Neuropsychiatric symptoms in thymoma-associated and non-thymoma myasthenia gravis

Includes abstract.Includes bibliographical references.Myasthenia gravis (MG) is an acetylcholine receptor antibody- mediated disease targeting the neuromuscular junction resulting in fatigable muscle weakness. A number of reports have suggested a high prevalence of psychiatric symptoms amongst MG patients. Approximately 10% of MG subjects are found to have an associated thymoma and despite thymomectomy, the MG persists. The presence of thymoma may lead to other antibody-mediated neuropsychiatric manifestations including limbic encephalitis. We hypothesized that the prevalence of neuropsychiatric symptoms may be higher in MG subjects with thymoma-associated MG when compared with those who have non-thymoma MG. This study aims to compare the prevalence of neuropsychiatric symptoms in a South African population of non-thymoma MG and thymoma-associated MG

White matter correlates of neuropsychological function in young adult methamphetamine users

Background: Methamphetamine (MA) abuse is a global health concern due to widespread use and harmful effects, which includes neurotoxicity. This study aimed to describe neurocognitive deficits associated with MA dependence in young adults and to explore whether these deficits correlate with white matter (WM) microstructural abnormalities using diffusion tensor imaging (DTI). Methods: Twenty-one MA dependent individuals recently enrolled in an outpatient rehabilitation program and nineteen healthy controls participated in the study. Each participant completed a neuropsychological evaluation and underwent diffusion tensor imaging within one week of testing. Average whole-brain fractional anisotropy (FA) and mean diffusion (MD) measures derived from DTI data were compared between groups. Group differences in performance within specific neurocognitive domains and in a composite global neurocognitive score (GNS) were tested using non-parametric univariate statistics and within a linear regression framework, adjusting for age and gender. Correlation analyses were conducted to test associations between the neuropsychological data and selected frontal white matter (WM) tracts, including the genu and body of the corpus callosum (CC); right and left cingulum bundle (CB); right and left uncinate fasciculus (UF); right and left anterior corona radiata (CR) and the right and left superior longitudinal fasciculus (SLF). Results: No significant between-group differences were detected for performance in any of the neuropsychological domains assessed. No relationship between FA or MD and the GNS was demonstrated in the tracts of interest. After adjusting for age and gender, significant group differences in FA and MD were detected across several regions of interest (ROI), however, these did not survive corrections for multiple comparisons. Conclusion: Cognitive performance and white matter integrity did not differ between young MA dependent subjects and healthy controls. Whatever differences that were found in white matter did not survive correction for multiple comparisons. These findings may reflect one or more of several possibilities: that brain function and structure is relatively preserved in younger individuals; or that differences were too small to be detected in this sample. Further studies should explore the effects of aging, poly-substance abuse and HIV coinfection on neurocognitive functioning and structural brain integrity in methamphetamine users

Early precut fistulotomy for biliary access: time to change the paradigm of "the later, the better?"

The precut timing during the biliary cannulation algorithm is a subject of controversy. Some studies suggest that early institution of precut is a safe and effective strategy even though the extent to which this approach may affect the duration of the ERCP is seldom addressed. OBJECTIVE: To assess the success, safety, and procedure duration of an early precut fistulotomy (group A) versus a classic precut strategy after a difficult biliary cannulation (group B). DESIGN: Single-center, prospective cohort study. SETTING: University-affiliated hospital. PATIENTS: A total of 350 patients with a naïve papilla. INTERVENTIONS: Standard biliary cannulation followed by needle-knife fistulotomy (NKF). MAIN OUTCOME MEASUREMENTS: Biliary cannulation rate, NKF success, adverse events, and ERCP duration. RESULTS: The overall cannulation rate was similar, at 96% and 94% for groups A and B, respectively. The adverse event rate was 6.2% and 6.4%, respectively, with pancreatitis as the most frequent adverse event (group A, 3.9%; group B, 5.2%). The mean ERCP duration was, however, significantly shorter in group A, both when biliary cannulation was achieved without precutting (14 minutes vs 25 minutes, P < .001) as well as when biliary cannulation was attempted after NKF (18 minutes vs 31 minutes, P < .0001). LIMITATIONS: Single-center study design, referral center. CONCLUSIONS: If the endoscopist is experienced in ERCP and precut techniques, an early precut strategy should be the preferred cannulation strategy because this approach is as safe and effective as the late fistulotomy approach and substantially reduces ERCP duration

Making Mas: TruDynasty Carnival Takes Josephine Baker to the Caribbean Carnival

Jacqueline Taucar, in conversation with Thea and Dario Jackson, investigates the sculptural qualities of the Josephine Baker Mas for the Scotiabank Caribbean Carnival Festival in 2011. This article traces the conception, construction, and complexities of choreography for this carnivalesque reimagining of Baker in Paris of the twenties for a contemporary Canadian ambulant expression. This Queen Mas talks back to the objectification by Parisians and embodying Queen Mas as an instance of female empowerment

Academic team formation as evolving hypergraphs

This paper quantitatively explores the social and socio-semantic patterns of constitution of academic collaboration teams. To this end, we broadly underline two critical features of social networks of knowledge-based collaboration: first, they essentially consist of group-level interactions which call for team-centered approaches. Formally, this induces the use of hypergraphs and n-adic interactions, rather than traditional dyadic frameworks of interaction such as graphs, binding only pairs of agents. Second, we advocate the joint consideration of structural and semantic features, as collaborations are allegedly constrained by both of them. Considering these provisions, we propose a framework which principally enables us to empirically test a series of hypotheses related to academic team formation patterns. In particular, we exhibit and characterize the influence of an implicit group structure driving recurrent team formation processes. On the whole, innovative production does not appear to be correlated with more original teams, while a polarization appears between groups composed of experts only or non-experts only, altogether corresponding to collectives with a high rate of repeated interactions

A systematic review of brief mental health and well-being interventions in organizational settings

Objectives The aim of the systematic review was to provide an overview of the evidence on the effectiveness of brief interventions targeting mental health and well-being in organizational settings and compare their effects with corresponding interventions of common (ie, longer) duration. Methods An extensive systematic search was conducted using the Medline and PsycINFO databases for the period of 2000-2016. Randomized-controlled trials (RCT) and quasi-experimental studies evaluating primary or secondary brief interventions carried out in the workplace settings were included. Subsequently, common interventions matching brief interventions by type and assessed outcomes were included. The methodological quality of included studies was appraised using NICE guidelines and the best evidence synthesis approach was applied. Results The review identified 11 brief interventions and 9 corresponding common interventions. Included studies varied substantially in sample size and characteristics, methodological quality, duration of follow-up, types of intervention, and assessed outcomes. All but one study evaluating brief interventions had high risk of bias. No evidence was found on the effectiveness of brief stress management, relaxation, massage, mindfulness meditation, or multimodal interventions. We found limited evidence on the effectiveness of brief positive psychology interventions. Conclusions Our review highlights the need for high-quality studies evaluating brief mental health and well-being interventions in organizational settings. Future studies should use methodologically rigorous designs and improved reporting of methods and results to provide conclusive evidence on the effectiveness and sustainability of the intervention effects

Emergencies after endoscopic procedures

Endoscopy adverse events (AEs), or complications, are a rising concern on the quality of endoscopic care, given the technical advances and the crescent complexity of therapeutic procedures, over the entire gastrointestinal and bilio-prancreatic tract. In a small percentage, not established, there can be real emergency conditions, as perforation, severe bleeding, embolization or infection. Distinct variables interfere in its occurrence, although, the awareness of the operator for their potential, early recognition, and local organized facilities for immediate handling, makes all the difference in the subsequent outcome. This review outlines general AEs’ frequencies, important predisposing factors and putative prophylactic measures for specific procedures (from conventional endoscopy to endoscopic cholangio-pancreatography and ultrasonography), with comprehensive approaches to the management of emergent bleeding and perforation

To err is human, to correct is public health: a systematic review examining poor quality testing and misdiagnosis of HIV status.

INTRODUCTION: In accordance with global testing and treatment targets, many countries are seeking ways to reach the "90-90-90" goals, starting with diagnosing 90% of all people with HIV. Quality HIV testing services are needed to enable people with HIV to be diagnosed and linked to treatment as early as possible. It is essential that opportunities to reach people with undiagnosed HIV are not missed, diagnoses are correct and HIV-negative individuals are not inadvertently initiated on life-long treatment. We conducted this systematic review to assess the magnitude of misdiagnosis and to describe poor HIV testing practices using rapid diagnostic tests. METHODS: We systematically searched peer-reviewed articles, abstracts and grey literature published from 1 January 1990 to 19 April 2017. Studies were included if they used at least two rapid diagnostic tests and reported on HIV misdiagnosis, factors related to potential misdiagnosis or described quality issues and errors related to HIV testing. RESULTS: Sixty-four studies were included in this review. A small proportion of false positive (median 3.1%, interquartile range (IQR): 0.4-5.2%) and false negative (median: 0.4%, IQR: 0-3.9%) diagnoses were identified. Suboptimal testing strategies were the most common factor in studies reporting misdiagnoses, particularly false positive diagnoses due to using a "tiebreaker" test to resolve discrepant test results. A substantial proportion of false negative diagnoses were related to retesting among people on antiretroviral therapy. Conclusions HIV testing errors and poor practices, particularly those resulting in false positive or false negative diagnoses, do occur but are preventable. Efforts to accelerate HIV diagnosis and linkage to treatment should be complemented by efforts to improve the quality of HIV testing services and strengthen the quality management systems, particularly the use of validated testing algorithms and strategies, retesting people diagnosed with HIV before initiating treatment and providing clear messages to people with HIV on treatment on the risk of a "false negative" test result