The transmission of music into the human uterus and the response to music of the human fetus and neonate

The aim of this study was to investigate whether music influences human life before birth. In order to determine the existence and character of music in the uterine acoustic environment, a study was conducted involving the insertion of a hydrophone through the cervix, next to the fetal head. The investigation was conducted on eight women in early labour. The average residual uterine sound of the eight subjects was measured at 65 dBA (A-weighted) re 20 µ.Pa in a 1 O KHz band, RMS averaged over 32-second records. Above this emerged the maternal voice, an external female voice and a male voice presented at approximately 65 dB (linear weighted). Pure tones between 50 Hz and 1 O KHz and orchestral music, all presented at 80 dB (linear weighted), were also shown to emerge above the residual uterine sound. Attenuation of external sound was observed to vary as a function of frequency, with less attenuation of lower frequencies. It was determined that the music was transmitted into the uterus without sufficient distortion to significantly alter the recognisable characteristics of the music. The fetal heart rate (FHA) response to a music stimulus (MS) and a vibroacoustic stimulus (VS) was measured in 40 subjects. Gestational age of the fetuses ranged from 32 to 42 weeks. The study included a control period with no acoustic stimulation; a period with the presentation of 5 music stimuli; and a period with the presentation of 5 vibroacoustic stimuli. A change in the FHA of 15 beats per minute or greater, lasting 15 seconds and occurring within 15 seconds of at least 2 of the 5 stimuli (or a tachycardia of greater than 15 beats per minute above the resting baseline, sustained for one minute or longer) was considered to be a positive response. The MS elicited a positive response in 35 of the fetuses (the 5 non-responses occurring in a period of low FHA variability) and all 40 fetuses responded to the VS (regardless of arousal state). In the third study, mothers attending childbirth education classes volunteered to listen to a prescribed music excerpt twice daily from the 34th week of pregnancy. Ten neonates (all clinically normal) were tested betw~en the 2nd and 5th day after birth. Investigators observed the effect of two music sti:Tiuli, the prescribed stimulus and a non-prescribed stimulus, on neonatal sucking of a non-nutritive nipple. A five-minute control period with no stimulation was compared with a ten-minute period during which two music stimuli were presented. By random allocation, either the prescribed music stimulus (PM) or the nonprescribed music (NM) was presented contingent upon sucking pressure. If a sucking burst was initiated, the PM stimulus was activated. On cessation of sucking, the NM stimulus was activated. Randomly, the procedure would be reversed for some of the subjects, where initiation of sucking activated the NM stimulus and cessation of sucking activated the PM stimulus. It was determined that the inter-burst intervals during the music period were significantly extended when coinciding with the PM stimulus and significantly shortened when coinciding with the NM stimulus.The studies indicated that music is transmitted into the uterus with insufficient distortion to alter the character of the music; that the normal fetus responds to a music stimulus from at least the 32nd week of gestation; and that the neonate alters the normal sucking pattern to activate longer periods of a music stimulus which has been repeatedly presented during the intrauterine stage and shorter periods of a novel music stimulus

South Africa, the arts and youth in conflict with the law

This paper describes the DIME (Diversion into Music Education) youth intervention program that originated in South Africa in 2001. DIME offers instruction in African marimba and djembe bands to juvenile offenders. Conceived as a community collaboration among organizations in the cities of Cape Town, SA and Tampa, USA (including the University of the Western Cape and the University of South Florida), DIME offers a unique example of community music and multicultural music education.Web of Scienc

Colorectal Cancer Video for the Deaf Community: A Randomized Control Trial

The Deaf community experiences multiple barriers to accessing cancer information. Deaf participants (n = 144) were randomly assigned to view a colorectal cancer education video or another program in American Sign Language. They completed surveys pre- and post-intervention and at 2 months post-intervention. By using a crossover model, control group participants were offered the option of seeing the intervention video. The experimental group gained and retained significantly more colorectal cancer knowledge than the control group, and the control group demonstrated the greatest knowledge gain after crossing into the experimental arm. This video effectively informed the Deaf community about colorectal cancer

Social inequalities in self-rated health by age: Cross-sectional study of 22 457 middle-aged men and women

<p>Abstract</p> <p>Background</p> <p>We investigate the association between occupational social class and self-rated health (SRH) at different ages in men and women.</p> <p>Methods</p> <p>Cross sectional population study of 22 457 men and women aged 39–79 years living in the general community in Norfolk, United Kingdom, recruited using general practice age-sex registers in 1993–1997. The relationship between self-rated health and social class was examined using logistic regression, with a poor or moderate rating as the outcome.</p> <p>Results</p> <p>The prevalence of poor or moderate (lower) self-rated health increased with increasing age in both men and women. There was a strong social class gradient: in manual classes, men and women under 50 years of age had a prevalence of lower self-rated health similar to that seen in men and women in non-manual social classes over 70 years old. Even after adjustment for age, educational status, and lifestyle factors (body mass index (BMI), smoking, physical activity and alcohol consumption) there was still strong evidence of a social gradient in self-rated health, with unskilled men and women approximately twice as likely to report lower self-rated health as professionals (OR_men= 2.44 (95%CI 1.69, 3.50); OR_women= 1.97 (95%CI 1.45, 2.68).</p> <p>Conclusion</p> <p>There was a strong gradient of decreased SRH with age in both men and women. We found a strong cross-sectional association between SRH and social class, which was independent of education and major health related behaviors. The social class differential in SRH was similar with age. Prospective studies to confirm this association should explore social and emotional as well as physical pathways to inequalities in self reported health.</p

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Applicability of ENCHANTED trial results to current acute ischemic stroke patients eligible for intravenous thrombolysis in England and Wales: Comparison with the Sentinel Stroke National Audit Programme registry

© 2019 World Stroke Organization. Background: Randomized controlled trials provide high-level evidence, but the necessity to include selected patients may limit the generalisability of their results. Methods: Comparisons were made of baseline and outcome data between patients with acute ischemic stroke (AIS) recruited into the alteplase-dose arm of the international, multi-center, Enhanced Control of Hypertension and Thrombolysis Stroke study (ENCHANTED) in the United Kingdom (UK), and alteplase-treated AIS patients registered in the UK Sentinel Stroke National Audit Programme (SSNAP) registry, over the study period June 2012 to October 2015. Results: There were 770 AIS patients (41.2% female; mean age 72 years) included in ENCHANTED at sites in England and Wales, which was 19.5% of alteplase-treated AIS patients registered in the SSNAP registry. Trial participants were significantly older, had lower baseline neurological severity, less likely Asian, and had more premorbid symptoms, hypertension and atrial fibrillation. Although ENCHANTED participants had higher rates of symptomatic intracerebral hemorrhage than those in SSNAP, there were no differences in onset-to-treatment time, levels of disability (assessed by the modified Rankin scale) at hospital discharge, and mortality over 90 days between groups. Conclusions: Despite the high level of participation, equipoise over the dose of alteplase among UK clinician investigators favored the inclusion of older, frailer, milder AIS patients in the ENCHANTED trial. Clinical trial registration: Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01422616

Genetic associations at 53 loci highlight cell types and biological pathways relevant for kidney function.

Reduced glomerular filtration rate defines chronic kidney disease and is associated with cardiovascular and all-cause mortality. We conducted a meta-analysis of genome-wide association studies for estimated glomerular filtration rate (eGFR), combining data across 133,413 individuals with replication in up to 42,166 individuals. We identify 24 new and confirm 29 previously identified loci. Of these 53 loci, 19 associate with eGFR among individuals with diabetes. Using bioinformatics, we show that identified genes at eGFR loci are enriched for expression in kidney tissues and in pathways relevant for kidney development and transmembrane transporter activity, kidney structure, and regulation of glucose metabolism. Chromatin state mapping and DNase I hypersensitivity analyses across adult tissues demonstrate preferential mapping of associated variants to regulatory regions in kidney but not extra-renal tissues. These findings suggest that genetic determinants of eGFR are mediated largely through direct effects within the kidney and highlight important cell types and biological pathways

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570