Open access to economic outcome data will help to bridge the gap between clinical trials and clinical guidelines

Buoyed by a burgeoning medical culture of “appropriate use” and rising doctor awareness of the financial ruin that threatens many patients who navigate expensive treatments in pursuit of better health, medical specialist societies have grown increasingly vocal about integrating economic value in their clinical guidelines. These encouraging developments are, however, threatened by a worsening decline in the generalisability of randomised controlled trials, a concern supported by widening differences between the characteristics of patients enrolled in trials and those of the populations targeted for intervention outside trials

Comparison of the Hindin Proteins of Strongylocentrotus franciscanus, S. purpuratus, and Lytechinus variegatus: Sequences involved in the Species Specificity of Fertilization

Bindin is the sea urchin sperm acrosomal protein that is responsible for the species-specific adhesion of the sperm to the egg. Two new bindin cDNA sequences that contain the entire open reading frame for the binding precursor are reported: one for Strongylocentrotus franciscanus and one for Lytechinus variegatus. Both contain inverted repetitive sequences in their 3' untranslated regions, and the S. franciscanus cDNA contains an inverted repetitive sequence match between the 5' untranslated region and the coding region. The middle third of the mature bindin sequence is highly conserved in all three species, and the flanking sequences share short repeated sequences that vary in number between the species. Cross-fertilization data are reported for the species S. purpuratus, S. franciscanus, L. variegatus, and L. pictus. A barrier to cross-fertilization exists between the sympatric Strongylocentrotus species, but there is no barrier between the allopatric Lytechinus species

Impact of Student Debt on Decisions of Terminal Clinical Education Experiences in Physical Therapist Education

Purpose: Student debt is of growing concern in physical therapy and other health professions in the United States. This study explored the extent to which finances and other factors influenced student decision making when applying to and selecting terminal clinical education experiences. Methods: An online survey was developed and distributed to 250 recent graduates of a Doctor of Physical Therapy Program (2016-19). A logistic regression model was used to determine the relationship between respondents’ reported student debt and other factors when choosing a nontraditional model (the yearlong internship model (YLI)/residency model) or the traditional 4-month model. A 5-point Likert scale was used to rate the level of importance for each factor. Results: Seventy-six participants, across four cohorts completed the survey, representing a 30.4% response rate. The logistic regression model found that student debt did not significantly predict whether a student was likely to choose the nontraditional model over the traditional shorter terminal clinical experience; however, age and relationship status were found to be significant predictors of preference for length of experience. Based on aggregate mean data, the most important decision-making criterion in deciding the terminal clinical experience was patient population, followed by the culture of the clinic, then geographic location, and type of clinical setting. The criterion with the lowest aggregate mean was peer (within cohort) competition followed by student debt. A comparison of means found two decision-making criteria significantly reduced from the point of application to the commitment decision: saving money and interprofessional opportunities. Both decision-making criteria became less important for students when deciding on their terminal clinical experience as compared to when they were applying for the terminal clinical experience approximately 3 months earlier. Conclusions / Recommendations: Student debt was not an important factor in selecting the terminal clinical education experience and did not predict whether a student would apply to or select the YLI model rather than the shorter, traditional option. Instead, students considered multiple factors when selecting their terminal experience. Healthcare education programs may want to consider these factors in recruitment of clinical sites, student advising, and/or student placements related to the terminal clinical education experience

Strengthening Mentoring in Low- and Middle-Income Countries to Advance Global Health Research: An Overview.

Mentoring is a proven path to scientific progress, but it is not a common practice in low- and middle-income countries (LMICs). Existing mentoring approaches and guidelines are geared toward high-income country settings, without considering in detail the differences in resources, culture, and structure of research systems of LMICs. To address this gap, we conducted five Mentoring-the-Mentor workshops in Africa, South America, and Asia, which aimed at strengthening the capacity for evidence-based, LMIC-specific institutional mentoring programs globally. The outcomes of the workshops and two follow-up working meetings are presented in this special edition of the American Journal of Tropical Medicine and Hygiene. Seven articles offer recommendations on how to tailor mentoring to the context and culture of LMICs, and provide guidance on how to implement mentoring programs. This introductory article provides both a prelude and executive summary to the seven articles, describing the motivation, cultural context and relevant background, and presenting key findings, conclusions, and recommendations

Is Depression After an Acute Coronary Syndrome Simply a Marker of Known Prognostic Factors for Mortality?

Objective: Controversy remains over whether the association between depression and mortality in patients with acute coronary syndrome (ACS) is confounded by incomplete adjustment for measures of known prognostic markers. We assessed a) whether depression was associated with the most comprehensive empirically derived index of clinical mortality predictors: the Global Registry of Acute Coronary Events (GRACE) risk score for predicting 6-month mortality after discharge for ACS; and b) whether depression remained an independent predictor of all-cause mortality after adjustment for the GRACE score and left ventricular dysfunction. Methods: We surveyed prospectively 457 patients with ACS (aged 25–92 years; 41% women, 13% black, and 11% Hispanic), hospitalized between May 2003 and June 2005. Depressive symptoms were assessed with the Beck Depression Inventory (BDI) and diagnosis of major depressive disorder (MDD) was made by a structured psychiatric interview, within 1 week of hospitalization. Results: Despite differences in individual components of the GRACE score between depressed and nondepressed participants, neither depression measure was associated with overall GRACE score. For participants with MDD, the mean ± standard deviation GRACE score was 84 ± 33, compared with 92 ± 31 for those without MDD (p = .09). Using Cox proportional hazards regression analysis, MDD and depressive symptom severity each predicted mortality after controlling for GRACE score and left ventricular dysfunction (adjusted hazard ratio for MDD = 2.51; 95% Confidence Interval = 1.45–4.37). Conclusion: Depression is not simply a marker of clinical indicators that predict all-cause mortality after ACS. This strengthens the assertion that there is something unique in the association between depression and post-ACS prognosis, independent of known prognostic markers

HISSbot: Sidewinding with a Soft Snake Robot

Snake robots are characterized by their ability to navigate through small spaces and loose terrain by utilizing efficient cyclic forms of locomotion. Soft snake robots are a subset of these robots which utilize soft, compliant actuators to produce movement. Prior work on soft snake robots has primarily focused on planar gaits, such as undulation. More efficient spatial gaits, such as sidewinding, are unexplored gaits for soft snake robots. We propose a novel means of constructing a soft snake robot capable of sidewinding, and introduce the Helical Inflating Soft Snake Robot (HISSbot). We validate this actuation through the physical HISSbot, and demonstrate its ability to sidewind across various surfaces. Our tests show robustness in locomotion through low-friction and granular media.Comment: 7 pages, 9 figures, to be published in RoboSoft 202

Recategorization of Video Game Genres

While the categories that are typically used to discriminate games have been useful in the past, more recently game mechanics have become utilized by a wider range of games, leading to earlier definitions becoming a less valuable categorization tool. This paper attempts to provide various ways games could be classified by focusing on the types of emotions they evoke, the skills they require or their relations with personality or cognitive variables. A description of those categories and the challenge in using them to define games is outlined as well as five alternate methods that may help make distinctions between games clearer

The Development and Validation of a Universal Enjoyment Measure: The Enjoy Scale

For decades, the concept of enjoyment has been used to measure the psychological benefits of activities and has been shown to determine future behavior toward activities and objects of interest. However, there has been little consensus on the definition and dimensionality of enjoyment. This study introduced a new measure of enjoyment with scale development and validation reported. CFA and EFA findings from 1466 participants across 739 different activities were reported. The instrument developed measured enjoyment across activities, with demonstrated content validity, internal consistency, discriminant and convergent validity. The final 25-item version of the ENJOY scale is composed of 5 factors: pleasure, relatedness, competence, challenge/improvement, and engagement. Discussion of the ENJOY Scale places it within the conceptual framework of Self-Determination Theory

Is vitamin D deficiency a risk factor for ischemic heart disease in patients with established cardiovascular disease? 10-year follow-up of the Nova Scotia Health Survey

Recent studies have reported that low serum vitamin D levels are associated with a variety of diseases, including cardiovascular disease and in particular ischemic heart disease (IHD). Possible mechanisms underlying this association include increased inflammation, reninangiotensin system upregulation, insulin resistance, altered lipid metabolism, and altered vascular smooth muscle growth and function that lead to hypertension, diabetes, dyslipidemia and atherosclerosis.[1][2] However, few longitudinal studies have explored the association between vitamin D levels and incident IHD. A nested case-control study of male health care professionals found an approximately doubled risk of incident myocardial infarction associated with lower vitamin D levels.[3] Other studies have identified trends between vitamin D levels and incident myocardial infarction but no statistically significant associations, [4][5][6] at least in part due to small sample sizes or short follow-up