Morphometric analysis of variation in the ribs with age and sex

Rib cage morphology changes with age and sex are expected to affect thoracic injury mechanisms and tolerance, particularly for vulnerable populations such as pediatrics and the elderly. The size and shape variation of the external geometry of the ribs was characterized for males and females aged 0–100 years. Computed tomography (CT) scans from 339 subjects were analyzed to collect between 2700 and 10 400 homologous landmarks from each rib. Rib landmarks were analyzed using the geometric morphometric technique known as Procrustes superimposition. Age‐ and sex‐specific functions of 3D rib morphology were produced representing the combined size and shape variation and the isolated shape variation. Statistically significant changes in the size and shape variation (P < 0.0001) and shape variation (P < 0.0053) of all 24 ribs were found to occur with age in males and females. Rib geometry, location, and orientation varied according to the rib level. From birth through adolescence, the rib cage experienced an increase in size, a decrease in thoracic kyphosis, and inferior rotation of the ribs relative to the spine within the sagittal plane. From young adulthood into elderly age, the rib cage experienced increased thoracic kyphosis and superior rotation of the ribs relative to the spine within the sagittal plane. The increased roundedness of the rib cage and horizontal angling of the ribs relative to the spine with age influences the biomechanical response of the thorax. With the plane of the rib oriented more horizontally, loading applied in the anterior‐posterior direction will result in increased deformation within the plane of the rib and an increased risk for rib fractures. Thus, morphological changes may be a contributing factor to the increased incidence of rib fractures in the elderly. The morphological functions derived in this study capture substantially more information on thoracic skeleton morphology variation with age and sex than is currently available in the literature. The developed models of rib cage anatomy can be used to study age and sex variations in thoracic injury patterns due to motor vehicle crashes or falls, and clinically relevant changes due to chronic obstructive pulmonary disease or other diseases evidenced by structural and anatomic changes to the chest.     

Comprehensive Profiling of an Aging Immune System Reveals Clonal GZMK+ CD8+ T Cells as Conserved Hallmark of Inflammaging

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Adult attachment and birth experience: importance of a secure base and safe haven during childbirth

Objective: Examine connections between mothers’ adult attachment and subjective birth experience in the context of parity and mode of delivery.

Background: Research has established a clear connection between adult attachment and birth experience. This study extended previous research with an in-depth self-report attachment measure examining different dimensions of mothers’ attachment representations and their relation to subjective birth experience. Interactions between mode of delivery and parity were also considered. Method: Participants were 257 mothers who gave birth 4 days to 12 months prior to the study. Mothers’ mean age was 30.5 years, 61% primiparas, and 26% delivered by caesarean. Participants completed an online survey with the Birth Experience Questionnaire, the Reciprocal Attachment Questionnaire, and demographic information.

Results: Hierarchical moderated regression analyses showed direct effects from adult attachment dimensions to mothers’ subjective birth experiences, specifically perceived availability, feared loss, separation protest, angry withdrawal, and compulsive careseeking. Interactions emerged for parity and/or mode of delivery for overall subjective birth experience, perceived control, perceived social support, and satisfaction.

Conclusion: Adult attachment representations related to subjective birth experience, indicating that attachment figures serve as secure bases and safe havens for mothers during childbirth. These results have implications for practitioners and provide direction for future research.     

The influence of a diet based on flaxseed,an omega-3 source,during different developmental periods,on the blood pressure of rats submitted to stress

Objective: This study aimed to investigate a flaxseed diet during different developmental periods, and its effect on the blood pressure of rats submitted to stress.

Methods: Fifty-six male rats (F₁), born from 14 rats (F₀), were divided into seven groups (n?=?8): flaxseed group (FG); flaxseed group gestation and lactation (FG-GL); flaxseed group weaning (FG-W); flaxseed group weaning and stress (FG-WS); flaxseed group stress (FG-S); flaxseed group gestation lactation and weaning (FG-GLW), and control Group (CG). Stress protocol was undertaken for 1 month. Blood pressure was analysed before and after the stress protocol. The left adrenal glands and serum corticosterone levels were analysed.

Results: Systolic blood pressure before stress was lower in all groups with flaxseed diet compared with the CG (p?=?.00001). After stress, CG showed higher blood pressure compared with FG, FG-GL, and FG-GLW (p?=?.004). The levels of corticosterone were lower in the FG between all groups (p?p?Conclusions: Results suggest a possible factor from a flaxseed diet against the effects of stress on a blood pressure in all periods of life but especially in the gestation and lactation periods.     

The Role of Noninvasive Endpoints in Predicting Long-Term Outcomes in Pulmonary Arterial Hypertension

Background

Until recently, many clinical trials in patients with pulmonary arterial hypertension (PAH) evaluated exercise capacity with 6-minute walk distance (6MWD) as the primary endpoint. Common secondary endpoints include PAH functional class (FC), which assesses symptoms, and either brain natriuretic peptide (BNP) or the inactive N-terminal cleavage product of its prohormone (NT-proBNP), which assesses cardiac function.

Objective

Examine the relationships among 6MWD, FC, and BNP/NT-proBNP measured at baseline or follow-up with long-term outcomes in PAH studies.

Methods

Relevant literature from January 1990 to April 2018 were obtained by searching PubMed, Embase, and Cochrane. Articles in English reporting on associations between 6MWD, FC, or BNP/NT-proBNP and outcomes in PAH were identified. Each endpoint was evaluated individually. Prespecified inclusion and exclusion criteria were applied at level 1 (titles/abstracts) and level 2 (full-text review).

Results

The database search yielded 836 unique records; 65 full-text articles were reviewed. Twenty-five studies were eligible for inclusion. Findings supported the importance of measuring PAH noninvasive endpoints in predicting long-term outcomes. Patients with shorter or decreased 6MWD, poor (III/IV) or declining FC (e.g., from II to III), or elevated or increasing BNP/NT-proBNP had a higher risk of death and costly events (e.g., hospitalization, lung transplant). FC also predicted health care resource utilization and costs. Collectively, these endpoints establish risk groups that predict likelihood of complications from PAH or death.

Conclusion

Assessment of 6MWD, FC, and BNP/NT-proBNP provides low-cost, efficient, and noninvasive means of predicting long-term health and economic outcomes in patients with PAH.

     

Critical Race Theory as a Lens for Examining Primary Care Provider Responses to Persistently-Elevated HbA1c

IntroductionClinical inertia remains a persistent problem in the treatment of diabetes in clinical care. Primary care provider behavior is thought to be a significant contributor to diabetes clinical inertia. This study used the lens of Critical Race Theory to examine whether provider's diabetes management activities differ by patient race and frame implications for future research.MethodsChart abstractors retrospectively reviewed a random sample of charts from primary care patients with persistently-elevated HbA1c to assess providers' diabetes management activities in the subsequent year. Provider activities aligned with the American Diabetes Association's standards of medical care and included HbA1c test ordering, documentation of patient medication adherence, counseling on lifestyle modification, lifestyle modification referral, endocrinologist participation in care, and medication titration. Differences in provider actions by patient race (Black, white, or other) were examined using chi-square tests.ResultsA total of 188 patient charts were reviewed. For all provider actions, there were statistically-significant differences by patient race. Black patients were least likely to be counseled on dietary changes (72.0%) or physical activity (57.7%) by their primary care provider, but most likely to be referred to an outside specialist for this counseling (46.2%). Black patients were also least likely to have medication adjustments made (72%).DiscussionStudy findings showed an association between provider diabetes management behaviors and patient race, Future studies showed explore providers' racial beliefs, attitudes and clinical decision-making, and patients’ experiences with historical exclusion from medical care and racism in healthcare encounters In addition, more research is needed to explore the role of structural racism in clinical inertia.     

Hand,foot, and mouth disease photolocalized to sunburn

Hand, foot, and mouth disease is a common exanthem linked to infection with several non‐polio enteroviruses. This case of an 11‐year‐old boy with an enteroviral infection limited to areas of sunburn is an atypical presentation of hand, foot, and mouth disease. Recognition of this unusual distribution will allow pediatricians and pediatric dermatologists to appropriately manage and counsel patients and parents.     

Differentiating between trust and dependence of patients with coronary heart disease: furthering the sociology of trust

Sociological health research on the concept of trust has been bedevilled by its multivocalities. This article extends Luhmann's attempts to clarify a sociology of trust. Luhmann argued a semantic distinction between trust and confidence. In this article, we use empirical data on patient ‘trust’ in doctors to argue that there is also a semantic distinction between trust and dependence. We conducted 37 semi-structured interviews with patients with coronary heart disease in Adelaide, Australia in 2008 and 2009. Our findings indicate that risk, familiarity and time were critical to understand the distinction between trust and dependence. We argue that patients in situations of emergency (heightened risk) ‘depended’ on, rather than trusted, doctors, given the patients lack of familiarity with their doctors. Time was a mediating factor, as the more ‘urgent’ the situation, the more likely it was that dependence came into play, since the situation was ‘unfamiliar’. Rather than juxtaposing trust and dependence, in this article we show how dependence may coexist with trust in the health care system in times of emergency.