This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.

ABSTRACT IMPACT: A machine learning approach using electronic health records can combine descriptive, population-level factors of pressure injury outcomes. OBJECTIVES/GOALS: Pressure injuries cause 60,000 deaths and cost $26 billion annually in the US, but prevention is laborious. We used clinical data to develop a machine learning algorithm for predicting pressure injury risk and prescribe the timing of intervention to help clinicians balance competing priorities. METHODS/STUDY POPULATION: We obtained 94,745 electronic health records with 7,000 predictors to calibrate a predictive algorithm of pressure injury risk. Machine learning was used to mine features predicting changes in pressure injury risk; random forests outperformed neural networks, boosting and bagging in feature selection. These features were fit to multilevel ordered logistic regression to create an algorithm that generated empirical Bayes estimates informing a decision-rule for follow-up based on individual risk trajectories over time. We used cross-validation to verify predictive validity, and constrained optimization to select a best-fit algorithm that reduced the time required to trigger patient follow-up. RESULTS/ANTICIPATED RESULTS: The algorithm significantly improved prediction of pressure injury risk (p<0.001) with an area under the ROC curve of 0.60 compared to the Braden Scale, a traditional clinician instrument of pressure injury risk. At a specificity of 0.50, the model achieved a sensitivity of 0.63 within 2.5 patient-days. Machine learning identified categorical increases in risk when patients were prescribed vasopressors (OR=16.4, p<0.001), beta-blockers (OR=4.8, p<0.001), erythropoietin stimulating agents (OR=3.0, p<0.001), or were ordered a urinalysis screen (OR=9.1, p<0.001), lipid panel (OR=5.7, p<0.001) or pre-albumin panel (OR=2.0, p<0.001). DISCUSSION/SIGNIFICANCE OF FINDINGS: This algorithm could help hospitals conserve resources within a critical period of patient vulnerability for pressure injury not reimbursed by Medicare. Savings generated by this approach could justify investment in machine learning to develop electronic warning systems for many iatrogenic injuries.

We performed a prospective study of 501 patients, regardless of symptoms, admitted to the hospital, to estimate the predictive value of a negative nasopharyngeal swab for severe acute respiratory coronavirus virus 2 (SARS-CoV-2). At a positivity rate of 10.2%, the estimated negative predictive value (NPV) was 97.2% and the NPV rose as prevalence decreased during the study.

Children with cancer are potentially at a high risk of plasma 25-hydroxyvitamin D (25(OH)D) inadequacy, and despite UK vitamin D supplementation guidelines their implementation remains inconsistent. Thus, we aimed to investigate 25(OH)D concentration and factors contributing to 25(OH)D inadequacy in paediatric cancer patients. A prospective cohort study of Scottish children aged <18 years diagnosed with, and treated for, cancer (patients) between August 2010 and January 2014 was performed, with control data from Scottish healthy children (controls). Clinical and nutritional data were collected at defined periods up to 24 months. 25(OH)D status was defined by the Royal College of Paediatrics and Child Health as inadequacy (<50 nmol/l: deficiency (<25 nmol/l), insufficiency (25–50 nmol/l)), sufficiency (51–75 nmol/l) and optimal (>75 nmol/l). In all, eighty-two patients (median age 3·9, interquartile ranges (IQR) 1·9–8·8; 56 % males) and thirty-five controls (median age 6·2, IQR 4·8–9·1; 49 % males) were recruited. 25(OH)D inadequacy was highly prevalent in the controls (63 %; 22/35) and in the patients (64 %; 42/65) at both baseline and during treatment (33–50 %). Non-supplemented children had the highest prevalence of 25(OH)D inadequacy at every stage with 25(OH)D median ranging from 32·0 (IQR 21·0–46·5) to 45·0 (28·0–64·5) nmol/l. Older age at baseline (R −0·46; P<0·001), overnutrition (BMI≥85th centile) at 3 months (P=0·005; relative risk=3·1) and not being supplemented at 6 months (P=0·04; relative risk=4·3) may have contributed to lower plasma 25(OH)D. Paediatric cancer patients are not at a higher risk of 25(OH)D inadequacy than healthy children at diagnosis; however, prevalence of 25(OH)D inadequacy is still high and non-supplemented children have a higher risk. Appropriate monitoring and therapeutic supplementation should be implemented.

Tests were performed to determine whether combining two thrips lures, ethyl nicotinate (EN) and ethyl isonicotinate (EI), in the same water trap increased the numbers of New Zealand flower thrips (NZFT), Thrips obscuratus Crawford, and onion thrips, T. tabaci Lindeman (Thysanoptera: Terebrantia: Thripidae), caught in the field relative to traps with a single lure. Traps with both lures (1:1 ratio; mixture or separate adjacent vials) caught 5–9 times more female onion thrips (thelyotokous populations are the most prevalent in New Zealand) than traps with EN only (P<0.001), but in similar numbers to traps with EI only. Traps with both lures caught 2–3 times as many male and female NZFT than traps with EI only, but in similar numbers to traps with EN only. Thus, a combination of the two lures in one trap could be used to detect and monitor flying onion thrips and NZFT simultaneously.

This article reviews the putative role of emotion dysregulation in diverse clinical presentations and considers some of its aetiological factors, such as insecure attachments in early life and traumatic experiences in later life. The neurobiology of emotional processes is described in relation to the ‘window of tolerance’ model of arousal levels optimal for information processing. Treatment options are considered and ways to regulate distress, derived from different approaches, are summarised in a ‘toolbox’. Fictitious case vignettes illustrate clinical applications.

Aims: Evaluation of users’ perspectives on ward meetings on a low secure challenging behaviour unit with high levels of morbidity as a means towards increasing their sense of empowerment.

Method: Semi-structured questionnaire designed and administered by a user to all users on the unit over the period of June–Aug 2004 and review of ward meeting minutes over the same period.

Results: 60% response rate. Issues were analysed and issues of importance highlighted and changes made.

Conclusion: On challenging behaviour wards with very high morbidity and long stays, involving the users actively in ward meetings and addressing concerns with feedback is empowering and can be therapeutic. This study highlights this need.

Reproducible nanoscale surface lithography have been produced on La00.66Ba0.33MnO3 thin films using Atomic Force Microscopy. Using an anodic oxidation technique, structures were produced using both positive tip bias voltages as well as negative tip voltages. The electric field produced by applying a positive tip bias acts to reduce the region near the surface, whereas negative tip bias causes an oxidation reaction. Using a positive tip bias, stable structures were consistently achieved which demonstrated a linear dependence of height and width on tip voltage and writing speed. Heights ranged from 5 – 50 nm and widths from 400 – 2000 nm. Negative bias voltages produced a rapid oxidation of the surface, resulting in uncontrollable writing. After etching with a 50% HCL solution it was found that controlled writing was possible with negative bias voltages.

We are developing Colossal Magnetoresistive (CMR) manganite thin film bolometric sensors to be employed as total energy detectors for beam diagnostics of the Linear Coherent Light Source (LCLS) Free Electron Laser (FEL) (at the Stanford Linear Accelerator). LCLS is an ultra bright, ultra short coherent x-ray source whose peak brightness will exceed that of third generation x-ray sources by about ten orders of magnitude and average brightness by three orders of magnitudes. It is expected to produce 1012 x-rays per 200 fs pulse with a repeat frequency of 120 Hz through self-amplified stimulated emission. In characterizing the beam, it will be necessary to measure the total energy of the FEL pulse. The Advanced Detector Group at Lawrence Livermore Laboratory has developed a scheme for FEL total energy measurements based on bolometric detection and are collaborating with Towson University to implement such a detector using CMR manganite thin films. Here we discuss the basic scheme, results of simulations of the thermal response and the materials development efforts towards fabricating the thin film detectors.

Granular material, fed continuously into the top of a slowly rotating, slightly inclined cylinder, forms a moving bed. Much of the bed rotates with the cylinder in solid body motion. When particles reach the surface of the bed, they move rapidly down it, and are absorbed once more into the solid body motion. Such cylinders are used in calcining, pharmaceutical manufacture, and drying. A steady state transport model, applicable when the bed depth varies slowly along the cylinder, has existed for around 50 years. The bed surface is considered locally flat, and particles in it fall along the line of steepest descent, inclined to the horizontal at the angle of repose. There is reasonable agreement with experiment.

We propose a quasi-steady state dynamical model, in which the steady state model is coupled with a volume balance across an axial element. The model takes the form of a nonlinear diffusion equation which was solved numerically. The parameters of the dynamic model are the dimensions of the cylinder and outlet dam, the inclination of the axis of the cylinder, its rotational speed, the angle of repose of the granular material and its feed volumetric flow rate: the dynamic model has no free parameters. Experiments were conducted using sand, mean particle size 490 μm, in a perspex tube of length 1 m, radius 0.0515 m, lined with sandpaper, with a feed end dam of height 0.029 m, and with no exit dam, or an exit dam of height 0.0105 m. With the system initially in steady state, step changes in feed flow rate, rotational speed or axis inclination were imposed, and the resulting discharge flow rate and bed depth axial profile measured as functions of time. Good agreement is found between model and experiment.

Neuropsychological outcome was evaluated in a prospective, longitudinal follow-up study of children age 4 months to 7 years at injury with either mild-to-moderate (N = 35) or severe (N = 44) traumatic brain injury (TBI). Age-appropriate tests were administered at baseline, 6 months, 12 months, and 24 months after the injury. Performance was compared on (1) composite IQ and motor, (2) receptive and expressive language, and (3) Verbal and Perceptual–Performance IQ scores. In comparison to mild-to-moderate TBI, severe TBI in infants and preschoolers produced deficits in all areas. Interactions between task and severity of injury were obtained. Motor scores were lower than IQ scores, particularly after severe TBI. Both receptive and expressive scores were reduced following severe TBI. Expressive language scores were lower than receptive language scores for children sustaining mild-to-moderate TBI. While severe TBI lowered both Verbal and Perceptual– Performance IQ scores, Verbal IQ scores were significantly lower than Perceptual–Performance IQ scores after mild-to-moderate TBI. Mild injuries may produce subtle linguistic changes adversely impacting estimates of Verbal IQ and expressive language. Within the limited age range evaluated within this study, age at injury was unrelated to test scores: The impact of TBI was comparable in children ages 4 to 41 months versus 42 to 72 months at the time of injury. All neuropsychological scores improved significantly from baseline to the 6-month follow-up. However, no further change in scores was observed from 6 to 24 months after the injury. The persistent deficits and lack of catch-up over time suggest a reduction in the rate of acquisition of new skills after severe TBI. Methodological issues in longitudinal studies of young children were discussed. (JINS, 1997, 3, 581–591.)

Background. In post-traumatic stress disorder (PTSD) there is a need for self-rating scales that are sensitive to treatment effects and have been tested in a broad range of trauma survivors. Separate measures of frequency and severity may also provide an advantage.

Methods. Three hundred and fifty-three men and women completed the Davidson Trauma Scale (DTS), a 17-item scale measuring each DSM-IV symptom of PTSD on 5-point frequency and severity scales. These subjects comprised war veterans, survivors of rape or hurricane and a mixed trauma group participating in a clinical trial. Other scales were included as validity checks as follows: Global ratings, SCL-90-R, Eysenck Scale, Impact of Event Scale and Structured Clinical Interview for DSM-III-R.

Results. The scale demonstrated good test–retest reliability (r = 0·86), internal consistency (r = 0·99). One main factor emerged for severity and a smaller one for intrusion. In PTSD diagnosed subjects, and the factor structure more closely resembled the traditional grouping of symptoms. Concurrent validity was obtained against the SCID, with a diagnostic accuracy of 83% at a DTS score of 40. Good convergent and divergent validity was obtained. The DTS showed predictive validity against response to treatment, as well as being sensitive to treatment effects.

Conclusions. The DTS showed good reliability and validity, and offers promised as a scale which is particularly suited to assessing symptom severity, treatment outcome and in screening for the likely diagnosis of PTSD.