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Concerns have been raised about the utility of self-report assessments in predicting future suicide attempts. Clinicians in pediatric emergency departments (EDs) often are required to assess suicidal risk. The Death Implicit Association Test (IAT) is an alternative to self-report assessment of suicidal risk that may have utility in ED settings.
A total of 1679 adolescents recruited from 13 pediatric emergency rooms in the Pediatric Emergency Care Applied Research Network were assessed using a self-report survey of risk and protective factors for a suicide attempt, and the IAT, and then followed up 3 months later to determine if an attempt had occurred. The accuracy of prediction was compared between self-reports and the IAT using the area under the curve (AUC) with respect to receiver operator characteristics.
A few self-report variables, namely, current and past suicide ideation, past suicidal behavior, total negative life events, and school or social connectedness, predicted an attempt at 3 months with an AUC of 0.87 [95% confidence interval (CI), 0.84–0.90] in the entire sample, and AUC = 0.91, (95% CI 0.85–0.95) for those who presented without reported suicidal ideation. The IAT did not add significantly to the predictive power of selected self-report variables. The IAT alone was modestly predictive of 3-month attempts in the overall sample ((AUC = 0.59, 95% CI 0.52–0.65) and was a better predictor in patients who were non-suicidal at baseline (AUC = 0.67, 95% CI 0.55–0.79).
In pediatric EDs, a small set of self-reported items predicted suicide attempts within 3 months more accurately than did the IAT.
COVID-19 is the latest episode of shortages of critical medical supplies. Historically and to the present day, medical supplies have been sourced from single regions in the world, thus rendering the supply chain vulnerable to a myriad of harmful circumstances. We argue that shortages in medications related and unrelated to COVID have illustrated the need for the United States to diversify its medical supply sources before future pandemics, political crises, or natural disasters occur.
Virtual reality (VR) is a promising tool with the potential to enhance care of cognitive and affective disorders in the aging population. VR has been implemented in clinical settings with adolescents and children; however, it has been less studied in the geriatric population.
The objective of this study is to determine the existing levels of evidence for VR use in clinical settings and identify areas where more evidence may guide translation of existing VR interventions for older adults.
Design and measurements:
We conducted a systematic review in PubMed and Web of Science in November 2019 for peer-reviewed journal articles on VR technology and its applications in older adults. We reviewed article content and extracted the number of study participants, study population, goal of the investigation, the level of evidence, and categorized articles based on the indication of the VR technology and the study population.
The database search yielded 1554 total results, and 55 articles were included in the final synthesis. The most represented study design was cross-sectional, and the most common study population was subjects with cognitive impairment. Articles fell into three categories for VR Indication: Testing, Training, and Screening. There was a wide variety of VR environments used across studies.
Existing evidence offers support for VR as a screening and training tool for cognitive impairment in older adults. VR-based tasks demonstrated validity comparable to some paper-based assessments of cognition, though more work is needed to refine diagnostic specificity. The variety of VR environments used shows a need for standardization before comparisons can be made across VR simulations. Future studies should address key issues such as usability, data privacy, and confidentiality. Since most literature was generated from high-income countries (HICs), it remains unclear how this may be translated to other parts of the world.
ABSTRACT IMPACT: Preliminary results will inform the formal evaluation of the reliability of point-of-care ultrasound (POCUS) done by the gastroenterologist compared to standard of care methods such as MR-Enterography. OBJECTIVES/GOALS: Evaluation of mucosal healing is standard for pediatric patients with inflammatory bowel disease (IBD). Point-of-care ultrasound is a non-invasive, cost-efficient tool for assessing intestinal inflammation. We aim to evaluate the agreement between POCUS and typical cross-sectional imaging, such as MR-Enterography (MRE). METHODS/STUDY POPULATION: In this cross-sectional study, we recruited consecutive patients newly diagnosed with IBD, presenting to the specialty outpatient clinic or hospitalized in a pediatric tertiary care center between August to November 2020. They underwent POCUS performed by a single gastroenterologist, in addition to MRE. The sonographer was blinded to MRE results. Bowel wall thickness (BWT) was measured across different bowel segments and recorded twice in longitudinal view and twice in axial view. An average segmental BWT of the four measurements of more than 3 mm was considered inflamed. Agreement between sections of the bowel measured as inflamed were compared to inflamed bowel segments seen by MRE, using Cohen’s kappa. RESULTS/ANTICIPATED RESULTS: Eight of 12 patients completed both MRE and POCUS.A total of 40 bowel segments were assessed, namely the terminal ileum, ascending, transverse, descending and sigmoid colon. There were 4 girls with a median age of 15 years (IQR 14.25-16 years), and 6 patients were diagnosed with Crohn’s disease. Median PCDAI was 32.5 (IQR 30.6-40), and median PUCAI was 75 (72.5-77.5). Agreement between MRE and point-of-care ultrasound was substantial to perfect for the terminal ileum *(Îº= 0.75, 95%CI 0.31-1), transverse colon (Îº= 1, 95%CI 1-1) and sigmoid colon (Îº= 1, 95%CI 1-1). The agreement was poor for the ascending (Îº= 0, 95%CI 0-0) and moderate for the descending colon. (Îº= 0.6, 95%CI -0.07-1) DISCUSSION/SIGNIFICANCE OF FINDINGS: In pediatric patients with IBD, we found a high agreement between POCUS and MRE for imaging of the terminal ileum, transverse and sigmoid colon, areas commonly involved in IBD. This reinforces adult data, outlining the potential of POCUS as an evaluation tool of disease activity in clinical practice.
Three-dimensional printing is increasingly utilised for congenital heart defect procedural planning. CT or MR datasets are typically used for printing, but similar datasets can be obtained from three-dimensional rotational angiography. We sought to assess the feasibility and accuracy of printing three-dimensional models of CHD from rotational angiography datasets.
Retrospective review of CHD catheterisations using rotational angiography was performed, and patient and procedural details were collected. Imaging data from rotational angiography were segmented, cleaned, and printed with polylactic acid on a Dremel® 3D Idea Builder (Dremel, Mount Prospect, IL, USA). Printing time and materials’ costs were captured. CT scans of printed models were compared objectively to the original virtual models. Two independent, non-interventional paediatric cardiologists provided subjective ratings of the quality and accuracy of the printed models.
Rotational angiography data from 15 catheterisations on vascular structures were printed. Median print time was 3.83 hours, and material costs were $2.84. The CT scans of the printed models highly matched with the original digital models (root mean square for Hausdorff distance 0.013 ± 0.003 mesh units). Independent reviewers correctly described 80 and 87% of the models (p = 0.334) and reported high quality and accuracy (5 versus 5, p = NS; κ = 0.615).
Imaging data from rotational angiography can be converted into accurate three-dimensional-printed models of CHD. The cost of printing the models was negligible, but the print time was prohibitive for real-time use. As the speed of three-dimensional printing technology increases, novel future applications may allow for printing patient-specific devices based on rotational angiography datasets.
Understanding place-based contributors to health requires geographically and culturally diverse study populations, but sharing location data is a significant challenge to multisite studies. Here, we describe a standardized and reproducible method to perform geospatial analyses for multisite studies. Using census tract-level information, we created software for geocoding and geospatial data linkage that was distributed to a consortium of birth cohorts located throughout the USA. Individual sites performed geospatial linkages and returned tract-level information for 8810 children to a central site for analyses. Our generalizable approach demonstrates the feasibility of geospatial analyses across study sites to promote collaborative translational research.
Reward Deficiency Syndrome (RDS) is an umbrella term for all drug and nondrug addictive behaviors, due to a dopamine deficiency, “hypodopaminergia.” There is an opioid-overdose epidemic in the USA, which may result in or worsen RDS. A paradigm shift is needed to combat a system that is not working. This shift involves the recognition of dopamine homeostasis as the ultimate treatment of RDS via precision, genetically guided KB220 variants, called Precision Behavioral Management (PBM). Recognition of RDS as an endophenotype and an umbrella term in the future DSM 6, following the Research Domain Criteria (RDoC), would assist in shifting this paradigm.
The insect commensal microbiota consists of prokaryotes and eukaryotes. We explored the effect of diet and the persistence of the gut microbiota across generations in Drosophila suzukii (Matsumura) (Diptera: Drosophilidae). We transferred subsets of a single population of D. suzukii to different fruit-based diets (blueberry (Vaccinium Linnaeus; Ericaceae), raspberry (Rubus Linnaeus; Rosaceae), and strawberry (Fragaria × ananassa Duchesne; Rosaceae)) for three generations and then returned them to a common, banana-based, diet. We used 16S rDNA (Bacteria) and ITS (internal transcribed spacer; Fungi) sequencing of female endosymbiont-free flies to identify the microbiota. We identified 2700 bacterial and 350 fungal operational taxonomic units (OTUs); there was no correlation between the number of bacterial and fungal OTUs in a sample. Bacterial communities were dominated by Proteobacteria (especially Acetobacteraceae); Ascomycota dominated the fungal communities. Species diversity of both bacteria and fungi differed among diets, but there were no differences in species-level diversity when these D. suzukii were returned to a control diet. A principle coordinates analysis revealed no differences in the bacterial or fungal community in the first generation on fruit diets, but that the communities diverged over the next two generations; neither fungal and bacterial communities converged after one generation on control food. We conclude that diet changes the D. suzukii microbiota, and that these changes persist for more than one generation.
Many biological processes are partitioned among organs and tissues, necessitating tissue-specific or organ-specific analysis (particularly for comparative -omics studies). Standardised techniques for tissue identification and dissection are therefore imperative for comparing among studies. Here we describe dissection protocols for isolating six key tissues/organs from larvae of the Asian longhorned beetle, Anoplophora glabripennis (Motschulsky) (Coleoptera: Cerambycidae): the supraoesophageal ganglion, posterior midgut, hindgut, Malpighian tubules, fat body, and thoracic muscle. We also describe how to extract haemolymph and preserve whole larvae for measurements such as protein, lipid, and carbohydrate content. We include dissection protocols for both fresh-killed and previously frozen specimens. Although this protocol is developed for A. glabripennis, it should allow standardised tissue collection from larvae of other cerambycids and be readily transferrable to other beetle taxa with similar larval morphology.
Suicidal behavior is transmitted within families, above and beyond the transmission of psychiatric disorder. The familial phenotype of suicidal behavior includes suicide completion and attempts, but not suicidal ideation, the latter of which is transmitted along with depression. The familial transmission of early-onset suicidal behavior is co-transmitted with, and appears to be mediated by the transmission of impulsive aggression. Additionally, the familial transmission of suicidal behavior is, in part, mediated by the familial transmission of abuse. Moreover, high family loading for mood disorder and suicidal behavior are related to multi-generational abuse, impulsive aggression, and early-onset of mood disorder and of suicidal behavior.
The short allele of the serotonin transporter gene 5’ promoter region polymorphism (5-HTTLPR) is reported by A. Caspi and others to be associated with susceptibility to depression and suicidality in response to stressful life events. We examined the relationship of a triallelic 5-HTTLPR polymorphism to stressful life events (SLE) and severity of major depression and suicidality.
Mood disorder subjects (N=191) and healthy volunteers (N=125), all Caucasians of European origin, were genotyped for the triallelic 5-HTTLPR polymorphism, two low expressing alleles (LG, S) and a higher expressing LA allele. All subjects underwent structured clinical interviews for DSM IV diagnoses, ratings of psychopathology, stressful life events, developmental history and suicidal behavior. Cerebrospinal fluid (CSF) 5-HIAA was assayed in a sub-sample.
Lower expressing alleles independently predicted greater depression severity and predicted greater severity of major depression with moderate-severe life events compared with the LA allele. No associations with suicidal behavior and CSF 5-HIAA were found.
Low expression transporter alleles explain 31% of the variance in major depression severity and increase the impact of stressful life events on severity. The biological phenotype responsible for these effects remains to be elucidated
Dissipation of S-metolachlor, a soil-applied herbicide, on organic and mineral soils used for sugarcane production in Florida was evaluated using field studies in 2013 to 2016. S-metolachlor was applied PRE at 2,270 g ha−1 on organic and mineral soils with 75% and 1.6% organic matter, respectively. The rate of dissipation of S-metolachlor was rapid on mineral soils compared with organic soils. Dissipation of S-metolachlor on organic soils followed a negative linear trend resulting in half-lives (DT50) ranging from 50 to 126 d. S-metolachlor loss on organic soils was more rapid under high soil-moisture conditions than in corresponding low soil-moisture conditions. On mineral soils, dissipation of S-metolachlor followed an exponential decline. The DT50 of S-metolachlor on mineral soils ranged from 12 to 24 d. The short persistence of S-metolachlor on mineral soils was likely attributed to low organic matter content with limited adsorptive capability. The results indicate that organic matter content and soil moisture are important for persistence of S-metolachlor on organic and mineral soils used for sugarcane production in Florida.
Field studies were conducted on organic soils in Belle Glade, FL, in 2016 to 2017 to evaluate sugarcane tolerance and fall panicum control with topramezone applied alone or in combination with triazine herbicides (atrazine, metribuzin, ametryn). Treatments included topramezone (25 and 50 g ai ha−1) applied alone or in combination with atrazine (2,240 g ai ha−1), metribuzin (2,240 g ai ha−1), and ametryn (440 g ha−1) on four plant cane varieties to evaluate tolerance, and on second ratoon fields to determine efficacy on fall panicum control. Topramezone applied alone had no effect on sugarcane chlorophyll fluorescence (i.e., the ratio of variable fluorescence to maximum fluorescence), total chlorophyll, and carotenoid 7 to 28 d after treatment (DAT), suggesting sugarcane tolerance. Significant reduction of these parameters occured 7 to 14 DAT when topramezone (50 g ai ha−1) was applied with ametryn or metribuzin; however, reductions were not detected thereafter, indicating recovery. Sugarcane yield was not affected by topramezone applied alone or in combination with the triazine herbicides. Topramezone (50 g ai ha−1) plus metribuzin resulted in acceptable control of fall panicum (84%) with limited to no regrowth of meristematic tissue at sugarcane canopy closure, equivalent to 56 to 70 DAT. These results indicate that when sequential applications of topramezone, applied alone or in combination with these triazine herbicides, are required for efficacious weed control, topramezone applications alone can be made after 7 d, whereas the combinations can be made after 14 or 21 d, depending on sugarcane sensitivity.
In analysing matters as diverse as state financing, strategic planning, public benefactions and long-term credit in private business transactions, the historian is faced with an underlying problem about the perceptions of time. One aspect of this problem is the manner in which pictures of a complex future are reflected in the behaviour of agents engaged in these activities. The manner in which actions were (or were not) taken by them suggests a peculiar configuration of future time in the Roman world. It is speculatively argued that perspectives on the future had analogies with the different ways in which a sense of depth was created by artists working on a two-dimensional space and with the contextual ways in which spatial perspective was employed.
Stanford University's indirect cost rates for federally sponsored research dramatically increased from 58 percent in 1980 to 78 percent in 1991. Faculty frustration with increasing rates and scrutiny from a zealous government contracting officer culminated in a congressional inquiry into Stanford's indirect cost accounting practices in 1990 and 1991. The investigation revealed controversial luxury expenses charged to the government, including a yacht and antiques for the Stanford president's home, which attracted extensive public attention. Stanford president Donald Kennedy admitted some expenses were accounting errors but defended many expenses as permissible under government rules. Stanford's aggressive overhead recovery practices represent the institution's struggle to adapt to a changing economy for sponsored research in the twilight of the Cold War. The congressional response, which included a cap on administrative cost recovery for all universities, highlighted how shifting federal priorities—from defense research to deficit reduction—strained the relationship between the federal government and academic science.
Sugarcane growers in Florida have been reporting reduced control of fall panicum with asulam, the main herbicide used for POST grass control. Therefore, outside container experiments were conducted to determine the response of four fall panicum populations from Florida to asulam applied alone and to evaluate whether tank-mix combination with trifloxysulfuron enhances control. Asulam was applied at 230 to 7,400 g ai ha−1, corresponding to 1/16 to 2X the maximum labeled rate for a single application in sugarcane, with or without combination with trifloxysulfuron at 16 g ai ha−1. Three fall panicum populations were collected from fields in which reduced control had been reported, while one population was from a field not used for sugarcane production but adjacent to a sugarcane field. The potency of asulam based on ED50 values (the rate required to cause 50% dry weight reduction at 28 d after treatment) ranged from 2,249 to 5,412 g ha−1 for tolerant populations with reported reduced fall panicum control compared with 1,808 g ha−1 for the susceptible population from the field not used for sugarcane production, showing that the latter was most sensitive to asulam. Addition of trifloxysulfuron to asulam increased potency on fall panicum by 5- to 15-fold, indicating that the tank mix enhanced dry weight reduction for all populations. The probability of fall panicum survival (regrowth after aboveground biomass harvesting) at the labeled rate of asulam ranged from 2% to 47% compared with 0% to 6% when trifloxysulfuron was added to the tank mix. Our results show differential response of fall panicum populations in Florida to asulam, which can be overcome by tank mixing with trifloxysulfuron even for populations that are difficult to control in sugarcane, but no evolution of resistance to asulam.
Tropical signalgrass (TSG) is one of the most problematic weeds found on golf courses, sports fields, and sod farms in south Florida. The recent ban of monosodium methane-arsonate (MSMA), an organic arsenical herbicide, from urban areas in Florida has left turfgrass managers searching for effective management options. In an effort to avoid relying solely on POST chemical control, this research examined the effect of combining a cultural practice, verticutting, along with PRE and POST herbicides as an integrated weed management approach to controlling TSG in hybrid bermudagrass. Field experiments were conducted at multiple locations over 2 yr in south Florida to: (1) determine whether verticutting before herbicide applications increases TSG control and (2) identify herbicide programs that effectively control TSG. No interactions between verticutting and herbicide programs were detected, but verticutting consistently provided a slight reduction (8% averaged across herbicide treatments) in TSG cover. Treatments containing a PRE herbicide resulted in a significant reduction (20% to 50%) in TSG cover at 52 wk after initial treatment (WAIT), while some POST herbicide treatments reduced TSG cover to <20% at 52 WAIT. A study was conducted to determine which POST herbicide combinations were most efficacious in controlling TSG. Amicarbazone alone provided ≤35% TSG control at 8 and 12 WAIT, but synergistic responses were observed between amicarbazone and mesotrione, trifloxysulfuron, and thiencarbazone+foramsulfuron+halosulfuron. Two- and three-way combinations of amicarbazone with these POST herbicides resulted in >80% TSG control at 4, 8, and 12 WAIT, with some reaching 100% TSG control at 4 WAIT. Based on these data, verticutting may provide limited complementary control, but certain combinations of POST herbicides exhibited excellent (>95%) TSG control.
Law enforcement is increasingly viewed as a key component in the out-of-hospital chain of survival, with expanded roles in cardiac arrest, narcotic overdose, and traumatic bleeding. Little is known about the nature of care provided by law enforcement prior to the arrival of Emergency Medical Services (EMS) assets. The purpose of the current study was to perform a descriptive analysis of events reported to a national EMS database.
This study was a descriptive analysis of the 2014 National Emergency Medical Services Information System (NEMSIS) public release research data set, containing EMS emergency response data from 41 states. Code E09_02 1200 specifically identifies care provided by law enforcement prior to EMS arrival.
A total of 25,835,729 unique events were reported. Of events in which pre-arrival care was documented, 2.0% received prior aid by law enforcement. Patients receiving law enforcement care prior to EMS arrival were more likely to be younger (52.8 [SD=23.3] years versus 58.7 [SD=23.3] years), male (54.8% versus 46.7%), and white (80.3% versus 77.5%). Basic Life Support (BLS) EMS response was twice as likely in patients receiving prior aid by law enforcement. Multiple-casualty incidents were five times more likely with prior aid by law enforcement. Compared with prior aid by other services, law enforcement pre-arrival care was more likely with motor vehicle accidents, firearm assaults, knife assaults, blunt assaults, and drug overdoses, and less likely at falls and childbirths. Cardiac arrest was significantly more common in patients receiving prior aid by law enforcement (16.5% versus 2.6%). Tourniquet application and naloxone administration were more common in the law enforcement prior aid group.
Where noted, law enforcement pre-arrival care occurs in 2.0% of EMS patient encounters. The majority of cases involve cardiac arrest, motor vehicle accidents, and assaults. Better understanding of the nature of law enforcement care is required in order to identify potential barriers to care and to develop appropriate training and policy recommendations.
KlassenAB, CoreSB, LohseCM, SztajnkrycerMD. A Descriptive Analysis of Care Provided by Law Enforcement Prior to EMS Arrival in the United States. Prehosp Disaster Med. 2018;33(2):165–170.
In the Journal of Roman Studies of 2015, I argued that the evidence in Tacitus for a state-directed punishment of Christians in Rome in 64 ce was too weak to sustain the historical interpretation of it as a persecution. In a reply in this journal last year, Christopher Jones argued that knowledge of Christians under that name could well have reached Rome by the mid-60s, that the vulgus of the city could well have accused such persons, and that the Tacitean account is therefore generally credible. While admitting the justice of some of his criticisms, I attempt in this reply to clarify some of my arguments and to restate my original claim that a persecution of Christians by the emperor Nero in connection with the Great Fire of 64 seems improbable given the context of the relations between officials of the Roman state and Christians over the first century ce.
In this paper, we summarise and critique a network meta-analysis (NMA) of antidepressant efficacy and tolerability for paediatric depression and an accompanying editorial. Although we agree that many of the extant studies are flawed, this meta-analysis showed clear efficacy of fluoxetine in the NMA, and for sertraline and escitalopram in pairwise analyses. Consequently, these papers underestimate the benefits of antidepressants for paediatric depression, and provide support for current practice guideline, which recommends the use of an antidepressant if the patient does not respond to psychotherapy. In these circumstances, fluoxetine should be the first choice, with escitalopram and sertraline as alternatives.
Declaration of interest
D.A.B. receives royalties from Guilford Press, has or will receive royalties from the electronic self-rated version of the C-SSRS from eResearch Technology, Inc., is on the editorial board of UpToDate, and is a reviewer for Healthwise. R.D.G. serves as an expert witness for the US Department of Justice, Pfizer, Wyeth and GSK; and is the founder of Adaptive Testing Technologies. P.W. receives personal fees from Lundbeck and Takeda. B.D. reports a licensing agreement with Lundbeck for a psychosocial treatment manual for depression. No other disclosures were reported.