Asymmetric hearing loss stratification and vestibular Schwannoma risk: a meta-analysis

INTRODUCTION: Asymmetrical sensorineural hearing loss [ASNHL] is a common otological complaint. Vestibular schwannoma [VS] is a rare, benign tumor that commonly presents with ASNHL. Magnetic resonance imaging [MRI] is the gold standard in diagnosing VS, but is an expensive imaging modality. Therefore, this meta-analysis evaluates the diagnostic yield of MRI scans in patients with ASNHL to rule out VS. METHODS: A systematic review was performed using a keyword search on the PubMed Database. We excluded articles based on: Non-English, case reports, wrong diagnostic test, solely pediatric subjects, inadequate/unnecessary data, repeated studies, and unclear presenting symptoms. The demographics, definition of ASNHL, and the number and results of MRIs were collected. Positive MRIs were grouped based on differences in interaural hearing loss. RESULTS: 5,783 MRIs on subjects with ASNHL were collected from fourteen studies. 296 MRI scans (5.1%) were positive for VS. 170 positive scans were grouped. In Group A (10+ dB) 11.2% had VS; in Group B (15+ dB at ≥2 frequencies or 20+ dB at 1 frequency) 6.5% had VS, Group C (20+ dB) yielded 5.1% with VS, and Group D (30+ dB) had 0.7% yield of positive VS. CONCLUSION: MRI scans to rule out VS in patients with ASNHL has an extremely low diagnostic yield when assessing subjects on the basis of ASNHL. The degree of ASNHL does not correlate with increased odds of VS diagnosis. Overall, the risk of VS diagnosis in patients with any degree of ASNHL is low

A Multiple Identity Approach to Gender: Identification with Women, Identification with Feminists, and Their Interaction

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/article/10.3389/fpsyg.2017.01019/full#supplementary-materialAcross four studies, we examine multiple identities in the context of gender and propose that women's attitudes toward gender group membership are governed by two largely orthogonal dimensions of gender identity: identification with women and identification with feminists. We argue that identification with women reflects attitudes toward the content society gives to group membership: what does it mean to be a woman in terms of group characteristics, interests and values? Identification with feminists, on the other hand, is a politicized identity dimension reflecting attitudes toward the social position of the group: what does it mean to be a woman in terms of disadvantage, inequality, and relative status? We examine the utility of this multiple identity approach in four studies. Study 1 showed that identification with women reflects attitudes toward group characteristics, such as femininity and self-stereotyping, while identification with feminists reflects attitudes toward the group's social position, such as perceived sexism. The two dimensions are shown to be largely independent, and as such provide support for the multiple identity approach. In Studies 2–4, we examine the utility of this multiple identity approach in predicting qualitative differences in gender attitudes. Results show that specific combinations of identification with women and feminists predicted attitudes toward collective action and gender stereotypes. Higher identification with feminists led to endorsement of radical collective action (Study 2) and critical attitudes toward gender stereotypes (Studies 3–4), especially at lower levels of identification with women. The different combinations of high vs. low identification with women and feminists can be thought of as reflecting four theoretical identity “types.” A woman can be (1) strongly identified with neither women nor feminists (“low identifier”), (2) strongly identified with women but less so with feminists (“traditional identifier”), (3) strongly identified with both women and feminists (“dual identifier”), or (4) strongly identified with feminists but less so with women (“distinctive feminist”). In sum, by considering identification with women and identification with feminists as multiple identities we aim to show how the multiple identity approach predicts distinct attitudes to gender issues and offer a new perspective on gender identity.This work was supported by Grant no. PSI2016-79971-P from the Spanish Ministry of Science and Technology (AEI/FEDER, UE) awarded to SdL

Spirit, mind and body: the archaeology of monastic healing

Archaeology and material culture are used in this chapter to consider how monastic experience responded to illness, ageing and disability. The approach taken is influenced by the material study of religion, which interrogates how bodies and things engage to construct the sensory experience of religion, and by practice-based approaches in archaeology, which examine the active role of space and material culture in shaping religious agency and embodiment. The archaeology of monastic healing focuses on the full spectrum of healing technologies, from managing the body in order to prevent illness, through to the treatment of the sick and preparation of the corpse for burial

First detection of a lithium rich carbon star in the Draco dwarf galaxy: evidence for a young stellar population

We present a spectroscopic study of D461, a giant star belonging to Draco dwarf spheroidal galaxy. From spectral synthesis in LTE we derive a lithium abundance of log e(Li)=3.5+/-0.4 and a C/O ratio between 3 and 5. This is the first detection of a lithium rich C-star in a dwarf spheroidal galaxy. Basing on stellar models of appropriate chemical composition, we show that a similar C enrichment is compatible with that expectedfor a low mass low metallicity thermally pulsing AGB star, undergoing few third dredge up episodes. The position in the log g-log Teff diagram of D461 is also compatible with this theoretical scenario. In particular, the low effective temperature, lower than that expected for a low metallicity giant star, is a consequence of the huge increase of the envelope opacity occurring after the carbon dredge up. The Li enrichment may be explained if a deep circulation would take place during the interpulse period, the so called cool bottom process. In spite of the low resolution of our spectra, we derive a lower limit for the carbon isotopic ratio, namely 12C/13C>40, and a constraint for the Ba abundance, namely 0.5<[Ba/Fe]< 2. The proposed scenario also fits these further constraints. Then, we estimate that the mass of D461 ranges between 1.2 and 2 $M_\odot$, which corresponds to an age ranging between 1 and 3 Gyr. We conclude that this star is more massive and younger than the typical stellar population of Draco.Comment: 10 pages, 5 figues. Accepted for publication in A&

A Fundamental Regulatory Mechanism Operating through OmpR and DNA Topology Controls Expression of Salmonella Pathogenicity Islands SPI-1 and SPI-2

DNA topology has fundamental control over the ability of transcription factors to access their target DNA sites at gene promoters. However, the influence of DNA topology on protein–DNA and protein–protein interactions is poorly understood. For example, relaxation of DNA supercoiling strongly induces the well-studied pathogenicity gene ssrA (also called spiR) in Salmonella enterica, but neither the mechanism nor the proteins involved are known. We have found that relaxation of DNA supercoiling induces expression of the Salmonella pathogenicity island (SPI)-2 regulator ssrA as well as the SPI-1 regulator hilC through a mechanism that requires the two-component regulator OmpR-EnvZ. Additionally, the ompR promoter is autoregulated in the same fashion. Conversely, the SPI-1 regulator hilD is induced by DNA relaxation but is repressed by OmpR. Relaxation of DNA supercoiling caused an increase in OmpR binding to DNA and a concomitant decrease in binding by the nucleoid-associated protein FIS. The reciprocal occupancy of DNA by OmpR and FIS was not due to antagonism between these transcription factors, but was instead a more intrinsic response to altered DNA topology. Surprisingly, DNA relaxation had no detectable effect on the binding of the global repressor H-NS. These results reveal the underlying molecular mechanism that primes SPI genes for rapid induction at the onset of host invasion. Additionally, our results reveal novel features of the archetypal two-component regulator OmpR. OmpR binding to relaxed DNA appears to generate a locally supercoiled state, which may assist promoter activation by relocating supercoiling stress-induced destabilization of DNA strands. Much has been made of the mechanisms that have evolved to regulate horizontally-acquired genes such as SPIs, but parallels among the ssrA, hilC, and ompR promoters illustrate that a fundamental form of regulation based on DNA topology coordinates the expression of these genes regardless of their origins

Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study.

OBJECTIVE: To characterise the clinical features of children and young people admitted to hospital with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK and explore factors associated with admission to critical care, mortality, and development of multisystem inflammatory syndrome in children and adolescents temporarily related to coronavirus disease 2019 (covid-19) (MIS-C). DESIGN: Prospective observational cohort study with rapid data gathering and near real time analysis. SETTING: 260 hospitals in England, Wales, and Scotland between 17 January and 3 July 2020, with a minimum follow-up time of two weeks (to 17 July 2020). PARTICIPANTS: 651 children and young people aged less than 19 years admitted to 138 hospitals and enrolled into the International Severe Acute Respiratory and emergency Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK study with laboratory confirmed SARS-CoV-2. MAIN OUTCOME MEASURES: Admission to critical care (high dependency or intensive care), in-hospital mortality, or meeting the WHO preliminary case definition for MIS-C. RESULTS: Median age was 4.6 (interquartile range 0.3-13.7) years, 35% (225/651) were under 12 months old, and 56% (367/650) were male. 57% (330/576) were white, 12% (67/576) South Asian, and 10% (56/576) black. 42% (276/651) had at least one recorded comorbidity. A systemic mucocutaneous-enteric cluster of symptoms was identified, which encompassed the symptoms for the WHO MIS-C criteria. 18% (116/632) of children were admitted to critical care. On multivariable analysis, this was associated with age under 1 month (odds ratio 3.21, 95% confidence interval 1.36 to 7.66; P=0.008), age 10-14 years (3.23, 1.55 to 6.99; P=0.002), and black ethnicity (2.82, 1.41 to 5.57; P=0.003). Six (1%) of 627 patients died in hospital, all of whom had profound comorbidity. 11% (52/456) met the WHO MIS-C criteria, with the first patient developing symptoms in mid-March. Children meeting MIS-C criteria were older (median age 10.7 (8.3-14.1) v 1.6 (0.2-12.9) years; P<0.001) and more likely to be of non-white ethnicity (64% (29/45) v 42% (148/355); P=0.004). Children with MIS-C were five times more likely to be admitted to critical care (73% (38/52) v 15% (62/404); P<0.001). In addition to the WHO criteria, children with MIS-C were more likely to present with fatigue (51% (24/47) v 28% (86/302); P=0.004), headache (34% (16/47) v 10% (26/263); P<0.001), myalgia (34% (15/44) v 8% (21/270); P<0.001), sore throat (30% (14/47) v (12% (34/284); P=0.003), and lymphadenopathy (20% (9/46) v 3% (10/318); P<0.001) and to have a platelet count of less than 150 × 109/L (32% (16/50) v 11% (38/348); P<0.001) than children who did not have MIS-C. No deaths occurred in the MIS-C group. CONCLUSIONS: Children and young people have less severe acute covid-19 than adults. A systemic mucocutaneous-enteric symptom cluster was also identified in acute cases that shares features with MIS-C. This study provides additional evidence for refining the WHO MIS-C preliminary case definition. Children meeting the MIS-C criteria have different demographic and clinical features depending on whether they have acute SARS-CoV-2 infection (polymerase chain reaction positive) or are post-acute (antibody positive). STUDY REGISTRATION: ISRCTN66726260

Multifactorial falls prevention programmes for older adults presenting to the Emergency Department with a fall: systematic review and meta-analysis.

Background: Falls are a leading cause of emergency department (ED) presentations in older adults. Objective: To determine whether multifactorial falls prevention interventions are effective in preventing falls, fall injuries, ED re-presentations and hospital admissions in older adults presenting to the ED with a fall. Design: Systematic review and meta-analyses of randomised control trials (RCTs). Methods: Four health-related electronic databases were searched (inception to June 2018) with two independent reviewers determining inclusion, assessing study quality and undertaking data extraction. Study selection: RCTs of multifactorial falls prevention interventions targeting community dwelling older adults (≥ 60 years) presenting to the ED with a fall and providing quantitative data on at least one of the review outcomes. Results: Twelve studies involving 3,986 participants, from six countries, were eligible for inclusion. Studies were of variable methodological quality. The multifactorial interventions were heterogeneous, though the majority included components such as education, referral to relevant healthcare services, home modifications, exercise, and medication changes. Meta-analyses demonstrated a non-significant reduction in falls (rate ratio=0.78; 95% CI 0.58, 1.05) with multi-factorial falls prevention programs. Multi-factorial interventions did not significantly affect the number of fallers (risk ratio=1.02; 95% CI 0.88, 1.18), rate of fractured neck of femur (risk ratio=0.82; 95% CI 0.53, 1.25), fall-related ED presentations (rate ratio=0.99; 95% CI 0.84, 1.16), or hospitalisations (rate ratio=1.14; 95% CI 0.69, 1.89). Conclusions: There is insufficient evidence to support the use of multifactorial falls interventions to prevent falls or hospital utilisation in older people presenting to ED following a fall. Further research targeting this population group is required

Inhaled corticosteroids for asthma: are they all the same?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72783/1/j.1365-2710.2008.00970.x.pd