This paper critically analyses how postfeminist discourse plays out in media constructions of politician New Zealand Prime Minister Jacinda Ardern becoming a mother while in office. Data for this ...project include Ardern's public announcements of her pregnancy, her daughter's birth, and responses to questions regarding being a working mother. Alongside Ardern's framing of becoming a working mother, we also analyze how mainstream media reported on and sought meaning around her story. We are guided by the questions: How do different feminisms materialize in Ardern's case and how do they help us make sense of working and mothering in postfeminist times? Our analysis contributes to gender and organizational literature by teasing out the tensions and possibilities that emerge for a feminist politics of mothering and working.
In recent decades, tech-companies such as Amazon, Google, Facebook, and Apple have grown exponentially, and it can be tempting for cities to try to attract these powerful corporations. This paper ...explores a particular aspect of this development, namely, how cities brand themselves to win the favor of a single big business. We draw on institutional isomorphism and a case study of North American cities’ branding efforts to attract Amazon’s second headquarters (dubbed HQ2). Our qualitative analysis shows that branding for a big business can lead cities into what we call sycomorphism, that is, acting obsequiously toward an important other in ways similar to other organizations. We identified three key expressions of sycomorphism: pandering, identification, and blank-checking. Our study contributes with knowledge that cities are not only subject to generalized pressure to compete for businesses, but they are also enticed by single powerful actors outside their organizational field, that can “jolt” cities to communicate obsequiously to win favor. Through the concept of sycomorphism, we advance the theoretical understanding of the relationship between isomorphism and city branding and thereby expand the usefulness of institutional theory in marketing scholarship.
This article explores desexualization in massage therapy as a complex interaction between therapists and clients wherein sexual subjectivities are co-constructed, reified and in one case revised to ...highlight how workers can create a professional sexual identity in the spaces between desexualization and re-eroticization. Findings suggest that organizational mandates for desexualization as well as therapists’ own framing maintains gendered subjectivities that paint men as aggressors and women as victims. It also offers, through the philosophy of one female therapist, an alternative to desexualization that seeks to encourage sexuality based on professionalism, respect and choice. A key implication of this study is that a more holistic and context-dependent view of work and workers is necessary for scholars and practitioners to understand the promise and perils of organizational desexualization.
Febrile infection-related epilepsy syndrome (FIRES) is a severe childhood epilepsy with refractory status epilepticus after a typically mild febrile infection. The etiology of FIRES is largely ...unknown, and outcomes in most individuals with FIRES are poor.
Here, we reviewed the current state-of-the art genetic testing strategies in individuals with FIRES. We performed a systematic computational analysis to identify individuals with FIRES and characterize the clinical landscape using the Electronic Medical Records (EMR). Among 25 individuals with a confirmed FIRES diagnosis over the last decade, we performed a comprehensive review of genetic testing and other diagnostic testing.
Management included use of steroids and intravenous immunoglobulin (IVIG) in most individuals, with an increased use of immunomodulatory agents, including IVIG, plasma exchange (PLEX) and immunosuppressants such as cytokine inhibitors, and the ketogenic diet after 2014. Genetic testing was performed on a clinical basis in almost all individuals and was non-diagnostic in all patients. We compared FIRES with both status epilepticus (SE) and refractory status epilepticus (RSE) as a broader comparison cohort and identified genetic causes in 36% of patients with RSE. The difference in genetic signatures between FIRES and RSE suggest distinct underlying etiologies. In summary, despite the absence of any identifiable etiologies in FIRES, we performed an unbiased analysis of the clinical landscape, identifying a heterogeneous range of treatment strategies and characterized real-world clinical practice.
FIRES remains one of the most enigmatic conditions in child neurology without any known etiologies to date despite significant efforts in the field, suggesting a clear need for further studies and novel diagnostic and treatment approaches.
Maternal history of depression is a strong predictor of depression in offspring and linked to structural and functional alterations in the developing brain. However, very little work has examined ...differences in white matter in adolescents at familial risk for depression. In a sample aged 9–14 (n = 117), we used tract-based spatial statistics (TBSS) to examine differences in white matter microstructure between adolescents with (n = 42) and without (n = 75) maternal history of depression. Microstructure was indexed using fractional anisotropy (FA). Threshold-free cluster enhancement was applied and cluster maps were thresholded at whole-brain family-wise error < .05. There was no significant main effect of risk status on FA. However, there was a significant interaction between risk status and age, such that large and diffuse portions of the white matter skeleton showed relatively increased FA with age for youth with a maternal history of depression compared to those without. Most tracts identified by the interaction were robust to controlling for sex, youth internalizing, in-scanner motion, neighborhood SES, and intra-cranial volume, evidence that maternal depression is a unique predictor of white matter alterations in youth. Widespread increases in FA with age may correspond to a global pattern of accelerated brain maturation in youth at risk for depression.
Objective
Individuals with disease‐causing variants in STXBP1 frequently have epilepsy onset in the first year of life with a variety of seizure types, including epileptic spasms. However, the impact ...of early onset seizures and antiseizure medication (ASM) on the risk of developing epileptic spasms and impact on their trajectory are poorly understood, limiting informed and anticipatory treatment, as well as trial design.
Methods
We retrospectively reconstructed seizure and medication histories in weekly intervals for individuals with STXBP1 developmental and epileptic encephalopathy (DEE) with epilepsy onset in the first year of life and quantitatively analyzed longitudinal seizure histories and medication response.
Results
We included 61 individuals with early onset seizures, 29 of whom had epileptic spasms. Individuals with neonatal seizures were likely to have continued seizures after the neonatal period (25/26). The risk of developing epileptic spasms was not increased in individuals with neonatal seizures or early infantile seizures (21/41 vs. 8/16, odds ratio OR = 1, 95% confidence interval CI = .3–3.9, p = 1). We did not find any ASM associated with the development of epileptic spasms following prior seizures. Individuals with prior seizures (n = 16/21, 76%) had a higher risk of developing refractory epileptic spasms (n = 5/8, 63%, OR = 1.9, 95% CI = .2–14.6, p = .6). Individuals with refractory epileptic spasms had a later onset of epileptic spasms (n = 20, median = 20 weeks) compared to individuals with nonrefractory epileptic spasms (n = 8, median = 13 weeks, p = .08).
Significance
We provide a comprehensive assessment of early onset seizures in STXBP1‐DEE and show that the risk of epileptic spasms is not increased following a prior history of early life seizures, nor by certain ASMs. Our study provides baseline information for targeted treatment and prognostication in early life seizures in STXBP1‐DEE.
Cerebral cavernous malformation (CCM) is a genetic, cerebrovascular disease. Familial CCM is caused by genetic mutations in
,
, or
Disease onset is earlier and more severe in individuals with
...mutations. Recent studies have shown that lesions arise from excess mitogen-activated protein kinase kinase kinase 3 (MEKK3) signaling downstream of Toll-like receptor 4 (TLR4) stimulation by lipopolysaccharide derived from the gut microbiome. These findings suggest a gut-brain CCM disease axis but fail to define it or explain the poor prognosis of patients with
mutations. Here, we demonstrate that the gut barrier is a primary determinant of CCM disease course, independent of microbiome configuration, that explains the increased severity of CCM disease associated with PDCD10 deficiency. Chemical disruption of the gut barrier with dextran sulfate sodium augments CCM formation in a mouse model, as does genetic loss of
, but not
, in gut epithelial cells. Loss of gut epithelial
results in disruption of the colonic mucosal barrier. Accordingly, loss of Mucin-2 or exposure to dietary emulsifiers that reduce the mucus barrier increases CCM burden analogous to loss of
in the gut epithelium. Last, we show that treatment with dexamethasone potently inhibits CCM formation in mice because of the combined effect of action at both brain endothelial cells and gut epithelial cells. These studies define a gut-brain disease axis in an experimental model of CCM in which a single gene is required for two critical components: gut epithelial function and brain endothelial signaling.
To investigate the relationship between history of anti-inflammatory medication use and delirium risk, as well as long-term mortality.
In this retrospective cohort study, subjects recruited between ...January 2016 and March 2020 were analyzed. Information about anti-inflammatory medication use history including aspirin, NSAIDs, glucosamine, and other anti-inflammatory drugs, was collected. Logistic regression analysis investigated the relationship between anti-inflammatory medications and delirium. Log-rank analysis and cox proportional hazards model investigated the relationship between anti-inflammatory medications and one-year mortality.
The data from 1274 subjects were analyzed. The prevalence of delirium was significantly lower in subjects with NSAIDs usage (23.0%) than in those without NSAIDs usage (35.0%) (p < 0.001). Logistic regression analysis controlling for age, sex, dementia status, and hospitalization department showed that the risk of delirium tended to be reduced by a history of NSAIDs use (OR, 0.76 95% CI, 0.55 to 1.03). The one-year mortality in the subjects with NSAIDs (survival rate, 0.879 95% CI, 0.845 to 0.906) was significantly lower than in the subjects without NSAIDs (survival rate, 0.776 95% CI, 0.746 to 0.803) (p < 0.001). A history of NSAIDs use associated with the decreased risk of one-year mortality even after adjustment for age, sex, Charlson Comorbidity Index, delirium status, and hospitalization department (HR, 0.70 95% CI, 0.51 to 0.96).
This study suggested that NSAIDs usage was associated with decreased delirium prevalence and lower one-year mortality. The potential benefit of NSAIDs on delirium risk and mortality were shown.
•History of NSAIDs use was associated with decreased delirium risk and mortality.•It might be possible that NSAIDs has benefits for patients to prevent delirium and decrease mortality.•Subjects with a history of glucosamine use had lower prevalence of delirium.
Objective
STXBP1‐related disorders are rare genetic epilepsies and neurodevelopmental disorders, but the impact of symptoms across clinical domains is poorly understood. Disease concept models are ...formal frameworks to assess the lived experience of individuals and their families and provide a basis for generating outcome measures.
Methods
We conducted semistructured, qualitative interviews with 19 caregivers of 16 individuals with STXBP1‐related disorders and 7 healthcare professionals. We systematically coded themes using NVivo software and grouped concepts into the domains of symptoms, symptom impact, and caregiver impact. We quantified the frequency of concepts throughout the lifespan and across clinical subgroups stratified by seizure history and developmental trajectories.
Results
Over 25 hours of interviews, we coded a total of 3626 references to 38 distinct concepts. In addition to well‐recognized clinical features such as developmental delay (n = 240 references), behavior (n = 201), and seizures (n = 147), we identified previously underrepresented symptoms including gastrointestinal (n = 68) and respiratory symptoms (n = 24) and pain (n = 30). The most frequently referenced symptom impacts were autonomy (n = 96), socialization (n = 64), and schooling (n = 61). Emotional impact (n = 354), support (n = 200), and daily life & activities (n = 108) were highly cited caregiver impacts. We found that seizures were more commonly referenced in infancy than in other age groups, while behavior and socialization were more likely to be referred to in childhood. We found that caregivers of individuals with ongoing seizures were less likely to reference developmental delay, possibly due to the relatively high impact of seizures.
Significance
STXBP1‐related disorders are complex conditions affecting a wide range of clinical and social domains. We comprehensively mapped symptoms and their impact on families to generate a comprehensive disease model as a foundation for clinical endpoints in future trials.
Metformin has been reported to improve age-related disorders, including dementia, and to lower mortality. This study was conducted to investigate whether metformin use lower delirium risk, as well as ...long-term mortality.
In this retrospective cohort study, previously recruited 1,404 subjects were analyzed. The relationship between metformin use and delirium, and the relationship between metformin use and 3-year mortality were investigated.
242 subjects were categorized into a type 2 diabetes mellitus (DM)-without-metformin group, and 264 subjects were categorized into a DM-with-metformin group. Prevalence of delirium was 36.0% in the DM-without-metformin group, and 29.2% in the DM-with-metformin group. A history of metformin use reduced the risk of delirium in patients with DM (OR, 0.50 95% CI, 0.32 to 0.79) after controlling for confounding factors. The 3-year mortality in the DM-without-metformin group (survival rate, 0.595 95% CI, 0.512 to 0.669) was higher than in the DM-with-metformin group (survival rate, 0.695 95% CI, 0.604 to 0.770) (p=0.035). A history of metformin use decreased the risk of 3-year mortality after adjustment for confounding factors (HR, 0.69 95% CI, 0.48 to 0.98).
Metformin use may lower the risk of delirium and mortality in DM patients.
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