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Recent work has identified a critical role for the hippocampus in reward-sensitive behaviors, including motivated memory, reinforcement learning, and decision-making. Animal histology and human functional neuroimaging have shown that brain regions involved in reward processing and motivation are more interconnected with the ventral/anterior hippocampus. However, direct evidence examining gradients of structural connectivity between reward regions and the hippocampus in humans is lacking. The present study used diffusion MRI (dMRI) and probabilistic tractography to quantify the structural connectivity of the hippocampus with key reward processing regions in vivo. Using a large sample of subjects (N = 628) from the human connectome dMRI data release, we found that connectivity profiles with the hippocampus varied widely between different regions of the reward circuit. While the dopaminergic midbrain (ventral tegmental area) showed stronger connectivity with the anterior versus posterior hippocampus, the ventromedial prefrontal cortex showed stronger connectivity with the posterior hippocampus. The limbic (ventral) striatum demonstrated a more homogeneous connectivity profile along the hippocampal long axis. This is the first study to generate a probabilistic atlas of the hippocampal structural connectivity with reward-related networks, which is essential to investigating how these circuits contribute to normative adaptive behavior and maladaptive behaviors in psychiatric illness. These findings describe nuanced structural connectivity that sets the foundation to better understand how the hippocampus influences reward-guided behavior in humans.
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Conectoma , Hipocampo , Vias Neurais , Recompensa , Humanos , Hipocampo/diagnóstico por imagem , Hipocampo/fisiologia , Masculino , Feminino , Adulto , Vias Neurais/fisiologia , Vias Neurais/diagnóstico por imagem , Adulto Jovem , Imagem de Difusão por Ressonância Magnética , Área Tegmentar Ventral/diagnóstico por imagem , Área Tegmentar Ventral/fisiologia , Imagem de Tensor de Difusão , Córtex Pré-Frontal/diagnóstico por imagem , Córtex Pré-Frontal/fisiologia , Estriado Ventral/diagnóstico por imagem , Estriado Ventral/fisiologiaRESUMO
Many female squids and cuttlefishes have a symbiotic reproductive organ called the accessory nidamental gland (ANG) that hosts a bacterial consortium involved with egg defense against pathogens and fouling organisms. While the ANG is found in multiple cephalopod families, little is known about the global microbial diversity of these ANG bacterial symbionts. We used 16S rRNA gene community analysis to characterize the ANG microbiome from different cephalopod species and assess the relationship between host and symbiont phylogenies. The ANG microbiome of 11 species of cephalopods from four families (superorder: Decapodiformes) that span seven geographic locations was characterized. Bacteria of class Alphaproteobacteria, Gammaproteobacteria, and Flavobacteriia were found in all species, yet analysis of amplicon sequence variants by multiple distance metrics revealed a significant difference between ANG microbiomes of cephalopod families (weighted/unweighted UniFrac, Bray-Curtis, P = 0.001). Despite being collected from widely disparate geographic locations, members of the family Sepiolidae (bobtail squid) shared many bacterial taxa including (~50%) Opitutae (Verrucomicrobia) and Ruegeria (Alphaproteobacteria) species. Furthermore, we tested for phylosymbiosis and found a positive correlation between host phylogenetic distance and bacterial community dissimilarity (Mantel test r = 0.7). These data suggest that closely related sepiolids select for distinct symbionts from similar bacterial taxa. Overall, the ANGs of different cephalopod species harbor distinct microbiomes and thus offer a diverse symbiont community to explore antimicrobial activity and other functional roles in host fitness.IMPORTANCEMany aquatic organisms recruit microbial symbionts from the environment that provide a variety of functions, including defense from pathogens. Some female cephalopods (squids, bobtail squids, and cuttlefish) have a reproductive organ called the accessory nidamental gland (ANG) that contains a bacterial consortium that protects eggs from pathogens. Despite the wide distribution of these cephalopods, whether they share similar microbiomes is unknown. Here, we studied the microbial diversity of the ANG in 11 species of cephalopods distributed over a broad geographic range and representing 15-120 million years of host divergence. The ANG microbiomes shared some bacterial taxa, but each cephalopod species had unique symbiotic members. Additionally, analysis of host-symbiont phylogenies suggests that the evolutionary histories of the partners have been important in shaping the ANG microbiome. This study advances our knowledge of cephalopod-bacteria relationships and provides a foundation to explore defensive symbionts in other systems.
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Cefalópodes , Microbiota , Humanos , Animais , Feminino , Cefalópodes/genética , Filogenia , RNA Ribossômico 16S/genética , Decapodiformes/microbiologia , Genitália/microbiologia , Bactérias/genética , SimbioseRESUMO
INTRODUCTION: Female patients frequently experience worse clinical outcomes than male patients after undergoing vascular surgery procedures. However, it is unclear whether these sex-based disparities also impact mental health outcomes. This study was designed to investigate sex differences in patient-reported outcome measures of depression for patients undergoing vascular surgery. METHODS: We retrospectively analyzed 107 patients (73 males and 34 females) who underwent vascular surgery procedures between January 2016 and April 2023. These patients completed a Patient-Reported Outcome Measurement Information System (PROMIS) Item Bank v1.0-Depression assessment 90 d before surgery and at least once after surgery. After stratifying patients by sex, we analyzed changes in PROMIS depression scores using a multiple mixed-effects linear regression model. Then, logistic regression was used to compare the proportion of patients who achieved a clinically meaningful difference in PROMIS depression score within 15 mo after surgery. RESULTS: There was no significant difference between female and male patients among rates of complications, length of hospital stay, or rates of nonhome discharge. However, female sex was associated with significantly improved PROMIS depression scores after surgery compared to male sex (P = 0.034). Furthermore, female patients were over 3-fold more likely than male patients to reach the minimal clinically important difference threshold for improvement in PROMIS depression scores (odds ratio 4.66, 95% confidence interval 1.39-15.61). CONCLUSIONS: These results suggest that female sex is associated with improved patient-reported measures of depression after undergoing vascular surgery. Clinicians should consider these mental health benefits when evaluating female patients for vascular interventions.
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Motivation is a powerful driver of learning and memory. Functional MRI studies show that interactions among the dopaminergic midbrain substantia nigra/ventral tegmental area (SN/VTA), hippocampus, and nucleus accumbens (NAc) are critical for motivated memory encoding. However, it is not known whether these effects are transient and purely functional, or whether individual differences in the structure of this circuit underlie motivated memory encoding. To quantify individual differences in structure, diffusion-weighted MRI and probabilistic tractography were used to quantify SN/VTA-striatum and SN/VTA-hippocampus pathways associated with motivated memory encoding in humans. Male and female participants completed a motivated source memory paradigm. During encoding, words were randomly assigned to one of three conditions, reward ($1.00), control ($0.00), or punishment (-$1.00). During retrieval, participants were asked to retrieve item and source information of the previously studied words and were rewarded or penalized according to their performance. Source memory for words assigned to both reward and punishment conditions was greater than those for control words, but there were no differences in item memory based on value. Anatomically, probabilistic tractography results revealed a heterogeneous, topological arrangement of the SN/VTA. Tract density measures of SN/VTA-hippocampus pathways were positively correlated with individual differences in reward-and-punishment-modulated memory performance, whereas density of SN/VTA-striatum pathways showed no association. This novel finding suggests that pathways emerging from the human SV/VTA are anatomically separable and functionally heterogeneous. Individual differences in structural connectivity of the dopaminergic hippocampus-VTA loop are selectively associated with motivated memory encoding.SIGNIFICANCE STATEMENT Functional MRI studies show that interactions among the SN/VTA, hippocampus, and NAc are critical for motivated memory encoding. This has led to competing theories that posit either SN/VTA-NAc reward prediction errors or SN/VTA-hippocampus signals underlie motivated memory encoding. Additionally, it is not known whether these effects are transient and purely functional or whether individual differences in the structure of these circuits underlie motivated memory encoding. Using diffusion-weighted MRI and probabilistic tractography, we show that tract density measures of SN/VTA-hippocampus pathways are positively correlated with motivated memory performance, whereas density of SN/VTA-striatum pathways show no association. This finding suggests that anatomic individual differences of the dopaminergic hippocampus-VTA loop are selectively associated with motivated memory encoding.
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Hipocampo , Área Tegmentar Ventral , Feminino , Humanos , Masculino , Dopamina/metabolismo , Hipocampo/metabolismo , Imageamento por Ressonância Magnética , Mesencéfalo/diagnóstico por imagem , Mesencéfalo/metabolismo , Recompensa , Substância Negra/diagnóstico por imagem , Substância Negra/metabolismo , Área Tegmentar Ventral/diagnóstico por imagem , Área Tegmentar Ventral/metabolismoRESUMO
Highlighting the importance of sex as a biological variable, we recently reported sex differences in guinea pig in vivo electrocardiogram (ECG) measurements. However, substantial inconsistencies exist in this animal model, with conflicting reports of sex-specific differences in cardiac electrophysiology observed in vivo and in vitro. Herein, we evaluated whether sexual dimorphism persists in ex vivo preparations, using an isolated intact heart preparation. Pseudo-ECG recordings were collected in conjunction with dual optical mapping of transmembrane voltage and intracellular calcium from Langendorff-perfused hearts. In contrast to our in vivo results, we did not observe sex-specific differences in ECG parameters collected from isolated hearts. Furthermore, we observed significant age-specific differences in action potential duration (APD) and Ca2+ transient duration (CaD) during both normal sinus rhythm (NSR) and in response to dynamic pacing but only a modest sex-specific difference in CaD30. Similarly, the alternans fluctuation coefficient, conduction velocity during sinus rhythm or in response to pacing, and electrophysiology parameters (atrioventricular nodal effective refractory period, Wenckebach cycle length) were comparable between males and females. Results of our study suggest that the observed sex-specific differences in in vivo ECG parameters from guinea pigs are diminished in ex vivo isolated heart preparations, although age-specific patterns are prevalent. To assess sex as a biological variable in cardiac electrophysiology, a comprehensive approach may be necessary using both in vitro measurements from cardiomyocyte or intact heart preparations with secondary follow-up in vivo studies.NEW & NOTEWORTHY We evaluated whether the guinea pig heart has intrinsic sex-specific differences in cardiac electrophysiology. Although we observed sex-specific differences in in vivo ECGs, these differences did not persist ex vivo. Using a whole heart model, we observed similar APD, CaD, conduction velocity, and alternans susceptibility in males and females. We conclude that sex-specific differences in guinea pig cardiac electrophysiology are likely influenced by the in vivo environment and less dependent on the intrinsic electrical properties of the heart.
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Técnicas Eletrofisiológicas Cardíacas , Sistema de Condução Cardíaco , Cobaias , Feminino , Animais , Masculino , Coração/fisiologia , Eletrocardiografia , Miócitos Cardíacos/fisiologia , Arritmias Cardíacas , Potenciais de AçãoRESUMO
BACKGROUND: Capture of cancer stage at diagnosis is important yet poorly reported by health services to population-based cancer registries. In this paper we describe current completeness of stage information for endometrial cancer available in Australian cancer registries; and develop and validate a set of rules to enable cancer registry medical coders to calculate stage using data available to them (registry-derived stage or 'RD-Stage'). METHODOLOGY: Rules for deriving RD-stage (Endometrial carcinoma) were developed using the American Joint Commission on Cancer (AJCC) TNM (tumour, nodes, metastasis) Staging System (8th Edition). An expert working group comprising cancer specialists responsible for delivering cancer care, epidemiologists and medical coders reviewed and endorsed the rules. Baseline completeness of data fields required to calculate RD-Stage, and calculation of the proportion of cases for whom an RD stage could be assigned, was assessed across each Australian jurisdiction. RD-Stage (Endometrial cancer) was calculated by Victorian Cancer Registry (VCR) medical coders and compared with clinical stage recorded by the patient's treating clinician and captured in the National Gynae-Oncology Registry (NGOR). RESULTS: The necessary data completeness level for calculating RD-Stage (Endometrial carcinoma) across various Australian jurisdictions varied from 0 to 89%. Three jurisdictions captured degree of spread of cancer, rendering RD-Stage unable to be calculated. RD-Stage (Endometrial carcinoma) could not be derived for 64/485 (13%) cases and was not captured for 44/485 (9%) cases in NGOR. At stage category level (I, II, III, IV), there was concordance between RD-Stage and NGOR captured stage in 393/410 (96%) of cases (95.8%, Kendall's coefficient = 0.95). CONCLUSION: A lack of consistency in data captured by, and data sources reporting to, population-based cancer registries meant that it was not possible to provide national endometrial carcinoma stage data at diagnosis. In a sample of Victorian cases, where surgical pathology was available, there was very good concordance between RD-Stage (Endometrial carcinoma) and clinician-recorded stage data available from NGOR. RD-Stage offers promise in capturing endometrial cancer stage at diagnosis for population epidemiological purposes when it is not provided by health services, but requires more extensive validation.
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Neoplasias do Endométrio , Feminino , Humanos , Estados Unidos , Austrália/epidemiologia , Sistema de Registros , Estadiamento de Neoplasias , Neoplasias do Endométrio/diagnóstico , Neoplasias do Endométrio/epidemiologiaRESUMO
BACKGROUND: Aging is associated with progressive declines in immune responses leading to increased risk of severe infection and diminished vaccination responses. Influenza (flu) is a leading killer of older adults despite availability of seasonal vaccines. Geroscience-guided interventions targeting biological aging could offer transformational approaches to reverse broad declines in immune responses with aging. Here, we evaluated effects of metformin, an FDA approved diabetes drug and candidate anti-aging drug, on flu vaccination responses and markers of immunological resilience in a pilot and feasibility double-blinded placebo-controlled study. RESULTS: Healthy older adults (non-diabetic/non-prediabetic, age: 74.4 ± 1.7 years) were randomized to metformin (n = 8, 1500 mg extended release/daily) or placebo (n = 7) treatment for 20 weeks and were vaccinated with high-dose flu vaccine after 10 weeks of treatment. Peripheral blood mononuclear cells (PBMCs), serum, and plasma were collected prior to treatment, immediately prior to vaccination, and 1, 5, and 10 weeks post vaccination. Increased serum antibody titers were observed post vaccination with no significant differences between groups. Metformin treatment led to trending increases in circulating T follicular helper cells post-vaccination. Furthermore, 20 weeks of metformin treatment reduced expression of exhaustion marker CD57 in circulating CD4 T cells. CONCLUSIONS: Pre-vaccination metformin treatment improved some components of flu vaccine responses and reduced some markers of T cell exhaustion without serious adverse events in nondiabetic older adults. Thus, our findings highlight the potential utility of metformin to improve flu vaccine responses and reduce age-related immune exhaustion in older adults, providing improved immunological resilience in nondiabetic older adults.
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This study evaluated adolescents' evening patterns in activities, social contact, and location to better understand antecedents to adolescents' sleep onset time (SOT). The SOT is important for sleep duration and related health outcomes. Using a nationally representative sample of 15- to 18-year-old adolescents from the American Time Use Survey (N = 10,341; 47% female; 57% white), structural equation modeling demonstrated that late SOTs mediated links between evening activities, social contact, locations, and shorter sleep durations. Passive leisure, time in public locations, and time with friends late in the evenings were associated with later SOTs, whereas homework and active leisure did not. Parents and practitioners can use this information to carefully evaluate evening activities, social contact, and location to support healthy SOTs for adolescents across time.
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Comportamento do Adolescente , Transtornos do Sono-Vigília , Humanos , Adolescente , Feminino , Estados Unidos/epidemiologia , Masculino , Sono , Inquéritos e Questionários , Atividades de LazerRESUMO
Neuraxial anaesthesia is widely utilised for elective caesarean section, but the prevalence of inadequate intra-operative anaesthesia is unclear. We aimed to determine the prevalence of inadequate neuraxial anaesthesia for elective caesarean section; prevalence of conversion from neuraxial anaesthesia to general anaesthesia following inadequate neuraxial anaesthesia; and the effect of mode of anaesthesia. We searched studies reporting inadequate neuraxial anaesthesia that used ≥ ED95 doses (effective dose in 95% of the population) of neuraxial local anaesthetic agents. Our primary outcome was the prevalence of inadequate neuraxial anaesthesia, defined as the need to convert to general anaesthesia; the need to repeat or abandon a planned primary neuraxial technique following incision; unplanned administration of intra-operative analgesia (excluding sedatives); or unplanned epidural drug supplementation. Fifty-four randomised controlled trials were included (3497 patients). The overall prevalence of requirement for supplemental analgesia or anaesthesia was 14.6% (95%CI 13.3-15.9%); 510 out of 3497 patients. The prevalence of general anaesthesia conversion was 2 out of 3497 patients (0.06% (95%CI 0.0-0.2%)). Spinal/combined spinal-epidural anaesthesia was associated with a lower overall prevalence of inadequate neuraxial anaesthesia than epidural anaesthesia (10.2% (95%CI 9.0-11.4%), 278 out of 2732 patients vs. 30.3% (95%CI 26.5-34.5%), 232 out of 765 patients). Further studies are needed to identify risk factors, optimise detection and management strategies and to determine long-term effects of inadequate neuraxial anaesthesia.
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Anestesia Epidural , Anestesia Obstétrica , Raquianestesia , Anestesia Epidural/efeitos adversos , Anestesia Geral/efeitos adversos , Anestesia Obstétrica/métodos , Raquianestesia/efeitos adversos , Cesárea , Feminino , Humanos , GravidezRESUMO
Recollection rejection (a form of memory monitoring) involves rejecting false details on the basis of remembering true details (recall to reject), thereby increasing memory accuracy. This study examined how recollection rejection instructions and feedback affect memory accuracy and false recognition in 5-year-olds, 6- and 7-year-olds, 8- and 9-year-olds, and adults. Participants (N = 336) completed three study-test phases. Instructions and item-level feedback were manipulated during the first two phases, with the third phase including a test containing no instructions or feedback to evaluate learning effects. As predicted, in the younger children, as compared with the older children and adults, we found reduced accuracy scores (hits to studied items minus false alarms to related lures), reduced recollection rejection to related lures, and increased false recognition scores. We also found that, in the third phase, prior feedback reduced false recognition scores, potentially by improving monitoring, and typical developmental differences in false recognition were eliminated. However, there were mixed findings of instructions and feedback, and in some conditions these interventions harmed memory. These findings provide initial evidence that combining instructions and feedback with repeated task practice may improve monitoring effectiveness, but additional work is needed on how these factors improve and sometimes harm performance in young children.
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Cognição , Rememoração Mental , Adolescente , Adulto , Criança , Pré-Escolar , Retroalimentação , Humanos , AprendizagemRESUMO
OBJECTIVES: In recent years, catastrophic hurricanes have devastated numerous areas, prompting a need to build resilience particularly in at-risk populations that rely on health care and social services. The Maternal and Child Health (MCH) workforce covers a wide breadth of services to pregnant women, families, and children with special health care needs. Research has noted the need to strengthen this workforce with training and skills to help their patients and clients prepare, respond, and recover from disasters. METHODS: Focus groups and interviews with 35 Florida parents and professionals impacted by Hurricanes Irma, Maria, and Michael were conducted to evaluate the stressors placed on systems of care serving mothers and infants in Florida. Journey mapping was used to explore opportunities for improving MCH training and services. RESULTS: Results highlight the importance of increased communication and collaboration between families and providers, coordination among health care and social services providers, effective public messaging, tailored preparedness materials and processes, and the need for post-disaster mental health services and employment resources. CONCLUSION: Ultimately, hurricane preparation and mitigation are key for improving community resilience and these efforts should be tailored to MCH populations as well as delivered by the providers who know their needs best.
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Tempestades Ciclônicas , Desastres , Criança , Feminino , Florida , Mão de Obra em Saúde , Humanos , Lactente , Gravidez , Recursos HumanosRESUMO
Soil degradation, which is linked to poor nutrient management, remains a major constraint to sustained crop production in smallholder urban agriculture (UA) in sub-Saharan Africa (SSA). While organic nutrient resources are often used in UA to complement mineral fertilizers in soil fertility management, they are usually scarce and of poor quality to provide optimum nutrients for crop uptake. Alternative soil nutrient management options are required. This study, therefore, evaluates the short-term benefits of applying an aluminium-based water treatment residual (Al-WTR), in combination with compost and inorganic P fertilizer, on soil chemical properties, and maize (Zea mays L.) productivity and nutrient uptake. An eight-week greenhouse experiment was established with 12 treatments consisting of soil, Al-WTR and compost (with or without P fertilizer). The co-amendment (10% Al-WTR + 10% compost) produced maize shoot biomass of 3.92 ± 0.16 g at 5 weeks after emergence, significantly (p < 0.05) out-yielding the unamended control which yielded 1.33 ± 0.17 g. The addition of P fertilizer to the co-amendment further increased maize shoot yield by about twofold (7.23 ± 0.07 g). The co-amendment (10% Al-WTR + 10% C) with P increased maize uptake of zinc (Zn), copper (Cu) and manganese (Mn), compared with 10% C + P. Overall, the results demonstrate that combining Al-WTR, compost and P fertilizer increases maize productivity and micronutrient uptake in comparison with single amendments of compost and fertilizer. The enhanced micronutrient uptake can potentially improve maize grain quality, and subsequently human nutrition for the urban population of SSA, partly addressing the UN's Sustainable Development Goal number 3 of improving diets.
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Oligoelementos , Purificação da Água , Agricultura/métodos , Alumínio , Cobre/metabolismo , Fertilizantes/análise , Humanos , Manganês , Micronutrientes , Minerais/metabolismo , Nitrogênio/análise , Solo/química , Zea mays/metabolismo , Zinco/metabolismoRESUMO
Projected future carbon dioxide (CO2) levels in the ocean can alter marine animal behaviours. Disrupted functioning of γ-aminobutyric acid type A (GABAA) receptors (ligand-gated chloride channels) is suggested to underlie CO2-induced behavioural changes in fish. However, the mechanisms underlying behavioural changes in marine invertebrates are poorly understood. We pharmacologically tested the role of GABA-, glutamate-, acetylcholine- and dopamine-gated chloride channels in CO2-induced behavioural changes in a cephalopod, the two-toned pygmy squid (Idiosepius pygmaeus). We exposed squid to ambient (â¼450â µatm) or elevated (â¼1000â µatm) CO2 for 7 days. Squid were treated with sham, the GABAA receptor antagonist gabazine or the non-specific GABAA receptor antagonist picrotoxin, before measurement of conspecific-directed behaviours and activity levels upon mirror exposure. Elevated CO2 increased conspecific-directed attraction and aggression, as well as activity levels. For some CO2-affected behaviours, both gabazine and picrotoxin had a different effect at elevated compared with ambient CO2, providing robust support for the GABA hypothesis within cephalopods. In another behavioural trait, picrotoxin but not gabazine had a different effect in elevated compared with ambient CO2, providing the first pharmacological evidence, in fish and marine invertebrates, for altered functioning of ligand-gated chloride channels, other than the GABAAR, underlying CO2-induced behavioural changes. For some other behaviours, both gabazine and picrotoxin had a similar effect in elevated and ambient CO2, suggesting altered function of ligand-gated chloride channels was not responsible for these CO2-induced changes. Multiple mechanisms may be involved, which could explain the variability in the CO2 and drug treatment effects across behaviours.
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Dióxido de Carbono , Cefalópodes , Animais , Canais de Cloreto , Cloretos , Ligantes , Receptores de GABA-ARESUMO
Caesarean delivery is the most commonly performed inpatient surgical procedure globally. Pain after caesarean delivery is moderate to severe if not adequately treated, and is a primary anaesthetic concern for patients. Transversus abdominis plane and quadratus lumborum blocks are fascial plane blocks that have the potential to improve analgesia following caesarean delivery. Although proponents of the quadratus lumborum block suggest that this technique may provide better analgesia compared with transversus abdominis plane block, there are limited data directly comparing these two techniques. We, therefore, performed a systematic review and network meta-analysis to compare transversus abdominis plane and quadratus lumborum block approaches, seeking randomised controlled trials comparing both techniques to each other, or to control, with or without intrathecal morphine. In all, 31 trials with 2188 patients were included and our primary outcome, the cumulative intravenous morphine equivalent consumption at 24 h, was reported in 12 trials. In the absence of intrathecal morphine, transversus abdominis plane and quadratus lumborum blocks were equivalent, and both were superior to control (moderate-quality evidence). In the presence of intrathecal morphine, no differences were found between control, transversus abdominis plane and quadratus lumborum blocks (moderate-quality evidence). Similar results were found for resting and active pain scores at 4-6 h, 8-12 h, 24 h and 36 h, although quadratus lumborum block was associated with lower pain scores at 36 h when compared with transversus abdominis plane block (very low-quality evidence). However, transversus abdominis plane block was associated with a reduced incidence of postoperative nausea and vomiting (moderate-quality evidence) and sedation when compared with inactive control following intrathecal morphine administration (low-quality evidence). There are insufficient data to draw definitive conclusions, but transversus abdominis plane and quadratus lumborum block appear to be superior to control in the absence of intrathecal morphine, but provide limited additional benefit over inactive control when intrathecal morphine is also used.
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Músculos Abdominais/efeitos dos fármacos , Analgesia Obstétrica/métodos , Cesárea , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Feminino , Humanos , Metanálise em Rede , GravidezRESUMO
The scale of the COVID-19 pandemic means that a significant number of patients who have previously been infected with SARS-CoV-2 will require surgery. Given the potential for multisystem involvement, timing of surgery needs to be carefully considered to plan for safe surgery. This consensus statement uses evidence from a systematic review and expert opinion to highlight key principles in the timing of surgery. Shared decision-making regarding timing of surgery after SARS-CoV-2 infection must account for severity of the initial infection; ongoing symptoms of COVID-19; comorbid and functional status; clinical priority and risk of disease progression; and complexity of surgery. For the protection of staff, other patients and the public, planned surgery should not be considered during the period that a patient may be infectious. Precautions should be undertaken to prevent pre- and peri-operative infection, especially in higher risk patients. Elective surgery should not be scheduled within 7 weeks of a diagnosis of SARS-CoV-2 infection unless the risks of deferring surgery outweigh the risk of postoperative morbidity or mortality associated with COVID-19. SARS-CoV-2 causes either transient or asymptomatic disease for most patients, who require no additional precautions beyond a 7-week delay, but those who have persistent symptoms or have been hospitalised require special attention. Patients with persistent symptoms of COVID-19 are at increased risk of postoperative morbidity and mortality even after 7 weeks. The time before surgery should be used for functional assessment, prehabilitation and multidisciplinary optimisation. Vaccination several weeks before surgery will reduce risk to patients and might lessen the risk of nosocomial SARS-CoV-2 infection of other patients and staff. National vaccine committees should consider whether such patients can be prioritised for vaccination. As further data emerge, these recommendations may need to be revised, but the principles presented should be considered to ensure safety of patients, the public and staff.
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COVID-19/prevenção & controle , Procedimentos Cirúrgicos Eletivos , Anestesistas , Consenso , Inglaterra , Humanos , Pandemias , Assistência Perioperatória , SARS-CoV-2 , Sociedades Médicas , TempoRESUMO
The prioritized encoding and retrieval of valuable information is an essential aspect of human memory. We used electroencephalography (EEG) to determine which of two hypothesized processes underlies the influence of reward value on episodic memory. One hypothesis is that value engages prefrontal executive control processes, so that valuable stimuli engage an elaborative rehearsal strategy that benefits memory. A second hypothesis is that value acts through the reward-related midbrain dopamine system to modulate synaptic plasticity in hippocampal and cortical efferents, thereby benefiting memory encoding. We used a value-directed recognition memory (VDR) paradigm in which participants encoded words assigned different point values and aimed to maximize the point value of subsequently recognized words. Subjective states of recollection (i.e., "remember") and familiarity (i.e., "know") were assessed at retrieval. Words assigned higher values at study were recognized more effectively than words assigned lower values, due to increased "remember" responses but no difference in "know" responses. Greater value was also associated with larger amplitudes of an EEG component at retrieval that indexes recollection (parietal old/new component), but had no relationship with a component that indexes familiarity (FN400 component). During encoding, we assessed a late frontal positivity (frontal slow wave, FSW) that has been related to elaborative rehearsal strategies and an early parietal component (P3) thought to index dopamine driven attention allocation. Our findings indicate that the effect of value on recognition memory is primarily driven by the dopamine-driven reward valuation system (P3) with no discernible effect on rehearsal processes (FSW).
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Córtex Cerebral/fisiologia , Eletroencefalografia , Potenciais Evocados/fisiologia , Neuroimagem Funcional , Rememoração Mental/fisiologia , Reconhecimento Psicológico/fisiologia , Recompensa , Adulto , Potenciais Evocados P300/fisiologia , Humanos , Adulto JovemRESUMO
Ego-resiliency is an enduring psychological construct reflecting how individuals-adapt to environmental stressors, conflict, and change which is linked to positive adjustment. Ego-resiliency has not been examined in Latino youth, despite their high risk for mental health problems; nor have cultural precursors to ego-resiliency been examined. Given these gaps, we examined whether familism values (supportive, obligation, and referent) were associated with ego-resiliency and, in turn, depressive problems in Latino adolescents across two time points (N = 123, mean age = 11.53). Results indicated that supportive familism was associated positively with ego-resiliency and negatively with depressive problems. Ego-resiliency negatively predicted depressive problems across time, controlling for prior levels, suggesting that ego-resiliency may have long-term effects on depressive problems in Latino youth.
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Depressão/diagnóstico , Relações Familiares/psicologia , Resiliência Psicológica , Criança , Depressão/etiologia , Ego , Feminino , Hispânico ou Latino/psicologia , Humanos , Indiana , Masculino , Mães/psicologia , Inquéritos e QuestionáriosRESUMO
AIMS: Decades of scientific research have found optimism to have wide-ranging effects on individuals' health and well-being. Researchers have largely examined optimism in adults, but have begun addressing the benefits of optimism in adolescents. Challenges and stressors in adolescence can threaten youths' subjective well-being; therefore, identifying factors that contribute to the growth of optimism could have important health implications. However, researchers have more often examined the effect of optimism on youth outcomes rather than factors that might positively or negatively contribute to the development of optimism. METHODS: We assessed how salient developmental tasks (resilience, ethnic pride, and school attachment), family stress, and depressive problems individually contribute to Latinx youths' optimism at two time points (N = 123, 58.8% female, M age = 11.54 years). RESULTS: We found support for associations between both resilience and school attachment and optimism, but findings were weaker across time and with stressors included in the model. Depressive problems also appeared to weaken optimism across time. CONCLUSION: Given the established links between optimism and health, it will be important for researchers to continue to identify factors that contribute to the development of youth optimism, and assess whether they could be used in interventions to foster optimism.
Assuntos
Emigrantes e Imigrantes/psicologia , Hispânico ou Latino/psicologia , Otimismo/psicologia , Resiliência Psicológica , Estudantes/psicologia , Adolescente , Comportamento do Adolescente/etnologia , Comportamento do Adolescente/psicologia , Criança , Depressão/etnologia , Depressão/psicologia , Relações Familiares/psicologia , Feminino , Humanos , Masculino , Apego ao Objeto , População Rural , Instituições Acadêmicas , Estresse Psicológico/etnologia , Estresse Psicológico/psicologia , Estados UnidosRESUMO
We performed a systematic review using 'consensus-based standards for the selection of health measurement instruments' (COSMIN) criteria to identify and evaluate the quality of patient-reported outcome measures (PROM) instruments that have been utilised to assess functional recovery following caesarean section, and determine the optimal instrument for use in this setting. A literature search was performed using five databases. Studies were included if a psychometrically validated instrument was used to assess functional recovery following caesarean section. The COSMIN appraisal checklist was utilised to: assess the quality of included studies reporting PROMs; determine psychometric quality of instruments; and identify the most promising instruments for use after caesarean section. We identified 13 PROMs used to assess the quality of recovery after caesarean section in 20 studies that included 9214 patients. All PROMs contained between two and seven domains. Five out of the 13 PROMs were specific to postpartum recovery. Only two of these PROM instruments were specifically designed for use after caesarean section (Obstetric Quality of Recovery-11 and Recovery from Caesarean Section Scale). We found very few adequate measures of functional recovery following caesarean section. Overall, the Obstetric Quality of Recovery-11 achieved the highest COSMIN standards for any PROM. Future development of PROMs for use after caesarean section should include multiple domains, and undergo validation as outlined by the COSMIN criteria.
Assuntos
Cesárea/estatística & dados numéricos , Lista de Checagem/métodos , Medidas de Resultados Relatados pelo Paciente , Recuperação de Função Fisiológica , Consenso , Feminino , Humanos , Gravidez , Psicometria , Inquéritos e QuestionáriosRESUMO
The objective of this study was to test if youth effortful control, a general process of self-regulation that is rooted in temperament, uniquely predicts maternal restrictive feeding with Latinx adolescents above and beyond demographic/contextual factors, prior use of restrictive feeding, and common markers of obesity-proneness. The study sample consisted of Latinx fifth and sixth graders and their mothers residing in the Midwestern U.S. (Nâ¯=⯠97 dyads). Effortful control, maternal restrictive feeding, demographic/contextual factors, and markers of obesity proneness were measured across two waves of data collection approximately one year apart. Results demonstrated an inverse relation between effortful control and maternal restrictive feeding after controlling for Time 1 demographic/contextual factors, maternal BMI, maternal restrictive feeding, youth BMI z-score, and perceived youth weight. Future directions include testing for the presence of an ironic feedback process such that Latinx mothers' attempts to overcome deficits in their children's self-regulation skills through restrictive feeding may be inadvertently maintaining the problem.