Marine-Derived Peptides with Anti-Hypertensive Properties: Prospects for Pharmaceuticals, Supplements, and Functional Food

Hypertension, a major health concern linked to heart disease and premature mortality, has prompted a search for alternative treatments due to side effects of existing medications. Sustainable harvesting of low-trophic marine organisms not only enhances food security but also provides a variety of bioactive molecules, including peptides. Despite comprising only a fraction of active natural compounds, peptides are ideal for drug development due to their size, stability, and resistance to degradation. Our review evaluates the anti-hypertensive properties of peptides and proteins derived from selected marine invertebrate phyla, examining the various methodologies used and their application in pharmaceuticals, supplements, and functional food. A considerable body of research exists on the anti-hypertensive effects of certain marine invertebrates, yet many species remain unexamined. The array of assessments methods, particularly for ACE inhibition, complicates the comparison of results. The dominance of in vitro and animal in vivo studies indicates a need for more clinical research in order to transition peptides into pharmaceuticals. Our findings lay the groundwork for further exploration of these promising marine invertebrates, emphasizing the need to balance scientific discovery and marine conservation for sustainable resource use.

The Interaction of Linguistic and Visual Cues for the Processing of Case in Russian by Russian-German Bilinguals: An Eye Tracking Study

Modulation of visual attention in the Visual World Paradigm relies on parallel processing of linguistic and visual information. Previous studies have argued that the human linguistic capacity includes an aspect of anticipation of upcoming material. Such anticipation can be triggered by both lexical and grammatical/morphosyntactic cues. In this study, we investigated the relationship between comprehension and prediction by testing how subtle changes in visual representations can affect the processing of grammatical case cues in Russian by Russian-German bilingual children (n = 49, age 8-13). The linguistic manipulation followed previous designs, contrasting SVO and OVS sentences, where the first NP (NP1) was marked with nominative or accusative case, respectively. Three types of visual displays were compared: (i) individual referents (potential agent/theme); (ii) pairs of referents (NP1 + potential agent/theme); and (iii) events (representing interactions between the referents). Participants were significantly more sensitive to the case manipulation when presented with events compared to the other two types of visual display. This suggests that they were able to quickly integrate the thematic role information signaled by grammatical case in the event representations. However, they were less likely to use the case information to anticipate upcoming arguments when the target pictures represented individual referents or pairs of noninteracting referents. We hypothesize that the process of argument anticipation is mediated by the activation of syntactic templates (SVO or OSV, depending on the case marking on NP1). The relatively weak anticipation effect observed may be attributed to the absence, or weak representation, of the noncanonical OVS template in the bilingual children's long-term memory.

Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: a national register-based cohort study

OBJECTIVES

This study aimed to investigate determinants of reperfusion within recommended time limits (timely reperfusion) for ST-segment elevation myocardial infarction patients, exploring the impact of geography, patient characteristics and socio-economy.

DESIGN

National register-based cohort study.

SETTING

Multilevel logistic regression models were applied to examine the associations between timely reperfusion and residency in hospital referral areas and municipalities, patient characteristics, and socio-economy.

PARTICIPANTS

7607 Norwegian ST-segment elevation myocardial infarction patients registered in the Norwegian Registry of Myocardial Infarction during 2015-2018.

MAIN OUTCOME MEASURES

The odds of timely reperfusion by primary percutaneous coronary intervention (PCI) or fibrinolysis.

RESULTS

Among 7607 ST-segment elevation myocardial infarction patients in Norway, 56% received timely reperfusion. The Norwegian goal is 85%. While 81% of the patients living in the Oslo hospital referral area received timely reperfusion, only 13% of the patients living in Finnmark did so.Patients aged 75-84 years had lower odds of timely reperfusion than patients below 55 years of age (OR 0.73, 95% CI 0.61 to 0.87). Patients with moderate or high comorbidity had lower odds than patients without (OR 0.81, 95% CI 0.68 to 0.95 and OR 0.61, 95% CI 0.44 to 0.84). More than 2 hours from symptom onset to first medical contact gave lower odds than less than 30 min (OR 0.63, 95% CI 0.54 to 0.72). 1-2 hours of travel time to a PCI centre (OR 0.39, 95% CI 0.31 to 0.49) and more than 2 hours (OR 0.22, 95% CI 0.16 to 0.30) gave substantially lower odds than less than 1 hour of travel time.

CONCLUSIONS

The varying proportion of patients receiving timely reperfusion across hospital referral areas implies inequity in fundamental healthcare services, not compatible with established Norwegian health policy. The importance of travel time to PCI centre points at the expanded use of prehospital pharmacoinvasive strategy to obtain the goals of timely reperfusion in Norway.

Patients' experiences with receiving sick leave certificates via remote consultations in Norway during the COVID-19 pandemic: a nationwide online survey

OBJECTIVES

To explore patients' experiences with receiving sick leave certificates via remote consultations during the COVID-19 pandemic and investigate whether there were differences among the types of remote consultation (telephone, video or text).

DESIGN

A nationwide online patient survey consisting of quantitative data supplemented by qualitative opinions conducted in Norway.

SETTING

Primary care.

PARTICIPANTS

Patients who received a sick leave certificate via remote consultation in the period from 16 November to 15 December 2020.

RESULTS

Of the 5429 respondents, 3233 (59.6%) received a sick leave certificate via telephone consultation, 657 (12.1%) via video consultation and 1539 (28.3%) via text-based e-consultation. Most respondents (76.8%) were satisfied. Only 10% of the respondents thought that the doctor would have obtained more information through an office appointment. The majority of the respondents (59.6%) found that they had as much time to explain the problem as at an office appointment. Some patients also thought that it was easier to formulate the problem via a remote consultation (18.2%) and agree with the doctor on the sick leave (10.3%).The users of text-based e-consultations were the most satisfied (79.3%, p<0.001) compared with those using telephone or video consultations. Among users of text-based e-consultations, there was a higher proportion of patients who thought that they had more time to explain the problem compared with an office appointment (p<0.001), it was easier to explain the problem (p<0.001) and agree with the doctor (p<0.001). Most respondents would use the same type of remote consultation if they were to contact the general practitioner (GP) for the same problem, with the highest proportion among the users of video consultations (62.1%, p<0.001).

CONCLUSIONS

Patients were satisfied with communicating and receiving sick leave certificates via remote consultations. Future studies should investigate patients' and GPs' use and experiences in a postpandemic setting.

The relationship between physical performance and alcohol consumption levels in Russian adults

Investigating the relationship between alcohol consumption and physical performance, we used data from the 2015-2018 Know Your Heart study on 4215 adults aged 35-69 from Arkhangelsk and Novosibirsk, Russia. We classified participants' drinking status into non-drinking, non-problem drinking, hazardous drinking, and harmful drinking based on their self-reported drinking behaviors. To evaluate physical performance, we developed a Composite Physical Performance Scale (CPPS), which combined the results of three functional tests: grip strength (GS), closed-eyes balance, and chair rises (CR). We applied multivariable linear regression to assess the relationship between alcohol consumption and CPPS score, and ordinal logistic regression to explore the associations between alcohol consumption and the three functional tests separately. The results showed that harmful drinking was associated with lower CPPS scores compared to non-problem drinking. Among harmful drinking men, the decrease in CPPS scores was explained by all three tests equally and exceptionally by GS among women. Non-drinking was also associated with decreased CPPS, linked to lower GS and CR scores in men, and only lower GS scores in women. The study revealed a reduced physical performance in the non-drinking and harmful drinking groups compared to non-problem drinking.

Biological timekeeping in polar environments: lessons from terrestrial vertebrates

The polar regions receive less solar energy than anywhere else on Earth, with the greatest year-round variation in daily light exposure; this produces highly seasonal environments, with short summers and long, cold winters. Polar environments are also characterised by a reduced daily amplitude of solar illumination. This is obvious around the solstices, when the Sun remains continuously above (polar 'day') or below (polar 'night') the horizon. Even at the solstices, however, light levels and spectral composition vary on a diel basis. These features raise interesting questions about polar biological timekeeping from the perspectives of function and causal mechanism. Functionally, to what extent are evolutionary drivers for circadian timekeeping maintained in polar environments, and how does this depend on physiology and life history? Mechanistically, how does polar solar illumination affect core daily or seasonal timekeeping and light entrainment? In birds and mammals, answers to these questions diverge widely between species, depending on physiology and bioenergetic constraints. In the high Arctic, photic cues can maintain circadian synchrony in some species, even in the polar summer. Under these conditions, timer systems may be refined to exploit polar cues. In other instances, temporal organisation may cease to be dominated by the circadian clock. Although the drive for seasonal synchronisation is strong in polar species, reliance on innate long-term (circannual) timer mechanisms varies. This variation reflects differing year-round access to photic cues. Polar chronobiology is a productive area for exploring the adaptive evolution of daily and seasonal timekeeping, with many outstanding areas for further investigation.

Is Dental Anxiety Associated with Oral Health-Related Quality of Life? Assessment of Statistical Significance and Clinical Meaningfulness in a Sample of Russian Medical and Dental Students

Information about oral health-related quality of life (OHRQoL) and dental anxiety (DA) in Russian young adults is scarce. We investigated how DA is associated with OHRQoL in a group of medical and dental students in North-West Russia. The study had a cross-sectional design and included 807 students aged 18-25 years who attended the Northern State Medical University in Arkhangelsk. OHRQoL and DA were measured by the Oral Health Impact Profile (OHIP-14) and Corah's Dental Anxiety Scale (DAS), respectively. A questionnaire collected information on socio-demographics and self-reported oral health (OH) characteristics. A dental examination was executed to assess dental caries and oral hygiene. We observed differences in the OHIP-14 scores between dentally anxious and non-anxious students: unadjusted incidence rate ratio [IRR] = 1.65, 95% confidence interval [CI]: 1.29-2.12; after adjustment for socio-demographics and clinically assessed OH: IRR = 1.58, 95% CI: 1.23-2.02; after adjustment for socio-demographics, clinically assessed OH, and self-reported OH characteristics: IRR = 1.27, 95% CI: 0.99-1.63. The differences between estimated marginal means for the DAS categories in the models were 2.92, 2.51, and 1.24, respectively. Minimal clinically important differences of OHIP-14 fell between 1.68 and 2.51. We found a negative statistical association between DA and OHRQoL in our study sample, but after adjustment for potential confounders, the association lost its clinical importance.

Liver sinusoidal endothelial cells show reduced scavenger function and downregulation of Fc gamma receptor IIb, yet maintain a preserved fenestration in the Glmpgt/gt mouse model of slowly progressing liver fibrosis

Liver sinusoidal endothelial cells (LSECs) are fenestrated endothelial cells with a unique, high endocytic clearance capacity for blood-borne waste macromolecules and colloids. This LSEC scavenger function has been insufficiently characterized in liver disease. The Glmpgt/gt mouse lacks expression of a subunit of the MFSD1/GLMP lysosomal membrane protein transporter complex, is born normal, but soon develops chronic, mild hepatocyte injury, leading to slowly progressing periportal liver fibrosis, and splenomegaly. This study examined how LSEC scavenger function and morphology are affected in the Glmpgt/gt model. FITC-labelled formaldehyde-treated serum albumin (FITC-FSA), a model ligand for LSEC scavenger receptors was administered intravenously into Glmpgt/gt mice, aged 4 months (peak of liver inflammation), 9-10 month, and age-matched Glmpwt/wt mice. Organs were harvested for light and electron microscopy, quantitative image analysis of ligand uptake, collagen accumulation, LSEC ultrastructure, and endocytosis receptor expression (also examined by qPCR and western blot). In both age groups, the Glmpgt/gt mice showed multifocal liver injury and fibrosis. The uptake of FITC-FSA in LSECs was significantly reduced in Glmpgt/gt compared to wild-type mice. Expression of LSEC receptors stabilin-1 (Stab1), and mannose receptor (Mcr1) was almost similar in liver of Glmpgt/gt mice and age-matched controls. At the same time, immunostaining revealed differences in the stabilin-1 expression pattern in sinusoids and accumulation of stabilin-1-positive macrophages in Glmpgt/gt liver. FcγRIIb (Fcgr2b), which mediates LSEC endocytosis of soluble immune complexes was widely and significantly downregulated in Glmpgt/gt liver. Despite increased collagen in space of Disse, LSECs of Glmpgt/gt mice showed well-preserved fenestrae organized in sieve plates but the frequency of holes >400 nm in diameter was increased, especially in areas with hepatocyte damage. In both genotypes, FITC-FSA also distributed to endothelial cells of spleen and bone marrow sinusoids, suggesting that these locations may function as possible compensatory sites of clearance of blood-borne scavenger receptor ligands in liver fibrosis.

'Days of Frustration': A Qualitative Study of Adolescents' Thoughts and Experiences of Schooling after Early Dropout

School dropout increases the risk of unemployment, health problems, and disability benefits. Employing an ecological-developmental perspective, we analyzed the interviews of thirteen students from a peripheral Norwegian county, aiming to explore the possible influence of upbringing and schooling on dropout. The analysis revealed that dropout was associated with an unstable family situation, lack of structure in everyday life, unresolved complex learning difficulties, bullying, and a tough existence in a rented room. The participants conveyed a sense of defeat, frustration, and an absence of meaningful alternatives. However, two participants had actively chosen to discontinue their education; this was because they preferred work practice to allow them time to mature and re-orientate in relation to future educational and career choices. Their families and social networks contributed actively to the implementation of their future plans. The findings point to the importance of studying interventions that may prevent school dropout, and that address central factors in the process of school dropout, such as social support, academic achievement, and parental involvement.

Beliefs about mental health in incarcerated males: a qualitative interview study

Introduction

Beliefs about mental health are shaped by the sociocultural context. Prisons have unique environmental and social features, and the prevalence of mental health problems in incarcerated populations is exceptionally high. These features make prisons especially interesting settings for exploring health beliefs. The aim of this study was to explore the conceptualizations of mental health and coping preferences in a prison environment.

Methods

Individual in-depth interviews were conducted with fifteen incarcerated males from three prisons in Northern Norway. The design draws on central elements from Grounded Theory.

Results

Mental health was perceived as distinct from mental illness by many of the participants. They coped with the prison environment by focusing on the things that gave them a sense of meaning and autonomy - this also formed their conceptualization of mental health. Furthermore, social interaction and activities were perceived as important to enhance and maintain mental well-being, however there were institutional barriers to using these coping strategies. The prison environment was integrated in the participants conceptualizations of mental health problems, and psychosocial stressors were emphasized in causal attributions. Biological and dispositional factors were less frequently mentioned. The participants preferred non-medical management for mental health problems and most displayed a reserved attitude towards psychotropic medications. The exception was attention-deficit hyperactivity disorder, for which they held neurobiological causal beliefs, together with a corresponding preference for medication as treatment.

Conclusion

The main finding was a firm integration of the prison context in in the participants' beliefs about mental health. We theorize that fusion of prison conditions and mental health beliefs were brought on by the processes of prisonization, observing mental distress in peers and attempts to protect self-esteem by externalizing the causes for mental health problems. Access to activities, social time, and "someone to talk to" were perceived to be crucial for improving and preserving mental health.

Risk of Intraepithelial Neoplasia Grade 3 or Worse (CIN3+) among Women Examined by a 5-Type HPV mRNA Test during 2003 and 2004, Followed through 2015

BACKGROUND

The study's purpose was to evaluate the performance of a five-type HPV mRNA test to predict cervical intraepithelial neoplasia grade 3 or worse (CIN3+) during up to 12 years of follow-up.

METHODS

Overall, 19,153 women were recruited by gynecologists and general practitioners in different parts of Norway between 2003 and 2004. The study population comprised 9582 women of these women, aged 25-69 years with normal cytology and a valid five-type HPV mRNA test at baseline. Follow-up for CIN3+ through 2015 was conducted in the Norwegian Cervical Cancer Screening Programme.

RESULTS

The cumulative incidence of CIN3+ by baseline status for HPV mRNA-positive and mRNA-negative women were 20.8% and 1.1%, respectively (p < 0.001). Age did not affect the long-term ability of the HPV mRNA test to predict CIN3+ during follow-up.

CONCLUSION

The low long-term risk of CIN3+ among HPV mRNA-negative women and the high long-term risk among HPV mRNA-positive women strengthen the evidence that the five-type HPV mRNA test is an appropriate screening test for women of all ages. Our findings suggest that women with a negative result may extend the screening interval up to 10 years.

Lecithin and Chitosan as Building Blocks in Anti-Candida Clotrimazole Nanoparticles

The main focus when considering treatment of non-healing and infected wounds is tied to the microbial, particularly bacterial, burden within the wound bed. However, as fungal contributions in these microbial communities become more recognized, the focus needs to be broadened, and the remaining participants in the complex wound microbiome need to be addressed in the development of new treatment strategies. In this study, lecithin/chitosan nanoparticles loaded with clotrimazole were tailored to eradicate one of the most abundant fungi in the wound environment, namely C. albicans. Moreover, this investigation was extended to the building blocks and their organization within the delivery system. In the evaluation of the novel nanoparticles, their compatibility with keratinocytes was confirmed. Furthermore, these biocompatible, biodegradable, and non-toxic carriers comprising clotrimazole (~189 nm, 24 mV) were evaluated for their antifungal activity through both disk diffusion and microdilution methods. It was found that the activity of clotrimazole was fully preserved upon its incorporation into this smart delivery system. These results indicate both that the novel carriers for clotrimazole could serve as a therapeutic alternative in the treatment of fungi-infected wounds and that the building blocks and their organization affect the performance of nanoparticles.

LC3B is a cofactor for LMX1B-mediated transcription of autophagy genes in dopaminergic neurons

It is becoming increasingly clear that the Atg8 family of autophagy proteins have roles not only in the cytoplasm, but also in the cell nucleus. In this issue, Jiménez-Moreno et al. (2023. J. Cell Biol.https://doi.org/10.1083/jcb.201910133) report that nuclear LC3B binds to the LIM homeodomain transcription factor LMX1B and acts as a cofactor for LMX1B-mediated transcription of autophagy genes, providing stress protection and ensuring survival of midbrain dopaminergic neurons.

Overall lifestyle changes in adulthood are associated with cancer incidence in the Norwegian Women and Cancer Study (NOWAC) - a prospective cohort study

BACKGROUND

Cancer is a leading cause of premature death worldwide and incidence is expected to rise in the coming decades. Many cohort studies, measuring lifestyle factors at one time-point, have observed that overall healthy lifestyles were inversely related to cancer incidence. However, there is little knowledge on the impact of lifestyle modification within adulthood.

METHODS

Using the Norwegian Women and Cancer study, two repeated self-reported assessments of lifestyle behaviours were used to calculate healthy lifestyle index scores at each time-point (N = 66 233). The associations between change in healthy lifestyle index score and lifestyle-related cancer incidence, including alcohol-, tobacco-, obesity-, and reproductive-related, and site-specific breast and colorectal cancer incidence were estimated using Cox proportional hazard regression models. To assess nonlinearity in the dose-response relationships, restricted cubic spline models were used.

RESULTS

Independent of baseline lifestyle, positive lifestyle changes were inversely related to the incidence of overall lifestyle-related cancers, as well as alcohol-related, tobacco-related, obesity-related, and reproductive-related cancers, but not breast and colorectal site-specific cancers. An association between lifestyle worsening and cancer incidence compared to stable lifestyle was observed.

CONCLUSIONS

This study provides evidence that overall lifestyle changes among cancer-free women between the ages of 41 and 76 impact the incidence of many cancer types. Regardless of baseline lifestyle, there was a negative dose-response relationship between magnitude of positive lifestyle change and the incidence of overall lifestyle-related cancers. We observed that underlying this trend was an especially clear association between lifestyle worsening and increased risk compared to stable lifestyle. For adult women, maintaining a stable healthy lifestyle and lifestyle improvement are important for preventing the occurrence of many cancer types.

Environment Context Variability and Incidental Word Learning: A Virtual Reality Study

Previous research has shown that changes in the scenarios in which something is learned and recalled, respectively, may result in a subpar performance in memory recollection. The current study aimed to evaluate how changes in the visuo-perceptual environmental learning context impact incidental vocabulary learning. To this end, a highly immersive virtual reality setting was created, and participants were required to read eight distinct stories visually presented to them. A novel word was delivered twice in every paragraph and embedded in each story. Stories could be displayed either in a high variability condition, where each paragraph was shown in a new environment context (four different classrooms) or in a low variability condition, where each paragraph was shown in the same context. The findings obtained across four assessment tasks (free recall, recognition, picture matching, and sentence completion) demonstrated that significant visuo-perceptual variability did not bring about any disadvantages in word learning. Thus, perceptual information from a physically diverse environment could provide a variety of instructional and educational beneficial possibilities in the absence of a learning disadvantage.

Getting real in interprofessional clinical placements: patient-centeredness in student teams' collaborative learning

Collaboration between healthcare providers helps tackle the increasing complexity of healthcare. When learning teamwork, interprofessional students are expected to work patient-centered; recognizing the patient's expertise and partnering with them. Research on interprofessional education (IPE) for undergraduates has illuminated learning outcomes, organization of learning activities, change in attitudes, etc. But, we know little about the interaction between patients and interprofessional student teams. This study aimed to explore how interprofessional student teams and patients interact in interprofessional clinical placements. With a focused ethnographic approach, participant observation and qualitative interviews were conducted in two contexts; a physical and an online arrangement. Central ideas in Goffman's dramaturgy constituted a theoretical lens. A reflexive thematic analysis generated three themes: (1) Preparing safe and comfortable encounters with patients, (2) Including and excluding the patient in the encounter, and (3) Adjusting to the patient's situation. We identified students' intentions of patient-centeredness when preparing encounters, but patients did not always feel included and listened to in encounters. After encountering patients, student teams adjusted their teamwork, by changing the team composition or the planned clinical interventions to better meet the patients' needs. Notably, team-based patient encounters led to a different view of the patient, their health issues, and how to collaborate. Our findings can inform educators of the importance of addressing patient-centered care in interprofessional learning arrangements. Today, clinical interprofessional placements may not exploit the potential for learning about patient-centeredness. A thematization of this, e.g., in supervision in future clinical placements can ensure an enhanced focus on this in interprofessional teamwork.

Evolution of β-lactamase-mediated cefiderocol resistance

BACKGROUND

Cefiderocol is a novel siderophore β-lactam with improved hydrolytic stability toward β-lactamases, including carbapenemases, achieved by combining structural moieties of two clinically efficient cephalosporins, ceftazidime and cefepime. Consequently, cefiderocol represents a treatment alternative for infections caused by MDR Gram-negatives.

OBJECTIVES

To study the role of cefiderocol on resistance development and on the evolution of β-lactamases from all Ambler classes, including KPC-2, CTX-M-15, NDM-1, CMY-2 and OXA-48.

METHODS

Directed evolution, using error-prone PCR followed by selective plating, was utilized to investigate how the production and the evolution of different β-lactamases cause changes in cefiderocol susceptibility determined using microbroth dilution assays (MIC and IC50).

RESULTS

We found that the expression of blaOXA-48 did not affect cefiderocol susceptibility. On the contrary, the expression of blaKPC-2, blaCMY-2, blaCTX-M-15 and blaNDM-1 substantially reduced cefiderocol susceptibility by 4-, 16-, 8- and 32-fold, respectively. Further, directed evolution on these enzymes showed that, with the acquisition of only 1-2 non-synonymous mutations, all β-lactamases were evolvable to further cefiderocol resistance by 2- (NDM-1, CTX-M-15), 4- (CMY-2), 8- (OXA-48) and 16-fold (KPC-2). Cefiderocol resistance development was often associated with collateral susceptibility changes including increased resistance to ceftazidime and ceftazidime/avibactam as well as functional trade-offs against different β-lactam drugs.

CONCLUSIONS

The expression of contemporary β-lactamase genes can potentially contribute to cefiderocol resistance development and the acquisition of mutations in these genes results in enzymes adapting to increasing cefiderocol concentrations. Resistance development caused clinically important cross-resistance, especially against ceftazidime and ceftazidime/avibactam.

Evidence of large systematic differences between countries in assigning ischaemic heart disease deaths to myocardial infarction: the contrasting examples of Russia and Norway

BACKGROUND

There is considerable variation in mortality rates from myocardial infarction (MI) across high-income countries, some of which may be artefactual.

METHODS

Time trends in mortality rates from ischaemic heart disease (IHD) and MI were analysed for a set of high-income countries from the end of the 1970s. Using individual-level mortality data from Russia (2005-2017) and Norway (2005-2016), we investigated factors associated with the proportion of total IHD deaths certified as due to MI.

RESULTS

In most countries, MI mortality rates have dramatically declined from the 1970s. However, the share of MI in total IHD deaths varies substantially across countries. In Russia, only 12% of IHD deaths had MI assigned as the underlying cause vs 63% in Norway. IHD deaths occurring outside of hospital without autopsy were far less likely to be assigned as MI in Russia (2%) than in Norway (59%).

CONCLUSIONS

Although established international criteria for MI require specific clinical or post-mortem evidence, it appears that certifying specialists in different countries may interpret these criteria differently. At one extreme, Russian doctors may only assign MI as a cause of death when there is specific pathophysiological evidence. At the other extreme, their counterparts in Norway may be willing to specify MI as the cause even when this evidence is not available. Internationally established criteria for MI diagnosis are challenging to apply for out-of-hospital deaths. Differences between countries in how certifiers interpret these criteria may account for at least some of the international variation in MI mortality rates.

Bilinguals are better than monolinguals in detecting manipulative discourse

One of the most contentious topics in cognitive science concerns the impact of bilingualism on cognitive functions and neural resources. Research on executive functions has shown that bilinguals often perform better than monolinguals in tasks that require monitoring and inhibiting automatic responses. The robustness of this effect is a matter of an ongoing debate, with both sides approaching bilingual cognition mainly through measuring abilities that fall outside the core domain of language processing. However, the mental juggling that bilinguals perform daily involves language. This study takes a novel path to bilingual cognition by comparing the performance of monolinguals and bilinguals in a timed task that features a special category of stimulus, which has the peculiar ability to manipulate the cognitive parser into treating it as well-formed while it is not: grammatical illusions. The results reveal that bilinguals outperform monolinguals in detecting illusions, but they are also slower across the board in judging the stimuli, illusory or not. We capture this trade-off by proposing the Plurilingual Adaptive Trade-off Hypothesis (PATH), according to which the adaptation of bilinguals' cognitive abilities may (i) decrease fallibility to illusions by means of recruiting sharpened top-down control processes, but (ii) this is part of a larger bundle of effects, not all of which are necessarily advantageous.

Chitosomes-In-Chitosan Hydrogel for Acute Skin Injuries: Prevention and Infection Control

Burns and other skin injuries are growing concerns as well as challenges in an era of antimicrobial resistance. Novel treatment options to improve the prevention and eradication of infectious skin biofilm-producing pathogens, while enhancing wound healing, are urgently needed for the timely treatment of infection-prone injuries. Treatment of acute skin injuries requires tailoring of formulation to assure both proper skin retention and the appropriate release of incorporated antimicrobials. The challenge remains to formulate antimicrobials with low water solubility, which often requires carriers as the primary vehicle, followed by a secondary skin-friendly vehicle. We focused on widely used chlorhexidine formulated in the chitosan-infused nanocarriers, chitosomes, incorporated into chitosan hydrogel for improved treatment of skin injuries. To prove our hypothesis, lipid nanocarriers and chitosan-comprising nanocarriers (≈250 nm) with membrane-active antimicrobial chlorhexidine were optimized and incorporated into chitosan hydrogel. The biological and antibacterial effects of both vesicles and a vesicles-in-hydrogel system were evaluated. The chitosomes-in-chitosan hydrogel formulation demonstrated promising physical properties and were proven safe. Additionally, the chitosan-based systems, both chitosomes and chitosan hydrogel, showed an improved antimicrobial effect against S. aureus and S. epidermidis compared to the formulations without chitosan. The novel formulation could serve as a foundation for infection prevention and bacterial eradication in acute wounds.

On the status of transfer in adult third language acquisition of early bilinguals

The study of linguistic transfer-understood here in terms of the copying of previous linguistic representations-seeks to reveal how domain-relevant prior language knowledge impacts the acquisition and development of new mental representations more generally. Studying sequential multilingualism offers a natural laboratory to observe cognitive-economical mechanisms that avoid redundancy in language learning. One of the key dividing questions between theories of transfer in sequential multilingualism is the extent of transfer, that is, whether a whole previous grammar is transferred (full transfer) or a potentially different source language is selected for each linguistic property (property-by-property transfer). We adopted a novel methodological approach to this question, examining four different linguistic properties from unrelated domains of grammar across the three languages of a heterogeneous population of highly proficient, early Catalan/Spanish bilinguals with different degrees of language dominance and order of acquisition, at the very beginning of (adult) L3 English. Results are variably complex across the different properties, but compatible with a scenario where one of the previous languages, Catalan, was selected as the basis for the initial L3 English grammar of these speakers. We discuss the theoretical implications of these findings.

The Transitivity Index: Using Transitivity as a continuous measure to account for clitic case alternation in Spanish causative constructions

In Spanish causative constructions with dejar 'let' and hacer 'make' the subject of the embedded infinitive verb can appear in the accusative or the dative case. This case alternation has been accounted for by resorting to the notion of direct vs. indirect causation. Under this account, the accusative clitic with a transitive verb denotes direct causation while the dative clitic with an intransitive verb expresses indirect causation. The problem with this account is that we lack an independent definition of (in)direct causation in this context and so this approach suffers from circularity: the case of the clitic is used to determine causation type and causation type implies use of one or the other grammatical case. Therefore, a more objective way to account for clitic case alternation is needed. In this paper, I offer one possible solution in this direction by investigating clitic case alternation against Hopper and Thompson's Transitivity parameters and a small number of other linguistic variables. The novelty of this approach is that I operationalise Transitivity as a weighted continuous measure (which I call the Transitivity Index) and use it to predict the case of the clitic. The results indicate that the transitivity of the infinitive verb, the animacy of the object and the agentivity of the subject are strong predictors of clitic case. Moreover, the Transitivity Index clearly shows that higher levels of Transitivity are associated with the dative clitic contrary to other contexts in which accusative is said to be more transitive. The findings in this paper allow us to arrive at a finer-grained characterization of the contexts in which each clitic case is more likely to occur and provide further evidence of the pervasiveness of Transitivity in natural language.

Adult attachment style and maternal-infant bonding: the indirect path of parenting stress

BACKGROUND

The quality of maternal-infant bonding is related to important child outcomes. The literature has assumed that the ability to form relationships is a relatively stable trait, and research studies have suggested that a mother's attachment style in close adult relationships is related to mother-infant bonding. The transition to parenthood is also often stressful, and the adult attachment style may relate to parenting stress in the first year after birth. Such stress could possibly have a negative relationship with the mother-infant bond. In the present study, we examined the associations between maternal adult attachment styles and the quality of mother-infant bonding and whether this relationship is mediated by parenting stress.

METHODS

The present study sample comprised 168 women (mean age 31.0 years, SD 4.23 years). Between weeks 31 and 41 of gestation, the anxious and avoidant adult attachment dimensions were measured with the Experiences in Close Relationships questionnaire (ECR). Between 5 and 15 weeks after birth mother-infant bonding and parenting stress were measured with the Maternal Postnatal Attachment Scale (MPAS) and the Parenting Stress Index-Parent Domain (PSI-PD), respectively.

RESULTS

Both attachment-related avoidance and attachment-related anxiety correlated significantly and negatively with mother-infant bonding. However, a regression analysis showed that only attachment-related avoidance was a significant predictor of mother-infant bonding when controlling for demographic variables and maternal mental health history. The relationship between the adult attachment style and bonding was mediated by parenting stress. Higher scores on attachment avoidance and anxiety were related to increased stress, which was related to decreased quality of bonding. The overall parent domain and the subscale of competence in the parent-related stress dimension mediated between attachment avoidance and bonding, and the overall parent domain and the subscales of competence and role restriction mediated between attachment anxiety and bonding. There was no direct relationship between the adult attachment style and mother-infant bonding when parenting stress was included as a mediator.

CONCLUSIONS

This study illustrates that maternal adult attachment style relates to mother-infant bonding. This relationship was mediated by parenting stress. The results may have implications for the early identification of mothers at risk of having bonding difficulties.

Careful expressions of social aspects: How local professionals in high school settings, municipal services, and general practice communicate care to youth presenting persistent bodily complaints

Persistent health complaints pose communicative dilemmas in care encounters, adversely affecting patient experiences and pathways. Little is known about the impact and role of professionals in encounters with young people with incipient, debilitating, and persistent symptoms. This study aims to explore communicative dilemmas and the role of language in care provided by local professionals in high school settings, municipal services, and general practice to young people presenting persistent bodily complaints. The study is based on in-depth individual interviews conducted from April to July 2016 with 12 professionals identified and selected during anthropological multi-sited fieldwork in a Norwegian community. We identify two modalities of what we have chosen to call 'careful expression', used as strategies across professions to overcome communicative dilemmas. Professionals reflexively and pragmatically negotiated with the powers of language to influence illness experience and to enact empowered young subjects. These insights may prove relevant for future studies of care encounters while also indicating a critical attitude to institutional logics that affect care responses.

Protocol for the Northern babies longitudinal study: predicting postpartum depression and improving parent-infant interaction with The Newborn Behavioral Observation

INTRODUCTION

Postpartum depression (PPD) is a prevalent disorder. Studying the factors related to PPD will help to identify families at risk and provide preventive interventions. This can in turn improve the developmental trajectories for the children. Several previous studies have investigated risk factors for PPD. However, few studies have focused on cognitive vulnerability factors. The first aim of the present study is to explore a range of protective and risk factors, including cognitive factors, for PPD, parent-infant interactions and child development. The second aim of the study is to evaluate the effectiveness of The Newborn Behavioral Observation (NBO) as a universal preventive intervention delivered in routine practice. The NBO is a brief relationship-enhancing intervention that may reduce depressive symptomatology in mothers.

METHODS

The study is a longitudinal observational study with an intervention. The observational study uses a prospective cohort design, whereas the intervention study has a non-randomised cluster-controlled design comparing a group receiving NBO with a group receiving standard care. The intervention group will receive three NBO sessions within the first 4 weeks postdelivery. Between 2015 and 2018, approximately 200 families will be recruited in the municipality of Tromsø, Norway. Parents are recruited during pregnancy, and assessments will be performed during gestational weeks 16-22, 24-30 and 31, and at 6 weeks, 4 months and 6 months postdelivery. Predictor variables include several cognitive vulnerability factors including early maladaptive schemas, implicit attitudes and cognitive processing of emotionally valenced infant facial information.

ETHICS AND DISSEMINATION

The Regional Committee for Medical and Health Research Ethics in Northern Norway has approved the project. The research team has collaboration with local health services and can assist participants who need more extensive follow-up. Results from the project will be disseminated in international and national peer-reviewed journals, and at courses and conferences.

TRIALS REGISTRATION NUMBER

NCT02538497; Pre-results.

Ligand-guided homology modelling of the GABAB2 subunit of the GABAB receptor

γ-aminobutyric acid (GABA) is the main inhibitory neurotransmitter in the central nervous system, and disturbances in the GABAergic system have been implicated in numerous neurological and neuropsychiatric diseases. The GABA_B receptor is a heterodimeric class C G protein-coupled receptor (GPCR) consisting of GABA_B1a/b and GABA_B2 subunits. Two GABA_B receptor ligand binding sites have been described, namely the orthosteric GABA binding site located in the extracellular GABA_B1 Venus fly trap domain and the allosteric binding site found in the GABA_B2 transmembrane domain. To date, the only experimentally solved three-dimensional structures of the GABA_B receptor are of the Venus fly trap domain. GABA_B receptor allosteric modulators, however, show great therapeutic potential, and elucidating the structure of the GABA_B2 transmembrane domain may lead to development of novel drugs and increased understanding of the allosteric mechanism of action. Despite the lack of x-ray crystal structures of the GABA_B2 transmembrane domain, multiple crystal structures belonging to other classes of GPCRs than class A have been released within the last years. More closely related template structures are now available for homology modelling of the GABA_B receptor. Here, multiple homology models of the GABA_B2 subunit of the GABA_B receptor have been constructed using templates from class A, B and C GPCRs, and docking of five clusters of positive allosteric modulators and decoys has been undertaken to select models that enrich the active compounds. Using this ligand-guided approach, eight GABA_B2 homology models have been chosen as possible structural representatives of the transmembrane domain of the GABA_B2 subunit. To the best of our knowledge, the present study is the first to describe homology modelling of the transmembrane domain of the GABA_B2 subunit and the docking of positive allosteric modulators in the receptor.

Blood pressure and age-related GFR decline in the general population

BACKGROUND

Hypertension is one of the most important causes of end-stage renal disease, but it is unclear whether elevated blood pressure (BP) also accelerates the gradual decline in the glomerular filtration rate (GFR) seen in the general population with increasing age. The reason may be that most studies have considered only baseline BP and not the effects of changes in BP, antihypertensive treatment and other determinants of GFR during follow-up. Additionally, the use of GFR estimated from creatinine or cystatin C instead of measurements of GFR may have biased the results because of influence from non-GFR related confounders. We studied the relationship between BP and GFR decline using time-varying variables in a cohort representative of the general population using measurements of GFR as iohexol clearance.

METHODS

We included 1594 subjects aged 50 to 62 years without baseline diabetes, kidney-, or cardiovascular disease in the Renal Iohexol-clearance Survey in Tromsø 6 (RENIS-T6). GFR, BP, antihypertensive medication and all adjustment variables were ascertained at baseline, and at follow-up after a median observation time of 5.6 years in 1299 persons (81%). The relationship between GFR decline and BP was analyzed in linear mixed models.

RESULTS

The mean (standard deviation) GFR decline rate was 0.95 (2.23) mL/min/year. The percentage of persons with hypertension (systolic BP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg or antihypertensive medication) increased from 42 to 52% between baseline and follow-up. In multivariable adjusted linear mixed models using time-varying independent variables measured at baseline and follow-up, higher systolic and diastolic BP were associated with slower GFR decline rates by 0.10 and 0.20 mL/min/year/10 mmHg, respectively (p < 0.05). The association was stronger in persons on antihypertensive medication than in others (p < 0.05 for the interaction between BP and antihypertensive medication).

CONCLUSIONS

In the medium-term, elevated BP is not associated with accelerated GFR decline in the general middle-aged population. In persons using antihypertensive medication, elevated BP is associated with a paradoxical slower GFR decline. Studies with even longer observation periods are needed to evaluate the ultimate effect of BP on kidney function.