A Bayesian Approach to Latent Class Modeling for Estimating the Prevalence of Schizophrenia Using Administrative Databases

Estimating the incidence and the prevalence of psychotic disorders in the province of Quebec has been the object of some interest in recent years as a contribution to the epidemiological study of the causes of psychotic disorders being carried out primarily in the UK and Scandinavia. A number of studies have used administrative data from the Régie de l’assurance maladie du Québec (RAMQ) that includes nearly all Quebec citizens to obtain geographical and temporal prevalence estimates for the illness. However, there has been no investigation of the validity of RAMQ diagnoses for psychotic disorders, and without a measure of the sensitivity and the specificity of these diagnoses, it is impossible to be confident in the accuracy of the estimates obtained. This paper proposes the use of latent class analysis to ascertain the validity of a diagnosis of schizophrenia using RAMQ data

Trust in Placebos

Trying to explain the placebo effect has forced researchers to consider human beings as a whole and not as the sum of their organs. Just as polluted particles in the air can make us cough, our own beliefs can make our symptoms disappear. Placebo effects operate through the socio-cultural beliefs that an injection, or a pill, is a healing agent in itself, independently of its actual constitution. These beliefs are naturally tightly linked to the meaningfulness of our environment. The white coat of the doctor, the hospital room, or words pronounced by an authority figure all have the power to create a physiological effect. The literature on placebos has not paid sufficient attention, however, to the meaning the patient assigns to her relationship to the doctor. It is plausible that there is a psychological difference between a doctor who is perceived to be both competent as well as acting with the patient’s well-being in mind as against the doctor who is perceived to be merely competent. That is to say, there is a distinction between trusting a doctor because we believe she cares for us and has our best interests at heart, as against trusting a doctor because we believe her to be merely reliable. Could this distinction make a difference in the context of placebos? In this paper, we develop the hypothesis that it could. We provide evidence from the literature supporting this hypothesis and suggest ways to test it. If correct, the hypothesis has implications not only for the theory of placebos but for healing more generally

Afterlife: the post-research affect and effect of software

Software plays an important role in contemporary research. Aside from its use for administering traditional instruments like surveys and in data analysis, the widespread use of mobile and web apps for social, medical and lifestyle engagement has led to software becoming a research intervention in its own right. For example, it is not unusual to find apps being studied for their utility as interventions in health and social life. Since the software may persist in use beyond the life of an investigation, this raises questions as to the extent of ethical duties for researchers involved in its production and/or study towards the participants involved. Key factors identified include the extent of affect created by the software, the effect it has on a participant’s life, the length of investigation, cost of maintenance and participant agency. In this article we discuss the issues raised in such situations, considering them in the context of post-research duties of care and suggesting strategies to balance the burden on researchers with the need for ongoing participant support

Remote Options for Medication Abortion: Improving Patient Care During and After the Covid-19 Crisis

The COVID-19 pandemic has shifted primary care and other practices towards remote care and telemedicine options to minimize viral exposure. Although in-person visits are sometimes indispensable, research shows that telemedicine can expand access to vital services without sacrificing patient-centered care. Medication abortion is an essential, time-sensitive service that is particularly well-suited to telemedicine provision, including in primary care settings. Decades of clinical research and practice guidelines from core medical societies affirm the safety and efficacy of providing medication abortion remotely. Neither FDA nor professional guidelines require sonography for medication abortion, and research shows that necessary clinical assessments can be achieved without ultrasound. New practice guidelines recommend against Rh testing for abortions under 8 weeks of pregnancy and rely on patient history for those provided from 8 to 11 weeks. As primary care providers, we can and should provide high-quality, low-risk abortion care for patients without point-of-care exams and labs. This discussion includes a detailed checklist for providing such remote-care medication abortion in a variety of settings. Such strategies will allow more clinicians to offer this essential care both during and after the Covid-19 crisis.https://deepblue.lib.umich.edu/bitstream/2027.42/155399/1/Stein main article.pd

The dynamic action of SecA during the initiation of protein translocation

Biotechnology and Biological Sciences Research Council (BBSRC) [a doctoral training grant Ph.D. studentship to S.W. and project grant number BB/I008675/1] and the Wellcome Trust [project grant number 084452]

Mobility of the SecA 2-helix-finger is not essential for polypeptide translocation via the SecYEG complex

The bacterial ATPase SecA and protein channel complex SecYEG form the core of an essential protein translocation machinery. The nature of the conformational changes induced by each stage of the hydrolytic cycle of ATP and how they are coupled to protein translocation are not well understood. The structure of the SecA–SecYEG complex revealed a 2-helix-finger (2HF) of SecA in an ideal position to contact the substrate protein and push it through the membrane. Surprisingly, immobilization of this finger at the edge of the protein channel had no effect on translocation, whereas its imposition inside the channel blocked transport. This analysis resolves the stoichiometry of the active complex, demonstrating that after the initiation process translocation requires only one copy each of SecA and SecYEG. The results also have important implications on the mechanism of energy transduction and the power stroke driving transport. Evidently, the 2HF is not a highly mobile transducing element of polypeptide translocation

Oxytocin in pregnancy and the postpartum: relations to labor and its management.

The purpose of this study was to examine variations in endogenous oxytocin levels in pregnancy and postpartum state. We also explored the associations between delivery variables and oxytocin levels. A final sample of 272 mothers in their first trimester of pregnancy was included for the study. Blood samples were drawn during the first trimester and third trimester of pregnancy and at 8 weeks postpartum. Socio-demographic data were collected at each time point and medical files were consulted for delivery details. In most women, levels of circulating oxytocin increased from the first to third trimester of pregnancy followed by a decrease in the postpartum period. Oxytocin levels varied considerably between individuals, ranging from 50 pg/mL to over 2000 pg/mL. Parity was the main predictor of oxytocin levels in the third trimester of pregnancy and of oxytocin level changes from the first to the third trimester of pregnancy. Oxytocin levels in the third trimester of pregnancy predicted a self-reported negative labor experience and increased the chances of having an epidural. Intrapartum exogenous oxytocin was positively associated with levels of oxytocin during the postpartum period. Our exploratory results suggest that circulating oxytocin levels during the third trimester of pregnancy may predict the type of labor a woman will experience. More importantly, the quantity of intrapartum exogenous oxytocin administered during labor predicted plasma oxytocin levels 2 months postpartum, suggesting a possible long-term effect of this routine intervention, the consequences of which are largely unknown

Lung volumes identify an at-risk group in persons with prolonged secondhand tobacco smoke exposure but without overt airflow obstruction.

IntroductionExposure to secondhand smoke (SHS) is associated with occult obstructive lung disease as evident by abnormal airflow indices representing small airway disease despite having preserved spirometry (normal forced expiratory volume in 1 s-to-forced vital capacity ratio, FEV1/FVC). The significance of lung volumes that reflect air trapping in the presence of preserved spirometry is unclear.MethodsTo investigate whether lung volumes representing air trapping could determine susceptibility to respiratory morbidity in people with SHS exposure but without spirometric chronic obstructive pulmonary disease, we examined a cohort of 256 subjects with prolonged occupational SHS exposure and preserved spirometry. We elicited symptom prevalence by structured questionnaires, examined functional capacity (maximum oxygen uptake, VO2max) by exercise testing, and estimated associations of those outcomes with air trapping (plethysmography-measured residual volume-to-total lung capacity ratio, RV/TLC), and progressive air trapping with exertion (increase in fraction of tidal breathing that is flow limited on expiration during exercise (per cent of expiratory flow limitation, %EFL)).ResultsRV/TLC was within the predicted normal limits, but was highly variable spanning 22%±13% and 16%±8% across the increments of FEV1/FVC and FEV1, respectively. Respiratory complaints were prevalent (50.4%) with the most common symptom being ≥2 episodes of cough per year (44.5%). Higher RV/TLC was associated with higher OR of reporting respiratory symptoms (n=256; r2=0.03; p=0.011) and lower VO2max (n=179; r2=0.47; p=0.013), and %EFL was negatively associated with VO2max (n=32; r2=0.40; p=0.017).ConclusionsIn those at risk for obstruction due to SHS exposure but with preserved spirometry, higher RV/TLC identifies a subgroup with increased respiratory symptoms and lower exercise capacity

A computational approach to linguistic knowledge

The rejection of behaviorism in the 1950s and 1960s led to the view, due mainly to Noam Chomsky, that language must be studied by looking at the mind and not just at behavior. It is an understatement to say that Chomskyan linguistics dominates the field. Despite being the overwhelming majority view, it has not gone unchallenged, and the challenges have focused on different aspects of the theory. What is almost universally accepted, however, is Chomsky’s view that understanding language demands a theory that posits mental states that represent rules of language. Call this claim, following Cowie (1999), Representationalism or (R). According to (R), ‘‘[e]xplaining language mastery and acquisition requires the postulation of contentful mental states and processes involving their manipulation’’ (Cowie, 1999, p. 154). Although (R) is nothing more than the general assumption on which cognitive psychology is founded applied to the case of language, even it has had its detractors. Critics have argued that linguistic competence should not in fact be thought of as based on the possession of a body of linguistic knowledge but should be thought of, rather, as a kind of skill. This is an important challenge because one might be inclined to think that no recognizable form of Chomskyan linguistics could withstand the falsification of (R). In this paper we attempt to show that in fact (R) could be false without doing much damage to Chomskyan linguistics at all. Indeed, it is possible that the Chomskyan position could be made more coherent by adopting the view we will sketch. Our claim, therefore, is that critics of (R) might be right, but that this does not obviously make them serious critics of the Chomskyan program