Representation of Racial and Ethnic Minority Populations in Dementia Prevention Trials: A Systematic Review

Despite older racial and ethnic minorities (REMs) being more likely to develop dementia they are underrepresented in clinical trials focused on neurological disorders. Inclusion of REMs in dementia prevention studies is vital to reducing the impact of disparities in dementia risk. We conducted a systematic review to characterize the number of REM enrolled in brain health and prevention randomized controlled trials (RCTs). RTCs published from January 1, 2004 to April 21, 2020 were included. Participants were normal cognitive adults aged 45 years and older who participated in a Phase II or Phase III U.S. based preventative trial. Analyses were performed to examine differences in trial characteristics between RCTs that did and those that did not report race/ethnicity and to calculate the pooled proportion of each racial/ethnic group in randomized brain healthy prevention trials. A total of 42 studies consisting of 100,748 participants were included in the final analyses. A total of 26 (62%) reported some racial/ethnic identity data. The pooled proportion of REM participants was 0.256 (95% CI, 0.191, 0.326). There is a lack of racial/ethnic reporting of participants and REMs remain underrepresented in brain health prevention RCTs.

A WC/WO star exploding within an expanding carbon-oxygen-neon nebula

The final fate of massive stars, and the nature of the compact remnants they leave behind (black holes and neutron stars), are open questions in astrophysics. Many massive stars are stripped of their outer hydrogen envelopes as they evolve. Such Wolf-Rayet stars¹ emit strong and rapidly expanding winds with speeds greater than 1,000 kilometres per second. A fraction of this population is also helium-depleted, with spectra dominated by highly ionized emission lines of carbon and oxygen (types WC/WO). Evidence indicates that the most commonly observed supernova explosions that lack hydrogen and helium (types Ib/Ic) cannot result from massive WC/WO stars^2,3, leading some to suggest that most such stars collapse directly into black holes without a visible supernova explosion⁴. Here we report observations of SN 2019hgp, beginning about a day after the explosion. Its short rise time and rapid decline place it among an emerging population of rapidly evolving transients^5-8. Spectroscopy reveals a rich set of emission lines indicating that the explosion occurred within a nebula composed of carbon, oxygen and neon. Narrow absorption features show that this material is expanding at high velocities (greater than 1,500 kilometres per second), requiring a compact progenitor. Our observations are consistent with an explosion of a massive WC/WO star, and suggest that massive Wolf-Rayet stars may be the progenitors of some rapidly evolving transients.

Laparoscopic ovarian ligament plication in pregnancy

This 32-year old patient presented at seven weeks gestation with severe left-sided lower abdominal pain. This was against the background of a previous history of left salpingectomy from a ruptured ectopic gestation seven years previously. Transvaginal sonographic evaluation revealed a viable seven week intrauterine embryo, a 2 cm left corpus luteum cyst and Doppler studies revealed reduced internal flow. This led the way for a conservative approach via laparoscopy of untwisting the pedicle to restore blood flow In this case, the ovarian ligament was shorted using 1/0 vicryl and the pregnancy went to term.

Crossed-gratings volume hologram: backward reflection with high angular and spectral selectivity

A new type of reflective hologram with both high angular and spectral selectivity is suggested. With novel design of crossed gratings inside the volume hologram, unusual angular selectivity is achieved via coupling of four waves. Analytic solution with spectral and angular detuning from Bragg regime is derived. The compensation between these two detuning forms an interesting figure of saddle shape.

Exercise-induced neurocardiogenic syncope: clinical data, pathophysiological aspects, and potential role of tilt table testing

The evaluation of syncope occurring during exercise or occurring spontaneously in highly trained individuals presents a unique diagnostic challenge. It is of critical importance to exclude potential life-threatening disorders such as hypertrophic cardiomyopathy, long QT syndrome, right ventricular dysplasia, anomalous coronary artery distribution, valvular heart disease, myocarditis, or exercise-induced arrhythmia. This review is not directed towards identifying, treating, or determining athletic eligibility of individuals with such disorders. Rather, we endeavour to discuss the pathophysiology of exercise-induced neurocardiogenic syncope and to address the role of head upright tilt testing in evaluating syncope in athletic individuals in whom proper evaluation has excluded the presence of ischaemic heart disease or primary structural or electrical heart disease.

Nortriptyline and cognitive-behavioral therapy in the treatment of cigarette smoking

BACKGROUND

A history of major depressive disorder (MDD) predicts failure to quit smoking. We determined the effect of nortriptyline hydrochloride and cognitive-behavioral therapy on smoking treatment outcome in smokers with a history of MDD. The study also addressed the effects of diagnosis and treatment condition on dysphoria after quitting smoking and the effects of dysphoria on abstinence.

METHODS

This was a 2 (nortriptyline vs placebo) x 2 (cognitive-behavioral therapy vs control) x 2 (history of MDD vs no history) randomized trial. The participants were 199 cigarette smokers. The outcome measures were biologically verified abstinence from cigarettes at weeks 12, 24, 38, and 64. Mood, withdrawal, and depression were measured at 3, 5, and 8 days after the smoking quit date.

RESULTS

Nortriptyline produced higher abstinence rates than placebo, independent of depression history. Cognitive-behavioral therapy was more effective for participants with a history of depression. Nortriptyline alleviated a negative affect occurring after smoking cessation. Increases in the level of negative affect from baseline to 3 days after the smoking quit date predicted abstinence at later assessments for MDD history-negative smokers. There was also a sex-by-depression history interaction; MDD history-positive women were less likely to be abstinent than MDD history-negative women, but depression history did not predict abstinence for men.

CONCLUSIONS

Nortriptyline is a promising adjunct for smoking cessation. Smokers with a history of depression are aided by more intensive psychosocial treatments. Mood and diagnosis interact to predict relapse. Increases in negative affect after quitting smoking are attenuated by nortriptyline.

Antiglucocorticoid treatments in psychiatry

A confluence of evidence indicates that alterations in hypothalamic-pituitary-adrenal regulation can have profound effects on the symptom picture of psychiatric illnesses and that therapeutic interventions directly targeted at corticosteroid metabolism may have clinical benefit. This paper reviews the varying lines of inference that support such a hypothesis and reviews work by our group and others utilizing the cortisol synthesis inhibitor, ketoconazole and, more recently, dehydroepiandrosterone (DHEA), as potential novel mood-altering agents. The data thus far suggest that antiglucocorticoid drug treatment may be useful in certain subgroups of depressed patients and may offer a theoretical rationale for alternative drug design.

The need for health care reform in Nebraska

This paper has identified some of the major health care problems in Nebraska. Although Nebraska does not face as many serious challenges as some other states, there is clearly a need for reform. For example, the health of our population is generally good, but many serious gaps exist, particularly for minority population groups. Per capita health care costs in Nebraska are only slightly below the national average, and out-of pocket costs for the average Nebraska family rank among the highest in the nation. In addition, Medicaid costs are exploding and create serious challenges to balancing the state's budget. Nearly 140,000 Nebraskans lack health insurance coverage and at least 90,000 others are underinsured. Many insurance policies limit or deny coverage to individuals with pre-existing medical conditions, deny coverage to individuals employed in certain occupations, and limit coverage for preventive services. "Cost shifting" continues to become more widespread, which significantly increases the number of small businesses that drop or reduce health insurance coverage for their employees. Finally, rural areas face some unique challenges related to their ability and capacity to provide services. There is a serious shortage of primary care physicians, mid-level practitioners, and many other allied health professionals. As a result, individuals, including a large elderly population, must travel long distances to obtain care. Many rural hospitals are under severe financial stress and some will close during the next five years. There appears to be an adequate supply of nursing home beds in rural areas, but many communities lack adequate in-home services.

An introduction to research: a primer for the nurse anesthetist

The goals of this article are to provide an overview of the research process and highlight some of the most important aspects. In the process, the definition of research and some general terminology will be reviewed. Discussions of how to define a problem, reviewing the literature, types of study designs, sampling, types of measurement, reliability and validity, limitations and assumptions, data analysis, ethical concerns with human subjects, and time management are included, as are examples of published research.

The perioral muscular phenomenon: Part II

Over twenty-five years of studying the perioral musculature, clinical observation of the dental and peridental tissues of hundreds of patients, and examining seven anatomy books--have revealed that there is a serious deficiency in our knowledge of this musculature and its effects on the dental tissues and this part of the face. Believed to be of no unusual significance, it has been almost ignored through the years. One hears vague terms such as lip pressure and cheek pressure; but no comprehensive studies of this musculature, how it functions and the effects of these functions are to be found in literature. By its actions, this musculature effects many phases of dentistry, directly or indirectly; and orthodontics is affected most of all. By its manipulations of the dental tissues, the alveolar bone and gingiva, it ultimately determines the position of the teeth. Almost every person exhibits pressure signs or damage to the tissues. The only exceptions are babies. By reading these signs, the strength and physical configuration of the pertinent parts of the musculature can be determined. This ability to 'read the signs' should be developed since it helps fine tune the diagnostic process. Only by this means may the correct surgical procedures be carried out. A representative sample from over 1200 cases treated in this manner in more than twenty years will be shown.

The perioral muscular phenomenon: Part I

More than twenty-five years of studying the perioral musculature, clinical observation of the dental and peridental tissues of hundreds of patients, and examining seven anatomy books--have revealed that there is a serious deficiency in our knowledge of this musculature and its effects on the dental tissues and this part of the face. Believed to be of no unusual significance, it has been almost ignored through the years. One hears vague terms such as lip pressure and cheek pressure; but no comprehensive studies of this musculature, how it functions and the effects of these functions are to be found in literature. By its actions, this musculature effects many phases of dentistry, directly or indirectly; and orthodontics is affected most of all. By its manipulations of the dental tissues, the alveolar bone and gingiva, it ultimately determines the position of the teeth. Almost every person is a live laboratory specimen in which pressure signs or damage to the tissues can be observed. By reading these signs, the strength and physical configuration of the pertinent parts of the musculature can be determined. This ability to 'read the signs' should be actively developed to fine tune the diagnosis. The perioral musculature phenomenon is a significant aetiological factor in many malocclusions.

A controlled trial of ivermectin and diethylcarbamazine in lymphatic filariasis

Ivermectin is a new antifilarial drug that can be given in a single oral dose. To compare the efficacy and side effects of ivermectin with those of diethylcarbamazine, the standard antifilarial treatment, we conducted a randomized, double-blind trial in 40 South Indian men with lymphatic filariasis caused by Wuchereria bancrofti. Patients were randomly assigned to one of three treatments: a single low dose of ivermectin (mean [+/- SE], 21.3 +/- 0.7 micrograms per kilogram of body weight; n = 13) followed by placebo for 12 days; a single high dose of ivermectin (mean, 126.2 +/- 3.7 micrograms per kilogram; n = 13) followed by placebo for 12 days; or diethylcarbamazine for 13 days (6 mg per kilogram per day for 12 days preceded by 3 mg per kilogram for 1 day; n = 14). Eleven patients were initially assigned to receive placebo and after five days were reassigned to one of the three treatment groups. At day 12 there was complete clearance of microfilariae from the blood in all 26 men who took ivermectin and in 11 of the 14 men who took diethylcarbamazine. At six months the numbers of detectable microfilariae (as a percentage of the pretreatment values) were 18.3 percent after low-dose ivermectin and 19.5 percent after high-dose ivermectin, as compared with 6.0 percent after diethylcarbamazine (P less than 0.05). The side effects were confined to the first five days and were similar in the three treatment groups. We conclude that in lymphatic filariasis, the clinical response to a single dose of ivermectin compares favorably with that after the standard 12-day course of diethylcarbamazine. Given the practical advantages of single-dose administration, ivermectin should become a useful medication for the control of bancroftian filariasis.