Breast cancer screening beliefs by practice location

BACKGROUND: This study examines variations in breast cancer screening among primary care clinicians by geographic location of clinical practice. METHODS: A cross-sectional survey design was used to examine approaches to breast cancer screening among physicians, nurse practitioners, and physician assistants involved in primary care practice. A summary index of beliefs about breast cancer screening was created by summing the total number of responses in agreement with each of four survey items; values for this summary variable ranged between zero and four. Respondents were classified into urban, rural and suburban categories based upon practise location. RESULTS: Among the 428 respondents, agreement with "correct" responses ranged from 50% to 71% for the individual survey items; overall, half agreed with three or more of the four breast cancer screening items. While no significant differences were noted by practice location, variation in responses were evident. Reported use of written breast cancer guidelines was less in both suburban (OR = 0.51) and urban areas (OR = 0.56) when compared to clinicians in rural areas. CONCLUSION: Development of an evidence-based consensus statement regarding breast cancer screening would support a single set of unambiguous guidelines for implementation in all primary care settings, thus decreasing variations in how breast cancer screening is approached across varied clinical settings

Examining the effect of state anxiety on compensatory and strategic adjustments in the planning of goal-directed aiming

The anxiety-perceptual-motor performance relationship may be enriched by investigations involving discrete manual responses due to the definitive demarcation of planning and control processes, which comprise the early and late portions of movement, respectively. To further examine the explanatory power of self-focus and distraction theories, we explored the potential of anxiety causing changes to movement planning that accommodate for anticipated negative effects in online control. As a result, we posed two hypotheses where anxiety causes performers to initially undershoot the target and enable more time to use visual feedback (“play-it-safe”), or fire a ballistic reach to cover a greater distance without later undertaking online control (“go-for-it”). Participants were tasked with an upper-limb movement to a single target under counter-balanced instructions to execute fast and accurate responses (low/normal anxiety) with non-contingent negative performance feedback (high anxiety). The results indicated that the previously identified negative impact of anxiety in online control was replicated. While anxiety caused a longer displacement to reach peak velocity and greater tendency to overshoot the target, there appeared to be no shift in the attempts to utilise online visual feedback. Thus, the tendency to initially overshoot may manifest from an inefficient auxiliary procedure that manages to uphold overall movement time and response accuracy

Microduplications of 16p11.2 are associated with schizophrenia

Recurrent microdeletions and microduplications of a 600-kb genomic region of chromosome 16p11.2 have been implicated in childhood-onset developmental disorders1,2,3. We report the association of 16p11.2 microduplications with schizophrenia in two large cohorts. The microduplication was detected in 12/1,906 (0.63%) cases and 1/3,971 (0.03%) controls (P = 1.2 × 10−5, OR = 25.8) from the initial cohort, and in 9/2,645 (0.34%) cases and 1/2,420 (0.04%) controls (P = 0.022, OR = 8.3) of the replication cohort. The 16p11.2 microduplication was associated with a 14.5-fold increased risk of schizophrenia (95% CI (3.3, 62)) in the combined sample. A meta-analysis of datasets for multiple psychiatric disorders showed a significant association of the microduplication with schizophrenia (P = 4.8 × 10−7), bipolar disorder (P = 0.017) and autism (P = 1.9 × 10−7). In contrast, the reciprocal microdeletion was associated only with autism and developmental disorders (P = 2.3 × 10−13). Head circumference was larger in patients with the microdeletion than in patients with the microduplication (P = 0.0007)

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

Perceptions of Work-Life Balance Among Military Law Enforcement Personnel and Their Spouses

The purpose of this study was to examine the extent to which military law enforcement agents and their spouses shared similar perceptions of work-life conflict and organizational support. One hundred seventy Special Agents in the Air Force Office of Special Investigations and their spouses participated in the study. Survey results revealed that Agents and spouses shared very similar views regarding the Agents’ work-life conflict and organizational support. Agents had slightly more positive views of supervisory support than their spouses did. Agents perceived somewhat more work-to-family conflict, and considerably more family-to-work conflict than their spouses thought they did. Both Agents and their spouses perceived greater support for work-life balance from immediate supervisors than from the organization as a whole. Implications for managing work-life conflict are discussed

Work-Life Conflict and Organizational Support in a Military Law Enforcement Agency

The purpose of this study was to examine the extent to which work-life conflict and organizational support for work-life balance are related to job satisfaction and turnover intentions for military law enforcement personnel. More specifically, 1203 members of the United States Air Force Office of Special Investigations completed a survey that measured family-to-work conflict, work-to-family conflict, perceptions of work-life support from the organization, support from immediate supervisors, and support from peers. Work-to-family and family-to-work conflict were related to job satisfaction and turnover intentions. Perceived social support, especially at the organizational level, was negatively correlated with work-to-family and family-to-work conflict. Agents within the OSI were experiencing more work-to-family and family-to-work conflict than OSI support staff although the relationships among support, conflict and satisfaction were the same for the two groups

Interpersonal precipitants are associated with suicide intent communication among United States Air Force suicide decedents

Background: Few studies explore differences between suicide intent communicators and noncommunicators, and to date, none have examined the association between suicide precipitants and intent communication. Methods: United States Air Force suicide decedents (N = 236) were categorized as suicide intent communicators or non-communicators within 30 days prior to death. The top two frequently occurring suicide precipitants, categorized as interpersonal and legal/administrative, were examined in relation to suicide intent communication. Results: Nearly half (47.0%) of suicide decedents communicated intent within 30 days of death, of which the majority (61.3%) communicated their suicide intent within 24 h of death. Suicide intent communicators and non-communicators did not differ on demographics. Decedents with interpersonal precipitants were significantly more likely than those without to communicate suicide intent (52.7% versus 33.3%). Decedents with documented legal/administrative precipitants were equally likely as those without to communicate suicide intent (49.6% versus 44.0%). Controlling for legal/administrative precipitants, decedents with interpersonal precipitants were twice as likely to communicate suicide intent communication, OR = 2.2, p = .008 (95% CI = 1.23, 3.98). Limitations: Limitations include the retrospective study design, unknown mode of intent communication, unclear timing of precipitants relative to communication, and exclusion of other types of precipitants. Conclusions: Suicide intent communication was most frequent among decedents with interpersonal precipitants. This finding has important implications for the continued education of military families and communities on identifying and intervening with those making suicide intent disclosures. Additional research is needed to examine individual trajectories toward suicide to understand nuances of distal and proximal precipitants as related to suicide intent communication

Cofilin-1 inactivation leads to proteinuria--studies in zebrafish, mice and humans.

BACKGROUND: Podocytes are highly specialized epithelial cells on the visceral side of the glomerulus. Their interdigitating primary and secondary foot processes contain an actin based contractile apparatus that can adjust to changes in the glomerular perfusion pressure. Thus, the dynamic regulation of actin bundles in the foot processes is critical for maintenance of a well functioning glomerular filtration barrier. Since the actin binding protein, cofilin-1, plays a significant role in the regulation of actin dynamics, we examined its role in podocytes to determine the impact of cofilin-1 dysfunction on glomerular filtration. METHODS AND FINDINGS: We evaluated zebrafish pronephros function by dextran clearance and structure by TEM in cofilin-1 morphant and mutant zebrafish and we found that cofilin-1 deficiency led to foot process effacement and proteinuria. In vitro studies in murine and human podocytes revealed that PMA stimulation induced activation of cofilin-1, whereas treatment with TGF-β resulted in cofilin-1 inactivation. Silencing of cofilin-1 led to an accumulation of F-actin fibers and significantly decreased podocyte migration ability. When we analyzed normal and diseased murine and human glomerular tissues to determine cofilin-1 localization and activity in podocytes, we found that in normal kidney tissues unphosphorylated, active cofilin-1 was distributed throughout the cell. However, in glomerular diseases that affect podocytes, cofilin-1 was inactivated by phosphorylation and observed in the nucleus. CONCLUSIONS: Based on these in vitro and in vivo studies we concluded cofilin-1 is an essential regulator for actin filament recycling that is required for the dynamic nature of podocyte foot processes. Therefore, we describe a novel pathomechanism of proteinuria development