Neuromodulation of the Cerebellum for Motor Applications: A Systematic Review.

BACKGROUND: Despite the connections and clear importance of the cerebellum in motor function, research utilizing cerebellar neuromodulation for treatment of movement disorders is still underdeveloped. Here we conduct a systematic review to investigate non-invasive neurostimulation of the cerebellum and its potential impact on motor systems and its function. Our aim is to give a general review of each neurostimulation study focusing on the cerebellum as a treatment target in the past five years at time of search, in order to update the field on current findings and inspire similar cerebellar neurostimulation research without unnecessary repetition. METHODS: Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, our search included articles over the past five years that evaluated neurostimulation of the cerebellum (e.g., transcranial magnetic stimulation, transcranial direct current stimulation, and transcranial alternating current stimulation, etc.). Inclusion criteria included: (1) neurostimulation (repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS)) of the cerebellum; (2) only original articles, and (3) outcomes focused on motor functions. Exclusion criteria included: (1) neurostimulation with the goal of targeting any brain structure other than the cerebellum and (2) reviews and conference abstracts. RESULTS: The search revealed 82 distinct articles relevant to the research question. Included are 17 articles concerning rTMS, 56 articles concerning tDCS, and 9 articles concerning tACS. The majority of the studies are controlled trials of varying types, with 79, with two case studies and one pilot study. CONCLUSIONS: Many studies showed significant effects on motor function and circuitry via non-invasive neurostimulation of the cerebellum. Common targets of cerebellar neurostimulation include visuomotor control, stroke rehabilitation for improvements in balance and coordination, and motor skill acquisition. The field is still exploring ideal parameters of neurostimulation for each disorder or function of interest. Future research areas should include the inclusion of individual anatomy, including functional connectivity, and improving stimulation selectivity.

A patient and family data domain collection framework for identifying disparities in pediatrics: results from the pediatric health equity collaborative.

BACKGROUND: By 2020, the child population is projected to have more racial and ethnic minorities make up the majority of the populations and health care organizations will need to have a system in place that collects accurate and reliable demographic data in order to monitor disparities. The goals of this group were to establish sample practices, approaches and lessons learned with regard to race, ethnicity, language, and other demographic data collection in pediatric care setting. METHODS: A panel of 16 research and clinical professional experts working in 10 pediatric care delivery systems in the US and Canada convened twice in person for 3-day consensus development meetings and met multiple times via conference calls over a two year period. Current evidence on adult demographic data collection was systematically reviewed and unique aspects of data collection in the pediatric setting were outlined. Human centered design methods were utilized to facilitate theme development, facilitate constructive and innovative discussion, and generate consensus. RESULTS: Group consensus determined six final data collection domains: 1) caregivers, 2) race and ethnicity, 3) language, 4) sexual orientation and gender identity, 5) disability, and 6) social determinants of health. For each domain, the group defined the domain, established a rational for collection, identified the unique challenges for data collection in a pediatric setting, and developed sample practices which are based on the experience of the members as a starting point to allow for customization unique to each health care organization. Several unique challenges in the pediatric setting across all domains include: data collection on caregivers, determining an age at which it is appropriate to collect data from the patient, collecting and updating data at multiple points across the lifespan, the limits of the electronic health record, and determining the purpose of the data collection before implementation. CONCLUSIONS: There is no single approach that will work for all organizations when collecting race, ethnicity, language and other social determinants of health data. Each organization will need to tailor their data collection based on the population they serve, the financial resources available, and the capacity of the electronic health record.

"We need good nutrition but we have no money to buy food": sociocultural context, care experiences, and newborn health in two UNHCR-supported camps in South Sudan.

BACKGROUND: Determinants of newborn health and survival exist across the reproductive life cycle, with many sociocultural and contextual factors influencing outcomes beyond the availability of, and access to, quality health services. In order to better understand key needs and opportunities to improve newborn health in refugee camp settings, we conducted a multi-methods qualitative study of the status of maternal and newborn health in refugee camps in Upper Nile state, South Sudan. METHODS: In 2016, we conducted 18 key informant interviews with health service managers and front-line providers and 13 focus group discussions in two Sudanese refugee camps in Maban County, South Sudan. Our focus group discussions comprised 147 refugee participants including groups of mothers, fathers, grandmothers, traditional birth attendants, community health workers, and midwives. We analysed our data for content and themes using inductive and deductive techniques. RESULTS: We found both positive practices and barriers to newborn health in the camps throughout the reproductive lifecycle. Environmental and contextual factors such as poor nutrition, lack of livelihood opportunities, and insecurity presented barriers to both general health and self-care during pregnancy. We found that the receipt of material incentives is one of the leading drivers of utilization of antenatal care and facility-based childbirth services. Barriers to facility-based childbirth included poor transportation specifically during the night; insecurity; being accustomed to home delivery; and fears of an unfamiliar birth environment, caesarean section, and encountering male health care providers during childbirth. Use of potentially harmful traditional practices with the newborn are commonplace including mixed feeding, use of herbal infusions to treat newborn illnesses, and the application of ash and oil to the newborn's umbilicus. CONCLUSIONS: Numerous sociocultural and contextual factors impact newborn health in this setting. Improving nutritional support during pregnancy, strengthening community-based transportation for women in labour, allowing a birth companion to be present during delivery, addressing harmful home-based newborn care practices such as mixed feeding and application of foreign substances to the umbilicus, and optimizing the networks of community health workers and traditional birth attendants are potential ways to improve newborn health outcomes.

Public Discourses of Ebola Contagion and Courtesy Stigma: The Real Risk to International Health Care Workers Returning Home From the West Africa Ebola Outbreak?

This article explores the homecoming experiences of international health care workers who responded to the 2014 to 2016 West African Ebola outbreak. Interviews with 11 frontline international medical staff were undertaken and data thematically analyzed. It was found that international health care workers faced an unforeseen risk of stigmatization upon their return home, related to others' fears of their infectious status. Media representations of the disease appear to have played a significant role in heightening societal perceptions of the risks associated with the returning health care workers, resulting in public hostility toward them. For participants, these social risks overtook concerns about biological risks during the immediate postmission period. The participants developed different strategies to cope with courtesy stigma, by rationalizing stigmatizing attitudes, educating people, or simply through an avoidance of others.

Naphthablins B and C, Meroterpenoids Identified from the Marine Sediment-Derived Streptomyces sp. CP26-58 Using HeLa Cell-Based Cytological Profiling.

HeLa cell-based cytological profiling (CP) was applied to an extract library of marine sediment-derived actinomycetes to discover new cytotoxic secondary metabolites. Among the hit strains, Streptomyces sp. CP26-58 was selected for further investigation to identify its cytotoxic metabolites. CP revealed that the known ionophore tetronasin (1) was responsible for the cytotoxic effect found in the extract. Furthermore, three naphthoquinone meroterpenoids, naphthablin A (2) and two new derivatives designated as naphthablins B (3) and C (4), were isolated from other cytotoxic fractions. The structures of the new compounds were elucidated based on analysis of their HRESIMS and comprehensive NMR data. The absolute configurations of the new compounds were deduced by simulating ECD spectra and calculating potential energies for the model compounds using density function theory (DFT) calculations. Compound 1 showed a significant cytotoxic effect against HeLa cells with an IC50 value of 0.23 µM, and CP successfully clustered 1 with calcium ionophores.

Future directions in neuropsychology: Training, education, clinical practice, and advocacy for Asians and Asian Americans.

Objective: Given the need for increased equity, justice, and inclusion in neuropsychology, this paper aimed to present an initial perspective on key areas of understanding necessary to provide ethically and culturally responsive services and training to Asians and Asian Americans. Method: We first reviewed the terms Asian and Asian American and established the large multitude of individuals these terms encompass. Second, a brief review of the foundations for Asian American psychology is provided to set the stage for the unique considerations when evaluating individuals of Asian descent. Lastly, the necessity of using the social justice lens in education and training pipelines needed to propel the field forward is emphasized. Conclusions: Overall, this paper reviewed key information to provide a foundational level of understanding regarding the nuances of working with persons of Asian descent in the field of neuropsychology.

Lessons Learned From Helping Babies Survive in Humanitarian Settings.

Humanitarian crises, driven by disasters, conflict, and disease epidemics, have profound effects on society, including on people's health and well-being. Occurrences of conflict by state and nonstate actors have increased in the last 2 decades: by the end of 2018, an estimated 41.3 million internally displaced persons and 20.4 million refugees were reported worldwide, representing a 70% increase from 2010. Although public health response for people affected by humanitarian crisis has improved in the last 2 decades, health actors have made insufficient progress in the use of evidence-based interventions to reduce neonatal mortality. Indeed, on average, conflict-affected countries report higher neonatal mortality rates and lower coverage of key maternal and newborn health interventions compared with non-conflict-affected countries. As of 2018, 55.6% of countries with the highest neonatal mortality rate (≥30 per 1000 live births) were affected by conflict and displacement. Systematic use of new evidence-based interventions requires the availability of a skilled health workforce and resources as well as commitment of health actors to implement interventions at scale. A review of the implementation of the Helping Babies Survive training program in 3 refugee responses and protracted conflict settings identify that this training is feasible, acceptable, and effective in improving health worker knowledge and competency and in changing newborn care practices at the primary care and hospital level. Ultimately, to improve neonatal survival, in addition to a trained health workforce, reliable supply and health information system, community engagement, financial support, and leadership with effective coordination, policy, and guidance are required.

"The more children you have, the more praise you get from the community": exploring the role of sociocultural context and perceptions of care on maternal and newborn health among Somali refugees in UNHCR supported camps in Kenya.

BACKGROUND: Maternal and neonatal survival are key components of population health and may be particularly vulnerable in humanitarian contexts of civil unrest and displacement. Understanding what factors contribute to poor health outcomes throughout the reproductive life cycle and across the continuum of care is crucial for improving health programming in acute and protracted refugee settings. METHODS: We undertook a mixed-methods baseline assessment of factors related to maternal and neonatal health among refugees living in the Dadaab refugee complex in eastern Kenya. The qualitative component included 23 focus group discussions with 207 community members and 22 key informant interviews with relevant UN and non-governmental organization staff, community leaders, health managers, and front-line health care providers. We analysed qualitative data for content and themes using inductive and deductive techniques. RESULTS: Taking a life course perspective, we found that the strong desire for large families and the primary social role of the woman as child bearer impacted maternal and neonatal health in the camps through preferences for early marriage, low demand for contraception, and avoidance of caesarean sections. Participants described how a strong fear of death, disability, and reduced fecundity from caesarean sections results in avoidance of the surgery, late presentation to the health facility in labour, and difficulty gaining timely informed consent. Mistrust of health service providers also played a role in this dynamic. In terms of newborn care practices, while breastfeeding is culturally supported and women increasingly accept feeding colostrum to the newborn, mixed feeding practices and application of foreign substances to the umbilicus continue to present risks to newborn health in this community. CONCLUSIONS: The findings from our study showcase the role that specific sociocultural beliefs and practices and perceptions of health care services have on maternal and neonatal health. An in-depth understanding of how these factors impact the utilization of biomedical health services provides valuable information for targeted improvements in health service provision that are tailored to the local context.

Navigating 'riskscapes': The experiences of international health care workers responding to the Ebola outbreak in West Africa.

This paper draws on interview data to examine how international health care workers navigated risk during the unprecedented Ebola outbreak in West Africa. It identifies the importance of place in risk perception, including how different spatial localities give rise to different feelings of threat or safety, some from the construction of physical boundaries, and others mediated through aspects of social relations, such as trust, communication and team dynamics. Referring to these spatial localities as 'riskscapes', the paper calls for greater recognition of the role of place in understanding risk perception, and how people navigate risk.

The role of risk perception in willingness to respond to the 2014-2016 West African Ebola outbreak: a qualitative study of international health care workers.

BACKGROUND: The 2014-2016 West Africa Ebola Virus Disease (EVD) outbreak was an unprecedented public health event, and in addition to claiming over 11,000 lives, it resulted in the deaths of more healthcare workers than any outbreak in recent history. While a cadre of willing and able health workers is essential for an effective epidemic response, health workforce capacity in times of crisis may be significantly impacted by how risks are perceived by health staff. This study aimed to explore how risk perceptions influenced healthcare workers' willingness to respond during this outbreak. METHODS: Through in-depth interviews with 11 front-line international health care workers who chose to respond to the West Africa outbreak, this qualitative study explores how perceptions of risk developed and subsequently mediated the decision to respond to the outbreak. Data was thematically organized using NVivo 10. RESULTS: We found that numerous individual and social-level factors played a role in modifying risk perception in health workers. Institutional trust emerged as a key risk attenuator, as did past experience, self-efficacy, duty of care, humanitarian ethos, and cognitive heuristics. Feelings of risk were amplified by infections of co-workers, and risk perceptions of family members and the public, which were mainly informed by media reports, also hampered willingness to respond in some cases. CONCLUSIONS: Understanding the risk perceptions of health workers, institutions, and the public, while complex and interdependent, are each crucial to understand for an effective public health response to epidemics, and as such should be taken into consideration in future program planning and research.

Family-specific aggregation of lipid GWAS variants confers the susceptibility to familial hypercholesterolemia in a large Austrian family.

BACKGROUND AND AIMS: Hypercholesterolemia confers susceptibility to cardiovascular disease (CVD). Both serum total cholesterol (TC) and LDL-cholesterol (LDL-C) exhibit a strong genetic component (heritability estimates 0.41-0.50). However, a large part of this heritability cannot be explained by the variants identified in recent extensive genome-wide association studies (GWAS) on lipids. Our aim was to find genetic causes leading to high LDL-C levels and ultimately CVD in a large Austrian family presenting with what appears to be autosomal dominant inheritance for familial hypercholesterolemia (FH). METHODS: We utilized linkage analysis followed by whole-exome sequencing and genetic risk score analysis using an Austrian multi-generational family with various dyslipidemias, including elevated TC and LDL-C, and one family branch with elevated lipoprotein (a) (Lp(a)). RESULTS: We did not find evidence for genome-wide significant linkage for LDL-C or apparent causative variants in the known FH genes rather, we discovered a particular family-specific combination of nine GWAS LDL-C SNPs (p = 0.02 by permutation), and putative less severe familial hypercholesterolemia mutations in the LDLR and APOB genes in a subset of the affected family members. Separately, high Lp(a) levels observed in one branch of the family were explained primarily by the LPA locus, including short (<23) Kringle IV repeats and rs3798220. CONCLUSIONS: Taken together, some forms of FH may be explained by family-specific combinations of LDL-C GWAS SNPs.

Opposition to redistributive employment policies for women: the role of policy experience and group interest.

We examined whether group interest affected ideological beliefs and attitudes towards redistributive policies among men and women. We found that group interest influenced meritocratic and neo-sexist beliefs and support for gender-based affirmative action and comparable worth policies. Men and women differed in their ideological beliefs and support for the redistributive policies only when they had conscious experience with these policies. Those with policy experience expressed policy attitudes that corresponded with their gender group's interests, while those lacking such experience did not. We also noted group interest effects within each gender: men who had conscious experience with the policies expressed more opposition and greater neo-sexism and meritocratic beliefs than did men who were not consciously experienced with these policies. In contrast, consciously experienced women expressed more policy support than did their not consciously experienced counterparts. Overall, our findings indicate that group interest is an important determinant of policy attitudes and related ideological beliefs.

Influenza H1N1pdm-specific maternal antibodies offer limited protection against wild-type virus replication and influence influenza vaccination in ferrets.

OBJECTIVE: The objective was to study passively acquired influenza H1N1 pandemic (H1N1pdm) maternal antibody kinetics and its impact on subsequent influenza infection and vaccination in ferrets during an outbreak of the H1N1pdm. DESIGN AND MAIN OUTCOME MEASURES: Infectivity of the H1N1pdm in the respiratory tract of ferrets was compared with the previous seasonal A/South Dakota/6/2007 (SD07, H1N1). Influenza-specific antibodies were quantitated and antibody-mediated protection against the homologous and heterologous H1N1 virus challenge infection was determined. RESULTS: H1N1pdm virus was approximately 10 times more infectious than SD07 in ferrets, replicated to higher viral titers in the upper respiratory tract and shed for a longer duration. Influenza-specific antibodies after natural infection persisted much longer in the circulation than passively acquired maternal antibodies. The protection conferred by the maternal antibodies was limited to the homologous virus strain and was ineffective against SD07 and H3N2 virus. Serum antibodies from maternal transmission or passive transfer interfered with homologous vaccine strain-mediated antibody responses in the ferret. A booster immunization was required to elicit a high level of antibody. CONCLUSIONS: The findings support the rationale for a prime and boost immunization strategy in young children in whom maternal antibodies are present.

The merit of meritocracy.

We argue that the preference for the merit principle is a separate construct from hierarchy-legitimizing ideologies (i.e., system justification beliefs, prejudice, social dominance orientation), including descriptive beliefs that meritocracy currently exists in society. Moreover, we hypothesized that prescriptive beliefs about merit should have a stronger influence on reactions to the status quo when hierarchy-legitimizing ideologies are weak (vs. strong). In 4 studies, participants' preference for the merit principle and hierarchy-legitimizing ideologies were assessed; later, the participants evaluated organizational selection practices that support or challenge the status quo. Participants' prescriptive and descriptive beliefs about merit were separate constructs; only the latter predicted other hierarchy-legitimizing ideologies. In addition, as hypothesized, among participants who weakly endorsed hierarchy-legitimizing ideologies, the stronger their preference for the merit principle, the more they opposed selection practices that were perceived to be merit violating but the more they supported practices that were perceived to be merit restoring. In contrast, those who strongly endorsed hierarchy-legitimizing ideologies were always motivated to support the status quo, regardless of their preference for the merit principle.