Tag: pubmed

Int J Law Psychiatry. 2021 Apr 28;76:101686. doi: 10.1016/j.ijlp.2021.101686. Online ahead of print.

ABSTRACT

The attribution of criminal responsibility in the context of substance intoxication is a matter of controversy in forensic psychiatry. In 2011, the Supreme Court of Canada ruled that Tommy Bouchard-Lebrun was guilty in the straightforward case of a crime committed while in a state of substance-induced psychosis by an individual without a history of mental disorder. However, the ruling may since have served as a precedent also for settling cases where an offence is committed while in a certain state of intoxication and where there is much more diagnostic uncertainty. The goal of our research was to study the impact of the Bouchard-Lebrun Supreme Court decision on rates of criminal responsibility judgements and toxic psychosis diagnosis in the context of such cases. Applying a time-trend ecological study design, we conducted a chart review of every patient treated at the forensic unit of the Malartic Psychiatric Hospital in northern Quebec in the short periods pre- and post-ruling. We then determined the proportion of patients judged not criminally responsible and the proportion diagnosed with substance-induced psychosis. We ran chi-squared tests on the two sets of dichotomous variables. In the period following the Bouchard-Lebrun ruling, a statistically significant decrease was observed in the proportion of individuals judged not criminally responsible, as was a statistically significant increase in the proportion of individuals diagnosed with substance-induced psychosis. The findings suggest that the Bouchard-Lebrun ruling may have had an impact on subsequent forensic psychiatry decision-making and treatment at the Malartic Hospital.

PMID:33932740 | DOI:10.1016/j.ijlp.2021.101686

Appl Radiat Isot. 2021 Apr 24;174:109744. doi: 10.1016/j.apradiso.2021.109744. Online ahead of print.

ABSTRACT

¹³³Ba has been standardised by direct measurements for the first time in the laboratory using two counting systems: (i) the 4πβ (plastic scintillator) -γ coincidence, (ii) the 4πβ (proportional counter) -γ coincidence. Furthermore, this standardisation experiment demonstrates the performance and applicability of the recently developed 4πβ (plastic scintillator)-γ coincidence system for radionuclides decaying with complex decay schemes as well as for e, X-γ emitters. Additionally, ¹³³Ba solution standards were prepared to calibrate the pressurized 4π γ ionisation chamber and determination of the calibration coefficient. The E_n score is a statistical indicator of the agreement between two independent estimations. Thus, the performance of the PS system was compared to the result obtained with the PC system using the E_n score as specified in the ISO13528:2015. The results of measurements are acceptable if E_n ≦ 1.0. An E_n score of 0.2 was obtained which indicates that, the ¹³³Ba activity concentration obtained by the 4πβ (plastic scintillator) -γ coincidence and 4πβ (proportional counter) -γ coincidence systems are in agreement. This paper presents the standardisation procedure, the results obtained by the measurements and their comparison.

PMID:33932690 | DOI:10.1016/j.apradiso.2021.109744

J Clin Anesth. 2021 Apr 28;72:110310. doi: 10.1016/j.jclinane.2021.110310. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: To clarify whether intraoperative hypotension contributes to the development of postoperative cognitive dysfunction.

DESIGN: A systematic review of prospective studies reporting on intraoperative hypotension and postoperative cognitive dysfunction in elective, non-cognitive impaired, adult surgical patients. PubMed, EMBASE and the Cochrane Library were searched up to the 1st of January 2021.

SETTING: Studies had to use a clear definition of hypotension, although differing definitions were accepted. Neurocognitive tests to determine postoperative cognitive dysfunction had to be done pre- and postoperatively, with a minimum follow-up of seven days postoperatively.

MEASUREMENTS: Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0 for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies.

MAIN RESULTS: Out of 941 studies screened, five randomized controlled trials and four cohort studies were included for qualitative analysis. Extensive methodological differences between studies were present hindering proper quantitive analysis. No studies reported statistically significant differences in incidence of postoperative cognitive dysfunction in hypo- compared to normotensive patients. Five studies reported exact incidences of postoperative cognitive dysfunction.

CONCLUSIONS: This systematic review showed no conclusive association between intraoperative hypotension and the development of postoperative cognitive dysfunction. Given the vast methodological differences of the included studies, the role of intraoperative hypotension in the development of postoperative cognitive dysfunction remains uncertain. Future research into the association between intraoperative hypotension and postoperative cognitive dysfunction should be conducted in a standardized manner.

PMID:33932723 | DOI:10.1016/j.jclinane.2021.110310

J Anxiety Disord. 2021 Apr 19;81:102406. doi: 10.1016/j.janxdis.2021.102406. Online ahead of print.

ABSTRACT

The Adjustment Disorder New Module (ADNM) is a self-report instrument for assessing Adjustment disorder (AjD), but uncertainties remain in evaluating factor structure and psychometric properties of ADNM in previous studies. Three studies were conducted to examine the factor structure, psychometrics properties, and clinical utility of the 20-item version of ADNM (ADNM-20) and 4-item version (ADNM-4) among samples of Hong Kong Chinese (N = 1,415). Confirmatory factor analysis demonstrated good model fitness with a bifactor model. Statistical indices indicated unidimensionality of AjD. The model-based reliability showed that the total score of ADNM-20 should be used in scoring and interpretation for capturing the construct of AjD. ADNM-4 model demonstrated full invariance between women and men and partial invariance between age groups. Receiver operating characteristic analysis revealed a cutoff score of 10 for probable AjD. The prevalence of probable AjD was 20.5 % excluding cases with probable depression among a population-representative sample of Hong Kong Chinese amid civil unrest in Hong Kong in July 2019. Cutoff scores of ADNM-20 (49) and ADNM-4 (9) were established for clinically significant common psychiatric conditions, namely PTSD, depression, and anxiety. Both ADNM-20 and ADNM-4 were reliable and valid to assess probable AjD. Implications for clinical research and practice are discussed.

PMID:33932632 | DOI:10.1016/j.janxdis.2021.102406

Comput Biol Med. 2021 Apr 15;133:104403. doi: 10.1016/j.compbiomed.2021.104403. Online ahead of print.

ABSTRACT

The quality of magnetic resonance (MR) images obtained with different instruments and imaging parameters varies greatly. A large number of heterogeneous images are collected, and they suffer from acquisition variation. Such imaging quality differences will have a great impact on the radiomics analysis. The main differences in MR images include modality mismatch (M), intensity distribution variance (I), and layer-spacing differences (L), which are referred to as MIL differences in this paper for convenience. An MIL normalization system is proposed to reconstruct uneven MR images into high-quality data with complete modality, a uniform intensity distribution and consistent layer spacing. Three radiomics tasks, including tumor segmentation, pathological grading and genetic diagnosis of glioma, were used to verify the effect of MIL normalization on radiomics analysis. Three retrospective glioma datasets were analyzed in this study: BraTs (285 cases), TCGA (112 cases) and HuaShan (403 cases). They were used to test the effect of MIL on three different radiomics tasks, including tumor segmentation, pathological grading and genetic diagnosis. MIL normalization included three components: multimodal synthesis based on an encoder-decoder network, intensity normalization based on CycleGAN, and layer-spacing unification based on Statistical Parametric Mapping (SPM). The Dice similarity coefficient, areas under the curve (AUC) and six other indicators were calculated and compared after different normalization steps. The MIL normalization system can improved the Dice coefficient of segmentation by 9% (P < .001), the AUC of pathological grading by 32% (P < .001), and IDH1 status prediction by 25% (P < .001) when compared to non-normalization. The proposed MIL normalization system provides high-quality standardized data, which is a prerequisite for accurate radiomics analysis.

PMID:33932645 | DOI:10.1016/j.compbiomed.2021.104403

Med Phys. 2021 May 1. doi: 10.1002/mp.14916. Online ahead of print.

ABSTRACT

PURPOSE: This study assesses the accuracy of effective atomic number (Z_eff ) and electron density measurements acquired from dual energy CT and characterizes the response to clinically-relevant variables representative of challenges in patient imaging, including: phantom size, material position within the phantom, variation over time, off-center positioning, and large cone beam angle.

METHODS: The Gammex Multi-Energy CT head and body phantom was used to measure Z_eff and electron density from 35 rod inserts that mimic tissues and varying concentrations of iodine and calcium. Scans were performed on a Canon Aquilion ONE Genesis CT scanner over a period of 6 months using default dual-energy protocols appropriate for each phantom size. Theoretical Z_eff and electron density values were calculated using data provided by the phantom manufacturer and compared to the measurements. Sources of variance were separated and quantified to identify the influences of random photon statistics, ROI placement, and variation over time. A subset of measurements were repeated with the phantom shifted in the vertical and horizontal directions, and over all slices in the volumetric scan.

RESULTS: All measurements showed strong correlation (r > 0.98) with their corresponding theoretical values; however, the system did demonstrate a bias of -0.58 atomic units in the body phantom and 0.28 atomic units in the head phantom for Z_eff measurements. The mean absolute percent error (MAPE) was 6.3% for the body phantom and 3.2% for the head phantom. Electron density measurements of the body and head phantoms gave MAPE values of 4.6% and 1.0%, respectively. Z_eff and electron density measurements significantly varied within the solid water background, showing a positional dependence within the phantom that dominated the total standard deviation in measurements. Z_eff values dropped by 0.2 atomic units when the phantom was off-center; electron density measurements were less affected by phantom position. Along the z-axis, the accuracy drops off markedly at more than 50-60 mm from the central slice.

CONCLUSION: The Canon dual energy system offers an accurate way of measuring the Z_eff and electron density of clinically-relevant materials. Accuracy could be improved further by calibration to remove bias, careful attention to centering within the FOV, and avoiding measurements at the edges of the cone beam.

PMID:33932301 | DOI:10.1002/mp.14916

Eur J Heart Fail. 2021 May 1. doi: 10.1002/ejhf.2210. Online ahead of print.

ABSTRACT

AIMS: Viral-induced cardiac inflammation can induce heart failure with preserved ejection fraction (HFpEF) like syndromes. COVID-19 can lead to myocardial damage and vascular injury. We hypothesised that COVID-19 patients frequently develop a HFpEF-like syndrome, and designed this study to explore this.

METHODS AND RESULTS: Cardiac function was assessed in 64 consecutive, hospitalized, and clinically stable COVID-19 patients from April – November 2020 with left ventricular ejection fraction (LVEF) ≥50% (age 56±19 years, females: 31%, severe COVID-19 disease: 69%). To investigate likelihood of HFpEF presence, we used the HFA-PEFF score. A low (0-1 points), intermediate (2-4 points), and high (5-6 points) HFA-PEFF score was observed in 42%, 33%, and 25% of patients, respectively. In comparison, 64 subjects of similar age, sex, and comorbidity status without COVID-19, showed these scores in 30%, 66%, and 4%, respectively (between groups: p=0.0002). High HFA-PEFF scores were more frequent in COVID-19 patients than controls (25% vs. 4%, p=0.001). In COVID-19 patients, HFA-PEFF score significantly correlated with age, estimated glomerular filtration rate, high sensitivity troponin T (hsTnT), haemoglobin, QTc interval, LVEF, mitral E/A ratio, and H₂ FPEF score (all p<0.05). In multivariate, ordinal regression analyses, higher age and hsTnT were significant predictors of increased HFA-PEFF scores. Patients with myocardial injury (hsTnT ≥14 ng/L: 31%) vs. patients without myocardial injury, showed higher HFA-PEFF scores (median 5 [IQR 3-6] vs. 1 [0-3], p<0.001) and more often showed LV diastolic dysfunction (75% vs. 27%, p<0.001).

CONCLUSION: Hospitalised COVID-19 patients frequently show high likelihood of presence of HFpEF that is associated with cardiac structural and functional alterations, and myocardial injury. Detailed cardiac assessments including echocardiographic determination of LV diastolic function and biomarkers should become routine in the care of hospitalised COVID-19 patients. This article is protected by copyright. All rights reserved.

PMID:33932255 | DOI:10.1002/ejhf.2210

Nurs Open. 2021 May 1. doi: 10.1002/nop2.762. Online ahead of print.

ABSTRACT

AIM: To investigate nurses’ perceptions of their work environment and to investigate the relationships between variables measuring the work environment (WE) and nursing outcomes (NO_s ).

DESIGN: A 2-year prospective longitudinal survey (2013-2015).

METHOD(S): Descriptive statistics of nurse demographics, organizational WE and NOs were calculated by position. The associations between Practice Environment Scale of the Nursing Work Index (PES-NWI) and NOs were examined for each unit.

RESULTS: The participants were 2,992 staff nurses, 137 nurse managers (NMs), and 8 chief nursing officers in Phase 1 and 7,849, 371 and 23 in Phase 2, respectively. The higher the job position, the better the WE was rated. The higher the PES-NWI scores, the better the outcomes. Descriptive statistics about organizational WEs and NOs and the statistically significant associations between the two were identified.

PMID:33932266 | DOI:10.1002/nop2.762

J Med Virol. 2021 May 1. doi: 10.1002/jmv.27058. Online ahead of print.

ABSTRACT

PROBLEM: Timing of detection of IgG, IgA and IgM antibodies against SARS-CoV-2, and their use to support the diagnosis are of increasing interest.

METHODS: We used the Gold Standard Diagnostics ELISA to evaluate the kinetics of SARS-CoV-2 IgG, IgA and IgM antibodies in sera of 82 hospitalized patients with PCR-confirmed COVID-19. Serum samples were collected 1-59 days post onset of symptoms (PoS) and we examined the association of age, sex, disease severity and symptoms’ duration with antibody levels. We also tested sera of 100 ambulatory hospital employees with PCR-confirmed COVID-19 and samples collected during convalescence, 35-57 days PoS.

RESULTS: All but 4 of the admitted patients (95.1%) developed antibodies to SARS-CoV-2. Antibodies were detected within seven days PoS; IgA in 60.0%, IgM in 53.3% and IgG in 46.7% of samples. IgG positivity increased to 100% at day 21. We did not observe significant differences in the rate of antibody development in regard to age and sex. IgA levels were highest in patients with severe and critical illness. In multiple regression analyses, only IgA levels were statistically significant correlated with critical disease (p=0.05) regardless of age, sex and duration of symptoms. Among 100 ambulatory hospital employees who had antibody testing after 4 weeks PoS only 10% had positive IgA antibodies. The most frequently isolated isotype in sera of employees after 30 days PoS was IgG (88%).

CONCLUSIONS: IgA was the predominant immunoglobulin in early disease and correlated independently with critical illness. IgG antibodies remained detectable in almost 90% on samples collected up to two months after infection. This article is protected by copyright. All rights reserved.

PMID:33932299 | DOI:10.1002/jmv.27058

Qual Life Res. 2021 May 1. doi: 10.1007/s11136-021-02853-x. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the associations between cardiovascular health (CVH) metrics and health-related quality of life (HRQL) among patients with ischemic stroke in China, and further explore the role of physical and cognitive function in their associations.

METHODS: This hospital-based study included 1714 patients with first-ever acute ischemic stroke (age ≥ 40 years; 36.7% women) who were admitted to two university hospitals in Shandong, China. We collected information on seven CVH metrics (smoking, body mass index, diet, physical activity, blood pressure, total cholesterol, and fasting blood glucose) through interviews, clinical examinations, and laboratory tests. EQ-5D-3L was used to assess HRQL. Cognitive and physical functioning was assessed by the Montreal Cognitive Assessment test and Barthel index, respectively. Data were analyzed using the general linear regression models.

RESULTS: The average score (SD) was 0.746 (0.23) for HRQL index and 72.7 (15.8) for self-rated health. Optimal levels of four individual CVH metric components (diet, physical activity, blood pressure, and blood glucose) and a higher composite CVH score were significantly associated with a greater HRQL index and better self-rated health (p < 0.05 for all). Physical dependence and cognitive impairment were associated with a lower HRQL index and poorer self-rated health status (p < 0.001). Furthermore, the relationships between CVH metrics and HRQL index varied by functional status, such that their associations were statistically significant only among people who had physical dependence or cognitive impairment.

CONCLUSION: Achieving a better cardiovascular health profile is associated with better quality of life among ischemic stroke survivors, primarily in those with physical or cognitive impairment.

PMID:33932220 | DOI:10.1007/s11136-021-02853-x