Interparental conflict and emotional insecurity: coparenting and parent-child relationships as mediating family processes

The relationship between exposure to destructive styles of interparental conflict and child maladjustment and psychological problems has long been documented . Marital conflict is thought to affect children by two pathways: directly, by threatening or enhancing their emotional security, or indirectly, by spilling over into coparenting and parenting practices. The present study examined both of these pathways. Participants were 74 nuclear families with infants aged 6 to 14 months. Participants engaged in two interactions: a marital discussion with their infant present and a play interaction. Results indicated a significant link between conflict expressions and emotional insecurity. Furthermore, conflict expressions were also significantly related to coparenting and parenting behaviors. While parent-child processes were linked with emotional insecurity, coparenting behaviors were not. While no mediation was observed for parenting behaviors in the relationship between conflict expression and emotional insecurity, there were trends in the anticipated directions. Results of this study highlight the importance of disseminating to clinicians and the community the significance of managing interparental conflict in appropriate, well-modulated ways. Moreover, emphasis should be placed upon the use of effective coparenting and parenting strategies, especially when destructive marital conflict exists in the home

Multicentre observational cohort study of NSAIDs as risk factors for postoperative adverse events in gastrointestinal surgery

Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as postoperative analgesia by the Enhanced Recovery After Surgery Society. Recent studies have raised concerns that NSAID administration following colorectal anastomosis may be associated with increased risk of anastomotic leak. This multicentre study aims to determine NSAIDs' safety profile following gastrointestinal resection. Methods and analysis: This prospective, multicentre cohort study will be performed over a 2-week period utilising a collaborative methodology. Consecutive adults undergoing open or laparoscopic, elective or emergency gastrointestinal resection will be included. The primary end point will be the 30-day morbidity, assessed using the Clavien-Dindo classification. This study will be disseminated through medical student networks, with an anticipated recruitment of at least 900 patients. The study will be powered to detect a 10% increase in complication rates with NSAID use. Ethics and dissemination: Following the Research Ethics Committee Chairperson's review, a formal waiver was received. This study will be registered as a clinical audit or service evaluation at each participating hospital. Dissemination will take place through previously described novel research collaborative networks

Medication adherence in patients with myotonic dystrophy and facioscapulohumeral muscular dystrophy

Myotonic dystrophy (DM) and facioscapulohumeral muscular dystrophy (FSHD) are the two most common adult muscular dystrophies and have progressive and often disabling manifestations. Higher levels of medication adherence lead to better health outcomes, especially important to patients with DM and FSHD because of their multisystem manifestations and complexity of care. However, medication adherence has not previously been studied in a large cohort of DM type 1 (DM1), DM type 2 (DM2), and FSHD patients. The purpose of our study was to survey medication adherence and disease manifestations in patients enrolled in the NIH-supported National DM and FSHD Registry. The study was completed by 110 DM1, 49 DM2, and 193 FSHD patients. Notable comorbidities were hypertension in FSHD (44 %) and DM2 (37 %), gastroesophageal reflux disease in DM1 (24 %) and DM2 (31 %) and arrhythmias (29 %) and thyroid disease (20 %) in DM1. Each group reported high levels of adherence based on regimen complexity, medication costs, health literacy, side effect profile, and their beliefs about treatment. Only dysphagia in DM1 was reported to significantly impact medication adherence. Approximately 35 % of study patients reported polypharmacy (taking 6 or more medications). Of the patients with polypharmacy, the DM1 cohort was significantly younger (mean 55.0 years) compared to DM2 (59.0 years) and FSHD (63.2 years), and had shorter disease duration (mean 26 years) compared to FSHD (26.8 years) and DM2 (34.8 years). Future research is needed to assess techniques to ease pill swallowing in DM1 and to monitor polypharmacy and potential drug interactions in DM and FSHD

Promoting research and audit at medical school: evaluating the educational impact of participation in a student-led national collaborative study

Medical students often struggle to engage in extra-curricular research and audit. The Student Audit and Research in Surgery (STARSurg) network is a novel student-led, national research collaborative. Student collaborators contribute data to national, clinical studies while gaining an understanding of audit and research methodology and ethical principles. This study aimed to evaluate the educational impact of participation

Differences in Complication Rates Between Roux-en-Y Gastric Bypass and Longitudinal Sleeve Gastrectomy

Introduction: Sleeve Gastrectomy (SG) has surpassed Roux-en-Y Gastric Bypass (RYGB) as the most commonly performed bariatric operation. Though the beneficial effect of SG on Type 2 Diabetes Mellitus is less than that of RYGB, it is perceived to have a lower complication rate. The purpose of this study was to quantify the complication rates between of SG and RYGB in a severely obese diabetic population. Methods: This was a retrospective cohort study that included all diabetic patients undergoing RYGB and SG at an academic medical center from January 1, 2011 to July 1, 2015. Patients were followed at 6 week, 6 month, 1 year, 2 year, and 3 year postoperatively. Outpatient and emergency visits were identified in the EMR system. Continuous data was analyzed using Student T tests and discrete data was analyzed using Fisher’s Exact Test. We defined early complications as those occurring within 30 days postoperatively, and late complications as those after 30 days. Results: A total of 96 patients underwent RYGB and 89 underwent SG. The groups were concurrent and similar with regards to preoperative demographic factors such as age, gender, Hgb-A1c, HOMA2 parameters, excess body weight, BMI, and diabetic medication use. In terms of early complications, the rate of hemorrhage requiring transfusion was higher in the SG group compared to RYGB (10.1% vs. 3.1%, p=0.073). Postoperative length of stay was lower in the SG group (m=1.7 d vs. m=2 d, p=0.02), but the early readmission rate was also higher in the SG group (7.9% vs. 2.1%, p=0.09). For late postoperative complications, there were 4 anastomotic ulcer perforations and one case of internal hernia in the RYGB group. There were 6 late postoperative reoperations in the RYGB group (6% vs. 0%, p=0.03). In addition, 13 patients underwent 16 total upper endoscopies in the RYGB group (13.5% vs. 0%, p=0.0002). The cumulative rate of early and late interventions was higher in the RYGB group (20% vs. 3.4%, p=0.0005). Conclusions: While the rate of early postoperative complication is similar between SG and RYGB, the need for late intervention is higher after RYGB. The cumulative need for reintervention (early and late) is higher after RYGB. This may explain the shift from Roux-en-Y Gastric Bypass to Sleeve Gastrectomy as the most commonly performed bariatric intervention

Comparison of Diabetic Remission Rates following Roux en-Y Gastric Bypass and Longitudinal Sleeve Gastrectomy

Introduction: Bariatric surgery is being increasingly investigated as treatment for Type II Diabetes Mellitus (T2DM). As Sleeve Gastrectomy (SG) surpasses Roux-en-Y Gastric Bypass (RYGB) as the new standard in bariatric surgery, it is still unknown if its efficacy in achieving remission is comparable to RYGB. This study compared diabetic remission rates between SG and RYGB in order to identify the predictive factors for remission and the mechanisms of achieving remission. Methods: This was a retrospective cohort study comparing all diabetic patients undergoing RYGB and SG at an academic medical center from 1/1/11-7/1/15. Patients were followed preoperatively and at 6 week, 6 month, and 1, 2, and 3 year intervals. We defined diabetic remission as HbA1c under 7 without insulin or hypoglycemic use and excess body weight (EBW) as percent over ideal body weight. Data were analyzed using Cox analysis, Fisher’s Exact Tests, and Student T Tests. Results: During the study, 96 patients underwent RYGB and 89 underwent SG. Preoperatively, patients from both groups had similar age, weight, gender, preoperative weight loss, HbA1c at onset and at surgery, oral hypoglycemic use, insulin use, and HOMA2 parameters. At one year postoperatively, patients who underwent RYGB showed a statistically greater postoperative EBW loss (62% vs. 36% p \u3c 0.0001). Kaplan Meier analysis showed a significantly higher rate of remission, (83% vs. 66%) in patients who underwent SG (p=0.02). After using Cox analysis to account for differences in delta BMI (p=0.04), EBW loss (p=0.04), preoperative HOMA2 parameters (p=0.008-0.011), and preoperative factors such as HbA1c and insulin use (p=0.001 for both), there was no change in RYGB’s impact on diabetic remission compared to SG. Conclusion: Our results confirm that RYGB achieves a significantly greater rate of diabetic remission and a significantly higher weight loss than SG. Additionally, the difference in rate of diabetic remission is not explained by weight loss or preoperative predictors of less reversible diabetes (HOMA2 parameters, use of insulin). Identification of the factor(s) responsible for this differential effect on diabetes may afford opportunity for therapeutic intervention

Collaboration between doctors and nurses in children's cancer care: insights from a European project.

Purpose It has long been recognised that effective cancer care is not possible without multi-professional team working. Collaboration and multi-professional working however are known to be less than straightforward. This project aimed to use a collaborative approach to explore and facilitate professional groups to work together more effectively in the field of children's cancer care. Method Based on an earlier project in Italy, a three-year seminar series was organised involving both a doctor and nurse from 15 paediatric haematology/oncology units across Europe. Participants had to be able to speak English and commit to participate in annual seminars as well as the development and implementation of a local project to enhance doctor–nurse collaboration in their own unit. Appreciative Inquiry was the methodological approach used to address organisational as well as interpersonal change. Results Fifteen doctor–nurse teams were initially selected from a range of different countries, and 10 completed the project. Key outcomes reported include implementation and successful completion of projects, publication of the results achieved, participant satisfaction with improvements in collaboration. Feedback from participants would suggest that change had been implemented and possibly sustained. Conclusions Active involvement and group support were required for success. More formal relationships needed to be activated with participating centres to guarantee support for those involved in implementing lasting change. A web-based resource to allow other programmes and centres to use the resources developed has been made available. The same approach, we believe, could be used to improve multi-professional working in the care of other childhood illnesses

Modelling coseismic displacements during the 1997 Umbria-Marche earthquake (central Italy)

We propose a dislocation model for the two normal faulting earthquakes that struck the central Apennines (Umbria-Marche, Italy) on 1997 September 26 at 00:33 (Mw 5.7) and 09:40 GMT (Mw 6.0). We fit coseismic horizontal and vertical displacements resulting from GPS measurements at several monuments of the IGMI (Istituto Geografico Militare Italiano) by means of a dislocation model in an elastic, homogeneous, isotropic half-space. Our best-fitting model consists of two normal faults whose mechanisms and seismic moments have been taken from CMT solutions; it is consistent with other seismological and geophysical observations. The first fault, which is 6 km long and 7 km wide, ruptured during the 00:33 event with a unilateral rupture towards the SE and an average slip of 27 cm. The second fault is 12 km long and 10 km wide, and ruptured during the 09:40 event with a nearly unilateral rupture towards the NW. Slip distribution on this second fault is non-uniform and is concentrated in its SE portion (maximum slip is 65 cm), where rupture initiated. The 00:33 fault is deeper than the 09:40 one: the top of the first rupture is deeper than 1.7 km; the top of the second is 0.6 km deep. In order to interpret the observed epicentral subsidence we have also considered the contributions of two further moderate-magnitude earthquakes that occurred on 1997 October 3 (Mw 5.2) and 6 (Mw 5.4), immediately before the GPS survey, and were located very close to the 09:40 event of September 26. We compare the pattern of vertical displacements resulting from our forward modelling of GPS data with that derived from SAR interferograms: the fit to SAR data is very good, confirming the reliability of the proposed dislocation model

Influence of Chaperone-Like Activity of Caseinomacropeptide on the Gelation Behaviour of Whey Proteins at pH 6.4 and 7.2

The effect of caseinomacropeptide (CMP) on the heat-induced denaturation and gelation of whey proteins (2.5–10%, w/v) at pH 6.4 and 7.2, at a whey protein:CMP ratio of 1:0.9 (w/w), was investigated using differential scanning calorimetry (DSC), oscillatory rheology (90 °C for 20 min) and confocal microscopy. Greater frequency-dependence in the presence of CMP suggested that the repulsive interactions between CMP and the whey proteins affected the network generated by the non-heated whey protein samples. At pH 6.4 or 7.2, CMP increased the temperature of denaturation of β-lactoglobulin by up to 3 °C and increased the gelation temperature by up to 7 °C. The inclusion of CMP strongly affected the structure of the heat-induced whey protein gels, resulting in a finer stranded structure at pH 6.4 and 7.2. The presence of CMP combined with a lower heating rate (2 °C/min) prevented the formation of a solid gel of whey proteins after heating for 20 min at 90 °C and at pH 7.2. These results show the potential of CMP for control of whey protein denaturation and gelation

Crab-fishing by chimpanzees in the Nimba Mountains, Guinea

The significance of aquatic food resources for hominins is poorly understood, despite evidence of consumption as early as 1.95 million years ago (Ma). Here we present the first evidence of a non-human ape habitually catching and consuming aquatic crabs. Chimpanzees (Pan troglodytes verus) in the rainforest of the Nimba Mountains (Guinea) consumed freshwater crabs year-round, irrespective of rainfall or ripe fruit availability. Parties of females and offspring fished for crabs more than predicted and for longer durations than adult males. Across months, crab-fishing was negatively correlated with ant-dipping, suggesting a similar nutritional role. These findings contribute to our understanding of aquatic faunivory among hominins. First, aquatic faunivory can occur in closed forests in addition to open wetlands. Second, aquatic fauna could have been a staple part of some hominin diets, rather than merely a fallback food. Third, the habitual consumption of aquatic fauna could have been especially important for females and their immature offspring. In addition to providing small amounts of essential fatty acids, crabs might also be eaten for their micronutrients such as sodium and calcium, especially by females and young individuals who may have limited access to meat