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COVID 19 has led to dramatic changes in the lives of people leading to an increase in stress and anxiety. Music intervention is a non-medicated method for relieving anxiety. This current study aims to understand whether music can be effectively used to alleviate anxiety in admitted COVID-19 patients.
To study the effect of music on anxiety in patients admitted for COVID-19 in a tertiary care hospital in New Delhi
34 patients (17 females &17 males) were randomly divided into two groups, a control (N=17) and a music group (N=17). Vitals of all the patients were noted. Patients of the music group were asked to listen to relaxing instrumental for 30 minutes, while patients of the control group were asked to relax for 30 minutes. Vitals of all the patients were noted again. Patients were asked to fill State Trait Anxiety Inventory (STAI) before and after intervention.
The post-intervention mean scores of STAI after the music session were lower in the music group than the control group [95.06 (SD 8.5)) versus 102.37 (SD 10.3)]. The differences in mean values of pre- to post-intervention changes between both groups after music session were statistically significant.
Our findings suggest that listening to music lowers anxiety. As music is non- invasive and free of side-effects we recommend that music intervention service should be used to improve health care quality.
Mood disorders are common psychiatric illnesses with major disability and mortality and it is estimated that 8% to 20% of the population experience a depressive episode at some point in their lives.
To find out the prevalence of cognitive impairment among patients with Mood Disorders i.e, Major Depressive Disorder
(MDD) and Bipolar Mood Disorder (BMD), etc. and to find out the status of cognitive impairment with clinical variables of Mood Disorders.
This was a descriptive cross-sectional study conducted among the patients attending both the inpatient and outpatient departments of the National Institute of Mental Health, Dhaka. The duration of the study was fourteen months starting from July 2011 to September 2012. A total of one hundred and thirty-three (n=133) patients who fulfilled the inclusion-exclusion criteria were selected.
The mean age of onset of mood disorder was 30.1± 10.7years.60.2% were male and 39.8% were female respondents. Cognitive impairment was found among 43.6% of the respondents. A substantial proportion of the study population was found to have cognitive impairment. In this study, the cognitive status of the respondents was not associated with the duration of illness (p>0.5).
So assessment of cognitive status should be an essential part of the management of this group of people.
We will present experience developing a system for monitoring training placements in psychiatry and community paediatrics, and how this was expanded to provide an automated anonymised MSF for trainers for annual appraisal and will identify trainers in need of additional support and other post/training programme issues. The session will be of interest to educators and medical education leads with practical tips and lessons learnt over the last 8 years since the system was first developed.
The system was also used to identify trainers in need of additional support and other post/training programme issues.
We used an electronic system to gain the infromation as stated in the introduction.
Over the last 8 years we have collected data using this system. the results for our trust will be displayed annoymously but the system is the ficus of this presenation.
The advantages of the system are that it runs throughout the year (so covers each post and placement), has high trainee response rates, has no selection bias (compared with some other MSF systems) and the results are embedded within local quality systems and individual consultant appraisals. The data that the system collects can help provide robust evidence when investigating concerns that might only arise periodically (for example through the annual GMC trainee survey in the UK). We believe that this system will be applicable for doctors providing training in other countries and empowers the improvement of psychiatric training for the profession.
The little-known Bristled Grassbird Chaetornis striata is thought to be declining due to the loss of grassland habitats throughout its range, and is currently classified as globally ‘Vulnerable’. In order to investigate the current status and possible causes of the presumed decline, we assessed population density of Bristled Grassbird in Padma and Jamuna river systems of Bangladesh. The study was conducted during the breeding seasons of the Bristled Grassbird in April and May in 2016–2019, using distance sampling and habitat suitability modelling. We also examined habitat preferences and responses to environmental changes based on vegetation structure and habitat modifications at point count locations. We detected a total of 39 birds with a mean group size of 1.44 individuals. We estimated 4.52 (95% CI: 2.65–7.73) individuals per km2 with an encounter rate of 1.48 detections per point count station and 341.15 birds within the study area. Our habitat suitability model projected a total of 167.41 km2 of suitable habitat and a total of 756.7 birds in floodplain grasslands of Padma and Jamuna river systems. The Bristled Grassbird was positively associated with grass height and grass density with 92.31% of 39 detections at Saccharum spontaneum dominated grasslands. We did not find a significant effect on Bristled Grassbird detections with increasing human activities, although the detection rate decreased linearly with increasing agricultural intervention and grass harvesting. These findings indicate that the Bristled Grassbird is more widely distributed throughout Bangladesh, and may be less vulnerable to grassland modifications, than previously thought.
Antimicrobial resistance (AMR) is a global priority with significant clinical and economic consequences. Multidrug-resistant (MDR) Pseudomonas aeruginosa is one of the major pathogens associated with significant morbidity and mortality. In healthcare settings, the evaluation of prevalence, microbiological characteristics, as well as mechanisms of resistance is of paramount importance to overcome associated challenges.
Consecutive clinical specimens of P. aeruginosa were collected prospectively from 5 acute-care and specialized hospitals between October 2014 and September 2017, including microbiological, clinical characteristics and outcomes. Identification and antimicrobial susceptibility test were performed using the BD Phoenix identification and susceptibility testing system, matrix-assisted laser desorption ionization–time-of-flight mass spectrometry (MALDI-TOF MS), and minimum inhibitory concentration (MIC) test strips. Overall, 78 selected MDR P. aeruginosa isolates were processed for whole-genome sequencing (WGS).
The overall prevalence of MDR P. aeruginosa isolates was 5.9% (525 of 8,892) and showed a decreasing trend; 95% of cases were hospital acquired and 44.8% were from respiratory samples. MDR P. aeruginosa demonstrated >86% resistance to cefepime, ciprofloxacin, meropenem, and piperacillin-tazobactam but 97.5% susceptibility to colistin. WGS revealed 29 different sequence types: 20.5% ST235, 10.3% ST357, 7.7% ST389, and 7.7% ST1284. ST233 was associated with bloodstream infections and increased 30-day mortality. All ST389 isolates were obtained from patients with cystic fibrosis. Encoded exotoxin genes were detected in 96.2% of isolates.
MDR P. aeruginosa isolated from clinical specimens from Qatar has significant resistance to most agents, with a decreasing trend that should be explored further. Genomic analysis revealed the dominance of 5 main clonal clusters associated with mortality and bloodstream infections. Microbiological and genomic monitoring of MDR P. aeruginosa has enhanced our understanding of AMR in Qatar.
Research has shown that 20–30% of prisoners meet the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD). Methylphenidate reduces ADHD symptoms, but effects in prisoners are uncertain because of comorbid mental health and substance use disorders.
To estimate the efficacy of an osmotic-release oral system methylphenidate (OROS-methylphenidate) in reducing ADHD symptoms in young adult prisoners with ADHD.
We conducted an 8-week parallel-arm, double-blind, randomised placebo-controlled trial of OROS-methylphenidate versus placebo in male prisoners (aged 16–25 years) meeting the DSM-5 criteria for ADHD. Primary outcome was ADHD symptoms at 8 weeks, using the investigator-rated Connors Adult ADHD Rating Scale (CAARS-O). Thirteen secondary outcomes were measured, including emotional dysregulation, mind wandering, violent attitudes, mental health symptoms, and prison officer and educational staff ratings of behaviour and aggression.
In the OROS-methylphenidate arm, mean CAARS-O score at 8 weeks was estimated to be reduced by 0.57 points relative to the placebo arm (95% CI −2.41 to 3.56), and non-significant. The responder rate, defined as a 20% reduction in CAARS-O score, was 48.3% for the OROS-methylphenidate arm and 47.9% for the placebo arm. No statistically significant trial arm differences were detected for any of the secondary outcomes. Mean final titrated dose was 53.8 mg in the OROS-methylphenidate arm.
ADHD symptoms did not respond to OROS-methylphenidate in young adult prisoners. The findings do not support routine treatment with OROS-methylphenidate in this population. Further research is needed to evaluate effects of higher average dosing and adherence to treatment, multi-modal treatments and preventative interventions in the community.
Background: Chordomas are rare malignant skull-base/spine cancers with devastating neurological morbidities and mortality. Unfortunately, no reliable prognostic factors exist to guide treatment decisions. This work identifies DNA methylation-based prognostic chordoma subtypes that are detectable non-invasively in plasma. Methods: Sixty-eight tissue samples underwent DNA methylation profiling and plasma methylomes were obtained for available paired samples. Immunohistochemical staining and publicly available methylation and gene expression data were utilized for validation. Results: Unsupervised clustering identified two prognostic tissue clusters (log-rank p=0.0062) predicting disease-specific survival independent of clinical factors (Multivariable Cox: HR=16.5, 95%CI: 2.8-96, p=0.0018). The poorer-performing cluster showed immune-related pathway promoter hypermethylation and higher immune cell abundance within tumours, which was validated with external RNA-seq data and immunohistochemical staining. The better-performing cluster showed higher tumour cellularity. Similar clusters were seen in external DNA methylation data. Plasma methylome-based models distinguished chordomas from differential diagnoses in independent testing sets (AUROC=0.84, 95%CI: 0.52-1.00). Plasma methylomes were highly correlated with tissue-based signals for both clusters (r=0.69 & 0.67) and leave-one-out models identified the correct cluster in all plasma cases. Conclusions: Prognostic molecular chordoma subgroups are for the first time identified, characterized, and validated. Plasma methylomes can detect and subtype chordomas which may transform chordoma treatment with personalized approaches tailored to prognosis.
In addition to risking their physical well-being, frontline physicians are enduring significant emotional burden both at work and home during the coronavirus disease 2019 (COVID-19) pandemic. This study aims to investigate the levels of anxiety and depressive symptoms and to identify associated factors among Bangladeshi physicians during the COVID-19 outbreak.
Methods and design
A cross-sectional study using an online survey following a convenience sampling technique was conducted between April 21 and May 10, 2020. Outcomes assessed included demographic questions, COVID-19 related questions, and the Hospital Anxiety and Depression Scale (HADS).
The survey was completed by 412 Bangladeshi physicians. The findings revealed that, in terms of standardized HADS cut-off points, the prevalence of anxiety and depressive symptoms among physicians was 67.72% and 48.5% respectively. Risk factors for higher rates of anxiety or depressive symptoms were: being female, physicians who had experienced COVID-19 like symptoms during the pandemic, those who had not received incentives, those who used self-funded personal protective equipment (PPE), not received adequate training, lacking perceived self-efficacy to manage COVID-19 positive patients, greater perceived stress of being infected, fear of getting assaulted/humiliated, being more connected with social media, having lower income levels to support the family, feeling more agitated, less than 2 h of leisure activity per day and short sleep duration. All these factors were found to be positively associated with anxiety and depression in unadjusted and adjusted statistical models.
This study identifies a real concern about the prevalence of anxiety and depressive symptoms among Bangladeshi physicians and identifies several associated factors during the COVID-19 pandemic. Given the vulnerability of the physicians in this extraordinary period whilst they are putting their own lives at risk to help people infected by COVID-19, health authorities should address the psychological needs of medical staff and formulate effective strategies to support vital frontline health workers.
Background: Taking antibiotics outside the guidance of a clinician (nonprescription use) is a potential safety issue and runs counter to antibiotic stewardship efforts. We identified the symptoms and illnesses and situations that may predispose patients to take antibiotics, and we compared these findings between patients attending public primary care clinics and private emergency departments. Methods: A cross-sectional survey was conducted between January 2020 and March 2021 in 6 primary care clinics and 2 emergency departments in the United States. We queried patients about 5 symptoms and illnesses (Fig. 1) and 14 situations (Fig. 2) to investigate whether these would lead the patients to take antibiotics without a prescription. We used the χ2 test to compare the symptoms and illnesses and situations between the respondents from public and private healthcare systems. We set the P value for significance at <.025. Results: In total, the survey had 564 respondents (median age, 49.7 years; range, 19–92), and 72% were female. Most respondents identified as either Hispanic or Latina/Latino (46.6%) or African American or Black (33%), followed by White (15.8%), and other (4.6%). Most respondents had visited public clinics (72%). The most common insurance status for our respondents included Medicaid or county financial assistance program (56.6%), followed by private insurance or Medicare (36.7%) and self-pay (6.7%). In public primary care clinics, only 23% had private insurance or Medicare compared to 72.9% in private emergency departments. Of those surveyed, 69% agreed that antibiotics would improve the recovery from sinus infections, followed by bronchitis (64%), sore throat (64%), cold/flu (61.4%), and diarrhea (31.5%). The proportions of respondents who believed that antibiotics would improve the recovery from diarrhea (36.2% vs 19.4%; P = .004) and sore throat (59.9% vs 48.4%; P < .001) were significantly higher among public versus private outpatient respondents. We did not find significant differences for cold/flu, sinus infection, or bronchitis between these 2 healthcare systems (Fig. 1). In 11 of the 14 situations, patients in public clinics were more likely to report a likelihood of using nonprescription antibiotics than the patients visiting the private emergency rooms (Fig. 2). Conclusions: Future stewardship interventions should be aware of the symptoms and illnesses and situations that may influence outpatients to take nonprescription antibiotics. Addressing modifiable factors (eg, leftover antibiotics, antibiotics given by friends or family, and antibiotics available without a prescription in stores or markets) may also curtail these unsafe practices and reduce antibiotic resistance.
We show that there exists a continuous function from the unit Lebesgue interval to itself such that for any
$\epsilon \geq 0$
and any natural number k, any point in its domain has an
-neighbourhood which, when feasible, contains k mutually disjoint extremally scrambled sets of identical Lebesgue measure, homeomorphic to each other. This result enables a satisfying generalisation of Li–Yorke (topological) chaos and suggests an open (difficult) problem as to whether the result is valid for piecewise linear functions.
Few studies have utilized person-centered approaches to examine co-occurrence of risk factors among pregnant women in low-and middle-income settings. The objective of this study was to utilize latent class analysis (LCA) to identify sociodemographic patterns and assess the association of these patterns on preterm birth (PTB) and/or low birth weight (LBW) in rural Mysore District, India. Secondary data analysis of a prospective cohort study among 1540 pregnant women was conducted. Latent class analysis was performed to identify distinct group memberships based on a chosen set of sociodemographic factors. Binary logistic regression was conducted to estimate the association between latent classes and preterm birth and low birth weight. LCA yielded four latent classes. Women belonging to Class 1 “low socioeconomic status (SES)/early marriage/multigravida/1 child or more”, had higher odds of preterm birth (adjusted Odds Ratio (aOR): 95% Confidence Intervals (CI): 1.77, 95% CI: 1.05-2.97) compared to women in Class 4 “high SES/later marriage/primigravida/no children”. Women in Class 2 “low SES/later marriage/primigravida/no children” had higher odds of low birth weight (aOR: 2.52, 95% CI: 1.51-4.22) compared to women in Class 4. Women less than 20 years old were twice as likely to have PTB compared to women aged 25 years and older (aOR: 2.00, 95% CI: 1.08-3.71). Hypertension (>140/>90 mm/Hg) was a significant determinant of PTB (aOR: 2.28, 95% CI: 1.02-5.07). Furthermore, women with a previous LBW infant had higher odds of delivering a subsequent LBW infant (aOR: 2.15, 95% CI: 1.40-3.29). Overall study findings highlighted that woman belonging to low socioeconomic status, and multigravida women had increased odds of preterm birth and low birth weight infants. Targeted government programs are crucial in reducing inequalities in preterm births and low birth weight infants in rural Mysore, India.
Propagation characteristics (propagation regions and cutoffs) of parallel propagating modes (Langmuir, right- and left-handed circularly polarized waves) are studied for relativistic, weakly relativistic and non-relativistic magnetized electron plasma using the kinetic model. The dispersion relation for parallel propagating modes in relativistic electron plasma is investigated by employing the Maxwell–Boltzmann–J üttner distribution function and the final dispersion relation obtained is more general since no approximation is used. As the integrals in the relativistic dispersion relation cannot be done analytically so these integrals have been solved with the numerical quadrature approach. For $\eta \leq 1$ (ratio of rest mass energy to thermal energy), the increase in the effective mass of electrons will result in a change in the mass-dependent quantities (plasma frequency, electron cyclotron frequency, electron sound velocity, etc.) which in turn significantly affect the propagation characteristics of parallel propagating modes. It is observed that the propagation region for these parallel propagating modes decreases and cutoff points are shifted to lower values when we consider a relativistic plasma environment. Moreover, a low-density and high-temperature plasma is more transparent as compared with a high-density and low-temperature plasma for these modes.
Early in the COVID-19 pandemic, the World Health Organization stressed the importance of daily clinical assessments of infected patients, yet current approaches frequently consider cross-sectional timepoints, cumulative summary measures, or time-to-event analyses. Statistical methods are available that make use of the rich information content of longitudinal assessments. We demonstrate the use of a multistate transition model to assess the dynamic nature of COVID-19-associated critical illness using daily evaluations of COVID-19 patients from 9 academic hospitals. We describe the accessibility and utility of methods that consider the clinical trajectory of critically ill COVID-19 patients.
Malnutrition among adolescents is often associated with inadequate dietary diversity (DD). We aimed to explore the prevalence of inadequate DD and its socio-economic determinants among adolescent girls and boys in Bangladesh. A cross-sectional survey was conducted during the 2018–19 round of national nutrition surveillance in Bangladesh. Univariate and multivariable logistic regression was performed to identify the determinants of inadequate DD among adolescent girls and boys separately. This population-based survey covered eighty-two rural, non-slum urban and slum clusters from all divisions of Bangladesh. A total of 4865 adolescent girls and 4907 adolescent boys were interviewed. The overall prevalence of inadequate DD was higher among girls (55⋅4 %) than the boys (50⋅6 %). Moreover, compared to boys, the prevalence of inadequate DD was higher among the girls for almost all socio-economic categories. Poor educational attainment, poor maternal education, female-headed household, household food insecurity and poor household wealth were associated with increased chances of having inadequate DD in both sexes. In conclusion, more than half of the Bangladeshi adolescent girls and boys consumed an inadequately diversified diet. The socio-economic determinants of inadequate DD should be addressed through context-specific multisectoral interventions.
Background: Establishing spatial correspondence between subject and template images is necessary in neuroimaging research and clinical applications. A point-based set of anatomical fiducials (AFIDs) was recently developed and validated to provide quantitative measures of image registration. We applied the AFIDs protocol to magnetic resonance images (MRIs) obtained from patients with Parkinson’s Disease (PD). Methods: Two expert and three novice raters placed AFIDs on MRIs of 39 PD patients. Localization and registration errors were calculated. To investigate for unique morphometric features, pairwise distances between AFIDs were calculated and compared to 30 controls who previously had AFIDs placed. Wilcoxon rank-sum tests with Bonferroni corrections were used. Results: 6240 AFIDs were placed with a mean localization error (±SD) of 1.57mm±1.16mm and mean registration error of 3.34mm±1.94mm. Out of the 496 pairwise distances, 40 were statistically significant (p<0.05/496). PD patients had a decreased pairwise distance between the left temporal horn, brainstem and pineal gland. Conclusions: AFIDs can be successfully applied with millimetric accuracy in a clinical setting and utilized to provide localized and quantitative measures of registration error. AFIDs provide clinicians and researchers with a common, open framework for quality control and validation of spatial correspondence, facilitating accurate aggregation of imaging datasets and comparisons between various neurological conditions.
Nearly 1 year into the coronavirus disease 2019 pandemic, the first severe acute respiratory syndrome coronavirus 2 vaccines received emergency use authorisation and vaccination campaigns began. A number of factors can reduce the averted burden of cases and deaths due to vaccination. Here, we use a dynamic model, parametrised with Bayesian inference methods, to assess the effects of non-pharmaceutical interventions (NPIs) (such as social distancing, mask mandates, school and workplace closure), and vaccine administration and uptake rates on infections and deaths averted in the United States. We show that scenarios depicting higher compliance with NPIs avert more than 60% of infections and 70% of deaths during the period of vaccine administration, and that increasing the vaccination rate from 5 to 11 million people per week could increase the averted burden by more than one-third. These findings underscore the importance of maintaining NPIs and increasing vaccine administration rates.
The Saudi Red Crescent Authority (SRCA) plays a major role in the event of disasters and crisis, as it is the main pre-hospital health-care provider. This study reports on the attitude and perceptions of SRCA medical staff concerning their knowledge of disaster management and response.
This is a descriptive cross-sectional study performed in Riyadh, Saudi Arabia. An Arabic version of the Disaster Preparedness Evaluation Tool (DPET), a self-administered Likert-scale survey, was used to obtain data from SRCA medical staff to evaluate the current status of disaster preparedness.
The population surveyed consisted of 302 participants; 20.9% had participated in a drill exercise or practical application of a regular disaster or emergency plan in their workplaces. Most of participants (85.3%) had incentives to extend their education regarding their role, scope of practice, and skills as medical staff in disaster situations.
Results indicate a lack of regular disaster drills available to prehospital care providers, although most of them are willing to participate in more training and education programs regarding preparedness for disaster management, especially concerning their role in a disaster situation.
Greenland glaciers exhibit variable seasonal velocity signals that may reflect differences in subglacial hydrology. Here, we conduct a first GrIS-wide glacier classification based on seasonal velocity patterns derived from 2017 Sentinel-1 radar data. Our classification focuses on two distinct seasonal ice velocity patterns, with the first (type-2 from Moon and others, 2014) showing periods of both speedup and slowdown during the melt season, and the second (type-3) instead showing a longer period of slowdown from elevated velocities in the winter and spring. We analyze 221 glaciers in 2017 and show that 48 exhibit type-2 behavior, and 72 exhibit type-3 behavior. We extend the classification to 2018 and 2019 and find that while the glaciers meeting each criterion vary year to year, type-2 is consistently more common in the northern regions and type-3 is more common in the south. Our results highlight the varied impact of meltwater on subglacial drainage systems and glacier flow in Greenland.