerable evidence that microRNAs (miRNAs) regulate several key tumor-associated genes/pathways and may themselves have a dual regulatory function either as tumor suppressors or oncogenic miRNA, depending on the tumor type. MicroRNA-590-3p (miR-590-3p) is a small non-coding RNA involved in the initiation and progression of numerous tumors. However, its expression pattern and biological role in hepatocellular carcinoma (HCC) are controversial. RESULTS: In the current work, computational and RT-qPCR analysis revealed that HCC tissues and cell lines exhibited miR-590-3p downregulation. Forced expression of miR-590-3p attenuated HepG2 cells proliferation, migration, and repressed EMT-related gene expression. Bioinformatic, RT-qPCR, and luciferase assays revealed that MDM2 is a direct functional target of miR-590-3p. Moreover, the knockdown of MDM2 mimicked the inhibitory effect of miR-590-3p in HepG2 cells. CONCLUSION: We have identified not only novel targets for miR-590-3p in HCC, but also novel target genes for miR590-3p/MDM2 pathway in HCC like SNAIL, SLUG, ZEB1, ZEB2, and N-cadherin. Furthermore, these findings demonstrate a crucial role for MDM2 in the regulatory mechanism of EMT in HCC.

The use of ultrasound sliding sign for prediction of adhesions in women undergoing repeated caesarean section.

We carried out this study to validate the use of ultrasound sliding sign to predict intraperitoneal adhesions in women undergoing repeated caesarean section (CS). A cross-section study was performed in women with at least one CS scheduled for an elective CS. We used the sliding sign of the uterus against the anterior abdominal wall to assess intraperitoneal adhesions, positive sliding sign if uterus moved freely and a negative sliding sign if limited mobility. The obstetrician was blind to the ultrasound results, asked to report if adhesions were absent or present during CS to validate accuracy of the sliding sign. We examined 120 women, negative sliding was reported in 54 patients, positive sliding in 66 women. The presence of intra-abdominal adhesions was confirmed in 44/54 cases assigned to the high-risk group, while the prediction of low risk for adhesions confirmed in 66/66 patients with a sensitivity of 100%, specificity of 86.84%. Sliding sign is an effective method to detect intra-abdominal adhesions in women with a history of repeated caesarean delivery.Impact statementWhat is already known on this subject? There has been a dramatic increase in the caesarean section (CS) rate worldwide; repeated CSs may be associated with intraperitoneal adhesions that result in difficulty during the procedure and may be related to bowel or bladder injuries and neonatal morbidities.What do the results of this study add? The sliding sign by ultrasound has a sensitivity of 100%, specificity of 86.84%, a positive predictive value of 81.5, a negative predictive value of 100, and accuracy of 91.67, considering it rapid, easy and reliable method for prediction of intraperitoneal adhesions.What are the implications of these findings for clinical practice and/or future research? The use of sliding sign by ultrasound in cases with repeated CSs offers a good predictor tool for presence of intraperitoneal adhesions and subsequently avoid severe sequels during surgery and good preparation.

The impact of COVID-19 pandemic on bariatric patients' self-management post-surgery.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had far reaching consequences on the health and well-being of the general public. Evidence from previous pandemics suggest that bariatric patients may experience increased emotional distress and difficulty adhering to healthy lifestyle changes post-surgery. OBJECTIVE: We aimed to examine the impact of the novel COVID-19 public health crisis on bariatric patients' self-management post-surgery. METHOD: In a nested-qualitative study, semi-structured telephone interviews were conducted with 23 post-operative bariatric patients who had undergone Roux-en-Y gastric bypass (RYGB) at a Canadian Bariatric Surgery Program between 2014 and 2020. A constant comparative approach was used to systematically analyze the data and identify the overarching themes. RESULTS: Participants (n = 23) had a mean age of (48.82 ± 10.03) years and most were female (n = 19). The median time post-surgery was 2 years (range: 6 months-7 years). Themes describing the impact of COVID-19 pandemic on patients' post-bariatric surgery self-management included: coping with COVID-19; vulnerability factors and physical isolation; resiliency factors during pandemic; and valuing access to support by virtual care. The need for patients to access post-operative bariatric care during COVID-19 differed based on gender and socioeconomic status. CONCLUSION: This study showed that the COVID-19 pandemic has impacted patients' ability to self-manage obesity and their mental health in a variety of ways. These findings suggest that patients may experience unique psychological distress and challenges requiring personalized care strategies to improve obesity self-care and overall well-being.

Biochemical and apoptotic changes in the nervous and ovotestis tissues of Biomphalaria alexandrina following infection with Schistosoma mansoni.

Infection with trematodes produces physiological and behavioural changes in intermediate snail hosts. One response to infection is parasitic castration, in which energy required for reproduction of the host is thought to be redirected to promote development and multiplication of the parasite. This study investigated some reproductive and biochemical parameters in the nervous (CNS) and ovotestis (OT) tissues of Biomphalaria alexandrina during the course of Schistosoma mansoni infection. Antioxidant and oxidative stress parameters including catalase (CAT), nitric oxide (NO) and lipid peroxidation (MDA) were measured. Levels of steroid hormones, including testosterone, progesterone and estradiol, were also assessed. Finally, flow cytometry was used to compare measures of apoptosis between control snails and those shedding cercariae by examining mitochondrial membrane potential with the stain 5,5',6,6'-tetrachloro-1,1',3,3'-tetraethylbenzimi-dazolylcarbocyanine iodide (JC-1) and poly(ADP-ribose) polymerase (PARP). Infection with S. mansoni caused a 47.7% reduction in the net reproductive rate (Ro) of B. alexandrina. CAT activity was increased in the CNS at 21 days post infection (dpi) but by 28 dpi it was reduced below control values. Also, CAT activity increased significantly in the OT at 14, 21 and 28 dpi. In CNS tissues, NO levels were reduced at 7 dpi, increased at 14 and 21 dpi, and reduced again at 28 dpi. The overall level of lipid peroxidation gradually increased during the course of infection to reach its highest levels at 28 dpi. Steroid hormone measurements showed that concentrations of testosterone and estradiol were reduced in the CNS tissues at 28 dpi, while those of progesterone were slightly increased in the CNS and OT tissues. The percentage of cells that positively stained with JC-1was significantly increased in CNS and OT tissues of infected snails while the percentage of cells positively stained with PARP was decreased compared to controls. Together, these findings indicate that infection initiates diverse biochemical and hormonal changes leading to loss of cells responsible for egg laying and reproduction in B. alexandrina.

Vaginal douching by women with vulvovaginitis and relation to reproductive health hazards.

BACKGROUND: Vaginal douching (VD) is a common practice among married women all over the world specially those in the Middle East. It is used for personal hygiene or for other aesthetic reasons in many countries. The current study investigates the prevalence of VD among patients with vulvovaginitis in Egypt. It also compares the reproductive health hazards among women performing routine VD with those using external hygiene. It also investigates why, and how women practice this douching. METHODS: A cross sectional observational study was conducted in a tertiary university affiliated hospital in Assiut, Egypt. An interview administered questionnaire was administered to 620 women by two trained clinic nurses. Women presented to the outpatient clinic and diagnosed to have any type of vaginal infections were approached for participation. The principle outcome was the history of preterm labor in women who routinely performed VD versus those who did not (upon which sample size was estimated). Other outcome measures were the types of vaginal infections, and reproductive implications comprising, ectopic pregnancy, abortion and pelvic inflammatory disease (PID). RESULTS: The participants were predominantly multiparas from semi-urban background and middle socioeconomic level. Considering VD as a religious duty and a kind of personal cleanliness were the most common reasons for performing VD in 88.9% and 80.6% of the studied population, respectively. History of preterm labor was reported in 19.2% versus 11.9% (p=0.048), while history of PID in 13.2% versus 6.0% (p=0.008) in women performing VD compared to those not performing this habit, respectively. There were no significant differences between the two groups as regard the history of ectopic pregnancy or the number of previous abortions. CONCLUSION: Vaginal douching is a prevalent practice in Egypt and has traditional and religious roots within the community. There are many misbeliefs around this habit in Egypt. Vaginal douching increases certain reproductive health hazards especially preterm labor and PID. Much effort and awareness campaigns are needed to increase women awareness about health hazards of this incorrect practice and to limit its use.

Inter-institutional data-driven education research: consensus values, principles, and recommendations to guide the ethical sharing of administrative education data in the Canadian medical education research context.

Background: Administrative data are generated when educating, licensing, and regulating future physicians but these data are rarely used beyond their pre-specified purposes. The capacity necessary for sensitive and responsive oversight that supports the sharing of administrative medical education data across institutions for research purposes needs to be developed. Method: A pan-Canadian consensus-building project was undertaken to develop agreement on the goals, benefits, risks, values, and principles that should underpin inter-institutional data-driven medical education research in Canada. A survey of key literature, consultations with various stakeholders and five successive knowledge synthesis workshops informed this project. Propositions were developed, driving subsequent discussions until collective agreement was distilled. Results: Consensus coalesced around six key principles: establishing clear purposes, rationale, and methodology for inter-institutional data-driven research a priori; informed consent from data generators in education systems is non-negotiable; multi-institutional data sharing requires special governance; data governance should be guided by data sovereignty; data use should be guided by an identified set of shared values; and best practices in research data-management should be applied. Conclusion: We recommend establishing a representative governance body, engaging trusted data facility, and adherence to extant data management policies when sharing administrative medical education data for research purposes in Canada.

Contexte: Des données administratives sont générées dans le cadre de la formation des médecins, d'octroi de permis d'exercice et de réglementation des activités professionnelles, mais ces données sont rarement utilisées au-delà de leurs objectifs prédéfinis. Il convient de créer un système de supervision réactif et sensible aux risques pour permettre le partage de données relatives à l'enseignement médical entre établissements à des fins de recherche. Méthode: Une initiative pancanadienne de recherche de consensus a été réalisée pour parvenir à un accord sur les objectifs, les avantages, les risques, les valeurs et les principes qui devraient sous-tendre la recherche interinstitutionnelle sur l'enseignement médical à l'aide des données existantes. Ce projet s'est appuyé sur une analyse de la littérature scientifique, sur des consultations avec diverses parties prenantes et sur cinq ateliers successifs de synthèse des connaissances. Des discussions ont été menées sur la base de propositions formulées préalablement jusqu'à la cristallisation d'un accord collectif. Résultats: Un consensus s'est dégagé autour de six principes clés : la création a priori d'objectifs, d'une logique et d'une méthodologie clairs pour la recherche interinstitutionnelle fondée sur les données; l'obtention, sans exception, du consentement éclairé des personnes concernées par la collecte de données dans les systèmes d'éducation; la création d'un cadre de gouvernance visant spécifiquement le partage des données entre établissements; le respect, dans ce cadre, de la souveraineté des données; l'utilisation des données fondée sur un ensemble de valeurs partagées; et l'application des meilleures pratiques en matière de gestion des données de recherche. Conclusion: En vue du partage des données administratives relatives à l'enseignement médical à des fins de recherche au Canada, nous recommandons la création d'une instance de gouvernance représentative ainsi que l'utilisation d'infrastructures fiables et le respect des politiques existantes régissant la gestion des données.

Perceptions of Data Set Experts on Important Characteristics of Health Data Sets Ready for Machine Learning: A Qualitative Study.

Importance: The lack of data quality frameworks to guide the development of artificial intelligence (AI)-ready data sets limits their usefulness for machine learning (ML) research in health care and hinders the diagnostic excellence of developed clinical AI applications for patient care. Objective: To discern what constitutes high-quality and useful data sets for health and biomedical ML research purposes according to subject matter experts. Design, Setting, and Participants: This qualitative study interviewed data set experts, particularly those who are creators and ML researchers. Semistructured interviews were conducted in English and remotely through a secure video conferencing platform between August 23, 2022, and January 5, 2023. A total of 93 experts were invited to participate. Twenty experts were enrolled and interviewed. Using purposive sampling, experts were affiliated with a diverse representation of 16 health data sets/databases across organizational sectors. Content analysis was used to evaluate survey information and thematic analysis was used to analyze interview data. Main Outcomes and Measures: Data set experts' perceptions on what makes data sets AI ready. Results: Participants included 20 data set experts (11 [55%] men; mean [SD] age, 42 [11] years), of whom all were health data set creators, and 18 of the 20 were also ML researchers. Themes (3 main and 11 subthemes) were identified and integrated into an AI-readiness framework to show their association within the health data ecosystem. Participants partially determined the AI readiness of data sets using priority appraisal elements of accuracy, completeness, consistency, and fitness. Ethical acquisition and societal impact emerged as appraisal considerations in that participant samples have not been described to date in prior data quality frameworks. Factors that drive creation of high-quality health data sets and mitigate risks associated with data reuse in ML research were also relevant to AI readiness. The state of data availability, data quality standards, documentation, team science, and incentivization were associated with elements of AI readiness and the overall perception of data set usefulness. Conclusions and Relevance: In this qualitative study of data set experts, participants contributed to the development of a grounded framework for AI data set quality. Data set AI readiness required the concerted appraisal of many elements and the balancing of transparency and ethical reflection against pragmatic constraints. The movement toward more reliable, relevant, and ethical AI and ML applications for patient care will inevitably require strategic updates to data set creation practices.

Organizational Factors in Clinical Data Sharing for Artificial Intelligence in Health Care.

Importance: Limited sharing of data sets that accurately represent disease and patient diversity limits the generalizability of artificial intelligence (AI) algorithms in health care. Objective: To explore the factors associated with organizational motivation to share health data for AI development. Design, Setting, and Participants: This qualitative study investigated organizational readiness for sharing health data across the academic, governmental, nonprofit, and private sectors. Using a multiple case studies approach, 27 semistructured interviews were conducted with leaders in data-sharing roles from August 29, 2022, to January 9, 2023. The interviews were conducted in the English language using a video conferencing platform. Using a purposive and nonprobabilistic sampling strategy, 78 individuals across 52 unique organizations were identified. Of these, 35 participants were enrolled. Participant recruitment concluded after 27 interviews, as theoretical saturation was reached and no additional themes emerged. Main Outcome and Measure: Concepts defining organizational readiness for data sharing and the association between data-sharing factors and organizational behavior were mapped through iterative qualitative analysis to establish a framework defining organizational readiness for sharing clinical data for AI development. Results: Interviews included 27 leaders from 18 organizations (academia: 10, government: 7, nonprofit: 8, and private: 2). Organizational readiness for data sharing centered around 2 main constructs: motivation and capabilities. Motivation related to the alignment of an organization's values with data-sharing priorities and was associated with its engagement in data-sharing efforts. However, organizational motivation could be modulated by extrinsic incentives for financial or reputational gains. Organizational capabilities comprised infrastructure, people, expertise, and access to data. Cross-sector collaboration was a key strategy to mitigate barriers to access health data. Conclusions and Relevance: This qualitative study identified sector-specific factors that may affect the data-sharing behaviors of health organizations. External incentives may bolster cross-sector collaborations by helping overcome barriers to accessing health data for AI development. The findings suggest that tailored incentives may boost organizational motivation and facilitate sustainable flow of health data for AI development.

A Comprehensive Review of Natural Alternatives for Treatment of Alopecia with an Overview of Market Products.

Alopecia or hair loss is a widespread issue that has significant effects on personal well-being for both genders nationally and internationally. In addition, alopecia causes extreme emotional stress and negatively impacts the psychological health and self-esteem of cancer patients suffering from chemotherapy-induced alopecia. Unfortunately, available synthetic medications are costly, invasive, or have extreme adverse effects. On the contrary, natural and herbal hair loss products are widely available in the local and international markets in variable pharmaceutical forms with different mechanisms of action, namely, androgen antagonists, nutritional supplements, vasodilators, and 5α-reductase inhibitors or dihydrotestosterone blockers. Thus, it is of great importance to encourage researchers to investigate these natural alternatives that can act as potent therapeutic agents having diverse mechanisms of action as well as limited side effects. Currently, natural remedies are considered a fast-rising pharmaceutical segment with demand from a wide range of consumers. In this study, we present a review of reported herbal remedies and herb combinations recommended for hair loss and their mode of action, along with an overview of available market products and formulations, their composition, and declared effects. In addition, a general outline of the different forms of alopecia, its causes, and recommended treatments are mentioned as well. This was all done with the aim of assisting further studies with developing standardized natural formulations for alopecia as many were found to lack standardization of their bioactive ingredients and efficiency confirmation.

Understanding bariatric patients' experiences of self-management post-surgery: A qualitative study.

Although most bariatric patients achieve significant weight loss and improvements in both physical and mental health-related quality of life (HRQoL) in the short-term, there is wide variability in weight and long-term HRQoL outcomes. The role of bariatric patients' self-management style in explaining variability in long-term outcomes is unclear. This qualitative study examined bariatric patients' self-management experiences after bariatric surgery in relation to long-term outcomes. A qualitative study was conducted using semi-structured individual interviews with post-surgery patients (n = 23) at a Canadian bariatric surgery program. A constant comparative approach was used to systematically analyse the data and identify overarching themes. Variation in patients' experiences and follow-up time were the two primary units of analysis. Patients were predominantly female (n = 19; 82.6%) and had a mean age of 50 ± 8.49 years. The median time post-surgery was 2 years (range: 6 months-7 years). Three distinct phases described the process of self-management post-bariatric surgery: (1) rediscovering self-esteem and confidence in one's ability to self-manage (1-month to 1.5-years post-surgery), (2) achieving weight maintenance and addressing emotion dysregulation (1.5-3-years post-surgery) and (3) embracing a flexible balanced lifestyle (beyond 3-years). Bariatric surgery patients experience distinct challenges relative to their post-surgery time course. Facilitating access to interprofessional bariatric care after surgery allowed patients to acquire the self-management knowledge and skills necessary to address challenges to following the bariatric guidelines in the long-term.

Digital Interventions to Support Population Mental Health in Canada During the COVID-19 Pandemic: Rapid Review.

BACKGROUND: The COVID-19 pandemic has resulted in a number of negative health related consequences, including impacts on mental health. More than 22% of Canadians reported that they had felt depressed in the last week, in response to a December 2020 national survey. Given the need to physically distance during the pandemic, and the increase in demand for mental health services, digital interventions that support mental health and wellness may be beneficial. OBJECTIVE: The purpose of this research was to identify digital interventions that could be used to support the mental health of the Canadian general population during the COVID-19 pandemic. The objectives were to identify (1) the populations these interventions were developed for, inclusive of exploring areas of equity such as socioeconomic status, sex/gender, race/ethnicity and culture, and relevance to Indigenous peoples and communities; (2) the effect of the interventions; and (3) any barriers or facilitators to the use of the intervention. METHODS: This study was completed using a Cochrane Rapid Review methodology. A search of Embase, PsycInfo, Medline, and Web of Science, along with Google, Million Short, and popular mobile app libraries, was conducted. Two screeners were involved in applying inclusion criteria using Covidence software. Academic articles and mobile apps identified were screened using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields resource, the American Psychiatric Association App Evaluation Framework, and the Mental Health Commission of Canada's guidance on app assessment and selection. RESULTS: A total of 31 mobile apps and 114 web-based resources (eg, telemedicine, virtual peer support groups, discussion forums, etc) that could be used to support the mental health of the Canadian population during the pandemic were identified. These resources have been listed on a publicly available website along with search tags that may help an individual make a suitable selection. Variability exists in the populations that the interventions were developed for, and little assessment has been done with regard to areas of equity. The effect of the interventions was not reported for all those identified in this synthesis; however, for those that did report the effect, it was shown that they were effective in the context that they were used. A number of barriers and facilitators to using these interventions were identified, such as access, cost, and connectivity. CONCLUSIONS: A number of digital interventions that could support population mental health in Canada during the global COVID-19 pandemic were identified, indicating that individuals have several options to choose from. These interventions vary in their purpose, approach, design, cost, and targeted user group. While some research and digital interventions addressed equity-related considerations, more research and focused attention should be given to this area.

"Caring About Me": a pilot framework to understand patient-centered care experience in integrated care - a qualitative study.

OBJECTIVE: The aim of this study is to examine patients' experiences in integrated care (IC) settings. DESIGN: Qualitative study using semistructured interviews. SETTINGS: Two IC sites in Toronto, Canada: (1) a community-based primary healthcare centre, supporting patients with hepatitis C and comorbid mental health and substance use issues; and (2) an integrated bariatric surgery programme, an academic tertiary care centre. PARTICIPANTS: The study included patients (n=12) with co-occurring mental and physical health conditions. Seven participants (58%) were female and five (42%) were male. METHODS: Twelve indepth semistructured interviews were conducted with a purposeful sample of patients (n=12) with comorbid mental and physical conditions at two IC sites in Toronto between 2017 and 2018. Data were collected and analysed using grounded theory approach. RESULTS: Four themes emerged in our analysis reflecting patients' perspectives on patient-centred care experience in IC: (1) caring about me; (2) collaborating with me; (3) helping me understand and self-manage my care; and (4) personalising care to address my needs. Patients' experiences of care were primarily shaped by quality of relational interactions with IC team members. Positive interactions with IC team members led to enhanced patient access to care and fostered personalising care plans to address unique needs. CONCLUSION: This study adds to the literature on creating patient-centredness in IC settings by highlighting the importance of recognising patients' unique needs and the context of care for the specific patient population.

Differences in physical and mental health-related quality of life outcomes 3 years after bariatric surgery: a group-based trajectory analysis.

BACKGROUND: While bariatric surgery has proven to be effective to achieve significant weight loss and short-term improvements in both physical and mental (HRQoL), little is known about the factors associated with long-term decline in mental HRQoL after bariatric surgery. OBJECTIVE: To examine differences in physical and mental HRQoL trajectories in a bariatric patient population 3 years after bariatric surgery and examine associated sociodemographic, weight, and mental health factors. SETTING: A Canadian academic bariatric care center. METHODS: A group-based trajectory model was used to examine physical and mental HRQoL trajectories 3 years after bariatric surgery. In a prospective cohort bariatric sample (n = 2270), demographic factors, body mass index, binge eating symptoms, anxiety symptoms (Generalized Anxiety Disorder-7), depressive symptoms (Patient Health Questionnaire-9), and physical and mental HRQoL (Short-form health survey-36 (SF-36)), were measured at baseline, 6 months, 1, 2, and 3 years respectively. The effect of time-varying covariates (body mass index, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7) were investigated to examine effects on physical and mental HRQoL trajectories. RESULTS: Five distinct trajectories described changes in (n = 1939 of 2270) individuals' physical HRQoL outcomes (SF-36-physical health component summary score) and five other trajectories described changes in mental HRQoL (SF-36-mental health component summary score) outcomes from baseline to 3 years postsurgery. The group-based distribution for the 5 physical HRQoL trajectories were as follows: (1) low baseline-stable low (5.8%); (2) low baseline-moderate rise (12%); (3) low baseline-stable high (41.1%); (4) high baseline-stable high (33.2%); and (5) moderate baseline-decline (7.9%). The 5 mental HRQoL trajectories were as follows: (1) low baseline-slow decline (10%); (2) low baseline-stable high (25%); (3) high baseline-unstable rise (12%); (4) high baseline-stable high (48.9%); and (5) high baseline-transient decline (4.1%). Compared with physical HRQoL, mental HRQoL trajectories were not associated with changes in body mass index, yet strongly correlated with changes in binge eating symptoms, Generalized Anxiety Disorder-7, and Patient Health Questionnaire measures at all time points. CONCLUSION: This study demonstrates distinct patterns in physical and mental HRQoL trajectories after bariatric surgery. The decline in mental HRQoL trajectories was more heterogeneous and associated with several psychosocial predictors that may be useful to guide risk prediction of long-term physical and mental HRQoL outcomes postbariatric surgery.

Mapping Evidence of Patients' Experiences in Integrated Care: A Scoping Review.

OBJECTIVES: Despite the established clinical and cost-effectiveness of integrated care (IC) models for patients with comorbid mental and physical illness, little is known about whether these models facilitate a better care experience from the patient's perspective. The authors conducted a scoping review of the literature to explore how IC influences patients' care experiences. METHODS: MEDLINE, EMBASE, PSYC INFO CINAHL, AMED, the Cochrane Library, and grey literature were searched to identify relevant articles. Eligible studies were systematically reviewed and analyzed, using thematic analysis approach, to identify patterns, trends, and variation in patient experience within IC settings. RESULTS: Search results yielded 5250 unique resources of which 21 primary studies met our eligibility criteria for analysis. Findings from this scoping review revealed variation in patients' experiences in IC settings. IC models enhanced patients' experience by creating theraputic spaces: improving patient access to care, developing collaborative relationships, and personalizing patient care to address individual needs. CONCLUSION: Productive interactions with care team were key to improve patient engagement and experience of centeredness in IC settings. Successful implementation of IC demanded purposeful alignment of IC structural components and care processes to create therapeutic spaces that address patient care needs and preferences.

Fetal biacromial diameter as a new ultrasound measure for prediction of macrosomia in term pregnancy: a prospective observational study.

OBJECTIVE: The current study aims to evaluate a simple method for sonographic measurement of the fetal biacromial diameter for prediction of fetal macrosomia in term pregnancy. MATERIALS AND METHODS: The current study was a single center prospective observational study conducted in a tertiary University Hospital from January 2015 to May 2017. We included all consecutive term (37-42 weeks) pregnant women presented to the labor ward for delivery. Ultrasound parameters were measured as biparietal diameter, head circumference, transverse thoracic diameter, mid arm diameter, abdominal circumference, femur length, estimated fetal weight, and amniotic fluid index. The proposed ultrasound formula "Youssef's formula" to measure the fetal biacromial diameter is: [Transverse thoracic diameter +2 × midarm diameter]. The accuracy of proposed formula was compared to the actual biacromial diameter of the newborn after delivery. The primary outcome of the study was accuracy of sonographic measurement of fetal biacromial diameter in prediction of fetal macrosomia in terms of sensitivity and specificity Results: The study included 600 participants; 49 (8.2%) of them delivered a macrosomic neonates and 551 (91.8%) delivered average weight neonates. There was no statistical significant difference between the proposed fetal biacromial diameter measured by ultrasound and the actual neonatal biacromial diameter measured after birth (p = .192). The area under the curve (AUC) for prediction of macrosomia at birth based on the fetal biacromial diameter and the abdominal circumference was 0.987 and 0.989, respectively, on receiver operating characteristic (ROC) curve analysis. Using the biacromial diameter cutoff of 15.4 cm has a PPV for prediction of macrosomia (88.4%) and 96.4% sensitivity with overall accuracy of 97%. Similarly, with the abdominal circumference (AC) cutoff of 35.5 cm, the PPV for prediction of macrosomia (87.7%) and 96.4% sensitivity with overall accuracy of 96.83%. No statistical significant difference between both of them was observed for prediction of fetal macrosomia (p = .841) Conclusions: The sonographic measurement of fetal biacromial diameter seems to be a new simple and accurate method for prediction of fetal macrosomia and shoulder dystocia at birth.

LINGO-1 siRNA nanoparticles promote central remyelination in ethidium bromide-induced demyelination in rats.

Multiple sclerosis is among the most common causes of neurological disabilities in young adults. Over the past decade, several therapeutic strategies have emerged as having potential neuroprotective and neuroregenerative properties. We investigated the effect of intranasal administration of LINGO-1-directed siRNA-loaded chitosan nanoparticles on demyelination and remyelination processes in a rat model of demyelination. Adult male Wistar rats were randomly assigned to one of 6 groups (n = 10 each) and subjected to intrapontine stereotaxic injection of ethidium bromide (EB) to induce demyelination. EB-treated rats were either left untreated or received intranasal LINGO-1-directed siRNA-chitosan nanoparticles from day 1 to day 7 (demyelination group) or from day 7 to day 21 (remyelination group) after EB injection. Chitosan nanoparticle (50 µl) was given alone after EB stereotaxic injection for both demyelination and remyelination groups. Two additional groups received 10 µl of saline by stereotaxic injection, followed by intranasal saline as controls for demyelination and remyelination groups (n = 10/group). Behavioural testing was conducted for all rats, as well as terminal biochemical assays and pathological examination of pontine tissues were done. After EB injection, rats had compromised motor performance and coordination. Pathological evidence of demyelination was observed in pontine tissue and higher levels of caspase-3 activity were detected compared to control rats. With LINGO-1-directed siRNA-chitosan nanoparticle treatment, animals performed better than controls. Remyelination-treated group showed better motor performance than demyelination group. LINGO-1 downregulation was associated with signs of repair in histopathological sections, higher expression of pontine myelin basic protein (MBP) mRNA and protein and lower levels of caspase-3 activity indicating neuroprotection and remyelination enhancement.

Examining Associations Between Physician Data Utilization for Practice Improvement and Lifelong Learning.

INTRODUCTION: Practice data can inform the selection of educational strategies; however, it is not widely used, even when available. This study's purpose was to determine factors that influence physician engagement with practice data to advance competence and drive practice change. METHODS: A practice-based, pan-Canadian survey was administered to three physician subspecialties: psychiatrists (Psy), radiation oncologists (RO), and general surgeons (GS). The survey was distributed through national specialty society membership lists. The survey assessed factors that influence the use of data for practice improvement and orientation to lifelong learning, using the Jefferson Scale of Physician Lifelong Learning (JeffSPLL). Linear regression was used to model the relationship between the outcome variable frequency of data use and independent predictors of continuous learning to improving practice. RESULTS: A total of 305 practicing physicians (Psy = 203, RO = 53, GS = 49) participated in this study. Most respondents used data for practice improvement (n = 177, 61.7%; Psy = 115, 40.1%; RO = 35; 12.2%; GS = 27, 9.4%) and had high orientation to lifelong learning (JeffSPLL mean scores: Psy = 47.4; RO = 43.5; GS = 45.1; Max = 56). Linear regression analysis identified significant predictors of data use in practice being: frequency of assessing learning needs, helpfulness of data to improve practice, and frequency to develop learning plans. Together, these predictors explained 42.9% of the variance in physicians' orientation toward integrating accessible data into practice (R = 0.426, P < .001). DISCUSSION: This study demonstrates an association between practice data use and perceived data utility, reflection on learning needs and learning plan development. Implications for this work include process development for data-informed action planning for practice improvement for physicians.