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Post-procedural antimicrobial prophylaxis is not recommended by professional guidelines but is commonly prescribed. We sought to reduce use of post-procedural antimicrobials after common endoscopic urologic procedures.
Design:
A before-after, quasi-experimental trial with a baseline (July 2020–June 2022), an implementation (July 2022), and an intervention period (August 2022–July 2023).
Setting:
Three participating medical centers.
Intervention:
We assessed the effect of a bundled intervention on excess post-procedural antimicrobial use (ie, antimicrobial use on post-procedural day 1) after three types of endoscopic urologic procedures: ureteroscopy and transurethral resection of bladder tumor or prostate. The intervention consisted of education, local champion(s), and audit-and-feedback of data on the frequency of post-procedural antimicrobial-prescribing.
Results:
1,272 procedures were performed across all 3 sites at baseline compared to 525 during the intervention period; 644 (50.6%) patients received excess post-procedural antimicrobials during the baseline period compared to 216 (41.1%) during the intervention period. There was no change in the use of post-procedural antimicrobials at sites 1 and 2 between the baseline and intervention periods. At site 3, the odds of prescribing a post-procedural antimicrobial significantly decreased during the intervention period relative to the baseline time trend (0.09; 95% CI 0.02–0.45). There was no significant increase in post-procedural unplanned visits at any of the sites.
Conclusions:
Implementation of a bundled intervention was associated with reduced post-procedural antimicrobial use at one of three sites, with no increase in complications. These findings demonstrate both the safety and challenge of guideline implementation for optimal perioperative antimicrobial prophylaxis.
This trial was registered on clinicaltrials.gov, NCT04196777.
The low-frequency modal and non-modal linear dynamics of an incompressible, pressure-gradient-induced turbulent separation bubble (TSB) are investigated, with the objective of studying the mechanism responsible for the low-frequency contraction and expansion (breathing) commonly observed in experimental studies. The configuration of interest is a TSB generated on a flat test surface by a succession of adverse and favourable pressure gradients. The base flow selected for the analysis is the average TSB from the direct numerical simulation of Coleman et al. (J. Fluid Mech., vol. 847, 2018, pp. 28–70). Global mode analysis reveals that the eigenmodes of the linear operator are damped for all frequencies and wavenumbers. Furthermore, the least damped eigenmode appears to occur at zero frequency and low, non-zero spanwise wavenumber when scaled with the separation length. Resolvent analysis is then employed to examine the forced dynamics of the flow. At low frequency, a region of low, non-zero spanwise wavenumber is also discernible, where the receptivity appears to be driven by the identified weakly damped global mode. The corresponding optimal energy gain is shown to have the shape of a first-order, low-pass filter with a cut-off frequency consistent with the low-frequency unsteadiness in TSBs. The results from resolvent analysis are compared to the unsteady experimental database of Le Floc'h et al. (J. Fluid Mech., vol. 902, 2020, A13) in a similar TSB flow. The alignment between the optimal response and the first spectral proper orthogonal decomposition mode computed from the experiments is shown to be close to $95\,\%$, while the spanwise wavenumber of the optimal response is consistent with that of the low-frequency breathing motion captured experimentally. This indicates that the fluctuations observed experimentally at low frequency closely match the response computed from resolvent analysis. Based on these results, we propose that the forced dynamics of the flow, driven by the weakly damped global mode, serve as a plausible mechanism for the origin of the low-frequency breathing motion commonly observed in experimental studies of TSBs.
Protein complexes of smectites in soils are difficult to detect if the usual smectite tests show no peculiarities. Andalusian black earths are typical examples. Investigation of the alkylam-monium derivatives, however, allows detection of adhered macromolecules which might be protein-like although this cannot be proved exactly.
Investigation of artificial clay-protein complexes reveals different types of clay protein interactions. Calcium smectites adsorb proteins mainly on the external surfaces, the macromolecules being anchored in the interlayer spaces. Sodium smectites give partial crystalline products in which the silicate layers are distributed in the protein matrix.
Exchange of alkylammonium ions can be used as a tool for detection of the protein. If this is adsorbed on external surfaces (calcium smectites) the increased layer separation during the cation exchange enables the macromolecules to slip between the layers and the basal spacing of the alkylammonium derivatives are changed in characteristic ways. The partial crystalline sodium clay-protein complexes are reorganized by alkylammonium ions to regular structures. The proteins are not displaced completely from the silicate surfaces so that the basal spacing of the alkylammonium derivatives are enhanced in comparison with pure montmorillonite.
The administration of Pre-Mortem Interventions (PMIs) to preserve the opportunity to donate, to assess the eligibility to donate, or to optimize the outcomes of donation and transplantation are controversial as they offer no direct medical benefit and include at least the possibility of harm to the still-living patient. In this article, we describe the legal analysis surrounding consent to PMIs, drawing on existing legal commentary and identifying key legal problems. We provide an overview of the approaches in several jurisdictions that have chosen to explicitly address PMIs within codified law. We then provide, as an example, a detailed exploration of how PMIs are likely to be addressed in one jurisdiction where general medical consent law applies because there is no specific legislation addressing PMIs — the province of Ontario in Canada.
The structure of montmorillonite intercalated with [Al13O4(OH)24+x(H2O)12−x](7−x)+ cations ( for short), where x = 0, 2 and 4, has been studied using the Cerius2 modeling environment. The Crystal Packer module used in the present study takes into account only the nonbonded interactions between the silicate layer and the Keggin cations. Minimization of the total sublimation energy led to the following conclusions: the structure of the interlayer (that is, the orientation of Keggin cations and the basal spacing) depends on the charge of cations (that is, on the degree of hydrolysis, x). The values of basal spacings in the range 19.38–20.27 Å have been obtained, depending on the charge and arrangement of cations in the interlayer. The dominating contribution to the total sublimation energy comes from the electrostatic interactions. Translations of cations along the 2:1 layers give only small fluctuations of the total sublimation energy and basal spacings. No preference for the position of cations in the interlayer of montmorillonite was found during translation along the 2:1 layers. This result confirmed the inhomogeneous distribution of cations in the interlayer and turbostratic stacking of layers.
The Crystal Packer module in the Cerius2 modeling environment has been used to study the structure of montmorillonite intercalated with Al(OH)3-fragment (gibbsite-like) polymers. Basal spacings in gibbsite-like polymers arranged in 2 layers in the interlayer of montmorillonite varied in the range 19.54–20.13 Å, depending on the type and arrangement of Al(OH)3 fragments. The inhomogeneous distribution of intercalating species in the interlayer and, consequently, the turbostratic stacking of layers has been found for gibbsite-like polymers as well as in the case of Keggin cations (Čapková et al. 1998). The dominating contribution to the total sublimation energy comes from electrostatic interactions for both intercalating species, gibbsite-like polymers and Keggin cations.
Languages vary in the mapping of relational terms onto events. For instance, English motion descriptions favor manner (how something moves) verbs over path (where something move) verbs, whereas those of other languages, like Spanish, show the opposite pattern. While these lexicalization biases are malleable, adopting a novel lexicalization pattern can be slow for second language learners. One potential mechanism for learning non-native verb mappings is cross-situational statistical learning (CSSL). However, the application of CSSL to verbs is limited and does not explicitly examine how lexicalization biases may complicate adults’ ability to resolve the referential uncertainty of multiple referents. We ask English-speaking monolingual adults to learn the mappings of ten verbs via CSSL. Verbs mapped onto either manner or path of motion, with the other event component held constant. Adults in both conditions demonstrated successful learning of novel verbs, with adults learning the manner verbs showing more consistent performance across accepting correct referents and rejecting incorrect ones. Our results are the first to demonstrate adults’ use of CSSL to acquire verb meanings that both align with and cut against native lexicalization biases and suggest a limited influence of lexicalization biases on adults’ learning in idealized CSSL conditions.
We evaluated a digital learning programme for non-specialists to develop knowledge-based competencies in a problem-solving intervention for adolescents to examine the overall impact of training on knowledge-based competencies among learners; and to compare the effects of two training conditions (self-guided digital training with or without coaching) in a nested parallel, two-arm, individually randomised controlled trial. Eligible participants were 18 or older; fluent in Hindi or English; able to access digital training; and had no prior experience of delivering structured psychotherapies. 277 participants were enrolled from 31 March 2022 to 19 June 2022 of which 230 (83%) completed the study. There was a significant increase in competency score from pre-training (Mean = 7.01, SD = 3.29) to post-training (Mean = 8.88, SD = 3.80), 6 weeks after the pre-training assessment. Knowledge competency scores showed larger increase among participants randomised to the coaching arm (AMD = 1.09, 95% CI 0.26–1.92, p = 0.01) with an effect size (d) of 0.33 (95% CI 0.08–0.58). More participants completed training in the coaching arm (n = 96, 69.6%) compared to the self-guided training arm (n = 56, 40.3%). In conclusion, a coach-supported remote digital training intervention is associated with enhanced participation by learners and increased psychotherapeutic knowledge competencies.
The view advanced by Madole & Harden falls back on the dogma of a gene as a DNA sequence that codes for a fixed product with an invariant function regardless of temporal and spatial contexts. This outdated perspective entrenches the metaphor of genes as static units of information and glosses over developmental complexities.
Madole & Harden argue that the Mendelian reshuffling of genes and genomes is analogous to randomised controlled trials. We are not convinced by their arguments. First, their recipe for meeting the demands on randomised experiments is inherently inconsistent. Second, disequilibrium across chromosomes conflicts with their assumption of statistical independence. Third, the genome-wide association study (GWAS) method has many pitfalls, including low repeatability.
The COVID-19 outbreak is a serious global public health issue with wide-ranging negative effects on people’s lives, which is reflected in steadily rising mental health problems. In order to appropriately respond to the increased occurrence of psychiatric illness, protect mental health and strengthen resilience it is necessary to include new technologies, such as extended reality (XR) or socially assistive robots (SAR) in not only psychiatric treatment but also in the prevention of psychiatric diseases. In this context, the use of new technologies offers innovative ways to strengthen resilience, self-efficacy and stress coping skills and plays an important role in improving psychological wellbeing.
Objectives
Preliminary results from studies at the Clinical Department of Psychiatry and Psychotherapeutic Medicine in Graz, Austria, dealing with new technologies in psychiatry, show new options for psychiatric settings.
Methods
Project AMIGA: The aim of this study is to test the effectiveness of a cognitive training session, conducted with the SAR named Pepper. In this randomized controlled trial, the effectiveness of SAR on depressive symptoms and correlates is evaluated in a sample of 60 individuals with major depression. While the intervention group will receive cognitive training with the SAR Pepper, the control group will receive “treatment-as-usual” therapy with a common PC software. Participants will receive 30 minutes of training 2 times per week over a period of 3 weeks.
Project XRes4HEALTH: The aim of this study is to develop an XR resilience training to increase resilience and stress coping mechanisms in healthcare workers. A total of 40 people will be included. To test the effectiveness of the resilience training, 3 XR training sessions of 15 minutes each will be held. A pre-post measurement will test the effectiveness of the training on wellbeing and stress levels as well as the acceptance and satisfaction with the training.
Project AI-REFIT: The overall goal of this study is to explore key information to increase resilience in healthy individuals who are at increased risk for mental health problems. Through a usability study, the artificial intelligence-based prototype app of the resilience training will be tested for acceptance, usability, functionality, and efficiency. During the resilience training, participants are wearing a smartwatch which measures psychophysiological parameters. Conclusions about the success of the therapy can be drawn based on digital data acquisition.
Results
New technologies including XR and SAR support classical psychiatric treatment in the topics of resilience and cognitive training as an add-on therapy in times of reduced availability of healthcare workers.
Conclusions
The rapid development of new technologies holds a lot of potential in the treatment of psychiatric disorders, which is why it is important to scientifically evaluate those innovative tools.
Psilocybin Therapy (PT) is being increasingly studied as a psychiatric intervention. Personality relates to mental health and can be used to probe the nature of PT's therapeutic action.
Methods
In a phase 2, double-blind, randomized, active comparator controlled trial involving patients with moderate-to-severe major depressive disorder, we compared psilocybin with escitalopram, over a core 6-week trial period. Five-Factor model personality domains, Big Five Aspect Scale Openness aspects, Absorption, and Impulsivity were measured at Baseline, Week 6, and Month 6 follow-up.
Results
PT was associated with decreases in neuroticism (B = −0.63), introversion (B = −0.38), disagreeableness (B = −0.47), impulsivity (B = −0.40), and increases in absorption (B = 0.32), conscientiousness (B = 0.30), and openness (B = 0.23) at week 6, with neuroticism (B = −0.47) and disagreeableness (B = −0.41) remaining decreased at month 6. Escitalopram Treatment (ET) was associated with decreases in neuroticism (B = −0.38), disagreeableness (B = −0.26), impulsivity (B = −0.35), and increases in openness (B = 0.28) at week 6, with neuroticism (B = −0.46) remaining decreased at month 6. No significant between-condition differences were observed.
Conclusions
Personality changes across both conditions were in a direction consistent with improved mental health. With the possible exception of trait absorption, there were no compelling between-condition differences warranting conclusions regarding a selective action of PT (v. ET) on personality; however, post-ET changes in personality were significantly moderated by pre-trial positive expectancy for escitalopram, whereas expectancy did not moderate response to PT.
Using a cognitive task (mental calculation) and a perceptual-motor task (stylized golf putting), we examined differential proficiency using the CWS index and several other quantitative measures of performance. The CWS index (Weiss & Shanteau, 2003) is a coherence criterion that looks only at internal properties of the data without incorporating an external standard. In Experiment 1, college students (n = 20) carried out 2- and 3-digit addition and multiplication problems under time pressure. In Experiment 2, experienced golfers (n = 12), also college students, putted toward a target from nine different locations. Within each experiment, we analyzed the same responses using different methods. For the arithmetic tasks, accuracy information (mean absolute deviation from the correct answer, MAD) using a coherence criterion was available; for golf, accuracy information using a correspondence criterion (mean deviation from the target, also MAD) was available. We ranked the performances of the participants according to each measure, then compared the orders using Spearman’s rs. For mental calculation, the CWS order correlated moderately (rs =.46) with that of MAD. However, a different coherence criterion, degree of model fit, did not correlate with either CWS or accuracy. For putting, the ranking generated by CWS correlated .68 with that generated by MAD. Consensual answers were also available for both experiments, and the rankings they generated correlated highly with those of MAD. The coherence vs. correspondence distinction did not map well onto criteria for performance evaluation.
Electrical injury (EI) is a significant, multifaceted trauma often with multi-domain cognitive sequelae, even when the expected current path does not pass through the brain. Chronic pain (CP) research suggests pain may affect cognition directly and indirectly by influencing emotional distress which then impacts cognitive functioning. As chronic pain may be critical to understanding EI-related cognitive difficulties, the aims of the current study were: examine the direct and indirect effects of pain on cognition following EI and compare the relationship between pain and cognition in EI and CP populations.
Method:
This cross-sectional study used data from a clinical sample of 50 patients with EI (84.0% male; Mage = 43.7 years) administered standardized measures of pain (Pain Patient Profile), depression, and neurocognitive functioning. A CP comparison sample of 93 patients was also included.
Results:
Higher pain levels were associated with poorer attention/processing speed and executive functioning performance among patients with EI. Depression was significantly correlated with pain and mediated the relationship between pain and attention/processing speed in patients with EI. When comparing the patients with EI and CP, the relationship between pain and cognition was similar for both clinical groups.
Conclusions:
Findings indicate that pain impacts mood and cognition in patients with EI, and the influence of pain and its effect on cognition should be considered in the assessment and treatment of patients who have experienced an electrical injury.
Background: Ancillary tests are indicated to diagnose death by neurological criteria whenever clinical neurological examination is unreliable, but their use is variable and subject to debate. Methods: Survey of Canadian intensivists providing care for potential organ donors. We included closed-ended questions and different clinical scenarios regarding the use of ancillary tests. Results: Among 550 identified intensivists, 249 completed the survey. Respondents indicated they would be comfortable diagnosing death based on neurological examination without ancillary tests in the following scenarios: movement in response to stimulation (48%), spontaneous peripheral movement (31%), inability to evaluate upper/lower extremity responses (34%) or both oculocephalic and oculo-caloric reflexes (17%), presence of high cervical spinal cord injury (16%) and within 24 hours of hypoxemic-ischemic brain injury (15%). Furthermore, 93% agreed that ancillary tests should always be conducted when a complete neurological examination is impossible, 89% if there remains possibility of residual sedative effect and 59% in suspected isolated brainstem death. Conclusions: Our findings suggest that Canadian intensivists have different perceptions on what constitutes a complete and reliable clinical neurological examination for determining death by neurologic criteria. Some self-reported practices also diverge from national recommendations. Further investigation and education are required to align and standardize medical practice across physicians and systems.
Substance use disorders are highly prevalent, affecting millions of Americans directly (social, occupational, and health problems) and indirectly (billions of dollars in health care costs and lost revenues due to disability). This section briefly introduces the chemical classification and neurobehavioral properties of the most commonly misused substances.
Introduction. Individuals with psychotic-spectrum disorders may smoke due to the ameliorating effect of nicotine on the cognitive deficits that accompany these illnesses. Metacognitive remediation therapy (MCR) has been shown to produce improvements in cognitive functioning among individuals with psychotic-spectrum disorders and provides a foundation for a novel smoking cessation intervention for this population. Aims. To complete an open investigation of pharmacotherapy and a modified version of MCR [MCR to Quit (MCR-Q)] in promoting smoking cessation among individuals with psychotic-spectrum disorders. Methods. Forty-nine individuals with a psychotic-spectrum disorder and who currently smoke cigarettes participated in MCR-Q while also receiving evidence-based smoking cessation pharmacotherapy. Tobacco use was assessed as follows: (i) prior to MCR-Q, (ii) immediately after completing MCR-Q, and (iii) six weeks after completion of MCR-Q. Results/Findings. During participation in MCR-Q, nearly 80% of participants made a 24-hour quit attempt. Following the completion of MCR-Q, participants experienced reductions in level of nicotine dependency and exhaled carbon monoxide, with reductions in nicotine dependency sustained six weeks after completion of MCR-Q. Over the course of their participation in MCR-Q, participants reported strong therapeutic alliance with their MCR-Q therapist and high levels of intrinsic motivation with regard to completing MCR-Q exercises. Conclusions. The results from the current study suggest cautious optimism with regard to the use of MCR-Q in combination with medication for individuals with psychotic-spectrum disorders who want to quit smoking.
Nothwithstanding the successes of the trait approach to personality in the last century-plus – one of psychology’s major achievements – problems persist. Although we are closer to solving these problems, issues remain about how psychologists know whether traits – and any given model of traits – are the right way to construe human personality, and their nature is still largely mysterious. These questions concern whether we have summary or causal views of traits (Allport, 1937), and whether we have identified surface or source traits (Cattell, 1945).
Untreated disrupted sleep is an important precursor for the development of depression. Several studies have confirmed the negative impact of pre-sleep cognitive and emotional activity such as worry and negative affect on subsequent sleep. Emotional stress may affect latencies to sleep onset, to REM-sleep and other markers of sleep disruption such as arousals. The way we cope with emotional stressors and events may have important effects on subsequent sleep.
Methods
In this study we investigated the effects of a failure-experience on polysomnographically recorded sleep in volunteers. Furthermore we explored whether dispositional coping factors such as emotion regulation moderate this effect.
Results
In contrast to the control condition the effect of the failure induction was clearly observed in emotional experience as well as within the physiological sleep architecture. Furthermore, we notice a tendency in which not only emotional experience, but also sleep physiology was affected by low and high emotional approach as emotion regulation style (cf. Stanton, 2000).
Conclusions
The present study has shown that emotional stress as a failure experience before sleep-goes together with a worsening of mood, an increase of level of rumination and enhanced sleep fragmentation with a moderating effect of emotion regulation as dispositional factor.