The Paternalistic Relationship: Authenticity and credibility as a source of healthy relationships

This article explores the how the Paternalistic Leadership model can be viewed as part of a relationship-based paradigm of leadership, and can incorporate concepts such as credibility and authenticity. The review highlights the need to understand paternalistic leadership as an approach to establishing productive relationships within a cultural context, with implications for researchers and practitioners in both collectivist and individualistic cultures

When are empiric antibiotics appropriate for urinary tract infection symptoms?

Healthy, nonpregnant women presenting with the triad of frequency, dysuria, and no vaginal symptoms have about a 96% chance of having an urinary tract infection (UTI) (positive likelihood ratio [LR+]=24.6). Since no urinalysis result would substantially change the high likelihood of disease for these patients, empiric therapy is appropriate (strength of recommendation [SOR]: B)

Toy Models for Galaxy Formation versus Simulations

We describe simple useful toy models for key processes of galaxy formation in its most active phase, at z > 1, and test the approximate expressions against the typical behaviour in a suite of high-resolution hydro-cosmological simulations of massive galaxies at z = 4-1. We address in particular the evolution of (a) the total mass inflow rate from the cosmic web into galactic haloes based on the EPS approximation, (b) the penetration of baryonic streams into the inner galaxy, (c) the disc size, (d) the implied steady-state gas content and star-formation rate (SFR) in the galaxy subject to mass conservation and a universal star-formation law, (e) the inflow rate within the disc to a central bulge and black hole as derived using energy conservation and self-regulated Q ~ 1 violent disc instability (VDI), and (f) the implied steady state in the disc and bulge. The toy models provide useful approximations for the behaviour of the simulated galaxies. We find that (a) the inflow rate is proportional to mass and to (1+z)^5/2, (b) the penetration to the inner halo is ~50% at z = 4-2, (c) the disc radius is ~5% of the virial radius, (d) the galaxies reach a steady state with the SFR following the accretion rate into the galaxy, (e) there is an intense gas inflow through the disc, comparable to the SFR, following the predictions of VDI, and (f) the galaxies approach a steady state with the bulge mass comparable to the disc mass, where the draining of gas by SFR, outflows and disc inflows is replenished by fresh accretion. Given the agreement with simulations, these toy models are useful for understanding the complex phenomena in simple terms and for back-of-the-envelope predictions.Comment: Resubmitted to MNRAS after responding to referee's comments; Revised figure

What are effective medication combinations for dyslipidemia?

Many combination drug therapies are effective in treating dyslipidemia. Compared with statin monotherapy, combinations that include ezetimibe (Zetia), a bile acid sequestrant, or niacin further lower low- density lipoprotein (LDL) cholesterol (strength of recommendation [SOR]: A), and increase the likelihood of attaining National Cholesterol Education Program (NCEP) LDL cholesterol goals (SOR: B). Adding ezetimibe to a bile acid sequestrant reduces LDL cholesterol (SOR: B). Fibrate or niacin added to statin monotherapy provide mixed lipid-modifying effects for combined dyslipidemia (SOR: A)

What's the best way to treat Achilles tendonopathy?

Rest and ice are considered first-line therapy for acute Achilles tendonopathy (strength of recommendation [SOR]: C, expert opinion), as is nonsteroidal anti- inflammatory drugs (NSAIDs) (SOR: B, systematic review). Chronic noninsertional Achilles tendonopathy should be treated with eccentric calf-muscle training (ECMT) (SOR: B, 3 randomized controlled trials [RCTs])

Do OTC remedies relieve cough in acute URIs?

Dextromethorphan (DM) for adults and honey for children provide some relief. DM may modestly decrease cough in adults compared with placebo (strength of recommendation [SOR]: B, systematic review of inconsistent or limited evidence). The data supporting zinc for the common cold are mixed (SOR: B, meta-analysis with inconsistent results). Antihistamines, antihistamine-decongestant combinations, and guaifenesin don't provide greater relief than placebo in adults (SOR: B, systematic review of inconsistent or limited evidence)

Is guaifenesin safe during pregnancy?

It's not clear; little evidence supports or refutes the safety of guaifenesin, a common expectorant, in pregnancy. A small number of observational and case-control studies suggest a weak association between guaifenesin use and inguinal hernias and neural tube defects in newborns. However, substantial methodological flaws, the absence of statistical significance, and low rates of prevalence cast a shadow of a doubt over the data (strength of recommendation [SOR]: B, based on observational and case- control studies)

What is the best way to manage GERD symptoms in the elderly?

No evidence supports one method over another in managing uncomplicated gastroesophageal reflux disease (GERD) for patients aged >65 years. For those with endoscopically documented esophagitis, proton pump inhibitors (PPIs) relieve symptoms faster than histamine H2 receptor antagonists (H2RAs) (strength of recommendation [SOR]: B, extrapolation from randomized controlled trials [RCTs]). Treating elderly patients with pantoprazole (Protonix) after resolution of acute esophagitis results in fewer relapses than with placebo (SOR: B, double-blind RCT). Limited evidence suggests that such maintenance therapy for prior esophagitis with either H2RAs or PPIs, at half- and full-dose strength, decreases the frequency of relapse (SOR: B, extrapolation from uncontrolled clinical trial)

Does DTC advertising affect physician prescribing habits?

Direct-to-consumer advertising (DTCA) is associated with both higher fidelity to minimum treatment recommendations for depression and higher prescribing levels of antidepressants for depression and adjustment disorder (strength of recommendation [SOR]: B, small randomized controlled trial [RCT]). DTCA is also associated with higher prescribing rates for osteoarthritis, allergies, and hyperlipidemia (SOR: C, time-series analyses). No changes in prescribing rates have been noted for hypertension and benign prostatic hyperplasia (SOR: C, time-series analyses). Physicians often accommodate requests for DTCA medications (SOR: C, 4 surveys). In some cases, they wouldn't have considered such prescriptions for other similar patients (SOR: C, 3 surveys)

Five-minute Apgar score and educational outcomes: retrospective cohort study of 751 369 children

Background: The Apgar score is used worldwide for assessing the clinical condition and short-term prognosis of newborn infants. Evidence for a relationship with long-term educational outcomes is conflicting. We investigated whether Apgar score at 5 min after birth was associated with additional support needs (ASN) and educational attainment. Methods: Data on pregnancy, delivery and later educational outcomes for children attending Scottish schools between 2006 and 2011 were collated by linking individual-level data from national educational and maternity databases. The relationship between Apgar score and overall ASN, type-specific ASN and educational attainment was assessed using binary, multinomial and generalised ordinal logistic regression models, respectively. Missing covariate data were imputed. Results: Of the 751 369 children eligible, 9741 (1.3%) had a low or intermediate Apgar score and 49 962 (6.6%) had ASN. Low Apgar score was independently associated with overall ASN status (adjusted OR for Apgar ≤3, OR 1.52 95% CI 1.35 to 1.70), as well as ASN due to cognitive (OR 1.26, 95% CI 1.09 to 1.47), sensory (OR 2.49 95% CI 1.66 to 3.73) and motor (OR 3.57, 95% CI 2.86 to 4.47) impairments. There was a dose-response relationship between Apgar score and overall ASN status: of those scoring 0–3, 10.1% had ASN, compared with 9.1% of those scoring 4–7 and 6.6% of those scoring 7–10. A low Apgar score was associated with lower educational attainment, but this was not robust to adjustment for confounders. Conclusions: Apgar scores are associated with long-term as well as short-term prognoses, and with educational as well as clinical outcomes at the population level