Symptomatic Individual Research Articles

The bigger the problem the littler: When the scope of a problem makes it seem less dangerous.

Across 15 studies (N = 2,636), people who considered the prevalence of a problem (e.g., 4.2 million people drive drunk each month) inferred it caused less harm, a phenomenon we dub the big problem paradox. People believed dire problems-ranging from poverty to drunk driving-were less problematic upon learning the number of people they affect (Studies 1-2). Prevalence information caused medical experts to infer medication nonadherence was less dangerous, just as it led women to underestimate their true risk of contracting cancer. The big problem paradox results from an optimistic view of the world. When people believe the world is good, they assume widespread problems have been addressed and, thus, cause less harm (Studies 3-4). The big problem paradox has key implications for motivation and helping behavior (Studies 5-6). Learning the prevalence of medical conditions (i.e., chest pain, suicidal ideation) led people to think a symptomatic individual was less sick and, as a result, to help less-in violation of clinical guidelines. The finding that scale warps judgments and de-motivates action is of particular relevance in the globalized 21st century. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Sleep studies in obese children with obstructive sleep apnea: Pulse oximetry as a diagnostic tool.

Obstructive sleep apnea is associated with many co-morbidities in children and young people. Obesity has long been recognised as an important risk factor associated with obstructive sleep apnea. Currently, polysomnography is regarded as the gold-standard diagnostic tool for obstructive sleep apnea. The validity of oximetry as a screening and diagnostic tool for obstructive sleep apnea has been the subject of several studies in the literature. There is little published evidence on the use of oximetry in children with obesity. This study assesses whether oximetry is a reliable diagnostic tool for obstructive sleep apnea in obese children. We reviewed the medical records of obese children with a suspected diagnosis of obstructive sleep apnea who underwent oximetry and cardiorespiratory polygraphy or full polysomnography at Sheffield Children's Hospital between January 2010 and March 2022. We compared oximetry results with the apnea-hypopnea index from cardiorespiratory polygraphy or full polysomnography for each patient. A total of 60 patient records were included in the analysis. The sensitivity of oximetry in diagnosing obstructive sleep apnea was 70.9%, with a specificity of 65.5% and a positive predictive value of 68.75%. In the subgroup of subjects with severe obstructive sleep apnea (apnea-hypopnea index > 10), oximetry had a sensitivity of 87.5%. We concluded that oximetry could be a helpful initial diagnostic tool for obstructive sleep apnea in obese children, but is not entirely reliable. A negative oximetry result in a symptomatic individual should prompt a referral for more detailed investigations, while a positive result can help in treatment decisions without needing a polysomnography.

Following WHO Guidelines to Respond to a Water Contamination Outbreak in the Edge of Hamadan, West of Iran

Background: Water and foodborne disease outbreaks continually present formidable challenges to healthcare systems, leading to morbidity, mortality, and substantial economic losses. Investigating and reporting these outbreaks play a pivotal role in effectively controlling and mitigating future occurrences. This study endeavors to scrutinize an outbreak of water contamination in Mariyanaj, Hamadan, Iran, employing the World Health Organization’s (WHO’s) comprehensive 10-step framework. Methods: In this descriptive study, we meticulously adhered to the WHO outbreak investigation and reporting guidelines, systematically progressing through each step to investigate and report the outbreak. Symptom/exposure samples, involving two samples per symptomatic individual, were collected and sent to the Center for Disease Control’s laboratory for examination. Additionally, we executed a case-control study (Step 7) to discern the root cause of the outbreak. Results: The outbreak affected 919 individuals among 12115 residents of Mariyanaj city, with a male prevalence of 57.7%. The most impacted age group was 10-14 years. Predominant symptoms included abdominal pain, nausea, and vomiting. Through meticulous field investigations and the case-control study, the contaminated water source was identified. Human samples exhibited Escherichia coli and norovirus as the most prevalent pathogens, with E. coli also detected in water samples. Conclusion: Despite advancements in outbreak investigation and reporting systems, the utilization of a standardized step-by-step approach proves more effective in identifying and managing outbreaks. The consistent monitoring of drinking water quality, particularly in times of water crises, emerges as a crucial factor in significantly preventing waterborne diseases.

Correlation of Impulse Oscillometry with Spirometry in Deployed Military Personnel with Airway Obstruction.

Evaluation of chronic respiratory symptoms in deployed military personnel has been conducted at Brooke Army Medical Center as part of the Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures III study. Although asthma and airway hyperreactivity have been the most common diagnoses, the clinical findings in these patients may be multifactorial. This study aims to evaluate the utility of impulse oscillometry (IOS) in diagnosing airway obstruction in patients undergoing multiple pulmonary function testing (PFT) studies. Military personnel referred for deployed-related pulmonary symptoms underwent a standardized evaluation at Brooke Army Medical Center and Walter Reed National Military Medical Center over a 5-year span. Initial studies included laboratory tests, high-resolution computed tomography imaging, cardiac evaluation with electrocardiogram, and echocardiography. PFT consisted of full PFTs, forced inspiratory/expiratory pressures, post-spirometry bronchodilator testing, IOS, exhaled nitric oxide, and methacholine challenge testing. A total of 360 patients have completed an evaluation to date. In this cohort, 108 patients (30.0%) have evidence of obstruction by spirometry, whereas 74 (20.6%) had IOS values of both an R5 > 150% and X5 < -1.5. Only 32 (8.9%) had evidence of obstruction by both spirometry and IOS, whereas 210 (57.3%) had neither. A comparison among R5 (resistance at 5 Hz), R20 (resistance at 20 Hz), and X5 (reactance at 5 Hz) was performed in those individuals with and without spirometric obstruction. R5 (% predicted) was 156.2 ± 57.4% (obstruction) vs. 129.1 ± 39.6% (no obstruction) (P < .001); R20 (% predicted) was 138.1 ± 37.7% (obstruction) vs. 125.3 ± 31.2% (no obstruction) (P = .007); and X5 (cmH2O/L/s) was -1.62 ± 1.28 (obstruction) vs. -1.25 ± 0.55 (no obstruction) (P < .001). Impulse oscillometry has been advocated as a supplemental pulmonary function test to aid in the diagnosis of airway obstruction. The use of IOS has been primarily used in pediatrics and elderly populations as a validated tool to establish a diagnosis of airway obstruction but is limited in the adult population because of a well-validated set of reference values. Prior studies in adults have most often demonstrated a correlation with an elevated R5 > 150%, elevated resonant frequency, and a negative X5 < -1.5 or a decrease of 30 to 35% in R5 post-bronchodilator. Impulse oscillometry may serve as an adjunct to diagnosis but likely cannot replace a standard spirometric evaluation. Our study highlights the future utility for diagnosing early obstructive disease in the symptomatic individual.

HiPSC-derived cardiomyocyte to model Brugada syndrome: both asymptomatic and symptomatic mutation carriers reveal increased arrhythmogenicity

Brugada syndrome is an inherited cardiac arrhythmia disorder that is mainly associated with mutations of the cardiac voltage-gated sodium channel alpha subunit 5 (SCN5A) gene. The clinical symptoms include ventricular fibrillation and an increased risk of sudden cardiac death. Human-induced pluripotent stem cell (hiPSC) lines were derived from symptomatic and asymptomatic individuals carrying the R1913C mutation in the SCN5A gene. The present work aimed to observe the phenotype-specific differences in hiPSC-derived cardiomyocytes (CMs) obtained from symptomatic and asymptomatic mutation carriers. In this study, CM electrophysiological properties, beating abilities and calcium parameters were measured. Mutant CMs exhibited higher average sodium current densities than healthy CMs, but the differences were not statistically significant. Action potential durations were significantly shorter in CMs from the symptomatic individual, and a spike-and-dome morphology of action potential was exclusively observed in CMs from the symptomatic individual. More arrhythmias occurred in mutant CMs at single cell and cell aggregate levels compared with those observed in wild-type CMs. Moreover, there were no major differences in ionic currents or intracellular calcium dynamics between the CMs of asymptomatic and symptomatic individuals after the administration of adrenaline and flecainide.In conclusion, mutant CMs were more prone to arrhythmia than healthy CMs but did not explain why only one of the mutation carriers was symptomatic.

Gut bacteria influence Blastocystis sp. phenotypes and may trigger pathogenicity.

Whilst the influence of intestinal microbiota has been shown in many diseases such as irritable bowel syndrome, colorectal cancer, and aging, investigations are still scarce on its role in altering the nature of other infective organisms. Here we studied the association and interaction of Blastocystis sp. and human intestinal microbiota. In this study, we investigated the gut microbiome of Blastocystis sp.-free and Blastocystis sp. ST3-infected individuals who are symptomatic and asymptomatic. We tested if the expression of phenotype and pathogenic characteristics of Blastocystis sp. ST3 was influenced by the alteration of its accompanying microbiota. Blastocystis sp. ST3 infection alters bacterial composition. Its presence in asymptomatic individuals showed a significant effect on microbial richness compared to symptomatic ones. Inferred metagenomic findings suggest that colonization of Blastocystis sp. ST3 could contribute to the alteration of microbial functions. For the first time, we demonstrate the influence of bacteria on Blastocystis sp. pathogenicity. When Blastocystis sp. isolated from a symptomatic individual was co-cultured with bacterial suspension of Blastocystis sp. from an asymptomatic individual, the parasite demonstrated increased growth and reduced potential pathogenic expressions. This study also reveals that Blastocystis sp. infection could influence microbial functions without much effect on the microbiota diversity itself. Our results also demonstrate evidence on the influential role of gut microbiota in altering the characteristics of the parasite, which becomes the basis for the contradictory findings on the parasite's pathogenic role seen across different studies. Our study provides evidence that asymptomatic Blastocystis sp. in a human gut can be triggered to show pathogenic characteristics when influenced by the intestinal microbiota.

A Discrete Model for the Evolution of Infection Prior to Symptom Onset

We consider a between-host model for a single epidemic outbreak of an infectious disease. According to the progression of the disease, hosts are classified in regard to the pathogen load. Specifically, we are assuming four phases: non-infectious asymptomatic phase, infectious asymptomatic phase (key-feature of the model where individuals show up mild or no symptoms), infectious symptomatic phase and finally an immune phase. The system takes the form of a non-linear Markov chain in discrete time where linear transitions are based on geometric (main model) or negative-binomial (enhanced model) probability distributions. The whole system is reduced to a single non-linear renewal equation. Moreover, after linearization, at least two meaningful definitions of the basic reproduction number arise: firstly as the expected secondary asymptomatic cases produced by an asymptomatic primary case, and secondly as the expected number of symptomatic individuals that a symptomatic individual will produce. We study the evolution of infection transmission before and after symptom onset. Provided that individuals can develop symptoms and die from the disease, we take disease-induced mortality as a measure of virulence and it is assumed to be positively correlated with a weighted average transmission rate. According to our findings, transmission rate of the infection is always higher in the symptomatic phase yet under a suitable condition, most of the infections take place prior to symptom onset.

Molecular prevalence of Entamoeba species in a cohort of Egyptians

Background and objective: Intestinal and extraintestinal amebiasis is caused by the protozoan parasite Entamoeba (E.) histolytica, it is of considerable morbidity and mortality in developing countries. E.histoltica complex species includes E.histolytica, E. moshkovskii and E. dispar are morphologically indistinctable. The current study goal was to use molecular assays to detect the true prevalence of E. histolytica complex species among a cohort of Egyptians. Methods: A single stool specimen was collected from 133 patients, examined coproscopically before and after concentration. DNA was extracted from microscopically positive stool specimens for E. histolytica complex species were molecularly idenitified using multiplex PCR. Results: The coroscopic prevalence of intestinal parasites was 51.1% (68/133) of them 30 cases had E.histolytica complex (22.6%; 30/133). Among coproscopically positive samples, E. dispar was the most common parasite (63.3%; 19/30), followed by E. histolytica (23.4%; 7/30) and E. moshkovskii (13.3%; 4/30). There was statistical significance association between sociodemographic characteristics and Entamoeba species in asymptomatic individuals, while in the symptomatic individual, only age groups were stastically significant. Conclusion: E.dispar is the predominant Entamoeba species among studied individuals. There is a need for molecular diagnosis of Entamoeba to determine the true prevalence of E. histolytica and avoid overmedication.

Controlling SARS-CoV-2 in schools using repetitive testing strategies.

SARS-CoV-2 remains a worldwide emergency. While vaccines have been approved and are widely administered, there is an ongoing debate whether children should be vaccinated or prioritized for vaccination. Therefore, in order to mitigate the spread of more transmissible SARS-CoV-2 variants among children, the use of non-pharmaceutical interventions is still warranted. We investigate the impact of different testing strategies on the SARS-CoV-2 infection dynamics in a primary school environment, using an individual-based modelling approach. Specifically, we consider three testing strategies: (1) symptomatic isolation, where we test symptomatic individuals and isolate them when they test positive, (2) reactive screening, where a class is screened once one symptomatic individual was identified, and (3) repetitive screening, where the school in its entirety is screened on regular time intervals. Through this analysis, we demonstrate that repetitive testing strategies can significantly reduce the attack rate in schools, contrary to a reactive screening or a symptomatic isolation approach. However, when a repetitive testing strategy is in place, more cases will be detected and class and school closures are more easily triggered, leading to a higher number of school days lost per child. While maintaining the epidemic under control with a repetitive testing strategy, we show that absenteeism can be reduced by relaxing class and school closure thresholds.

Excess Risk of COVID-19 to University Populations Resulting from In-Person Sporting Events

Background: One of the consequences of COVID-19 has been the cancelation of collegiate sporting events. We explore the impact of sports on COVID-19 transmission on a college campus. Methods: Using a compartmental model representing the university, we model the impact of influxes of 10,000 visitors attending events and ancillary activities (dining out, visiting family, shopping, etc.) on 20,000 students. We vary the extent visitors interact with the campus, the number of infectious visitors, and the extent to which the campus has controlled COVID-19 absent events. We also conduct a global sensitivity analysis. Results: Events caused an increase in the number of cases ranging from a 25% increase when the campus already had an uncontrolled COVID-19 outbreak and visitors had a low prevalence of COVID-19 and mixed lightly with the campus community to an 822% increase where the campus had controlled their COVID-19 outbreak and visitors had both a high prevalence of COVID-19 and mixed heavily with the campus community. The model was insensitive to parameter uncertainty, save for the duration a symptomatic individual was infectious. Conclusion: Sporting events represent a threat to the health of the campus community. This is the case even in circumstances where COVID-19 seems controlled both on-campus and among the general population.

Understanding conversion disorder: How contemporary brain imaging is shedding light on an early Freudian concept

Conversion disorder, also called Functional Neurological Symptom Disorder is poorly understood by many in the medical profession and is associated with considerable health care costs. Sigmund Freud, in an early, pre-psychoanalytic period paper, suggested that hysterical motor paralyses arose from a “functional or dynamic lesion” which was no different from an organic one, but rather an altered expression of it. He linked this functional brain disturbance to an excess of affect, a faulty conceptualization on the part of the symptomatic individual of how the affected organ works, and elements of dissociation and dual consciousness. One hundred and thirty years later converging functional imaging studies provide support for the excess affect component of his hypothesis. A small but growing fMRI literature has revealed bottom-up hyperactive neural activity in limbic regions and a potential failure of top-down regulation from prefrontal regions. Aberrant functional connectivity of limbic-motor regions now provides a mechanistic model that sheds light on an early Freudian theory explaining, in part, how symptoms of Conversion Disorder arise.

COVID-19 in schools: Mitigating classroom clusters in the context of variable transmission.

Widespread school closures occurred during the COVID-19 pandemic. Because closures are costly and damaging, many jurisdictions have since reopened schools with control measures in place. Early evidence indicated that schools were low risk and children were unlikely to be very infectious, but it is becoming clear that children and youth can acquire and transmit COVID-19 in school settings and that transmission clusters and outbreaks can be large. We describe the contrasting literature on school transmission, and argue that the apparent discrepancy can be reconciled by heterogeneity, or "overdispersion" in transmission, with many exposures yielding little to no risk of onward transmission, but some unfortunate exposures causing sizeable onward transmission. In addition, respiratory viral loads are as high in children and youth as in adults, pre- and asymptomatic transmission occur, and the possibility of aerosol transmission has been established. We use a stochastic individual-based model to find the implications of these combined observations for cluster sizes and control measures. We consider both individual and environment/activity contributions to the transmission rate, as both are known to contribute to variability in transmission. We find that even small heterogeneities in these contributions result in highly variable transmission cluster sizes in the classroom setting, with clusters ranging from 1 to 20 individuals in a class of 25. None of the mitigation protocols we modeled, initiated by a positive test in a symptomatic individual, are able to prevent large transmission clusters unless the transmission rate is low (in which case large clusters do not occur in any case). Among the measures we modeled, only rapid universal monitoring (for example by regular, onsite, pooled testing) accomplished this prevention. We suggest approaches and the rationale for mitigating these larger clusters, even if they are expected to be rare.

Clinical spectrum and outcome of patients visiting coronavirus screening centre in North India and clinical predictors for COVID-19.

Aim:The aim of this study is to elucidate the demographics, symptoms and outcome of sick persons visiting coronavirus (COVID) screening OPD of a tertiary institute in North India.Study Design:The present descriptive, prospective study was done on 1030 patients and information about presenting symptoms, demographics (age, sex, nationality, residence), contact and travel history, comorbidities etc., were recorded. On the basis of criteria given by Indian Council of Medical Research, patients were divided into suspected (SARS-CoV-2) and non-suspected group. Of the suspected patients, with RT-PCR test positive were classified as confirmed COVID-19 case and negative RT-PCR symptomatic individual were defined as negative COVID-19 case.Results:Out of the total patients, 65.6% were male and 34.4% were females. The mean age was 37.04 years. Fever 49.3%, cough 57.1% and sore throat 43.5% were the main symptoms. Comorbidities were seen in 8.5% patients with hypertension (3.5%) and diabetes mellitus (3.4%). Forty patients were positive. Highly significant correlation (P < 0.01) was found between COVID-19 positive status and in patients without any symptoms, between COVID-19 and cough and sore throat, between COVID-19 and comorbidity (diabetes mellitus), between COVID-19 and high-risk exposures (resident of hot spot and history of contact with confirmed case). Our study also found COVID-19 positive status, shortness of breath and tachycardia as independent predictors of mortality (P < 0.05).Conclusions:Most of the patients were young adults and males were mainly affected. Main presentation was cough followed by fever. Infectivity was higher in patients who had underlying comorbid diseases, especially diabetes and chronic kidney disease. Critical patients with decreased oxygen saturation, tachypnoea and tachycardia had strong predictability for COVID-19 positivity. COVID-19 positive status, shortness of breath and tachycardia are important predictors of mortality.

Behavioural barriers and perceived trade-offs to care-seeking for tuberculosis in the Philippines

ABSTRACT Effective tuberculosis (TB) treatment has existed for more than 50 years, but TB remains a leading cause of death worldwide and in the Philippines, in part because symptomatic individuals delay or avoid seeking care. Through qualitative interviews in Pampanga, Philippines, we investigated barriers to care-seeking using a behavioural science lens. We found barriers to TB care-seeking to be shaped by: (1) ambiguous symptoms; (2) association of TB risk with lifestyle and habits; (3) expectations of stigma, discrimination, and isolation; (4) short-term costs and long-term financial burden of TB; and (5) visibility of care in public sector facilities. Findings suggest that these barriers are deeply intertwined and that, typically, it is a combination of barriers that holds back a particular symptomatic individual from seeking care, as the barriers influence implicit trade-offs related to health, social, and financial consequences of having TB or another serious illness and of seeking care or not seeking care. The findings suggest avenues for more effectively reaching those with symptoms and their family members to encourage care-seeking by elevating the perceived benefits and putting perceived costs in proper perspective.

HiPSC-Derived Cardiomyocyte Model of LQT2 Syndrome Derived from Asymptomatic and Symptomatic Mutation Carriers Reproduces Clinical Differences in Aggregates but Not in Single Cells.

Mutations in the HERG gene encoding the potassium ion channel HERG, represent one of the most frequent causes of long QT syndrome type-2 (LQT2). The same genetic mutation frequently presents different clinical phenotypes in the family. Our study aimed to model LQT2 and study functional differences between the mutation carriers of variable clinical phenotypes. We derived human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CM) from asymptomatic and symptomatic HERG mutation carriers from the same family. When comparing asymptomatic and symptomatic single LQT2 hiPSC-CMs, results from allelic imbalance, potassium current density, and arrhythmicity on adrenaline exposure were similar, but a difference in Ca2+ transients was observed. The major differences were, however, observed at aggregate level with increased susceptibility to arrhythmias on exposure to adrenaline or potassium channel blockers on CM aggregates derived from the symptomatic individual. The effect of this mutation was modeled in-silico which indicated the reactivation of an inward calcium current as one of the main causes of arrhythmia. Our in-vitro hiPSC-CM model recapitulated major phenotype characteristics observed in LQT2 mutation carriers and strong phenotype differences between LQT2 asymptomatic vs. symptomatic were revealed at CM-aggregate level.

In the frame, road map for Australian sport on an uncertain journey through COVID-19

In the frame, road map for Australian sport on an uncertain journey through COVID-19

Less femoral cartilage deformation following walking associates with clinically relevant symptoms in individuals with anterior cruciate ligament reconstruction

Purpose: Approximately one-third of individuals with an anterior cruciate ligament reconstruction (ACLR) develop post-traumatic knee osteoarthritis (PTOA) within the first decade following ACLR. Currently there is a need to develop methods of early detection of PTOA, as articular cartilage damage is irreversible. Diagnostic brightness-mode (B-mode) ultrasound has been used to evaluate femoral cartilage deformation, evidenced by a decrease in cross-sectional area (CSA), following 30 minutes of treadmill walking in healthy uninjured individuals. Additionally, femoral cartilage CSA is greater in the ACLR limb compared to the uninjured limb in a resting state, which is similar to results from magnetic resonance imaging studies hypothesized to demonstrate cartilage swelling following joint injury. It remains unknown if the magnitude of femoral cartilage deformation following a standardized walking protocol is related to clinically relevant symptoms (CRS) in those with an ACLR. Persistent CRS, measured with the Knee Osteoarthritis and Injury Outcome Score (KOOS), have been reported in 39% of individuals six years following ACLR. The purpose of the current study was to determine the magnitude of femoral cartilage deformation following a standardized walking protocol which best-identified individuals with CRS. We hypothesized that individuals with this magnitude of femoral cartilage deformation would also be more likely to demonstrate CRS. Methods: Thirty-two individuals (56% female, 22±4 years old, 23.8±2.8 kg/m2body mass index, 50±37 months since ACLR) with a history of primary unilateral ACLR were recruited for a cross-sectional descriptive laboratory experiment. Femoral cartilage CSA was measured with B-mode ultrasound immediately prior to and following 3,000 steps of walking on a treadmill at a self-selected comfortable speed. Prior to the pre-walking ultrasound images, individuals rested in the long-sit position for 45 minutes to allow the cartilage rebound for a baseline CSA assessment. Individuals moved their knee into 140° of flexion to capture the anterior portion of the femur on the ultrasound during imaging. Femoral cartilage was segmented using ImageJ software, and cartilage deformation on the involved limb was calculated as a percent change (%Δ)from baseline, with negative %Δ indicating deformation following walking. All individuals were classified as symptomatic or asymptomatic based on previously defined cutoff values for the KOOS. A symptomatic individual was defined as scoring ≤ 87.5 on the quality of life portion of the KOOS as well as scoring below the cutoff of at least two other subscales of the KOOS questionnaire (KOOS Symptoms ≤ 85.7; KOOS Pain ≤ 86.1; KOOS ADL ≤ 86.8, KOOS Sports ≤ 85.0). Fourteen of the 32 individuals were classified as symptomatic. Area under the curve (AUC) values were calculated using receiver operator characteristic curve analysis to determine the capacity of femoral cartilage deformation to identify symptomatic individuals. If a significant AUC was determined (i.e. AUC 95% confidence intervals [CI] did not cross 0.5), we identified the cutoff value maximizing sensitivity and specificity. Lastly, an odds ratio was calculated to demonstrate the association between the cartilage deformation cutoff score and symptoms. Results: Femoral cartilage deformation -0.15±4.47%Δ, range: -8.18 - 13.87%Δ) displayed fair accuracy (AUC = 0.70; 95% CI, 0.51 - 0.89) for identifying symptomatic individuals. A femoral cartilage deformation cutoff of -0.29% was found to maximize sensitivity (0.79) and specificity (0.67). Individuals whose femoral cartilage did not deform by at least -0.29%Δ (meaning cartilage CSA stayed the same or increased during walking) displayed 7.33 (1.47 - 36.66) times higher odds of being symptomatic. Conclusions: Contrary to our hypothesis, individuals who did not demonstrate deformation of at least -0.29%Δ in the involved limb during 3,000 steps were more likely to report CRS. Sixteen individuals (50%) did not demonstrate deformation and experienced an increase in CSA during walking. Overall, while the mean is small and the standard deviation is large, this reflects half of participants increased CSA while the other half decreased CSA during walking. Individuals who demonstrated an increase in femoral cartilage CSA following walking were more likely to be symptomatic. Preliminary data demonstrates femoral cartilage in uninjured controls deforms (-1.33±1.65%) following 3,000 steps, which may indicate that femoral cartilage deformation is a healthy response to walking. The mechanism leading to an increase in CSA following 3,000 steps in these ACLR individuals remains unknown. It is possible increased CSA following walking is due to altered cartilage composition or aberrant biomechanics, which may promote cartilage swelling or altered fluid shifts within the tissue during movement.

A review of functional gastrointestinal disorders: A primer for mental health professionals

Functional gastrointestinal disorders (FGIDs) are chronic, recurrent, frequently debilitating disorders with no identifiable underlying pathology. They occur due to a complex interplay between biological, psychological, and social factors and are some of the most common conditions encountered in general clinical practice as well as the specialist gastroenterological clinic. The top-down regulation of visceral sensations plays an important role in the pathophysiology of the disease, i.e., the central processing of emotions and stressors altering the sensory and motor components of the gut, which increases hypersensitivity and therefore symptom severity. In addition, the core personality traits of the individual play their part in the way symptoms are perceived, further providing proof for the long-prevailing belief that the gut and emotions are linked, the so-called “gut feeling.” The current diagnostic criteria for FGIDs are entirely based on subjective symptoms, challenging in itself due to the varied presentations, and further complicated by the current unavailability of objective laboratory tests which could confirm its presence in the symptomatic individual. The various treatment modalities include psychotherapies ranging from cognitive behavioral therapy to mindfulness, along with appropriate pharmacotherapy to treat physical and psychiatric comorbidities. Addressing all these underlying causes, in addition to weighing in the genetic makeup of the individual, is necessary for delineating accurate prognosis, reducing attending health-care costs, and improving overall outcome of the individual.

Trauma and the Family: A Systems‐oriented Approach

Since at least the middle of the 19th century clinicians have been interested in the symptoms expressed by individuals following exposure to situations inducing severe and chronic stress (trauma). The symptom cluster has been labelled differently over the years. The current diagnosis of post‐traumatic stress disorder (PTSD) refers to these symptoms. Although not formally noted in the diagnostic categories, the literature has included much discussion of complex of PTSD (C‐PTSD), also often referred to as disorders extreme stress not otherwise specific (DESNOS). The linking of PTSD and C‐PTSD to early developmental environments represents an important step in understanding the individual's susceptibility to subsequent stress. The focus of clinical assistance has generally settled on the symptomatic individual. Various treatment approaches and techniques have been applied with varying results. The notion that the individual symptoms might be addressed with therapeutic processes applied beyond the individual to the relationship systems, particularly the family, in which the symptomatic individual lives and functions, has received less attention. The idea of chronic anxiety, included in Bowen's discussion of the relationship between anxiety and family relational activity (Bowen, ), provides a conceptual framework from which specific therapeutic processes directed to the relationship system itself can be hypothesised and implemented.

Aetiology of diarrhoeal disease and evaluation of viral–bacterial coinfection in children under 5 years old in China: a matched case–control study

Globally, diarrhoeal diseases are the second leading cause of death among children under 5 years old. Few case–control studies on the aetiology of diarrhoea have been conducted in China. A case–control study on 922 children under 5 years old who presented with diarrhoea and individually matched controls was conducted in China between May 2011 and January 2013. Quantitative PCR was used to analyze stool samples for 10 diarrhoeal pathogens. Potential enteric pathogens were detected in 377 (81.8%) of 461 children with diarrhoea and 215 controls (46.6%, p <0.001). Rotavirus, norovirus GII, Shigella and adenovirus were qualitatively associated with diarrhoea. Using receiver operating characteristic curves, the optimal cutoff threshold for defining a symptomatic individual was 72, 5840, and 104 copies per reaction for rotavirus (odds ratio 259), norovirus GII (odds ratio 10.6) and Shigella (odds ratio 5.1). The attributable fractions were 0.18 for rotavirus, 0.08 for norovirus GII, 0.01 for Shigella and 0.04 for adenovirus. Coinfections between pathogens were common. Two pairs, rotavirus and adenovirus, and norovirus GII and Salmonella were positively associated. The co-occurrence of rotavirus and sapovirus, astrovirus, enterotoxigenic Escherichia coli or Campylobacter jejuni only occurred in children with disease. Coinfection was not correlated with clinical symptoms. Quantitative data are critical. Our results indicate that increased pathogen loads increase the OR between diarrhoea and rotavirus, norovirus GII and Shigella. Coinfections with rotavirus and norovirus GII are common and occur in a nonrandom distribution. Despite testing for ten diarrhoeal pathogens, over two-thirds of cases do not have a recognized attributable cause.