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Observational studies in adults suggest nasal methicillin-resistant Staphylococcus aureus(MRSA) swabs have a high negative predictive value (NPV) for ruling out MRSA pneumonia, however, pediatric data are limited. This retrospective study of 505 pediatric patients found a 99.8% NPV among children with suspected respiratory infections.In pediatric patients with a suspected respiratory infection, nasal methicillin-resistant Staphylococcus aureus(MRSA) polymerase chain reaction (PCR)testing may be beneficial for its high negative predictive value and ability to rule out MRSA infection in a population with a low prevalence of MRSA.

•No differences in agentic vs communal language based on applicant gender.•Female letter writers wrote longer letters with more communal terms.•Increased use of agentic terms negatively impacted interview invitation; did not affect successful matching.•Largest study of this nature conducted across all sub-specialties of OB/GYN.•Contradicts current literature demonstrating gender-bias in letters of recommendation in male-dominated surgical specialties.

Background: Vancomycin area-under-the-curve (AUC) monitoring is associated with reduced nephrotoxicity but may increase cost and workload for personnel compared to trough monitoring.Objective: The purpose of this study was to compare the accuracy of vancomycin AUC calculated by open-access, online, trough-only calculators to AUCs calculated by the trapezoidal method (TM) using peak and trough concentrations.Methods: This retrospective, multi-center study included adults ≥18 years old with stable renal function who received vancomycin with steady-state peak and trough concentrations. Areas under the curve calculated by TM were compared to AUCs calculated by 3 online calculators using trough-only options for calculation: ClinCalc, VancoVanco, and VancoPK. The primary outcome was actual difference in AUC between TM and the online calculators. Secondary outcomes were percent difference in AUC and clinical alignment in dose adjustments between methods.Results: Seventy patients were included for analysis. There was a statistically significant difference in AUC between TM and ClinCalc (median actual difference: −52, P< 0.001) and VancoVanco (median actual difference: 95, P< 0.001), whereas there was no significant difference between TM and VancoPK (median actual difference: −0.8, P= 0.827). Discordant dose adjustments were indicated when comparing ClinCalc, VancoVanco, and VancoPK to TM in 28%, 36%, and 12% of cases, respectively.Conclusion: The AUC calculator most closely aligned with TM was VancoPK, whereas other included calculators were statistically different. Owing to the cost and complexity of obtaining multiple levels, our findings support using a single steady-state trough using VancoPK as an alternative to TM for calculation of vancomycin AUC.

IMPORTANCE: Restrictions on postoperative activity following pelvic organ prolapse (POP) surgery are not evidence based. Nonetheless, many pelvic surgeons place lifting and activity restrictions on patients following surgery. OBJECTIVE: To evaluate whether expedited activity results in noninferior anatomic and symptomatic outcomes compared with standard activity restrictions after POP surgery. DESIGN, SETTING, AND PARTICIPANTS: This randomized noninferiority clinical trial included patients undergoing vaginal or laparoscopic apical reconstructive surgery for POP between July 1, 2020, and October 31, 2021, at a single academic tertiary referral center in Durham, North Carolina. Anatomic outcomes were assessed by masked examiners, and subjective outcomes were assessed via validated surveys, both completed at 3 months postoperatively. Patients meeting minimum physical activity criteria with at least stage II bothersome POP were eligible. A total of 218 patients were approached, of whom 123 were randomly assigned and 107 had complete outcome data and were included in the analysis. INTERVENTIONS: Patients were randomly assigned to receive standard restrictions vs expedited postoperative activity instructions. MAIN OUTCOMES AND MEASURES: The anatomic coprimary outcome was maximum anatomic POP support loss (SLmax), which is the most distal point of pelvic organ support loss according to the Pelvic Organ Prolapse Quantification System (noninferiority margin, 1.0 cm). The symptomatic coprimary outcome was the Pelvic Organ Prolapse Distress Inventory (POPDI) symptom score (noninferiority margin, 34.3 points). Differences between outcomes were assessed using linear regression models controlling for baseline SLmax and POPDI, respectively. RESULTS: Of 123 participants randomized, 107 had complete 3-month outcome data and were included in the analysis. Mean (SD) age was 62.8 (10.1) years. At 3 months, mean (SD) SLmax was −1.7 (1.4) cm in the expedited group and −1.5 (1.4) cm in the standard group (P = .44). After adjusting for baseline SLmax, the mean maximum support loss was 0.18 cm higher within the vaginal canal in the expedited group (95% CI, −0.68 to 0.33 cm). The coprimary outcome of POPDI score was a mean (SD) 23.7 (41.8) points in the expedited group vs 25.7 (39.3) points in the standard group (P = .80). After adjusting for baseline scores, mean POPDI scores were 5.79 points lower in the expedited group (95% CI, −20.41 to 8.84). CONCLUSIONS AND RELEVANCE: The findings demonstrate that expedited activity after prolapse surgery results in noninferior anatomic and symptomatic prolapse outcomes. It is reasonable to instruct patients undergoing minimally invasive prolapse surgery to resume physical activities ad lib postoperatively. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04329715

The regulation of emotion is crucial for sustaining mental health in the face of cumulative stressors over one's lifetime. Although it is well documented that some emotion regulation abilities are preserved or even improved in healthy aging, little is known about why regulatory deficits persist in older adults who suffer from depression. Treatments for major depressive disorder (MDD) focus on remediating affective dysregulation processes that confer risks for disability, poor quality of life, and morbidity into late life. Theoretical perspectives on emotional aging propose myriad lifespan changes that potentially impact regulatory capacities, including structural and functional integrity of dorsal attentional and ventral affective processing pathways, cognitive control in affective contexts, and use of specific regulatory strategies. Here, we investigated the relation of magnetic resonance imaging (MRI) measures of brain activation and connectivity to emotional dysregulation in older adults with and without depression. We also examined the differences among specific regulation strategies. We hypothesized that reappraisal would be a cognitive emotion regulation strategy that is highly effective in younger adults, but less effective for older adults and individuals with affective disorders. In contrast, we hypothesized that distraction, defined as intentional shifting of attention from a distressing stimulus to a different attentional target, would be effective independently of age and presence of depression.

The Statin Use in Persons with Diabetes (SUPD) measure is a Star measure by the Center for Medicare & Medicaid Services. The Duke Population Health Management Office has a team of pharmacists and pharmacy students who conduct targeted outreach to patients at risk of failing statin quality measures. Pharmacy services are embedded in select primary care clinics and other clinics are supported remotely.

Despite research indicating that stressful life events are associated with subsequent suicidal ideation (SI) and behavior, there is a lack of clarity regarding whether specific types of life events are differentially related to SI and attempts. The current prospective study examines whether social rejection related life events are proximally related to SI and suicide attempts in a clinically acute sample of adolescents. Adolescents aged 12 to 18 (n= 219) were followed for 6 months after discharge from inpatient hospitalization. A contextual threat interview of stressful life events between index admission and 6-month follow-up was administered. Participants were also assessed for current SI and suicide attempts at baseline and 6-month follow-up. Results from a multiple linear regression model indicated a significant prospective association between number of social rejection stressors and SI, even after controlling for baseline depressive symptoms, SI at study entry, gender, age, and number of non-social rejections stressors. An Anderson-Gill recurrent events model was conducted to examine the relationship between SR stressors and suicide attempts. Results demonstrated that the 31 days following a major social rejection stressor were associated with heightened risk for prospective suicide attempts. However, social rejection stressors were not more strongly related to risk for suicide attempt than non-social rejection stressors. These findings help clarify the role of social rejection as a precipitant of suicidal crises and have potential to inform more accurate, targeted risk assessment.

AbstractAmulticategory item-response theory model was developed to characterize developmental changes in three items relating to the assessment of puberty in adolescent twin girls and boys. The model allowed for the fixed effects of age on probability of endorsing the responses and for the random effects of individual differences on the timing of pubertal changes relative to chronological age. In girls, the model was applied three-wave data on twin pairs (N= 414 female monozygotic [MZ] and 197 female dizygotic [DZ] pairs) and female twins from boy?girl pairs (N= 300 twins) from the Virginia Twin Study of Adolescent Behavioral Development. In boys, the data comprised 318 MZ and 185 DZ pairs and 297 male twins from boy?girl pairs. A total of 3172 and 2790 individual twin assessments were available in girls and boys, respectively, spanning ages 8?17 years. The availability of twin data allows the contributions of genes, the shared environment and individual unique environmental experiences to be resolved in the relative timing of pubertal changes. Parameters of the mixed model including fixed effects of age and random effects of genes and environment were estimated by Markov Chain Monte Carlo simulations using the BUGS algorithm for Gibbs sampling. The estimated standard deviation of random differences in the timing of puberty relative to age was 0.96 years in girls and 1.01 years in boys. The estimated intraclass correlations for the relative timing of pubertal changes were 0.99 +/?0.01 in MZ girls, 0.52 +/?0.02 in DZ girls, 0.88 +/?0.04 in MZ boys and 0.44+/?0.02 in DZ boys, indicating a very large contribution of genetic factors to the relative timing of pubertal change in both sexes. Additive genetic factors account for an estimated 96.3+/?3.3% of the total variance in random effects in girls and 88.0+/?3.6% in boys. Shared environmental influences account for 3.6+/?3.4% in girls and 0% in boys. In girls, nonshared environmental effects explain 0.1+/?0.1% of the total residual variance. The comparable figure in boys is 12.0+/?;3.6%.

We present non-homogenous Markov regression models of unknown order as a means to assess the duration of autoregressive dependence in longitudinal binary data. We describe a subject's transition probability evolving over time using logistic regression models for his or her past outcomes and covariates. When the initial values of the binary process are unknown, they are treated as latent variables. The unknown initial values, model parameters, and the order of transitions are then estimated using a Bayesian variable selection approach, via Gibbs sampling. As a comparison with our approach, we also implement the deviance information criterion (DIC) for the determination of the order of transitions. An example addresses the progression of substance use in a community sample of n=242 American Indian children who were interviewed annually four times. An extension of the Markov model to account for subject-to-subject heterogeneity is also discussed. Copyright © 2001 John Wiley & Sons, Ltd.

Summary. We consider Bayesian inference and model selection for prevalence estimation using a longitudinal two‐phase design in which subjects initially receive a low‐cost screening test followed by an expensive diagnostic test conducted on several occasions. The change in the subject's diagnostic probability over time is described using four mixed‐effects probit models in which the subject‐specific effects are captured by latent variables. The computations are performed using Markov chain Monte Carlo methods. These models are then compared using the deviance information criterion. The methodology is illustrated with an analysis of alcohol and drug use in adolescents using data from the Great Smoky Mountains Study.

BACKGROUND: Federal regulations require states to estimate the prevalence and incidence of serious emotional disturbance (SED) in children, defined as a DSMIII-R diagnosis in the presence of impaired functioning in 1 or more areas. We reviewed the published data on SED and examined rates and correlates of SED in an ongoing epidemiologic study of children. METHODS: Rates of DSM-III-R disorders, functional impairment, and their co-occurrence (SED) were examined in a representative population sample of 9-, 11-, and 13-year-olds from a predominantly rural area of North Carolina. Three measures of functional impairment were used, and their interrelationship and impact on rates of SED were examined. RESULTS: Serious emotional disturbance was identified in 4% to 8% of the study population, depending on the measure of impairment; the rate of DSM-III-R disorder ignoring impairment was 20.3%. One quarter of children identified as having SED on any measure were identified by all 3, and one half by 2 or more. Behavioral disorders, emotional disorders, and comorbidity were associated with a significant increase in the likelihood of SED; enuresis and tic disorders in the absence of comorbidity were not. Diagnosis and impairment made independent contributions to the increase in service use seen in children with SED. Poverty greatly increased the likelihood of SED. CONCLUSIONS: Specific areas of functional impairment should be examined when SED is assessed and treatment is planned. Plans to target mental health care resources to children with SED need to be accompanied by efforts to ensure access to those resources.

BACKGROUND: The Great Smoky Mountains Study of youth focuses on the relationship between the development of psychiatric disorder and the need for and use of mental health services. METHODS: A multistage, overlapping cohorts design was used, in which 4500 of the 11 758 children aged 9, 11, and 13 years in an 11-country area of the southeastern United States were randomly selected for screening for psychiatric symptoms. Children who scored in the top 25% on the screening questionnaire, together with a 1 in 10 random sample of the rest, were recruited for 4 waves of intensive, annual interviews (n=1015 at wave 1). In a parallel study, all American Indian children aged 9, 11, and 13 years were recruited (N=323 at wave 1). RESULTS: The 3-month prevalence (±SE) of any DSMIII-R axis I disorder in the main sample, weighted to reflect population prevalence rates, was 20.3%±1.7%. The most common diagnoses were anxiety disorders (5.7%±1.0%), enuresis (5.1%±1.0%), tic disorders (4.2%±0.9%), conduct disorder (3.3%±0.6%), oppositional defiant disorder (2.7%±0.4%), and hyperactivity (1.9%±0.4%). CONCLUSIONS: The prevalence of psychiatric disorder in this rural sample was similar to rates reported in other recent studies. Poverty was the strongest demographic correlate of diagnosis, in both urban and rural children.

This paper discusses Bayesian methods for the assessment of the prevalence of a disorder based on data from a two‐phase design with a short screening instrument administered at the first phase followed by an in‐depth diagnostic instrument given at the second phase. In calculating the posterior distributions of the quantities of interest, for example, the prevalence, sensitivity and specificity, and predictive distributions, we used the Gibbs sampler. We illustrate our approach by assessing the prevalence of depression in adolescents with use of data attained from a two‐phase design. © 1997 by John Wiley & Sons, Ltd. Stat. Med., Vol. 16, 1121–1133 (1997).