Investigate the relationship of chronic neurobehavioral and cognitive symptoms in military personnel with history of blast-related mild TBI and compare to a well-matched group of combat-deployed controls.

274 participants (mean age=34 years; mean education=14.75 years; 91.2% male) enrolled in the EVOLVE longitudinal study of combat-deployed military personnel were subdivided into those with history of blast TBI (n=165) and controls without history of blast exposure and TBI (n=109). As part of a larger study, we conducted a sub-analysis of 5-year follow up data. We focused on group differences (Mann-Whitney U) and correlational relationships between self-report neurobehavioral symptoms via the Frontal Systems Behavior Scale (FrSBE) and cognitive performances on measures of attention, working memory, processing speed, and executive functioning including D-KEFS Color Word Interference (CWI), Trailmaking A and B, and the Conners Continuous Performance Test (CPT).

The Blast TBI group reported higher levels of neurobehavioral symptoms on the FrSBE (p<.001), including domains of apathy (p<.001), disinhibition (p<.001), and executive dysfunction (p<.001), compared to Controls. On cognitive measures, group differences were observed on CWI Inhibition/Switching (p=.008), Trails B time (p=.010), and CPT commission errors (p=.014), such that the Blast TBI group performed worse than Controls. No significant group differences were observed for CPT omission errors or CPT hit rate (p’s>.05). After adjustment for multiple comparisons, greater FrSBE apathy correlated with slower performance on Trails A for Blast TBI (r=0.22, p=.014) but not Controls. Apathy endorsement was not significantly related to CPT omission errors for either group (p’s>.05). Higher endorsement of disinhibition symptoms was associated with worse performance on CWI Inhibition (Blast TBI: r=-0.19, p=.036; Controls: r=-0.28, p=.012) and Inhibition/Switching (Blast TBI: r=-0.23, p=.010; Controls: r=-0.29, p=.010) conditions for both groups, whereas only the Blast TBI group showed significant relationships between disinhibition symptoms and Trails B-A time (r=0.20, p=.025) and CPT commission errors (r=.18, p=.038). Higher endorsement of executive dysfunction correlated with poorer performance for Trails B-A for both groups (Blast TBI: r=.24, p=.009; Controls: r=.24, p=.030).

Our findings reveal that at 5-year follow up, military personnel with history of blast-related mild TBI reported significantly greater neurobehavioral symptoms and performed lower on standardized measures of executive functioning, relative to combat-deployed controls without TBI or blast exposure. Significant relationships between neurobehavioral symptoms and cognitive performance were present in both groups. However, these relationships were more pronounced in the Blast TBI group, including greater apathy associated with slower visual tracking as well as greater endorsement of disinhibition associated with set-switching. Objective measures of response inhibition were related to disinhibition endorsement for both groups, though impulsive errors were more pronounced for the Blast TBI group. Our results suggest chronic cognitive and neurobehavioral symptoms are present in military personnel with history of blast TBI exposure, and also discrepant from a well-matched control group of combat deployed military personnel. Future studies of this population should explore models to predict cognitive performance from neurobehavioral symptoms in military personnel, as this could inform treatment approaches for those at greatest risk of cognitive change.

To evaluate the impact of implementing clinical decision support (CDS) tools for outpatient antibiotic prescribing in the emergency department (ED) and clinic settings.

We performed a before-and-after, quasi-experimental study that employed an interrupted time-series analysis.

The study institution was a quaternary, academic referral center in Northern California.

We included prescriptions for patients in the ED and 21 primary-care clinics within the same health system.

We implemented a CDS tool for azithromycin on March 1, 2020, and a CDS tool for fluoroquinolones (FQs; ie, ciprofloxacin, levofloxacin, and moxifloxacin) on November 1, 2020. The CDS added friction to inappropriate ordering workflows while adding health information technology (HIT) features to easily perform recommended actions. The primary outcome was the number of monthly prescriptions for each antibiotic type, by implementation period (before vs after).

Immediately after azithromycin-CDS implementation, monthly rates of azithromycin prescribing decreased significantly in both the ED (−24%; 95% CI, −37% to −10%; P < .001) and outpatient clinics (−47%; 95% CI, −56% to −37%; P < .001). In the first month after FQ-CDS implementation in the clinics, there was no significant drop in ciprofloxacin prescriptions; however, there was a significant decrease in ciprofloxacin prescriptions over time (−5% per month; 95% CI, −6% to −3%; P < .001), suggesting a delayed effect of the CDS.

Implementing CDS tools was associated with an immediate decrease in azithromycin prescriptions, in both the ED and clinics. CDS may serve as a valuable adjunct to existing antimicrobial stewardship programs.

This study aimed to analyse the temporal and spatial trends in the burden of anxiety disorders and major depressive disorder related to bullying victimisation on global, regional and country scales.

Data were from the 2019 Global Burden of Disease (GBD) Study. We assessed the global disability-adjusted life years (DALYs, per 100 000 population) of anxiety disorders and major depressive disorder attributable to bullying victimisation by age, sex and geographical location. The percentage changes in age-standardised rates of DALYs were used to quantify temporal trends, and the annual rate changes across 204 countries and territories were used to present spatial trends. Furthermore, we examined the relationship between the sociodemographic index (SDI) and the burden of anxiety disorders as well as major depressive disorder attributable to bullying victimisation and its spatial and temporal characteristics globally.

From 1990 to 2019, the global DALY rates of anxiety disorders and major depressive disorder attributable to bullying victimisation increased by 23.31 and 26.60%, respectively, with 27.27 and 29.07% for females and 18.88 and 23.84% for males. Across the 21 GBD regions, the highest age-standardised rates of bullying victimisation-related DALYs for anxiety disorders were in North Africa and the Middle East and for major depressive disorder in High-income North America. From 1990 to 2019, the region with the largest percentage increase in the rates of DALYs was High-income North America (54.66% for anxiety disorders and 105.88% for major depressive disorder), whereas the region with the slowest growth rate or largest percentage decline was East Asia (1.71% for anxiety disorders and −25.37% for major depressive disorder). In terms of SDI, this study found overall upward trends of bullying-related mental disorders in areas regardless of the SDI levels, although there were temporary downward trends in some stages of certain areas.

The number and rates of DALYs of anxiety disorders and major depressive disorder attributable to bullying victimisation increased from 1990 to 2019. Effective strategies to eliminate bullying victimisation in children and adolescents are needed to reduce the burden of anxiety disorders and major depressive disorder. Considering the large variations in the burden by SDI and geographic location, future protective actions should be developed based on the specific cultural contexts, development status and regional characteristics of each country.

To evaluate the association of systolic blood pressure percentile, race, and body mass index with left ventricular hypertrophy on electrocardiogram and echocardiogram to define populations at risk.

This is a retrospective cross-sectional study design utilising a data analytics tool (Tableau) combining electrocardiogram and echocardiogram databases from 2003 to 2020. Customized queries identified patients aged 2–18 years who had an outpatient electrocardiogram and echocardiogram on the same date with available systolic blood pressure and body measurements. Cases with CHD, cardiomyopathy, or arrhythmia diagnoses were excluded. Echocardiograms with left ventricle mass (indexed to height2.7) were included. The main outcome was left ventricular hypertrophy on echocardiogram defined as Left ventricle mass index greater than the 95th percentile for age.

In a cohort of 13,539 patients, 6.7% of studies had left ventricular hypertrophy on echocardiogram. Systolic blood pressure percentile >90% has a sensitivity of 35% and specificity of 82% for left ventricular hypertrophy on echocardiogram. Left ventricular hypertrophy on electrocardiogram was a poor predictor of left ventricular hypertrophy on echocardiogram (9% sensitivity and 92% specificity). African American race (OR 1.31, 95% CI = 1.10, 1.56, p = 0.002), systolic blood pressure percentile >95% (OR = 1.60, 95% CI = 1.34, 1.93, p < 0.001), and higher body mass index (OR = 7.22, 95% CI = 6.23, 8.36, p < 0.001) were independently associated with left ventricular hypertrophy on echocardiogram.

African American race, obesity, and hypertension on outpatient blood pressure measurements are independent risk factors for left ventricular hypertrophy in children. Electrocardiogram has little utility in the screening for left ventricular hypertrophy.

The COVID-19 pandemic has created a high demand on personal protective equipment, including disposable N95 masks. Given the need for mask reuse, we tested the feasibility of vaporized hydrogen peroxide (VHP), ultraviolet light (UV), and ethanol decontamination strategies on N95 mask integrity and the ability to remove the infectious potential of SARS-CoV-2.

Disposable N95 masks, including medical grade (1860, 1870+) and industrial grade (8511) masks, were treated by VHP, UV, and ethanol decontamination. Mask degradation was tested using a quantitative respirator fit testing. Pooled clinical samples of SARS-CoV-2 were applied to mask samples, treated, and then either sent immediately for real-time reverse transcriptase–polymerase chain reaction (RT-PCR) or incubated with Vero E6 cells to assess for virucidal effect.

Both ethanol and UV decontamination showed functional degradation to different degrees while VHP treatment showed no significant change after two treatments. We also report a single SARS-CoV-2 virucidal experiment using Vero E6 cell infection in which only ethanol treatment eliminated detectable SARS-CoV-2 RNA.

We hope our data will guide further research for evidenced-based decisions for disposable N95 mask reuse and help protect caregivers from SARS-CoV-2 and other pathogens.

Implementation of genome-scale sequencing in clinical care has significant challenges: the technology is highly dimensional with many kinds of potential results, results interpretation and delivery require expertise and coordination across multiple medical specialties, clinical utility may be uncertain, and there may be broader familial or societal implications beyond the individual participant. Transdisciplinary consortia and collaborative team science are well poised to address these challenges. However, understanding the complex web of organizational, institutional, physical, environmental, technologic, and other political and societal factors that influence the effectiveness of consortia is understudied. We describe our experience working in the Clinical Sequencing Evidence-Generating Research (CSER) consortium, a multi-institutional translational genomics consortium.

A key aspect of the CSER consortium was the juxtaposition of site-specific measures with the need to identify consensus measures related to clinical utility and to create a core set of harmonized measures. During this harmonization process, we sought to minimize participant burden, accommodate project-specific choices, and use validated measures that allow data sharing.

Identifying platforms to ensure swift communication between teams and management of materials and data were essential to our harmonization efforts. Funding agencies can help consortia by clarifying key study design elements across projects during the proposal preparation phase and by providing a framework for data sharing data across participating projects.

In summary, time and resources must be devoted to developing and implementing collaborative practices as preparatory work at the beginning of project timelines to improve the effectiveness of research consortia.

An increasing number of studies have described the relationship between celiac disease and schizophrenia. Based on the reported correlations and the overlapping linkage regions on 19p13, the myosin IXB gene (MYO9B) can be considered a highly relevant positional and functional candidate gene for schizophrenia. The present work was undertaken to investigate the association of the MYO9B gene with schizophrenia in a Chinese population.

A total of 329 patients with schizophrenia and 350 healthy control subjects in a Chinese population were recruited. A PCR-based RFLP protocol was applied to genotype 7 single nucleotide polymorphisms (SNPs), including rs7249490, rs7256689, rs2279007, rs8113494, rs2305767, rs1545620 and rs2305764, in the MYO9B gene to investigate their association with schizophrenia.

The X2 goodness-of-fit test showed that the genotypic distributions of all 7 SNPs were in Hardy-Weinberg equilibrium in both the patient group and the control group. Disease association was shown for rs8113494 (X2=12.77, P=0.0003, OR=1.89, 95% CI 1.33-2.68) and rs1545620 (X2=15.44, P=8.379e-5, OR=1.65, 95% CI 1.29-2.12), while rs2279007 was associated with schizophrenia in the female subjects (X2=4.637, P=0.031, OR=0.69, 95% CI 0.49-0.97) but not in the male subjects (X2=1.082, P=0.299, OR=0.85, 95% CI 0.63-1.15).

The present work shows that the polymorphisms of the MYO9B gene are likely to confer susceptibility to schizophrenia. Because the MYO9B gene has been found to be highly expressed in the tight junction gate, it could be considered as a meeting point for the interaction between environmental and genetic factors in the pathogenesis of schizophrenia.

Delirium occur frequently in hospitalized patients. High-potency antipsychotic drugs have been used for the treatment of delirium; however, there is a risk of acute side effects. Therefore, atypical antipsychotic drugs could be used to the treatment of delirium.

The present study aimed to provide comparison of intramuscular injection of olanzapine and intramuscular injection of haloperidol for patients with delirium was conducted with a randomized, open prospective study.

Sixty-two patients admitted at the Catholic University of Korea Kangnam St. Mary's hospital, Seoul, South Korea were enrolled in this study. They were diagnosed as delirium by two independent psychiatrists using DSM-IV-TR. the Delirium Rating Scale-revised-98(DRS-R-98) and clinical global impression-severity (CGI-S) were checked daily. the Simpson-Angus Rating Scale, the Barnes Akathisia Rating Scale and the Abnormal Involuntary Movement Scale were used for the assessment of side effects.

The DRS-R-98 and CGI-S scores were significantly decreased over time in both treatment groups without any significant group difference and time by the group interaction effect (F=28.35, P< 0.0001). Adverse events occurred lower in olanzapine group. both treatments were well tolerated and there were no serious adverse events occurred by intramuscular olanzapine or haloperidol.

This study showed that either intramuscular olanzapine or intramuscular haloperidol would be effective and tolerable for treating delirium, however, olanzapine showed lower side effects than haloperidol. Adequately powered studies will be mandatory to draw any definite conclusion.