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There is a lack of standardised psychometric data in electronic health record (EHR)-based research. Proxy measures of symptom severity based on patients' clinical records may be useful surrogates in mental health EHR research.
Aims
This study aimed to validate proxy tools for the short versions of the Positive and Negative Syndrome Scale (PANSS-6), Young Mania Rating Scale (YMRS-6) and Montgomery–Åsberg Depression Rating Scale (MADRS-6).
Method
A cross-sectional, multicentre study was conducted in a sample of 116 patients with first-episode psychosis from 12 public hospitals in Spain. Concordance between PANSS-6, YMRS-6 and MADRS-6 scores and their respective proxies was evaluated based on information from EHR clinical notes, using a variety of statistical procedures, including multivariate tests to adjust for potential confounders. Bootstrapping techniques were used for internal validation, and an independent cohort from the Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne, Switzerland) for external validation.
Results
The proxy versions correlated strongly with their respective standardised scales (partial correlations ranged from 0.75 to 0.84) and had good accuracy and discriminatory power in distinguishing between patients in and not in remission (percentage of patients correctly classified ranged from 83.9 to 91.4% and bootstrapped optimism-corrected area under the receiver operating characteristic curve ranged from 0.76 to 0.89), with high interrater reliability (intraclass correlation coefficient of 0.81). The findings remained robust in the external validation data-set.
Conclusions
The proxy instruments proposed for assessing psychotic and affective symptoms by reviewing EHR provide a feasible and reliable alternative to traditional structured psychometric procedures, and a promising methodology for real-world practice settings.
Despite infection control guidance, sporadic nosocomial coronavirus disease 2019 (COVID-19) outbreaks occur. We describe a complex severe acute respiratory coronavirus virus 2 (SARS-CoV-2) cluster with interfacility spread during the SARS-CoV-2 δ (delta) pandemic surge in the Midwest.
Setting:
This study was conducted in (1) a hematology-oncology ward in a regional academic medical center and (2) a geographically distant acute rehabilitation hospital.
Methods:
We conducted contact tracing for each COVID-19 case to identify healthcare exposures within 14 days prior to diagnosis. Liberal testing was performed for asymptomatic carriage for patients and staff. Whole-genome sequencing was conducted for all available clinical isolates from patients and healthcare workers (HCWs) to identify transmission clusters.
Results:
In the immunosuppressed ward, 19 cases (4 patients, 15 HCWs) shared a genetically related SARS-CoV-2 isolate. Of these 4 patients, 3 died in the hospital or within 1 week of discharge. The suspected index case was a patient with new dyspnea, diagnosed during preprocedure screening. In the rehabilitation hospital, 20 cases (5 patients and 15 HCWs) positive for COVID-19, of whom 2 patients and 3 HCWs had an isolate genetically related to the above cluster. The suspected index case was a patient from the immune suppressed ward whose positive status was not detected at admission to the rehabilitation facility. Our response to this cluster included the following interventions in both settings: restricting visitors, restricting learners, restricting overflow admissions, enforcing strict compliance with escalated PPE, access to on-site free and frequent testing for staff, and testing all patients prior to hospital discharge and transfer to other facilities.
Conclusions:
Stringent infection control measures can prevent nosocomial COVID-19 transmission in healthcare facilities with high-risk patients during pandemic surges. These interventions were successful in ending these outbreaks.
Experiments on the responsiveness of elected officials highlight the tension between the freedom to carry out research and the right of subjects to be treated with respect. Controversy emerges from the power of politicians to block or object to experimental designs using identity deception. One way to resolve this conundrum is to consult citizens who, as constituents of politicians, have an interest in promoting the accountability of elected representatives. Building on the work of Desposato and Naurin and Öhberg, this survey experiment presented research designs to UK citizens for their evaluation. The findings show that citizens strongly approve of experimental research on Members of Parliament (MPs) and are glad to see their representatives participate. There are no differences in support whether designs use identity deception, debriefing, confederates or pre-agreement from MPs. Linked to high interest in politics, more citizens are glad their MPs participate in studies using identity deception than those deploying confederates.
ABSTRACT IMPACT: Current practice guidelines offer a variety of treatment options for sternal reconstruction but complications and infections remain a serious surgical problem. This work seeks to provide a comprehensive picture of the com-morbidities and reconstructive methods that lead to success and improve patient outcomes. OBJECTIVES/GOALS: Patients that undergo cardiac surgery via the median sternotomy approach are at risk of wound complications that require repair. We seek to evaluate how outcomes of sternal reconstruction are influenced by patient comorbidities, flap usage and internal mammary artery grafts and methods of sternal closure. METHODS/STUDY POPULATION: We identified patients between 2005 and 2020 who underwent sternotomy followed by debridement and flap coverage at our institution. Comorbidities, method of reconstruction, demographic data, surgical history, and other factors pertaining to mortality and morbidity were collected. The data will then be analyzed to identify population characteristics using logistic regression variables to determine univariate and adjusted multivariable measures of association with mortality. We present the pre-liminary data analyzed using chi-square and one-way anova in R. RESULTS/ANTICIPATED RESULTS: In this study we present a preliminary characterization of one institution’s sternal reconstruction patient outcomes with a variety of reconstruction methods including pectoralis advancement flaps, omental flaps and latissumus dorsi flaps. Notable preoperative comorbidities include 50% of patients > age 60, 18% with diabetes mellitus, 18 % with diagnosed hypertension, 18% with COPD, and 9% with a smoking history DISCUSSION/SIGNIFICANCE OF FINDINGS: In an evolving cardiothoracic landscape, clinical characteristics of patients being treated for sternal reconstructive surgery present a moving target. Understanding current risk factors, preoperative management and timing for aggressive surgical treatment offers an opportunity to update treatment protocol and maximize successful outcomes.
Technological development within information technology has permeated all areas of business and types of institutions; public institutions have not been the exception. Most applications of artificial intelligence (AI), machine learning, or robotic process automation (RPA) have been developed with commercial applications in mind. However, governments worldwide have also been working on applications of AI aiming to improve their service levels to their citizens (see Figure 13.1).
As opposed to an Orwellian, big brother approach (Orwell, 1949) that makes governments look like wanting to take advantage of technology to control their citizens, this chapter takes a customer service approach to explore the most likely applications that governments are developing to improve customer service. Three different examples have been selected.
From the several applications of intelligent automation health care is prominent. Kalis et al. (2018) find that robot-assisted technology is one application in this area with a potential annual value of $40 billion. This application lies on the RPA category; nevertheless, other applications such as administrative workflow ($18 billion) and fraud detection ($17 billion) are more on the thinking side of intelligent automation. It is in these applications that we have been able to identify real examples of AI applications in government settings, which we describe using a customer service interactionist mindset.
When a person (customer) approaches a government institution seeking for a service, for the service experience to occur, the parties need to engage in interaction; one party acts and the other re-acts. The customer request is an act that the service provider first needs to make sense of. That is, the service provider interprets the request and responds accordingly; the customer construes the response and depending on the meaning it has given to the response, the customer responds. This exchange of acts continues for as long as the parties understand the other acts and the service experience is completed. Norms of interaction develop over time. The parties build a relationship and learn how to make sense of the other party's action and how to respond. Fundamental to relationship development is that one party trusts and considers the other party committed. Thus, interaction occurs within the context of relationship and is guided by the parties’ previous experiences and expectation of the future.
We evaluated the effects of fermentation time and acid casein content on the microbial rennet obtained by solid-state fermentation using wheat bran as the carbon source. The experiments used two fermentation times (72 and 96 h), while acid casein content was 1.5, 2.0, 2.5, and 3.0 g. Rennet strength from eight enzymatic extracts was measured using pasteurized whole milk. Rennet strength of samples from 72 h of fermentation showed an increase when acid casein content increased. The rennet strength increased at 96 h of fermentation with increasing amount of casein (up to 2.5 g), and then decreased with the largest addition (3.0 g) of casein. Coagulation time for the sample with highest rennet strength was 420 s.
The purpose of this research was to determine biosecurity measures at the dental office after the appearance of coronavirus disease 2019 (COVID-19). A search was conducted in the main databases of the scientific literature using the words “COVID-19, coronavirus, SARS-Cov2, biosecurity, disinfection and dentistry.” We analyzed biosecurity and disinfection standards at the dental office and dental health personnel to date, and their adaptation to the needs and way of working of each. As a result, according to the information collected the following procedure was identified: a telephone appointment must be made and a questionnaire should be given before dental care; at arrival to the appointment, the temperature of the patient should be taken and proper cleaning and disinfection of the waiting room should be maintained. Panoramic radiography and CBCT are the auxiliary methods of choice. Absolute isolation and atraumatic restorative therapy techniques are a good alternative to decrease fluid exposure. The removal of protective clothing and accessories must follow a specific order and washing hands before and after is essential. In conclusion, the efficient biosecurity for dentists and patients in all dental care processes before, during, and immediately after the appointment reduces the risk of COVID-19 infection and allows healthy dental care environments.
The purpose of this investigation was to identify, synthesize, and compare all the current information on the efficacy of dental masks, emphasizing their use, types, and filters to prevent the spread and infection of COVID-19 and other infectious diseases. A bibliographic search of the main scientific databases was carried out using the words “masks, COVID-19, and dentistry.” Articles without language restriction up to May 31, 2020, were obtained. The types of masks, their half-life, method to use, sterilization, and proposed alternatives for dental masks were analyzed. Most of the articles refer to the use of N95 or FFP2 respirators presented as a strategy to extend the life of the masks and limited reuse. Regarding sterilization, most of the articles presented studies using ultraviolet germicidal irradiation as the sterilization method. Regarding respirator mask half-life, we recommend prolonged use, combined with a disposable surgical mask over the respirator mask. Finally, the use of N95 or FFP2 respirators are recommended as part of personal protective equipment for dental use.
The world is currently changing due to coronavirus disease 2019 (COVID-19), and the field of dentistry is no stranger to this. The care of patients in the dental office involves very strict biosafety protocols, and patients must be aware of the protection barriers implemented to allow satisfactory, safe dental care. The purpose of this study was to synthesize and analyze the management of the current biosafety standards for dental patients since the arrival of the COVID-19 pandemic. A bibliographic search of the main sources of information including MEDLINE (by means of PubMed), Scopus, Science Direct, SCIELO, and Google Scholar was carried out. Articles published without language restriction, systematic reviews, literature reviews, and observational studies were included. We identified the biosafety measures that must be taken before, during, and after dental practice following the arrival of COVID-19. The main measures include telephone triage, temperature taking on arrival at the office, the organization of the waiting room, washing hands before entering the office, knowing the auxiliary radiographic exams of choice and what type of treatment can be performed, albeit with restrictions. In conclusion, dental patients must comply with all the biosafety measures established by international protection standards and implemented by dentists before, during, and after dental practice to reduce the possibility of COVID-19 infection.
The interactions between the senses are essential for cognitive functions such as perception, attention, and action planning. Past research helped understanding of multisensory processes in the laboratory. Yet, the efforts to extrapolate these findings to the real-world are scarce. Extrapolation to real-world contexts is important for practical and theoretical reasons. Multisensory phenomena might be expressed differently in real-world settings compared to simpler laboratory situations. Some effects might become stronger, others may disappear, and new outcomes could be discovered. This Element discusses research that uncovers multisensory interactions under complex environments, with an emphasis on the interplay of multisensory mechanisms with other processes.
This work proposes a strategy for position control and obstacle avoidance in a quadcopter based on constrained generalized predictive control and geometric attitude control. The approach allows real-time trajectory tracking using optimal control actions and avoids collisions with static obstacles whose position is known. An experimental validation of the proposed controller is presented.
To estimate the prevalence of the metabolic syndrome (MS) in a population of patients with overweight and obesity of the A Coruña and Granada health areas, using the definitions of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (ATP III) and of the International Diabetes Federation (IDF).
Patients and methods
During a period extending from 1996 to 2003, only those patients attending endocrinology outpatient clinics for whom all the anthropometric and biochemical parameters used to define the MS, both according to the ATP IIII and the IDF, were available were selected. The final study sample consisted of 285 patients, 198 females (69.5%) and 87 males (30.5%).
Results
The prevalence of the MS was 29.8% when the ATP III definition was applied, and 41.1% according to the IDF criteria. Prevalence by sex was 32.2% in men and 28.8% in women according to the ATP III, and 42.5% and 40.4%, respectively, according to the IDF.
Conclusions
In a patient population with overweight or obesity, the prevalence of the MS is higher when the IDF criteria, instead of the ATP III criteria, are used. These findings may have significant implications when it comes to addressing early diagnosis of cardiovascular disease and diabetes mellitus in these patients, in order to perform therapeutic measures at the initial stages and thereby reduce metabolic and cardiovascular complications.
To determine the tick species that bite humans in the province of Soria (Spain) and ascertain the tick-borne pathogens that threaten people's health in that province, 185 tick specimens were collected from 179 patients who sought medical advice at health-care centres. The ticks were identified, and their DNA examined by PCR for pathogens. Most ticks were collected in autumn and spring (59 and 57 respectively). Nine species of ticks were identified, the most frequent being Dermacentor marginatus (55·7%), Ixodes ricinus (12·4%) and Rhipicephalus bursa (11·9%). Ninety-seven females, 66 males, 21 nymphs and one larva were identified. Twenty-six ticks carried DNA from Rickettsia spp. (11 Rickettsia slovaca, 6 Rickettsia spp. RpA4/DnS14, 1 Rickettsia massiliae/Bar29, and 8 unidentified); two ticks carried DNA from Borrelia burgdorferi sensu lato and seven ticks harboured DNA from Anaplasma phagocytophilum.
Slope Water anticyclonic Oceanic eDDIES (SWODDIES) are typical mesoscale features of open-ocean waters of the southern Bay of Biscay which usually develop in winter by shedding from the seasonal poleward current flowing along the northern Spanish slope. These eddies have been intensively studied from the physical perspective. However, their effect on the distribution of biological properties and on the functioning of the pelagic ecosystem has not been assessed so far. To this aim, a sea-truth, multidisciplinary and comprehensive study of a SWODDY was carried out in summer 1998. The eddy, radius of ≈50 km, was initially centred at 45·5°N 6·0°W, being characterized by a relatively homogeneous core of water in the centre of the eddy extending from 80 to about 200 dbar. In the central region of the core, temperature (12·55–12·75°C) and salinity (≈35·70) values were higher than outside the eddy. The optical properties of the eddy also differed from those of the surrounding waters. A distinct biological signature was found associated with the eddy. Depth-integrated chlorophyll-a concentrations were 25% higher at the eddy centre where upward doming of the seasonal pycnocline (up to 30 dbar) occurred. Enhanced phytoplankton biomass was related to a higher contribution of >10 μm cells, mainly represented by diatoms and chrysophyceans. Phytoplankton and mesozooplankton species composition in and outside the eddy differed significantly reflecting the coastal origin of the water parcel trapped by the eddy. The sharp modification of the planktonic community composition, biomass and associated size-structure caused by slope water oceanic eddies are likely to exert a significant effect upon the upper trophic levels of the pelagic ecosystem of the southern Bay of Biscay.
Taking into account that the relationship between metabolic substrate and the characteristics of the diet is essential for understanding the mechanisms associated with the use of the components of a certain food substance, the aim of this study was to examine the metabolic substrate used by Penaeus setiferus,P. schmitti, P. duorurum and P. notialis postlarvae PL 35–40 (35–40 days after metamorphosis) fed purified diets with different levels of proteins (40, 50, 60 and 65%). Oxygen consumption and ammonia excretion were measured in animals in intermoult which had been acclimatized to each diet over a minimum of 5 days. Measurements were taken on fasted (24 h) and fed animals. Oxygen consumption of fasting animals increased with a rise in the proteins of the diet in the four species. In the fed animals, this tendency was observed in P. setiferus and P. notialis, while in P. schmitti and P. duorarum oxygen consumption was a weak relationship, decreasing or increasing with a diet with 50% protein. Both in fasting and feeding animals, the ammonia excretion increased with the increase in proteins in the diet. The O : N atomic ratios of the four species decreased (between 30 and 3), according to increase in dietetic protein : energy ratio, (10.4 to 17.0 mg protein/kcal). The highest value of O : N ratio was observed in P. setiferus (40% of protein requirement, O : N = 24 to 34) and lowest in P. schmitti (60% of proteinrequirement, O : N = 4 to 11), with intermediate values in P. duorarum and P. notialis (50% protein requirement, O : N = 8 to 14 and 13 to 19, respectively). These results support previous research that showed that the omnivorous-herbivorous species, like P. setiferus, use protein-lipids normally as energy source in contrast to omnivorous-carnivorous species such as P. duorarum which use protein preferentially as a source of energy.
The effect of electrical stimulation on the quality of P. setiferus sperm cells was studied during the regeneration of the spermatophore. The proportion of the animals that responded to electroejaculation was quantified and the number of live, abnormal and dead cells, as well as the relationship between the number of cells and body weight, were taken into consideration as indicators of the effect of manipulation during stimulation. It was found that electrical stimulation caused some degree of spermatophore expulsion in 78% of the cases. Total expulsion of the spermatophores occurred in only 8.3% of the cases. A logistic curve was adjusted to the relationship between the number of sperm cells and the weight of the shrimp. After regeneration no curve was adjusted to the relationship. Eighty per cent of the stimulated shrimp regenerated the spermatophore in a maximum of 168 h. Fifty per cent regeneration was obtained in 96 h after stimulation. A decrease in the number of live cells from 26.8 to 7.6 million and an increase in abnormal (from 0.02 to 3.92 million) and dead (from no cells dead to 4.6 million) respectively, were registered for regenerated animals. Necrotic areas in 60% of the ampulae of regenerated shrimps were also observed. Bacteria associated with the necrotic ampulae was observed when counting sperm. As the spermatophore of this species is complex, it is necessary to search for a way to reduce the stress produced by the handling of the ampulae so as to avoid altering the reproductive capacity of the shrimp.