Notes

Mental Well being being a Mediator in the Organization Among Informative Inequality and Cardiovascular Disease: A new Mendelian Randomization Review.
Stroke and COVID-19 are both traumatic and life-altering experiences that are marked by uncertainty, fear, and medical intervention. The devastation that stroke and COVID-19 oppress on an individual and a population is well established, and these traumas are potently magnified in the troughs of the COVID-19 pandemic. Furthermore, stroke has been shown to be a potential complication of COVID-19 infection, and while there is global controversy regarding this finding, it is undeniable that there are patients across the world presenting with both conditions concurrently. Thus, the topic of isolated stroke and the co-occurrence of stroke and COVID-19 amidst the pandemic both warrant considerable investigation on both a basic science level and a humanistic level. This opinion article advocates for a narrative medicine approach to better explicate the intertwining of stroke and COVID-19. Interviewing patients who presented with both stroke and COVID-19 as well as patients who present with stroke during the pandemic will provide the opportunity to gather and juxtapose individual illness experiences, including encounters with the health care system, relationship with care teams and care takers, recovery, and insights into the future. Creating, analyzing, and comparing such an anthology of illness narratives of the 2 patient populations will offer a unique understanding into the experience of different, yet over-lapping, medical traumas in an unprecedented time. With this deeper appreciation of patient accounts, the health care system can better recognize how to provide for future patients who present specifically with stroke or stroke and COVID-19. However, more broadly, this study can also afford insight into how the health care system can better provide for and support patients who present with complex diagnoses in the context of a complex healthcare system, which most probably will operate under the effects of the pandemic for time to come as well as other, future complicating factors.The present study was designed to investigate the rostral-caudal effect of spinal magnetic stimulation on diaphragmatic motor-evoked potentials after cervical spinal cord injury. The diaphragm electromyogram was recorded in rats that received a laminectomy or a left midcervical contusion at the acute (1 day), subchronic (2 weeks), or chronic (8 weeks) injury stages. The center of a figure-eight coil was placed at 30 mm lateral to bregma on the left side, and the effect of magnetic stimulation was evaluated by stimulating the rostral, middle, and caudal cervical regions in spontaneously breathing rats. The results demonstrated that cervical magnetic stimulation induced intensity-dependent motor-evoked potentials in the bilateral diaphragm in both uninjured and contused rats; however, the left diaphragm exhibited a higher amplitude and earlier onset than the right diaphragm. Moreover, the intensity-response curve was shifted upward in the rostral-to-caudal direction of magnetic stimulation, suggesting that caudal cervical magnetic stimulation produced more robust diaphragmatic motor-evoked potentials compared with rostral cervical magnetic stimulation. Interestingly, the diaphragmatic motor-evoked potentials were similar between uninjured and contused rats during cervical magnetic stimulation despite weaker inspiratory diaphragmatic activity in contused rats. In addition, in contused animals but not uninjured animals, diaphragmatic motor-evoked potential amplitudes were greater at the chronic stage than during earlier injury stages. These results demonstrated that cervical magnetic stimulation can excite the residual phrenic motor circuit to activate the diaphragm in the presence of a significant lesion in the cervical spinal cord. These findings indicate that this non-invasive approach is effective for modulating diaphragmatic excitability after cervical spinal cord injury.Objective To analyze operating room (OR) efficiency by evaluating fixed OR times for three common urologic robotic-assisted procedures. Methods Over a 24-month period, we prospectively collected intraoperative data for 635-consecutive robotic-assisted surgeries. Fixed (nonprocedural) OR times were evaluated for robotic-assisted partial nephrectomy (RAPN) (n=146), robotic-assisted radical cystectomy (RARC) (n=77), and robotic-assisted radical prostatectomy (RARP) (n=412). Fixed OR times were defined as nonprocedural time in the OR, including in room time to anesthesia release time (IRAT), anesthesia release to cut time (ARCT), in room time to cut time (IRCT; IRAT + ARCT), and close time to wheels out time (CTWO). The effects of surgery time of day and the number of anesthesia personnel (AP) present in surgery on fixed OR times were also analyzed. Results Fixed OR times occupied 15.1% (IQR 12.9%-17.1%) (RARC), 26.6% (22.9%-30.8%) (RAPN), and 20.1% (17.4%-23.1%) (RARP) of total OR time. Time of day did not have a negative effect on fixed OR times for robotic urologic surgeries. Median AP count was highest for RARC (median 3, range 1-7). We did not find any association between AP count and fixed OR times for any of the procedures (P≥0.19). Conclusions Fixed OR times made up a significant percentage of total OR time for robotic-assisted procedures and should be incorporated into OR efficiency analyses. The number of AP per case and time of day of surgery did not negatively impact fixed OR times in urologic robotic surgeries.Commonsense epidemiology-how lay people think about diseases and their causes and consequences-can influence how people respond. We examined three lay epidemiological beliefs about 20 triggers and 19 symptoms among 349 caregivers of children with asthma. Our findings contradicted the prevalence-seriousness hypothesis (perceived prevalence and seriousness correlate negatively). The data partially supported the prevalence-control hypothesis (perceived prevalence and asthma control correlate negatively). We found weak support for the seriousness-control hypothesis (perceived seriousness and asthma control correlate negatively). These findings suggest boundary conditions on the application of commonsense epidemiological beliefs.
This study evaluated a modified working memory training program, Cogmed, for ADHD youth.

Forty youth were randomized to modified Cogmed training (MCT) or treatment as usual (CON). MCT was delivered in an outpatient mental health clinic in 3 weekly 35-minute sessions with a dedicated coach for 10 weeks. Participants completed assessments at baseline, after the intervention, and again 3 months later.

After controlling for baseline, groups were comparable on working memory, academics, and ADHD symptoms. The MCT group was rated by parents and teachers as having fewer executive function challenges and youth endorsed better self-concept compared with the CON group.

MCT was associated with some improvement, which could not be attributed to increased working memory capacity and may reflect other facets of the program. Results question the usefulness of Cogmed but highlight considerations for optimizing adherence, engagement, and the therapeutic alliance in interventions for ADHD youth.
MCT was associated with some improvement, which could not be attributed to increased working memory capacity and may reflect other facets of the program. Results question the usefulness of Cogmed but highlight considerations for optimizing adherence, engagement, and the therapeutic alliance in interventions for ADHD youth.
The systematic review sought to understand the relationship between maternal depression and later ADHD in children.

Three databases were used to identify the studies (Medline, Web of Science and PsychInfo) resulting in 1,223 studies being screened and 14 articles being included in the review.

The majority of studies (
= 11) reported a significant relationship between maternal depression (across both prenatal and postnatal periods) and ADHD symptoms in children. This relationship remained significant when temperament, or past ADHD symptoms were controlled for. EUK 134 in vitro Several methodological issues were identified including; overreliance on maternal report and parental ADHD not being accounted for in most studies.

The review adds to the literature regarding the temporal relationship between maternal depression and the development of ADHD in children, and thus supports the case for improving access to mental health services for mothers as a preventative strategy in the development of child psychopathology.
The review adds to the literature regarding the temporal relationship between maternal depression and the development of ADHD in children, and thus supports the case for improving access to mental health services for mothers as a preventative strategy in the development of child psychopathology.
Good governance of integrated care is key to better health care, but we know little about how professions can help make this happen. Our aim is to introduce a conceptual framework to analyse how professions contribute to the governance of integrated care, and to apply the framework to a secondary analysis of selected case studies from Denmark.

We developed a framework, which identified the
,
and
of the contribution professions make to the governance of integrated care. We included five qualitative Danish studies, using coordination as an indicator of integrated care. We adopted a thematic approach in our analysis, combining deductive and inductive elements.

Health professions engage in highly diverse activities, which fall into closely connected clusters of more formal or more informal coordination. Professions apply many different adaptive mechanisms at different levels to fit coordination into local contexts. Professions are driven by interlocking rationales, where a common focus on patients connects organizational and professional concerns.

Our analytical framework emerges as a useful tool for analysis. The contribution of professions to the governance of integrated care needs greater attention in health policy implementation as it can promote more effective governance of integrated care.
Our analytical framework emerges as a useful tool for analysis. The contribution of professions to the governance of integrated care needs greater attention in health policy implementation as it can promote more effective governance of integrated care.
Children with ADHD often show a positive illusory bias (PIB), reporting an extremely positive idea of their own competence, despite their difficulties. The mechanisms underlying this phenomenon are still poorly understood. In the present study, we examined social PIB and investigated the role of executive functions (EFs) and pragmatic language (PL).

Forty-one children with ADHD and 42 typically-developing children matched on age, IQ, and receptive language were administered measures of social competence, EFs and PL. The parents were also asked to estimate their child's social competence.

There was evidence of social difficulties and PIB in children with ADHD. Only PL, not EFs, seemed to mediate the association between ADHD and PIB.

Our findings suggest that PL abilities should be considered in efforts to improve self-perception in children with ADHD.
Our findings suggest that PL abilities should be considered in efforts to improve self-perception in children with ADHD.
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