Why is concealment associated with health and wellbeing? An investigation of potential mechanisms.

RATIONALE: Many members of stigmatized groups face health and wellbeing deficits relative to their non-stigmatized peers. Ample evidence suggests that one method used by some members of stigmatized groups to manage the stigma they face-concealing their stigmatized identities-may contribute to these health and wellbeing disparities. However, precisely why concealment may contribute to these disparities is less clear. OBJECTIVE: The present work seeks to identify and distinguish between plausible explanations for why concealment may contribute to worse health and wellbeing. METHODS: In the present work, we explore a large number of plausible mechanisms that may explain why concealment is associated with worse health and wellbeing. In three studies (N = 2304) using cross-sectional (Studies 1 and 2) and longitudinal (Study 3) methods, participants were recruited from an online recruitment pool (Studies 1-3) and from an institutional recruitment pool (Study 2). Participants reported on their concealment, health and wellbeing, and constructs related to plausible explanations for the relationships between concealment and health and wellbeing. RESULTS: We find that concealment is associated with worse health and wellbeing, with generally small effect sizes. We further find that lower feelings of belonging, less social support, and lower self-esteem are the most plausible mechanisms for explaining why concealment is associated with worse health and wellbeing. When between- and within-subjects effects were distinguishable (i.e., Study 3), we observed only between-subjects relationships. CONCLUSION: Because people's choices to engage in self-protection through concealment should be respected, potential avenues for intervention to reduce minority health disparities may be more appropriately targeted at the mechanisms that account for why concealment may undermine health and wellbeing than at concealment itself. The present work makes strides towards identifying those mechanisms and thus towards addressing them.

Evaluating the sensitivity of mortality attributable to pollution to modeling Choices: A case study for Colorado.

We evaluated the sensitivity of estimated PM2.5 and NO2 health impacts to varying key input parameters and assumptions including: 1) the spatial scale at which impacts are estimated, 2) using either a single concentration-response function (CRF) or using racial/ethnic group specific CRFs from the same epidemiologic study, 3) assigning exposure to residents based on home, instead of home and work locations for the state of Colorado. We found that the spatial scale of the analysis influences the magnitude of NO2, but not PM2.5, attributable deaths. Using county-level predictions instead of 1 km2 predictions of NO2 resulted in a lower estimate of mortality attributable to NO2 by âˆ¼ 50 % for all of Colorado for each year between 2000 and 2020. Using an all-population CRF instead of racial/ethnic group specific CRFs results in a 130 % higher estimate of annual mortality attributable for the white population and a 40 % and 80 % lower estimate of mortality attributable to PM2.5 for Black and Hispanic residents, respectively. Using racial/ethnic group specific CRFs did not result in a different estimation of NO2 attributable mortality for white residents, but led to âˆ¼ 50 % lower estimates of mortality for Black residents, and 290 % lower estimate for Hispanic residents. Using NO2 based on home instead of home and workplace locations results in a smaller estimate of annual mortality attributable to NO2 for all of Colorado by 2 % each year and 0.3 % for PM2.5. Our results should be interpreted as an exercise to make methodological recommendations for future health impact assessments of pollution.

Triarchic traits as risk versus protective factors for ADHD symptomatology: A prospective longitudinal investigation.

Attention-deficit/hyperactivity disorder (ADHD) symptoms are associated with myriad adverse outcomes, including interpersonal difficulties, but factors that moderate the developmental course and functional impact of ADHD over time are not well understood. The present study evaluated developmental contributions of the triarchic neurobehavioral traits (boldness, meanness, and disinhibition) to ADHD symptomatology and its subdimensions from adolescence to young adulthood. Participants were twins and triplets assessed at ages 14, 17, and 19 (initial N = 1,185, 51.2% female). Path analyses using negative binomial regression revealed that boldness at age 14 was associated with more ADHD symptoms cross-sectionally (especially hyperactivity/impulsivity), but fewer symptoms (especially inattention) at age 19 in the prospective analysis. Notably, inclusion of interpersonal problems at ages 14 and 17 as covariates reduced the latter effect to nonsignificant. Disinhibition concurrently and prospectively predicted higher levels of ADHD symptoms, including both subdimensions, and the prospective effects were partially mediated by greater social impairment at age 17. Meanness prospectively (but not concurrently) predicted higher levels of hyperactivity/impulsivity symptoms. Sex moderated certain associations of meanness and disinhibition with ADHD symptoms. These findings highlight how fundamental neurobehavioral traits shape both psychopathology and adaptive outcomes in the developmental course of ADHD.

Working memory and math skills in children with and without ADHD.

OBJECTIVE: Children with attention-deficit/hyperactivity disorder (ADHD) frequently demonstrate deficits in working memory and in multiple domains of math skills, including underdeveloped problem-solving and computation skills. The Baddeley model of working memory posits a multicomponent system, including a domain-general central executive and two domain-specific subsystems-phonological short-term memory and visuospatial short-term memory. Extant literature indicates a strong link between neurocognitive deficits in working/short-term memory and math skills; however, the extent to which each component of working/short-term memory may account for this relation is unclear. METHOD: The present study was the first to use bifactor (S·I-1) modeling to examine relations between each working/short-term memory subcomponent (i.e., central executive, phonological short-term memory, and visuospatial short-term memory), ADHD symptoms, and math skills in a clinically evaluated sample of 186 children ages 8-13 (Myears = 10.40, SD = 1.49; 62 girls; 69% White/non-Hispanic). RESULTS: Structural equation modeling indicated that all three working/short-term memory components exert a significant and approximately equal effect on latent math skills (ß = .29-.50, all p < .05) and together explain 56% of the variance in children's math achievement (R² = .56). Exploratory analyses indicated that teacher-reported ADHD inattentive symptoms provided a small but significant contribution to predicting latent math skills (ΔR² = .07) and accounted for 24% of the central executive/math association. CONCLUSIONS: These findings suggest that math difficulties in children with ADHD and clinically evaluated children without ADHD are associated, in large part, with their neurocognitive vulnerabilities in working/short-term memory and, to a lesser extent, overt ADHD symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Does Anxiety Systematically Bias Estimates of Executive Functioning Deficits in Pediatric Attention-Deficit/Hyperactivity Disorder?

Growing evidence suggests that childhood ADHD is associated with larger impairments in working memory relative to inhibition. However, most studies have not considered the role of co-occurring anxiety on these estimates - a potentially significant confound given prior evidence that anxiety may increase working memory difficulties but decrease inhibition difficulties for these children. The current study extends prior work to examine the extent to which co-occurring anxiety may be systematically affecting recent estimates of the magnitude of working memory/inhibitory control deficits in ADHD. The carefully-phenotyped sample included 197 children with ADHD and 142 children without ADHD between the ages of 8 and 13 years (N = 339; Mage = 10.31, SD = 1.39; 144 female participants). Results demonstrated that ADHD diagnosis predicted small impairments in inhibitory control (d = 0.31) and large impairments in working memory (d = 0.99). However, child trait anxiety assessed dimensionally across multiple informants (child, parent, teacher) did not uniquely predict either executive function, nor did it moderate estimates of ADHD-related working memory/inhibition deficits. When evaluating anxiety categorically and controlling for ADHD, anxiety diagnosis predicted slightly better working memory (d = 0.19) but not inhibitory control for clinically evaluated children generally. Findings from the current study indicate that trait anxiety, measured dimensionally or categorically, does not differentially affect estimates of executive dysfunction in pediatric ADHD. Further, results suggest that trait anxiety is generally not associated with executive dysfunction above and beyond the impact of co-occurring ADHD. Future research is needed to further assess the role of anxiety in ADHD behavioral symptomatology, neurocognitive functioning, and mechanisms underlying these relations.

Acute cytomegalovirus proctitis and epididymitis acquired via sexual transmission in an immunocompetent patient: a case report.

BACKGROUND: We present a case report of an immunocompetent host with presumed sexually transmitted cytomegalovirus proctitis and epididymitis, where there currently is a sparsity of published data. CASE PRESENTATION: A 21-year-old previously healthy Caucasian individual was admitted for severe rectal and testicular pain in the setting of proctitis and epididymitis. Serology and rectal pathology confirmed acute primary cytomegalovirus infection. CONCLUSIONS: This report details his diagnostic workup and highlights cytomegalovirus as a rare cause of sexually transmitted disease among immunocompetent persons.

Evaluating the Simple View of Reading for Children With Attention-Deficit/Hyperactivity Disorder.

The 'simple view of reading' is an influential model of reading comprehension which asserts that children's reading comprehension performance can be explained entirely by their decoding and language comprehension skills. Children with ADHD often exhibit difficulty across all three of these reading domains on standardized achievement tests, yet it is unclear whether the simple view of reading is sufficient to explain reading comprehension performance for these children. The current study was the first to use multiple indicators and latent estimates to examine the veracity of key predictions from the simple view of reading in a clinically-evaluated sample of 250 children with and without ADHD (ages 8-13, Mage=10.29, SD=1.47; 93 girls; 70% White/Non-Hispanic). Results of the full-sample structural equation model revealed that decoding and language comprehension explained all (R2=.99) of the variance in reading comprehension for children with and without ADHD. Further, multigroup modeling (ADHD, Non-ADHD) indicated that there was no difference in the quantity of variance explained for children with ADHD versus clinically-evaluated children without ADHD, and that the quantity of explained variance did not differ from 100% for either group. Sensitivity analyses indicated that these effects were generally robust to control for monomethod bias, time sampling error, and IQ. These findings are consistent with 'simple view' predictions that decoding and language comprehension are both necessary and together sufficient for explaining children's reading comprehension skills. The findings extend prior work by indicating that the 'simple view' holds for both children with ADHD and clinically-evaluated children without ADHD.

Evaluating reduced-form modeling tools for simulating ozone and PM2.5 monetized health impacts.

Reduced-form modeling approaches are an increasingly popular way to rapidly estimate air quality and human health impacts related to changes in air pollutant emissions. These approaches reduce computation time by making simplifying assumptions about pollutant source characteristics, transport and chemistry. Two reduced form tools used by the Environmental Protection Agency in recent assessments are source apportionment-based benefit per ton (SA BPT) and source apportionment-based air quality surfaces (SABAQS). In this work, we apply these two reduced form tools to predict changes in ambient summer-season ozone, ambient annual PM2.5 component species and monetized health benefits for multiple sector-specific emission control scenarios: on-road mobile, electricity generating units (EGUs), cement kilns, petroleum refineries, and pulp and paper facilities. We then compare results against photochemical grid and standard health model-based estimates. We additionally compare monetized PM2.5 health benefits to values derived from three reduced form tools available in the literature: the Intervention Model for Air Pollution (InMAP), Air Pollution Emission Experiments and Policy Analysis (APEEP) version 2 (AP2) and Estimating Air pollution Social Impact Using Regression (EASIUR). Ozone and PM2.5 changes derived from SABAQS for EGU scenarios were well-correlated with values obtained from photochemical modeling simulations with spatial correlation coefficients between 0.64 and 0.89 for ozone and between 0.75 and 0.94 for PM2.5. SABAQS ambient ozone and PM2.5 bias when compared to photochemical modeling predictions varied by emissions scenario: SABAQS PM2.5 changes were overpredicted by up to 46% in one scenario and underpredicted by up to 19% in another scenario; SABAQS seasonal ozone changes were overpredicted by 34% to 83%. All tools predicted total PM2.5 benefits within a factor of 2 of the full-form predictions consistent with intercomparisons of reduced form tools available in the literature. As reduced form tools evolve, it is important to continue periodic comparison with comprehensive models to identify systematic biases in estimating air pollution impacts and resulting monetized health benefits.

A preliminary 'shortlist' of individual, family, and social-community assets to promote resilience in pediatric ADHD.

BACKGROUND: Understanding factors that promote resilience in pediatric ADHD is important though highly understudied. AIMS: The current study sought to provide a preliminary 'shortlist' of key individual, family, and social-community assets among children with ADHD. METHODS AND PROCEDURES: The study included well-characterized, clinically-evaluated samples of children with (n=108) and without ADHD (n=98) ages 8-13 years (M=10.31; 41.3% girls; 66.5% White/Non-Hispanic). All subsets regression and dominance analysis identified the subset of predictors that accounted for the most variance in broad-based resilience for children with ADHD and their relative importance. Findings were compared for children with versus without ADHD as preliminary evidence regarding the extent to which identified assets are promotive, protective, or conditionally helpful. OUTCOMES AND RESULTS: Higher levels of peer acceptance, social skills, and academic performance were top predictors of resilience among children with ADHD. Better child working memory, attention, higher levels of hyperactivity, older age, and fewer parent self-reported mental health concerns were also identified as predictors of resilience in ADHD. Both overlapping and unique factors were associated with resilience for children with versus without ADHD. Conclusions and Results: These results, if replicated, provide a strong preliminary basis for strength-based basic/applied research on key assets that promote resilience in ADHD.

Urinary Tract Infection Epidemiology in NICUs in the United States.

OBJECTIVE: Our objective was to characterize the incidence, associated clinical factors, timing of infection, microbiology, and incidence of concordant blood culture of urinary tract infections (UTIs) in very low birth weight (VLBW <1,500g) infants. STUDY DESIGN: Multicenter observational cohort study of VLBW infants with gestational age (GA) ≤32 weeks, still hospitalized on postnatal day 7, and discharged 2010 to 2018 from Pediatrix Medical Group neonatal intensive care units. Demographic and clinical characteristics of infants with and without UTI were compared. Multivariable logistic regression evaluated adjusted odds of UTI diagnosis. RESULTS: Of 86,492 included infants, 5,988 (7%) had a UTI. The most common pathogen was Enterococcus spp. (20%), followed by Escherichia coli (19%) and Klebsiella spp. (18%). Candida spp. (6%) was the most common nonbacterial pathogen. Concordant-positive blood culture was present in 8% of infants with UTI diagnoses. UTI was associated with lower GA, male sex, vaginal delivery, prenatal steroid exposure, and longer duration of hospitalization. CONCLUSION: UTI is a common cause of infection in VLBW infants, especially among the smallest, most premature, male infants, and those with a longer duration of hospitalization. Neonatal clinicians should consider obtaining urine culture in the setting of late-onset sepsis evaluations in VLBW infants. KEY POINTS: · UTI is a common cause of LOS in VLBW infants.. · The most common pathogens are Enterococcus spp. and E. coli.. · UTI risk varies among different VLBW infant populations.. · Next steps should include evaluation of preventative measures..

Central executive training for ADHD: Impact on organizational skills at home and school. A randomized controlled trial.

OBJECTIVE: The current randomized controlled trial (RCT) was the first to examine the benefits of central executive training (CET, which trains the working components of working memory [WM]) for reducing organizational skills difficulties relative to a carefully matched neurocognitive training intervention (inhibitory control training [ICT]). METHOD: A carefully phenotyped sample of 73 children with attention-deficit/hyperactivity-impulsivity disorder (ADHD; ages 8-13, M = 10.15, SD = 1.43; 20 girls; 73% White/Non-Hispanic) participated in a preregistered RCT of CET versus ICT (both 10-week treatments). Parent-rated task planning, organized actions, and memory/materials management data were collected at pretreatment, posttreatment, and 2-4 month follow-up; teacher ratings were obtained at pretreatment and 1-2 month follow-up. RESULTS: CET was superior to ICT for improving organizational skills based on teacher report (Treatment × Time interaction: d = 0.61, p = .01, BF10 = 31.61). The CET group also improved significantly based on parent report, but this improvement was equivalent in both groups (main effect of time: d = 0.48, p < .001, BF10 = 3.13 × 107; Treatment × Time interaction: d = 0.29, p = .25, BF01 = 3.73). Post hocs/preregistered planned contrasts indicated that CET produced significant and clinically meaningful (number needed to treat = 3-8) pre/post gains on all three parent (d = 0.50 -0.62) and all three teacher (d = 0.46 -0.95) subscales, with gains that were maintained at 1-2 month (teacher report) and 2-4 month follow-up (parent report) for five of six outcomes. CONCLUSIONS: Results provide strong initial evidence that CET produces robust and lasting downstream improvements in school-based organizational skills for children with ADHD based on teacher report. These findings are generally consistent with model-driven predictions that ADHD-related organizational problems are secondary outcomes caused, at least in part, by underdeveloped working memory abilities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Veterinary Curriculum Leaders: Motivators, Barriers, and Attributes.

Curriculum leaders (individuals with responsibility for an institution's veterinary curriculum) play a vital role in driving local curriculum priorities, development, and accreditation. This study aimed to describe the career paths of curriculum leaders, and identify what motivates them, the barriers they face, and the knowledge, skills, and attributes they perceive as essential for the role. Self-determination theory was used to identify tensions experienced within the role. An international online survey targeted at those identifying as curriculum leaders was completed by 45 participants. 91% of participants held a doctoral level qualification and/or clinical Boards; 82% had additional training in leadership; 38% had additional formal training in education. Motivators included a desire to make a difference, personal satisfaction with teaching and working with students, and social influences. Participants experienced barriers relating to self-development and achievement of their curriculum goals; participants described essential knowledge (of the profession, educational theory, and wider higher education context) and skills (leading teams, change management, and communication). Attributes considered important related both to self (open-minded, patient, resilient, able to see the big picture as well as detail) and relationships with others (approachable, listener, respectful and respected, supportive, credible). Tensions arose in participants' need for autonomy (experiencing barriers to achieving their goals), in their social relatedness (achieving curriculum goals while working with colleagues with conflicting priorities), and in perceptions of necessary competence (a need, but lack of opportunity, for advanced training in educational theory). The findings may help institutions more effectively support and train current and future curriculum leaders.

CLOCK and TIMELESS regulate rhythmic occupancy of the BRAHMA chromatin-remodeling protein at clock gene promoters.

Circadian clock and chromatin-remodeling complexes are tightly intertwined systems that regulate rhythmic gene expression. The circadian clock promotes rhythmic expression, timely recruitment, and/or activation of chromatin remodelers, while chromatin remodelers regulate accessibility of clock transcription factors to the DNA to influence expression of clock genes. We previously reported that the BRAHMA (BRM) chromatin-remodeling complex promotes the repression of circadian gene expression in Drosophila. In this study, we investigated the mechanisms by which the circadian clock feeds back to modulate daily BRM activity. Using chromatin immunoprecipitation, we observed rhythmic BRM binding to clock gene promoters despite constitutive BRM protein expression, suggesting that factors other than protein abundance are responsible for rhythmic BRM occupancy at clock-controlled loci. Since we previously reported that BRM interacts with two key clock proteins, CLOCK (CLK) and TIMELESS (TIM), we examined their effect on BRM occupancy to the period (per) promoter. We observed reduced BRM binding to the DNA in clk null flies, suggesting that CLK is involved in enhancing BRM occupancy to initiate transcriptional repression at the conclusion of the activation phase. Additionally, we observed reduced BRM binding to the per promoter in flies overexpressing TIM, suggesting that TIM promotes BRM removal from DNA. These conclusions are further supported by elevated BRM binding to the per promoter in flies subjected to constant light and experiments in Drosophila tissue culture in which the levels of CLK and TIM are manipulated. In summary, this study provides new insights into the reciprocal regulation between the circadian clock and the BRM chromatin-remodeling complex.

Are Reading Interventions Effective for At-Risk Readers with ADHD? A Meta-Analysis.

OBJECTIVE: Utilizing a multi-level meta-analytic approach, this review is the first to systematically quantify the efficacy of reading interventions for school-aged children with ADHD and identify potential factors that may increase the success of reading-related interventions for these children. METHOD: 18 studies (15 peer-reviewed articles, 3 dissertations) published from 1986 to 2020 (N = 564) were meta-analyzed. RESULTS: Findings revealed reading interventions are highly effective for improving reading skills based on both study-developed/curriculum-based measures (g = 1.91) and standardized/norm-referenced achievement tests (g = 1.11) in high-quality studies of children with rigorously-diagnosed ADHD. Reading interventions that include at least 30 hours of intervention targeting decoding/phonemic awareness meet all benchmarks to be considered a Level 1 (Well-Established) Evidence-Based Practice with Strong Research Support for children with ADHD based on clinical and special education criteria. CONCLUSIONS: Our findings collectively indicate that reading interventions should be the first-line treatment for reading difficulties among at-risk readers with ADHD.

PM2.5-Attributable Mortality Burden Variability in the Continental U.S.

Epidemiologic studies have consistently observed associations between fine particulate matter (PM2.5) exposure and premature mortality. These studies use air quality concentration information from a combination of sources to estimate pollutant exposures and then assess how mortality varies as a result of differing exposures. Health impact assessments then typically use a single log-linear hazard ratio (HR) per health outcome to estimate counts of avoided human health effects resulting from air quality improvements. This paper estimates the total PM2.5-attributable premature mortality burden using a variety of methods for estimating exposures and quantifying PM2.5-attributable deaths in 2011 and 2028. We use: 1) several exposure models that apply a wide range of methods, and 2) a variety of HRs from the epidemiologic literature that relate long-term PM2.5 exposures to mortality among the U.S. population. We then further evaluate the variability of aggregated national premature mortality estimates to stratification by race and/or ethnicity or exposure level (e.g., below the current annual PM2.5 National Ambient Air Quality Standards). We find that unstratified annual adult mortality burden incidence estimates vary more (e.g., ~3-fold) by HR than by exposure model (e.g., <10%). In addition, future mortality burden estimates stratified by race/ethnicity are larger than the unstratified estimates of the entire population, and studies that stratify PM2.5-attributable mortality HRs by an exposure concentration threshold led to substantially higher estimates. These results are intended to provide transparency regarding the sensitivity of mortality estimates to upstream input choices.

Does central executive training and/or inhibitory control training improve emotion regulation for children with attention-deficit/hyperactivity disorder? A randomized controlled trial.

Introduction: Approximately 48-54% of children with attention-deficit/hyperactivity disorder (ADHD) have impairing difficulties with emotion regulation, and these difficulties are not ameliorated by first-line ADHD treatments. Working memory and inhibitory control represent promising intervention targets given their functional, if not causal, links with ADHD-related emotion dysregulation. Methods: This preregistered randomized controlled trial tested whether two digital therapeutic training protocols that have been previously shown to improve working memory (Central Executive Training [CET]) and inhibitory control (Inhibitory Control Training [ICT]) can improve emotion regulation in a sample of 94 children with ADHD aged 8-13 years (M = 10.22, SD = 1.43; 76% White/non-Hispanic; 29 girls). Results: Results of Bayesian mixed model ANOVAs indicated both treatment groups demonstrated significant decreases in emotion dysregulation relative to pre-treatment at immediate post-treatment (parent report; d = 1.25, BF10 = 8.04 × 1013, p < 0.001), at 1-2 months after completing treatment (teacher report; d = 0.99, BF10 = 1.22 × 106, p < 0.001), and at 2-4-months follow-up (parent report; d = 1.22, BF10 = 1.15 × 1014, p < 0.001). Contrary to our hypotheses, the CET and ICT groups demonstrated equivalent reductions in emotion dysregulation and maintenance of effects. Exploratory analyses revealed that results were robust to control for informant expectancies, ADHD medication status/changes, in-person vs. at-home treatment, child age, and time from treatment completion to post-treatment ratings. Discussion: To determine whether working memory and inhibitory control are causally linked with ADHD-related emotion dysregulation, future studies should include active control conditions that do not train executive functions prior to making decisions about the clinical utility of CET/ICT for the treatment of emotion dysregulation in ADHD. Clinical trial registration: [https://clinicaltrials.gov/], identifier [NCT03324464].

Novel application of intravascular lithotripsy in stent under-expansion: A single-center experience.

INTRODUCTION: Stent under-expansion due to calcification is associated with a less durable result. The development of intravascular lithotripsy (IVL) has provided clinicians with a readily available, simple-to-use treatment option for coronary calcification, but the use of IVL within a previously stented segment is currently off-license. There are, however, developing data suggesting that the use of IVL can be an effective treatment option for patients with calcific stent under-expansion. METHOD: This was a single-center study of all patients treated with IVL for calcific stent under-expansion between January 2019 and June 2021. The impact of IVL on quantitative coronary angiography (QCA) stenosis and on the minimal stent area (MSA) derived from intracoronary imaging were recorded. The presence of periprocedural complications and adverse cardiovascular events was obtained from the clinical record during the study timeframe. RESULTS: Thirty-nine patients underwent IVL for calcific stent under-expansion during the study time frame with one patient treated with more than one lesion in the same session. In all lesions, there was an improvement in the QCA stenosis with 37 (92.5%) having a residual stenosis of ≤30%. The mean QCA stenosis pre-IVL was 68 ± 21% and following IVL the mean QCA was 18 ± 9% (p < 0.001). In all lesions, there was an improvement in the MSA, with 26 (92.9%) achieving an MSA of more than 4.5 mm2 . The mean MSA pre-IVL was 3.88 ± 1.51 mm2 and following IVL the mean MSA was 7.41 ± 2.34 mm2 (p < 0.001). There were no major procedural complications. Over a mean follow-up of 506 ± 277 days, one patient died from ventricular arrhythmia but there were no other major adverse cardiovascular events. CONCLUSION: This single-center study demonstrates that IVL is a safe and effective treatment for calcific stent under-expansion with good medium-term results.

Professional Identity of Pakistani Veterinary Students: Conceptualization and Negotiation.

Most work on the professional identity of veterinary and medical professionals has been conceptualized in the USA and Europe. It reports professional identity formation to be highly individualized, triggered by experiences of identity distress, and identity negotiation strategies to be generally focused around personal reflection. However, within Asia, important sociocultural differences exist that might influence professional identity and its development. Societal values may take precedence over individual ones, and some cultures consider the veterinary profession as stigmatized. With this background, we seek to understand professional identity and its construction in Pakistani veterinary students. We selected five students through purposive sampling and invited them for narrative interviews. Social identity theory and Maslow's theory of hierarchy of needs predominantly contributed to the theoretical framework, which together with principles of social phenomenology and narrative analysis informed qualitative analysis of the transcribed interviews using an in-depth approach. We found that students' professional identity was predominantly socially constructed, though their sense of their identity was not very well developed. Role models, social stigma, professional socialization in clinical settings, gender, and to some extent, cultural interpretations of religious messages seemed to mediate professional identity development. Students responded differently to their understanding of professional stigma, making sense of stigma through strategies such as denial or internalization. Since Pakistani veterinary students experience social and personal values differently compared to those from predominantly individualistic cultures, identity formation through reflecting on personal values may be less effective than strategies that emphasize social learning and beliefs.

Allosteric potentiation of GABAA receptor single-channel conductance by netrin-1 during neuronal-excitation-induced inhibitory synaptic homeostasis.

As the principal receptor that mediates both synaptic and tonic inhibition of neurons in the brain, the A-type gamma-aminobutyric acid receptor (GABAAR) is functionally important for maintaining the balance between neuronal excitation and inhibition. Here, we report the identification of netrin-1 as an endogenous allosteric modulator of GABAARs. Following increased neuronal excitability, netrin-1 is secreted and binds to the extracellular domains of GABAAR subunits, thereby inducing homeostatic upscaling of GABAAR-mediated synaptic efficacy and currents. Surprisingly, this homeostatic plasticity is primarily mediated by increasing GABAAR single-channel conductance. Our study reveals an important role of netrin-1 as an endogenous GABAAR allosteric modulator in maintaining neuronal excitation-inhibition balance, a fundamental process for brain function and dysfunction.

Sex-based differences in referral of heart failure patients to outpatient clinics: a scoping review.

BACKGROUND: Guidelines recommend that hospitalized patients newly diagnosed with HF be referred to an outpatient HF clinic (HFC) within 2 weeks of discharge. Our study aims were (i) to assess the current literary landscape on the impact of patient sex on HFC referral and outcomes and (ii) to provide a qualitative overview of possible considerations for the impact of sex on referral patterns and HF characteristics including aetiology, symptom severity, investigations undertaken and pharmacologic therapy. METHODS AND RESULTS: We conducted a scoping review using the Arksey and O'Malley framework and searched Medline, EMBASE, PsychINFO, Cochrane Library, Ageline databases and grey literature. Eligible articles included index HF hospitalizations or presentations to the Emergency Department (ED), a description of the HFC referral of patients not previously followed by an HF specialist and sex-specific analysis. Of the 11 372 potential studies, 8 met the inclusion criteria. These studies reported on a total of 11 484 participants, with sample sizes ranging between 168 and 3909 (25.6%-50.7% female). The included studies were divided into two groups: (i) those outlining the referral process to an HFC and (ii) studies which include patients newly enrolled in an HFC. Of the studies in Group 1, males (51%-82.4%) were more frequently referred to an HFC compared with females (29%-78.1%). Studies in Group 2 enrolled a higher proportion of males (62%-74% vs. 26%-38%). One study identified independent predictors of HFC referral which included male sex, younger age, and the presence of systolic dysfunction, the latter two more often found in males. Two studies, one from each group reported a higher mortality amongst males compared with females, whereas another study from Group 2 reported a higher hospitalization rate amongst females following HFC assessment. CONCLUSIONS: Males were more likely than females to be referred to HFCs after hospitalization and visits to the Emergency Department, however heterogeneity across studies precluded a robust assessment of sex-based differences in outcomes. This highlights the need for more comprehensive longitudinal data on HF patients discharged from the acute care setting to better understand the role of sex on patient outcomes.