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Introduction: Clinical simulations in are designed to evoke feelings of stress and uncertainty in order to mimic challenges that learners will face in the real world. When not managed properly, these sources of extraneous cognitive load cause a burden on working memory, leading to a hindered ability to acquire new information. The “Beat the Stress Fool” (BTSF) protocol is a performance-enhancing tool designed to reduce cognitive overload during acute care scenarios. It involves breathing exercises, positive self-talk, visualization, and deliberate articulations. This study aims to validate the BTSF protocol as a method for reducing cognitive load using both psychometric and physiologic measures. Methods: Data collection took place during the Queen's University “Nightmares-FM” course. This clinical simulation program involves team-based scenarios designed to teach the fundamentals of acute care to first-year family medicine residents. Participants were divided equally into experimental and control groups based on pre-existing cohorts. Participants completed a baseline state-trait anxiety inventory and a demographics survey. The experimental group was guided through the BTSF protocol prior to each of 16 simulations; in both groups, physiologic and psychometric cognitive load measurements were collected for the alternating team leader. Galvanic skin response (GSR) and heart rate (HR) were collected during a 15-second baseline and throughout each simulation using a Shimmer 3 GSR+ wearable sensor. Self-reported cognitive load was assessed after each scenario using the 9-point Paas scale. Results: The mean Paas scores for the BTSF group were significantly lower than the control group (6.2 vs 6.9, p < 0.05), indicating lower subjective cognitive load. GSR signal magnitude (p = 0.086), spike amplitude (p = 0.066), and spike density (p = 0.584) were also lower in the BTSF group. There was no difference in HR between groups. There was not a significant correlation between self-reported cognitive load and the normalized physiologic measures. Conclusion: The results demonstrate the effectiveness of the BTSF protocol in lowering the amount of perceived mental effort required to perform clinical simulation tasks. These findings were mirrored in the galvanic skin response signal, though our study was likely underpowered for significance. This is the first study to validate a proof-of-concept for the BTSF protocol in learners during simulated training.
Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset.
Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA.
Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) < 0.01]. The structure of EPDS responses significantly differed between Europe and the USA (∆*CFI > 0.01), but not between European countries (∆*CFI < 0.01).
Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.
It is widely recognized that environmental insults during adulthood including smoking, lack of exercise and a poor diet increases an individual's risk of cardiovascular disease (CVD). However, research initiated over the last two decades has highlighted that our risk of CVD can be programmed following adverse exposures during early development. Such adverse exposures may include, undernutrition, placental insufficiency, hypoxia, overnutrition and obesity. This review aims to address the current Western obesity crisis by addressing the long-term impact of maternal overnutrition and obesity on the offspring's future risk of CVD. Although current human studies have observed the presence of adverse CVD markers in children born to obese mothers, animal models have proved vital in understanding the underlying mechanisms involved. Mechanisms suggested to be involved in the programming of CVD in the offspring include increased oxidative stress, inflammation, lipotoxicity and epigenetics. CVD remains the greatest cause of death worldwide, therefore further understanding of the mechanisms mediating these effects is important in the development of intervention strategies.
This study characterized the current epidemiology of vibrio infections in Florida and examined cases reported from 1998 to 2007. Logistic regression was used to determine risk of death. There were 834 vibrio infections in 825 individuals (average annual incidence rate 4·8/1 000 000). Common Vibrio species reported were Vibrio vulnificus (33%), V. parahaemolyticus (29%), and V. alginolyticus (16%). Most exposures were attributed to wounds (42%), and the most common clinical syndromes were wound infections (45%) and gastroenteritis (42%). Almost half of individuals reported an underlying health condition. Risk of death was associated with any underlying condition and increased with the number of conditions (P<0·0001). In Florida, incidence of vibriosis associated with raw oyster consumption has decreased while incidence associated with wound infections has increased. Most prevention efforts to date have focused on oyster consumption. New educational messages focusing on the risk of vibriosis from wound infections should target high-risk populations.
Clinical samples have identified a number of psychosocial risk factors
for suicidal acts but it is unclear if these findings relate to the
To describe the prevalence of and psychosocial risk factors for suicidal
acts in a general adult population.
Data were obtained from a Canadian epidemiological survey of 36 984
respondents aged 15 years and older (weighted sample
n=23 662 430).
Of these respondents, 0.6% (weighted n=130 143) endorsed
a 12-month suicidal act. Female gender (OR=4.27, 95% CI 4.05–4.50), being
separated (OR=37.88, 95% CI 33.92–42.31) or divorced (OR=7.79, 95% CI
7.22–8.41), being unemployed (OR=1.70, 95% CI 1.50–1.80), experiencing a
chronic physical health condition (OR=1.70, 95% CI 1.67–1.86) and
experiencing a major depressive episode in the same 12-month period as
the act (OR=9.10, 95% CI 8.65–9.59) were significantly associated with a
The psychosocial correlates of suicidal acts in this sample are
consistent with those previously reported in clinical and general
population samples. These findings reinforce the importance of the
determination of suicide risk and its prevention not only of psychiatric
illness but of physical and psychosocial factors as well.
Isolates from 3903 cases of invasive pneumococcal disease (IPD) were referred to the national reference laboratory over the 8 years, 1998–2005, as part of the laboratory-based surveillance of this disease in New Zealand. All isolates were serotyped and their antimicrobial susceptibility was tested. The incidence of IPD was highest in young children, with an average annual incidence of 100·8/100 000 in infants aged <2 years. There were changes in the prevalence of several of the serotypes during the 8-year period. Overall the seven serotypes included in the 7-valent pneumococcal conjugate vaccine, 4, 6B, 9V, 14, 18C, 19F and 23F, were the most common serotypes and accounted for 80·9% of the disease in infants aged <2 years. There was no overall change in penicillin resistance or non-susceptibility during the 8 years, and rates were 7·1% and 17·1%, respectively, in 2005. In contrast, cefotaxime and erythromycin resistance increased to reach 3·1% and 12·2%, respectively, by 2005.
Toxic anterior segment syndrome (TASS), a complication of cataract surgery, is a sterile inflammation of the anterior chamber of the eye. An outbreak of TASS was recognized at an outpatient surgical center and its affiliated hospital in December 2002.
Medical records of patients who underwent cataract surgery during the outbreak were reviewed, and surgical team members who participated in the operations were interviewed. Potential causes of TASS were identified and eliminated. Feedwater from autoclave steam generators and steam condensates were analyzed by use of spectroscopy and ion chromatography.
During the outbreak, 8 (38%) of 21 cataract operations were complicated by TASS, compared with 2 (0.07%) of 2,713 operations performed from January 1996 through November 2002. Results of an initial investigation suggested that cataract surgical equipment may have been contaminated by suboptimal equipment reprocessing or as a result of personnel changes. The frequency of TASS decreased (1 of 44 cataract operations) after reassignment of personnel and revision of equipment reprocessing procedures. Further investigation identified the presence of impurities (eg, sulfates, copper, zinc, nickel, and silica) in autoclave steam moisture, which was attributed to improper maintenance of the autoclave steam generator in the outpatient surgical center. When impurities in autoclave steam moisture were eliminated, no cases of TASS were observed after more than 1,000 cataract operations.
Suboptimal reprocessing of cataract surgical equipment may evolve over time in busy, multidisciplinary surgical centers. Clinically significant contamination of surgical equipment may result from inappropriate maintenance of steam sterilization systems. Standardization of protocols for reprocessing of cataract surgical equipment may prevent outbreaks of TASS and may be of assistance during outbreak investigations.
Background. Knowledge about factors that predict relapse in anorexia nervosa (AN) is needed for the development of effective relapse prevention treatments and may also advance understanding of the psychopathology of AN. The aim of the present study was to examine the rate, timing and prediction of relapse in AN following weight restoration in a specialized in-patient treatment programme.
Method. Fifty-one consecutive first-admission AN patients who were weight-restored following in-patient treatment participated in the study. Follow-up assessments were conducted a median of 15 months post-discharge. Relapse of AN was defined as a body mass index <17·5 for 3 consecutive months. Data were analysed using Kaplan–Meier survival analysis and Cox regression.
Results. The overall rate of relapse was 35% and the mean survival time was 18 months. The highest risk period was from 6 to 17 months after discharge. Several significant predictors of relapse were identified: a history of suicide attempt; previous specialized treatment for an eating disorder; severity of obsessive–compulsive symptoms at presentation; excessive exercise immediately after discharge; and residual concern about shape and weight at discharge.
Conclusions. There continues to be a significant risk of relapse among AN patients who remain well for the first year post-discharge. Several variables were shown to be associated with an elevated risk of relapse. These findings have implications for the development of initial treatments and relapse prevention strategies for AN.
Maternal nutrition and growth hormone (GH) treatment during early- to mid-pregnancy can each alter the subsequent growth and differentiation of muscle in progeny. We have investigated the effects of varying maternal nutrition and maternal treatment with porcine (p) GH during the second quarter of pregnancy in gilts on semitendinosus muscle cross-sectional area and fibre composition of progeny, and relationships between maternal and progeny measures and progeny muscularity. Fifty-three Large White×Landrace gilts, pregnant to Large White×Duroc boars, were fed either 2·2 kg (about 35 % ad libitum intake) or 3·0 kg commercial ration (13·5 MJ digestible energy, 150 g crude protein (N×6·25)/kg DM)/d and injected with 0, 4 or 8 mg pGH/d from day 25 to 50 of pregnancy, then all were fed 2·2 kg/d for the remainder of pregnancy. The higher maternal feed allowance from day 25 to 50 of pregnancy increased the densities of total and secondary fibres and the secondary:primary fibre ratio in semitendinosus muscles of their female progeny at 61 d of age postnatally. The densities of secondary and total muscle fibres in semitendinosus muscles of progeny were predicted by maternal weight before treatment and maternal plasma insulin-like growth factor-II during treatment. Maternal pGH treatment from day 25 to day 50 of pregnancy did not alter fibre densities, but increased the cross-sectional area of the semitendinosus muscle; this may be partially explained by increased maternal plasma glucose. Thus, maternal nutrition and pGH treatment during the second quarter of pregnancy in pigs independently alter muscle characteristics in progeny.
Recent evidence indicates that endurance-trained athletes are able to increase their stroke volume (SV) throughout incremental upright exercise, probably due to a progressively greater effect of the Frank-Starling mechanism. This is contrary to the widely held belief that SV reaches a plateau at a submaximal heart rate (irrespective of fitness level), owing to a limitation in the time for diastolic filling. The purpose of this investigation was to evaluate whether endurance-trained athletes rely on a progressively greater effect of the Frank-Starling mechanism throughout incremental exercise. A secondary purpose was to evaluate the effects of postural position on the cardiovascular responses to incremental exercise. Ten male cyclists participated in this investigation. Left ventricular function was assessed throughout incremental exercise in the supine and upright positions (counterbalanced) using radionuclide ventriculography. Stroke volume increased in a linear fashion during incremental exercise in both the upright and supine positions. The increases in cardiac output (Q) throughout incremental to maximal exercise (in both the supine and upright positions) were significantly related to changes in heart rate, myocardial contractility and the Frank-Starling mechanism. Percentage changes in end-diastolic volume and SV were significantly greater in the upright position versus the supine position, reflecting an increased reliance on the Frank-Starling effect to increase Q. We conclude from this investigation that highly trained endurance athletes are able to make progressively increasing usage of the Frank-Starling effect throughout incremental exercise. Postural position has a significant effect on the relative contribution of heart rate, myocardial contractility and the Frank-Starling mechanism to the increase in Q during exercise conditions. Experimental Physiology (2002) 87.5, 613-622.
The results of a reconnaissance apatite fission track study from southeast Ireland are compared with modelled ages and length distributions predicted using both traditional thermal histories and the thermal history indicated by the fission track age and length data. All samples have experienced total annealing during the Variscan orogeny. There is strong evidence for significant post-Variscan, pre-Mid Jurassic heating and cooling. The modelling also recognizes a third thermal event subsequent to 100 Ma. The implications of these results are examined in terms of the timing and extent of subsidence and inversion along the northern margin of the North Celtic Sea Basin.
The binder burn-out behavior in PMMA/glass powder composites was studied as a function of glass composition in the PbO-SiO2-B203 system. The PbO content was varied to obtain glasses having optical basicities in the range of 0.62-0.81. TGA measurements on PMMA/glass composites show that the main decomposition end temperatures of PMMA increase with decreasing PbO content, and therefore, decreasing optical basicity. This indicates that PMMA interacts strongly with more acidic surfaces. The effect of the milling fluid was also studied. Milling in toluene does not significantly alter the behavior. Milling in water of a PbO-rich glass leads to significant leaching of lead. During drying, the leached lead deposits on the glass particle surfaces and drastically alters the thermal behaviour of the glass powder and PMMA/glass composites.