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Critical shortages of personal protective equipment especially N95 respirators during the COVID- 19 pandemic continues to be a source of concern. Novel methods of N95 filtering facepiece respirator decontamination that can be scaled-up for in-hospital use can help address this concern and keep HCWs safe.
A multidisciplinary pragmatic study was conducted to evaluate the use of an ultrasonic room high-level disinfection system (HLDS) that generates aerosolized peracetic acid (PAA) and hydrogen peroxide for decontamination of large numbers of N95 respirators. A cycle duration that consistently achieved disinfection of N95 respirators (defined as ≥6 log10 reductions in bacteriophage MS2 and Geobacillus stearothermophilus spores inoculated onto respirators) was identified. The treated masks were assessed for changes to their hydrophobicity, material structure, strap elasticity, and filtration efficiency (FE). PAA and hydrogen peroxide off-gassing from treated masks were also assessed.
The PAA room HLDS was effective for disinfection of bacteriophage MS2 and G. stearothermophilus spores on respirators in a 2447 cubic feet room with aerosol deploy and dwell times of 16 and 32 minutes, respectively. The total cycle time was 1 hour and 16 minutes. After 5 treatment cycles, no adverse effects were detected on filtration efficiency, structural integrity, or strap elasticity. There was no detectable off-gassing of PAA and hydrogen peroxide from the treated masks at 20 and 60 minutes after the disinfection cycle respectively.
The PAA room disinfection system provides a rapidly scalable solution for in-hospital decontamination of large numbers of N95 respirators during the COVID- 19 pandemic.
Elective surgical patients routinely bathe with chlorhexidine gluconate (CHG) at home days prior to their procedures. However, the impact of home CHG bathing on surgical site CHG concentration is unclear. We examined 3 different methods of applying CHG and hypothesized that different application methods would impact resulting CHG skin concentration.
School psychologists play a vital role in the mental health and well-being of students and are often tasked with establishing the assessment and intervention plans for reducing the severity of mental health difficulties, including suicidal behavior. With suicide the second-leading cause of death for middle and high school students, school psychologists need to be familiar with what their role is in recommending and providing suicide prevention and intervention programs within a multitiered systems of support (MTSS) framework. This chapter provides an overview of the problem of adolescent suicidal behavior (“what to know”), while also providing specific recommendations (“what to do”) for suicide prevention/intervention programs within each tier of the MTSS. Finally, this chapter includes specific guidelines for implementing “suicide postvention” (after a death due to suicide) procedures, in hopes of reducing the likelihood of another death due to suicide.
This article provides an overview of selected ongoing international efforts that have been inspired by Edward Zigler's vision to improve programs and policies for young children and families in the United States. The efforts presented are in close alignment with three strategies articulated by Edward Zigler: (a) conduct research that will inform policy advocacy; (b) design, implement, and revise quality early childhood development (ECD) programs; and (c) invest in building the next generation of scholars and advocates in child development. The intergenerational legacy left by Edward Zigler has had an impact on young children not only in the United States, but also across the globe. More needs to be done. We need to work together with a full commitment to ensure the optimal development of each child.
The perinatal period is a vulnerable time for the development of psychopathology, particularly mood and anxiety disorders. In the study of maternal anxiety, important questions remain regarding the association between maternal anxiety symptoms and subsequent child outcomes. This study examined the association between depressive and anxiety symptoms, namely social anxiety, panic, and agoraphobia disorder symptoms during the perinatal period and maternal perception of child behavior, specifically different facets of development and temperament. Participants (N = 104) were recruited during pregnancy from a community sample. Participants completed clinician-administered and self-report measures of depressive and anxiety symptoms during the third trimester of pregnancy and at 16 months postpartum; child behavior and temperament outcomes were assessed at 16 months postpartum. Child development areas included gross and fine motor skills, language and problem-solving abilities, and personal/social skills. Child temperament domains included surgency, negative affectivity, and effortful control. Hierarchical multiple regression analyses demonstrated that elevated prenatal social anxiety symptoms significantly predicted more negative maternal report of child behavior across most measured domains. Elevated prenatal social anxiety and panic symptoms predicted more negative maternal report of child effortful control. Depressive and agoraphobia symptoms were not significant predictors of child outcomes. Elevated anxiety symptoms appear to have a distinct association with maternal report of child development and temperament. Considering the relative influence of anxiety symptoms, particularly social anxiety, on maternal report of child behavior and temperament can help to identify potential difficulties early on in mother–child interactions as well as inform interventions for women and their families.
Human-computer hybrid teams can meet challenges in designing complex engineered systems. However, the understanding of interaction in the hybrid teams is lacking. We review the literature and identify four key attributes to construct design research platforms that support multi-phase design, hybrid teams, multiple design scenarios, and data logging. Then, we introduce a platform for unmanned aerial vehicle (UAV) design embodying these attributes. With the platform, experiments can be conducted to study how designers and intelligent computational agents interact, support, and impact each other.
Yushu Prefecture in Qinghai Province provides some of the largest known stretches of habitat for the Vulnerable snow leopard Panthera uncia in China. People living in these areas are dependent on agropastoralism. Support from local communities is necessary for effective long-term conservation action for snow leopards, but loss of livestock to snow leopards can create financial burdens that induce negative attitudes and encourage retaliatory killing. We assessed factors driving herders' attitudes towards snow leopards and their conservation. We found that herders had higher agreement with positive than with negative statements about snow leopards despite nearly half reporting livestock loss to snow leopards within the last 5 years. No retaliatory killing was reported. Herders with more years of formal education and fewer livestock losses were more likely to have positive attitudes whereas those with lower importance of snow leopards to their religion, fewer livestock losses, and fewer years of education were more likely to have negative attitudes. Understanding the multifaceted mechanisms responsible for positive views towards species is imperative for reaching conservation goals. Our findings ascribe to the importance of increased education and adherence to Tibetan beliefs in promoting conservation tolerance towards snow leopards in Qinghai Province, but also indicate a need for further research into the impact of livestock loss.
To evaluate total usual intakes and biomarkers of micronutrients, overall dietary quality and related health characteristics of US older adults who were overweight or obese compared with a healthy weight.
Two 24-h dietary recalls, nutritional biomarkers and objective and subjective health characteristic data were analysed from the National Health and Nutrition Examination Survey 2011–2014. We used the National Cancer Institute method to estimate distributions of total usual intakes from foods and dietary supplements for eleven micronutrients of potential concern and the Healthy Eating Index (HEI)-2015 score.
Older adults aged ≥60 years (n 2969) were categorised by sex and body weight status, using standard BMI categories. Underweight individuals (n 47) were excluded due to small sample size.
A greater percentage of obese older adults compared with their healthy-weight counterparts was at risk of inadequate Mg (both sexes), Ca, vitamin B6 and vitamin D (women only) intakes. The proportion of those with serum 25-hydroxyvitamin D < 40 nmol/l was higher in obese (12 %) than in healthy-weight older women (6 %). Mean overall HEI-2015 scores were 8·6 (men) and 7·1 (women) points lower in obese than in healthy-weight older adults. In addition, compared with healthy-weight counterparts, obese older adults were more likely to self-report fair/poor health, use ≥ 5 medications and have limitations in activities of daily living and cardio-metabolic risk factors; and obese older women were more likely to be food-insecure and have depression.
Our findings suggest that obesity may coexist with micronutrient inadequacy in older adults, especially among women.
The purpose of this study was to examine how exposure to the armed conflict and the tsunami, perceived availability of resources, and perceived helpfulness of religious practices would predict depression, anxiety, posttraumatic stress, and psychosocial functioning in a multi-ethnic sample of Sri Lankan youth. A sample of Tamil (174), Sinhalese (332), and Muslim (215) children (girls=391) between 12 and 19 years (mean age =14.4, sd =1.9), completed a survey including demographic questions and items assessing exposure to the conflict and the tsunami, the perceived availability of resources, and perceived helpfulness of religious practices. Scales assessing depression, anxiety, posttraumatic stress, and psychosocial functioning were also completed. Four hierarchical multiple regression analyses were conducted with exposure to the conflict and tsunami, perceived availability of resources, and perceived helpfulness of religious beliefs as predictors, and with depression, anxiety, posttraumatic stress and psychosocial functioning as outcomes. The results revealed that exposure to the armed conflict significantly predicted posttraumatic stress (R2 =.03, F [1,494] = 12.77, p< .001), while exposure to the tsunami predicted anxiety (R2 =.03, F [2,506] = 7.8, p< .001), and perceived availability of resources predicted depression (R2=.09, F [4,499] = 11.83, p< .001) and psychosocial functioning (R2=.098, F [4,506] = 13.67, p< .001). The results suggest that exposure to traumatic events should not be assumed to be the only or even the most important variable when considering the overall psychological and psychosocial functioning of children in developing countries and traditional cultures. Implications for interventions, policy, and future research are discussed.
Clinical trials suggest that patients receiving atypical antipsychotics are less likely to develop movement disorders than those receiving conventional antipsychotics. We determined incidence of treatment-emergent TD during long-term treatment of schizophrenia or schizoaffective disorder with aripiprazole or haloperidol.
In a post hoc analysis of pooled data collected from two 52-week double-blind trials involving 1,294 patients treated either with aripiprazole 20-30mg/d (n=861) or haloperidol 5-10mg/d (n=433), treatment-emergent TD was identified based on Research Diagnostic Criteria (RDC) extracted from the Abnormal Involuntary Movement Scale (AIMS) (Schooler-Kane criteria).
In patients without baseline TD (n=1,177), the rate of new-onset TD at any time point following randomization was 5.09% for aripiprazole-treated patients and 11.76% for haloperidol-treated patients (p<0.0001). Using a stricter definition of RDC-defined TD on the last two study visits, new-onset TD was seen in 0.25% of aripiprazole-treated patients versus 4.09% of haloperidol-treated patients (p<0.0001), and was mild in 100% of aripiprazole-treated patients, and mild in 68.75% and moderate or severe in 31.25% of haloperidol-treated patients. Mean baseline to endpoint increase in AIMS score was significantly greater in haloperidol- versus aripiprazole-treated patients in both LOCF (n=1177, p=0.0001) and OC (n=427, p<0.0001) analyses.
Aripiprazole is associated with a significantly reduced risk of new-onset tardive dyskinesia compared with haloperidol in patients with schizophrenia or schizoaffective disorder treated for up to 52 weeks. Aripiprazole's dopamine D2 partial agonist and/or serotonin 5HT2A antagonist receptor binding profile may contribute to this.
A randomised study (D1444C00004) to show superior relapse prevention with quetiapine sustained release (SR) versus placebo.
327 patients with schizophrenia were switched to open-label, once-daily quetiapine SR dosed at 300 mg on Day 1, 600 mg on Day 2, then 400-800 mg for a 16-week stabilisation period. Stable patients (clinically and by dose) were randomised (n=197; double-blind phase) to either quetiapine SR (400-800 mg/day) or placebo. Primary endpoint: time from randomisation to psychiatric relapse (hospitalisation for worsening schizophrenia, PANSS increase ≥30%, CGI-I score ≥6, or need for additional antipsychotics). An independent Data Safety Monitoring Board (DSMB) monitored the study. Planned analyses: interim, after 45 and 60 relapses (to permit termination if a significant treatment difference in primary endpoint was observed); final, after 90 relapses.
Early termination occurred after the first interim analysis (following DSMB recommendation) as quetiapine SR (mean dose 669 mg/day; mean randomised-treatment period 4 months) was significantly superior to placebo for time to relapse: HR 0.16 (95% CI 0.08, 0.34; p<0.001). Numbers (%) of relapses were: 9 (10.7%), quetiapine SR; 36 (41.4%), placebo (interim ITT population). Estimated relapse rate at 6 months was: 14.3%, quetiapine SR; 68.2%, placebo (difference 54% [95% CI 42.5, 65.4; p<0.001]). Incidence of: treatment-related AEs 18% (quetiapine SR), 21% (placebo); total EPS-related AEs 1.1% and 1%, respectively. One patient in each group withdrew due to AEs.
Once-daily quetiapine SR (400-800 mg/day) was effective versus placebo in preventing relapse in patients with clinically-stable schizophrenia and was well tolerated during longer-term use.
Schizophrenia is associated with impaired cognition, which persists despite current treatments, and is an important determinant of quality of life and overall function. Converging lines of evidence suggest that interleukin-6 (IL-6) may play a role in the pathophysiology of schizophrenia. We previously found that higher blood IL-6 levels were a significant predictor of greater cognitive impairment in schizophrenia after controlling for multiple potential confounding factors. We are conducting an 8-week open-label trial of adjunctive tocilizumab in schizophrenia. Tocilizumab is a humanized monoclonal antibody against the IL-6 receptor, approved by the US FDA for the treatment of adults with moderately to severely active rheumatoid arthritis. Tocilizumab is administered as an intravenous infusion every 4 weeks. Subjects in the trial are age 18–55, taking a nonclozapine antipsychotic, stable based on clinical judgment and no psychiatric hospitalizations in the past 3 months, and on the same psychotropic medications for at least 1 month. Following a screening visit, subjects receive a 4 mg/kg infusion of tocilizumab at baseline and again at 4 weeks. Cognition, as measured by the Brief Assessment of Cognition in Schizophrenia (BACS, using alternate forms) is assessed at baseline, and 2, 4, and 8 weeks. In the first 3 subjects, tocilizumab infusions were well tolerated without significant adverse effects. The mean improvement was 16% on the BACS composite score, including a significant mean 35% improvement (12 points) on digit symbol coding (p=0.03). These preliminary data suggest that anti-cytokine therapy may be a viable adjunctive treatment for cognitive impairment in schizophrenia.
Posttraumatic stress disorder and substance use disorder is an important comorbidity in terms of its prevalence, clinical impact, and treatment challenges. To date, interventions for this comorbidity have been solely professionally led.
In this pilot study, we sought to evaluate the impact of a peer-led model, using Seeking Safety (SS; Najavits, 2002), which is the most evidence-based intervention thus far for the comorbidity. We adapted it for peer-led use to help make it accessible and safe for this modality.
Eighteen women in residential substance abuse treatment participated. The 25 SS topics were conducted twice weekly. They were assessed at baseline and end of treatment, with some measures also collected at monthly interims.
Results showed decreases in trauma-related symptoms (Trauma Symptom Checklist-40 total scale and all subscales, i.e., dissociation, sexual problems, depression, sleep problems, anxiety, and sexual abuse); self-compassion (the Self-Compassion Scale subscales self-judgment, isolation, and overidentified); the Brief Symptom Inventory (total and all nine subscales); and a measure of use of SS coping skills (total score). Also, ratings of fidelity to SS was very high (on the SS Adherence Scale), as was satisfaction with SS.
Limitations of the study and areas for future research development are discussed.