Category: Nevin Manimala

Schizophr Bull. 2021 May 3:sbab041. doi: 10.1093/schbul/sbab041. Online ahead of print.

ABSTRACT

There is limited research in adolescents at risk for psychosis. The new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition attenuated psychosis syndrome (DSM-5 APS) criteria have not been validated in this group. We conducted a RECORD-compliant, real-world, prospective, 5-year cohort study addressing clinical profile, transition to psychosis, and prognostic accuracy of DSM-5 APS in help-seeking inpatient/outpatient adolescents accessing Children and Adolescent Neuropsychiatric services at IRCCS Mondino Foundation (Pavia, Lombardy, Italy) between 2012 and 2019. About 243 adolescents (31 early-onset psychosis [EOP]; 110 meeting DSM-5 APS criteria, DSM-5 APS; 102 not meeting psychotic or DSM-5 APS criteria, non-APS) were included. At baseline, DSM-5 APS adolescents (aged 15.4 ± 1.6) had on average 2.3 comorbid disorders (higher than EOP/non-APS, P < .001). DSM-5 APS adolescents had an intermediate psychopathological profile between non-APS/EOP (P < .001) and worsen Clinical Global Impression-Severity than non-APS (P < .001). DSM-5 APS functioning was intermediate between non-APS and EOP. 39.1% of DSM-5 APS were treated with psychotropic drugs (average = 64 days); 53.6% received psychotherapy. Follow-up of DSM-5 APS and non-APS groups lasted 33 and 26 months, respectively (median). The cumulative risk of transition at 1-5 years was 13%, 17%, 24.2%, 26.8%, and 26.8% in the DSM-5 APS group, 0%, 0%, 3.2%, 3.2%, and 3.2% in the non-APS group. The 5-year prognostic accuracy of the DSM-5 APS in adolescent was adequate (area under the curve = 0.77; Harrell’s C = 0.736, 95%CI 0.697-0.775), with high sensitivity (91.3%) and suboptimal specificity (63.2%). The DSM-5 APS diagnosis can be used to detect help-seeking adolescents at risk of psychosis and predict their long-term outcomes. Future research should consolidate these findings.

PMID:33939829 | DOI:10.1093/schbul/sbab041

Environ Toxicol Chem. 2021 May 3. doi: 10.1002/etc.5078. Online ahead of print.

ABSTRACT

The Amphibian Metamorphosis Assay (AMA, OPPTS 890.1100, 2009 and OECD TG 231, 2009) has been used for over a decade to assess potential thyroid (T)-mediated endocrine activity of chemicals. In 2013, in the context of the Endocrine Disruptor Screening Program of the United States Environmental Protection Agency, a Scientific Advisory Panel reviewed the results from 18 studies and recommended changes to the AMA Test Guideline (TG), including a modification to a fixed-stage design rather than a fixed-time (i.e., 21-day) design. In this paper, we describe an extended test design for the AMA (or EAMA) that includes thyroid histopathology and time to metamorphosis (Nieuwkoop-Faber, NF stage 62) in order to address both the issues with the fixed-time design and the specific question of T-mediated adversity in a shorter assay than the Larval Amphibian Growth and Development Assay (LAGDA, OECD TG 241), using fewer animals and resources. A demonstration study was conducted with the EAMA (up to NF stage 58) using sodium-perchlorate. Data analyses and interpretation of the fixed-stage design of the EAMA are more straightforward than the fixed-time design because it avoids confounded morphometric measurements and thyroid histopathology, caused by varying developmental stages at test termination. It also results in greater statistical power to detect metamorphic delays than the fixed-time design. By preferentially extending the AMA to NF stage 62, suitable data can be produced to evaluate T-mediated adversity and preclude the need to perform a LAGDA for thyroid mode of action analysis. The LAGDA remains of further interest should investigations of longer-term effects related to sexual development modulated though the hypothalamus-pituitary gonadal (HPG) axis be necessary. However, reproduction assessment or life-cycle testing is currently not addressed in the LAGDA study design. This is better addressed by higher-tier studies in fish, which should then include specific T-related endpoints. This article is protected by copyright. All rights reserved.

PMID:33939850 | DOI:10.1002/etc.5078

J Gastroenterol Hepatol. 2021 May 3. doi: 10.1111/jgh.15535. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Despite widespread recommendations and use of intravenous corticosteroids (IVCS) for the treatment of acute flares of ulcerative colitis and Crohn’s disease, limited evidence exists comparing outcomes of the two most common regimens, intravenous methylprednisolone (IVMP) and intravenous hydrocortisone (IVHC). IVHC has stronger mineralocorticoid effects compared to IVMP and may cause higher rates of hypokalaemia. We aimed to determine differences in clinical outcomes including requirement for inpatient rescue therapy, bowel resection and rates of hypokalaemia.

METHODS: We conducted a multicentre cohort study of all adult patients admitted with an acute flare of inflammatory bowel disease (IBD) to the three tertiary hospitals in Auckland, New Zealand where the protocol at each institution is either IVMP 60 mg daily or IVHC 100 mg four times daily. All patients requiring IVCS between 20 June 2016 and 30 June 2018 were included. The IVCS protocol was then changed at one hospital, where further data was collected for a further 12 months from 30 January 2019 until 30 December 2019.

RESULTS: There were 359 patients, including 129 (35.9%) patients receiving IVMP and 230 (64.1%) patients receiving IVHC. IVMP treatment was associated with a greater requirement for rescue therapy than IVHC (36.4% vs 19.6%, p=0.001; odds ratio [OR]= 2.79; 95% confidence interval [CI], 1.64-4.75, p<0.001), but also reduced rates of hypokalaemia (55.8% vs 67.0%, p=0.04; OR=0.49; 95% CI, 0.30-0.81, p=0.005). There was no difference between treatment groups for the median length of admission (5 days, interquartile range, IQR 3-8), median duration of IVCS treatment (3 days, IQR 2-5) or bowel resection within 30 days of admission (12.4% vs 11.7%; OR=1.04).

CONCLUSION: For the treatment of an acute flare of IBD, treatment with IVMP results in significantly more requirement for inpatient rescue biologic or cyclosporin. In addition, it causes statistically significant less hypokalemia than IVHC, although in practice differences are negligible.

PMID:33939853 | DOI:10.1111/jgh.15535

Mil Med. 2021 May 3:usab176. doi: 10.1093/milmed/usab176. Online ahead of print.

ABSTRACT

INTRODUCTION: Ultrasound guidance is now widely available in military treatment facilities and civilian hospitals alike, both in the USA and in forward-deployed military environments. Technical mastery of ultrasound-guided peripheral intravenous (USGPIV) catheter insertion can be easily achieved through a short training course. Mastery can be achieved even when trainees have a limited medical background before course attendance. An evidence-based practice project team sought to improve the knowledge, confidence, and skills in the placement of USGPIV catheters by clinicians at Naval Hospital Jacksonville. Completion of an USGPIV training program can equip healthcare providers with knowledge and confidence for placement of peripheral access necessary in critical situations such as those requiring medications or blood products.

MATERIALS AND METHODS: The project team conducted a literature review to evaluate the appropriateness of USGPIV training for the nurses and military medical technicians in this setting. The team developed and delivered a USGPIV training program based on adaptations from the literature. During the training period, knowledge and confidence scores were reported by each trainee to evaluate the perceptions of the quality of training. The number of attempted catheter placements and ultrasound utilization was recorded in the pre- and post-implementation periods to evaluate the project’s effect on the delivery of patient care. Statistical analysis was conducted to evaluate project outcomes.

RESULTS: In the pre-intervention period, none of the 252 intravenous catheters were placed with the USGPIV technique, compared to 50 of 267 in the post-intervention period. These results demonstrate an 18.7% increase in the USGPIV access approach by nursing staff. Mean knowledge scores significantly increased following the delivery of the training, 60% versus 80% in the pre- and post-training assessments, respectively (P < .001). Mean self-reported skill confidence scores also significantly improved (P < .001).

CONCLUSION: Knowledge and self-reported confidence in USGPIV access improved for the trainees. Mean knowledge improved from 60% to 80%, while mean confidence scores increased from 2.74 to 3.79 for corpsman and from 3.0 to 3.88 for nurses. Utilization of the USGPIV technique increased by 18.7% in the post-intervention period. These results demonstrate that implementing this training program can improve knowledge, confidence, and use of ultrasound during the placement of PIV catheters.

PMID:33939820 | DOI:10.1093/milmed/usab176

Mil Med. 2021 May 3:usab168. doi: 10.1093/milmed/usab168. Online ahead of print.

ABSTRACT

INTRODUCTION: Special Weapons and Tactics (SWAT) personnel who practice breaching with blast exposure are at risk for blast-related head trauma. We aimed to investigate the impact of low-level blast exposure on underlying white matter (WM) microstructure based on diffusion tensor imaging (DTI) and neurite orientation and density imaging (NODDI) in SWAT personnel before and after breacher training. Diffusion tensor imaging is an advanced MRI technique sensitive to underlying WM alterations. NODDI is a novel MRI technique emerged recently that acquires diffusion weighted data from multiple shells modeling for different compartments in the microstructural environment in the brain. We also aimed to evaluate the effect of a jugular vein compression collar device in mitigating the alteration of the diffusion properties in the WM as well as its role as a moderator on the association between the diffusion property changes and the blast exposure.

MATERIALS AND METHODS: Twenty-one SWAT personnel (10 non-collar and 11 collar) completed the breacher training and underwent MRI at both baseline and after blast exposure. Diffusion weighted data were acquired with two shells (b = 1,000, 2,000 s/mm2) on 3T Phillips scanners. Diffusion tensor imaging metrices, including fractional anisotropy, mean, axial, and radial diffusivity, and NODDI metrics, including neurite density index (NDI), isotropic volume fraction (fiso), and orientation dispersion index, were calculated. Tract-based spatial statistics was used in the voxel-wise statistical analysis. Post hoc analyses were performed for the quantification of the pre- to post-blast exposure diffusion percentage change in the WM regions with significant group difference and for the assessment of the interaction of the relationship between blast exposure and diffusion alteration.

RESULTS: The non-collar group exhibited significant pre- to post-blast increase in NDI (corrected P < .05) in the WM involving the right internal capsule, the right posterior corona radiation, the right posterior thalamic radiation, and the right sagittal stratum. A subset of these regions showed significantly greater alteration in NDI and fiso in the non-collar group when compared with those in the collar group (corrected P < .05). In addition, collar wearing exhibited a significant moderating effect for the alteration of fiso for its association with average peak pulse pressure.

CONCLUSIONS: Our data provided initial evidence of the impact of blast exposure on WM diffusion alteration based on both DTI and NODDI. The mitigating effect of WM diffusivity changes and the moderating effect of collar wearing suggest that the device may serve as a promising solution to protect WM against blast exposure.

PMID:33939823 | DOI:10.1093/milmed/usab168

PLoS One. 2021 May 3;16(5):e0251029. doi: 10.1371/journal.pone.0251029. eCollection 2021.

ABSTRACT

Assisting patients with upper gastrointestinal bleeding is a crucial role for nurses, and as future nurses, students should demonstrate sound clinical judgment. Well-structured, high-quality simulations are useful alternatives to prepare students for clinical practice. However, nursing simulation scenarios focused on enhancing clinical judgment in managing upper gastrointestinal bleeding are limited. This study aims to develop, apply, and evaluate an effective nursing simulation scenario for patients with upper gastrointestinal bleeding based on Tanner’s clinical judgment model using a mixed methods study design. A high-fidelity patient simulation was conducted among 80 undergraduate nursing students divided into a simulated control group (n = 39) and an experimental group (n = 41). Subsequent student performance evaluations used questionnaires and video recordings. After scenario simulations, the students showed a statistically significant increase in theoretical knowledge (p = 0.001) and clinical performance skills (p < 0.001), but there was no significant increase in self-confidence (p = 0.291). According to the video analysis, the “noticing” clinical judgment phase was the most frequently observed phase, while “reflection” was the least frequently observed phase. Additionally, “education” was the most frequently observed nursing domain, and “anxiety” was the least frequently observed domain. Although further simulation repetitions are required to reinforce students’ self-confidence when caring for patients with upper gastrointestinal bleeding, the scenario was deemed effective. Moreover, emphasis should be placed on developing various scenarios to strengthen students’ clinical judgment skills, especially “reflecting” and “emotional care.”

PMID:33939752 | DOI:10.1371/journal.pone.0251029

PLoS One. 2021 May 3;16(5):e0250963. doi: 10.1371/journal.pone.0250963. eCollection 2021.

ABSTRACT

Time-to-event analysis is a common occurrence in political science. In recent years, there has been an increased usage of machine learning methods in quantitative political science research. This article advocates for the implementation of machine learning duration models to assist in a sound model selection process. We provide a brief tutorial introduction to the random survival forest (RSF) algorithm and contrast it to a popular predecessor, the Cox proportional hazards model, with emphasis on methodological utility for political science researchers. We implement both methods for simulated time-to-event data and the Power-Sharing Event Dataset (PSED) to assist researchers in evaluating the merits of machine learning duration models. We provide evidence of significantly higher survival probabilities for peace agreements with 3rd party mediated design and implementation. We also detect increased survival probabilities for peace agreements that incorporate territorial power-sharing and avoid multiple rebel party signatories. Further, the RSF, a previously under-used method for analyzing political science time-to event data, provides a novel approach for ranking of peace agreement criteria importance in predicting peace agreement duration. Our findings demonstrate a scenario exhibiting the interpretability and performance of RSF for political science time-to-event data. These findings justify the robust interpretability and competitive performance of the random survival forest algorithm in numerous circumstances, in addition to promoting a diverse, holistic model-selection process for time-to-event political science data.

PMID:33939757 | DOI:10.1371/journal.pone.0250963

J Anim Sci. 2021 May 3:skab133. doi: 10.1093/jas/skab133. Online ahead of print.

ABSTRACT

The interest and demand for healthy and less processed foods for people has been mirrored in the pet industry, with an explosion of alternative diets available. Several non-traditional feeding methodologies including raw meat based diets (RMBD) are believed by many dog owners to be superior to traditional extruded commercial dog foods. Despite the strong opinions, limited data are available comparing objective health measures among healthy dogs fed using different methods of diet preparation. Therefore, we compared health markers in client owned dogs fed a RMBD to markers in dogs fed a high quality, extruded kibble. We hypothesized that healthy adult dogs fed RMBD would show differences in biochemical and hematological parameters and improved clinical health scores (e.g.,dental, external ear canal and integument scores) compared to dogs fed a kibble diet. A cross-sectional observational study was performed comparing hematology, serum biochemistry, urinalysis management history and clinical health scores in healthy client-owned dogs reported as fed RMBD (n=28) or kibble (n=27) for > 1 year. Dental, external ear canal and integument health scores were assigned by a single veterinary evaluator blinded to feed group, using a scale where 0 was normal and 3 was most severely affected. Spearman correlation coefficient (rs) was calculated to assess the strength and direction of the relationship of biochemical outcomes with age and BCS, while analysis of variance was used to determine if biochemical analytes differed by breed or gender. Biochemical data were analyzed using multiple linear regression models, adjusting for the covariates gender, breed, age and BCS. A composite clinical health score, CCS= 9- (dental score + otitis score + integument score), was compared between feeding groups using Mann Whitney test. Serum alkaline phosphatase activity (P<0.001) and globulin concentration (P<0.001) was lower, while lymphocyte count (P<0.05) was higher in dogs fed RMBD. No differences were found in urinalysis between diet groups. Dogs fed RMBD showed a slight improvement in CCS compared to kibble fed dogs (CCS: P=0.03). Owner management significantly differed with greater likelihood of management interventions including dietary supplements and sporting activities in the RMBD group. Further work is needed to specifically determine the impact of diet processing and nutrient content on canine health.

PMID:33939804 | DOI:10.1093/jas/skab133

PLoS One. 2021 May 3;16(5):e0250927. doi: 10.1371/journal.pone.0250927. eCollection 2021.

ABSTRACT

OBJECTIVES: To determine the prevalence and socio-demographic and parental-related factors of depression among school adolescents in Jimma town, southwest Ethiopia.

METHODS: Using a cross-sectional survey, 546 school adolescents were screened for depression using the patient health questionnaire (PHQ-9) from five randomly selected public and private schools. Oslo social support scale, adverse childhood experience tool, and socio-demographic questionnaire were used to gather data on risk factors. Linear regression analysis was used, and unstandardized beta (β) coefficients with 95% confidence intervals (CI) were reported to declare statistical significance.

RESULTS: A total of 546 adolescents participated in the study, with a response rate of 97.3%. The mean (±SD) age of participants was 16.8 ± 1.3 years. The majority (81%) of the adolescents were attending day classes at public schools. The prevalence of depression was found to be 28% using the patient health questionnaire. Based on the PHQ-9 depression severity scale, 18.5% and 8.2% of the adolescent had moderate and moderate to severe depression while 1.3% had severe depression. In the final multivariate linear regression analysis, it was found that sex, rural residence, low social support, being in higher grade level, and adverse childhood experience were found to be independently associated with a higher score of depression.

CONCLUSION: One in three adolescents was found to have a depressive syndrome. We recommend schools to integrate school mental health service that contains routine screening and intervention services. Moreover, efforts are needed to sensitize and educate the communities on child protection, social support, and safeguarding to effectively tackle the magnitude of adolescent depression.

PMID:33939748 | DOI:10.1371/journal.pone.0250927

PLoS One. 2021 May 3;16(5):e0250105. doi: 10.1371/journal.pone.0250105. eCollection 2021.

ABSTRACT

Previous research has shown that behavioural mimicry fosters affiliation, and can be used to infer whether people belong to the same social unit. However, we still know very little about the generalizability of these findings and the individual factors involved. The present study intends to disentangle two important variables and assess their importance for affiliation: the matching in time of the behaviours versus their matching in form. In order to address this issue, we presented participants with short videos in which two actors displayed a set of small movements (e.g. crossing their legs, folding their arms, tapping their fingers) arranged to be either contingent in time or in form. A dark filter was used to eliminate ostensive group marks, such us phenotype or clothing. Participants attributed the highest degree of affiliation to the actors when their subsequent movements matched in form, but were delayed by 4-5 seconds, and the lowest degree when the timing of their movements matched, but they differed in form. To assess the generalizability of our findings, we took our study outside the usual Western context and tested a matching sample of participants from a traditional small-scale society in Kenya. In all, our results suggest that movements are used to judge the degree of affiliation between two individuals in both large- and small-scale societies. While moving in different ways at the same time seems to increase the perceived distance between two individuals, movements which match in form seem to invoke closeness.

PMID:33939734 | DOI:10.1371/journal.pone.0250105