Understanding Traumatic Brain Injury in the Primary Care Setting

poster abstractBackground: TBI is being re-conceptualized as a chronic disease causative agent rather than as a single, acute event. This study examined how familiar family medicine physicians (PCPs) are with TBI and their level of confidence in treating TBI sequelae likely to be seen in primary care. We also examined PCP attitudes regarding care for post-acute mild TBI and moderate/severe TBI in primary care and how recently the respondent had cared for a mild TBI and/or moderate/severe TBI patient. Methods: The study featured a mixed methods study design. A survey was administered on paper and electronically. A semi-structured qualitative interview guide was developed based upon survey responses. Descriptive statistics were calculated. Results: Most respondents associated neurological symptoms/conditions as TBI sequelae: irritability, 100.0%, fatigue, 98.0%; insomnia, 88.2%, depression, 98.0%, headaches, 98.0%, anxiety, 80.4%. Two-thirds (66.7%) identified epilepsy as a condition associated with TBI. Just over one-half associated tinnitus (51.0%) or loss of libido (52.9%) with TBI while only one-third (33.3%) associated incontinence with TBI. Most physicians felt confident treating depression (84.0%), anxiety (82.4%), headache (80.4%) and insomnia (76.0%). Physicians felt less confident in treating fatigue (68.0%), irritability (68.0%), incontinence (51.2%) and loss of libido (50.0%). The least amount of confidence was claimed in treating epilepsy (37.5%) and tinnitus (36.4%). All respondents (100.0%) believed that a PCP can manage post-acute mild TBI (concussion) care while 52.0% agreed that a PCP can manage post-acute care for moderate/severe TBI. Only one respondent (2.0%) had never cared for a mild TBI patient. Most (70.6%) had cared for a moderate/severe TBI patient within the past two years while 5.9% had cared for one of these patients more than a year ago. Nearly twenty percent (19.7%) had never cared for a moderate/severe TBI patient and 3.9% were unsure if they had

Opioid Overdose Prevention in Family Medicine Clerkships: A CERA Study

BACKGROUND AND OBJECTIVES: The national opioid crisis requires medical education to develop a proactive response centering on prevention and treatment. Primary care providers (PCPs)—many of whom are family medicine physicians—commonly treat patients on opiates, and write nearly 50% of opioid prescriptions. Despite linkages between PCP opioid prescribing patterns and the associated potential for overdose, little is known about how family medicine clerkship students are trained to prevent opioid overdose, including training on the use of naloxone. This study describes the presence of opioid overdose education at the national level and barriers to inclusion. It also discusses implementation strategies along with instructional methodology and learner evaluation. METHODS: Data were collected as part of a cross-sectional survey administered electronically by the Council of Academic Family Medicine Educational Research Alliance to 139 family medicine clerkship directors. RESULTS: A total of 99 clerkship directors (71.2% response rate) responded to the survey. A large majority (86.4%) agreed that it is important to offer opioid overdose prevention education in the clerkship, yet only 25.8% include this topic. Of these, only 50.0% address naloxone use. The most common barriers to including opioid overdose prevention education were prioritization of educational topics (82.1%) followed by lack of available faculty with sufficient experience/expertise (67.7%). CONCLUSIONS: Findings point to a disparity between perceived importance of opioid overdose prevention education and inclusion of this topic in family medicine clerkship-level medical education. Innovative use of online education and partnering with community resources may address barriers related to curricular prioritization while supporting interprofessional education principles

University Practice As A Key Factor In Increasing The Sensitivity To Educational Inclusion

The present article is based on research carried out in three universities, the University Center South (Cusur, Mexico), Jaen and Cuenca (Spain) on the influence of university practice in the development of sensitivity towards inclusive education in our students the first years of the Diploma in Education, using the subject "pedagogical basis of special education" and the equivalent Cusur and Cuenca. With the idea that the practices of the subject are the ideal time to promote positive attitudes towards inclusive education a questionnaire to collect data prior to the four month long activities focused on the presentation of case studies and program auditions radio "A Light in the Chest" which airs on Ciudad Guzman (Mexico) directed by Professor De Luna and which revolves around the inclusion. When the semester ended he turned to pass the quiz to test variations in sensitivity to educational inclusion or not been able to develop our university students

Loss of active neurogenesis in the adult shark retina

Neurogenesis is the process by which progenitor cells generate new neurons. As development progresses neurogenesis becomes restricted to discrete neurogenic niches, where it persists during postnatal life. The retina of teleost fishes is thought to proliferate and produce new cells throughout life. Whether this capacity may be an ancestral characteristic of gnathostome vertebrates is completely unknown. Cartilaginous fishes occupy a key phylogenetic position to infer ancestral states fixed prior to the gnathostome radiation. Previous work from our group revealed that the juvenile retina of the catshark Scyliorhinus canicula, a cartilaginous fish, shows active proliferation and neurogenesis. Here, we compared the morphology and proliferative status of the retina in catshark juveniles and adults. Histological and immunohistochemical analyses revealed an important reduction in the size of the peripheral retina (where progenitor cells are mainly located), a decrease in the thickness of the inner nuclear layer (INL), an increase in the thickness of the inner plexiform layer and a decrease in the cell density in the INL and in the ganglion cell layer in adults. Contrary to what has been reported in teleost fish, mitotic activity in the catshark retina was virtually absent after sexual maturation. Based on these results, we carried out RNA-Sequencing (RNA-Seq) analyses comparing the retinal transcriptome of juveniles and adults, which revealed a statistically significant decrease in the expression of many genes involved in cell proliferation and neurogenesis in adult catsharks. Our RNA-Seq data provides an excellent resource to identify new signaling pathways controlling neurogenesis in the vertebrate retinaFunded by the Ministerio de Economía Industria y Competitividad (to EC; grant number BFU-2017-89861-P) and Xunta de Galicia Predoctoral Fellowship (to IH-N; grant number ED 481 A 2018 216). Both grants were partially financed by the European Social FundS

Effects of Schizochytrium microalgae and sunflower oil as sources of unsaturated fatty acids for the sustainable mitigation of ruminal biogases methane and carbon dioxide

Biogases produced during ruminant production needs to be reduced. The Food and Agriculture Organization (FAO) estimated CH4 production from livestock to contribute about 18% of all greenhouse gas emissions, while carbon dioxide (CO2) accounted for about 9% of the emission (FAO, 2006). Besides, these gases including CH4, CO2, and H2 are produced during ruminal fermentation and cause losses amounting to 2e12% of dietary energy in ruminants (Johnson and Johnson, 1995). Furthermore, these emissions have been implicated in causing climate change. Yeast, organic acids salt, exogenous enzymes, and essential oils have been used as new strategies to mitigate the production of ruminal methane from ruminants (Elghandour et al., 2016, 2017; Hernandez et al., 2017).Mitigation of methane (CH4) and carbon dioxide (CO2) emissions as well as ruminal fermentation parameters of a total mixed ration in the presence of Schizochytrium microalgae (SA) and sunflower oil (SO) or their mixture (SASO) as unsaturated fatty acid sources was investigated. Rumen liquor from two rumen cannulated Holstein steers and two rumen cannulated Creole goats was used as inoculum. Interactions between inoculum source additive type, and inoculum source additive type dose were observed for gas, CH4 and CO2 production and fermentation parameters. Additives affected the fermentation parameters in a dose-dependent manner. With goats’ inoculum, the inclusion of SO (1, 2, 4, 5%), SA (2, 3, 5%) and SASO (1, 3%) increased gas production (GP) and decreased the rate of GP, while with the steer inoculum, SO at 1 and 4% increased GP and the rate of GP. All levels of SA and SASO decreased the asymptotic GP and increased the rate of GP. The goat inoculum decreased CH4 at different doses of SO, SA and SASO whereas the steer inoculum decreased CH4 production. At all doses, additives decreased fermentation pH, protozoal counts, and increased ammonia-N, DM degradability and total bacterial counts. Sunflower oil (i.e., SO) at 1e3%, SA at 1e2%, and SASO at 1e2% were the most efficacious in the nutrition of goats, compared with SO at 1 to 2 in steers. The results suggest that Schizochytrium microalgae and sunflower oil could be a valuable means of sustainably mitigating CH4 and CO2 emissions for improved environmental conditions

Nutrient content and stoichiometry of pelagic Sargassum reflects increasing nitrogen availability in the Atlantic Basin

© The Author(s), 2021. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Lapointe, B. E., Brewton, R. A., Herren, L. W., Wang, M., Hu, C., McGillicuddy, D. J., Lindell, S., Hernandez, F. J., & Morton, P. L. Nutrient content and stoichiometry of pelagic Sargassum reflects increasing nitrogen availability in the Atlantic Basin. Nature Communications, 12(1), (2021): 3060, https://doi.org/10.1038/s41467-021-23135-7.The pelagic brown macroalgae Sargassum spp. have grown for centuries in oligotrophic waters of the North Atlantic Ocean supported by natural nutrient sources, such as excretions from associated fishes and invertebrates, upwelling, and N2 fixation. Using a unique historical baseline, we show that since the 1980s the tissue %N of Sargassum spp. has increased by 35%, while %P has decreased by 44%, resulting in a 111% increase in the N:P ratio (13:1 to 28:1) and increased P limitation. The highest %N and δ15N values occurred in coastal waters influenced by N-rich terrestrial runoff, while lower C:N and C:P ratios occurred in winter and spring during peak river discharges. These findings suggest that increased N availability is supporting blooms of Sargassum and turning a critical nursery habitat into harmful algal blooms with catastrophic impacts on coastal ecosystems, economies, and human health.This work was funded by the US NASA Ocean Biology and Biogeochemistry Program (80NSSC20M0264, NNX16AR74G) and Ecological Forecast Program (NNX17AF57G), NOAA RESTORE Science Program (NA17NOS4510099), National Science Foundation (NSF-OCE 85–15492 and OCE 88–12055), “Save Our Seas” Specialty License Plate funds, granted through the Harbor Branch Oceanographic Institute Foundation, Ft. Pierce, FL, and a Red Wright Fellowship from the Bermuda Biological Station. A portion of this work was performed at the National High Magnetic Field Laboratory, which is supported by National Science Foundation Cooperative Agreement No. DMR-1644779 and the State of Florida. D.J.M. gratefully acknowledges the Holger W. Jannasch and Columbus O’Donnell Iselin Shared Chairs for Excellence in Oceanography, as well as support from the Mill Reef Fund

Changes in ponderal index and body mass index across childhood and their associations with fat mass and cardiovascular risk factors at age 15

Background: Little is known about whether associations between childhood adiposity and later adverse cardiovascular health outcomes are driven by tracking of overweight from childhood to adulthood and/or by vascular and metabolic changes from childhood overweight that persist into adulthood. Our objective is to characterise associations between trajectories of adiposity across childhood and a wide range of cardiovascular risk factors measured in adolescence, and explore the extent to which these are mediated by fat mass at age 15. Methods and Findings: Using data from the Avon Longitudinal Study of Parents and Children, we estimated individual trajectories of ponderal index (PI) from 0-2 years and BMI from 2-10 years using random-effects linear spline models (N = 4601). We explored associations between PI/BMI trajectories and DXA-determined total-body fat-mass and cardiovascular risk factors at 15 years (systolic and diastolic blood pressure, fasting LDL-and HDL-cholesterol, triglycerides, C-reactive protein, glucose, insulin) with and without adjustment for confounders. Changes in PI/BMI during all periods of infancy and childhood were associated with greater DXA-determined fat-mass at age 15. BMI changes in childhood, but not PI changes from 0-2 years, were associated with most cardiovascular risk factors in adolescence; associations tended to be strongest for BMI changes in later childhood (ages 8.5-10), and were largely mediated by fat mass at age 15. Conclusion: Changes in PI/BMI from 0-10 years were associated with greater fat-mass at age 15. Greater increases in BMI from age 8.5-10 years are most strongly associated with cardiovascular risk factors at age 15, with much of these associations mediated by fat-mass at this age. We found little evidence supporting previous reports that rapid PI changes in infancy are associated with future cardiovascular risk. This study suggests that associations between early overweight and subsequent adverse cardiovascular health are largely due to overweight children tending to remain overweight

Influence of cellulase or xylanase on the in vitro rumen gas production and fermentation of corn stover

In vitro gas production (GP) technique was used to investigate effect of exogenous enzymes cellulase (CEL) or xylanase (XYL) at different doses on in vitro fermentation characteristics of corn stover. Enzymes were supplemented at 0 (control), 10, 20, 40 and 80 μg/g DM. Gas production was determined at 2, 4, 6, 8, 10, 12, 24, 36, 48 and 72 h of incubation. After 72 h, the incubation was stopped and supernatant pH was determined, and filtered to determine dry matter (DMD), neutral detergent fiber (NDFD) and acid detergent fiber (ADFD) degradabilities. Interaction effects occurred for enzyme type and dose for all measured gas parameters with exception of the lag time, DMD, organic matter degradability (OMD), NDFD, metabolizable energy (ME), short chain fatty acids (SCFA) and microbial crude protein (MCP) production. Cellulase and XYL increased GP (P<0.05) at different incubation hours with better results at the dose of 40 μg/g DM. The dose 80 μg XYL/g DM had the lowest GP compared to other doses. In addition, CEL and XYL decreased pH with increasing OMD, ME, SCFA and MCP production at 40 μg/ g DM of corn stover. The present results suggested that the level of CEL and XYL at 40 μg/g DM have higher GP than other levels of enzymes, imply this level can be more effectively to improve rumen fermentation; however, the difference of XYL between treatments and control was less than that of CEL

DNM1 encephalopathy: A new disease of vesicle fission.

ObjectiveTo evaluate the phenotypic spectrum caused by mutations in dynamin 1 (DNM1), encoding the presynaptic protein DNM1, and to investigate possible genotype-phenotype correlations and predicted functional consequences based on structural modeling.MethodsWe reviewed phenotypic data of 21 patients (7 previously published) with DNM1 mutations. We compared mutation data to known functional data and undertook biomolecular modeling to assess the effect of the mutations on protein function.ResultsWe identified 19 patients with de novo mutations in DNM1 and a sibling pair who had an inherited mutation from a mosaic parent. Seven patients (33.3%) carried the recurrent p.Arg237Trp mutation. A common phenotype emerged that included severe to profound intellectual disability and muscular hypotonia in all patients and an epilepsy characterized by infantile spasms in 16 of 21 patients, frequently evolving into Lennox-Gastaut syndrome. Two patients had profound global developmental delay without seizures. In addition, we describe a single patient with normal development before the onset of a catastrophic epilepsy, consistent with febrile infection-related epilepsy syndrome at 4 years. All mutations cluster within the GTPase or middle domains, and structural modeling and existing functional data suggest a dominant-negative effect on DMN1 function.ConclusionsThe phenotypic spectrum of DNM1-related encephalopathy is relatively homogeneous, in contrast to many other genetic epilepsies. Up to one-third of patients carry the recurrent p.Arg237Trp variant, which is now one of the most common recurrent variants in epileptic encephalopathies identified to date. Given the predicted dominant-negative mechanism of this mutation, this variant presents a prime target for therapeutic intervention