Whether initiation of statins could increase survival free of dementia and disability in adults aged ≥75 years is unknown. PREVENTABLE, a double‐blind, placebo‐controlled randomized pragmatic clinical trial, will compare high‐intensity statin therapy (atorvastatin 40 mg) with placebo in 20,000 community‐dwelling adults aged ≥75 years without cardiovascular disease, disability, or dementia at baseline. Exclusion criteria include statin use in the prior year or for >5 years and inability to take a statin. Potential participants are identified using computable phenotypes derived from the electronic health record and local referrals from the community. Participants will undergo baseline cognitive testing, with physical testing and a blinded lipid panel if feasible. Cognitive testing and disability screening will be conducted annually. Multiple data sources will be queried for cardiovascular events, dementia, and disability; survival is site‐reported and supplemented by a National Death Index search. The primary outcome is survival free of new dementia or persisting disability. Co‐secondary outcomes are a composite of cardiovascular death, hospitalization for unstable angina or myocardial infarction, heart failure, stroke, or coronary revascularization; and a composite of mild cognitive impairment or dementia. Ancillary studies will offer mechanistic insights into the effects of statins on key outcomes. Biorepository samples are obtained and stored for future study. These results will inform the benefit of statins for increasing survival free of dementia and disability among older adults. This is a pioneering pragmatic study testing important questions with low participant burden to align with the needs of the growing population of older adults.
There is very little literature on the actual decision-making frameworks used by general practitioners with respect to ethical issues and virtually none on the impact of personal experiences of illness on this. This study aimed to investigate what these frameworks might be and if and how they were altered by doctors' own illness experience. Twenty general practitioners were recruited, 10 having had a previous serious medical illness and 10 having no such history. They participated in a semi-structured interview, including case vignettes, recorded and analysed using qualitative thematic analysis. Being a patient themselves altered general practitioners' decision-making by enhancing physician empathy, increasing ease at discussing difficult topics, having a greater willingness to support patient choice and a wider ability to provide a greater diversity of therapeutic strategies, with the role of empathy being the most noticeable difference between the groups. Doctors who had not had a severe personal illness showed difficulty in anticipating how this might change their decision-making. Virtue ethics was most commonly used for decision-making by both groups. There was considerable divergence of opinion on the ethics and usefulness of self-disclosure of personal illness in both groups of doctors. These findings have implications for the teaching and learning of medical ethics at both undergraduate and postgraduate level.
Chemistry laboratories ordinarily involve a number of visual observations and require qualitative and quantitative explanations of these observations. A student with blindness at Truman State University successfully completed the laboratory portion of the nonmajors liberal arts chemistry course with the assistance of a senior undergraduate chemistry education major, the guidance of a chemistry professor with blindness, and a variety of alternative laboratory methods. Volumes were measured using a notched syringe or the graduated cylinder pipet technique. Changes in color were measured by a Color Analysis Laboratory Sensor (CALS) and a Submersible Audio Light Sensor (SALS). Balance and Vernier probe measurements were recorded using Vernier data acquisition software (Logger Pro 3.6) and Job Access with Speech (JAWS) screen review software. This paper reports the impact of these alternative methods on the level of participation of the student with blindness for the following experiments: Density Determination, Flame Emissions Tests, Simulation of the Measurement of Hemoglobin in the Blood Using Spectrophotometry, the Investigation of Hydrates, the Study of Chemical Reactions in Everyday Life, and Titrations. The Solutions, the Soap-Making, and Paper Chromatography laboratories are not reported. All the laboratories except the Density laboratory are part of the Chemistry 100 curriculum at Truman State University ("CHEM 100", 2010).
Objectives Research into the effects of mindfulness meditation indicates improvements in mental health and cognitive function. Mechanisms underpinning these improvements include increased attentional function and decreased emotional reactivity. These functions are engaged when an individual reacts to an error. As such, researchers have examined differences in neural activity between mindful and non-mindful groups during tasks that elicit error responses using electroencephalography (EEG). Event-related potentials associated with error-processing are primarily the error-related negativity (ERN) and error positivity (Pe), which occur ~ 0–150 ms and ~ 200–400 ms following an error. This meta-analysis aimed to determine the effects of mindfulness on ERN and Pe amplitudes. Methods Our literature search revealed 16 studies that examined the ERN (total N = 887, 469 mindfulness, 418 controls) and 12 studies that examined the Pe (total N = 747, 395 mindfulness, 352 controls). Results Results showed a weak association between mindfulness and more negative ERN amplitudes at electrode FCz, with inconsequential Bayesian evidence, after the analysis was restricted to studies including healthy participants only (Q(1) = 4.725, p = 0.030, BF10 = 1.714). The results also provided a preliminary suggestion that mindfulness reduced the Pe amplitude at electrode Pz (Q(2) = 8.023, p = 0.018), when studying individuals that had weeks to years of mindfulness practice (but not less than weeks of mindfulness practice). Conclusions The results do not provide good evidence that mindfulness meditation affects EEG measures of error processing. However, our findings are limited by heterogeneity and potential biases, and as such should be interpreted with caution. Protocol and Registration Systematic Review Registration: PROSPERO CRD42021249775.
Objective The aim was to determine the proportion of patients with inflammatory arthritis who have a flare of their rheumatological disease within 4 weeks of receiving a coronavirus disease 2019 (COVID-19) vaccine, using CRP as a surrogate marker. Methods A retrospective review was conducted of notes for patients with inflammatory arthritis within 30 days of their COVID-19 vaccine. An electronic database (DAWN) was used to identify all patients who were currently on a DMARD or biologic therapy. This was then correlated with vaccine data from the National Immunisation and Vaccination System (NIVS) and CRP within 30 days of their vaccination. Results From the DAWN database, 1620 adults were identified (mean age 61 years, 64% female). Three types of vaccinations were administered: AstraZeneca (AZ), BioNTech-Pfizer or Moderna. Vaccine uptake was 1542 of 1620 (95.2% for the first dose), 1550 of 1620 (95.7% for the second dose) and 1437 of 1620 (88.7% for the third dose). One hundred and ninety-two of 1542 patients (12.5%) had a CRP rise of >10 mg/l within 30 days of their vaccine, which was higher than the baseline flare rate of 8.6% (P = 0.0004). Conclusion Patients with inflammatory arthritis and on DMARDs have a high uptake of COVID-19 vaccine (95%), which is greater than the national average. A CRP rise >10 mg/l within 30 days of vaccination was observed in ∼1 in 10 patients in our study population after all three doses. There might be a slight increase in disease flare in patients with inflammatory arthritis after COVID-19 vaccinations, and additional research is required to assess this association further.
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