Alpha-linolenic acid: A promising nutraceutical for the prevention of stroke

International audienceStroke is a worldwide main cause of mortality and morbidity. Most of the preventive and neuroprotective treatments identified in preclinical studies failed in clinical trials. Although there is a consensus that nutrition is important for health, its role is underestimated in stroke. Indeed an increase consumption of salt and fatty foods may promote hypertension and obesity, which are well known risk factors of stroke. In contrast it is more difficult to identify a risk factor arising from a deficiency in an essential nutrient in the diet. Western modern diets are deficient in omega-3 polyunsaturated fatty acids, which are essential for brain health. Such deficiency may constitute by itself a risk factor for stroke. Furthermore, an imbalance in the consumption of omega-6 and omega-3 progressively took place in the past 40 years leading to omega-6/omega-3 ratios that are far above the WHO healthy recommendations. A consequence of this imbalanced ratio has been the fostering of elevations in and increased prevalence of inflammatory cardiovascular diseases and obesity. In this context, this review outlines a promising therapeutic opportunity by integrating a nutritional-based approach focusing on omega-3 alpha-linolenic acid as nutraceutical to prevent the devastating damage caused by brain ischemia

What is next in African neuroscience?

Working in Africa provides neuroscientists with opportunities that are not available in other continents. Populations in this region exhibit the greatest genetic diversity; they live in ecosystems with diverse flora and fauna; and they face unique stresses to brain health, including child brain health and development, due to high levels of traumatic brain injury and diseases endemic to the region. However, the neuroscience community in Africa has yet to reach its full potential. In this article we report the outcomes from a series of meetings at which the African neuroscience community came together to identify barriers and opportunities, and to discuss ways forward. This exercise resulted in the identification of six domains of distinction in African neuroscience: the diverse DNA of African populations; diverse flora, fauna and ecosystems for comparative research; child brain health and development; the impact of climate change on mental and neurological health; access to clinical populations with important conditions less prevalent in the global North; and resourcefulness in the reuse and adaption of existing technologies and resources to answer new questions. The article also outlines plans to advance the field of neuroscience in Africa in order to unlock the potential of African neuroscientists to address regional and global mental health and neurological problems

Racial and ethnic differences in internal medicine residency assessments

IMPORTANCE: Previous studies have demonstrated racial and ethnic inequities in medical student assessments, awards, and faculty promotions at academic medical centers. Few data exist about similar racial and ethnic disparities at the level of graduate medical education. OBJECTIVE: To examine the association between race and ethnicity and performance assessments among a national cohort of internal medicine residents. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study evaluated assessments of performance for 9026 internal medicine residents from the graduating classes of 2016 and 2017 at Accreditation Council of Graduate Medical Education (ACGME)-accredited internal medicine residency programs in the US. Analyses were conducted between July 1, 2020, and June 31, 2022. MAIN OUTCOMES AND MEASURES: The primary outcome was midyear and year-end total ACGME Milestone scores for underrepresented in medicine (URiM [Hispanic only; non-Hispanic American Indian, Alaska Native, or Native Hawaiian/Pacific Islander only; or non-Hispanic Black/African American]) and Asian residents compared with White residents as determined by their Clinical Competency Committees and residency program directors. Differences in scores between Asian and URiM residents compared with White residents were also compared for each of the 6 competency domains as supportive outcomes. RESULTS: The study cohort included 9026 residents from 305 internal medicine residency programs. Of these residents, 3994 (44.2%) were female, 3258 (36.1%) were Asian, 1216 (13.5%) were URiM, and 4552 (50.4%) were White. In the fully adjusted model, no difference was found in the initial midyear total Milestone scores between URiM and White residents, but there was a difference between Asian and White residents, which favored White residents (mean [SD] difference in scores for Asian residents: -1.27 [0.38]; P \u3c .001). In the second year of training, White residents received increasingly higher scores relative to URiM and Asian residents. These racial disparities peaked in postgraduate year (PGY) 2 (mean [SD] difference in scores for URiM residents, -2.54 [0.38]; P \u3c .001; mean [SD] difference in scores for Asian residents, -1.9 [0.27]; P \u3c .001). By the final year 3 assessment, the gap between White and Asian and URiM residents\u27 scores narrowed, and no racial or ethnic differences were found. Trends in racial and ethnic differences among the 6 competency domains mirrored total Milestone scores, with differences peaking in PGY2 and then decreasing in PGY3 such that parity in assessment was reached in all competency domains by the end of training. CONCLUSIONS AND RELEVANCE: In this cohort study, URiM and Asian internal medicine residents received lower ratings on performance assessments than their White peers during the first and second years of training, which may reflect racial bias in assessment. This disparity in assessment may limit opportunities for physicians from minoritized racial and ethnic groups and hinder physician workforce diversity

Racial disparities in the SOFA score among patients hospitalized with COVID-19

BACKGROUND: Sequential Organ Failure Assessment (SOFA) score predicts probability of in-hospital mortality. Many crisis standards of care suggest the use of SOFA scores to allocate medical resources during the COVID-19 pandemic. RESEARCH QUESTION: Are SOFA scores elevated among Non-Hispanic Black and Hispanic patients hospitalized with COVID-19, compared to Non-Hispanic White patients? STUDY DESIGN AND METHODS: Retrospective cohort study conducted in Yale New Haven Health System, including 5 hospitals with total of 2681 beds. Study population drawn from consecutive patients aged ≥18 admitted with COVID-19 from March 29th to August 1st, 2020. Patients excluded from the analysis if not their first admission with COVID-19, if they did not have SOFA score recorded within 24 hours of admission, if race and ethnicity data were not Non-Hispanic Black, Non-Hispanic White, or Hispanic, or if they had other missing data. The primary outcome was SOFA score, with peak score within 24 hours of admission dichotomized as \u3c6 or ≥6. RESULTS: Of 2982 patients admitted with COVID-19, 2320 met inclusion criteria and were analyzed, of whom 1058 (45.6%) were Non-Hispanic White, 645 (27.8%) were Hispanic, and 617 (26.6%) were Non-Hispanic Black. Median age was 65.0 and 1226 (52.8%) were female. In univariate logistic screen and in full multivariate model, Non-Hispanic Black patients but not Hispanic patients had greater odds of an elevated SOFA score ≥6 when compared to Non-Hispanic White patients (OR 1.49, 95%CI 1.11-1.99). INTERPRETATION: Given current unequal patterns in social determinants of health, US crisis standards of care utilizing the SOFA score to allocate medical resources would be more likely to deny these resources to Non-Hispanic Black patients

Alpha-Linolenic Acid Intake and 10-Year Incidence of Coronary Heart Disease and Stroke in 20,000 Middle-Aged Men and Women in The Netherlands

Background - Whether intake of alpha-linolenic acid (ALA), the plant-derived n-3 polyunsaturated fatty acid (PUFA), could prevent cardiovascular diseases is not yet clear. We examined the associations of ALA intake with 10-year incidence of coronary heart disease (CHD) and stroke in the Netherlands. Methods - Data were collected from a general population of 20,069 generally healthy men and women, aged 20 to 65 years. Habitual diet was assessed at baseline (1993–1997) with a validated 178-item food frequency questionnaire. Incidences of CHD and stroke were assessed through linkage with mortality and morbidity registers. Hazard ratios (HR) were calculated with multivariable Cox proportional hazards models, adjusted for age, gender, lifestyle, and dietary factors. Results - During 8–13 years of follow-up, we observed 280 incident CHD events (19% fatal) and 221 strokes (4% fatal). Intakes of energy-adjusted ALA in quintiles ranged from less than 1.0 g/d in the bottom quintile (Q1) to more than 1.9 g/d in the top quintile (Q5). ALA intake was not associated with incident CHD, with HRs varying between 0.89 and 1.01 (all p>0.05) in Q2–Q5 compared with the bottom quintile of ALA intake. For incident stroke, however, participants in Q2–Q5 had a 35–50% lower risk compared with the reference group. HRs were 0.65 (0.43–0.97), 0.49 (0.31–0.76), 0.53 (0.34–0.83), and 0.65 (0.41–1.04) for Q2–Q5 respectively. Conclusion - In this general Dutch population, ALA intake was not associated with incident CHD. The data suggested that a low intake of ALA may be a risk factor for incident stroke. These results warrant confirmation in other population-based studies and in trial

What is next in African neuroscience?

Working in Africa provides neuroscientists with opportunities that are not available in other continents. Populations in this region exhibit the greatest genetic diversity; they live in ecosystems with diverse flora and fauna; and they face unique stresses to brain health, including child brain health and development, due to high levels of traumatic brain injury and diseases endemic to the region. However, the neuroscience community in Africa has yet to reach its full potential. In this article we report the outcomes from a series of meetings at which the African neuroscience community came together to identify barriers and opportunities, and to discuss ways forward. This exercise resulted in the identification of six domains of distinction in African neuroscience: the diverse DNA of African populations; diverse flora, fauna and ecosystems for comparative research; child brain health and development; the impact of climate change on mental and neurological health; access to clinical populations with important conditions less prevalent in the global North; and resourcefulness in the reuse and adaption of existing technologies and resources to answer new questions. The article also outlines plans to advance the field of neuroscience in Africa in order to unlock the potential of African neuroscientists to address regional and global mental health and neurological problems

Mechanism of Options Markets

This topic is talking options markets, how options are traded in such call options exchange. to conduct this research, we take as case study Chicago Board of Options Exchange which is one of the largest options markets in USA. the main purpose of this research is to provide an understanding description of options in general and to describe how options are traded in Chicago Board of Opitons Exchange.BscMBAV

Pitfalls And Growth Areas In The Treatment Of Prenatal Opioid Use Disorder In The United States

Opioid Use Disorder (OUD) during pregnancy is associated with high rates of maternal and neonatal morbidity. Guidelines recommend medications for OUD (MOUD); however, pregnant women have limited access to MOUD. First, we describe trends and factors associated with MOUD administration and retention in care (defined as treatment lasting 6 months or longer) among pregnant women with OUD. Second, we describe the prevalence and geographic distribution of Obstetrician-gynecologists trained to prescribe buprenorphine (henceforth referred to as X-waivered), the first-line treatment for OUD currently under-utilized. The first study is a retrospective nationwide, cross-sectional analysis of treatment episodes for primary OUD among pregnant women based on a national database of treatment episodes for substance use disorders at centers that receive federal funds. The second study is a cross-sectional, nationwide study linking physician-specific data to the county- and state-level data, including 31,211 obstetrician-gynecologists who treat Medicaid enrollees.There were 42,239 treatment episodes for primary OUD among pregnant women of age 15 to 49 reporting using heroin, a synthetic opioid, or non-prescribed methadone between 2013 and 2017 included in the analysis. Most episodes were among non-Hispanic White women (77.8%). Patients were mostly unemployed or not in the labor force (88.7%, 27,459). Heroin was the leading substance reported (65.0%, 27,459). MOUD was administered in 47.4% (20,013) of episodes. Retention occurred in 16.6% of episodes without MOUD and 37.8% of episodes with MOUD (p = 0.01). MOUD administration grew from 41% in 2013 to 52% in 2017, however, retention rates declined from 38% to 33%. Only 1.8% (560) of identified obstetrician-gynecologists were X-waivered. Those in counties with fewer than 5% uninsured residents had nearly twice the odds of being X-waivered compared to those in counties with greater than 15% uninsured residents. Compared to those located in metropolitan counties, Obstetrician-gynecologists in suburban counties were more likely to be X-waivered. Most treatment episodes for prenatal OUD did not include MOUD. Fewer than 2% of Obstetrician-gynecologists who treat Medicaid enrollees were X-waivered, and their geographic distribution skews in favor of suburbia. Our findings highlight significant gaps and growth areas in the U.S. addiction care system and may inform initiatives and policies aimed at improving maternal and child health

Design of maxillofacial implants for cosmetic and reconstructive procedures

Maxillofacial surgery can be used to help appearance and restore function. Often there is a need to provide additional volume with soft tissue properties. This works explores the use of a new biomaterial invented at GT with soft tissue properties as possible maxillofacial implants to provide volume. The implants are for restoring speech function in cleft palate patients presenting velopharyngeal insufficiency and providing volume to reduce the nasolabial folds in order to create a more youthful appearance. We have developed facial implants for the nasolabial fold and lip plumping to address low efficiency of the current methods employed for dermal fillers by providing both long-term usage as well as removability. Furthermore, an insertion method and insertion tools were developed to facilitate the implantation for the surgeons. Regarding the reconstructive aspects of the maxillofacial implants, we have developed a pharyngeal implant aiming to reduce the gap between the pharyngeal implant and the velum (soft palate) of 20% of patients presenting a cleft palate. This implant will allow the care team to delay the palatoplasty in order to not hinder palatal growth in patients. The material used for the implants can also be used to better the current obturators by replacing the acrylic, posterior portion. The main current obturators are the nance obturator and custom acrylic obturators, deemed uncomfortable for the patients due to the hardness of the material. The design process for the implants and the novel obturator involved the optimization of material and shape, taking into consideration mechanical properties of the implants’ surrounding tissues, the anatomy of each feature being enhanced as well as potential implantation modes.M.S