Not Just Fun and Games: A Review of College Drinking Games Research From 2004 to 2013

Drinking games are a high-risk social drinking activity consisting of rules and guidelines that determine when and how much to drink (Polizzotto et al., 2007). Borsari\u27s (2004) seminal review paper on drinking games in the college environment succinctly captured the published literature as of February 2004. However, research on college drinking games has grown exponentially during the last decade, necessitating an updated review of the literature. This review provides an in-depth summary and synthesis of current drinking games research (e.g., characteristics of drinking games, and behavioral, demographic, social, and psychological influences on participation) and suggests several promising areas for future drinking games research. This review is intended to foster a better understanding of drinking game behaviors among college students and improve efforts to reduce the negative impact of this practice on college campuses

Individual common variants exert weak effects on the risk for autism spectrum disorders.

While it is apparent that rare variation can play an important role in the genetic architecture of autism spectrum disorders (ASDs), the contribution of common variation to the risk of developing ASD is less clear. To produce a more comprehensive picture, we report Stage 2 of the Autism Genome Project genome-wide association study, adding 1301 ASD families and bringing the total to 2705 families analysed (Stages 1 and 2). In addition to evaluating the association of individual single nucleotide polymorphisms (SNPs), we also sought evidence that common variants, en masse, might affect the risk. Despite genotyping over a million SNPs covering the genome, no single SNP shows significant association with ASD or selected phenotypes at a genome-wide level. The SNP that achieves the smallest P-value from secondary analyses is rs1718101. It falls in CNTNAP2, a gene previously implicated in susceptibility for ASD. This SNP also shows modest association with age of word/phrase acquisition in ASD subjects, of interest because features of language development are also associated with other variation in CNTNAP2. In contrast, allele scores derived from the transmission of common alleles to Stage 1 cases significantly predict case status in the independent Stage 2 sample. Despite being significant, the variance explained by these allele scores was small (Vm< 1%). Based on results from individual SNPs and their en masse effect on risk, as inferred from the allele score results, it is reasonable to conclude that common variants affect the risk for ASD but their individual effects are modest

Target product profile for a test for the early assessment of treatment efficacy in Chagas disease patients: An expert consensus.

Six to 7 million people are estimated to be infected by Trypanosoma cruzi, the parasite causing Chagas disease. Thirty to 40% of them, i.e., 1.8 to 2.4 million people, will suffer cardiac disorders and/or digestive clinical manifestations if they are not treated early during the course of the infection [1, 2]. However, only a small fraction of patients are properly diagnosed and treated [3]. Current clinical guidelines recommend treating T. cruzi–infected people if they are asymptomatic or present early symptoms of the disease (Table 1) [4, 5]. Benznidazole (BNZ) and nifurtimox (NFX) are the first-line antiparasitic treatments currently available, both with long administration regimens (60 days) that can produce adverse side effects [6–8]. Despite the fact they are not 100% effective in patients with chronic disease [9–12], they are the only drugs currently registered, and the benefits of their administration have been confirmed in several clinical studies. Currently, clinical trials with new compounds, using alternative regimens that aim to maintain efficacy whilst reducing toxicity, are ongoing and could lead to new therapeutic opportunities and/or policy change

Relative contribution of various chronic diseases and multi-morbidity to potential disability among Dutch elderly

BACKGROUND: The amount of time spent living with disease greatly influences elderly people’s wellbeing, disability and healthcare costs, but differs by disease, age and sex. METHODS: We assessed how various single and combined diseases differentially affect life years spent living with disease in Dutch elderly men and women (65+) over their remaining life course. Multistate life table calculations were applied to age and sex-specific disease prevalence, incidence and death rates for the Netherlands in 2007. We distinguished congestive heart failure, coronary heart disease (CHD), breast and prostate cancer, colon cancer, lung cancer, diabetes, COPD, stroke, dementia and osteoarthritis. RESULTS: Across ages 65, 70, 75, 80 and 85, CHD caused the most time spent living with disease for Dutch men (from 7.6 years at age 65 to 3.7 years at age 85) and osteoarthritis for Dutch women (from 11.7 years at age 65 to 4. 8 years at age 85). Of the various co-occurrences of disease, the combination of diabetes and osteoarthritis led to the most time spent living with disease, for both men (from 11.2 years at age 65 to 4.9 -years at age 85) and women (from 14.2 years at age 65 to 6.0 years at age 85). CONCLUSIONS: Specific single and multi-morbid diseases affect men and women differently at different phases in the life course in terms of the time spent living with disease, and consequently, their potential disability. Timely sex and age-specific interventions targeting prevention of the single and combined diseases identified could reduce healthcare costs and increase wellbeing in elderly people

A novel approach of homozygous haplotype sharing identifies candidate genes in autism spectrum disorder

Autism spectrum disorder (ASD) is a highly heritable disorder of complex and heterogeneous aetiology. It is primarily characterized by altered cognitive ability including impaired language and communication skills and fundamental deficits in social reciprocity. Despite some notable successes in neuropsychiatric genetics, overall, the high heritability of ASD (~90%) remains poorly explained by common genetic risk variants. However, recent studies suggest that rare genomic variation, in particular copy number variation, may account for a significant proportion of the genetic basis of ASD. We present a large scale analysis to identify candidate genes which may contain low-frequency recessive variation contributing to ASD while taking into account the potential contribution of population differences to the genetic heterogeneity of ASD. Our strategy, homozygous haplotype (HH) mapping, aims to detect homozygous segments of identical haplotype structure that are shared at a higher frequency amongst ASD patients compared to parental controls. The analysis was performed on 1,402 Autism Genome Project trios genotyped for 1 million single nucleotide polymorphisms (SNPs). We identified 25 known and 1,218 novel ASD candidate genes in the discovery analysis including CADM2, ABHD14A, CHRFAM7A, GRIK2, GRM3, EPHA3, FGF10, KCND2, PDZK1, IMMP2L and FOXP2. Furthermore, 10 of the previously reported ASD genes and 300 of the novel candidates identified in the discovery analysis were replicated in an independent sample of 1,182 trios. Our results demonstrate that regions of HH are significantly enriched for previously reported ASD candidate genes and the observed association is independent of gene size (odds ratio 2.10). Our findings highlight the applicability of HH mapping in complex disorders such as ASD and offer an alternative approach to the analysis of genome-wide association data

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Learning cross-sectional anatomy using ultrasound: perspectives of undergraduate clinical anatomy students

Thesis (MPhil)--Stellenbosch University, 2021.ENGLISH SUMMARY : Ultrasound (US) is increasingly used across the medical specialities as a diagnostic tool and as a result, medical faculties are being advised to further incorporate imaging into their programmes. Using US within undergraduate instruction has several benefits. The use of US, as a learning instrument, may strengthen existing anatomical knowledge and improve visual understanding of anatomy. The cost-effectiveness, as well as portability of the US, makes it a valuable means to add-on to traditional anatomy teaching modalities. Furthermore, students may develop skills in interpreting US images and ultrasound may add a different element to the study of anatomy. The literature clearly shows evidence of the benefits of US in teaching anatomy, as well as the fact that anatomy educators can be trained by clinicians to incorporate US during dissection sessions. The value of US is evident from published works and will be worth investigating in the undergraduate setting. Furthermore, although US training may not always improve students’ performances, it may lead to increased interest in learning anatomy for enhanced clinical practice. The study aimed to explore undergraduate clinical anatomy students’ perceptions on the use of ultrasound as an add-on to cadaveric dissection in the Division of Clinical Anatomy. The study population included the third-year undergraduate clinical anatomy students (25 students) at Stellenbosch University. The research question was aimed at obtaining students’ perceptions about their views on the use of US in teaching and learning anatomy. To answer the research question, students were invited to participate in virtual focus group interviews. Three virtual focus group interviews were held following the US session with three to five participants in each; 11 participants volunteered to take part in the virtual focus groups. The thematic analysis of the data obtained from the virtual focus groups was conducted and six themes were generated from the data. The six main themes are the study of living anatomy, learning cross-sectional anatomy, enhanced relevance of anatomy learning, increased interest in anatomy, instructional design and the affective and technical experience of using US. The research demonstrated that it is feasible and advantageous to implement US sessions as an add-on to the teaching of anatomy during practical dissection sessions of undergraduate clinical anatomy students. The use of innovative technologies like US enhances the interest of students and allows them to develop dexterity and competencies in their learning process.AFRIKAANSE OPSOMMING : Ultraklank word toenemend onder die mediese spesialiteite gebruik as 'n diagnostiese instrument en gevolglik word mediese fakulteite aangeraai om beeld vorming verder in hul programme in te voeg. Die gebruik van ultraklank tydens voorgraadse onderrig het verskeie voordele. Die gebruik van ultraklank as 'n leerinstrument kan die bestaande anatomie kennis versterk en die visuele begrip van anatomie verbeter. Die koste-effektiwiteit sowel as draagbaarheid van ultraklank maak dit 'n waardevolle manier om saam met tradisionele anatomie-onderrig modelle te voeg. Verder kan studente vaardighede ontwikkel om ultraklank beelde te interpreteer, en ultraklank kan 'n ander element by die studie van anatomie voeg. Die literatuur toon duidelik die voordele van ultraklank in die onderrig van anatomie, sowel as die feit dat anatomie-opvoeders deur mediese dokters opgelei kan word om ultraklank tydens disseksie sessies te gebruik. Die waarde van ultraklank blyk uit gepubliseerde werke en dit is die moeite werd om die gebruik daarvan in die voorgraadse studie te ondersoek. Verder, alhoewel ultraklank opleiding nie altyd studente se prestasies kan verbeter nie, kan dit lei tot verhoogde belangstelling in anatomie vir verbeterde kliniese praktyk. Die doel van hierdie studie was om voorgraadse kliniese anatomie studente se persepsies oor die gebruik van ultraklank as aanvulling tydens kadawer disseksie in die Afdeling van Kliniese Anatomie te ondersoek. Die studie populasie het die voorgraadse, derdejaar kliniese anatomie studente (25 studente) aan die Universiteit Stellenbosch ingesluit. Die navorsingsvraag was gerig op die verkryging van studente se persepsies oor hul siening oor die gebruik van ultraklank in onderrig en leer van anatomie. Om die navorsingsvraag te beantwoord, is studente genooi om aan virtuele fokusgroep onderhoude deel te neem. Drie virtuele fokusgroep onderhoude is gehou na afloop van die ultraklank sessie met drie tot vyf studente in elk; 11 studente het aangebied om aan die virtuele fokus groepe deel te neem. Die tematiese ontleding van die data verkry uit die virtuele fokus groepe is geanaliseer en ses temas is gegenereer uit die data. Die ses hooftemas is die studie van lewende anatomie, aanleer van dwarsdeursnee-anatomie, verbeterde relevansie van anatomie-leer, verhoogde belangstelling in anatomie, instruksie-ontwerp en die ervaring van die gebruik van ultraklank. Die navorsing het getoon dat dit moontlik en voordelig is om ultraklank sessies te implementeer as 'n aanvulling in die onderrig van anatomie tydens praktiese disseksie sessies van voorgraadse kliniese anatomie studente. Die gebruik van innoverende tegnologieë soos ultraklank verhoog die belangstelling van studente en stel hulle in staat om vaardighede in hul leerproses te verwerf.Master