A Cross-Sectional Study Investigating Canadian and Australian Adolescents' Perceived Experiences of COVID-19: Gender Differences and Mental Health Implications.

The coronavirus (COVID-19) disease pandemic has been associated with adverse psychological outcomes. This cross-cultural study (N = 1326, 71% female) aimed to investigate Canadian and Australian adolescents' subjective experiences of COVID-19, gender differences, and psychological implications. Mixed-methods analyses were used to examine differences in COVID-19 experiences and mental health outcomes between country and gender in a Canadian (N = 913, 78% female) and an Australian sample (N = 413, 57% female) of adolescents. Canadian adolescents reported increased COVID-19 discussions and more concerns related to their COVID-19 experiences compared to Australian adolescents. Girls consistently reported more concerns related to COVID-19 and poorer psychological outcomes compared to boys. School lockdown for the Canadian sample may have played a role in these country differences. Further, girls might be at significantly more risk for mental health concerns during COVID-19, which should be considered in adolescent mental health initiatives during the pandemic. Although school disruption and separation of peers due to the pandemic likely have a role in adolescent perceived stressors and mental health, the differences between Canadian and Australian adolescents were less clear and future investigations comparing more objective pre-COVID-19 data to current data are needed.

A Mitochondrial Biomarker-Based Study of S-Equol in Alzheimer's Disease Subjects: Results of a Single-Arm, Pilot Trial.

Reductions in bioenergetic fluxes, mitochondrial enzyme activities, and mitochondrial number are observed in Alzheimer's disease (AD). Preclinical work indicates estrogen pathway signaling by either estrogen or selective ß estrogen receptor (ERß) agonists benefits these parameters. To assess whether an ERß agonist could improve mitochondrial function in actual AD subjects, we administered S-equol (10 mg twice daily) to 15 women with AD and determined the platelet mitochondria cytochrome oxidase (COX) activity before initiating S-equol (lead-in), after two weeks of S-equol (active treatment), and two weeks after stopping S-equol (wash-out). Because the intra-individual variation of this enzyme across samples taken at different times was unknown we used a nonparametric, single-arm, dichotomous endpoint that classified subjects whose active treatment COX activity exceeded the average of their lead-in and wash-out measures as positive responders. Eleven positive responses were observed (p < 0.06). The implications of this finding on our null hypothesis (that S-equol does not influence platelet mitochondria COX activity) are discussed. To our knowledge, this is the first time a direct mitochondrial target engagement biomarker has been utilized in an AD clinical study.

Grounded theory - a lens to understanding clinical reasoning.

This article was migrated. The article was marked as recommended. Clinical reasoning is fundamental to medical education and clinical practice ( Schmidt & Mamede, 2015). Despite its centrality, clinical reasoning is often regarded as difficult to conceptualise and teach ( Charlin, 2012; Pinnock & Welch, 2014). The pivotal role of clinical reasoning constitutes a compelling case for better understanding, more efficient teaching and practice that is more systematic and evidence-based. Clinical reasoning has been regarded as an art rather than a science ( Braude, 2012) and has attracted less research effort than befits its important function. The authors examined the suitability of grounded theory methodology to provide a more complete understanding of the clinical reasoning process. Grounded theory and clinical reasoning are processes which both qualitatively evaluate and analyse information from an interview subject as well as additional sources and arrive at a robust, defensible theory to explain their findings. Grounded theory offers considerable utility for (i) understanding and modelling clinical reasoning, (ii) researching clinical reasoning and (iii) as a heuristic for teaching clinical reasoning skills. This paper explores the parallels between grounded theory methodology and clinical reasoning, as well as the suitability of grounded theory as a framework for informing and transforming our understanding of clinical reasoning.

Safety and Tolerability of R(+) Pramipexole in Mild-to-Moderate Alzheimer's Disease.

Alzheimer's disease (AD) is an aging-related, degenerative brain disease of adults. Most (∼95%) of AD occurs sporadically and is associated with early-appearing deficits in brain regional glucose uptake, changes in cerebrospinal fluid (CSF) AD-related proteins, regional brain atrophy, and oxidative stress damage. We treated mild-moderate AD individuals with R(+)-pramipexole-dihydrochloride (R(+)PPX), a neuroprotective, lipophilic-cation, free-radical scavenger that accumulates into brain and mitochondria. 19 subjects took R(+)PPX twice a day in increasing daily doses up to 300 mg/day under a physician-sponsor IND (60,948, JPB), IRB-approved protocol and quarterly external safety committee monitoring. 15 persons finished and contributed baseline and post-treatment serum, lumbar spinal fluid, brain 18F-2DG PET scans, and ADAS-Cog scores. ADAS-Cog scores did not change (n = 1), improved (n = 2), declined 1-3 points (n = 5), or declined 4-13 points (n = 8) over 6 months of R(+)PPX treatment. Serum PPX levels were not related to changes in ADAS-Cog scores. Fasting AM serum PPX levels at 6 months varied considerably across subjects and correlated strongly with CSF [PPX] (r = 0.97, p <  0.0001). CSF [PPX] was not related to CSF [Aß(42)], [Tau], or [P-Tau]. Regional 18F-2DG measures of brain glucose uptake demonstrated a 3-6% decline during R(+)PPX treatment. 56 mild-moderate adverse events occurred, 26 probably/definitely related to R(+)PPX use, with 4 withdrawals. R(+)PPX was generally well-tolerated and entered brain extracellular space linearly. Further studies of R(+)PPX in AD should include a detailed pharmacokinetic study of peak and trough serum [PPX] variations among subjects prior to planning any larger studies that would be needed to determine efficacy in altering disease progression.

A study of statistics anxiety levels of graduate dental hygiene students.

PURPOSE: In light of increased emphasis on evidence-based practice in the profession of dental hygiene, it is important that today's dental hygienist comprehend statistical measures to fully understand research articles, and thereby apply scientific evidence to practice. Therefore, the purpose of this study was to investigate statistics anxiety among graduate dental hygiene students in the U.S. METHODS: A web-based self-report, anonymous survey was emailed to directors of 17 MSDH programs in the U.S. with a request to distribute to graduate students. The survey collected data on statistics anxiety, sociodemographic characteristics and evidence-based practice. Statistic anxiety was assessed using the Statistical Anxiety Rating Scale. Study significance level was α=0.05. RESULTS: Only 8 of the 17 invited programs participated in the study. Statistical Anxiety Rating Scale data revealed graduate dental hygiene students experience low to moderate levels of statistics anxiety. Specifically, the level of anxiety on the Interpretation Anxiety factor indicated this population could struggle with making sense of scientific research. A decisive majority (92%) of students indicated statistics is essential for evidence-based practice and should be a required course for all dental hygienists. CONCLUSION: This study served to identify statistics anxiety in a previously unexplored population. The findings should be useful in both theory building and in practical applications. Furthermore, the results can be used to direct future research.

Learning clinical reasoning.

Errors in clinical reasoning continue to account for significant morbidity and mortality, despite evidence-based guidelines and improved technology. Experts in clinical reasoning often use unconscious cognitive processes that they are not aware of unless they explain how they are thinking. Understanding the intuitive and analytical thinking processes provides a guide for instruction. How knowledge is stored is critical to expertise in clinical reasoning. Curricula should be designed so that trainees store knowledge in a way that is clinically relevant. Competence in clinical reasoning is acquired by supervised practice with effective feedback. Clinicians must recognise the common errors in clinical reasoning and how to avoid them. Trainees can learn clinical reasoning effectively in everyday practice if teachers provide guidance on the cognitive processes involved in making diagnostic decisions.

Thermal fluctuations in shape, thickness, and molecular orientation in lipid bilayers. II. Finite surface tensions.

We investigate the role of lipid chemical potential on the shape, thickness, and molecular orientation (lipid tilting relative to the monolayer surface normal) of lipid bilayers via a continuum-level model. We predict that decreasing the chemical potential at constant temperature, which is associated with an increase in surface tension via the Gibbs-Duhem relation, leads both to the well known reduction in thermal membrane undulations and also to increasing fluctuation amplitudes for bilayer thickness and molecular orientation. These trends are shown to be in good agreement with molecular simulations, however it is impossible to achieve full quantitative agreement between theory and simulation within the confines of the present model. We suggest that the assumption of lipid volume incompressibility, common to our theoretical treatment and other continuum models in the literature, may be partially responsible for the quantitative discrepancies between theory and simulation.

Determining biomembrane bending rigidities from simulations of modest size.

Thermal fluctuations of lipid orientation are analyzed to infer the bending rigidity of lipid bilayers directly from molecular simulations. Compared to the traditional analysis of thermal membrane undulations, the proposed method is reliable down to shorter wavelengths and allows for determination of the bending rigidity using smaller simulation boxes. The requisite theoretical arguments behind this analysis are presented and verified by simulations spanning a diverse range of lipid models from the literature.

The integration of clerkships: WVU's innovative approach to curriculum delivery at a regional campus.

PURPOSE: The purpose of this descriptive paper is to examine the development of West Virginia University School of Medicine's integrated medical school curriculum on a regional campus. BACKGROUND: In 2003, the West Virginia University School of Medicine created a regional campus, the WVU Eastern Division, for third- and fourth-year medical students. The campus is located in a semi-rural area served by 3 small hospitals with lower numbers of physicians than average for West Virginia. Our campus was one of the first models in the United States using an integrated curricular design. CONCLUSIONS: Assessment data suggest that students do as well on high-stakes examinations and have acquired preferred residency placements as well as students who learn in more traditional curricular models. Graduates have also remained to practice in West Virginia's Eastern panhandle, helping to meet the patient care demands of an expanding population. Our experience may help inform future efforts to develop new curricular models for student education.

Thermal fluctuations in shape, thickness, and molecular orientation in lipid bilayers.

We present a unified continuum-level model for bilayer energetics that includes the effects of bending, compression, lipid orientation (tilting relative to the monolayer surface normal), and microscopic noise (protrusions). Expressions for thermal fluctuation amplitudes of several physical quantities are derived. These predictions are shown to be in good agreement with molecular simulations.

The effects of crowding in dendronized polymers.

We present a comprehensive numerical study of the effect of degree of polymerization, generation of dendron growth, length of dendron tether, and dendron grafting density on the conformational statistics of dendronized polymers. This class of supramolecular assembly promises to find application in a number of nanotechnological devices in which their dimensions and conformations are key. We find that the radius of gyration estimates obtained from Brownian dynamics simulations yield to a "Flory" scaling argument in the high degree of polymerization regime and that these data from a range of topologically distinct molecules collapse onto a single curve in this limit. The size of the tethered dendrons serve as the key parameter in the scaling theory. Close examination of the dendrons also reveals some curious trends. In particular, we observe that as the grafting density is increased, spatial packing constraints around the main chain backbone force the dendrons further away from the backbone and compress them, significantly affecting the spatial distribution and accessibility of terminal groups; in contrast to dendrimers, the terminal groups of these molecules display a tendency to partition near the surface at high dendron grafting densities.

Correlations of placental perfusion and PlGF protein expression in early human pregnancy.

OBJECTIVE: The purpose of this study was to investigate temporal correlations between maternal serum placenta growth factor levels and placental perfusion in early human pregnancies. STUDY DESIGN: Systolic umbilical artery Doppler blood flow velocity indices at fetal and placental insertion sites were measured between 7 and 22 weeks of gestation from normal singleton pregnancies. Maternal serum placenta growth factor levels were determined by enzyme-linked immunosorbent assay. RESULTS: Maternal serum placenta growth factor levels showed an exponential increase at approximately 14 weeks of gestation. Placenta perfusion, as estimated by systolic Doppler blood flow indices, significantly increased with gestational age (P < .0001). There was a close association between placenta growth factor expression levels and evidence of increased placenta perfusion (P < .033). CONCLUSION: The significant increase in serum placenta growth factor coincides with the increased perfusion of the maternal/fetal interface at approximately 12 to 14 weeks of gestation. Correlation of placenta growth factor expression and placental perfusion suggests that placenta growth factor may contribute to assuring adequate vascular development/function of the placenta early in gestation.

Dipsogenic diabetes insipidus: report of a novel treatment strategy and literature review.

Dipsogenic diabetes insipidus is a syndrome of disordered thirst, in patients without psychiatric disease, which may be confused with partial central diabetes insipidus. Distinguishing these entities involves monitored water testing. Therapy with antidiuretic hormone in patients with dipsogenic diabetes insipidus is thought to be contraindicated for fear of inducing water intoxication. We report a case of a 26-year-old woman without psychiatric illness referred for longstanding polyuria and polydipsia. Otherwise healthy, she complained of near-constant thirst and frequent urination, causing severe disruption of her personal and professional life. She had been consistently eunatremic and polyuric, with low urine osmolality. Results of extensive water testing revealed intact urinary concentrating and diluting capacity, physiologic though blunted antidiuretic hormone (ADH) release, and an abnormally low thirst threshold, consistent with the diagnosis of dipsogenic diabetes insipidus. To control her polyuria we initiated treatment with intermittent, low-dose, intranasal desmopressin and strict water restriction during drug dosing. In follow-up she reported excellent control of polyuria and significant functional improvement. The reviewed literature demonstrates a limited number of reports about dipsogenic diabetes insipidus, and no prior report of a similar treatment strategy. Dipsogenic diabetes insipidus is an uncommonly (and not universally) recognized disorder, requiring monitored testing in order to distinguish it from incomplete forms of central diabetes insipidus. Though therapy with desmopressin cannot be recommended based on the results of a single case, the outcome presented here is intriguing and suggests that larger studies in such patients is warranted to assess the broader application of such an intervention.

A tunable dendritic molecular actuator.

I present an electroresponsive molecular actuator based upon a diblock copolymer of a positively charged dendrimer and a negatively charged linear chain. Brownian dynamics simulations demonstrate the hybrid polyampholyte's ability to apply a force or assume an equilibrium molecular strain tunable with an applied electric field. The free energy as a function of molecular strain at differing electric field strengths, as obtained via the Jarzynski identity, suggests a phase transition in the hybrid.

Influence of supercoiling on the disruption of dsDNA.

We propose that supercoiling energizes double-stranded DNA (dsDNA) so as to facilitate thermal fluctuations to an unzipped state. We support this with a model of two elastic rods coupled via forces that represent base-pair interactions. Supercoiling is shown to lead to a distention of base pairs over a short span of dsDNA. This enhances the thermal probability for their disruption. The localized region of distention is analogous to a soliton. Our theory permits the development of an analogy between the unzipping transition and a second-order phase transition, for which the possibility of a new set of critical exponents is identified.

A multidisciplinary program for achieving lipid goals in chronic hemodialysis patients.

BACKGROUND: There is little information on how target lipid levels can be achieved in end stage renal disease (ESRD) patients in a systematic, multidisciplinary fashion. METHODS: We retrospectively reviewed a pharmacist-directed hyperlipidemia management program for chronic hemodialysis (HD) patients. All 26 adult patients on chronic HD at a tertiary care medical facility were entered into the program. A clinical pharmacist was responsible for laboratory monitoring, patient counseling, and the initiation and dosage adjustment of an appropriate 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor (statin) using a dosing algorithm and monitoring guidelines. The low-density lipoprotein (LDL) cholesterol goal was leq; 100 mg/dl. A renal dietitian provided nutrition counseling and the nephrologist was notified of potential or existing drug interactions or adverse drug reactions (ADRs). Patients received a flyer containing lipid panel results to encourage compliance. Data was collected at program initiation and for 6 months thereafter. RESULTS: At the start of the program, 58% of patients were at target LDL cholesterol. At 6 months, 88% had achieved target LDL (p = 0.015). Mean LDL cholesterol decreased from 96 +/- 5 to 80 +/- 3 mg/dl (p < 0.01), and mean total cholesterol decreased from 170 +/- 7 to 151 +/- 4 mg/dl (p < 0.01). Fifteen adjustments in drug therapy were made. Eight adverse drug reactions were identified; 2 required drug discontinuation or an alternative agent. Physicians were alerted to 8 potential drug-drug interactions, and appropriate monitoring was performed. CONCLUSIONS: Our findings demonstrate both feasibility and efficacy of a multidisciplinary approach in management of hyperlipidemia in HD patients.

Scleroderma at end stage renal disease in the United States: patient characteristics and survival.

BACKGROUND: The patient characteristics and mortality associated with scleroderma have not been characterized for a national sample of end stage renal disease (ESRD) patients. METHODS: 364,317 patients in the United States Renal Data System initiated on ESRD therapy between 1 January 1992 and 30 June 1997 with valid causes of ESRD were analyzed in an historical cohort study of scleroderma. RESULTS: Of the study population, 820 (0.22%) had scleroderma. The mean age of patients with scleroderma was 56.38 +/- 13.93 years vs. 60.48 +/- 16.51 years for patients with other causes of ESRD (p<0.01 by Student's t-test). In histogram analysis, there were two age peaks: 45-49 and 65-69. In logistic regression, patients with scleroderma, compared to patients with other causes of ESRD, were significantly more likely to be women, Caucasian, younger, and more likely to have congestive heart failure but less likely to have ischemic heart disease, stroke, and receive predialysis erythropoietin. The unadjusted two-year survival of patients with scleroderma during the study period was 49.3% vs. 63.8% in all other patients (adjusted hazard ratio, 1.96, 95% CI 1.70-2.26, p=0.0001 by Cox Regression). CONCLUSIONS: Among patients with ESRD, the demographics of patients with scleroderma were similar to those of patients with scleroderma in the general population. Patients with scleroderma had decreased survival compared to patients with other causes of ESRD, despite being equally likely to be wait listed and receive renal transplantation adjusted for other factors.