To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
To examine associations between sociodemographic and mental health characteristics with household risk for food insecurity during the COVID-19 outbreak.
Cross-sectional online survey analyzed using univariable tests and a multivariable logistic regression model.
The United States during the week of March 30, 2020.
Convenience sample of 1,965 American adults using Amazon’s Mechanical Turk (MTurk) platform. Participants reporting household food insecurity prior to the pandemic were excluded from analyses.
1,250 participants reported household food security before the COVID-19 outbreak. Among this subset, 41% were identified as at risk for food insecurity after COVID-19, 55% were women and 73% were white. On multivariable analysis, race, income, relationship status, living situation, anxiety, and depression were significantly associated with incident risk for food insecurity. Black, Asian, and Hispanic/Latino respondents, respondents with annual income less than $100,000, and those living with children or others were significantly more likely to be newly at risk for food insecurity. Individuals at risk for food insecurity were 2.60 (95% CI 1.91-3.55) times more likely to screen positively for anxiety and 1.71 (95% CI 1.21-2.42) times more likely to screen positively for depression.
Increased risk for food insecurity during the COVID-19 pandemic is common, and certain populations are particularly vulnerable. There are strong associations between being at risk for food insecurity and anxiety/depression. Interventions to increase access to healthful foods, especially among minority and low-income individuals, and ease the socioemotional effects of the outbreak are crucial to relieving the economic stress of this pandemic.
Approximately, 1.7 million individuals in the United States have been infected with SARS-CoV-2, the virus responsible for the novel coronavirus disease-2019 (COVID-19). This has disproportionately impacted adults, but many children have been infected and hospitalised as well. To date, there is not much information published addressing the cardiac workup and monitoring of children with COVID-19. Here, we share the approach to the cardiac workup and monitoring utilised at a large congenital heart centre in New York City, the epicentre of the COVID-19 pandemic in the United States.
Currently available antipsychotics are often effective against positive symptoms of schizophrenia but have limited effect in treating core features such as negative or cognitive symptoms. New drugs developed on the basis of current dogmas have shown no breakthroughs in effectiveness and novel understandings of the mechanisms responsible for symptom productions and treatment response are needed.
Clinical studies have shown that resistant negative symptoms may improve when antipsychotics are augmented with selective serotonin reuptake inhibitor (SSRI). This augmenting effect cannot be explained by summating pharmacological effects of the individual drugs. We reasoned that study of this synergism may reveal novel mechanisms relevant to the core features of schizophrenia and their treatment.
Here we present results of in vitro and in vivo laboratory studies showing that the SSRI-Antipsychotic combination, produces unique changes in gamma-aminobutyric acid (GABA)-A receptor and its regulating system which are different from each individual drug. The changes include GABAA receptor phosphorylation, and cellular compartment distribution and changes in proteins modulating GABAA activity including PKC, GSK, ERK and BDNF.
Results are also presented from clinical studies showing that SSRI augmentation in schizophrenia patients results in changes in blood mononuclear cell mRNA encoding for GABAA receptor and related proteins which are similar to those observed in the laboratory and associated with clinical improvement. Taken together these findings support the view that GABA A receptor modulation may be part of the mechanism mediating SSRI-antipsychotic synergistic effect ameliorating some core features of schizophrenia.
Introduction: The acute onset of flashes and floaters is a common presentation to the emergency department (ED). The most emergent etiology is retinal detachment (RD), which requires prompt ophthalmologic assessment. Previous studies of point of care ultrasound (POCUS) have reported high sensitivity and specificity for RD, but are limited by small sample size, use of highly trained and experienced sonographers, and referral bias. Our primary objective was to assess the test characteristics of POCUS performed by a large heterogeneous group of emergency physicians (EPs) for the diagnosis of RD. Methods: This was a prospective diagnostic test assessment of POCUS performed by EPs with varying ultrasound experience on a convenience sample of ED patients presenting with the complaint of flashes or floaters in one or both eyes. Participating EPs completed a one hour didactic lecture and were expected to demonstrate appropriate performance of one practice scan before enrolling patients. After standard ED assessment, patients underwent an ocular POCUS scan targeted to detect RD. EPs recorded the presence or absence of RD on the data collection instrument based on their POCUS scan. After completing their ED visit, all patients were assessed by a retina specialist who was blinded to the results of the POCUS scan. We calculated sensitivity and specificity with associated exact binomial confidence intervals (CI) using the retina specialist’s determination of the final diagnosis as the criterion standard. Results: A total of 30 EPs, consisting of 21 staff physicians and 9 residents, participated in this study. These EPs performed a total of 128 POCUS scans. Of these scans, 13 were excluded. Of the remaining 115 enrolled patients, median age was 60 years, and 64% were female. The retina specialist diagnosed RD in 16 (14%) cases. The sensitivity and specificity of POCUS for detecting RD was 75% (95% CI 48% to 93%) and 94% (95% CI 87% to 98%), respectively. The positive likelihood ratio was 12.4 (95% CI 5.4 to 28.3), and negative likelihood ratio was 0.27 (95% CI 0.11 to 0.62). Conclusion: In a heterogeneous group of EPs with varying ultrasound experience, POCUS demonstrates high specificity but only intermediate sensitivity for the detection of RD. A negative POCUS scan is not sufficiently sensitive to rule out RD in a patient with new onset flashes or floaters.
Our aim was to evaluate interrater reliability for the diagnosis of pediatric delirium by child psychiatrists.
Critically ill patients (N = 17), 0–21 years old, including 7 infants, 5 children with developmental delay, and 7 intubated children, were assessed for delirium using the Diagnostic and Statistical Manual–IV (DSM–IV) (comparable to DSM–V) criteria. Delirium assessments were completed by two psychiatrists, each blinded to the other's diagnosis, and interrater reliability was measured using Cohen's κ coefficient along with its 95% confidence interval.
Interrater reliability for the psychiatric assessment was high (Cohen's κ = 0.94, CI [0.83, 1.00]). Delirium diagnosis showed excellent interrater reliability regardless of age, developmental delay, or intubation status (Cohen's κ range 0.81–1.00).
Significance of results:
In our study cohort, the psychiatric interview and exam, long considered the “gold standard” in the diagnosis of delirium, was highly reliable, even in extremely young, critically ill, and developmentally delayed children. A developmental approach to diagnosing delirium in this challenging population is recommended.
This chapter reviews the principles of pharmacotherapy for neuropsychiatric disturbances and addresses practical issues that often arise during treatment. There are controlled clinical trials assessing the effects of medications on neuropsychiatric symptoms among neurodegenerative dementias. Side effect profiles may guide medication selection, especially when selecting among several medications within a particular pharmacologic class. An individual clinician's prior experience with the use of a particular medication to treat a specific neuropsychiatric problem also influences treatment selection. Continuous reassessment of treatment need is necessary whenever medications are prescribed. Vigilant observation for the development of drug-drug interactions is necessary. These interactions may be predicated on medication combination-specific alteration of pharmacokinetics that result in increased half-lives and serum levels of medications. In Behavioral Neurology & Neuropsychiatry (BN&NP), many medications are used for non-approved indications. While physicians are permitted to prescribe medications for non-approved purposes, insurance carriers may not approve payment for such prescriptions.
Zinc oxide (ZnO) nanoparticles and nanoparticles of luminescent zinc oxide (ZnO:Zn) phosphor were successfully synthesised and well characterised. A transparent polystyrene composite sheet containing ZnO:Zn nanoparticles was prepared by a solvent casting method. The sheet manifested comparable transmission to a virgin polystyrene film due to very uniform dispersion of the ZnO:Zn nanoparticles into the polystyrene. Evidence for uniform dispersion was evident in both its luminescent properties and in a SEM image. The photoluminescent characteristics of the ZnO:Zn, both as a pure powder and embedded in a polystyrene matrix, are reported. The uniformity of the photoluminescence of the composite sheet under near ultraviolet excitation is demonstrated. The luminescent ZnO:Zn nanoparticles are shown to have applications for use not only as an inhibitor of the ultraviolet degradation of polymers, but also for providing polymers with light emitting functionality.