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In 829 hospital encounters for patients with COVID-19, 73.2% included orders for antibiotics; however, only 1.8% had respiratory cultures during the first 3 hospital days isolating bacteria. Case–control analysis of 30 patients and 96 controls found that each antibiotic day increased the risk of isolating multidrug-resistant gram-negative bacteria (MDR-GNB) in respiratory cultures by 6.5%.
This study aimed to analyse social, health and environmental factors associated with the development of chronic otitis media by age nine.
This was a prospective, longitudinal, birth cohort study of 6560 children, reviewed at age nine. Chronic otitis media defined as previous surgical history or video-otoscopic changes of tympanic membrane retraction, perforation or cholesteatoma. Non-affected children were used as the control group.
Univariate analysis demonstrated an association between chronic otitis media and otorrhoea, snoring, grommet insertion, adenoidectomy, tonsillectomy, hearing loss, abnormal tympanograms and preterm birth. Multivariate analysis suggests many of these factors may be interrelated.
The association between chronic otitis media and otorrhoea, abnormal tympanograms and grommets supports the role of the Eustachian tube and otitis media (with effusion or acute) in the pathogenesis of chronic otitis media. The role of snoring, adenoidectomy and tonsillectomy is unclear. Associations suggested by previous studies (sex, socioeconomic group, parental smoking, maternal education, childcare, crowding and siblings) were not found to be significant predictors in this analysis.
Schizophrenia is a disorder characterized by pervasive deficits in cognitive functioning. However, few well-powered studies have examined the degree to which cognitive performance is impaired even among individuals with schizophrenia not currently on antipsychotic medications using a wide range of cognitive and reinforcement learning measures derived from cognitive neuroscience. Such research is particularly needed in the domain of reinforcement learning, given the central role of dopamine in reinforcement learning, and the potential impact of antipsychotic medications on dopamine function.
The present study sought to fill this gap by examining healthy controls (N = 75), unmedicated (N = 48) and medicated (N = 148) individuals with schizophrenia. Participants were recruited across five sites as part of the CNTRaCS Consortium to complete tasks assessing processing speed, cognitive control, working memory, verbal learning, relational encoding and retrieval, visual integration and reinforcement learning.
Individuals with schizophrenia who were not taking antipsychotic medications, as well as those taking antipsychotic medications, showed pervasive deficits across cognitive domains including reinforcement learning, processing speed, cognitive control, working memory, verbal learning and relational encoding and retrieval. Further, we found that chlorpromazine equivalency rates were significantly related to processing speed and working memory, while there were no significant relationships between anticholinergic load and performance on other tasks.
These findings add to a body of literature suggesting that cognitive deficits are an enduring aspect of schizophrenia, present in those off antipsychotic medications as well as those taking antipsychotic medications.
Substance use disorders affect physicians at a prevalence like the general population, yet they are difficult to detect and are inextricably linked to job dissatisfaction and burnout. Often physicians develop complex denial strategies and rationalizations, and shame and stigma prevent them from seeking help. However, when engaged in treatment and monitored through state-level Physicians Health Programs (PHPs), including long term monitoring and systems of accountability, approximately 80 percent will stay sober for and return to work in five years. This continuing care model with long-term monitoring and follow up, if adopted for the general population, may provide a paradigm shifting approach for the treatment of substance addictions, and might be extended to behavioral addictions.
Associations between smell identification deficits (SID) and impairments in basic cognitive domains have been shown in patients with neuropsychiatric disorders.
We analyzed social and basic cognitive deficits and SID.
To assess differences in affective decision making tasks in patients with schizophrenia-spectrum disorders, their 1st degree relatives and healthy controls. Methods: We examined 51 patients with schizophrenia-spectrum disorders (49% female, age 33.1 years, SD 11), 21 first-degree relatives (61.9% female, age 49.5 years, SD 17.6, one affected, others non-affected) and 51 matched healthy controls (49% female, age 33 years, SD 12.1). Psychopathology was evaluated using the Positive and Negative Syndrome Scale (PANSS). Subjects were administered the University of Pennsylvania Smell Identification Test (UPSIT), the Facially Expressed Emotion Labelling (FEEL) test, the spatial span subtest of the Wechsler Memory Scale-Revised (WMS-R) and the Mehrfachwahl-Wortschatz Test (MWT-B).
Patients, controls and 1st degree relatives differed in age (p = 0.000), WMS-R (p = 0.000) and FEEL scores (p = 0.007). In healthy controls, patients and 1st degree relatives FEEL correlated with age (p = 0.005, p = 0.003, p = 0.004, respectively). In patients FEEL also correlated with MWT-B (p = 0.000), UPSIT (p = 0.000) and PANSS negative scores (p = 0.016); furthermore, UPSIT correlated with MWT-B (p = 0.001). In 1st degree relatives age correlated with WMS-R (p = 0.04) and FEEL (p = 0.004), both of which inter-correlated (p = 0.006).
We found that SID, basic and social cognition, i.e. affective decision-making processes, inter-correlate in patients with schizophrenia-spectrum disorders and are partly under the influence of negative symptoms. Some of these relationships can also be seen in 1st degree relatives of patients.
Schizophrenia has often been associated with a reduced skin flush response to niacin. Blunted response suggests potential disturbance in phospholipid metabolism.
We performed niacin skin tests in patients with schizophrenia, their first-degree relatives and healthy controls.
To examine possible differences in skin flush response to niacin.
We examined 51 patients (female 49%, age 33.1 years, SD 11), with schizophrenia-spectrum disorders, 51 matched healthy controls (female 49%, age 33 years, SD 12.1), and 21 first-degree relatives (female 61,9%, age 49,5 years, SD 17,6, one affected, others non-affected). The Positive and Negative Syndrome Scale and the Mini International Neuropsychiatrie Interview were used to assess psychopathology and diagnosis, respectively. The non-invasive niacin skin flush test was used to assess vasodilatative reaction to four different concentrations of niacin on the forearms of subjects.
We found no differences in total scores on the niacin skin flush test between the three groups (p = 0.774). Mean scores were 60.27 (SD 14.2) in healthy controls, 58.84 (SD 10.2) in patients and 58.48 (SD 9.4) in first-degree relatives.
Contrary to our expectations we did not find a significantly blunted niacin skin flush reaction in patients with schizophrenia-spectrum disorders compared to healthy controls or 1st degree relatives.
Sex-related differences in smell identification have been shown in healthy subjects, however, in patients with schizophrenia these findings are still controversial.
We analyzed sex-related differences with respect to smell identification in patients with schizophrenia, their first-degree relatives and healthy controls.
To assess possible sex-related differences in smell identification.
The sample consisted of 51 patients with schizophrenia-spectrum disorders (49% female; mean age 33.1 years; SD: 11), 21 first-degree relatives (61.9% female, age 49.5 years, SD 17.6, one affected, others non-affected) ; mean age 49.5 years; SD: 17.6) and 51 matched healthy controls (49% female; mean age 33 years; SD: 12.1). The Positive and Negative Syndrome Scale (PANSS) and the Mini International Neuropsychiatric Interview (M.I.N.I.) were used to assess psychopathology and diagnosis, respectively. The University of Pennsylvania Smell Identification Test (UPSIT), a standardized, multiple- and forced-choice scratch- and sniff test consisting of 40 items, was administered to all subjects.
We found no significant differences in smell identification between the three groups (p = 0.182). Also, the female and male subgroups did not differ significantly in smell identification (p = 0.105, p = 0.387, respectively). The mean UPSIT scores were 34.4 (SD: 4.1) for healthy women (males: 33.2; SD: 3.5), 32.0 (SD: 5.1) for women with schizophrenia-spectrum disorders (males: 32.5; SD: 4.4), and 34.5 (SD: 2.6) for female first-degree relatives (males: 30.5; SD: 2.8).
We found neither significant differences in smell identification in patients with schizophrenia-spectrum disorders, their first-degree relatives or healthy controls, nor sex-related differences.
Trust matters to fiduciary law in a variety of ways. This chapter will focus on the importance of trust in advisory relationships, and it will emphasize two settings: categorical fiduciary relationships and ad hoc fiduciary relationships. In the former setting, I will suggest that these relationships are appropriately treated as fiduciary in part due to the likelihood of a beneficiary’s epistemic dependence on a fiduciary’s judgements. It is not necessary for epistemic dependence to exist in any particular advisory relationship to support this categorical treatment, so long as the likelihood of epistemic dependence is high enough across the category. In turn, the presence of trust supports the likelihood of that epistemic dependence. In the ad hoc fiduciary setting, I will suggest that these relationships are sometimes best seen as a kind of “involvement” (as that concept is developed in David Owens’s work). Involvements are voluntary relationships even though they may have no precise moment when they come into existence. Importantly, the existence of involvements is generally recognizable by the parties involved. Trust is relevant here as an aid in legally identifying such relationships.
Irritability and anxiety are two common clinical phenotypes that involve high-arousal negative affect states (anger and fear), and that frequently co-occur. Elucidating how these two forms of emotion dysregulation relate to perturbed neurodevelopment may benefit from alternate phenotyping strategies. One such strategy applies a bifactor latent variable approach that can parse shared versus unique mechanisms of these two phenotypes. Here, we aim to replicate and extend this approach and examine associations with neural structure in a large transdiagnostic sample of youth (N = 331; M = 13.57, SD = 2.69 years old; 45.92% male). FreeSurfer was used to extract cortical thickness, cortical surface area, and subcortical volume. The current findings replicated the bifactor model and demonstrate measurement invariance as a function of youth age and sex. There were no associations of youth's factor scores with cortical thickness, surface area, or subcortical volume. However, we found strong convergent and divergent validity between parent-reported irritability and anxiety factors with clinician-rated symptoms and impairment. A general negative affectivity factor was robustly associated with overall functional impairment across symptom domains. Together, these results support the utility of the bifactor model as an alternative phenotyping strategy for irritability and anxiety, which may aid in the development of targeted treatments.