Pressure Pain Sensitivity is Independent of Structural Pathology in Patients with Subacromial Pain Syndrome: A Cross-Sectional Analysis.

Objective: To compare localized (primary) and widespread (secondary) hyperalgesia using pressure pain threshold (PPT) of patients with normal imaging findings, rotator cuff tear, or other pathologies.

Design: This was a cross-sectional design with data collected at a single time point.

Setting: This study was performed at two large, urban, academic medical centers.

Utility of standing office blood pressure in detecting hypertension in healthy adults.

Current guidelines recommend office blood pressures (BP) be taken in a seated position when screening for hypertension (HTN). Seated BP is known to have limited accuracy in detecting high BP, while the utility of standing BP in diagnosing HTN is unknown. We conducted a cross-sectional study to determine the incremental value of standing BP in diagnosing HTN.

Exaggerated renal sympathetic nerve and pressor responses during spontaneously occurring motor activity in hypertensive rats.

Stimulation of the mesencephalic locomotor region elicits exaggerated sympathetic nerve and pressor responses in spontaneously hypertensive rats (SHR) as compared with normotensive Wistar-Kyoto rats (WKY). This suggests that central command or its influence on vasomotor centers is augmented in hypertension. The decerebrate animal model possesses an ability to evoke intermittent bouts of spontaneously occurring motor activity (SpMA) and generates cardiovascular responses associated with the SpMA.

Bayesianism from a philosophical perspective and its application to medicine.

Bayesian philosophy and Bayesian statistics have diverged in recent years, because Bayesian philosophers have become more interested in philosophical problems other than the foundations of statistics and Bayesian statisticians have become less concerned with philosophical foundations. One way in which this divergence manifests itself is through the use of direct inference principles: Bayesian philosophers routinely advocate principles that require calibration of degrees of belief to available non-epistemic probabilities, while Bayesian statisticians rarely invoke such principles. As I explain, however, the standard Bayesian framework cannot coherently employ direct inference principles.

Direct Inference and Probabilistic Accounts of Induction.

Schurz (2019, ch. 4) argues that probabilistic accounts of induction fail. In particular, he criticises probabilistic accounts of induction that appeal to direct inference principles, including subjective Bayesian approaches (e.

The use of mechanistic reasoning in assessing coronavirus interventions.

Rationale: Evidence-based medicine (EBM), the dominant approach to assessing the effectiveness of clinical and public health interventions, focuses on the results of association studies. EBM+ is a development of EBM that systematically considers mechanistic studies alongside association studies.

Aims And Objectives: To explore examples of the importance of mechanistic evidence to coronavirus research.

The IARC Monographs: Updated Procedures for Modern and Transparent Evidence Synthesis in Cancer Hazard Identification.

The Monographs produced by the International Agency for Research on Cancer (IARC) apply rigorous procedures for the scientific review and evaluation of carcinogenic hazards by independent experts. The Preamble to the IARC Monographs, which outlines these procedures, was updated in 2019, following recommendations of a 2018 expert advisory group. This article presents the key features of the updated Preamble, a major milestone that will enable IARC to take advantage of recent scientific and procedural advances made during the 12 years since the last Preamble amendments.

Mechanisms in clinical practice: use and justification.

While the importance of mechanisms in determining causality in medicine is currently the subject of active debate, the role of mechanistic reasoning in clinical practice has received far less attention. In this paper we look at this question in the context of the treatment of a particular individual, and argue that evidence of mechanisms is indeed key to various aspects of clinical practice, including assessing population-level research reports, diagnostic as well as therapeutic decision making, and the assessment of treatment effects. We use the pulmonary condition bronchiectasis as a source of examples of the importance of mechanistic reasoning to clinical practice.

Evidential Proximity, Independence, and the evaluation of carcinogenicity.

This paper analyses the methods of the International Agency for Research on Cancer (IARC) for evaluating the carcinogenicity of various agents. I identify two fundamental evidential principles that underpin these methods, which I call Evidential Proximity and Independence. I then show, by considering the 2018 evaluation of the carcinogenicity of styrene and styrene-7,8-oxide, that these principles have been implemented in a way that can lead to inconsistency.

The use of mechanistic evidence in drug approval.

The role of mechanistic evidence tends to be under-appreciated in current evidence-based medicine (EBM), which focusses on clinical studies, tending to restrict attention to randomized controlled studies (RCTs) when they are available. The EBM+ programme seeks to redress this imbalance, by suggesting methods for evaluating mechanistic studies alongside clinical studies. Drug approval is a problematic case for the view that mechanistic evidence should be taken into account, because RCTs are almost always available.

Intervention and Identifiability in Latent Variable Modelling.

We consider the use of interventions for resolving a problem of unidentified statistical models. The leading examples are from latent variable modelling, an influential statistical tool in the social sciences. We first explain the problem of statistical identifiability and contrast it with the identifiability of causal models.

Justifying the principle of indifference.

This paper presents a new argument for the Principle of Indifference. This argument can be thought of in two ways: as a pragmatic argument, justifying the principle as needing to hold if one is to minimise worst-case expected loss, or as an epistemic argument, justifying the principle as needing to hold in order to minimise worst-case expected inaccuracy. The question arises as to which interpretation is preferable.

Autonomic dysfunction in muscular dystrophy: a theoretical framework for muscle reflex involvement.

Muscular dystrophies are a heterogeneous group of genetically inherited disorders whose most prominent clinical feature is progressive degeneration of skeletal muscle. In several forms of the disease, the function of cardiac muscle is likewise affected. The primary defect in this group of diseases is caused by mutations in myocyte proteins important to cellular structure and/or performance.

Pre-admission factors and utilization of tutoring services in health professions educational programs.

Pre-admission factors tend to serve as indicators of student success in health professions educational programs, but less is known about the effects that academic assistance programs have on student success. This study sought to determine whether specific pre-admission factors could help to identify students who may require academic support during their health professions education. This retrospective analysis aimed to identify differences in pre-admission variables between those students requiring tutoring and a matched sample of students who did not require tutoring.

The evidence that evidence-based medicine omits.

According to current hierarchies of evidence for EBM, evidence of correlation (e.g., from RCTs) is always more important than evidence of mechanisms when evaluating and establishing causal claims.

Development, implementation, and short-term effectiveness of an interprofessional education course in a school of health professions.

It is accepted that interprofessional education (IPE) has positive benefits for health profession students, including effective communication, increased teamwork skills, and better appreciation for the roles of other health professions. However, the question remains of how to effectively deliver IPE for health professions students in an educational environment. To address this problem, the University of Texas Southwestern School of Health Professions developed an IPE course, Interdisciplinary Development, Education, and Active Learning (IDEAL), incorporating seven disciplines represented within the school.

Epistemic causality and evidence-based medicine.

Causal claims in biomedical contexts are ubiquitous albeit they are not always made explicit. This paper addresses the question of what causal claims mean in the context of disease. It is argued that in medical contexts causality ought to be interpreted according to the epistemic theory.

Function and organization: comparing the mechanisms of protein synthesis and natural selection.

In this paper, we compare the mechanisms of protein synthesis and natural selection. We identify three core elements of mechanistic explanation: functional individuation, hierarchical nestedness or decomposition, and organization. These are now well understood elements of mechanistic explanation in fields such as protein synthesis, and widely accepted in the mechanisms literature.

Are decreases in insular regional cerebral blood flow sustained during postexercise hypotension?

Unlabelled: Regional cerebral blood flow (rCBF) in the insular cortex (IC), a well-recognized site for central blood pressure (BP) modulation, is decreased at minute 10 during postexercise hypotension (PEH).

Purpose: To determine whether exercise-induced decreases in IC rCBF are associated with BP changes throughout PEH.

Methods: Ten subjects were studied on three different days using a counterbalanced design with a randomized order for conditions; all were tested during a resting baseline and then at two of three time points postexercise: 10, 30, and 60 min.

Exercise-induced decrease in insular cortex rCBF during postexercise hypotension.

Unlabelled: The insular cortex (IC), a region of the brain involved in blood pressure (BP) modulation, shows decreases in regional cerebral blood flow (rCBF) during postexercise hypotension (PEH).

Purpose: To determine whether changes in IC neural activity were caused by prior exercise or by changes in BP, this investigation compared patterns of rCBF during periods of hypotension, which was induced by prior exercise (i.e.

Changes in supraspinal activation patterns following robotic locomotor therapy in motor-incomplete spinal cord injury.

Objectives: Body weight-supported treadmill training (BWSTT) is a task-specific rehabilitation strategy that enhances functional locomotion in patients following spinal cord injury (SCI). Supraspinal centers may play an important role in the recovery of over-ground locomotor function in patients with motor-incomplete SCI. The purpose of this study was to evaluate the potential for supraspinal reorganization associated with 12 weeks of robotic BWSTT using functional magnetic resonance imaging (fMRI).