A case of an anomalous pectoralis major muscle

We present a case of a right sided accessory head of the pectoralis major muscle located inferior to its abdominal head. This variation was found during a routine anatomy dissection at the American University of the Caribbean School of Medicine. The muscle fibres of the accessory head of the pectoralis major muscle arose from those of the serratus anterior muscle and travelled superolaterally towards the axilla. The accessory muscle terminated by fusing with the tendinous fibres of the pectoralis major muscle as they underwent their normal anatomical rotation before insertion upon the lateral lip of the bicipital groove of the humerus. Although variations in the pectoral muscles are not uncommon, this case appears to be unique in the literature. The possible clinical implications are discussed

Challenges and Benefits of Using a Virtual Community to Explore Nursing Concepts Among Baccalaureate Nursing Students

This research study examines learner perceptions of benefits and challenges associated with the Neighborhood (NBH), an innovative pedagogy that fosters learner engagement and integration of nursing concepts using a “virtual community” as an alternative to lecture. First-semester students from five baccalaureate nursing programs that used the NBH intervention were divided into high (N = 78) and low faculty use (N = 203) groups. Qualitative analysis revealed that the NBH intervention promoted application of concepts to real life situation was engaging and “eye-opening,” allowing students to understand health care issues from a variety of perspectives. A major challenge was busy work generated by faculty assignments unrelated to enhancing conceptual clarity. Statistical analyses indicate that benefits and challenges grow together; benefits outweigh challenges and net benefit increases with increased faculty use. This study highlights the need to provide initial and ongoing training and support to faculty at schools who adopt this intervention

Racial Differences in the Human Endogenous Circadian Period

The length of the endogenous period of the human circadian clock (tau) is slightly greater than 24 hours. There are individual differences in tau, which influence the phase angle of entrainment to the light/dark (LD) cycle, and in doing so contribute to morningness-eveningness. We have recently reported that tau measured in subjects living on an ultradian LD cycle averaged 24.2 hours, and is similar to tau measured using different experimental methods. Here we report racial differences in tau. Subjects lived on an ultradian LD cycle (1.5 hours sleep, 2.5 hours wake) for 3 days. Circadian phase assessments were conducted before and after the ultradian days to determine the change in circadian phase, which was attributed to tau. African American subjects had a significantly shorter tau than subjects of other races. We also tested for racial differences in our previous circadian phase advancing and phase delaying studies. In the phase advancing study, subjects underwent 4 days of a gradually advancing sleep schedule combined with a bright light pulse upon awakening each morning. In the phase delaying study, subjects underwent 4 days of a gradually delaying sleep schedule combined with evening light pulses before bedtime. African American subjects had larger phase advances and smaller phase delays, relative to Caucasian subjects. The racial differences in tau and circadian phase shifting have important implications for understanding normal phase differences between individuals, for developing solutions to the problems of jet lag and shift work, and for the diagnosis and treatment of circadian rhythm based sleep disorders such as advanced and delayed sleep phase disorder

Single-Arm, Non-randomized, Time Series, Single-Subject Study of Fecal Microbiota Transplantation in Multiple Sclerosis

Emerging evidence suggests intestinal microbiota as a central contributing factor to the pathogenesis of Relapsing-Remitting-Multiple-Sclerosis (RRMS). This novel RRMS study evaluated the impact of fecal-microbiota-transplantation (FMT) on a broad array of physiological/clinical outcomes using deep metagenome sequencing of fecal microbiome. FMT interventions were associated with increased abundances of putative beneficial stool bacteria and short-chain-fatty-acid metabolites, which were associated with increased/improved serum brain-derived-neurotrophic-factor levels and gait/walking metrics. This proof-of-concept single-subject longitudinal study provides evidence of potential importance of intestinal microbiota in the pathogenesis of MS, and scientific rationale to help design future randomized controlled trials assessing FMT in RRMS patients

Aqueous phase methylation as a potential source of methylmercury in wet deposition

Author Posting. © The Authors, 2006. This is the author's version of the work. It is posted here by permission of Elsevier B.V for personal use, not for redistribution. The definitive version was published in Atmospheric Environment 41 (2007): 1663-1668, doi:10.1016/j.atmosenv.2006.10.032.The source of monomethylmercury (MMHg) in wet deposition is unknown. Volatilization of gaseous MMHg, evasion and demethylation of dimethylmercury, and methylation of Hg0 have been either proposed or tested unsuccessfully as potential sources. Here, we show that MMHg in precipitation, sampled across a wide geographical range in North America, is related positively to an operationally defined and measured reactive Hg species (HgR), but connected weakly to total Hg. The mean molar ratio of MMHg:HgR measured in continental precipitation (0.025 ± 0.006) is comparable to the MMHg:Hg(II) ratio estimated from first-order rate constants for acetate-mediated Hg methylation and MMHg photolysis (0.025 ± 0.002). This suggests MMHg may be formed in the atmosphere through a reaction between labile Hg(II) complexes and an unknown methylating agent(s), potentially acetate or similar molecules. Availability of Hg(II) appears to limit the reaction, and accordingly, increased atmospheric loadings of Hg could lead to enhanced MMHg in precipitation.This study was supported by a grant from the National Science Foundation-Office of Polar Programs (0425562) and the Postdoctoral Scholar Program at the Woods Hole Oceanographic Institution, with funding from the Doherty Foundation

Wind/WAVES observations of Auroral Kilometric Radiation: automated burst detection and Terrestrial Solar Wind - Magnetosphere coupling effects

Auroral Kilometric Radiation (AKR) is the strongest terrestrial radio emission, and emanates from the same electron acceleration regions from which particles precipitate into the ionosphere, exciting the aurorae and other phenomena. As such, AKR is a barometer for the state of solar wind - magnetosphere - ionosphere coupling. AKR is anisotropically beamed in a hollow cone from a source region generally found at nightside local times, meaning that a single source region cannot be viewed from all local times in the magnetosphere. In radio data such as dynamic spectra, AKR is frequently observed simultaneously to other radio emissions which can have a similar intensity and frequency range, making it difficult to automatically detect. Building on a previously published pipeline to extract AKR emissions from Wind/WAVES data, in this paper a novel automated AKR burst detection technique is presented and applied again to Wind/WAVES data. Over a five year interval, about 5000 AKR bursts are detected with median burst length ranging from about 30-60 minutes. During detected burst windows, higher solar wind velocity is observed, and the interplanetary magnetic field (IMF) clock angle is observed to tend towards BZ<0, BY<0, when compared with the entire statistical interval. Additionally, higher geomagnetic activity is observed during burst windows at polar, high and equatorial latitudes

Effect of a magnetosphere compression on Jovian radio emissions: in situ case study using Juno data

During its 53-day polar orbit around Jupiter, Juno often crosses the boundaries of the Jovian magnetosphere (namely the magnetopause and bow shock). From the boundary locations, the upstream solar wind dynamic pressure can be inferred, which in turn illustrates the state of compression or relaxation of the system. The aim of this study is to examine Jovian radio emissions during magnetospheric compressions, in order to determine the relationship between the solar wind and Jovian radio emissions. In this paper, we give a complete list of bow shock and magnetopause crossings (from June 2016 to August 2022), along with some extra informations (e.g. solar wind dynamic pressure and position of the standoff distances inferred from Joy et al. (2002)). We then select two compression events that occur in succession (inferred from magnetopause crossings) and we present a case study of the response of the Jovian radio emissions. We demonstrate that magnetospheric compressions lead to the activation of new radio sources. Newly activated broadband kilometric emissions are observed almost simultaneously to compression of the magnetosphere, with sources covering a large range of longitudes. Decametric emission sources are seen to be activated more than one rotation later only at specific longitudes and dusk local times. Finally, the activation of narrowband kilometric radiation is not observed during the compression phase, but when the magnetosphere is in its expansion phase

A randomized controlled trial of CBT-I and PAP for obstructive sleep apnea and comorbid insomnia : main outcomes from the MATRICS study

Study Objectives -- To investigate treatment models using cognitive behavioral therapy for insomnia (CBT-I) and positive airway pressure (PAP) for people with obstructive sleep apnea (OSA) and comorbid insomnia. Methods -- 121 adults with OSA and comorbid insomnia were randomized to receive CBT-I followed by PAP, CBT-I concurrent with PAP, or PAP only. PAP was delivered following standard clinical procedures for in-lab titration and home setup and CBT-I was delivered in four individual sessions. The primary outcome measure was PAP adherence across the first 90 days, with regular PAP use (≥4 h on ≥70% of nights during a 30-day period) serving as the clinical endpoint. The secondary outcome measures were the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) with good sleeper (PSQI 7) serving as the clinical endpoints. Results -- No significant differences were found between the concomitant treatment arms and PAP only on PAP adherence measures, including the percentage of participants who met the clinical endpoint. Compared to PAP alone, the concomitant treatment arms reported a significantly greater reduction from baseline on the ISI (p = .0009) and had a greater percentage of participants who were good sleepers (p = .044) and remitters (p = .008). No significant differences were found between the sequential and concurrent treatment models on any outcome measure. Conclusions -- The findings from this study indicate that combining CBT-I with PAP is superior to PAP alone on insomnia outcomes but does not significantly improve adherence to PAP

The rise of consumer health wearables: promises and barriers

Will consumer wearable technology ever be adopted or accepted by the medical community? Patients and practitioners regularly use digital technology (e.g., thermometers and glucose monitors) to identify and discuss symptoms. In addition, a third of general practitioners in the United Kingdom report that patients arrive with suggestions for treatment based on online search results. However, consumer health wearables are predicted to become the next “Dr Google.” One in six (15%) consumers in the United States currently uses wearable technology, including smartwatches or fitness bands. While 19 million fitness devices are likely to be sold this year, that number is predicted to grow to 110 million in 2018. As the line between consumer health wearables and medical devices begins to blur, it is now possible for a single wearable device to monitor a range of medical risk factors. Potentially, these devices could give patients direct access to personal analytics that can contribute to their health, facilitate preventive care, and aid in the management of ongoing illness. However, how this new wearable technology might best serve medicine remains unclea

Haematological consequences of acute uncomplicated falciparum malaria: a WorldWide Antimalarial Resistance Network pooled analysis of individual patient data

Background: Plasmodium falciparum malaria is associated with anaemia-related morbidity, attributable to host, parasite and drug factors. We quantified the haematological response following treatment of uncomplicated P. falciparum malaria to identify the factors associated with malarial anaemia. Methods: Individual patient data from eligible antimalarial efficacy studies of uncomplicated P. falciparum malaria, available through the WorldWide Antimalarial Resistance Network data repository prior to August 2015, were pooled using standardised methodology. The haematological response over time was quantified using a multivariable linear mixed effects model with nonlinear terms for time, and the model was then used to estimate the mean haemoglobin at day of nadir and day 7. Multivariable logistic regression quantified risk factors for moderately severe anaemia (haemoglobin < 7 g/dL) at day 0, day 3 and day 7 as well as a fractional fall ≥ 25% at day 3 and day 7. Results: A total of 70,226 patients, recruited into 200 studies between 1991 and 2013, were included in the analysis: 50,859 (72.4%) enrolled in Africa, 18,451 (26.3%) in Asia and 916 (1.3%) in South America. The median haemoglobin concentration at presentation was 9.9 g/dL (range 5.0–19.7 g/dL) in Africa, 11.6 g/dL (range 5.0–20.0 g/dL) in Asia and 12.3 g/dL (range 6.9–17.9 g/dL) in South America. Moderately severe anaemia (Hb < 7g/dl) was present in 8.4% (4284/50,859) of patients from Africa, 3.3% (606/18,451) from Asia and 0.1% (1/916) from South America. The nadir haemoglobin occurred on day 2 post treatment with a mean fall from baseline of 0.57 g/dL in Africa and 1.13 g/dL in Asia. Independent risk factors for moderately severe anaemia on day 7, in both Africa and Asia, included moderately severe anaemia at baseline (adjusted odds ratio (AOR) = 16.10 and AOR = 23.00, respectively), young age (age < 1 compared to ≥ 12 years AOR = 12.81 and AOR = 6.79, respectively), high parasitaemia (AOR = 1.78 and AOR = 1.58, respectively) and delayed parasite clearance (AOR = 2.44 and AOR = 2.59, respectively). In Asia, patients treated with an artemisinin-based regimen were at significantly greater risk of moderately severe anaemia on day 7 compared to those treated with a non-artemisinin-based regimen (AOR = 2.06 [95%CI 1.39–3.05], p < 0.001). Conclusions: In patients with uncomplicated P. falciparum malaria, the nadir haemoglobin occurs 2 days after starting treatment. Although artemisinin-based treatments increase the rate of parasite clearance, in Asia they are associated with a greater risk of anaemia during recovery