Association between vitamin D deficiency and benign paroxysmal positional vertigo (BPPV) incidence and recurrence: a systematic review and meta-analysis.

OBJECTIVES: The objective of this study is to determine the relationship between serum vitamin D level and the risk of developing benign paroxysmal positional vertigo (BPPV) incidence and recurrence in countries in the Northern Hemisphere. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Scopus and Web of Science databases were searched for studies published between January 2000 and February 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Participants located in the Northern Hemisphere aged 18 or over with at least one episode of BPPV, serum 25-hydroxyvitamin D levels measured and reported, no comorbidities or history of vitamin D supplementation. DATA EXTRACTION AND SYNTHESIS: Data extraction and synthesis were performed by a single reviewer and checked by a second reviewer. Inclusion and exclusion criteria and risk of bias were assessed by two independent reviewers using the Newcastle Ottawa Tool for Cohort studies and Risk of Bias Assessment Tool for Nonrandomised Studies checklist for case-control studies. Meta-analysis was conducted using random effects models. Standard mean difference with a 95% CI was used to measure the relationship between vitamin D level and BPPV. RESULTS: The 35 articles identified by the literature search reported data of 9843 individuals. 19 studies (7387 individuals) were included in the BPPV incidence meta-analysis while 7 studies (622 individuals) were included in the BPPV recurrence meta-analysis. Lower serum vitamin D levels were found in BPPV incidence compared with controls, but the relationship between vitamin D levels in recurrent BPPV compared with non-recurrent disease remained uncertain. CONCLUSION: Results of this systematic review and meta-analysis demonstrated a negative correlation between serum vitamin D and BPPV incidence, while any relationship between serum vitamin D and BPPV recurrence remained uncertain. Risk of bias analysis revealed evidence of variable quality. There were insufficient data available to evaluate seasonal relationships between serum vitamin D and BPPV. Given the potential for this as a confounding factor, future research should aim to investigate this further. PROSPERO REGISTRATION NUMBER: CRD42021271840.

Interprofessional Post-Graduate Training Model for Nurse Practitioners and Physician Trainees.

CONTEXT: People living with serious illness and their care partners rely on team-based specialty hospice and palliative care (HPC) in order to achieve high quality end of life outcomes. In HPC, physician and nurse practitioner (NP) scope of practice has significant overlap so training together may offer benefits to clinicians and patients. OBJECTIVES: Assessment of clinical competencies in a post-graduate training program consisting of NPs and physicians training and learning side-by-side. METHODS: A crosswalk assured NP and physician HPC clinical competencies were captured in evaluation questions used by interprofessional program faculty to observe and assess trainees. Six clinical competencies were calculated based on aggregated evaluations for each physician and NP HPC post-graduate trainee at 3, 6, 9, and 12 months annually for 3 years. For NPs and physicians, the mean slopes of the best fit lines, the final numeric score, and the mean net change between 12 and three month competencies were compared. Learner experience was captured qualitatively. RESULTS: There was no statistical difference in the change of competency scores, the final competency scores, or the trajectory of improvement in the six competencies between physician to NP trainees. Adding NP trainees was considered by post-graduate trainees as a strength of the program, and did not detract from physician competence achievement. CONCLUSION: Assessing an IPE post-graduate training program in HPC was possible using a shared clinical competency framework, and revealed similar clinical gains for NPs and physicians enrolled in the program.

Cognition and saccadic eye movement performance are impaired in chronic rhinosinusitis.

BACKGROUND: Patients with chronic rhinosinusitis (CRS) can experience cognitive dysfunction. The literature on this topic mostly reflects patient-reported measurements. Our goal was to assess cognitive function in patients with CRS using objective measures, including saccadic eye movements-a behavioral response reflecting cognitive and sensory information integration that is often compromised in conditions with impaired cognition. METHODS: Participants (N = 24 with CRS, N = 23 non-CRS healthy controls) enrolled from rhinology clinic underwent sinonasal evaluation, quality of life assessment (Sino-nasal Outcome Test 22 [SNOT-22]), and cognitive assessment with the Neuro-QOL Cognitive Function-Short Form, the Montreal Cognitive Assessment (MoCA), and recording of eye movements using video-oculography. RESULTS: Participants with CRS were more likely to report cognitive dysfunction (Neuro-QOL; 45.8% vs. 8.7%; p = 0.005) and demonstrate mild or greater cognitive impairment (MoCA; 41.7% vs. 8.7%; p = 0.005) than controls. Additionally, participants with CRS performed worse on the MoCA overall and within the executive functioning and memory domains (all p < 0.05) and on the anti-saccade (p = 0.014) and delay saccade (p = 0.044) eye movement tasks. Poorer performance on the MoCA (r = -0.422; p = 0.003) and the anti-saccade (r = -0.347; p = 0.017) and delay saccade (r = -0.419; p = 0.004) eye movement tasks correlated with worse CRS severity according to SNOT-22 scores. CONCLUSION: This study is the first to utilize objective eye movement assessments in addition to researcher-administered cognitive testing in patients with CRS. These patients demonstrated a high prevalence of cognitive dysfunction, most notably within executive functioning and memory domains, with the degree of dysfunction correlating with the severity of CRS.

Relaxation of mitochondrial hyperfusion in the diabetic retina via N6-furfuryladenosine confers neuroprotection regardless of glycaemic status.

The recovery of mitochondrial quality control (MQC) may bring innovative solutions for neuroprotection, while imposing a significant challenge given the need of holistic approaches to restore mitochondrial dynamics (fusion/fission) and turnover (mitophagy and biogenesis). In diabetic retinopathy, this is compounded by our lack of understanding of human retinal neurodegeneration, but also how MQC processes interact during disease progression. Here, we show that mitochondria hyperfusion is characteristic of retinal neurodegeneration in human and murine diabetes, blunting the homeostatic turnover of mitochondria and causing metabolic and neuro-inflammatory stress. By mimicking this mitochondrial remodelling in vitro, we ascertain that N6-furfuryladenosine enhances mitochondrial turnover and bioenergetics by relaxing hyperfusion in a controlled fashion. Oral administration of N6-furfuryladenosine enhances mitochondrial turnover in the diabetic mouse retina (Ins2Akita males), improving clinical correlates and conferring neuroprotection regardless of glycaemic status. Our findings provide translational insights for neuroprotection in the diabetic retina through the holistic recovery of MQC.

Variability in bat morphology is influenced by temperature and forest cover and their interactions.

Multiple climatic and landscape drivers have been linked to variations in bat body size and wing functional traits. Most previous studies used proxies rather than actual climate and land-use data, and their interactions are rarely explored. We investigate whether higher summer average temperatures are driving decreasing bat body size as predicted by Bergmann's rule or increasing appendage size as per Allen's rule. We also explore whether temperature or resource availability (namely forest cover) is responsible for changes in wing functional traits. Using land-use data from historical maps and national statistics combined with climatic data, we assessed the effect of temperature and resource availability on bat morphology. We used 464 museum specimens of three bat species (Eptesicus nilssonii, Pipistrellus pygmaeus, and Plecotus auritus), spanning 180 years, across a 1200 km latitudinal gradient. We found no evidence of higher summer average temperatures driving decreases in body size in bats. Jaw sizes of P. auritus and P. pygmaeus changed over time but in different directions. The geographical variation of forest cover was also related to differences in wing functional traits in two species. Crucially, there was a significant antagonistic interactive effect of forest and temperature on tip index in P. pygmaeus whereby above 14.5°C the relationship between forest and tip index actually reversed. This could indicate that higher temperatures promote more pointed wings, which may provide energetic benefits. Our results show the importance of including both climatic and land-use variables when assessing trends in bat morphology and exploring interactions. Encouragingly, all three species have shown an ability to adapt their body size and functional traits to different conditions, and it could demonstrate their potential to overcome future negative impacts of climate and land-use change.

Examining missingness among children in out-of-home care placement in Nebraska.

BACKGROUND: Little is known regarding the prevalence and context of missingness (i.e., being reported as a missing person) among children in out-of-home (OOH) care. OBJECTIVE: The present research examines the relationship between missingness and OOH care placements as well as predictors and case contexts of children missing from OOH care. METHODS: Point-in-time count data of reported missing persons in Nebraska and administrative records on children's OOH placements are used. Bivariate significance tests examine group differences; case contexts are explored through content analysis of OOH case reviews. RESULTS: About 30 % of Nebraska's missing children are in OOH care. Bivariate tests show that children missing from OOH care are older and are more likely to be Black and less likely to have their race listed as "unknown" than children missing from their families of origin. Children in OOH who are missing are also more likely to be in group care, on probation, and have greater placement instability compared to children in OOH care who are not missing. Case contexts of missingness include unmet substance use and mental health challenges, experiences with violence and victimization, and few bonds to school. CONCLUSIONS: Screening and interventions for high-need children in OOH care and their caregivers are necessary to prevent children from going missing from placements.

How do African elephants utilize the landscape during wet season? A habitat connectivity analysis for Sioma Ngwezi landscape in Zambia.

The influence of environmental factors on the distribution and persistence of African elephants (Loxodonta africana) is pertinent to policy makers and managers to formulate balanced plans for different land-use types.The study focuses on movement of elephants and how they utilize foraging areas in Sioma Ngwezi landscape in Zambia by answering the following questions: (1) Which environmental variables and land-cover class predict the movement of elephants during the wet season in Sioma Ngwezi landscape? (2) What is the wet season suitable habitat for elephants in Sioma Ngwezi landscape? (3) What are the major wet season movement corridors for elephants in Sioma Ngwezi landscape?We used GPS telemetry data from the collared elephants to assess habitat connectivity. Maximum entropy (MaxEnt) and linkage mapper were the tools used to predict habitat suitability, movement corridors, and barriers in the landscape during the wet season.The study identified elevation, land cover, and NDVI as the most important environmental predictors that modify the dispersal of elephants in the landscape during the wet season. Additionally, a total of 36 potential wet season corridors were identified connecting 15 core areas mainly used for foraging and protection from poachers in the landscape. Of these, 24 corridors were highly utilized and are suggested as priority corridors for elephant movement in the landscape.The identified wet season habitats and functional corridors may help to combat elephant poaching by patrolling areas with high relative probability of elephant presence. The findings may also help abate human-elephant conflict such as crop-raiding by managing identified corridors that run into agriculture zones in the game management area.

The Triarchic Model of Psychopathy and Antisocial Behavior: Results From an Offender Population With Personality Disorder.

The triarchic model posits that psychopathy is a combination of phenotypes related to boldness, meanness, and disinhibition. We examined how each of these phenotypes of psychopathy related to past violence and antisocial behavior and to behavior within the prison. The sample consisted of men (n = 108) with a history of serious offending and a diagnosis of personality disorder at the point of admission to a prison serving as a therapeutic community. We took four indices of violence and antisocial behavior, (a) self-report of lifetime proactive and reaction aggression, (b) criminal convictions prior to admission to the prison, (c) exclusion from the prison within 12 months due to rule breaking, and (d) behavior within the first 12 months of admission to the unit. The constructs of the triarchic model, as assessed by the triarchic psychopathy measure (TriPM), were strong predictors of self-reported aggression, with disinhibition being related to both proactive and reactive aggression, whereas boldness was related to proactive aggression alone. Past criminal convictions were also associated with disinhibition, except for convictions for violent behavior. Both meanness and disinhibition were predictive of exclusion from the prison within 12 months for rule-breaking behavior and of aggressive behavior within the prison. The triarchic model of psychopathy is associated with past antisocial behavior and is predictive of antisocial behaviors within the prison, and the different constructs of the triarchic model are associated with different manifestations of antisocial behavior. The TriPM holds great promise for improved assessment and enhanced understanding of psychopathic personality within institutions and can facilitate offender management via improved phenotypic analysis of boldness, meanness, and disinhibition.

Validation study of a receptor-based lateral flow assay for detection of beta-lactam antibiotics in milk.

A validation study designed to meet the requirements of the AOAC Research Institute and the U.S. Food and Drug Administration (FDA), Center for Veterinary Medicine, was conducted for a receptor-based, immunochromatographic method (BetaStar US) for detection of beta-lactam antibiotic residues in raw, commingled bovine milk. The assay was found to detect amoxicillin, ampicillin, cephapirin, cloxacillin, and penicillin G at levels below the FDA tolerance/safe levels but above the maximum sensitivity thresholds established by the National Conference on Interstate Milk Shipments. Results of the Part I (internal) and Part II (independent laboratory) dose-response studies using spiked samples were in very close agreement for all five drugs tested, with differences between the Part I and Part II 90/95% sensitivity values ranging from 0 to 1 ppb. The test was able to detect all five drugs at the approximate 90/95% sensitivity levels when present as incurred residues in milk collected from cows that had been treated with the specific drug. A sixth drug, ceftiofur, was found to be undetectable at levels of < or = 500 ppb (as total ceftiofur metabolites from incurred residues in milk samples). The selectivity of the assay was 100%, because no false-positive results were obtained in tests of >1000 control milk samples. The assay was found to be applicable to the testing of frozen raw milk samples. Results of ruggedness experiments established the operating parameter tolerances for the BetaStar US assay. Results of cross-reactivity testing established that the assay detects certain other beta-lactam drugs (dicloxacillin and ticarcillin), but it does not cross-react with any of 30 drugs belonging to other classes. Abnormally high bacterial or somatic cell counts in raw milk produced no interference with the ability of the test to detect beta-lactams at tolerance/safe levels.