Posttreatment Lyme Disease Syndrome and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Systematic Review and Comparison of Pathogenesis

Lyme disease is the most common vector-borne illness in the United States and has been causing significant morbidity since its discovery in 1977. It is well-documented that about 10% of patients properly treated with antibiotics never fully recover, but instead go on to develop a chronic illness dubbed, posttreatment Lyme disease syndrome (PTLDS) characterized by severe fatigue, cognitive slowing, chronic pain, and sleep difficulties. This review includes 18 studies that detail the symptoms of patients with PTLDS and uses qualitative analysis to compare them to myalgic encephalitis/chronic fatigue syndrome (ME/CFS), a strikingly similar syndrome. In the majority of the PTLDS studies, at least four of the six major symptoms of ME/CFS were also noted, including substantial impairment in activity level and fatigue for more than 6 months, post-exertional malaise, and unrefreshing sleep. In one of the included PTLDS articles, 26 of the 29 ME/CFS symptoms were noted. This study adds to the expanding literature on the post-active phase of infection syndromes, which suggests that chronic illnesses such as PTLDS and ME/CFS have similar pathogenesis despite different infectious origins

Injuries of the mind, body, and soul : an exploration of moral injury among military service members and veterans

Military service often requires engaging in activities, witnessing acts, or immediate decision-making that may violate the moral codes and personal values to which most individuals ascribe. If unacknowledged, these factors can lead to injuries that can affect the physical, psychological, social, and spiritual health of military men and women. The term moral injury has been assigned to these soul-ceasing experiences. Although researchers have attempted to define moral injury and what leads to such experiences, inconsistencies across definitions exist. In addition, nearly all existing definitions have lacked empirical support. Thus, an in-depth literature review, systematic review, and phenomenological qualitative study were completed to explore how moral injury has been conceptualized and defined across the literature and to respond to the need for an empirically-based, veteran-informed definitional understanding of such injuries. Findings from a qualitative study with United States veterans revealed that moral injuries can be conceptualized by chronic, deep-rooted experiences of (a) betrayal, (b) moral ambivalence, (c) soul injuries, and (d) lack of reconciliation. Recommendations for future research and clinical practice with moral injury must consider the systemic roots and implications for these injuries of the soul. Rather than viewing moral injury as a construct distinct to the field of psychology, trauma, or theology, applying a more systemic framework may be most appropriate for capturing the multi-level implications. For instance, a biopsychosocial-spiritual lens may support the cellular to society and spiritual implications of moral injuries. Additionally, Bronfenbrenner's ecological theory was proposed as a potentially influential theory in grounding future assessments and interventions for the constructs by emphasizing the interplay between context, personal characteristics/values, and multi-level systemic influences on the development of moral injury

The Effects of a High Fat Meal on Blood Flow Regulation during Arm Exercise

A diet high in saturated fats results in endothelial dysfunction and can lead to atherosclerosis, a precursor to cardiovascular disease. Exercise training is a potent stimulus though to mitigate the negative effects of a high saturated fat diet; however, it is unclear how high-saturated fat meal (HSFM) consumption impacts blood flow regulation during a single exercise session. PURPOSE: This study sought to examine the impact of a single HSFM on peripheral vascular function during an acute upper limb exercise bout. METHODS: Ten young healthy individuals completed two sessions of progressive handgrip exercise. Subjects either consumed a HSFM (0.84 g of fat/kg of body weight) 4 hours prior or remained fasted before the exercise bout. Progressive rhythmic handgrip exercise (6kg, 12kg, 18kg) was performed for 3 minutes per stage at rate of 1 Hz. The brachial artery (BA) diameter and blood velocity was obtained using Doppler Ultrasound (GE Logiq e) and BA blood flow was calculated with these values. RESULTS: BA blood flow and flow mediated dilation (normalized for shear rate) during the handgrip exercise significant increased from baseline in all workloads, but no differences were revealed in response to the HSFM consumption. CONCLUSION: Progressive handgrip exercise augmented BA blood flow and flow mediated dilation in both testing days; however, there was no significant differences following the HSFM consumption. This suggests that upper limb blood flow regulation during exercise is unaltered by a high fat meal in young healthy individuals.https://scholarscompass.vcu.edu/gradposters/1060/thumbnail.jp

Understanding the structure and processes of primary health care for young indigenous children

INTRODUCTION: Primary health care organisations need to continuously reform to more effectively address current health challenges, particularly for vulnerable populations. There is growing evidence that optimal health service structures are essential for producing positive outcomes. AIM: To determine if there is an association between process of care indicators (PoCIs) for important young indigenous child health and social issues and: (i) primary health-care service and child characteristics; and (ii) organisational health service structures. METHODS: This was a cross-sectional study of 1554 clinical child health audits and associated system assessments from 74 primary care services from 2012 to 2014. Composite PoCIs were developed for social and emotional wellbeing, child neurodevelopment and anaemia. Crude and adjusted logistic regression models were fitted, clustering for health services. Odds ratios and 95% confidence intervals were derived. RESULTS: Overall, 32.0% (449) of records had a social and emotional wellbeing PoCI, 56.6% (791) had an anaemia PoCI and 49.3% (430) had a child neurodevelopment PoCI. Children aged 12–23 months were significantly more likely to receive all PoCIs compared to children aged 24–59 months. For every one point increase in assessment scores for team structure and function (aOR 1.14, 95% CI 1.01–1.27) and care planning (aOR 1.14, 95% CI 1.01–1.29) items, there was a 14% greater odds of a child having an anaemia PoCI. Social and emotional wellbeing and child neurodevelopment PoCIs were not associated with system assessment scores. DISCUSSION: Ensuring young indigenous children aged 24–59 months are receiving quality care for important social and health indicators is a priority. Processes of care and organisational systems in primary care services are important for the optimal management of anaemia in indigenous children

Piperonyl butoxide (PBO) combined with pyrethroids in long-lasting insecticidal nets (LLINs) to prevent malaria in Africa

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: 1. Evaluate whether adding PBO to pyrethroid LLINs increases the epidemiological and entomological effectiveness of the nets. 2. Compare the effects of PBO-LLINs currently in commercial development or on the market with their non-PBO equivalent in relation to: a. malaria infection (prevalence or incidence); b. entomological outcomes

Feeling safe at work:Development and validation of the Psychological Safety Inventory

Psychological safety, defined as perceptions that an individual within a team is supported and feels safe to take interpersonal risks, voice opinions, and share ideas, is vital for organizational effectiveness. However, there is no consensus on how workplace psychological safety should be measured. We developed the Psychological Safety Inventory (PSI) in response to organizational needs to accurately assess psychological safety. A 70-item version of the PSI was administered to 497 employees from Canada, the United States, and the United Kingdom. Based on factor analytic findings, we reduced the preliminary PSI to a 30-item, five-factor scale. The PSI showed high reliability and correlated as anticipated with convergent measures. Overall, the PSI is a valid and reliable measure of workplace psychological safety.</p

Cytology, culture and genomics to evaluate the microbiome in healthy rabbit external ear canals

Background: Lop-eared rabbits may be predisposed to otitis externa (OE) as a consequence of their ear conformation. Although otoscopy, otic cytological evaluation and culture are valuable tools in dogs and cats, published data on rabbits remain lacking. Hypothesis/Objectives: This study aimed to assess the utility of otoscopy and cytological results in evaluating healthy rabbit external ear canals (EECs) and to characterise ear cytological and microbiological findings through culture techniques and metagenomic sequencing. Animals: Sixty-three otitis-free client-owned rabbits. Materials and Methods: All rabbits underwent otoscopy and ear cytological evaluation. In a subset of 12 rabbits, further bacterial and fungal culture, fungal DNA assessment and metagenomic sequencing were performed. Results: Otic cytological results revealed yeast in 73%, cocci in 42.9% and rods in 28.6% of healthy rabbit EECs. Compared to upright-eared rabbits, lop-eared rabbits had more discharge and more bacteria per oil immersion field. Culture isolated eight different species yet metagenomic sequencing identified 36, belonging to the Bacillota (Firmicutes), Pseudomonadota and Actinomycetota phyla. Staphylococcus were the most commonly observed species with both methods. Ten of 12 rabbits were yeast-positive on cytological evaluation with only three yielding fungal growth identified as Yarrowia (Candida) lipolytica, Eurotium echinulatum and Cystofilobasidium infirmominiatum. Conclusions and Clinical Relevance: Healthy rabbit EECs lack inflammatory cells yet can host yeast and bacteria, emphasising the need to evaluate cytological results alongside the clinical signs. Lop-ear anatomy may predispose to bacterial overgrowth and OE. Notably, yeasts may be present despite a negative culture.</p

Hospital healthcare experiences of children and young people with life-threatening or life-shortening conditions, and their parents : scoping reviews and resultant conceptual frameworks

Abstract Background Patient experience is a core component of healthcare quality. Patient-reported experience measures (PREMs) are increasingly used to assess this, but there are few paediatric PREMs. This paper reports the first stage of developing two such measures, one for children and young people (0–18 years) (CYP) with a life-threatening or life-shortening condition (LT/LSC), and one for their parents. It comprised parallel scoping reviews of qualitative evidence on the elements of health service delivery and care that matter to, or impact on, CYP (Review 1) and parents (Review 2). Methods Medline and PsychINFO (1/1/2010 – 11/8/2020) and CINAHL Complete (1/1/2010 – 4/7/2020) were searched and records identified screened against inclusion criteria. A thematic approach was used to manage and analyse relevant data, informed by existing understandings of patient/family experiences as comprising aspects of staff’s attributes, their actions and behaviours, and organisational features. The objective was to identity the data discrete elements of health service delivery and care which matter to, or impact on, CYP or parents which, when organised under higher order conceptual domains, created separate conceptual frameworks. Results 18,531 records were identified. Sparsity of data on community-based services meant the reviews focused only on hospital-based (inpatient and outpatient) experiences. 53 studies were included in Review 1 and 64 in Review 2. For Review 1 (CYP), 36 discrete elements of healthcare experience were identified and organized under 8 higher order domains (e.g. staff’s empathetic qualities; information-sharing/decision making; resources for socializing/play). In Review 2 (parents), 55 elements were identified and organized under 9 higher order domains. Some domains were similar to those identified in Review 1 (e.g. professionalism; information-sharing/decision-making), others were unique (e.g. supporting parenting; access to additional support). Conclusions Multiple and wide-ranging aspects of the way hospital healthcare is organized and delivered matters to and impacts on CYP with LT/LSCs, and their parents. The aspects that matter differ between CYP and parents, highlighting the importance of measuring and understanding CYP and parent experience seperately. These findings are key to the development of patient/parent experience measures for this patient population and the resultant conceptual frameworks have potential application in service development

Poetic Inquiry of and on Play

Dear Carl, Pamela, Natalie, Sandra, and Kimberly,Would you like to come out and play? John, Lynn, Celeste, and I are knocking at your door.We wonder if you might be interested in joining us in a poetic inquiry? The call from CJE asks for papers that address play, playfulness, and childhood.Poetically yours,John, Lynn, Celeste, and SeanP.S. Can’t, too busy, don’t have time? Ready or not, here we come