Separate Groups Research Articles

Fraudulent Participation in Online Qualitative Studies: Practical Recommendations on an Emerging Phenomenon.

Fraudulent participation is defined in the following as participation in research by individuals who, for one reason or another, intentionally provide false responses. Qualitative studies are at an increased risk of fraudulent participation when online recruitment and participation are used, and monetary incentives offered. Fraudulent participation threatens data quality and subsequent evidence-based practice, yet validated guidance on how to tackle it is lacking. This paper offers a critical reflection thereon by three separate qualitative research groups that experienced fraudulent participation in collaboration with a patient representative, a bioethicist, a legal expert, a journal deputy editor, and a chief executive of a national charity. The Prevent FRaudulent Online STudy participation (P-FROST) recommendations provide advice on (1) Study set-up (including team members and study design), (2) Monetary incentives and recruitment, (3) Data collection (screening and interview considerations), and (4) Analysis, reporting, and support. The reflection which balances the diverse perspectives of patients, researchers, funders, ethics boards, and legal teams puts forward the P-FROST recommendations to identify and prevent fraudulent participation throughout the design, ethical approval, and implementation of online qualitative research.

Battle of Kalniškės: a Fragment of the Fight for Freedom

The article analyses the structure and composition of the partisan division – the company of Jonas Neifalta-Lakūnas [‘Pilot’] – that fought in the Battle of Kalniškės and its role within the context of the Lithuanian resistance against the second Soviet occupation. The direct causes of the battle, its progress and individual stages are discussed. The study uses narrative, analytical and inductive approaches. Lakūnas’ company was part of the partisan forces of several rural areas under the leadership of Albinas Kisieliauskas- Karvelis [‘Pigeon’]. Neifalta-Lakūnas, commander of the Kalniškės area partisans, was deputy to Kisieliauskas- Karvelis and the head of the command post. The composition and organisational structure of the force was the same as many other Lithuanian partisan forces. The detachment adopted the structural principles of the independent Lithuanian Army and tailored them to the needs of the guerrilla war. In order to ensure confidentiality, separate smaller groups operated in different areas. These smaller groups were usually made from smaller mobile units formed from men of adjacent villages, and were lead by fighters with experience in the army or police service. From the beginning of the Soviet occupation, this partisan company was trying to unite itself into a centralised resistance movement. Initially a relationship was established with the Lithuanian Freedom Army, and 2 new units – Tauras and Dainava Commands – emerged as a result of this centralisation. The creation of centralised underground structures legitimised the activities of the partisan force. The release of proclamations and regulatory documents by the leadership formed the concept of anti-Soviet resistance, regulated its tactics, discipline and behaviour with the civilian population. However, the chain of subordination was on many occasions disrupted and changed, while orders from command headquarters did not always reach the distant Kalniškės Forest. From February 1945 to March 1945, as far as mobility was concerned, the forces under the leadership of Karvelis and Lakūnas stood out from the rest of the partisan divisions operating in the ethnographic area of Užnemunės Dzūkija [south-western part of Lithuania]. The area of operations of this partisan force, which was extremely mobile and frequently changed its campsite, covered as many as seven rural areas. In the winter of 1944–1945 and spring 1945, up until the famous Kalniškės Battle, these fighters participated in many clashes with the occupational forces, but managed to avoid any major losses. Perhaps one of the most significant of these was the attack on the town of Rudamina and the skirmish at Panara. In both cases the partisans won, believed in the power of their weapons, and did not hesitate to initiate the Battle of Kalniškės. The Battle of Kalniškės was one of many defensive combats fought by partisans in 1945. It started when the NKVD Regiment surrounded the company of Neifalta- Lakūnas camping in the forest. The progress of the battle can be divided into four stages. During the battle partisans could not withdraw in an organised fashion and had to fight the enemy attacks on Meškakalnis hill. Some fighters were cut off from the main division and were scattered to the depths of the forest. After intensive fire, partisan resistance weakened. The NKVD assault group tried to push the partisans from their occupied positions and to completely destroy them, but around 20 men managed to break out of the encirclement. Although the Battle of Kalniškės claimed the lives of nearly 50 partisans, their dedication inspired their brothers in arms, kept the movement smouldering in the nation’s consciousness, and lead to the re-establishment of Lithuania’s independence.

Barriers and Facilitators Associated With Remote Concussion Physical Assessments From the Perspectives of Clinicians and People Living With Workplace Concussions: Focus Group Study.

Evaluating the clinical status of concussions using virtual platforms has become increasingly common. While virtual approaches to care are useful, there is limited information regarding the barriers and facilitators associated with a virtual concussion assessment. This study aims to identify the barriers and facilitators associated with engaging in virtual concussion assessments from the perspective of people living with workplace concussions; identify the barriers and facilitators to completing virtual concussion assessments from the perspectives of clinicians; and identify the clinical measures related to 4 clinical domains that would be most appropriate in virtual practice: general neurological examination and vestibular, oculomotor, and cervical spine assessment. We also evaluated effort. Separate online focus groups were conducted with expert concussion clinicians and people living with workplace concussions. A moderator led the focus groups using a semistructured interview guide that targeted a discussion of participants' experiences with virtual assessments. The discussions were recorded, transcribed, and analyzed by 2 reviewers using content analysis. Barriers and facilitators associated with completing the physical concussion examination were categorized based on the domain of the concussion examination and more general barriers and facilitators. Clinician-selected measures believed to work best in a virtual practice were described using frequency counts. A total of 4 focus groups with 15 people living with workplace concussions and 3 focus groups with 14 clinicians were completed using Microsoft Teams. Barriers were identified, such as triggering of symptoms associated with completing an assessment over video (mentioned 13/162 (8%) and 9/201 (4%) of the time for patient and clinician participants, respectively); challenges with location and setup (mentioned 16/162 (10%) of the time for patient participants); communication (mentioned 34/162 (21%) and 9/201 (4%) of the time for patient and clinician participants, respectively); and safety concerns (mentioned 11/162 (7%) of the time for patient and 15/201 (7%) for clinician participants). Facilitators were identified, such as having access to support (mentioned 42/154 (27%) and 21/151 (14%) of the time for patient and clinician participants, respectively); implementing symptom management strategies throughout the assessment (mentioned 11/154 (7%) of the time for patient participants); and having access to resources (mentioned 25/151 (17%) of the time for clinician participants). From the perspective of the clinician participants included in this study, the clinical measures recommended most for a virtual practice were finger to nose testing; balance testing; the Vestibular/Ocular Motor Screening tool; saccades; and cervical spine range of motion within their respective domains (ie, neurological examination, vestibular, oculomotor, and cervical spine assessment). Virtual assessments appear to be useful for both people living with workplace concussions and clinicians. While barriers were identified, such as challenges associated with exposure to screens, virtual assessments have benefits such as improved access to care. The clinician-selected measures that were considered best in a virtual practice will be investigated in an upcoming evaluative study. RR2-10.2196/40446.

A Model for Understanding Lived Expertise to Support Effective Recruitment of Peer Roles.

Peer roles have increased within mental health and alcohol and other drug services. However, there is a lack of understanding about the 'lived experience' necessary for success in these roles and how to recruit effectively. This study explores participants' views on the essential knowledge and skills derived from lived experience to inform the design of peer roles and support effective recruitment. This qualitative study involved 132 participants employed across five multi-disciplinary organizations in the United States. Participants represent three cohorts: designated peer workers, management, and colleagues in other roles. Fourteen focus groups and eight individual interviews were conducted, with separate focus groups for peers, colleagues in non-designated roles, and management. Findings indicate essential aspects of lived experience comprise three domains: life-changing or life-shaping individual experiences (including intersectionality); common impacts of adverse experiences, identification as a peer, and understanding and application of the collective peer thinking and values; and ultimately, Lived Expertise, a unique, experientially developed knowledge base and set of skills that can benefit others. The study identifies Lived Expertise as a unique combination of individual and collectively derived experiential knowledge. Understanding what comprises Lived Expertise can guide the design of roles and improve recruitment strategies, thereby enhancing the effectiveness of roles and support for the peer workforce. This study offers a model for understanding Lived Expertise that can be readily applied in developing recruitment materials, including position descriptions.

Effects of sex and estrous cycle on extended-access oxycodone self-administration and cue-induced drug seeking behavior

IntroductionIncreasing evidence indicates that sex is a factor that impacts the abuse liability and relapse vulnerability of prescription opioids like oxycodone. However, while women are more likely than men to be prescribed and to use these drugs, the impact of sex and ovarian hormones on prescription opioid use and relapse vulnerability remains unclear. Accurately assessing these measures is complicated by the fact that chronic opioid exposure can lower ovarian hormone levels and cause cycle irregularities.MethodsAdult male and female Sprague–Dawley rats self-administered oxycodone (0.1 mg/kg/infusion) under extended-access conditions (6 h/day, 10 days) followed by forced abstinence. Separate groups of animals received cue-induced seeking tests in a drug-free state during early (1–2 days) or later periods of abstinence (43–45 days). To track estrous cycle stage, animals were regularly vaginally swabbed throughout the study.ResultsWe observed oxycodone-induced estrous cycle dysregulation in the majority (~60%) of the animals during both self-administration and the first month of abstinence. In animals whose cycles were not dysregulated, we found a reduction in oxycodone intake during estrus compared to all other cycle stages (non-estrus). We also found that males but not females showed a time-dependent intensification or incubation of cue-induced oxycodone craving over the first 6 weeks of abstinence. This sex difference was estrous cycle-dependent, driven by a selective reduction in drug seeking during estrus.DiscussionThese findings highlight the importance of tracking drug-induced estrous cyclicity and identify a clear impact of ovarian hormones on oxycodone taking and seeking behavior.

EXPRESS: Spontaneous Transfer of Relational Category Structures Between Category Learning Tasks: A Novel Approach to Measure Analogical Transfer.

The ability to spontaneously access knowledge of relational concepts acquired in one domain and apply it to a novel domain has traditionally been explored in the analogy literature via the problem-solving paradigm (cf. Gick & Holyoak, 1980, 1983). In the present work, we propose a novel procedure based on categorization as a complementary approach to assess spontaneous analogical transfer-using one category learning task to enhance learning of the same underlying category structures in another domain. In Experiment 1, we demonstrate larger improvements in classification performance across blocks of training in a Target Category Learning task among participants that underwent a Base Category Learning task relative to a separate group of participants learning the Target category structures for the first time; thus providing evidence for spontaneous transfer of the category structures. In Experiment 2, we demonstrate similar evidence of spontaneous transfer for participants that underwent a comparison-based Base Category Learning task under a more rigorous context-shift between the Base and Target Category Learning tasks. Additional exploratory analyses across both experiments showcase ways in which this paradigm can be used to answer questions regarding the analogical transfer of relational category structures and generate promising paths for future work.

Development of a Novel Gluten-Free Cookie Premix Enriched with Natural Flours Using an Extreme Vertices Design: Physical, Sensory, Rheological, and Antioxidant Characteristics

This work aimed to develop novel alternative gluten-free premixes for use in the production of cookies by optimizing the formulation of three different starches (corn, potato, and tapioca starch) in a rice/corn formula and then enriching the optimized formula with various natural flours (acorn, soy, chestnut, chickpea, millet, and quinoa). An extreme vertices mixture design was used to optimize the mixing sub-part consisting of 30% (w/w) of starches. The enriched gluten-free cookies were characterized by physical, rheological, antioxidant, color, and sensory properties. An optimum was obtained by mixing 18.5084 g of corn starch, 6 g of potato starch, and 5.4916 g of tapioca starch. The enrichment results indicated that soy-enriched gluten-free cookies have a high specific volume (2.428 cm3/g) with the highest spread ratio (12.25) compared to other cookies. The rheological properties of enriched gluten-free doughs indicated a higher value of the consistency coefficient (K) of soy-enriched gluten-free cookies. The antioxidant characteristics were enhanced by replacing corn with several types of flours, with higher TPC for acorn (2.83 mg GAE/g dw) and soy-enriched cookies (2.49 mg GAE/g dw) with better antioxidant activities (DPPH, ABTS, and RED). The tasters gave all the cookies favorable ratings for overall acceptability. With an average rating of 7.09, cookies enhanced with chickpea flour have a high acceptability compared to the other cookies. Considering all the tested parameters, PCA analysis clustered millet, corn, quinoa, and chestnut gluten-free enriched cookies into the same group. However, acorn and soy cookies were placed in a separate group, and chickpea-enriched cookies were classified separately.

Abstract 4120918: Prevalence Of Prediabetes According To Sleep Apnea Status

Aim: The association between obstructive sleep apnea and prediabetes using STOP-Bang questionnaire is unknown. We aimed to investigate prevalence of prediabetes among people according to sleep apnea status. Methods: This cross-sectional study included 10131 Korean adults without diabetes with information of STOP-Bang score were identified from the dataset of the Korea National Health and Nutrition Examination Survey 2019-2021. Prediabetes was categorized into three subsets: fasting blood glucose only (fasting blood glucose 100-125 mg/dL, HbA1c <5.7%), HbA1c only group (fasting blood glucose <100mg/dL, HbA1c 5.7-6.4%) and both fasting blood glucose and HbA1c group (fasting blood glucose 100-125mg/dL, HbA1c 5.7-6.4%). We used multivariable logistic regression to see the odds ratio and 95% confidence intervals for prediabetes. Results: There were 3828 subjects who reported STOP-Bang score of ≥3, which shows increased risk of OSA. Multivariable-adjusted odds ratio (95% confidence interval) for prediabetes meeting both fasting blood glucose and HbA1c comparing STOP-Bang score of ≥3 with <3 was 1.06 (1.01-1.12). In further evaluation of separate gender groups, statistically significant results were seen in women. The multivariable adjusted result correlated with that of the total population. (odds ratio 1.20, 95% confidence interval 1.10-1.30) This was more prominently seen in postmenopausal women. (odds ratio 1.21, 95% confidence interval 1.11-1.32) Conclusion: In Korean general population, the odds of the risk of obstructive sleep apnea was significant in prediabetes group meeting both fasting blood glucose and HbA1c, especially in postmenopausal women.

The potential for predicting neonatal disabilities in preterm infants

The urgent task of modern pediatricians and neonatologists is to predict the course of the early neonatal period, during which the basic adaptive mechanisms of newborn children are in an unstable state. This is particularly important for the study of premature newborns, who are at high risk for an unfavorable outcome.Purpose. The aim of this study was to investigate the nature of early neonatal adaptation in children born between 32- and 36-weeks’ gestation, from mothers with burdened obstetric and gynecological histories and concomitant medical conditions.Material and methods. Out of 75 patients, we divided children born against a background of placental abruption and pre-eclampsia into separate groups. We provide a comparative analysis of their obstetric, gynecological, and medical histories, as well as their pre-dictive factors, somatic status dynamics, and laboratory and instrumental examinationsResults. Analysis of the data showed that in late preterm newborns, the presence of placental abruption in the history of 100% of cases led to the development of general somatic distress, with deterioration in hemodynamic and respiratory parameters, requiring transfer to the second phase of care. In children born preterm due to severe preeclampsia or other causes, stable severe conditions were observed in 33.3 and 39.6%, respectively, and 53.9 to 60% of infants required respiratory support.Conclusion. These findings allow for individualized assessment of a newborn’s condition in the first few days of life, based on predictive factors that may lead to a breakdown in compensatory responses.

A mixed method service evaluation of Electronic Prescribing and Medicines Administration (EPMA) within 10 community hospitals in England

Abstract Introduction Electronic Prescribing and Medicines Administration (EPMA) was implemented in 13 adult inpatient wards across 10 community hospitals within one NHS community trust in England, March 2023, replacing paper drug-charts. EPMA, integrates with patients’ electronic health records, includes prescribing, administration, closed-loop supply, discharge prescribing, electronic-tasking between clinicians and provides a medicines audit trail. Laptops enable remote access. Aim To evaluate EPMA against expected safety, quality and efficiencies benefits, assess clinicians’ acceptance of EPMA and impact on pharmacy practice compared to paper-drug charts. Methods Mixed methods1 evaluation conducted in November and December 2023. This evaluation included assessing twenty-six expected multi-dimensional benefits as being achieved, partially achieved or not achieved post-EPMA implementation based on quantitative and qualitative data. Online anonymous surveys were emailed to all eligible clinicians: prescribers, nurses and pharmacy staff working on 13 inpatient wards, containing closed and open questions, adapted according to clinical group for different aspects of EPMA including questions to assess clinicians’ acceptance of EPMA2. These data were analysed using descriptive statistics in Excel. Pharmacy staff working on the inpatient wards and the dispensary were invited to attend separate virtual focus groups for pharmacists, pharmacy technicians and dispensary staff, respectively. These were recorded and transcribed via Microsoft Teams. Eight pharmacists, six pharmacy technicians and five dispensary staff agreed to participate. A semi-structured interview guide was used covering EPMA’s impact on practice, communication, patient safety, benefits and challenges. Thematic-analysis3 of the focus group interviews were undertaken by IA. Themes were validated with pharmacists and pharmacy technicians, respectively. The NHS Health Research Authority decision tool confirmed this evaluation was not NHS Research therefore did not require NHS ethics review or approval. Sussex Community NHS Foundation Trust approved this service evaluation. Results Of 26 expected multi-dimensional benefits post EPMA, 77% were achieved or partially achieved with 13% not achieved. Thirty-seven inpatient ward clinicians responded to the survey: eight prescribers, fifteen nurses, six pharmacists and eight pharmacy technicians. This showed clinicians underutilised some functionalities, although 100% felt confident using EPMA. Overall, 81% of clinicians stated medication safety had improved with EPMA, 16% felt it was the same and 3% felt it was worse, with 92% not wanting to return to paper drug-charts. Clinicians requested further prescribing developments. Thematic analysis identified four themes for pharmacists: maintaining visibility with prescribers, moving towards targeted interactions with prescribers but reducing opportunistic interactions, being increasingly available due to remotely accessing EPMA and improving patient safety through increased prescription checking; and three themes for pharmacy technicians: expanding role, improving workflow and enhancing communication with clinicians. The dispensary staff focus group emphasised that EPMA adversely impacted dispensary workflow. Discussion/Conclusion EPMA achieved some expected benefits. Clinicians have accepted EPMA, perceiving improved medication safety compared to paper-drug charts. Pharmacists are exploring ways of adapting their practice. Pharmacy technicians are enhancing their roles. Recommendations include EPMA system improvements, additional EPMA training, reviewing dispensary and pharmacists’ workflow. EPMA needs time to embed in practice. Limitations of the evaluation included no focus groups for prescribers and nurses, and limited baseline data pre-EPMA.

Patient-centred composite scores as tools for assesment of response to biological therapy for paediatric and adult severe asthma.

We have previously developed Core Outcome Measures sets for Severe Asthma (COMSA) by multi-stakeholder consensus. There are no patient-centred tools to quantify response to biologics for severe asthma. We aimed to develop paediatric and adult CompOsite iNdexes For Response in asthMa (CONFiRM) incorporating clinical parameters and patient-reported quality of life (QoL). International expert healthcare professionals (HCPs) and patients with severe asthma were invited to: 1) develop consensus levels of clinically relevant changes for each outcome measure within COMSA; 2) use multicriteria decision analysis to develop the CONFiRM scores and 3) assess their internal validity. A separate group of HCPs evaluated CONFiRM's external validity. Five levels of change for each COMSA outcome were agreed. Severe exacerbations and maintenance oral corticosteroids use were rated as most important in determining both paediatric and adult CONFiRM scores. There was strong agreement between HCPs and patients, although patients assigned greater importance to QoL. The CONFiRM score quantified response to a biological from -31 (deterioration) to 69 (best possible response). Paediatric and adult CONFiRMs had good discriminative ability for a sufficient (AUC≥0.92) and a substantial (AUC≥0.95) response to biologics. Both CONFiRMs demonstrated excellent external validity (Spearman correlation coefficients 0.9 and 0.8 for paediatric and adult respectively (p<0.0001)). We have developed novel patient-centred paediatric and adult CONFiRMs which include QoL measures. CONFiRMs should allow a more holistic understanding of response for the patient and a standardised assessment of the effectiveness of biologics between studies. Further research is needed to prospectively validate CONFiRM scores.

Immunomorphological specifcity of HER2-low breast cancer

Assessment of tumor infltrating lymphocytes (TiLs) has been recognized as an additional tool for predicting survival in triple negative (TN) and HER2/neu positive (HER2+) subtypes of breast cancer (BC). Recently, BC, including the above-mentioned subtypes and characterized by low/undefined expression of HER2/neu, has been isolated into a separate group, designated HER2-low BC. The relationship between clinical and morphological parameters of HER2-low breast cancer and infiltration by immunocompetent cells, including tumor associated macrophages (TAM), has not been studied to date. The purpose of the study was to identify significant relationships between the level of subpopulations of immunocompetent cells (Tils + TAM) and the clinical and morphological parameters of HER2-low BC.Material and Methods. The study examined the surgical specimens of 33 patients with HER2-low BC. Visual counting of TILs and assessment (IHC) of the level of T-helpers, T-killers, M1 and M2 macrophages were carried out in intratumor sites and the invasive edge of the primary tumor.Results. The study of mastectomy specimens showed that infiltration of Tils (Me=5 [5; 10] %) was observed in all 33 patients. The level of M2 of macrophages was found to be the highest both in the invasive margin and in the intratumor sites (CD163inv: Me=20 [10; 40] %; CD163c: Me=15 [7; 30] %, respectively). In patients with high (≥20 %) levels of M2 macrophages in the invasive margin, there was also a high level of other immunocompetent cells, and perineural invasion was detected significantly more often (р=0.019).Conclusion. A high level of infiltration by M2 macrophages of the invasive margin is combined with the detection of perineural invasion in primary HER2-low breast cancer, which is one of the predictors of a high risk of progression. In combination with other clinical and morphological parameters, the level of M2 macrophages in HER2-low breast cancer may become another factor in predicting disease prognosis.

Effect of Aphantasia on Academic Achievement and Learning Styles in Higher Education

This investigation targets to clarify Learning Styles (LSs) of aphantasic and non-aphantasic higher education students/graduates in accordance with Vermunt Learning Style Model and to LSs of the participants according to their demographic characteristics such as gender and age. Model of study is relational screening and research was carried out online with 260 volunteer participants. "Vermunt Learning Styles Inventory" was utilized to determine LSs of two separate groups with and without aphanatic. Although there are many studies on the LSs in literature, there are very limited study on the Vermunt Learning Style. Differences were found in the learning orientation and academic success of aphantasic people compared to non-aphantasic people. It was concluded that academic achievements of aphantasic participants were higher than the academic achievements of the non-aphantasic participants. When literature is examined, there is no research to examine level of imagination in terms of the LSs and academic success. Therefore, it is thought that the studies to be carried out by expanding scope with different sample groups will contribute to the aphantasic individuals, students and educators with this research. More studies can be done on this subject and experiments can be made for its use in the field of guidance.

Inherited kidney disease and CAKUT are common causes of kidney failure requiring kidney replacement therapy: an ERA Registry study.

Inherited kidney diseases (IKD) and congenital anomalies of the kidney and urinary tract (CAKUT) are causes of kidney failure requiring kidney replacement therapy (KRT) that major renal registries usually amalgamate into the primary renal disease (PRD) category 'miscellaneous' or in the glomerulonephritis or pyelonephritis categories. This makes IKDs invisible (except for polycystic kidney disease) and may negatively influence the use of genetic testing, which may identify a cause for IKDs and some CAKUT. We have re-examined the etiology of KRT by composing a separate IKD and CAKUT PRD group using data from the European Renal Association (ERA) Registry. In 2019, IKD-CAKUT was the fourth most common cause of kidney failure among incident KRT patients, accounting for 8.9% of cases (IKD 7.4% [including 5.0% ADPKD], CAKUT 1.5%), behind diabetes (23.0%), hypertension (14.4%) and glomerulonephritis (10.6%). IKD-CAKUT was the most common cause of kidney failure among patients younger than 20 years (41.0% of cases), but their incidence rate was highest among those aged 45-74 years (22.5 per million age-related population). Among prevalent KRT patients, IKD-CAKUT (18.5%) and glomerulonephritis (18.7%) were the two most common causes of kidney failure overall, while IKD-CAKUT was the most common cause in women (21.6%) and in patients younger than 45 years (29.1%). IKD and CAKUT are common causes of kidney failure among KRT patients. Distinct categorization of IKD and CAKUT better characterizes the epidemiology of the causes of chronic kidney disease, and highlights the importance of genetic testing in the diagnostic workup of CKD.

Deep mantle plumes feeding periodic alignments of asthenospheric fingers beneath the central and southern Atlantic Ocean

High-resolution full waveform seismic tomography of the Earth's mantle beneath the south and central Atlantic Ocean brings into focus a series of asthenospheric low shear velocity channels, or "fingers" on both sides of the southern and central mid-Atlantic ridge (MAR), elongated in the direction of absolute plate motion with a spacing of [Formula: see text]1,800 to 2,000 km, and associated with bands of shallower residual seafloor depth anomalies that suggest channeled flow over thousands of kilometers. Each of the three most clearly resolved fingers on the African side of the MAR corresponds to a separate group of whole mantle plumes rooted in distinct patches at the core-mantle boundary, feeding hotspots, and volcanic lines with distinct isotopic signatures. Plumes of a given group appear to merge at the top of the lower mantle before separating again, suggesting interaction of deep mantle flow with a more vigorous mesoscale circulation in the upper mantle. The corresponding hotspots are generally offset from the location of the deep mantle plume roots. The distinct isotopic signatures of these hotspot groups are also detected in the mid-ocean ridge basalts at the location where the fingers meet the ridge. Meanwhile, at least some of the variability within each plume group could originate in the upper mantle and extended transition zone where plumes in a given group appear to merge and pond. This study also adds to mounting evidence that the African large low shear velocity province is not a uniform, unbroken pile of dense material rising high above the core-mantle boundary, but rather a collection of mantle plumes rooted in patches of distinct composition.

An Exploratory Study of Small-Group Learning Interactions in Pre-Clerkship Medical Education: Uncovering a Mismatch Between Student Perceptions and Real-Time Observations

Small-group learning is a mainstay of medical education, and group functioning can have a major influence on these learning experiences. Our objective was to explore verbal exchange patterns within small-group learning sessions and examine how different patterns related to tutor involvement, tutor expertise, and participants’ perceptions. A non-participant observer collected group interactivity data using a real-time mobile device-based system. Verbal interaction patterns were visualized and analyzed using social network analysis and correlated with participant survey data and aggregate course grades. There were 46 observations across 30 separate groups. Group interactions clustered into four patterns defined by (1) tutor involvement (high vs. low) and (2) interactivity (high vs. low). Interaction patterns were largely stable for a given group and groups with content expert facilitators were generally less interactive. Students reported objectively fewer interactive groups as more interactive and enjoyable. There were no significant intergroup differences in aggregate course grades. Paradoxically, student perceptions were not aligned with observed interactivity data, and tutor content expertise influenced group interactivity. These findings suggest the need to better manage learner expectations of small-group learning, and to explicitly reflect on and develop skills for effective collaborative learning with both faculty and students.

Shifts in the spatiotemporal profile of inflammatory phenotypes of innate immune cells in the rat brain following acute intoxication with the organophosphate diisopropylfluorophosphate

Acute intoxication with cholinesterase inhibiting organophosphates (OP) can produce life-threatening cholinergic crisis and status epilepticus (SE). Survivors often develop long-term neurological consequences, including spontaneous recurrent seizures (SRS) and impaired cognition. Numerous studies implicate OP-induced neuroinflammation as a pathogenic mechanism contributing to these chronic sequelae; however, little is known about the inflammatory phenotype of innate immune cells in the brain following acute OP intoxication. Thus, the aim of this study was to characterize the natural history of microglial and astrocytic inflammatory phenotypes following acute intoxication with the OP, diisopropylfluorophosphate (DFP). Adult male and female Sprague–Dawley rats were administered a single dose of DFP (4 mg/kg, sc) followed by standard medical countermeasures. Within minutes, animals developed benzodiazepine-resistant SE as determined by monitoring seizures using a modified Racine scale. At 1, 3, 7, 14, and 28 d post-exposure (DPE), neuroinflammation was assessed using translocator protein (TSPO) positron emission tomography (PET) and magnetic resonance imaging (MRI). In both sexes, we observed consistently elevated radiotracer uptake across all examined brain regions and time points. A separate group of animals was euthanized at these same time points to collect tissues for immunohistochemical analyses. Colocalization of IBA-1, a marker for microglia, with iNOS or Arg1 was used to identify pro- and anti-inflammatory microglia, respectively; colocalization of GFAP, a marker for astrocytes, with C3 or S100A10, pro- and anti-inflammatory astrocytes, respectively. We observed shifts in the inflammatory profiles of microglia and astrocyte populations during the first month post-intoxication, largely in hyperintense inflammatory lesions in the piriform cortex and amygdala regions. In these areas, iNOS+ proinflammatory microglial cell density peaked at 3 and 7 DPE, while anti-inflammatory Arg1+ microglia cell density peaked at 14 DPE. Pro- and anti-inflammatory astrocytes emerged within 7 DPE, and roughly equal ratios of C3+ pro-inflammatory and S100A10+ anti-inflammatory astrocytes persisted at 28 DPE. In summary, microglia and astrocytes adopted mixed inflammatory phenotypes post-OP intoxication, which evolved over one month post exposure. These activated cell populations were most prominent in the piriform and amygdala areas and were more abundant in males compared to females. The temporal relationship between microglial and astrocytic responses suggests that initial microglial activity may influence delayed, persistent astrocytic responses. Further, our findings identify putative windows for inhibition of OP-induced neuroinflammatory responses in both sexes to evaluate the therapeutic benefit of anti-inflammation in this context.

SOCIO-CULTURAL STUDY OF GOPALI CASTE OF NEPAL: A CASE STUDY IN MACHHEGAUN, CHANDRAGIRI 9, KATHMANDU, NEPAL

The Gopali caste, a subgroup within the Newar community, has a unique socio-cultural heritage that remains under-researched and underrepresented. This study examines the social and cultural conditions of the Gopali caste in Ward No. 9 of Chandragiri Municipality using a qualitative approach. Data was collected from primary sources such as on-site observation, participant observation, focus group discussions, and interviews, and secondary sources including books and online materials. The findings reveal that the Gopalis, who migrated from the Mathura region of India around 3,500 years ago, have historically maintained unique social and ritual practices while living in seclusion. Today, Gopali settlements are primarily in the southwestern Kathmandu Valley and Makwanpur district. Despite diversifying into various occupations, they face limited participation in Nepal's administrative and political processes. This research underscores the importance of recognizing the Gopalis as a separate ethnic group to preserve their cultural heritage. Future research should focus on detailed ethnographic studies to document their traditions and explore ways to integrate the Gopalis into Nepal's broader socio-political landscape while preserving their distinct identity.

Cardioprotective potential of sakuranetin to counteract polyethylene microplastics induced cardiotoxicity

Polyethylene microplastics (PEMPs) are toxic environmental contaminants which can impair multiple organs including heart. Sakuranetin (SKN) is a potential flavonoid with diverse pharmacological benefits. This research was undertaken to analyze the defensive impact of SKN to avert PEMPs-induced cardiotoxicity. Rats were allocated into 4 separate groups: control, PEMPs (1.5 mg kg−1), PEMPs + SKN (1.5 mg kg−1 + 10 mg kg−1) & only SKN (10 mg kg−1) treated group. After 30 days of treatment, our results revealed that PEMPs exposure reduced Nrf2 & antioxidant genes whereas increased Keap1 expression. Besides PEMPs intoxication escalated the level of cardiac biomarkers (CPK, LDH, Troponin I & CK-MB). Additionally, it lessened the activities of GSH, GST, SOD, HO-1, CAT, GSR, GPx whereas the levels of MDA and OS were increased. Conversely, the levels of inflammatory biomarkers i.e., COX-2 activity IL-1β, TNF-α, NF-kB & IL-6 were augmented. Besides, the expressions of apoptotic biomarkers i.e., Bax & caspase-3 were enhanced while the Bcl-2 expression was decreased. Furthermore, histological analysis indicated substantial cardiac tissue damage. However, SKN treatment significantly restored the PEMPs-induced biochemical as well as histological impairments. Therefore, SKN could be used as a therapeutic compound to ameliorate PEMPs-induced cardiac impairments in rats, possibly due to its tremendous pharmacotherapeutic potential.

Early adverse outcomes remain challenging to prevent in morbidly obese patients undergoing total hip arthroplasty.

The prevalence of obesity is increasing substantially around the world. Elevated BMI increases the risk of complications following total hip arthroplasty (THA). We sought to evaluate trends in BMI and complication rates of obese patients undergoing primary THA over the last 30 years. Through our institutional total joint registry, we identified 15,455 primary THAs performed for osteoarthritis from 1990 to 2019. Patients were categorized according to the World Health Organization (WHO) obesity classification and groups were trended over time. Cox proportional hazards regression analysis controlling for confounders was used to investigate the association between year of surgery and two-year risk of any reoperation, any revision, dislocation, periprosthetic joint infection (PJI), venous thromboembolism (VTE), and periprosthetic fracture. Regression was stratified by three separate groups: non-obese; WHO Class I and Class II (BMI 30 to 39 kg/m2); and WHO Class III patients (BMI ≥ 40 kg/m2). There was a significant increase in the proportion of all obesity classes from 1990 to 2019, and the BMI values within each WHO class significantly increased over time. Risk of any reoperation did not change over time among non-obese or WHO Class I/II patients, but increased for WHO Class III patients (hazard ratio (HR) 1.04; p = 0.044). Risk of dislocation decreased over time for non-obese (HR 0.96; p < 0.001) and WHO Class I/II (HR 0.96; p = 0.002) patients, but did not change over time for WHO Class III (HR 0.94; p = 0.073) patients. Risks of any revision and PJI did not change over time for any group. The proportion of patients undergoing THA who are obese has increased dramatically at our institution between 1990 and 2019. Despite BMI values increasing within all WHO classes over time, two-year complication risks have remained stable or decreased in WHO Class I/II patients. However, continued efforts will be required to mitigate risks in the heaviest WHO Class III patients.