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Audits play a critical role in maintaining the integrity of observational cohort data. While previous work has validated the audit process, sending trained auditors to sites (“travel-audits”) can be costly. We investigate the efficacy of training sites to conduct “self-audits.”
In 2017, eight research groups in the Caribbean, Central, and South America network for HIV Epidemiology each audited a subset of their patient records randomly selected by the data coordinating center at Vanderbilt. Designated investigators at each site compared abstracted research data to the original clinical source documents and captured audit findings electronically. Additionally, two Vanderbilt investigators performed on-site travel-audits at three randomly selected sites (one adult and two pediatric) in late summer 2017.
Self- and travel-auditors, respectively, reported that 93% and 92% of 8919 data entries, captured across 28 unique clinical variables on 65 patients, were entered correctly. Across all entries, 8409 (94%) received the same assessment from self- and travel-auditors (7988 correct and 421 incorrect). Of 421 entries mutually assessed as “incorrect,” 304 (82%) were corrected by both self- and travel-auditors and 250 of these (72%) received the same corrections. Reason for changing antiretroviral therapy (ART) regimen, ART end date, viral load value, CD4%, and HIV diagnosis date had the most mismatched corrections.
With similar overall error rates, findings suggest that data audits conducted by trained local investigators could provide an alternative to on-site audits by external auditors to ensure continued data quality. However, discrepancies observed between corrections illustrate challenges in determining correct values even with audits.
Although executive and other cognitive deficits have been found in patients with borderline personality disorder (BPD), whether these have brain functional correlates has been little studied. This study aimed to examine patterns of task-related activation and de-activation during the performance of a working memory task in patients with the disorder.
Sixty-seven DSM-IV BPD patients and 67 healthy controls underwent fMRI during the performance of the n-back task. Linear models were used to obtain maps of within-group activations and areas of differential activation between the groups.
On corrected whole-brain analysis, there were no activation differences between the BPD patients and the healthy controls during the main 2-back v. baseline contrast, but reduced activation was seen in the precentral cortex bilaterally and the left inferior parietal cortex in the 2-back v. 1-back contrast. The patients showed failure of de-activation affecting the medial frontal cortex and the precuneus, plus in other areas. The changes did not appear to be attributable to previous history of depression, which was present in nearly half the sample.
In this study, there was some, though limited, evidence for lateral frontal hypoactivation in BPD during the performance of an executive task. BPD also appears to be associated with failure of de-activation in key regions of the default mode network.
Here we report the results of an experimental study where we measure the hydrodynamic force acting on a plate which is lifted from a water surface, suddenly starting to move upwards with an acceleration much larger than gravity. Our work focuses on the early stage of the plate motion, when the hydrodynamic suction forces due to the liquid inertia are the most relevant ones. Besides the force, we measure as well the acceleration at the centre of the plate and the time evolution of the wetted area. The results of this study show that, at very early stages, the hydrodynamic force can be estimated by a simple extension of the linear exit theory by Korobkin (J. Fluid Mech., vol. 737, 2013, pp. 368–386), which incorporates an added mass to the body dynamics. However, at longer times, the measured acceleration decays even though the applied external force continues to increase. Moreover, high-speed recordings of the disc displacement and the radius of the wetted area reveal that the latter does not change before the disc acceleration reaches its maximum value. We show in this paper that these phenomena are caused by the elastic deflection of the disc during the initial transient stage of water exit. We present a linearised model of water exit that accounts for the elastic behaviour of the lifted body. The results obtained with this new model agree fairly well with the experimental results.
We describe the use of immobilized deoxyribonucleic acid (DNA) in a silica matrix as a biorecognition agent for the detection of albendazole sulfoxide (ASU), the primary metabolite of albendazole and a suspected teratogenic and embryotoxic agent. The biomaterial (DNA-containing gel) was synthesized by physical entrapment of salmon sperm in an inorganic silicate matrix by the sol-gel method. Functionality of the DNA-containing gel was evaluated by comparative offline frontal chromatography followed by HPLC analysis of ASU and caffeine (CAF, control) using DNA-containing gel and DNA-free gel. The DNA-containing gel showed relatively high specific retention for ASU, while CAF showed no retention using frontal analysis. We anticipate that the DNA-containing gel can be implemented to identify the interactions of DNA with other active pharmaceutical ingredients (APIs) and their metabolites in a readily available, sensitive and selective frontal chromatography experiment.
The objective was to compare the performance of the updated Charlson comorbidity index (uCCI) and classical CCI (cCCI) in predicting 30-day mortality in patients with Staphylococcus aureus bacteraemia (SAB). All cases of SAB in patients aged ⩾14 years identified at the Microbiology Unit were included prospectively and followed. Comorbidity was evaluated using the cCCI and uCCI. Relevant variables associated with SAB-related mortality, along with cCCI or uCCI scores, were entered into multivariate logistic regression models. Global model fit, model calibration and predictive validity of each model were evaluated and compared. In total, 257 episodes of SAB in 239 patients were included (mean age 74 years; 65% were male). The mean cCCI and uCCI scores were 3.6 (standard deviation, 2.4) and 2.9 (2.3), respectively; 161 (63%) cases had cCCI score ⩾3 and 89 (35%) cases had uCCI score ⩾4. Sixty-five (25%) patients died within 30 days. The cCCI score was not related to mortality in any model, but uCCI score ⩾4 was an independent factor of 30-day mortality (odds ratio, 1.98; 95% confidence interval, 1.05–3.74). The uCCI is a more up-to-date, refined and parsimonious prognostic mortality score than the cCCI; it may thus serve better than the latter in the identification of patients with SAB with worse prognoses.
Treatment for hoarding disorder is typically performed by mental health professionals, potentially limiting access to care in underserved areas.
We aimed to conduct a non-inferiority trial of group peer-facilitated therapy (G-PFT) and group psychologist-led cognitive–behavioural therapy (G-CBT).
We randomised 323 adults with hording disorder 15 weeks of G-PFT or 16 weeks of G-CBT and assessed at baseline, post-treatment and longitudinally (≥3 months post-treatment: mean 14.4 months, range 3–25). Predictors of treatment response were examined.
G-PFT (effect size 1.20) was as effective as G-CBT (effect size 1.21; between-group difference 1.82 points, t = −1.71, d.f. = 245, P = 0.04). More homework completion and ongoing help from family and friends resulted in lower severity scores at longitudinal follow-up (t = 2.79, d.f. = 175, P = 0.006; t = 2.89, d.f. = 175, P = 0.004).
Peer-led groups were as effective as psychologist-led groups, providing a novel treatment avenue for individuals without access to mental health professionals.
Declaration of interest
C.A.M. has received grant funding from the National Institutes of Health (NIH) and travel reimbursement and speakers’ honoraria from the Tourette Association of America (TAA), as well as honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. K.D. receives research support from the NIH and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. R.S.M. receives research support from the National Institute of Mental Health, National Institute of Aging, the Hillblom Foundation, Janssen Pharmaceuticals (research grant) and the Alzheimer's Association. R.S.M. has also received travel support from the National Institute of Mental Health for Workshop participation. J.Y.T. receives research support from the NIH, Patient-Centered Outcomes Research Institute and the California Tobacco Related Research Program, and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. All other authors report no conflicts of interest.
We aimed to quantify the proportion of people receiving care for HIV-infection that are 50 years or older (older HIV patients) in Latin America and the Caribbean between 2000 and 2015 and to estimate the contribution to the growth of this population of people enrolled before (<50yo) and after 50 years old (yo) (⩾50yo). We used a series of repeated, cross-sectional measurements over time in the Caribbean, Central and South American network (CCASAnet) cohort. We estimated the percentage of patients retained in care each year that were older HIV patients. For every calendar year, we divided patients into two groups: those who enrolled before age 50 and after age 50. We used logistic regression models to estimate the change in the proportion of older HIV patients between 2000 and 2015. The percentage of CCASAnet HIV patients over 50 years had a threefold increase (8% to 24%) between 2000 and 2015. Most of the growth of this population can be explained by the increasing proportion of people that enrolled before 50 years and aged in care. These changes will impact needs of care for people living with HIV, due to multiple comorbidities and high risk of disability associated with aging.
We present a fast method to prepare hybrid materials of polyaniline (PAni) with carbon nanotubes (CNTs, both undoped and nitrogen-doped) by ball milling without solvents or strong oxidants. PAni forms nanoparticles, attached to CNTs in a nanocomposite structure, with the nanotubes well dispersed among the polymer. This is achieved with only a few minutes of ball milling. Raman spectroscopy confirms that PAni was synthesized in its conductive state and suggests a good CNT–PAni interaction, particularly with nitrogen-doped CNTs. We found that water increased polymer yield, which we optimized, together with the nanocomposite conductivity, as function of amount of water and of oxidant (FeCl3). The nanocomposite conductivity is four orders of magnitude higher than that of PAni, for both types of nanotubes. Scanning electron microscopy and X-ray diffraction both show negligible damage to the CNT during this mechanosynthesis procedure, while dry milling and milling CNT in water without aniline does damage nanotubes, indicating that the reaction absorbs most of the mechanical energy.
There is a need for clinical tools to identify cultural issues in diagnostic assessment.
To assess the feasibility, acceptability and clinical utility of the DSM-5 Cultural Formulation Interview (CFI) in routine clinical practice.
Mixed-methods evaluation of field trial data from six countries. The CFI was administered to diagnostically diverse psychiatric out-patients during a diagnostic interview. In post-evaluation sessions, patients and clinicians completed debriefing qualitative interviews and Likert-scale questionnaires. The duration of CFI administration and the full diagnostic session were monitored.
Mixed-methods data from 318 patients and 75 clinicians found the CFI feasible, acceptable and useful. Clinician feasibility ratings were significantly lower than patient ratings and other clinician-assessed outcomes. After administering one CFI, however, clinician feasibility ratings improved significantly and subsequent interviews required less time.
The CFI was included in DSM-5 as a feasible, acceptable and useful cultural assessment tool.
The intensity of annual Spanish influenza activity is currently estimated from historical data of the Spanish Influenza Sentinel Surveillance System (SISSS) using qualitative indicators from the European Influenza Surveillance Network. However, these indicators are subjective, based on qualitative comparison with historical data of influenza-like illness rates. This pilot study assesses the implementation of Moving Epidemic Method (MEM) intensity levels during the 2014–2015 influenza season within the 17 sentinel networks covered by SISSS, comparing them to historically reported indicators. Intensity levels reported and those obtained with MEM at the epidemic peak of the influenza wave, and at national and regional levels did not show statistical difference (P = 0·74, Wilcoxon signed-rank test), suggesting that the implementation of MEM would have limited disrupting effects on the dynamic of notification within the surveillance system. MEM allows objective influenza surveillance monitoring and standardization of criteria for comparing the intensity of influenza epidemics in regions in Spain. Following this pilot study, MEM has been adopted to harmonize the reporting of intensity levels of influenza activity in Spain, starting in the 2015–2016 season.
In cattle, reduced reproductive efficiency of beef and milk production systems is attributed to nutritional factors, health, climate changes and ultimately to genetic characteristics of animals. However, under warm humid tropics genetic variations between breeds could reduce age first calving, calving interval and increase the life of cows. Sanmartinero and Casanareño creole breeds can improve cattle production due to the contribution of genetic variants that emerged in the process of adaptation to the harsh conditions of the Colombian Orinoqia. Currently, genes with known biological function are used as molecular markers to estimate livestock genetic diversity parameters, facilitating the identification and location of genetic loci within the genome that encode or regulate the expression of traits of economic interest. In Colombia Romosinuano cattle candidate genes of the Growth hormone / Insulin growth factor axis have been identified and are positively associated with age at first calving, calving interval, longevity and protection of the embryo growth to heat stress. However, native Colombian bovine breeds such as Casanareño and Sanmartinero, which are empirically recognized by having those characteristic, have not been subjected to those genetic analysis for candidate genes that may allow to promote added value to animals. The aim of this review is to document some reproductive and genetic parameters of Sanmartinero and Casanareño bovine brees that may give support the need to conduct molecular studies and justify their use in beef and milk production systems in the Colombian Orinoquia.
Spatial heterogeneity of snow and firn properties on glaciers introduces uncertainty in interpretation of point and profile observations and complicates modelling of meltwater percolation and runoff. Here we present a study of the temporal and spatial dynamics of firn density and stratigraphy at the plot-scale (≈10 m × 10 m × 10 m) repeated annually during 2012–14 at the Lomonosovfonna icefield, Svalbard. Results from cores, video inspections in boreholes and radar grid surveys are compared. Ice layers 0.1–50 cm thick comprised ≈8% of the borehole length. Most of them are 1–3 cm thick and could not be traced between boreholes separated by 3 m. Large lateral variability of firn structure affects representativeness of observations in single holes and calls for repeated studies in multiple points to derive a representative stratigraphy signal. Radar reflections are poorly correlated with ice layers in individual boreholes. However, the match between the high amplitude peaks in the grid-averaged radar signal and horizons of preferential ice layer formation revealed by averaging the video surveys over multiple boreholes is higher. These horizons are interpreted as buried firn layers previously exposed to melt-freeze or wind-driven densification and several of them are consistently recovered throughout three field campaigns.
The peroxyformic process is based on the action of a carboxylic acid (mainly formic acid) and the corresponding peroxyacid. The influences of processing time (60–180 min), formic acid concentration (80–95%), temperature (60–80°C), and hydrogen peroxide concentration (2–4%) on peroxyformic pulping of agave leaves were studied by surface response methodology using a face-centered factorial design. Empirical models were obtained for the prediction of yield, κ number (KN) and pulp viscosity as functions of the aforementioned variables. Mathematical optimization enabled us to select a set of operational variables that produced the best fractionation of the material with the following results: pulp yield (26.9%), KN (3.6), and pulp viscosity (777 mL/g). Furthermore, this work allowed the description and evaluation of changes to the agave fibers during the fractionation process using different microscopic and spectroscopic techniques, and provided a comprehensive and qualitative view of the phenomena occurring in the delignification of agave fibers. The use of confocal and scanning electron microscopy provided a detailed understanding of the microstructural changes to the lignin and cellulose in the fibers throughout the process, whereas Raman spectroscopy and X-ray diffraction analysis indicated that cellulose in the pulp after treatment was mainly of type I.
Objectives: Engagement in risky sexual behavior (RSB) is a significant public health concern. A growing body of literature is elucidating the role of brain systems and neuropsychological constructs implicated in RSB, which may pave the way for novel insights and prevention efforts. Methods: In this article, we review studies incorporating neuropsychology into the study of RSB across the lifespan. The review of the literature on the neuropsychology of RSB is separated into three different sections by age of participants. Background is presented on research associating RSB with neurocognitive processes and the brain systems involved. Given the overlap between RSBs and substance use, studies addressing these problems in tandem are also discussed. Results: Neurocognitive constructs are implicated in RSB, including impulsivity, decision-making, and working memory. Discussion: Thus far, evidence suggest that neuropsychological factors are associated with engagement in RSB. More research on the influence of neuropsychological factors on engagement in RSB is necessary and may help inform future prevention efforts. (JINS, 2016, 22, 586–594)
Protected areas are regarded as the main strategy to halt biodiversity loss; however, protected area effectiveness evaluations remain scarce and mostly rely on limited scientific evidence. Protected area managers from two case studies in the Mediterranean basin biodiversity hotspot (networks of Spanish terrestrial protected areas and individual Mediterranean marine protected areas) were surveyed to assess the use of two protected area evaluation systems: the ‘System for the Integrated Assessment of Protected Areas’ (SIAPA) and the ‘System for Quick Evaluation of Management in Mediterranean MPAs’ using the ‘Knowledge Systems for Sustainable Development’ framework. A second survey in Spain ascertained the degree of implementation of protected area evaluation systems and the institutional interest in implementing such systems. The main weaknesses attributable to the systems presented were limited salience (for the SIAPA) and legitimacy in terms of costs (for the System for Quick Evaluation of Management in Mediterranean MPAs). However, the main reasons for the limited uptake of the evaluation systems presented were not attributable to the systems themselves, but to management or institutional limitations: the lack of basic data for and weak institutional interest in evaluation in Spain, and the scarce resources available for evaluation in the case of some Mediterranean marine protected areas.