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Striving to recover – wrist splint or plaster cast: a qualitative study of patients’ experience of recovery after a distal radius fracture
Get PDFAims
We sought to explore patients’ experience of early recovery from a fracture of the wrist (distal radius). This study was nested in the DRAFT-CASP randomized controlled trial (RCT), which explores the effectiveness of two treatment pathways for patients with a fracture of the distal radius that does not require manipulation: a plaster cast which is removed in fracture clinic, versus a wrist splint that patients remove themselves without returning to hospital.
Methods
Qualitative interviews were undertaken with 21 adults (mean age 58.2 years (SD 13.96), six male), from eight NHS hospitals, four to ten weeks post injury. Interviews were informed by phenomenology and analyzed using reflexive thematic analysis.
Results
We identified the overarching theme ‘striving to recover’, which conveys patients’ determination to get back to normal after a wrist fracture. To recover, patients needed to be comfortable, to adapt, and to be certain that their wrist was healing. Early in their recovery, they were unable to complete their daily activities, experienced pain, loss of strength, worry, and were cautious about using their wrist. Overall, both treatments were considered acceptable. The splint was advantageous for the freedom and control it provided. The cast was valued for the protection and safety it provided. Both groups required more information and reassurance, but had varied views on the need for follow-up appointments.
Conclusion
The splint made life easier for patients and was an acceptable treatment. Patients wanted reassurance that their wrist was healing, but they felt this could be achieved in a variety of ways. Most patients coped without a follow-up appointment. Innovative ways to maximize recovery are required. These include support for patients to, manage their pain and provide comfort, be able to adapt, and feel certain of healing. Sharing patients’ experiences may help future patients to make informed treatment and recovery decisions
Early environmental risks and the developmental dynamics of internalizing and externalizing problems from birth to adolescence
Get PDFInternalizing and externalizing problems often co-exist throughout an individual's development, shaped by a shared set of early environmental risks. However, most existing studies focused on discrete developmental periods, limiting understanding of how the negative impact of early-life adversity on mental health varies with age. Using data from 7,377 participants across seven waves of the UK Millennium Cohort Study (MCS), the current study investigated the bidirectional associations between internalizing and externalizing problems from ages 5 to 17, as well as the long-term impact of early environmental risks (i.e., prenatal influences, neonatal factors, maternal mental health, harsh parenting, and socioeconomic status) on the two symptom domains across time. Random-intercept cross-lagged panel analyses indicated that individuals with higher internalizing symptoms tended to report higher externalizing symptoms, with both symptom domains showing high stability over time. A significant positive bidirectional relationship between internalizing and externalizing problems was found from childhood to early adolescence. However, this pattern diverged in late adolescence: internalizing problems at age 14 no longer predict externalizing problems at age 17, whereas externalizing problems negatively predict subsequent internalizing symptoms. Early environmental risk factors significantly predicted both internalizing and externalizing problems from ages 5 to 14, with the effects generally decreasing with age, except for an increase at age 11. Gender differences were also observed in both the bidirectional relationships between the symptom domains and the long-term impact of early environmental risks. Findings underscore the enduring impact of early adversity on adolescent mental health and highlight the complex, evolving interaction between internalizing and externalizing problems. The study offers critical insights for early, sustained interventions that address multiple risks and adapt to adolescents' changing mental health needs over time
Next Generation EU, PNRR e settore culturale: profili critici dell'attuazione e il caso di Wikipedia
Get PDFSommario: 1. Il contributo del Next Generation EU alla ripresa culturale. – 2. Il recepimento italiano: PNRR, PND e d.m. 161/2023. – 3. Il caso di Wikipedia e l’opposizione di Wikimedia Italia: profili critici e problematiche concrete del nuovo tariffario. – 4. Il d.m. 108/2024: parziali migliorie e prospettive di sviluppo
Addressing mental health challenges in clinical practice: a qualitative study to investigate perspectives of international mental health experts
Get PDFIntroduction: Mental illnesses are not only associated with the highest level of subjective suffering compared to other chronic diseases but at the same time with a significantly increased morbidity. Especially in industrialized countries, a dramatically increasing proportion of sick leave and early retirement due to mental illness diagnoses is observed, pointing to increased social stress factors and a close association with societal changes and emphasizing challenges to the health care system. The following qualitative study was conducted as part of the establishment of the German Center for Mental Health, which unites excellence in psychiatric, psychological and neuroscientific research in Germany to facilitate translation of basic into clinical research and general health care. Methods: A 120-minute, guided, virtual focus group discussion was conducted with international experts in the field of mental health research from Chile, the USA, the UK, South Africa, and Australia to represent views from different continents. The participants discussed international trends, unrecognized needs and gaps in clinical practice and recognized many opportunities and challenges in the research of the different topics of the German Center for Mental Health. Furthermore, the focus areas of the German Center were presented, and participants were asked about the opportunities and challenges in researching these topics. The evaluation method was based on qualitative content analysis according to Mayring. The focus group discussion was transcribed and coded with MAXQDA 2022 software. The reliability of the coding was checked by using the intercoder reliability and Cohens Kappa. Results: The experts emphasized the high mortality due to comorbidity of somatic and mental disorders including addiction and called for a mechanism-based approach to promote individualized treatment. Furthermore, the impact of poverty, social exclusion, stigma and discrimination was addressed as a key modifiable environmental risk factor. The experts highlighted digital tools, computational models and AI based approaches for precision psychiatry. To systematically evaluate real-world outcomes, the experts emphasized the need for interdisciplinary research including behavioral, computational, social, and neurobiological scientists and experts by experience. Discussion: This study highlights the need for interdisciplinary and participatory approaches in mental health research. Key challenges include the high comorbidity of mental and physical disorders, the impact of social determinants, and gaps in translating research into practice. Experts emphasized the importance of digital tools, computational psychiatry, and community-based interventions to enhance prevention and treatment. The German Center for Mental Health (DZPG) is well-positioned to address these challenges by integrating diverse expertise and fostering innovation in mental health care
The genome sequence of the Nut-tree Tussock moth, Colocasia coryli (Linnaeus, 1758) (Lepidoptera: Noctuidae) [version 1; peer review: 2 approved]
Get PDFRevealed beliefs and the marriage market return to education
Get PDFWe develop a new methodology to estimate subjective beliefs from hypothetical choice data. Our identification approach is based on the novel insight that by varying the amount of information on future realizations of stochastic variables, discrete choice experiments can identify not only preferences, but also subjective beliefs. We formally prove this result in a general setting and apply it to design a strategic survey instrument to measure Rajasthani parents’ subjective beliefs over the joint distribution of girls’ age of marriage, education, and marriage match quality. Our approach allows us to quantify the importance of perceived marriage market returns to education and youth, and perform various counterfactual simulation exercises. We find that eliminating the perceived marriage market return to education causes a 60% drop in the number of girls still in school at age-16, and almost none continue their education by age-18. Responses to our strategic survey instrument allow us accurately to predict realized schooling trajectories in follow-up data we collect from the same sample five years after our experimental data collection
Proneural–mesenchymal hybrid glioblastoma cells are resistant to therapy and dependent on nuclear import
Get PDFBackground: Despite extensive research efforts, glioblastoma (GBM) remains a deadly disease with poor prognosis. Although previous studies have identified various cell states within GBM tumors, the molecular mechanism underlying adaptive GBM cell plasticity induced by conventional therapy remains unclear. Methods: We used fluorescent reporters for proneural (PN) and mesenchymal (MES) subtypes to monitor GBM cell plasticity in real-time across multiple patient-derived cell lines. This approach revealed cells that concurrently expressed both PN and MES markers. To investigate this unique hybrid population, we implemented a comprehensive methodological approach encompassing bulk and single-cell RNA sequencing, single-cell ChIP sequencing, nuclear proteomics, high-resolution imaging, orthotopic mouse models, clinical dataset analysis, and pharmacological and genetic techniques. This multifaceted strategy allowed us to gain functional and molecular insights into this distinct cellular population. Results: We showed that these hybrid cells are increased by conventional therapies, and are resistant to these therapies. At the molecular level, hybrid cells display significant alterations in chromatin structure and nuclear protein composition, elevated transcriptional activity, Myc activation, and improved transport between the nucleus and cytoplasm. Genetic and pharmaceutical inhibition of the nuclear import/export shuttling machinery, increased in hybrid cells, effectively suppressed adaptive GBM cell plasticity and hybrid identity, thereby enhancing the sensitivity of GBM cells to therapies. Conclusions: Our results indicate that GBM hybrid cells play a crucial role in chemoradiation resistance. The nuclear transport machinery presents a potential therapeutic target for hybrid cells, offering a way to counteract the typical resistance to treatment observed in GBM
The Pan-African Parliament's Model Law on Implementation: A missing link for domestic implementation of the judgments of the African Court on Human and Peoples' Rights
Get PDFOne of the central challenges in the implementation of any reparations awarded or recommended by supranational bodies such as the African Court on Human and Peoples' Rights lies in identifying what initiates the national-level administrative processes that must follow. Failure to implement is often attributed to a lack of 'political will', but this conceals the intricate network of factors, relationships and actors affecting the domestic implementation ofinternational judgments. Decisions from judicial and quasi-judicial organs of the African Union, such as the African Court, often have an unclear status when they reach the domestic level. They may not be considered 'foreign judgments' and, therefore, able to be enforced by domestic courts, nor are they 'self-executing'. In some states there is 'enabling legislation' which provides national courts with the ability to enforce decisions of supranational bodies, clarifies the process for their implementation or ensures the decisions are seen as self-executing. Model laws have been adopted by the Pan-African Parliament to offer practical, legislative guidance and solutions for national legislatures and state authorities. This article suggests that the Pan-African Parliament's draft Model Law on Implementation of Decisions of the African Human Rights Bodies (Model Law on Implementation) constitutes a missing link for implementation of the African Court. It offers a toolbox of clauses for states to use at the domestic level in order to bridge the gap between the supranational decisions and their national implementation in a practical way, offering a product that can be adapted by states to suit their national context
Deciphering cell-type-and temporally specific matrisome expression signatures in human cortical development and neurodevelopmental disorders via scRNA-seq meta-analysis
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Midterm Outcomes of Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation According to Anatomical Characteristics
Get PDFBackgroundMitral transcatheter edge-to-edge repair (M-TEER) is an established option for high-risk primary mitral regurgitation (PMR) patients, but data on the impact of anatomical complexity on prognosis are scarce and conflicting.ObjectivesThe aims of this study were to characterize patients with severe PMR undergoing M-TEER, assess mid-term prognosis after M-TEER, and identify prognostic factors based on PMR mechanism.MethodsData from symptomatic PMR patients with severe PMR treated with M-TEER between July 2013 and October 2023 at two Swiss centers were collected retrospectively until 2017 and prospectively thereafter. Patients were categorized by lesion type: A2-P2 prolapse/flail vs. non-A2-P2 prolapse/flail. A subset was classified by mitral valve (MV) anatomical complexity (defined by the presence of ≥1 of the following: ≥moderate calcifications, Barlow's disease, multiple prolapses, or commissural prolapses). Cox regression identified predictors of 1-year all-cause mortality.ResultsAmong 315 patients (mean age 82.2 ± 6.3 years, 46.3% female, European System for Cardiac Operative Risk Evaluation II 5.1% ± 4.1%) followed for a median (interquartile range [IQR]) of 13 months (5-33), technical success was 93.0%. Compared with the non-A2-P2 prolapse/flail group (n = 186), the A2-P2 prolapse/flail group (n = 129) had better echocardiographic outcomes at discharge (residual mitral regurgitation [MR] ≤ 1+: 70.5 vs. 60.4%; p = 0.031) and superior symptomatic improvement at 1 year (New York Heart Association class ≤ II: 91.4 vs. 74.5%; p = 0.017) but similar 1-year all-cause mortality (15.1 vs. 18.8%; p = 0.492). Among patients classified by MV anatomical complexity (n = 143), patients with complex MV anatomy (n = 68) had a higher mortality at a median (IQR) follow-up of 22 months (9-36) compared to those with noncomplex MV anatomy (n = 75) (51.5 vs. 34.7%; p = 0.042). Multivariate analysis identified complex MV anatomy and severe renal failure as predictors of 1-year all-cause mortality.ConclusionsMV anatomical characteristics have a significant influence on symptomatic improvement and all-cause mortality at 1 year and should be carefully considered during the selection of PMR patients for M-TEER