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Bupropion is not licensed as an antidepressant in the UK, limiting its use. We highlight bupropion’s distinct pharmacological profile and its potential benefits in treatment-resistant depression and people experiencing selective serotonin reuptake inhibitor-induced sexual dysfunction. The National Health Service repurposing medicines programme could improve equity of access for UK patients.
Assess the efficacy of staged interventions aimed to reduce inappropriate Clostridioides difficile testing and hospital-onset C. difficile infection (HO-CDI) rates.
Design:
Interrupted time series.
Setting:
Community-based.
Methods/Interventions:
National Healthcare Safety Network (NHSN) C. difficile metrics from January 2019 to November 2022 were analyzed after three interventions at a community-based healthcare system. Interventions included: (1) an electronic medical record (EMR) based hard stop requiring confirming ≥3 loose or liquid stools over 24 h, (2) an infectious diseases (ID) review and approval of testing >3 days of hospital admission, and (3) an infection control practitioner (ICP) reviews combined with switching to a reverse two-tiered clinical testing algorithm.
Results:
After all interventions, the number of C. difficile tests per 1,000 patient-days (PD) and HO-CDI cases per 10,000 PD decreased from 20.53 to 6.92 and 9.80 to 0.20, respectively. The EMR hard stop resulted in a (28%) reduction in the CDI testing rate (adjusted incidence rate ratio ((aIRR): 0.72; 95% confidence interval [CI], 0.53 to 0.96)) and ID review resulted in a (42%) reduction in the CDI testing rate (aIRR: 0.58; 95% CI, 0.42–0.79). Changing to the reverse testing algorithm reduced reported HO-CDI rate by (95%) (cIRR: 0.05; 95% CI; 0.01–0.40).
Conclusions:
Staged interventions aimed at improving diagnostic stewardship were effective in overall reducing CDI testing in a community healthcare system.
Preliminary evidence suggests that a ketogenic diet may be effective for bipolar disorder.
Aims
To assess the impact of a ketogenic diet in bipolar disorder on clinical, metabolic and magnetic resonance spectroscopy outcomes.
Method
Euthymic individuals with bipolar disorder (N = 27) were recruited to a 6- to 8-week single-arm open pilot study of a modified ketogenic diet. Clinical, metabolic and MRS measures were assessed before and after the intervention.
Results
Of 27 recruited participants, 26 began and 20 completed the ketogenic diet. For participants completing the intervention, mean body weight fell by 4.2 kg (P < 0.001), mean body mass index fell by 1.5 kg/m2 (P < 0.001) and mean systolic blood pressure fell by 7.4 mmHg (P < 0.041). The euthymic participants had average baseline and follow-up assessments consistent with them being in the euthymic range with no statistically significant changes in Affective Lability Scale-18, Beck Depression Inventory and Young Mania Rating Scale. In participants providing reliable daily ecological momentary assessment data (n = 14), there was a positive correlation between daily ketone levels and self-rated mood (r = 0.21, P < 0.001) and energy (r = 0.19 P < 0.001), and an inverse correlation between ketone levels and both impulsivity (r = −0.30, P < 0.001) and anxiety (r = −0.19, P < 0.001). From the MRS measurements, brain glutamate plus glutamine concentration decreased by 11.6% in the anterior cingulate cortex (P = 0.025) and fell by 13.6% in the posterior cingulate cortex (P = <0.001).
Conclusions
These findings suggest that a ketogenic diet may be clinically useful in bipolar disorder, for both mental health and metabolic outcomes. Replication and randomised controlled trials are now warranted.
This article describes local normal forms of functions in noncommuting variables, up to equivalence generated by isomorphism of noncommutative Jacobi algebras, extending singularity theory in the style of Arnold’s commutative local normal forms into the noncommutative realm. This generalisation unveils many new phenomena, including an ADE classification when the Jacobi ring has dimension zero and, by taking suitable limits, a further ADE classification in dimension one. These are natural generalisations of the simple singularities and those with infinite multiplicity in Arnold’s classification. We obtain normal forms away from some exceptional Type E cases. Remarkably, these normal forms have no continuous parameters, and the key new feature is that the noncommutative world affords larger families.
This theory has a range of immediate consequences to the birational geometry of 3-folds. The normal forms of dimension zero are the analytic classification of smooth 3-fold flops, and one outcome of NC singularity theory is the first list of all Type D flopping germs, generalising Reid’s famous pagoda classification of Type A, with variants covering Type E. The normal forms of dimension one have further applications to divisorial contractions to a curve. In addition, the general techniques also give strong evidence towards new contractibility criteria for rational curves.
Skin and soft tissue infections (SSTIs) account for over 2.8 million annual emergency department (ED) visits and often result in suboptimal antibiotic therapy. The objective of this study was to evaluate a set of interventions in minimizing inappropriate prescription of antibiotics for presumed SSTIs in the ED.
Design:
Case vignette survey.
Participants:
A national sample of emergency medicine (EM) physicians.
Methods:
Each vignette described a clinical scenario of a presumed SSTI (cellulitis or abscess) and included a unique combination of zero to five interventions (outpatient follow-up, inappropriate antibiotic request flag, thermal imaging for cellulitis or rapid wound MRSA PCR for abscess, patient education/shared decision-making, and clinical decision support). Out of 64 possible vignettes, we asked participants to respond to eight vignettes. Following each vignette, we asked participants if they would prescribe an antibiotic in their everyday practice (yes/no). We built adjusted hierarchical logistic regression models to estimate the probability of prescribing an antibiotic for each intervention and vignette.
Results:
Surveys were completed by 113 EM physicians. The thermal imaging, rapid wound MRSA PCR, and patient education/shared decision-making interventions showed the largest decrease (15–20%) in antibiotic prescribing probability. Vignettes with a combination of both a diagnostic intervention (thermal imaging or rapid wound MRSA PCR) and a patient education/shared decision-making intervention had the lowest prescribing probabilities.
Conclusion:
We recommend future research focuses on the development and integration of novel diagnostic tools to identify true infection and incorporate shared decision-making to improve diagnosis and management of SSTIs.
Studies show that mental health promotion is an effective strategy that can reduce the burden of mental health disorders and improve overall well-being in both children and adults. In addition to promoting high levels of mental well-being and preventing the onset of mental illness, these mental health promotion programmes, including mental illness prevention interventions, help increase levels of mental health literacy in community members. While there is evidence showing the effectiveness of mental health promotion, much of what is known about this field is informed by studies conducted in high-income countries. There is a need to gather evidence about the effectiveness of such interventions in low- and middle-income countries (LMICs) where mental health services are often inadequate. In this systematic review, we synthesised the available published primary evidence from sub-Saharan Africa (SSA) on the types and effectiveness of mental health promotion programmes for young people. We performed a search of selected global databases (PubMed, PsycINFO, ScienceDirect and Google Scholar) and regional databases (Sabinet African Journals). We included observational, mixed methods, trials, pilots and quantitative original papers published from 2013 to 2023. We used the Mixed Methods Appraisal Tool (MMAT) to evaluate the quality of methods in selected studies, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA-2020) for reporting the evidence gathered. We identified 15 types of youth mental health promotion and illness prevention interventions. Among those identified, we found that school-based interventions enhanced mental health literacy, mental health-seeking behaviours and self-assurance and confidence among young people. Family-based interventions also showed a potential to improve relationships between young people and their caregivers. Future studies should explore how to further strengthen school- and family-based interventions that promote mental health among young people.
Covariance structure analysis and its structural equation modeling extensions have become one of the most widely used methodologies in social sciences such as psychology, education, and economics. An important issue in such analysis is to assess the goodness of fit of a model under analysis. One of the most popular test statistics used in covariance structure analysis is the asymptotically distribution-free (ADF) test statistic introduced by Browne (Br J Math Stat Psychol 37:62–83, 1984). The ADF statistic can be used to test models without any specific distribution assumption (e.g., multivariate normal distribution) of the observed data. Despite its advantage, it has been shown in various empirical studies that unless sample sizes are extremely large, this ADF statistic could perform very poorly in practice. In this paper, we provide a theoretical explanation for this phenomenon and further propose a modified test statistic that improves the performance in samples of realistic size. The proposed statistic deals with the possible ill-conditioning of the involved large-scale covariance matrices.
A general procedure is provided for comparing correlation coefficients between optimal linear composites. The procedure allows computationally efficient significance tests on independent or dependent multiple correlations, partial correlations, and canonical correlations, with or without the assumption of multivariate normality. Evidence from some Monte Carlo studies on the effectiveness of the methods is also provided.
Exploratory process factor analysis (EPFA) is a data-driven latent variable model for multivariate time series. This article presents analytic standard errors for EPFA. Unlike standard errors for exploratory factor analysis with independent data, the analytic standard errors for EPFA take into account the time dependency in time series data. In addition, factor rotation is treated as the imposition of equality constraints on model parameters. Properties of the analytic standard errors are demonstrated using empirical and simulated data.
We present an approach to quantifying errors in covariance structures in which adventitious error, identified as the process underlying the discrepancy between the population and the structured model, is explicitly modeled as a random effect with a distribution, and the dispersion parameter of this distribution to be estimated gives a measure of misspecification. Analytical properties of the resultant procedure are investigated and the measure of misspecification is found to be related to the root mean square error of approximation. An algorithm is developed for numerical implementation of the procedure. The consistency and asymptotic sampling distributions of the estimators are established under a new asymptotic paradigm and an assumption weaker than the standard Pitman drift assumption. Simulations validate the asymptotic sampling distributions and demonstrate the importance of accounting for the variations in the parameter estimates due to adventitious error. Two examples are also given as illustrations.
Algebraic properties of the normal theory maximum likelihood solution in factor analysis regression are investigated. Two commonly employed measures of the within sample predictive accuracy of the factor analysis regression function are considered: the variance of the regression residuals and the squared correlation coefficient between the criterion variable and the regression function. It is shown that this within sample residual variance and within sample squared correlation may be obtained directly from the factor loading and unique variance estimates, without use of the original observations or the sample covariance matrix.
In this rejoinder we discuss the following aspects of our approach to model discrepancy: the interpretations of the two populations and adventitious error, the choice of inverse Wishart distribution, the perceived danger of justifying a model with bad fit, the relationship among our new approach, Chen’s (J R Stat Soc Ser B, 41:235–248, 1979) approach and the existing RMSEA-based approach, and the Pitman drift assumption.
When the covariance matrix Σ(p×P) does not satisfy the formal factor analysis model for m factors, there will be no factor matrix Λ(p×m) such that γ=(Σ-ΛΛ′) is diagonal. The factor analysis model may then be replaced by a tautology where γ is regarded as the covariance matrix of a set of “residual variates.” These residual variates are linear combinations of “discarded” common factors and unique factors and are correlated. Maximum likelihood, alpha and iterated principal factor analysis are compared in terms of the manner in which γ is defined, a “maximum determinant” derivation for alpha factor analysis being given. Weighted least squares solutions using residual variances and common variances as weights are derived for comparison with the maximum likelihood and alpha solutions. It is shown that the covariance matrix γ defined by maximum likelihood factor analysis is Gramian, provided that all diagonal elements are nonnegative. Other methods can define a γ which is nonGramian even when all diagonal elements are nonnegative.
We consider the problem of least-squares fitting of squared distances in unfolding. An alternating procedure is proposed which fixes the row or column configuration in turn and finds the global optimum of the objective criterion with respect to the free parameters, iterating in this fashion until convergence is reached. A considerable simplification in the algorithm results, namely that this conditional global optimum is identified by performing a single unidimensional search for each point, irrespective of the dimensionality of the unfolding solution.
Structural models that yield circumplex inequality patterns for the elements of correlation matrices are reviewed. Particular attention is given to a stochastic process defined on the circle proposed by T. W. Anderson. It is shown that the Anderson circumplex contains the Markov Process model for a simplex as a limiting case when a parameter tends to infinity.
Anderson's model is intended for correlation matrices with positive elements. A replacement for Anderson's correlation function that permits negative correlations is suggested. It is shown that the resulting model may be reparametrzed as a factor analysis model with nonlinear constraints on the factor loadings. An unrestricted factor analysis, followed by an appropriate rotation, is employed to obtain parameter estimates. These estimates may be used as initial approximations in an iterative procedure to obtain minimum discrepancy estimates.
In a recent article Jennrich and Satorra (Psychometrika 78: 545–552, 2013) showed that a proof by Browne (British Journal of Mathematical and Statistical Psychology 37: 62–83, 1984) of the asymptotic distribution of a goodness of fit test statistic is incomplete because it fails to prove that the orthogonal component function employed is continuous. Jennrich and Satorra (Psychometrika 78: 545–552, 2013) showed how Browne’s proof can be completed satisfactorily but this required the development of an extensive and mathematically sophisticated framework for continuous orthogonal component functions. This short note provides a simple proof of the asymptotic distribution of Browne’s (British Journal of Mathematical and Statistical Psychology 37: 62–83, 1984) test statistic by using an equivalent form of the statistic that does not involve orthogonal component functions and consequently avoids all complicating issues associated with them.
The composite direct product (CDP) model is a multiplicative model for multitrait-multimethod (MTMM) designs. It is extended to incomplete MTMM correlation matrices where some trait-method combinations are not available. Rules for omitting trait-method combinations without resulting in an indeterminate model are also suggested. Maximum likelihood estimation and the log absolute correlation procedure are used to fit the model, and are found to yield similar results. The balanced incomplete MTMM design tends to yield more accurate estimates than the randomly missing design.
The composite direct product model for the multitrait-multimethod matrix is reparameterized as a second-order factor analysis model. This facilitates the use of widely available computer programs such as LISREL and LISCOMP for fitting the model.