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This study explores and compares the impact of in-person and online versions of a Research-based Theatre production named "Alone in the Ring," aimed at increasing knowledge and fostering positive attitudes towards persons with disabilities in healthcare professions. The study examines changes in attitudes towards disabled persons in healthcare professions, levels of engagement in the play and knowledge about the experiences and challenges of disabled individuals in healthcare professions. It also investigates possible actions to increase inclusion for disabled persons in healthcare education and practice. Disabled students face numerous barriers in healthcare education and practice, many of which are rooted in stigma and negative attitudes. Research-based Theatre promotes experiential learning to address these attitudes and stereotypes. The performance "Alone in the Ring" is based on a comprehensive study of the experiences of disabled students and clinicians in health professions, aiming to promote inclusion for students with disabilities in these fields. This study uses a pre-test and post-test design with two comparison groups. The study employed an explanatory sequential mixed method design to explore the impact of online versus in-person Research-based Theatre teaching in healthcare education. Participants were graduate health students (N = 198); 100 watched the in-person version and 98 watched the online version. Surveys were administered before and after the performance. Participants were also invited to share their experiences in semi-structured interviews and their responses were analyzed using thematic analysis. Results indicated that students generally felt more comfortable with disabled persons in healthcare professions in the post-survey compared to the pre-survey, with online participants reporting greater comfort and higher engagement than those in-person. Knowledge of disabled persons' experiences and challenges, as well as possible actions to increase belonging and inclusion, improved significantly for both groups from pre- to post-performance, with online participants showing a greater change. Qualitative data revealed that online theatre was perceived as authentic and beneficial for accessibility, engagement and emotional impact on students, though challenges included potential distractions and technological issues. Positive correlations were found between changes in knowledge, positive attitude and engagement, suggesting that increased engagement and a shift in attitudes can promote knowledge and awareness of the inclusion of disabled persons in healthcare professions. These results support the use of online theatre-based academic teaching that experientially engages students, increases empathy and can promote more inclusive healthcare educational settings for disabled persons. [ABSTRACT FROM AUTHOR]

Background: Major depressive disorder (MDD) is characterized by impairments in emotional and cognitive functions. Emerging studies have shown that cognition and emotion interact by reaching identical brain regions, and the insula is one such region with functional and structural heterogeneity. Although previous literatures have shown the role of insula in MDD，it remains unclear whether the insular subregions show differential change patterns in MDD.Methods: Using the resting-state fMRI data in a group of 23 drug-free MDD patients and 34 healthy controls (HCs), we investigated whether the abnormal connectivity patterns of insular sub-regions or any behavioural correlates can be detected in MDD. Further hierarchical cluster analysis was used to identify the functional connectivity-clustering patterns of insular sub-regions.Results: Compared with HCs, the MDD exhibited higher connectivities between dorsal agranular insula and inferior parietal lobule and between ventral dysgranular and granular insula and thalamus/habehula, and lower connectivity of hypergranular insula to subgenual anterior cingulate cortex. Moreover, the three subregions with significant group differences were in three separate functional systems along anterior-to-posteior gradient. The anterior and middle insula showed positive correlation with depressive severity, while the posterior insular was to the contrary.Limitations: The small and unbalanced sample size, only included moderate and severe depression and the possible inter-individual differences may limit the interpretability.Conclusions: These findings provided evidences for the MDD-related effects in functional connectivity patterns of insular subregions, and revealed that the subregions might be involved in different neural circuits associated with the contrary impacts on the depressive symptoms. [ABSTRACT FROM AUTHOR]

Introduction: The intoxicated person may cause harm to others, often requiring expert evaluation for the determination of guilt. The primary aim of this study was to determine the mechanisms of mistakes that led 17 doctors accused of working under the influence of alcohol to face malpractice. We also wanted to clarify what were the legal, professional, and financial consequences - depending on specific patient outcomes.Method: We based analysis on the review and meta-analysis of the past forensic evaluation reports of institution-run forensics programs. Furthermore, we apply thematic analysis using combination of grounded theory and Pierre Bourdieu's theoretical framework.Results: During the 2010-2016 timeframe, the regional forensic service opinionated on 17 physicians (3F, 14M) subjected to disciplinary action due to providing treatment under the influence of alcohol. In total, there were 157 patients potentially affected by malpractice - out of those, four were harmed; only one qualified for compensation. In the remaining 153 patients - only 11 persons reported having had awareness about the doctors' intoxication and apparent inability to perform the job, yet they agreed to receive care. Overall, in over 90% of patients, the physician did not harm anyone to a degree threatening patient's life. The supporting staff did not report experiencing distress either. The results of a blood test for the presence of alcohol were available for only four cases. Therefore, it was impossible to analyze the correlation between intoxication level and performance in providing care. All in all, in our analysis - less than 10% of 157 patients' care were compromised by provider's intoxication, either due to a mistake in diagnosis, medical procedure, or lacking communication skills.Conclusion: For physicians, working under the influence of alcohol is an uncommon phenomenon, but when it occurs - patients are at risk for receiving poor treatment. Presented analysis indicates that patients - just as much as supporting staff - frequently agree to receive supervision and care from a drunk doctor, despite possible harm. Therefore, it is evident that patients as much as supporting staff fear retaliation, leading to underreporting of these cases. [ABSTRACT FROM AUTHOR]

The websites of many physician health programs provide lists describing signs of impairment or indications to refer physician-employees for evaluation and possible treatment. This study aimed (1) to determine how many of these descriptions likely provide physicians' employers with sufficient evidence to legally request mental health examinations under the general regulations of the Americans with Disabilities Act (ADA); and (2) to find out who they described. The authors applied US Equal Employment Opportunity Commission guidance documents and sought expert legal advice to evaluate the descriptions for their consistency with the ADA. They used directed content analysis to review and code these descriptions into categories. Very few, if any, of the 571 descriptions appeared to provide sufficient evidence for employers to request an examination under the ADA. About 14%, however, could refer to physicians attempting to defend themselves, assert their ADA rights, or otherwise complain about the hospital; and 27% either described physicians who complain or else had discriminatory effects in one of several different ways. Leaders within the medical field should ensure that their policies and state laws pertaining to physician impairment comply with and incorporate the language of the ADA. They should also reevaluate the functions of these policies, laws, and physician health programs, and the implications for patient safety, physician wellness, suicide, and other important issues. [ABSTRACT FROM AUTHOR]

Previous research indicates that employees with long commutes suffer from impaired health. In this paper, we argue that this relation should be conceptualized within a stress–strain framework. Using data from 1928 expatriate employees of the German Foreign Office, we test the mediating role of perceived stress in the relation between daily commuting time and health-related quality of life (HRQOL). We find that long commutes are associated with substantially lower HRQOL and that this relation is well-accounted for by associated increases in stress, particularly among parents. We discuss how a stress perspective can inform future research on commuting impacts and implications for individual, organizational, and policy interventions to mitigate adverse consequences of commuting. [ABSTRACT FROM AUTHOR]

Previous studies have found an association between motor immaturity and developmental language impairment in children. However, systematic investigations of somatosensory dysfunctions that might be linked to motor deficits in children with developmental language disorder (DLD) are lacking. Examined haptic perception and motor skills in school-age children with DLD and typically-developing (TD) children. Sixteen children with DLD and sixteen age-matched TD children performed a curvature detection task measuring haptic sensitivity and a curvature discrimination task measuring haptic acuity. The Movement Assessment Battery for Children, 2nd edition (MABC-2) was also conducted to evaluate children's motor ability. The results revealed elevated thresholds of both haptic detection (67.5%) and haptic discrimination (67.9%) in the DLD group when compared to the TD group. In addition, the children with DLD performed significantly less well on the manual dexterity of MABC-2. Finally, a lower haptic acuity was associated with poorer manual dexterity scores of MABC-2. This study demonstrates for the first time that not only motor skills, but also haptic function is altered in children with DLD. The observed association between manual dexterity and haptic acuity suggests a close relationship between haptic and motor skills in school-age children. • Haptic sensitivity is altered in children with DLD, with the group mean detection threshold in children with DLD being 67.5% higher than that in their peers. • Half of the children with DLD score below the 5th percentile of the normative mean on a standardized movement assessment. • Children with DLD show poorer manual dexterity than their peers. • Decreased haptic acuity is significantly linked to lower levels of fine motor function in children with DLD. [ABSTRACT FROM AUTHOR]

Background When health professionals practice with active and untreated addiction, it is a complex occupational and professional issue impacting numerous stakeholders. Health professionals are responsive to evidence-based addiction interventions and their return-to-work has been demonstrated to be achievable, sustainable and safe. Facilitating help seeking in health professionals with addiction is a priority for reducing associated risks to their health and to patient safety. Aim The purpose of this study was to identify the process by which health professionals seek help for addiction, and factors that facilitate and deter help seeking, through a review of the qualitative and quantitative literature. Methods Both phases of this sequential mixed studies review followed the standard systematic review steps of: (1) identifying the review question, (2) defining eligibility criteria, (3) applying an extensive search strategy, (4) independent screening of titles and abstracts, (5) selecting relevant studies based on reviewing the full text, (6) appraising the quality of included studies, and (7) synthesizing the study findings. Our two searches of five databases from 1995 to 2015 resulted in the inclusion of eight qualitative and twenty-three quantitative studies. We first conducted a meta-synthesis of the qualitative literature to garner an understanding of the help seeking process for health professionals for addiction. We then conducted a narrative synthesis of the quantitative studies to generalize these findings through examining the data for convergent, complementary or divergent results. Results Synthesis of the included qualitative studies revealed that the professional and experiential context of healthcare compromised the health professional's readiness to seek help for addiction. Typically, a pivotal event initiated the help seeking process. The studies in the quantitative review identified that help seeking most often resulted from reports of adverse events to formal organizations such as their employer and regulatory bodies. This process does not adequately address the scope of health professionals requiring help for addiction. Informal sources such as colleagues and family, often aware of the addiction earlier, preferred referral to voluntary, confidential treatment programs. Conclusions Facilitating the help seeking process for health professionals with addiction in as effective strategy to reduce the associated risks to the health professional, their families and colleagues, their employers and regulatory bodies, and to the general public. Our findings suggest that intervention is possible at multiple points in the help seeking process for health professionals with addiction. Confidential, compassionate and supportive alternatives offer potential for closing this gap. [ABSTRACT FROM AUTHOR]

Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. The content is also available on www.palliativedrugs.com and will feature in future editions of the Hospice and Palliative Care Formulary USA and its British and Canadian counterparts. The series editors welcome feedback on the articles ( hq@palliativedrugs.com ). [ABSTRACT FROM AUTHOR]

Abstract: Accumulating evidence suggests that oxidative stress induced mechanisms are believed to be associated with the pathophysiology of autism. In this study, we recruited 19 Omani autistic children with age-matched controls to analyze their plasma and serum redox status and the levels of ATP, NAD+ and NADH using well established spectrophotometric assays. A significant decrease was observed in the levels of plasma total antioxidants (TA), reduced glutathione (GSH), superoxide and catalase activity in Omani autistic children as compared to their age-matched controls. In contrary, the level of plasma glutathione peroxidase (GSH-Px) was significantly increased in autistic children. Reduced serum NAD+ and ATP levels and lower NAD+:NADH ratio were observedin patients with autism compared to controls. Finally, a significant inverse correlation was observed between plasma GSH, SOD, catalase activity, and serum NAD+ and ATP levels, and autism severity using Childhood Autism Rating Scale (CARS) scores. The levels of plasma GSH-Px and serum NADH correlated strongly with autism severity whilst no significant correlation was observed for plasma TA. Our data suggests that increased vulnerability to oxidative stress in autism may occur as a consequence of alterations in antioxidant enzymes leading to mitochondrial dysfunction. [Copyright &y& Elsevier]

Abstract: Steady vocal pace performance according to a multi-level syllable repetition paradigm has been previously shown to be compromised in patients in advanced stages of Parkinson''s disease (PD) under chronic deep brain stimulation. The aim of the present study was to implement the same syllable repetition test in mildy to moderately affected patients in order to survey if (a) the characteristic pattern of abnormalities can be observed even in early stages of PD and (b) if there are correlations to motor symptoms of PD. Sixty-four patients with PD who were on stable dopaminergic medication and 40 healthy subjects had to repeat a single syllable (/pa/) or a pair of alternating syllables (/pa-ti/) in a self chosen steady pace or in a given pace of 80/min. As main results, PD patients’ pace performance was (1) already irregular in the simple steady syllable repetition task, (2) even more impaired when a given pace had to be kept and (3) showed a further decline when two alternating syllables had to be repeated in a given pace; (4) measures of irregular pace performance showed a correlation to axial motor symptoms. This pattern of impaired vocal pace performance was similar, although less pronounced, to the previously reported findings in advanced PD and therefore might be a characteristic feature of PD. The results could be interpreted as a hint for increasing disruption of automaticity in speech performance with rising complexity of the task which can be found even in early stages of PD and correlate to axial motor symptoms. [Copyright &y& Elsevier]

Abstract: To characterize the altered directed connectivity within a distributed cortical network, as is associated with the impaired attention modulation involved in the manifestation of mood disorder in depression, short-window partial directed coherence (PDC) combining with the event-related brain potentials (ERPs) was applied in this study. ERPs were recorded from 13 normal subjects and 12 depressed patients during visual search for facial expressions. The evoked N2 component of ERPs by responding to all neutral faces (F(1,22)=5.51, P<0.05) and the positive face was reduced in the depressed patients as compared to the normal subjects (F(1,22)=5.71, P<0.05), while the evoked N2 component by detecting the negative face showed no significant between-group effect (F(1,22)=2.10, P=0.16). The reduced N2 amplitude reflected deficits in effortful attentional modulation in depression. Obtained PDC values within the N2 time-window (150–300ms post stimulus) showed weaker intra-frontal and intra-central directed interactions and enhanced occipital information output when responding to all neutral faces in depression relative to those in the normal group. Few decreased intra-frontal directed interactions were observed when detecting the emotional face in depression. The altered cortical directed connectivity contributed to the impairment occurring in the effortful attention modulation in depression. Our findings supported that the impaired attention modulation processing in depression was associated with the altered cortical connectivity. [Copyright &y& Elsevier]

Abstract: An enlarged volume of the pituitary gland has been reported in the schizophrenia spectrum, possibly reflecting the hypothalamic–pituitary–adrenal (HPA) hyperactivity. However, it remains largely unknown whether the pituitary size longitudinally changes in the course of the spectrum disorders. In the present study, longitudinal magnetic resonance imaging (MRI) data were obtained from 18 patients with first-episode schizophrenia, 13 patients with schizotypal disorder, and 20 healthy controls. The pituitary volume was measured at baseline and follow-up (mean, 2.7years) scans and was compared across groups. The pituitary volume was larger in the schizophrenia patients than controls at baseline, and both patient groups had significantly larger pituitary volume than controls at follow-up. In a longitudinal comparison, both schizophrenia (3.6%/year) and schizotypal (2.7%/year) patients showed significant pituitary enlargement compared with controls (−1.8%/year). In the schizophrenia patients, greater pituitary enlargement over time was associated with less improvement of delusions and higher scores for thought disorders at the follow-up. These findings suggest that the pituitary gland exhibits ongoing volume changes during the early course of the schizophrenia spectrum as a possible marker of state-related impairments. [ABSTRACT FROM AUTHOR]

Abstract: In this article we assess the prevalence rates of harmful spirit possession, different features of the spirits and of their hosts, the correlates of the spirit possession experience, health patterns and the sources of health care consulted by possessed individuals in a population sample of 941 adults (255 men, 686 women) in post-civil war Mozambique in 2003–2004. A combined quantitative–qualitative research design was used for data collection. A major study outcome is that the prevalence rates vary according to the severity of the possession as measured by the number of harmful spirits involved in the affliction. The prevalence rate of participants suffering from at least one spirit was 18.6 percent; among those individuals, 5.6 percent were suffering from possession by two or more spirits. A comparison between possessed and non-possessed individuals shows that certain types of spirit possession are a major cause of health impairment. We propose that knowledge of both local understandings of harmful spirit possession and the community prevalence of this kind of possession is a precondition for designing public health interventions that sensitively respond to the health needs of people afflicted by spirits. [Copyright &y& Elsevier]

Abstract: Aims: The current study was undertaken to determine the role of dorsal hippocampal N-methyl-d-aspartate (NMDA) receptors in nicotine''s effect on impairment of memory by ethanol. Main methods: Adult male mice were cannulated in the CA1 regions of dorsal hippocampi and trained on a passive avoidance learning task for memory assessment. Key findings: We found that pre-training intraperitoneal (i.p.) administration of ethanol (0.5 and 1g/kg) decreased memory retrieval when tested 24h later. Pre-test administration of ethanol reversed the decrease in inhibitory avoidance response induced by pre-training ethanol. Similar to ethanol, pre-test administration of nicotine (0.125–0.75mg/kg, s.c.) prevented impairment of memory by pre-training ethanol. In the animals that received ethanol (1g/kg, i.p) before training and tested following intra-CA1 administration of different doses of NMDA (0.0005–0.005µg/mouse), no significant change was observed in the retrieval latencies. Co-administration of the same doses of NMDA with an ineffective dose of nicotine (0.125mg/kg, s.c.) significantly improved the memory retrieval and mimicked the effects of pre-test administration of a higher dose of nicotine. Pre-test intra-CA1 microinjection of MK-801 (0.25–1µg/mouse), which had no effect alone, in combination with an effective dose of nicotine (0.75mg/kg, s.c.) prevented the improving effect of nicotine on memory impaired by pre-training ethanol. Moreover, intra-CA1 microinjection of MK-801 reversed the NMDA-induced potentiation of the nicotine response. Significance: The results suggest the importance of NMDA glutamate system(s) in the CA1 regions of dorsal hippocampus for improving the effect of nicotine on the ethanol-induced amnesia. [Copyright &y& Elsevier]

You are the chief-of-surgery at a major urban medical center. Dr X is a 69-year-old vascular surgeon who has been a close friend for years. Dr X has had excellent clinical results throughout her career, but recent cases reviewed by the Deaths & Complications Conference suggest that her complication rate has risen. Also, during the last year, anecdotal reports from several sources have indicated her professional behavior occasionally is somewhat uneven. This Monday morning, a surgeon with a well-known long-standing dislike of Dr X came to your office, reporting indignantly that he detected the odor of alcohol when Dr X arrived for an emergency case last evening. How should this be handled? [A] Refer the matter to the hospital chief-of-staff [B] Meet about the report, interview the other parties, document your findings, and refer for counseling, if indicated [C] Appoint an investigative committee, which you will chair [D] Meet with Dr X and document your findings [E] Make extensive notes and wait to see if it happens again. [Copyright &y& Elsevier]