Right Bundle Branch Block After Transvenous Lead Extraction: An Unreported Complication With Potentially Severe Outcomes

INTRODUCTION: Right bundle branch block (RBBB) following cardiac device extraction has not been previously reported but may have catastrophic consequences. METHODS AND RESULTS: We present two cases of young male patients who developed RBBB following the extraction of single chamber TV ICD systems where the coil was adherent close to the superior tricuspid valve annulus. Both patients had a subcutaneous ICD (SICD) implanted but suffered an inappropriate shock due to T-wave oversensing, requiring very early SICD removal for one patient. CONCLUSION: The development of RBBB following the extraction of a TV ICD is a previously unreported complication and may cause significant sensing problems if an SICD is implanted subsequently. Placement of the ICD lead tip in the right ventricular outflow tract or high on the intraventricular septum may predispose to this complication

Mapping provider and consumer voices using the AACTT framework: a focus group study of advance care planning

BACKGROUND: The provision of healthcare is complex. When evidence-practice gaps are identified, interventions to improve practice across multi-level systems are required. These interventions often consist of multiple interacting components and behaviours. To effectively address these complexities, it is crucial to first identify the specific roles and actions required at each stage of the intervention. This approach enables a thorough examination of what is working well and what needs to be optimised. The action, actor, context, target, time (AACTT) framework provides a consistent approach to identifying key elements such as 'who' (actor) does 'what' (action), 'where' (context), 'to or with whom' (target) and 'when' (time). To our knowledge the AACTT has not yet been applied: 1) to specify complex interventions across patient journeys; and 2) to investigate consumer views, despite the importance of patient-centred care. AIM: Using advance care planning (ACP) as an exemplar complex healthcare process, we describe a method for using the AACTT framework to 1) map a complex model of care across a patient journey 2) capture the consumer perspective; and 3) operationalise these perspectives by comparing across groups and identifying alignments or misalignments. METHODS: Two groups were recruited (healthcare professionals and consumers). Informed by the AACTT framework, four focus groups discussed the process of ACP across existing care pathways. Maps visually representing the perspectives and preferences of healthcare professionals and consumers were co-created iteratively. Qualitative data was deductively coded to the AACTT framework and inductively coded to identify themes within domains. Maps were circulated for critical feedback and refined. RESULTS: Healthcare professional (n-13) and consumer perspectives (n = 11) highlighted what is 'currently occurring' in practice, what is 'not occurring', and what 'should be occurring' to align practice with consumer preferences of care. Comparing participant perspectives identified that most misalignment occurred within the actor, context, and time domains. Misalignment was found predominantly in actions 'occurring sometimes', with no converging perspectives reported for the context and time domains. CONCLUSION: This novel application of the AACTT framework systematically brings in the consumer voice in ways that may influence the delivery of care. This approach to specifying healthcare professional and consumer perspectives across a complex care pathway identifies barriers that are not found with traditional mapping methods or in current applications of the AACTT framework

A generalized epilepsy network derived from brain abnormalities and deep brain stimulation

Idiopathic generalized epilepsy (IGE) is a brain network disease, but the location of this network and its relevance for treatment remain unclear. We combine the locations of brain abnormalities in IGE (131 coordinates from 21 studies) with the human connectome to identify an IGE network. We validate this network by showing alignment with structural brain abnormalities previously identified in IGE and brain areas activated by generalized epileptiform discharges in simultaneous electroencephalogram-functional magnetic resonance imaging. The topography of the IGE network aligns with brain networks involved in motor control and loss of consciousness consistent with generalized seizure semiology. To investigate therapeutic relevance, we analyze data from 21 patients with IGE treated with deep brain stimulation (DBS) for generalized seizures. Seizure frequency reduced a median 90% after DBS and stimulation sites intersect an IGE network peak in the centromedian nucleus of the thalamus. Together, this study helps unify prior findings in IGE and identify a brain network target that can be tested in clinical trials of brain stimulation to control generalized seizures

Step-Wise Assembly of LAT Signaling Clusters Immediately After T Cell Receptor Triggering Contributes to Signal Propagation

Linker for activation of T cells (LAT) is an essential adaptor protein in early T cell receptor (TCR) signaling that propagates multiple signaling pathways. However, how LAT spatial organization facilitates signal initiation and propagation after TCR triggering is not clear. To differentiate de novo assembly in the plasma membrane from pre-existing LAT vesicles and clusters, we developed imaging protocols and analyses to capture the organization and dynamics of single LAT molecules immediately after TCR engagement. We could observe individual LAT molecules in the plasma membrane that assembled into immobile signaling entities requiring LAT phosphorylation. This step-wise assembly process was temporally highly coordinated via the zeta-chain-associated protein kinase 70 (Zap70)-LAT-growth factor receptor-bound protein 2 (Grb2) pathway. While multiple spatial organization co-existed even within the plasma membrane, our data suggest that de novo plasma membrane assemblies facilitated signal propagation

Dietary Patterns and Major Depression: Results from 15,262 Participants (International ALIMENTAL Study)

BACKGROUND: Different patterns of food consumption may be associated with a differential risk of depression. Differences in dietary patterns between men and women and across different age groups have been reported, but their influence on the risk of depression has not been fully explored. OBJECTIVES: To investigate the associations between dietary patterns and risk of depression across sex and age groups to identify vulnerable subpopulations, which may inform targeted prevention and intervention strategies. METHODS: The ALIMENTAL study was a cross-sectional, online international survey conducted between 2021 and 2023. Dietary data were collected using a validated food frequency questionnaire; depression data were collected using a self-reported validated questionnaire. Principal component analysis (PCA) was applied to identify distinct food consumption patterns. Multivariate analyses were then conducted to assess the associations between these patterns and depression, adjusting for multiple potential confounders. RESULTS: Among 15,262 participants without chronic diseases or current psychotropic treatments, 4923 (32.2%) were classified in the depression group. Among those aged 18-34, the PCA-derived factor of ultra-processed foods consumption was significantly associated with increased risk of depression in both sexes with similar odds ratios (women 1.21, 95% confidence interval (CI): (1.15; 1.27), men 1.21, 95% CI: (1.07-1.18)). In women aged 18-34, the PCA factors for sodas (aOR 1.10, 95% CI: (1.06; 1.95) and canned and frozen foods (aOR 1.10, 95% CI: (1.04; 1.15) were associated with an increased risk of depression. In participants aged 35-54 years, the association between ultra-processed foods and depression was only observed in women (35-54 years: aOR 1.30, 95% CI: (1.20; 1.42), ≥55 years: 1.41, 95% CI: (1.11; 1.79)), with a significant association between a higher adherence to the PCA-derived "healthy diet" factor (e.g., fruits, nuts, green vegetables) and a lower risk of depression (35-54 years: aOR 0.82, 95% CI: (0.75; 0.89), ≥55 years: aOR 0.79, 95% CI: (0.64; 0.97)). CONCLUSIONS: These results show significant differences between men and women and between age groups regarding associations between dietary patterns and the risk of depression. These findings can help better target public health interventions

The Gender Euphoria Scale (GES): development of a tool to measure gender euphoria

Background Gender euphoria is a concept that arose from within the trans and gender diverse (hereafter trans) community to describe positive feelings associated with gender identity, expression, and affirmation. Despite its importance within the trans population, there is currently no consistent, valid or reliable way of measuring gender euphoria. Accordingly, this article describes the development and validation of a tool to measure gender euphoria in trans individuals. Method An initial 121-item pool for the scale was developed based on qualitative research and a review of existing tools measuring related psychological constructs in trans adults. Trans researchers and experts in trans health reviewed and revised the items, enabling development of a preliminary scale which was pilot tested with a trans community advisory group before being further refined and administered to a larger cohort of trans individuals. A subgroup of individuals within the cohort repeated the scale two weeks following the initial completion to assess for test-retest reliability. Results The preliminary scale was undertaken by 664 trans participants aged 16–79 years (median = 32 years, IQR = 25, 43). Exploratory factor analysis produced a final 26-item Gender Euphoria Scale (GES) comprising three subscales: social affirmation, self-affirmation, and community connection. The GES was found to have excellent internal consistency (α = .97), strong test-retest reliability (r = .88), and some evidence of discriminant and convergent validity. Conclusion The GES is a reliable and consistent tool to measure gender euphoria in trans individuals and is likely to be of value in both research and clinical settings

Designing gamified branching scenarios on a technological platform to enhance clinical reasoning in dental education

Simulation and gamification offer valuable pedagogical approaches, providing safe environments for dental students to practice complex professional skills. Developing clinical reasoning is crucial as students perform irreversible procedures early in their training. Traditional methods may offer limited opportunities to experience decision consequences without risking patient harm. Simulation based learning in a branching scenario (BrSc) format, that incorporates gamification and productive failure (Kapur, 2008), bridges the gap between preclinical theory and clinical practice, addressing the need for engaging, relevant learning experiences (ASE Strategy). This project aligns with the University's ASE Strategy, 'A curriculum defined by quality and relevance' through innovative, inquiry-based learning and authentic assessment, and 'Environments and systems that enable innovation' by leveraging digital technologies

Risk management in translation: A reply to critics

Risk management has been proposed as an approach that can help explain why translators make certain decisions in certain situations. A review of the surprisingly extensive work done to apply the concepts to translation suggests that one of the intellectual attractions of the approach is that it can avoid the essentialisms of equivalence and univocal purposes. Risk management has nevertheless been criticized on several fronts: for purporting to explain all aspects of a more complex process, for assuming a rational translator, for deviating from accuracy as the translator’s main task, for overlooking the affective dimensions of language use, and for being associated with the evils of economics. These criticisms lose ground when risk management is seen as part of a wider approach to translation, and when the concepts are not taken as an account of everything that translators do