The effect of transmucosal 0.2mg/kg Midazolam premedication on dental anxiety, anaesthetic induction and psychological morbidity in children undergoing general anaesthesia for tooth extraction

<b>Background:</b> The project aims were to evaluate the benefit of transmucosal Midazolam 0.2mg/kg pre-medication on anxiety, induction behaviour and psychological morbidity in children undergoing general anaesthesia (GA) extractions. <b>Method:</b> 179 children aged 5-10 years (mean 6.53 years) participated in this randomised, double blind, placebo controlled trial. Ninety children had Midazolam placed in the buccal pouch. Dental anxiety was recorded pre operatively and 48 hours later using a child reported MCDAS-FIS scale. Behaviour at anaesthetic induction was recorded and psychological morbidity was scored by the parent using the Rutter Scale pre-operatively and again one-week later. Subsequent dental attendance was recorded at one, three and six months after GA. <b>Results:</b> Whilst levels of mental anxiety did not reduce overall, the most anxious patients demonstrated a reduction in anxiety after receiving midazolam premedicationmay (p=0.01). Neither induction behaviour nor psychological morbidity improved. Irrespective of group, parents reported less hyperactive (p= 0.002) and more prosocial behaviour (p=0.002) after the procedure:;, older children improved most (p=0.048), Post GA Dental attendance was poor and unrelated to after the procedure and unaffected by premedication. <b>Conclusion:</b> 0.2mg/kg buccal Midazolam provided some evidence for reducing anxiety in the most dentally anxious patients. However, induction behaviour, psychological morbidity and subsequent dental attendance were not found to alter between the premedication groups

Lipofibromatous hamartoma of the median nerve

Lipofibromatous hamartoma is a rare tumour of peripheral nerves which is characterised by an excessive infiltration of the epineurium and perineurium by fibroadipose tissue. To the best of our knowledge, only approximately 88 cases are reported in the literature. We report a rare case of lipofibromatous hamartoma of the median nerve causing secondary carpal tunnel syndrome in a 25 year old patient. This patient was treated conservatively with decompression and biopsy and experienced a complete resolution of symptoms post-operatively. Magnetic resonance imaging may be used to diagnose this lesion as it has very distinctive characteristics. Multiple conditions have been associated with this lesion and a greater understanding of these associations may clarify the pathogenesis. The architecture of the tumour makes excision very challenging and the surgical management remains controversial. A review of the literature regarding the etiology, pathogenesis and surgical management of lipofibromatous hamartoma is included

Aetiology and incidence of diarrhoea requiring hospitalisation in children under 5 years of age in 28 low-income and middle-income countries: findings from the Global Pediatric Diarrhea Surveillance network.

Introduction: Diarrhoea remains a leading cause of child morbidity and mortality. Systematically collected and analysed data on the aetiology of hospitalised diarrhoea in low-income and middle-income countries are needed to prioritise interventions. Methods: We established the Global Pediatric Diarrhea Surveillance network, in which children under 5 years hospitalised with diarrhoea were enrolled at 33 sentinel surveillance hospitals in 28 low-income and middle-income countries. Randomly selected stool specimens were tested by quantitative PCR for 16 causes of diarrhoea. We estimated pathogen-specific attributable burdens of diarrhoeal hospitalisations and deaths. We incorporated country-level incidence to estimate the number of pathogen-specific deaths on a global scale. Results: During 2017–2018, 29 502 diarrhoea hospitalisations were enrolled, of which 5465 were randomly selected and tested. Rotavirus was the leading cause of diarrhoea requiring hospitalisation (attributable fraction (AF) 33.3%; 95% CI 27.7 to 40.3), followed by Shigella (9.7%; 95% CI 7.7 to 11.6), norovirus (6.5%; 95% CI 5.4 to 7.6) and adenovirus 40/41 (5.5%; 95% CI 4.4 to 6.7). Rotavirus was the leading cause of hospitalised diarrhoea in all regions except the Americas, where the leading aetiologies were Shigella (19.2%; 95% CI 11.4 to 28.1) and norovirus (22.2%; 95% CI 17.5 to 27.9) in Central and South America, respectively. The proportion of hospitalisations attributable to rotavirus was approximately 50% lower in sites that had introduced rotavirus vaccine (AF 20.8%; 95% CI 18.0 to 24.1) compared with sites that had not (42.1%; 95% CI 33.2 to 53.4). Globally, we estimated 208 009 annual rotavirus-attributable deaths (95% CI 169 561 to 259 216), 62 853 Shigella-attributable deaths (95% CI 48 656 to 78 805), 36 922 adenovirus 40/41-attributable deaths (95% CI 28 469 to 46 672) and 35 914 norovirus-attributable deaths (95% CI 27 258 to 46 516). Conclusions: Despite the substantial impact of rotavirus vaccine introduction, rotavirus remained the leading cause of paediatric diarrhoea hospitalisations. Improving the efficacy and coverage of rotavirus vaccination and prioritising interventions against Shigella, norovirus and adenovirus could further reduce diarrhoea morbidity and mortality

Modeling Individual Differences in Perceptual Decision Making

To deal with the abundant amount of information in the environment in order to achieve our goals, human beings adopt a strategy to accumulate some information and filter out other information to ultimately make decisions. Since the development of cognitive science in the 1960s, researchers have been interested in understanding how human beings process and accumulate information for decision-making. Researchers have conducted extensive behavioral studies and applied a wide range of modeling tools to study human behavior in simple-detection tasks and two-choice decision tasks (e.g., discrimination, classification). In general, researchers often assume that the manner in which information is processed for decision-making is invariant across individuals given a particular experimental context. Independent variables, including speed-accuracy instructions, stimulus properties (i.e., intensity), and characteristics of the participants (i.e., aging, cognitive ability) are assumed to affect the parameters in a model (i.e., speed of information accumulation, response bias) but not the way that participants process information (e.g., the order of information processing). Given these assumptions, much modeling has been accomplished based on the grouped data, rather than the individual data. However, a growing number of studies have demonstrated that there were individual differences in the perceptual decision process. In the same task context, different groups of the participants may process information in different manners. The capacity and architecture of the decision mechanism were found to vary across individuals, implying that humans’ decision strategies can vary depending on the context to maximize their performance. In this special issue, we focused on a particular subset of cognitive models, particularly accumulator models, multinomial processing trees and systems factorial technology (SFT) as applied to perceptual decision making. The motivation for the focus on perceptual decision-making is threefold. Empirical studies of perception have grown out of a history of making a large number of observations for each individual so as to achieve precise estimates of each individual’s performance. This type of data, rather than a small number of observations per individual, is most amenable to achieving precision in individual-level and group-level cognitive modeling. Second, the interaction between the acquisition of perceptual information and the decisions based on that information (to the extent that those processes are distinguishable) offers rich data for scientific exploration. Finally, there is an increasing interest in the practical application of individual variation in perceptual ability, whether to inform perceptual training and expertise, or to guide personnel decisions. Although these practical applications are beyond the scope of this issue, we hope that the research presented herein may serve as the foundation for future endeavors in that domain. To deal with the abundant amount of information in the environment in order to achieve our goals, human beings adopt a strategy to accumulate some information and filter out other information to ultimately make decisions. Since the development of cognitive science in the 1960s, researchers have been interested in understanding how human beings process and accumulate information for decision-making. Researchers have conducted extensive behavioral studies and applied a wide range of modeling tools to study human behavior in simple-detection tasks and two-choice decision tasks (e.g., discrimination, classification). In general, researchers often assume that the manner in which information is processed for decision-making is invariant across individuals given a particular experimental context. Independent variables, including speed-accuracy instructions, stimulus properties (i.e., intensity), and characteristics of the participants (i.e., aging, cognitive ability) are assumed to affect the parameters in a model (i.e., speed of information accumulation, response bias) but not the way that participants process information (e.g., the order of information processing). Given these assumptions, much modeling has been accomplished based on the grouped data, rather than the individual data. However, a growing number of studies have demonstrated that there were individual differences in the perceptual decision process. In the same task context, different groups of the participants may process information in different manners. The capacity and architecture of the decision mechanism were found to vary across individuals, implying that humans’ decision strategies can vary depending on the context to maximize their performance. In this special issue, we focused on a particular subset of cognitive models, particularly accumulator models, multinomial processing trees and systems factorial technology (SFT) as applied to perceptual decision making. The motivation for the focus on perceptual decision-making is threefold. Empirical studies of perception have grown out of a history of making a large number of observations for each individual so as to achieve precise estimates of each individual’s performance. This type of data, rather than a small number of observations per individual, is most amenable to achieving precision in individual-level and group-level cognitive modeling. Second, the interaction between the acquisition of perceptual information and the decisions based on that information (to the extent that those processes are distinguishable) offers rich data for scientific exploration. Finally, there is an increasing interest in the practical application of individual variation in perceptual ability, whether to inform perceptual training and expertise, or to guide personnel decisions. Although these practical applications are beyond the scope of this issue, we hope that the research presented herein may serve as the foundation for future endeavors in that domain

Chinese holistic processing: Evidence from cognitive mental architecture using Systems Factorial Technology

Previous research has presented conflicting evidence regarding whether Chinese characters are processed holistically. In past work, we applied Systems Factorial Technology (SFT) and discovered that native Chinese speakers exhibited limited capacity when processing characters and words. To pinpoint the source of this limitation, our current research delved further into the mental architecture involved in processing Chinese characters and English words, taking into consideration information from each component. In our current study, participants were directed to make the same/different judgments on characters/words presented sequentially. Our results indicated that participants utilized a parallel self-terminating strategy when both or neither of the left/right components differed (Experiment 1). Faced with the decisional uncertainty that either the left/right component would also differ, most participants processed with a parallel exhaustive architecture, while a few exhibited the coactive architecture (Experiment 2). Taken together, our work provides evidence that in word/character perception, there is weak holistic processing (parallel self-terminating processing) when partial information is sufficient for the decision; robust holistic processing (coactive or parallel exhaustive processing) occurs under decisional uncertainty. Our findings underscore the significant role that the task and presentation context play in visual word processing

Evaluation of cytokines in peripheral blood mononuclear cell supernatants for the diagnosis of tuberculosis

Margaretha Sariko,1–3 Athanasia Maro,1,3 Jean Gratz,1,4 Eric Houpt,4 Riziki Kisonga,1,5 Stellah Mpagama,1,5 Scott Heysell,4 Blandina T Mmbaga,1–3,* Tania A Thomas4,* 1Kilimanjaro Clinical Research Institute, Moshi, Tanzania; 2Kilimanjaro Christian Medical University College, Moshi, Tanzania; 3Kilimanjaro Christian Medical Centre, Moshi, Tanzania; 4Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, USA; 5Kibong’oto Infectious Diseases Hospital, Kilimanjaro, Tanzania *These authors contributed equally to this work Introduction: There is active interest in leveraging host immune responses as biomarkers of tuberculosis (TB) disease activity. We had previously evaluated an immunodiagnostic test called the antibody in lymphocyte supernatant (ALS) assay. Here, we aimed to evaluate a panel of inflammatory mediators and associate the responses with the ALS results to identify a biosignature to distinguish TB cases from controls. Methodology: In this case–control study, adults with TB were compared to controls who were hospitalized for non-infectious conditions. Blood was collected at baseline and after 4 weeks of TB treatment (from TB cases only). Peripheral blood mononuclear cells were isolated and cultured without antigenic stimulation for 72 hours. Inflammatory mediators were measured using the Multiplex cytokine kit and compared between TB cases and controls; among TB cases, responses were compared over time. ALS and inflammatory mediator results were evaluated using generalized discriminant analysis to identify the optimal biosignature to predict TB. Results: When comparing inflammatory mediators between groups, IL-1ra, IL-1β, and granulocyte macrophage-colony stimulating factor (GM-CSF) were lower in TB cases (P<0.002). Fibroblast growth factor-basic significantly increased from baseline to week-4 (P=0.002). Generalized discriminant analysis yielded a model with IL-2, tumor necrosis factor-alpha, vascular endothelial growth factor, and ALS, providing a sensitivity of 82.2% and specificity of 76.2%. Conclusion: Our results suggest that IL-1ra, IL-1β, and GM-CSF might be used as diagnostic biomarkers to distinguish between TB cases and non-TB cases. We could not identify a group of mediators that outperformed the diagnostic accuracy of the ALS alone. Keywords: cytokines, chemokines, biomarkers, TB, diagnostic

Functional characterization of IgA-targeted bacterial taxa from undernourished Malawian children that produce diet-dependent enteropathy

To gain insights into the interrelationships among childhood undernutrition, the gut microbiota, and gut mucosal immune/barrier function, we purified bacterial strains targeted by immunoglobulin A (IgA) from the fecal microbiota of two cohorts of Malawian infants and children. IgA responses to several bacterial taxa, including Enterobacteriaceae, correlated with anthropometric measurements of nutritional status in longitudinal studies. The relationship between IgA responses and growth was further explained by enteropathogen burden. Gnotobiotic mouse recipients of an IgA(+) bacterial consortium purified from the gut microbiota of undernourished children exhibited a diet-dependent enteropathy characterized by rapid disruption of the small intestinal and colonic epithelial barrier, weight loss, and sepsis that could be prevented by administering two IgA-targeted bacterial species from a healthy microbiota. Dissection of a culture collection of 11 IgA-targeted strains from an undernourished donor, sufficient to transmit these phenotypes, disclosed that Enterobacteriaceae interacted with other consortium members to produce enteropathy. These findings indicate that bacterial targets of IgA responses have etiologic, diagnostic, and therapeutic implications for childhood undernutrition