Cause For Caution Research Articles

Age-specific in the relationship between diastolic blood pressure and the risk of cardiovascular disease: A cohort study of the UK Biobank.

To investigate the effect of optimal diastolic blood pressure (DBP) level on cardiovascular disease (CVD) events, considering different age groups. And the nonlinear relationship between DBP and CVD events by age were evaluated. 358,734 participants of the UK biobank were included. Multivariable Cox regressions were performed to evaluate the relation between DBP and cardiovascular risk, and the natural cubic spline was applied to estimate the nonlinear relationship between the DBP measures and the hazard. In the UK Biobank, a total of 358,734 participants (mean [SD] age, 55.3 [8.1] years; 205,215 [57.2 %] female) were included in this analysis. The rate of CVD cases was 6.05 per 1000 person-years. For each SD increase, DBP was associated with elevated CVD events for both <50 year (HR, 1.19; 95 % CI, 1.12 to 1.26) and 50-59 year-old group (HR, 1.04; 95 % CI, 1.01 to 1.08). However, for every SD increment, a marginal protective effect against CVD events was observed between DBP and the CVD events in elder people (≥60 years old) and lower DBP (<70 mm Hg) may confer an increased CVD risks (HR, 1.10; 95 % CI, 1.03 to 1.17). For adults younger than 60 years old, the study seems to support the ACC/AHA blood pressure guidelines lowering the DBP threshold to 80 mm Hg. Conversely, it may be reasonable to rule out large effects of high DBP on CVD events and DBP <70 mm Hg may be cause for caution in older people aged 60-69.

Single-cell sequencing shows mosaic aneuploidy in most human embryos.

Mammalian preimplantation embryos often contain chromosomal defects that arose in the first divisions after fertilization and affect a subpopulation of cells - an event known as mosaic aneuploidy. In this issue of the JCI, Chavli et al. report single-cell genomic sequencing data for rigorous evaluation of the incidence and degree of mosaic aneuploidy in healthy human in vitro fertilization (IVF) embryos. Remarkably, mosaic aneuploidy occurred in at least 80% of human blastocyst-stage embryos, with often less than 20% of cells showing defects. These findings confirm that mosaic aneuploidy is prevalent in human embryos, indicating that the process is a widespread event that rarely has clinical consequences. There are major implications for preimplantation genetic testing of aneuploidy (PGT-A), a test commonly used to screen and select IVF embryos for transfer. The application and benefit of this technology is controversial, and the findings provide more cause for caution on its use.

Energy policy as a driver of energy poverty? Perhaps not

This short communication critiques the paper of Primc & Slabe-Erker published in this journal in 2020. The reasons for this critique fall into two categories: engagement with the energy poverty literature and application of QCA according to best practices. The argumentation is supported by discussion of the EP literature and QCA methodology as well as reproduction of the study in question. Based on an evidenced critique, the paper argues that there is cause for caution regarding the claims the authors have made and need for additional research in this vein.

Therapeutic doses of acetaminophen with co-administration of cysteine and mannitol during early development result in long term behavioral changes in laboratory rats.

Based on several lines of evidence, numerous investigators have suggested that acetaminophen exposure during early development can induce neurological disorders. We had previously postulated that acetaminophen exposure early in life, if combined with antioxidants that prevent accumulation of NAPQI, the toxic metabolite of acetaminophen, might be innocuous. In this study, we administered acetaminophen at or below the currently recommended therapeutic dose to male laboratory rat pups aged 4–10 days. The antioxidants cysteine and mannitol were included to prevent accumulation of NAPQI. In addition, animals were exposed to a cassette of common stress factors: an inflammatory diet, psychological stress, antibiotics, and mock infections using killed bacteria. At age 37–49 days, observation during introduction to a novel conspecific revealed increased rearing behavior, an asocial activity, in animals treated with acetaminophen plus antioxidants, regardless of their exposure to oxidative stress factors (2-way ANOVA; P < 0.0001). This observation would suggest that the initial hypothesis is incorrect, and that oxidative stress mediators do not entirely eliminate the effects of acetaminophen on neurodevelopment. This study provides additional cause for caution when considering the use of acetaminophen in the pediatric population, and provides evidence that the effects of acetaminophen on neurodevelopment need to be considered both in the presence and in the absence of oxidative stress.

Questioning the Effort Hypothesis That Depressed Patients Perform Disproportionately Worse on Effortful Cognitive Tasks.

The debate over Hasher and Zacks’ effort hypothesis—that performance on effortful tasks by patients with depression will be disproportionately worse than their performance on automatic tasks—shows a need for additional research to settle whether or not this notion is “clinical lore.” In this study, we categorized 285 outpatient recipients of neuropsychological evaluations into three groups—No Depression, Mild-to-Moderate Depression, and Severe Depression—based on their Beck Depression Inventory-2 self-reports. We then compared these groups’ performances on both “automatic” and “effortful” versions of the Ruff 2 &amp; 7 Selective Attention Test Total Speed and Total Accuracy Indices, the Digit Span subtest from the Wechsler Adult Intellectual Scale—Fourth Edition, and Trail Making Test Parts A and B, using a two-way (3 × 2) mixed multivariate analysis of variance. Patients with Mild-to-Moderate Depression or Severe Depression performed disproportionately worse than patients with No Depression in our sample on more effortful versions of only one of the four attention or executive functioning measures (Trail Making Test). Thus, these data failed to fully support a hypothesis of disproportionately worse performance on more effortful tasks. While this study failed to negate the effort hypothesis in some specific instances, particularly for use in the Trail Making Test, there is cause for caution in routinely applying the effort hypothesis when interpreting test findings in most clinical settings and for most measures.

Discrete processes and their continuous limits

The possibility that a discrete process can be fruitfully approximated by a continuous one, with the latter involving a differential system, is fascinating. Important theoretical insights, as well as significant computational efficiency gains may lie in store. A great success story in this regard are the Navier-Stokes equations, which model many phenomena in fluid flow rather well. Recent years saw many attempts to formulate more such continuous limits, and thus harvest theoretical and practical advantages, in diverse areas including mathematical biology, image processing, game theory, computational optimization, and machine learning. Caution must be applied as well, however. In fact, it is often the case that the given discrete process is richer in possibilities than its continuous differential system limit, and that a further study of the discrete process is practically rewarding. Furthermore, there are situations where the continuous limit process may provide important qualitative, but not quantitative, information about the actual discrete process. This paper considers several case studies of such continuous limits and demonstrates success as well as cause for caution. Consequences are discussed.

The Divergence and Convergence of Critical Reflection and Critical Reflexivity: Implications for Health Professions Education.

As a field, health professions education (HPE) has begun to answer calls to draw on social sciences and humanities (SS&H) knowledge and approaches for curricular content, design, and pedagogy. Two commonly used SS&H concepts in HPE are critical reflection and critical reflexivity. But these are often conflated, misunderstood, and misapplied. Improved clarity of these concepts may positively affect both the education and practice of health professionals. Thus, the authors seek to clarify the origins of each, identify the similarities and differences between them, and delineate the types of teaching and assessment methods that fit with critical reflection and/or critical reflexivity. Common to both concepts is an ultimate goal of social improvement. Key differences include the material emphasis of critical reflection and the discursive emphasis of critical reflexivity. These similarities and differences result in some different and some similar teaching and assessment approaches, which are highlighted through examples. The authors stress that all scientific and social scientific concepts and methods imported into HPE must be subject to continued scrutiny both from within their originating disciplines and in HPE. This continued questioning is core to the ongoing development of the HPE field and also to health professionals' thinking and practice.

The Self-Contaminating Nature of Repeated Reports of Negative Emotions

Three experiments examined effects of measuring self-reported emotional intensity on subsequent self-reported emotional intensity. Across 3 experiments, we induced sadness, envy, and happiness and manipulated the number of emotional intensity measurements. In all experiments, repeated measurement led to weaker intensity of negative emotions than did a single measurement. Although the intensity of happiness was unaffected by repeated measurement, data suggest that measurements interfered with ongoing emotional experience. We suggest that our findings have methodological, conceptual, and practical implications, but perhaps foremost is the warning that social scientists may have greater cause for caution regarding repeated self-report measures than previously thought.

TCR deep sequencing of transgenic RAG-1-deficient mice reveals endogenous TCR recombination: a cause for caution.

The utility of T-cell receptor (TCR) transgenic mice in medical research has been considerable, with applications ranging from basic biology all the way to translational and clinical investigations. Crossing of TCR transgenic mice with either recombination-activating gene (RAG)-1 or RAG-2 knockouts is frequently used to generate mice with a monoclonal T-cell repertoire. However, low level productive TCR rearrangement has been reported in RAG-deficient mice expressing transgenic TCRs. Using deep sequencing, we set out to directly examine and quantify the presence of these endogenous TCRs. Our demonstration that functional nontransgenic TCRs are present in nonmanipulated mice has wide reaching ramifications worthy of critical consideration.

Mindfulness‐based interventions for improving cognition, academic achievement, behavior, and socioemotional functioning of primary and secondary school students

Mindfulness‐based interventions for improving cognition, academic achievement, behavior, and socioemotional functioning of primary and secondary school students

Long-term follow-up of a randomized trial of family foundations: effects on children's emotional, behavioral, and school adjustment.

This study examines long-term effects of a transition to parenthood program, Family Foundations, designed to enhance child outcomes through a strategic focus on supporting the coparenting relationship. Roughly 5 to 7 years after baseline (pregnancy), parent and teacher reports of internalizing and externalizing problems and school adjustment were collected by mail for 98 children born to couples enrolled in the randomized trial. Teachers reported significantly lower levels of internalizing problems among children in the intervention group compared with children in the control group and, consistent with prior findings at age 3, lower levels of externalizing problems for boys in the intervention group. Baseline level of observed couple negative communication moderated intervention effects for parent and teacher report of child adjustment and teacher report of school adjustment and adaptation. Effect sizes ranged from 0.40 to 0.98. Results indicate that relatively brief preventive programs for couples at the transition to parenthood have the capacity to promote long-term positive benefits for children's adjustment. Although we attended to missing data issues in several ways, high levels of attrition in this long-term follow-up study is a cause for caution.

Unilateral Preoperative Chest Wall Irradiation in Bilateral Tissue Expander Breast Reconstruction with Acellular Dermal Matrix

Prior breast irradiation increases the rate of postoperative complications, including capsular contracture, in tissue expander/implant reconstruction. Acellular dermal matrix is heralded to decrease capsular contracture, but recent evidence suggests a possible increase in postoperative complications. The authors evaluated outcomes in patients undergoing bilateral tissue expander/implant reconstruction with acellular dermal matrix in the setting of prior unilateral irradiation. A case-control study was conducted on all patients undergoing bilateral, acellular dermal matrix-assisted, tissue expander/implant reconstruction with a history of previous unilateral irradiation at Memorial Sloan-Kettering Cancer Center. Complication rates were compared. Twenty-three patients met inclusion criteria and had an average follow-up of 19 months (range, 4 to 60 months). The perioperative infection rate was 21.7 percent (n = 5) in irradiated breasts and 4.3 percent (n = 1) in control breasts (p = 0.079). Mastectomy skin flap necrosis, explantation, hematoma, and seroma rates were not significantly different between the groups. Sixty percent of patients had irradiated breast contracture that was one Baker grade greater than that in the nonirradiated breast. Body mass index greater than 25 and smoking history were significant independent risk factors for early postoperative complications in univariate analysis (p = 0.01). Previous irradiation does not appear to increase the risk of early postoperative complications associated with acellular dermal matrix use in tissue expander/implant breast reconstruction. However, body mass index greater than 25 and smoking history are cause for caution. In addition, acellular dermal matrix does not appear to affect the degree of capsular contracture formation in the setting of prior irradiation. : Therapeutic, III.

African American Homeschooling and the Question of Curricular Cultural Relevance

Homeschooling, and academic interest in this phenomenon, have increased tremendously over the last decade. The surge of African American involvement in the homeschool movement has also become noticeable. However, there continues to be a general paucity of research on the motivations of African American parents that choose homeschooling. In order to capture the voice of African American homeschoolers, the authors conducted seventy-four interviews in the spring and summer of 2010 in several large U.S. metropolitan areas. The findings revealed that curricular considerations play a critical part, since many African American homeschoolers believe that a Eurocentric curriculum is bound to gravely interfere with their children's selfesteem and sense of purpose.Keywords: homeschooling, African American, Afrocentricity, Protectionists, CulturalistsAcademic interest in homeschooling has increased over the last decade, as what was once perceived as a marginal development, has, in fact, turned into a significant and growing phenomenon. It is estimated that over two million children are being homeschooled today in the United States, as opposed to 300,000 in 1990, thereby indicating a dramatic increase over a relatively short period of time (Gathier, 2007; Ray, 2010). In fact, homeschooling appears to be the most rapidly growing form of education in the United States. While White homeschooled students still represent about 75% of all homeschooled children, there has also been a noticeable surge in African American involvement in the homeschool movement. In 1999, it was estimated that nearly 10% of all homeschooled children were Black and those numbers appear to be consistently growing (Coleman, 2003; Fulbright, 2006; Ray, 2010). However, there continues to be a general paucity of research on the motivations of homeschooling Black parents, as the common and implicit assumption seems to be that African Americans' disengagement from the school system is dictated by reasons quite similar to those cited by European Americans (Gathier, 2007; Taylor, 2005). Nonetheless, the very unique experiences of African Americans in this society should be cause for caution. Throughout this article, Black, African, and African American will be used interchangeably for the same population as will White and European American.It is the purpose of this article is to* explore one of the main reasons why African Americans increasingly choose to educate their children at home, namely African American discontent with the common Eurocentric orientation of school curricula, at times assorted with a rejection of schooling altogether;* provide a historical and philosophical contextualization of African American discontent with Eurocentric education and;* present empirical evidence regarding African American motivations for homeschooling. Too often, previous research on African American homeschooling has presented it as simply an epiphenomenon of the failure of public education. While it may not be incorrect, such a view nonetheless fails to appreciate homeschooling as the latest phase of the African American struggle for adequate education.While previous studies (Fields-Smith & Williams, 2009; Llewellyn, 1996) have been limited by narrow geographical scopes, and small subject pools, this study sought to overcome these limitations by drawing from a larger number of households distributed over a wide geographical area.African American Quest for EducationAs pointed out by many scholars, there exists a long history of a sustained and heroic effort on the part of Africans in America to obtain education. Many enslaved Africans, in their quest for freedom, did not hesitate to risk severe punishment, and sometimes even their lives in order to learn to read and write (Lomotey, 2010). During and after the Civil War, more than one thousand Sabbath schools, for example, were established in the South by formerly enslaved Africans for the purpose of making literacy available to adults and children. …

Oil, Politics, and Ghana’s Democracy

Africa’s natural resource-rich countries tend to combine mismanagement of their “windfall” with poor record of democratic governance. However, for Ghana, which has recently become an oil producer, the prospect of escaping the “resource curse” is decent – largely on account of its current status as an electoral democracy. While the prevailing democratic political environment has contributed positively to the crafting of policy governing the new oil sector, and legislation and nascent institutions partially justify such optimism, severe deficiencies in contemporary Ghanaian politics, together with the new resource’s aggravation of the country’s patronage-fuelled democracy and acrimonious political competition, give cause for caution.

Just deliberation: Can communicative rationality support socially just environmental conservation in rural Africa?

This article evaluates the use of deliberative methods for filling the democratic deficit arising from the shift to management through partnerships in conservation in developing countries. We ask whether deliberative approaches are feasible in a rural African context and the extent to which they can form a basis for socially just environmental decision making. In answering these questions we focus on two main concerns: the possibility of achieving satisfactory representation and the possibility of constructing counter-factual spaces of deliberation in which identity-based bias is suspended in favour of reasoned argument. Our survey data suggests that participants are themselves satisfied that representation is fair, and that the consensus attained at the end of deliberative events is not the result of domination of more powerful interests. Nevertheless, our more qualitative observations of individuals involved in deliberative events provide stronger cause for caution. It is not possible to leave power and prejudice out of deliberative processes, though well managed spaces of deliberation can temporarily mitigate these and in doing so provide some empowerment to normally marginalised participants.

Clinical experience of entirely subcutaneous implantable cardioverter-defibrillators in children and adults: cause for caution

This paper describes our clinical experience of using an entirely subcutaneous implantable cardioverter-defibrillator (S-ICD) in children and adults. Maintaining lead integrity and long-term vascular access are critical challenges of ICD therapy, especially in younger patients. The S-ICD has considerable theoretical advantages in selected patients without pacing indications, particularly children and young adults. Although sensing in an S-ICD may be influenced by age, pathology, and posture, there are currently few published data on clinical sensing performance outside the setting of intra-operative testing or in younger patients. Patients were selected by a multi-disciplinary team on clinical grounds for S-ICD implantation from a broad population at risk of sudden arrhythmic death. Sixteen patients underwent implantation [median age 20 years (range 10-48 years)]. Twelve had primary electrical disease and four had congenital structural heart disease. There were no operative complications, and ventricular fibrillation (VF) induction testing was successful in all cases. During median follow-up of 9 months (range 3-15 months), three children required re-operation. Eighteen clinical shocks were delivered in six patients. Ten shocks in four patients were inappropriate due to T-wave over-sensing. Within the eight shocks for ventricular arrhythmia, three were delivered for VF, among which two had delays in detection with time to therapy of 24 and 27 s. The S-ICD is an important new option for some patients. However, these data give cause for caution in light of the limited published data regarding clinical sensing capabilities, particularly among younger patients.

The adoption of market-based practices within care for older people: is the work satisfaction of Nordic care workers at risk?

Market-based practices, including privatization and the increased emphasis on managerialism, have entered Nordic social- and health-care systems for elderly people. This article examines whether the adoption of these practices has affected the work satisfaction of care workers in Denmark, Finland, Norway, and Sweden. The data used comes from a postal survey conducted in spring 2005 among Nordic care workers, covering 2716 respondents who provided care for older people. The items analysed include background questions, Likert-scale questions on working conditions, and questions on the presence of different market-based practices in the workplace. The results indicate that there are many variations between the four Nordic countries concerning the adoption of market-inspired practices in the care for elderly people, with Denmark having been the most eager and Norway the least to introduce them. Employees of for-profit employers report a lower level of work satisfaction than public employees. On the other hand, the adoption of most market-based instruments correlates with higher and not lower levels of work satisfaction among care workers working with elderly people.The results do not show a simple connection between the adoption of market-based practices and lower levels of work satisfaction, which might have been expected on the basis of earlier research discussions. However, due to some weaknesses of the data and the many variations between individual market-based models as well as between different Nordic countries, there is cause for caution in the interpretation of the results. It is particularly necessary for policymakers to remain sensitive to the national context.

The adoption of market-based practices within care for older people: is the work satisfaction of Nordic care workers at risk?

Market-based practices, including privatization and the increased emphasis on managerialism, have entered Nordic social- and health-care systems for elderly people. This article examines whether the adoption of these practices has affected the work satisfaction of care workers in Denmark, Finland, Norway, and Sweden. The data used comes from a postal survey conducted in spring 2005 among Nordic care workers, covering 2716 respondents who provided care for older people. The items analysed include background questions, Likert-scale questions on working conditions, and questions on the presence of different market-based practices in the workplace. The results indicate that there are many variations between the four Nordic countries concerning the adoption of market-inspired practices in the care for elderly people, with Denmark having been the most eager and Norway the least to introduce them. Employees of for-profit employers report a lower level of work satisfaction than public employees. On the other hand, the adoption of most market-based instruments correlates with higher and not lower levels of work satisfaction among care workers working with elderly people.The results do not show a simple connection between the adoption of market-based practices and lower levels of work satisfaction, which might have been expected on the basis of earlier research discussions. However, due to some weaknesses of the data and the many variations between individual market-based models as well as between different Nordic countries, there is cause for caution in the interpretation of the results. It is particularly necessary for policymakers to remain sensitive to the national context.

Do modern humans and Neandertals have different patterns of cranial integration?

Studies of cranial differences between modern humans and Neandertals have identified several characteristics for which the two groups differ in their mean values, the proportional relationships with other traits, or both. However, the limited number of fairly complete Neandertals has hindered investigations into patterns of integration – covariance and correlation among traits – in this fossil group. Here, we use multiple approaches specifically designed to deal with fragmentary fossils to test if metric cranial traits in Neandertals fit modern human patterns of integration. Based on 37 traits collected from a sample of 2524 modern humans from Howells’ data set and 20 Neandertals, we show that overall patterns of cranial integration are significantly different between Neandertals and modern humans. However, at the same time, Neandertals are consistent with a modern human pattern of integration for more than three-quarters of the traits. Additionally, the differences between the predicted and actual values for the deviating traits are rather small, indicating that the differences in integration are subtle. Traits for which Neandertals deviate from modern human integration patterns tend to be found in regions where Neandertals and modern humans are known to also differ in their mean values. We conclude that the evolution of patterns of cranial integration is a cause for caution but also presents an opportunity for understanding cranial differences between modern humans and Neandertals.

Cobbsian Historiography Takes on the Revolutionary State

Cobbsian Historiography Takes on the Revolutionary State Julia Douthwaite Howard G. Brown , Ending the Revolution: Violence, Justice, and Repression from the Terror to Napoleon (Charlottesville: University of Virginia Press, 2006). Pp. xii, 461. $45.00. Joseph Clarke , Commemorating the Dead in Revolutionary France: Revolution and Remembrance, 1789–1799 (Cambridge: Cambridge University Press, 2007). Pp. x, 306. $99.00. Richard Cobb—long considered the lone wolf of revolutionary historiography—is back with a vengeance. Although Cobb passed away in 1996, his legacy continues in two recent books by Howard Brown (State University of New York, Binghamton) and Joseph Clarke (Trinity College, Dublin). Like their forebear, Clarke and Brown have spent years mining the riches of archives; and both focus systematically on le menu peuple and profess to reveal how politics touched their lives. Or, more precisely, how it accidentally battered their lives. Neither Clarke nor Brown has much patience for revolutionary enthusiasts, rather they emphasize the devastating toll the tumult took on the families and communities left in its wake. Both downplay the long-term advances wrought by the Revolution in the domains of education, jurisprudence, or human rights, and instead stress the hypocrisy and failings of the First Republic and its various post-Thermidorian successors. [End Page 468] By ending the Revolution in 1802 or 1799 instead of 1794, they demonstrate the powerful way that periodization molds history. Educators should take care to balance the harsh appraisals provided here with the more equitable assessment of the period by scholars such as James Livesey or Martyn Lyons. Although the erudition of Clarke and Brown is laudable, the bitterness expressed in these books is cause for caution. Clarke's Commemorating the Dead is a feisty tome. The topic—bereavement and memory—is of perennial human import, and the approach is promising. Focusing on the rituals, commodities, and oratory associated with the victims of the turmoil and warfare that marked the years 1789–1799, Clarke proposes to explain why those practices and objects emerged in their historical moment and what ends they served. Although his claims to originality are sometimes exaggerated—one need only conjure up John McManners's writings on funereal practices or Carol Blum on revolutionary virtue—Clarke nevertheless affects an independence of spirit that is invigorating. Emphasizing the importance of Catholicism in the lives of French people even under the Terror, Clarke refuses to believe that words like saint, martyr, or sacrilege were irrelevant or could be reinvented to serve the ends of revolutionary ideology as readily as historians such as Lynn Hunt and Mona Ozouf have claimed. Like Cobb, who famously debunked republican populism by studying the tax records of wealthy sans-culottes, Clarke has a keen eye for the telling detail. This attentiveness to the hidden meanings of words and ritual allows for some surprising interpretations, including the deconstruction of the Marat cult (185–209). Citing French sources in the original makes the claims persuasive, as demonstrated in his analysis of the artful use of pronouns tu, vous, and especially nous in Abbé Fauchet's sermons (54–86). These passages do a masterful job of revealing the mixed motives—of worshipful sorrow as well as fear and opportunism—that drew crowds to memorials, parades, and other public shows of remembrance. Commemorating has some rough patches. The introduction will raise hackles by dismissing contemporary cultural history as the work of historians who "prefer the firm and reassuringly familiar ground of ideological engagement to the shifting sands of individual emotion" (6). Clarke claims to reintroduce agency into history by eschewing the "fashionable effusions of sentimental literature" in favor of "real tears shed by real families" (6). This assertion shocks by its naive assumption that some forms of textual evidence are more "real" than others. Just as the funerary practices so beautifully described by Clarke are rooted in a specific sense of time, place, and the sacred, so the memoirs of widows and common folk he relies on to tell this story are rooted in literary genres of almanac, breviary, and saints' lives, not to mention local legend. Clarke's impatience with literature seems hard to reconcile with his dedication to nuance. But there is much to admire in Commemorating. Clarke...