Discovery of Claytonia lanceolata var. peirsonii in the San Bernardino Mountains Perpetuates a History of Taxonomic Uncertainty

Claytonia lanceolata is a widespread perennial herb that typically blooms in areas where snow persists, occurring along mountain corridors from Canada to southern California. Numerous varieties have been described for this species, but most are not recognized under current taxonomic treatments. The discovery of new populations of C. lanceolata in southern California is reported, and the taxonomic uncertainties associated with the C. lanceolata species complex and the southern California var. peirsonii are discussed. Subtle characters for distinguishing the southern populations of C. lanceolata may be obscured during the process of making herbarium specimens. We clarify some of the distinguishing morphological features and associated ecology of C. lanceolata var. peirsonii. Based on detailed field observations in southern California, information is collated for populations across the entire known range of the variety. Recommendations are made regarding opportunities for further investigation, and information pertinent to the conservation of C. lanceolata var. peirsonii in California is updated

C1 inhibitor deficiency: 2014 United Kingdom consensus document

C1 inhibitor deficiency is a rare disorder manifesting with recurrent attacks of disabling and potentially life-threatening angioedema. Here we present an updated 2014 United Kingdom consensus document for the management of C1 inhibitor-deficient patients, representing a joint venture between the United Kingdom Primary Immunodeficiency Network and Hereditary Angioedema UK. To develop the consensus, we assembled a multi-disciplinary steering group of clinicians, nurses and a patient representative. This steering group first met in 2012, developing a total of 48 recommendations across 11 themes. The statements were distributed to relevant clinicians and a representative group of patients to be scored for agreement on a Likert scale. All 48 statements achieved a high degree of consensus, indicating strong alignment of opinion. The recommendations have evolved significantly since the 2005 document, with particularly notable developments including an improved evidence base to guide dosing and indications for acute treatment, greater emphasis on home therapy for acute attacks and a strong focus on service organisation. This article is protected by copyright. All rights reserved

Bioimpedance spectroscopy for swelling evaluation following total knee arthroplasty: a validation study

BACKGROUND: The evaluation of swelling is important for the outcome of total knee arthroplasty (TKA) surgery. The circumference or volume measurements are applicable at the bedside of the patient but are altered by muscular atrophy and the post-surgical dressing. Bioimpedance spectroscopy might overcome these limitations; however, it should be validated. This study aimed to explore the validity, the reliability and the responsiveness of bioimpedance spectroscopy for measuring swelling after TKA. METHODS: The degree of swelling in 25 patients undergoing TKA surgery was measured using bioimpedance spectroscopy (BIS R0), knee circumference and limb volume. The measurements were performed on D-1 (day before surgery), D + 2 (2 days after surgery) and D + 8 (8 days after surgery). The BIS R0 measurements were repeated twice, alternating between two evaluators. The percentage of the difference between the limbs was calculated for BIS R0, circumference and volume. The intra- and inter-observer intraclass correlation coefficients (ICCs), limits of agreement (LOA), effect size (Cohen's d), correlations between the methods and diagnostic sensitivity were calculated. RESULTS: BIS R0, circumference and volume detected swelling < 3.5% at D-1. The swelling at D2 and D8 was greater with BIS R0 [mean (SD) 29.9% (±9.8) and 38.27 (±7.8)] than with volume [14.7 (±9.5) and 14.9 (±8.2)] and circumference [11.1 (±5.7) and 11.7 (±4.1)]. The BIS R0 intra- and inter-evaluator ICCs ranged from 0.89 to 0.99, whereas the LOA were < 5.2%. The BIS R0 correlation was 0.73 with volume and 0.75 with circumference. The BIS R0 Cohen's d was 3.32 for the D-1-D2 evolution. The diagnostic sensitivity was 83% D2 and 96% at D8. CONCLUSION: Bioimpedance is a valid method for the evaluation of swelling following TKA. BIS R0 also demonstrated excellent intra- and inter-evaluator reliability. The diagnostic sensitivity and responsiveness is superior to that of concurrent methods. BIS R0 is an efficient method for post-surgical follow up at the bedside of the patient. The measurement of BIS R0 is a straightforward, valid, reliable and responsive method for lower limb swelling following TKA surgery that could be used in clinics and research. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00627770

Secondary antibody deficiency: a complication of anti-CD20 therapy for neuroinflammation

B-cell depleting anti-CD20 monoclonal antibody therapies are being increasingly used as long-term maintenance therapy for neuroinflammatory disease compared to many non-neurological diseases where they are used as remission-inducing agents. While hypogammaglobulinaemia is known to occur in over half of patients treated with medium to long-term B-cell-depleting therapy (in our cohort IgG 38, IgM 56 and IgA 18%), the risk of infections it poses seems to be under-recognised. Here, we report five cases of serious infections associated with hypogammaglobulinaemia occurring in patients receiving rituximab for neuromyelitis optica spectrum disorders. Sixty-four per cent of the whole cohort of patients studied had hypogammaglobulinemia. We discuss the implications of these cases to the wider use of anti-CD20 therapy in neuroinflammatory disease

Tibial tunnel placement in posterior cruciate ligament reconstruction: a systematic review

Purpose: Reconstruction of the posterior cruciate ligament (PCL) yields less satisfying results than anterior cruciate ligament reconstruction with respect to laxity control. Accurate tibial tunnel placement is crucial for successful PCL reconstruction using arthroscopic tibial tunnel techniques. A discrepancy between anatomical studies of the tibial PCL insertion site and surgical recommendations for tibial tunnel placement remains. The objective of this study was to identify the optimal placement of the tibial tunnel in PCL reconstruction based on clinical studies. Methods: In a systematic review of the literature, MEDLINE, EMBASE, Cochrane Review, and Cochrane Central Register of Controlled Trials were screened for articles about PCL reconstruction from January 1990 to September 2011. Clinical trials comparing at least two PCL reconstruction techniques were extracted and independently analysed by each author. Only studies comparing different tibial tunnel placements in the retrospinal area were included. Results: This systematic review found no comparative clinical trial for tibial tunnel placement in PCL reconstruction. Several anatomical, radiological, and biomechanical studies have described the tibial insertion sites of the native PCL and have led to recommendations for placement of the tibial tunnel outlet in the retrospinal area. However, surgical recommendations and the results of morphological studies are often contradictory. Conclusions: Reliable anatomical landmarks for tunnel placement are lacking. Future randomized controlled trials could compare precisely defined tibial tunnel placements in PCL reconstruction, which would require an established mapping of the retrospinal area of the tibial plateau with defined anatomical and radiological landmarks. Level of evidence: III

Are COVID-19 conspiracies a threat to public health? Psychological characteristics and health protective behaviours of believers

We tested the link between COVID-19 conspiracy theories and health protective behaviours in three studies: one at the onset of the pandemic in the United Kingdom (UK), a second just before the first national lockdown, and a third during that lockdown (N = 302, 404 and 399). We focused on conspiracy theories that did not deny the existence of COVID-19 and evaluated the extent to which they predicted a range of health protective behaviours, before and after controlling for psychological and sociodemographic characteristics associated with conspiracy theory belief. COVID-19 conspiracy beliefs were positively correlated with beliefs in other unrelated conspiracies and a general conspiracy mind-set, and negatively correlated with trust in government and a tendency towards analytical thinking (vs. intuitive thinking). Unexpectedly, COVID-19 conspiracy believers adhered to basic health guidelines and advanced health protective measures as strictly as non-believers. Conspiracy believers were, however, less willing to install the contact-tracing app, get tested for and vaccinated against COVID-19, and were more likely to share COVID-19 misinformation – all of which might undermine public health initiatives. Study 3 showed conspiracy theory believers were less willing to undertake health protective behaviours that were outside of their personal control, perceiving these as having a negative balance of risks and benefits. We discuss models explaining conspiracy beliefs and health protective behaviours, and suggest practical recommendations for public health initiatives

Children's integration of information across texts: reading processes and knowledge representations.

Constructing a knowledge representation from multiple texts requires the integration of information across texts. The aim of the current study was to investigate how elementary school students integrate information across multiple text passages and, particularly, whether students use information from a prior text to improve understanding of a current text. A sample of 105 children in grades 4 and 6 participated in the experiment. The multiple-text integration paradigm was used to study integration processes across texts during reading. Recall and (application) questions were used to investigate the extent to which information from different text passages was integrated into knowledge representations after reading. Individual differences in reading comprehension ability and working memory were also considered. The results indicate that children in both grades spontaneously activate information from an earlier text to aid their understanding during reading, and that they integrate information across texts in their knowledge representations. This was the case regardless of grade or individual differences in reading-comprehension ability and working memory. These findings provide insight into the mechanisms that may be involved in the integration of information across texts.Development Psychopathology in context: schoo

Minding the load or loading the mind: the effect of manipulating working memory on coherence monitoring

Education and Child Studie

Metacognitive scaffolding boosts cognitive and neural benefits following executive attention training in children

Version of Record online: 25 October 2018Interventions including social scaffolding and metacognitive strategies have been used in educational settings to promote cognition. In addition, increasing evidence shows that computerized process-based training enhances cognitive skills. However, no prior studies have examined the effect of combining these two training strategies. The goal of this study was to test the combined effect of metacognitive scaffolding and computer-based training of executive attention in a sample of typically developing preschoolers at the cognitive and brain levels. Compared to children in the regular training protocol and an untrained active control group, children in the metacognitive group showed larger gains on intelligence and significant increases on an electrophysiological index associated with conflict processing. Moreover, changes in the conflict-related brain activity predicted gains in intelligence in the metacognitive scaffolding group. These results suggest that metacognitive scaffolding boosts the influence of process-based training on cognitive efficiency and brain plasticity related to executive attention.Secretaría de Estado de Investigación, Desarrollo e Innovación, Grant/Award Number: PSI2014-55833-