Thoracic impedance pneumography in propofol-sedated patients undergoing percutaneous endoscopic gastrostomy (PEG) placement in gastrointestinal endoscopy: A prospective, randomized trial.

STUDY OBJECTIVE: To assess the efficacy of an ECG-based method called thoracic impedance pneumography to reduce hypoxic events in endoscopy. DESIGN: This was a single center, 1:1 randomized controlled trial. SETTING: The trial was conducted during the placement of percutaneous endoscopic gastrostomy (PEG). PATIENTS: 173 patients who underwent PEG placement were enrolled in the present trial. Indication was oncological in most patients (89%). 58% of patients were ASA class II and 42% of patients ASA class III. INTERVENTIONS: Patients were randomized in the standard monitoring group (SM) with pulse oximetry and automatic blood pressure measurement or in the intervention group with additional thoracic impedance pneumography (TIM). Sedation was performed with propofol by gastroenterologists or trained nurses. MEASUREMENTS: Hypoxic episodes defined as SpO2 < 90% for >15 s were the primary endpoint. Secondary endpoints were minimal SpO2, apnea >10s/>30s and incurred costs. MAIN RESULTS: Additional use of thoracic impedance pneumography reduced hypoxic episodes (TIM: 31% vs SM: 49%; p = 0.016; OR 0.47; NNT 5.6) and elevated minimal SpO2 per procedure (TIM: 90.0% ± 8.9; SM: 84.0% ± 17.6; p = 0.007) significantly. Apnea events >10s and > 30s were significantly more often detected in TIM (43%; 7%) compared to SM (1%; 0%; p < 0.001; p = 0.014) resulting in a time advantage of 17 s before the occurrence of hypoxic events. As a result, adjustments of oxygen flow were significantly more often necessary in SM than in TIM (p = 0.034) and assisted ventilation was less often needed in TIM (2%) compared with SM (9%; p = 0.053). Calculated costs for the additional use of thoracic impedance pneumography were 0.13$ (0.12 €/0.11 £) per procedure. CONCLUSIONS: Additional thoracic impedance pneumography reduced the quantity and extent of hypoxic events with less need of assisted ventilation. Supplemental costs per procedure were negligible. KEY WORDS: thoracic impedance pneumography, capnography, sedation, monitoring, gastrointestinal endoscopy, percutaneous endoscopic gastrostomy.

Emerging Alzheimer's disease therapeutics: promising insights from lipid metabolism and microglia-focused interventions.

More than 55 million people suffer from dementia, with this number projected to double every 20 years. In the United States, 1 in 3 aged individuals dies from Alzheimer's disease (AD) or another type of dementia and AD kills more individuals than breast cancer and prostate cancer combined. AD is a complex and multifactorial disease involving amyloid plaque and neurofibrillary tangle formation, glial cell dysfunction, and lipid droplet accumulation (among other pathologies), ultimately leading to neurodegeneration and neuronal death. Unfortunately, the current FDA-approved therapeutics do not reverse nor halt AD. While recently approved amyloid-targeting antibodies can slow AD progression to improve outcomes for some patients, they are associated with adverse side effects, may have a narrow therapeutic window, and are expensive. In this review, we evaluate current and emerging AD therapeutics in preclinical and clinical development and provide insight into emerging strategies that target brain lipid metabolism and microglial function - an approach that may synergistically target multiple mechanisms that drive AD neuropathogenesis. Overall, we evaluate whether these disease-modifying emerging therapeutics hold promise as interventions that may be able to reverse or halt AD progression.

Perception of Saudi undergraduate medical students on telemedicine training and its implementation.

BACKGROUND: The use of telemedicine has increased considerably in healthcare delivery, especially during this time of the coronavirus disease 2019 (COVID-19) pandemic. It has, therefore, become necessary to train medical students to better equip them for this new means of healthcare delivery. The aim of the present study was to assess the perception of undergraduate medical students on telemedicine training. MATERIALS AND METHODS: A cross-sectional study was conducted on a total of 521 undergraduate medical students studying in the Eastern Region of Saudi Arabia. Data were collected via a self-administered pretested questionnaire comprising two main sections: demographics and knowledge and opinions regarding telemedicine training. RESULTS: About 73% students think that the use of telemedicine for patient care will increase in the future, and 59.3% think that the medical students should be trained in telemedicine. Majority of the students (78%) opined that telemedicine training should be optional and 58% said it should be taught during the clinical phase of the undergraduate curriculum. The best telemedicine training course learning objectives medical students opined to be included were: telemedicine practical skills (70.2%), legal aspects of telemedicine practice (68.3%), and potential positive and/or negative use of telemedicine tools and methods (67.6%). Telemedicine skills students would like to learn how to effectively engage patients, knowledge about telemedicine regulations and the consequences of breaching them. CONCLUSION: Medical students are aware of the importance of incorporating telemedicine training into the medical curriculum. Training these students is vital to ensure their competence as physicians in their future clinical careers, that is make them a digitally health-literate future workforce.

How reputation does (and does not) drive people to punish without looking.

Punishing wrongdoers can confer reputational benefits, and people sometimes punish without careful consideration. But are these observations related? Does reputation drive people to people to "punish without looking"? And if so, is this because unquestioning punishment looks particularly virtuous? To investigate, we assigned "Actors" to decide whether to sign punitive petitions about politicized issues ("punishment"), after first deciding whether to read articles opposing these petitions ("looking"). To manipulate reputation, we matched Actors with copartisan "Evaluators," varying whether Evaluators observed i) nothing about Actors' behavior, ii) whether Actors punished, or iii) whether Actors punished and whether they looked. Across four studies of Americans (total n = 10,343), Evaluators rated Actors more positively, and financially rewarded them, if they chose to (vs. not to) punish. Correspondingly, making punishment observable to Evaluators (i.e., moving from our first to second condition) drove Actors to punish more overall. Furthermore, because some of these individuals did not look, making punishment observable increased rates of punishment without looking. Yet punishers who eschewed opposing perspectives did not appear particularly virtuous. In fact, Evaluators preferred Actors who punished with (vs. without) looking. Correspondingly, making looking observable (i.e., moving from our second to third condition) drove Actors to look more overall-and to punish without looking at comparable or diminished rates. We thus find that reputation can encourage reflexive punishment-but simply as a byproduct of generally encouraging punishment, and not as a specific reputational strategy. Indeed, rather than fueling unquestioning decisions, spotlighting punishers' decision-making processes may encourage reflection.

Final Measurement of the

This Letter reports one of the most precise measurements to date of the antineutrino spectrum from a purely ^{235}U-fueled reactor, made with the final dataset from the PROSPECT-I detector at the High Flux Isotope Reactor. By extracting information from previously unused detector segments, this analysis effectively doubles the statistics of the previous PROSPECT measurement. The reconstructed energy spectrum is unfolded into antineutrino energy and compared with both the Huber-Mueller model and a spectrum from a commercial reactor burning multiple fuel isotopes. A local excess over the model is observed in the 5-7 MeV energy region. Comparison of the PROSPECT results with those from commercial reactors provides new constraints on the origin of this excess, disfavoring at 2.0 and 3.7 standard deviations the hypotheses that antineutrinos from ^{235}U are solely responsible and noncontributors to the excess observed at commercial reactors, respectively.

Political (Meta-)Dehumanization in Mental Representations: Divergent Emphases in the Minds of Liberals Versus Conservatives.

We conducted two reverse-correlation studies, as well as two pilot studies reported in the online supplement (total N = 1,411), on the topics of (a) whether liberals and conservatives differ in the types of dehumanization that they cognitively emphasize when mentally representing one another, and if so, (b) whether liberals and conservatives are sensitive to how they are represented in the minds of political outgroup members. Results suggest that partisans indeed differ in the types of dehumanization that they cognitively emphasize when mentally representing one another: whereas conservatives' dehumanization of liberals emphasizes immaturity (vs. savagery), liberals' dehumanization of conservatives more strongly emphasizes savagery (vs. immaturity). In addition, results suggest that partisans may be sensitive to how they are represented. That is, partisans' meta-representations-their representations of how the outgroup represents the ingroup-appear to accurately index the relative emphases of these two dimensions in the minds of political outgroup members.

Neutrophil lymphocyte ratio (NLR) and systemic immune inflammatory index (SII) for the differential diagnosis of CT-negative mild acute ischemic stroke and transient ischemic attack.

Background: A number of acute ischemic stroke (AIS) cases may be misdiagnosed as transient ischemic attack (TIA), due to no infarct on initial computed tomography scan and/or mild deficits upon presentation. Several studies have found that the neutrophil-lymphocyte ratio (NLR) is an accurate differential diagnostic biomarker for AIS versus TIA; however, no study has evaluated the use of the NLR in differentiating CT negative AIS from TIA. Furthermore, the systemic immune-inflammation index (SII) is a relatively novel immune biomarker that has been shown to be positively correlated with AIS severity, poor functional outcomes and mortality. The purpose of this study is to determine if NLR or SII can be used as a diagnostic biomarker for the differential diagnosis of mild AIS with a negative CT upon admission and TIA. Methods: We performed a retrospective medical record review of patients diagnosed with either AIS or TIA. We collected peripheral white blood cell counts within 24 h of symptom onset and calculated the NLR and SII. Logistic regression was utilized to determine if NLR or SII are significant predictors of CT negative mild AIS. Results: CT negative mild AIS patients were 2 times as likely to have an NLR ≥ 2.71 compared to TIA patients, and CT negative mild AIS patients were 2.1 times as likely to have an SII ≥ 595 compared to TIA patients. Conclusion: NLR and SII are easily obtained biomarkers that can be used in early clinical decision making in cases of mild AIS with negative CT scan upon admission.

Autophagy and Its Association with Genetic Mutations in Parkinson Disease.

Parkinson disease is the second most common neurodegenerative disorder, affecting 0.1-0.2% of the general population. It is a progressive debilitating disorder caused by degeneration of dopaminergic neurons in the substantia nigra pars compacta. It is characterized by motor and non-motor symptoms. Parkinson disease can be caused by mutations in genes that encode proteins involved in the autophagic process, resulting in impaired autophagy. Indeed, autophagy has been implicated in the pathogenesis of Parkinson disease, particularly because its impairment causes the buildup of proteins. Thus, this review aims to provide an overview of Parkinson disease-related genetic mutations and their association with autophagy impairment in Parkinson disease, which can be helpful in improving the understanding of the pathogenesis of Parkinson disease, illustrating the potential therapeutic implications of agents that can enhance autophagy in Parkinson disease. Additionally, we will highlight the essential need for the development of highly sensitive and specific assays for gene-based diagnostic biomarkers. Finally, we will provide an overview on the potential gene-based therapeutic approaches for Parkinson disease, which have been most advanced and are associated with the most common targets being alpha-synuclein (SNCA), leucine-rich repeat kinase-2 (LRRK2), and glucocerebrosidase (GBA).

Programmed Cell Death in Diabetic Nephropathy: A Review of Apoptosis, Autophagy, and Necroptosis.

Diabetic nephropathy is a common complication of type I and type II diabetes, in which renal glomeruli are destroyed, resulting in renal damage, proteinuria, and hypertension. Apoptosis, autophagy, and necroptosis are 3 forms of programmed cell death that have been implicated in the pathogenesis of diabetic nephropathy. Apoptosis of podocytes leads to glomerular injury and podocyte depletion, which are associated with proteinuria and glomerular structural damage in diabetic nephropathy. Additionally, epithelial cells in the proximal convoluted tubules also undergo apoptosis in diabetic nephropathy, leading to tubular atrophy, which causes tubular cell depletion and the subsequent formation of atubular glomeruli in association with the loss of renal function. On the other hand, insufficiency of autophagy has been correlated with the pathogenesis of diabetic nephropathy. For instance, decreased autophagic activity has been shown in podocytes of the diabetic kidney, causing variations in podocyte function and subsequent disruption to the glomerular filtration barrier. Furthermore, attenuated autophagic activity has also been demonstrated in proximal tubular cells of the diabetic kidney, resulting in the buildup of impaired molecules and organelles, which are normally broken down by autophagy, leading to proteinuria. Moreover, necroptosis might have a key role in podocyte damage and subsequent decline in diabetic nephropathy. Thus, this article aims to review the mechanisms and effects of programmed cell death in diabetic nephropathy, including the roles of apoptosis, autophagy, and necroptosis.

James H. (Jim) Sidanius (1945-2021).

Memorializes Jim Sidanius (née James Brown [1945-2021]), one of the the foremost social and political psychologists of his generation. His theory of social dominance redefined the scientific study of intergroup relations, advancing novel hypotheses regarding the causes and consequences of intergroup conflict and inequality by integrating insights across the social and biological sciences. Jim's theoretical insights were matched only by his empirical prowess; he was a master at analyzing large data sets with advanced statistical methods, methods that he taught to hundreds of doctoral students over the years in his notoriously challenging but rewarding graduate statistics courses at the University of California, Los Angeles (UCLA), and Harvard. Beyond his teaching of statistics and advanced topics in social psychology and African American studies, Jim mentored dozens of aspiring intergroup relations scholars over a 44-year career. As one of few Black social psychologists, he served as a role model for young Black scholars in particular. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Endurance exercise training suppresses myostatin upregulation and nuclear factor-kappa B activation in a mouse model of Parkinson's disease.

Background and Aim: Muscle atrophy is common in Parkinson's disease (PD). Although myostatin has been implicated in muscle atrophy, its expression in PD skeletal muscle has not been investigated. Therefore, this study aimed to elucidate the influence of PD induction and exercise training on myostatin expression in the gastrocnemius skeletal muscle. Materials and Methods: Thirty albino mice were randomly selected and separated into three groups of 10 mice each: Sedentary control, sedentary PD (SPD), and exercised PD (EPD). 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine and probenecid were used to induce chronic parkinsonism in the PD groups. Immunohistochemistry was used to investigate the expression of myostatin and nuclear factor kappa B (NF-kB) in gastrocnemius muscles of all three groups. Results: Myostatin expression and NF-kB nuclear localization, indicative of its activation, were significantly (p<0.01) higher in gastrocnemius skeletal muscle in the SPD group than in the control and EPD groups. Concomitantly, the average cross-sectional area of gastrocnemius muscle fibers in the SPD albino mice was significantly smaller (p<0.01) than in the control and EPD groups, indicating muscle atrophy. Conclusion: The present data are the first to indicate a correlation between PD induction and myostatin overexpression and NF-kB activation in the gastrocnemius muscle, potentially promoting the muscle atrophy commonly seen in PD. Additionally, the current data are the first to indicate the beneficial effects of exercise training on PD-associated myostatin overexpression, NF-κB activation, and muscle atrophy. Thus, our data are the first to suggest that myostatin and NF-κB might be regarded as potential therapeutic targets in an attempt to ameliorate skeletal muscle abnormalities commonly observed in PD.

Programmed cell death in cerebellar Purkinje neurons.

Apoptosis, autophagy and necrosis are the three main types of programmed cell death. One or more of these types of programmed cell death may take place in neurons leading to their death in various neurodegenerative disorders in humans. Purkinje neurons (PNs) are among the most highly vulnerable population of neurons to cell death in response to intrinsic hereditary diseases or extrinsic toxic, hypoxic, ischemic, and traumatic injury. In this review, we will describe the three main types of programmed cell death, including the molecular mechanisms and the sequence of events in each of them, and thus illustrating the intracellular proteins that mediate and regulate each of these types. Then, we will discuss the role of Ca2+ in PN function and increased vulnerability to cell death. Additionally, PN death will be described in animal models, namely lurcher mutant mouse and shaker mutant rat, in order to illustrate the potential therapeutic implications of programmed cell death in PNs by reviewing the previous studies that were carried out to interfere with the programmed cell death in an attempt to rescue PNs from death.

Dehumanization: trends, insights, and challenges.

Despite our many differences, one superordinate category we all belong to is 'humans'. To strip away or overlook others' humanity, then, is to mark them as 'other' and, typically, 'less than'. We review growing evidence revealing how and why we subtly disregard the humanity of those around us. We then highlight new research suggesting that we continue to blatantly dehumanize certain groups, overtly likening them to animals, with important implications for intergroup hostility. We discuss advances in understanding the experience of being dehumanized and novel interventions to mitigate dehumanization, address the conceptual boundaries of dehumanization, and consider recent accounts challenging the importance of dehumanization and its role in intergroup violence. Finally, we present an agenda of outstanding questions to propel dehumanization research forward.

Apoptosis and its therapeutic implications in neurodegenerative diseases.

Neurodegenerative disorders are characterized by progressive loss of particular populations of neurons. Apoptosis has been implicated in the pathogenesis of neurodegenerative diseases, including Parkinson disease, Alzheimer disease, Huntington disease, and amyotrophic lateral sclerosis. In this review, we focus on the existing notions relevant to comprehending the apoptotic death process, including the morphological features, mediators and regulators of cellular apoptosis. We also highlight the evidence of neuronal apoptotic death in Parkinson disease, Alzheimer disease, Huntington disease, and amyotrophic lateral sclerosis. Additionally, we present evidence of potential therapeutic agents that could modify the apoptotic pathway in the aforementioned neurodegenerative diseases and delay disease progression. Finally, we review the clinical trials that were conducted to evaluate the use of anti-apoptotic drugs in the treatment of the aforementioned neurodegenerative diseases, in order to highlight the essential need for early detection and intervention of neurodegenerative diseases in humans.

A prospective evaluation of the American College of Surgeons Surgical Risk Calculator as a predictor of complications for breast surgery.

BACKGROUND: The infection rates for operative management of breast cancer are often unpredictable and higher than average for a clean surgical procedure (0.8% and 28%). We aimed to assess the effectiveness of the American College of Surgeons (ACS) Surgical Risk Calculator (SRC), a preoperative scoring system to calculate the risk of surgical site infection (SSI) and serious complications following breast surgery. METHODS: Prospective risk scoring using the SRC on 213 patients in the preoperative clinic and the incidence of SSI and serious complications within 30 days postoperatively was prospectively collected. RESULTS: The overall SSI rate in our sample was 5% (n=11/210 patients). For a one-unit increase in SRC score, the odds of having SSI increased by a factor of 1.88 (95% CI 1.33 to 2.74). Odds of developing SSI were higher in patients with high Body Mass Index (OR 1.25; 95% 1.13 to 1.40) and American Society of Anesthesiologists score 3 (OR 11.54; 95% CI 2.98 to 43.65). The odds of developing an SSI were ∼19 times higher if a patient had an SRC score >3.0 versus those with an SRC score <3.0. Only 3% (n=4) of patients who had an SRC score of <3.0 experienced SSI, compared with 33% (n=7) for those with a risk score of >3.0. Out of 210 patients, 9 had serious complications (4.2%). CONCLUSIONS: ACS SRC Score of more than 3 was associated with a higher likelihood of SSI. SRC was able to predict the risk of SSI and serious complications and can be used preoperatively for identification and risk minimisation.

Evaluation of Community Pharmacists' Professional Practice and Management of Patient's Respiratory Conditions.

OBJECTIVES: We assessed the extent of community pharmacists managing respiratory conditions and their ability to make differential diagnoses between the common cold and allergic rhinitis. METHODS: A simulated patient technique was used to achieve the study objectives. Thirty community pharmacies were randomized to be visited by a patient with allergic rhinitis symptoms, followed by a patient with common cold symptoms, and vice versa. One simulated patient visited the 15 pharmacies assigned to allergic rhinitis. Then, after 3-4 days, the pharmacies were revisited by a second simulated patient using the same symptoms; likewise, a simulated patient visited the other 15 pharmacies with common cold symptoms. Then, these pharmacies were revisited by the other simulated patient with the common cold symptoms. Descriptive statistics and correlation analyses were carried out using SPSS at alpha 0.05. RESULTS: Fifteen pharmacies were used for the common cold scenario and 15 for the allergic rhinitis scenario (a total of 30 visits per scenario). Pharmacists showed overall poor skills in asking questions for differential diagnosis between the two conditions. No significant difference was found in the overall differential diagnosis score between the two groups (P = 0.744). The overall adherence to the labeling standard score was low, with an average of 2.38 (standard deviation [SD] = 2.50) out of 11, with no significant difference between the two scenarios (P = 0.332). The overall adherence score to the counseling standard was low, with an average of 2.93 (SD = 3.74) out of 15, with no significant difference between the two scenarios (P = 0.586). CONCLUSION: The simulated patient technique approach revealed a lack of ability of pharmacists in Amman, Jordan, to make differential diagnoses between the common cold and allergic rhinitis. In addition, pharmacists lacked the ability to carry out their role with respect to the management of the common cold and allergic rhinitis, including treatment recommendations, adherence to medicine labeling standards, and adherence to the counseling standard.

Endurance exercise training suppresses Parkinson disease-induced overexpression of apoptotic mediators in the heart.

BACKGROUNDWe have shown elevated levels of p53 and active caspase-3 in the heart with Parkinson disease (PD). The main aim of this study is to examine the effect of treadmill training on the cardiac expression of p53 and active caspase-3 in the mouse with induced Parkinsonism. METHODS: Thirty randomly selected normal albino mice were equally divided into the following 3 groups: sedentary control (SC), sedentary Parkinson diseased (SPD), and exercised Parkinson diseased (EPD). 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine and probenecid (MPTP/p) were used to induce chronic Parkinson disease in the SPD and EPD animals. The expression of p53 and active caspase-3 was investigated, using immunohistochemistry, in the heart in each animal group. RESULTS: Both p53 and active caspase-3 expression was significantly (p value < 0.05) reduced in the PD heart following endurance exercise training. CONCLUSION: Our present data suggest that chronic exercise training reduced PD-induced upregulation of p53 and active caspase-3 in the heart. Thus, our study suggests that inhibiting p53 and/or active caspase-3 may be considered as a therapeutic approach to ameliorate PD cardiomyopathy.

Ideology selectively shapes attention to inequality.

Contemporary debates about addressing inequality require a common, accurate understanding of the scope of the issue at hand. Yet little is known about who notices inequality in the world around them and when. Across five studies (N = 8,779) employing various paradigms, we consider the role of ideological beliefs about the desirability of social equality in shaping individuals' attention to-and accuracy in detecting-inequality across the class, gender, and racial domains. In Study 1, individuals higher (versus lower) on social egalitarianism were more likely to naturalistically remark on inequality when shown photographs of urban scenes. In Study 2, social egalitarians were more accurate at differentiating between equal versus unequal distributions of resources between men and women on a basic cognitive task. In Study 3, social egalitarians were faster to notice inequality-relevant changes in images in a change detection paradigm indexing basic attentional processes. In Studies 4 and 5, we varied whether unequal treatment adversely affected groups at the top or bottom of society. In Study 4, social egalitarians were, on an incentivized task, more accurate at detecting inequality in speaking time in a panel discussion that disadvantaged women but not when inequality disadvantaged men. In Study 5, social egalitarians were more likely to naturalistically point out bias in a pattern detection hiring task when the employer was biased against minorities but not when majority group members faced equivalent bias. Our results reveal the nuances in how our ideological beliefs shape whether we accurately notice inequality, with implications for prospects for addressing it.

Fabrication and characterization of cellulose acetate-based nanofibers and nanofilms for H2S gas sensing application.

Electrospun nanofibers and solution-casting nanofilms were produced from an environmentally friendly cellulose acetate (CA) blended with glycerol (as an ionic liquid (IL)), mixed with polypyrrole (PPy, a conducting polymer) and doped with tungsten oxide (WO3) nanoparticles. The sensing membranes fabricated were used to detect H2S gas at room temperature and shown to exhibit high performance. The results revealed that the lowest operating temperature of both nanofiber and nanofilm sensors was 20 °C, with a minimum gas detection limit of 1 ppm. Moreover, the sensor exhibits a reasonably fast response, with a minimum average response time of 22.8 and 31.7 s for the proposed nanofiber and nanofilm based sensors, respectively. Furthermore, the results obtained indicated an excellent reproducibility, long-term stability, and low humidity dependence. Such distinctive properties coupled with an easy fabrication technique provide a promising potential to achieve a precise monitoring of harmful H2S gas in both indoor and outdoor atmospheres.