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Antidepressant medication and interpersonal psychotherapy (IPT) are both recommended interventions in depression treatment guidelines based on literature reviews and meta-analyses. However, ‘conventional’ meta-analyses comparing their efficacy are limited by their reliance on reported study-level information and a narrow focus on depression outcome measures assessed at treatment completion. Individual participant data (IPD) meta-analysis, considered the gold standard in evidence synthesis, can improve the quality of the analyses when compared with conventional meta-analysis.
We describe the protocol for a systematic review and IPD meta-analysis comparing the efficacy of antidepressants and IPT for adult acute-phase depression across a range of outcome measures, including depressive symptom severity as well as functioning and well-being, at both post-treatment and follow-up (PROSPERO: CRD42020219891).
We will conduct a systematic literature search in PubMed, PsycINFO, Embase and the Cochrane Library to identify randomised clinical trials comparing antidepressants and IPT in the acute-phase treatment of adults with depression. We will invite the authors of these studies to share the participant-level data of their trials. One-stage IPD meta-analyses will be conducted using mixed-effects models to assess treatment effects at post-treatment and follow-up for all outcome measures that are assessed in at least two studies.
This will be the first IPD meta-analysis examining antidepressants versus IPT efficacy. This study has the potential to enhance our knowledge of depression treatment by comparing the short- and long-term effects of two widely used interventions across a range of outcome measures using state-of-the-art statistical techniques.
Schizophrenia is associated with an increased risk of sudden cardiac death, traditionally attributed to prolonged QTc interval and cardiovascular risk factors such as metabolic syndrome. However, defective ion channels are also implicated in schizophrenia. This applies as well for Brugada syndrome (BrS), a rare hereditary cardiac disorder associated with an increased risk of cardiac arrhythmias, which can been provoked by various drugs, including psychotropic.
To screen whether an increased prevalence of suspect Brugada ECG is present in patients with recent onset schizophrenia.
273 subjects with recent onset schizophrenia admitted between 2006 and 2012 and 306 healthy controls, underwent an ECG. All persons who had an ECG suspect for BrS were asked to undergo a provocation test to diagnose/exclude BrS. We checked whether patients had deceased during follow-up.
20/273 patients (7.3%) and 5/306 healthy controls (1.6%) showed an ECG suspect for BrS, with a Relative risk (RR) of 4.8 (p<0.001). Thus far 12 provocation tests have been performed, confirming BrS in three patients (1.1%). Ten patients had deceased during follow-up, of which two due to sudden cardiac death. Patients and controls didn’t differ significantly on average QTc interval.
Conclusion: This study shows that a considerable subset of patients with recent onset schizophrenia have an ECG suspect of Brugada Syndrome, confirming results in a population with chronic schizophrenia (Blom 2014). This may imply that there is a common pathophysiologic mechanism involved in both disorders. Screening for Brugada Syndrome in schizophrenia is relevant to prevent sudden cardiac death.
Online learning has become an increasingly expected and popular component for education of the modern-day adult learner, including the medical provider. In light of the recent coronavirus pandemic, there has never been more urgency to establish opportunities for supplemental online learning. Heart University aims to be “the go-to online resource” for e-learning in CHD and paediatric-acquired heart disease. It is a carefully curated open access library of paedagogical material for all providers of care to children and adults with CHD or children with acquired heart disease, whether a trainee or a practising provider. In this manuscript, we review the aims, development, current offerings and standing, and future goals of Heart University.
Auditory hallucinations (AH) are often considered a sign of a psychotic disorder. This is promoted by the DSM-5 category of Other Specified Schizophrenia Spectrum And Other Psychotic Disorder (OSSSOPD), the diagnostic criteria for which are fulfilled with the sole presence of persistent AH, in the absence of any other psychotic symptoms. And yet, persistent AH are not synonymous with having a psychotic disorder, and should therefore not be uncritically treated as such. Many people who seek treatment for persistent AH have no other psychotic symptoms, have preserved reality-testing capacities, and will never develop a schizophrenia spectrum disorder. Instead, hallucinations may be the result of many different causes, including borderline personality disorder, post-traumatic stress disorder (PTSD), hearing loss, sleep disorders or brain lesions, and they may even occur outside the context of any demonstrable pathology. In such cases, the usage of the DSM-5 diagnosis of OSSSOPD would be incorrect, and it may prompt unwarranted treatment with antipsychotic medication. We therefore argue that a DSM-5 diagnosis of Schizophrenia Spectrum Disorder (or any other type of psychotic disorder) characterized by AH should require at least one more symptom listed under the A-criterion (i.e. delusions, disorganized speech, disorganized or catatonic behavior or negative symptoms). Adhering to these more stringent criteria may help to distinguish between individuals with persistent AH which are part of a psychotic disorder, for whom antipsychotic medication may be helpful, and individuals with AH in the absence of such a disorder who may benefit from other approaches (e.g. different pharmacological interventions, improving coping style, trauma-related therapy).
To identify modifiable risk factors for acquisition of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC) colonization among long-term acute-care hospital (LTACH) patients.
Multicenter, matched case-control study.
Four LTACHs in Chicago, Illinois.
Each case patient included in this study had a KPC-negative rectal surveillance culture on admission followed by a KPC-positive surveillance culture later in the hospital stay. Each matched control patient had a KPC-negative rectal surveillance culture on admission and no KPC isolated during the hospital stay.
From June 2012 to June 2013, 2,575 patients were admitted to 4 LTACHs; 217 of 2,144 KPC-negative patients (10.1%) acquired KPC. In total, 100 of these patients were selected at random and matched to 100 controls by LTACH facility, admission date, and censored length of stay. Acquisitions occurred a median of 16.5 days after admission. On multivariate analysis, we found that exposure to higher colonization pressure (OR, 1.02; 95% CI, 1.01–1.04; P=.002), exposure to a carbapenem (OR, 2.25; 95% CI, 1.06–4.77; P=.04), and higher Charlson comorbidity index (OR, 1.14; 95% CI, 1.01–1.29; P=.04) were independent risk factors for KPC acquisition; the odds of KPC acquisition increased by 2% for each 1% increase in colonization pressure.
Higher colonization pressure, exposure to carbapenems, and a higher Charlson comorbidity index independently increased the odds of KPC acquisition among LTACH patients. Reducing colonization pressure (through separation of KPC-positive patients from KPC-negative patients using strict cohorts or private rooms) and reducing carbapenem exposure may prevent KPC cross transmission in this high-risk patient population.
Accurate identification of individuals at high risk of surgical site infections (SSIs) or periprosthetic joint infections (PJIs) influences clinical decisions and development of preventive strategies. We aimed to determine progress in the development and validation of risk prediction models for SSI or PJI using a systematic review. We searched for studies that have developed or validated a risk prediction tool for SSI or PJI following joint replacement in MEDLINE, EMBASE, Web of Science and Cochrane databases; trial registers and reference lists of studies up to September 2016. Nine studies describing 16 risk scores for SSI or PJI were identified. The number of component variables in a risk score ranged from 4 to 45. The C-index ranged from 0·56 to 0·74, with only three risk scores reporting a discriminative ability of >0·70. Five risk scores were validated internally. The National Healthcare Safety Network SSIs risk models for hip and knee arthroplasties (HPRO and KPRO) were the only scores to be externally validated. Except for HPRO which shows some promise for use in a clinical setting (based on predictive performance and external validation), none of the identified risk scores can be considered ready for use. Further research is urgently warranted within the field.
The first half of the Mississippian or Early Carboniferous (Tournaisian to mid- Viséan), an interval of about 20 million years, has become known as “Romer's Gap” because of its poor tetrapod record. Recent discoveries emphasise the differences between pre-“Gap” Devonian tetrapods, unambiguous stem-group members retaining numerous “fish” characters indicative of an at least partially aquatic lifestyle, and post-“Gap” Carboniferous tetrapods, which are far more diverse and include fully terrestrial representatives of the main crown-group lineages. It seems that “Romer's Gap” coincided with the cladogenetic events leading to the origin of the tetrapod crown group. Here, we describe a partial right lower jaw ramus of a tetrapod from the late Tournaisian or early Viséan of Scotland. The large and robust jaw displays a distinctive character combination, including a significant mesial lamina of the strongly sculptured angular, an open sulcus for the mandibular lateral line, a non-ossified narrow Meckelian exposure, a well-defined dorsal longitudinal denticle ridge on the prearticular, and a mesially open adductor fossa. A phylogenetic analysis places this specimen in a trichotomy with Crassigyrinus and baphetids + higher tetrapods in the upper part of the tetrapod stem group, above Whatcheeria, Pederpes, Ossinodus, Sigournea and Greererpeton. It represents a small but significant step in the gradual closure of “Romer's Gap”.
This study evaluates the effects of Age of Exposure to English (AoEE) and Current Input/Output on language performance in a cross-sectional sample of Spanish–English bilingual children. First- (N = 586) and third-graders (N = 298) who spanned a wide range of bilingual language experience participated. Parents and teachers provided information about English and Spanish language use. Short tests of semantic and morphosyntactic development in Spanish and English were used to quantify children's knowledge of each language. There were significant interactions between AoEE and Current Input/Output for children at third grade in English and in both grades for Spanish. In English, the relationship between AoEE and language scores were linear for first- and third-graders. In Spanish a nonlinear relationship was observed. We discuss how much of the variance was accounted for by AoEE and Current Input/Output.
Prevalence of blaKPC-encoding Enterobacteriaceae (KPC) in Chicago long-term acute care hospitals (LTACHs) rose rapidly after the first recognition in 2007. We studied the epidemiology and transmission capacity of KPC in LTACHs and the effect of patient cohorting.
Data were available from 4 Chicago LTACHs from June 2012 to June 2013 during a period of bundled interventions. These consisted of screening for KPC rectal carriage, daily chlorhexidine bathing, medical staff education, and 3 cohort strategies: a pure cohort (all KPC-positive patients on 1 floor), single rooms for KPC-positive patients, and a mixed cohort (all KPC-positive patients on 1 floor, supplemented with KPC-negative patients). A data-augmented Markov chain Monte Carlo (MCMC) method was used to model the transmission process.
Average prevalence of KPC colonization was 29.3%. On admission, 18% of patients were colonized; the sensitivity of the screening process was 81%. The per admission reproduction number was 0.40. The number of acquisitions per 1,000 patient days was lowest in LTACHs with a pure cohort ward or single rooms for colonized patients compared with mixed-cohort wards, but 95% credible intervals overlapped.
Prevalence of KPC in LTACHs is high, primarily due to high admission prevalence and the resultant impact of high colonization pressure on cross transmission. In this setting, with an intervention in place, patient-to-patient transmission is insufficient to maintain endemicity. Inclusion of a pure cohort or single rooms for KPC-positive patients in an intervention bundle seemed to limit transmission compared to use of a mixed cohort.
Infect Control Hosp Epidemiol 2015;36(10):1148–1154
We evaluated the effectiveness of daily chlorhexidine gluconate (CHG) bathing in decreasing skin carriage of Klebsiella pneumoniae carbapenemase–producing Enterobacteriaceae (KPC) among long-term acute care hospital patients. CHG bathing reduced KPC skin colonization, particularly when CHG skin concentrations greater than or equal to 128 μg/mL were achieved.
Auditory verbal hallucinations (AVH) in patients with borderline personality disorder (BPD) are frequently claimed to be brief, less severe and qualitatively different from those in schizophrenia, hence the term ‘pseudohallucinations’. AVH in BPD may be more similar to those experienced by healthy individuals, who experience AVH in a lower frequency and with a more positive content than AVH in schizophrenia. In this study the phenomenology of AVH in BPD patients was compared to that in schizophrenia and to AVH experienced by non-patients.
In a cross-sectional setting, the phenomenological characteristics of AVH in 38 BPD patients were compared to those in 51 patients with schizophrenia/schizoaffective disorder and to AVH of 66 non-patients, using the Psychotic Symptom Rating Scales (PSYRATS).
BPD patients experienced AVH for a mean duration of 18 years, with a mean frequency of at least daily lasting several minutes or more. The ensuing distress was high. No differences in the phenomenological characteristics of AVH were revealed among patients diagnosed with BPD and those with schizophrenia/schizoaffective disorder, except for ‘disruption of life’, which was higher in the latter group. Compared to non-patients experiencing AVH, BPD patients had higher scores on almost all items.
AVH in BPD patients are phenomenologically similar to those in schizophrenia, and different from those in healthy individuals. As AVH in patients with BPD fulfil the criteria of hallucinations proper, we prefer the term AVH over ‘pseudohallucinations’, so as to prevent trivialization and to promote adequate diagnosis and treatment.
The complex admittance of the Si+/SiO2/Pentacene/Au (metal/oxide/pentacene) thin film junctions is investigated under ambient conditions. The results are compared with the ones obtained for the corresponding Si+/SiO2/Au junctions (i.e. a small part of the surface left free from pentacene) which constitutes the “reference” of our samples. This allows us to extract the “organic” part of the dielectric response from the whole spectrum. Our data clearly show that the admittance is decomposed in three main contributions. At low frequencies, a contribution attributed to proton diffusion through the oxide is seen. This diffusion is shown to be anomalous and is believed to be also at the origin of the bias stress effect observed in organic field effect transistors. At higher frequencies, two dipolar contributions are evidenced, attributed to defects located one at the organic/oxide interface or within the organic, and the other in the bulk of the oxide. These two dipolar responses show different dynamic properties that manifest themselves in the admittance in the form of a Debye contribution for the defects located in the oxide, and of a Cole-Cole contribution for the defects related to the organic.
The bitter winds of financial crisis have once again swept global markets, this time beginning at the core of the system, Wall Street. Whether blame be assigned to private greed, public policy lapses, or both, vast sums of public money and shareholder capital have been wiped out in the otherwise noble cause of preventing systemic breakdown. Vulnerable citizens once more count the costs to the real economy. As massive liquidity has been made available to private financial institutions on exceptionally permissive terms, it has been difficult not to notice the striking contrast with the management of earlier crises based in the emerging markets. When they were in the dock, the emphasis was on the conditionality of the terms of rescue; with Wall Street and the City in trouble, the terms of rescue have been much more open-ended.
As growing uncertainty combined with these apparent double standards, the crisis has reopened debate on the global financial architecture, public policy and regulation. Global financial integration and the governance of the global monetary and financial system stand at a crossroads after over thirty years of market-oriented cross-border integration and development preceded and indeed exacerbated a financial crisis on a scale not seen since the 1930s. This ongoing process of integration, regularly punctuated by crises and instability, raises analytical, normative and policy dilemmas which challenge our current understanding of financial and monetary governance.
Producing a volume on financial governance just at the outbreak of the worst financial crisis since the Great Depression proved to be both a daunting and exciting task. While the onset of crisis raised the salience of work on financial governance considerably, both editors and contributors might be forgiven for a sense of exhaustion related to the hot pursuit of a moving target. This has meant that the purpose of the volume has evolved rather rapidly over the past three years. The volume began life as an analysis of the record and historical experience of the ‘new international financial architecture’ developed in the wake of the emerging market crises of the 1990s and early 2000s. The analysis yielded the conclusion that not all was functioning as effectively as the architects believed. The aim was to challenge the apparent complacency of the period of calm following the Argentine default, and to stimulate new thinking based on the understanding and reading of the evidence that all was not well and that fundamental flaws in global financial governance required urgent attention.
By August 2007, when an early version of the manuscript was ready and much of the research findings had been discussed in workshops, it became clear that the usual crisis rumblings but of unusual force were beginning deep below the fine edifice constructed by the architects.
Early in the new millennium it appeared that a long period of financial crisis had come to an end, but the world now faces renewed and greater turmoil. This 2010 volume analyses the past three decades of global financial integration and governance and the recent collapse into crisis, offering a coherent and policy-relevant overview. State-of-the-art research from an interdisciplinary group of scholars illuminates the economic, political and social issues at the heart of devising an effective and legitimate financial system for the future. The chapters offer debate around a series of core themes which probe the ties between public and private actors and their consequences for outcomes for both developed markets and developing countries alike. The contributors argue that developing effective, legitimate financial governance requires enhancing public versus private authority through broader stakeholder representation, ensuring more acceptable policy outcomes.