Search

Background: Attention-deficit/hyperactivity disorder (ADHD) is highly prevalent among youth with or at familial risk for bipolar-I disorder (BD-I), and ADHD symptoms commonly precede and may increase the risk for BD-I; however, associated neuropathophysiological mechanisms are not known. In this cross-sectional study, we sought to investigate brain structural network topology among youth with ADHD, with and without familial risk of BD-I. Methods: We recruited 3 groups of psychostimulant-free youth (aged 10-18 yr), namely youth with ADHD and at least 1 biological parent or sibling with BD-I (high-risk group), youth with ADHD who did not have a first- or second-degree relative with a mood or psychotic disorder (low-risk group) and healthy controls. We used graph- based network analysis of structural magnetic resonance imaging data to investigate topological properties of brain networks. We also evaluated relationships between topological metrics and mood and ADHD symptom ratings. Results: A total of 149 youth were included in the analysis (49 healthy controls, 50 low-risk youth, 50 high-risk youth). Low-risk and high-risk ADHD groups exhibited similar differences from healthy controls, mainly in the default mode network and central executive network. We found topological alterations in the salience network of the high-risk group, relative to both low-risk and control groups. We found significant abnormalities in global network properties in the high-risk group only, compared with healthy controls. Among both low-risk and high-risk ADHD groups, nodal metrics in the right triangular inferior frontal gyrus correlated positively with ADHD total and hyperactivity/impulsivity subscale scores. Limitations: The crosssectional design of this study could not determine the relevance of these findings to BD-I risk progression. Conclusion: Youth with ADHD, with and without familial risk for BD-I, exhibit common regional abnormalities in the brain connectome compared with healthy youth, whereas alterations in the salience network distinguish these groups and may represent a prodromal feature relevant to BD-I risk., Introduction Bipolar-I disorder (BD-I) is associated with premature functional disability and mortality. (1) The initial onset of BD-I frequently occurs during the peripubertal period (2) and is often preceded by [...]

Introduction: During a hospital-based active shooter (AS) event, clinicians may be forced to choose between saving themselves or their patients. The Hartford Consensus survey of clinicians and the public demonstrated mixed feelings on the role of doctors and nurses in these situations. Our objective was to evaluate the effect of simulation on ethical dilemmas during a hospital-based AS simulation. The objective was to determine whether a hospital-based AS event simulation and debrief would impact the ethical beliefs of emergency physicians relating to personal duty and risk.Methods: Forty-eight emergency physicians and physicians-in-training participated in this cohort study based in an urban academic hospital. Simulation scenarios presented ethical dilemmas for participants (eg, they decided between running a code or hiding from a shooter). Surveys based upon the Hartford Consensus were completed before and after the simulation. Questions focused on preparedness and ethical duties of physicians to their patients during an AS incident. We evaluated differences using a chi-squared test.Results: Preparedness for an AS event significantly improved after the simulation (P = 0.0001). Pre-simulation, 56% of participants felt that doctors/nurses have a special duty like police to protect patients who cannot hide/run, and 20% reported that a provider should accept a very high/high level of personal risk to protect patients who cannot hide/run. This was similar to the findings of the Hartford Consensus. Interestingly, post-simulation, percentages decreased to 25% (P = 0.008) and 5% (P = 0.041), respectively.Conclusion: Simulation training influenced ethical beliefs relating to the duty of emergency physicians during a hospital-based AS incident. In addition to traditional learning objectives, ethics should be another important design consideration for planning future simulations in this domain.

Introduction: Airway management is a fundamental skill of emergency medicine (EM) practice, and suboptimal management leads to poor outcomes. Endotracheal intubation (ETI) is a procedure that is specifically taught in residency, but little is known how best to maintain proficiency in this skill throughout the practitioner’s career. The goal of this study was to identify how the frequency of intubation correlated with measured performance.Methods: We assessed 44 emergency physicians for proficiency at ETI by direct laryngoscopy on a simulator. The electronic health record was then queried to obtain their average number of annual ETIs and the time since their last ETI, supervised and individually performed, over a two-year period. We evaluated the strength of correlation between these factors and assessment scores, and then conducted a receiver operator characteristic (ROC) curve analysis to identify factors that predicted proficient performance.Results: The mean score was 81% (95% confidence interval, 76% - 86%). Scores correlated well with the mean number of ETIs performed annually and with the mean number supervised annually (r = 0.6, p = 0.001 for both). ROC curve analysis identified that physicians would obtain a proficient score if they had performed an average of at least three ETIs annually (sensitivity = 90%, specificity = 64%, AUC = 0.87, p = 0.001) or supervised an average of at least five ETIs annually (sensitivity = 90%, specificity = 59%, AUC = 0.81, p = 0.006) over the previous two years.Conclusion: Performing at least three or supervising at least five ETIs annually, averaged over a two-year period, predicted proficient performance on a simulation-based skills assessment. We advocate for proactive maintenance and enhancement of skills, particularly for those who infrequently perform this procedure

Introduction: Goal setting is used in education to promote learning and performance. Debriefing after clinical scenario-based simulation is a well-established practice that provides learners a defined structure to review and improve performance. Our objective was to integrate formal learning goal generation, using the SMART framework (Specific, Measurable, Attainable, Realistic, and Time-bound), into standard debriefing processes (i.e., “SMART Goal Enhanced Debriefing”) and subsequently measure the impact on the development of learning goals and execution of educational actions.Methods: This was a prospective multicenter randomized controlled study of 80 emergency medicine residents at three academic hospitals comparing the effectiveness of SMART Goal Enhanced Debriefing to a standard debriefing. Residents were block randomized on a rolling basis following a simulation case. SMART Goal Enhanced Debriefing included five minutes of formal instruction on the development of SMART learning goals during the summary/application phase of the debrief. Outcome measures included the number of recalled learning goals, self-reported executed educational actions, and quality of each learning goal and educational action after a two-week follow-up period.  Results: The mean number of reported learning goals was similar in the standard debriefing group (mean 2.05 goals, SD 1.13, n=37 residents), and in the SMART Goal Enhanced Debriefing group (mean 1.93, SD 0.96, n=43), with no difference in learning goal quality. Residents receiving SMART Goal Enhanced Debriefing completed more educational actions on average (Control group actions completed 0.97 (SD 0.87), SMART debrief group 1.44 (SD 1.03) p=0.03). Conclusion: The number and quality of learning goals reported by residents was not improved as a result of SMART Goal Enhanced Debriefing. Residents did, however, execute more educational actions, which is consistent with the overarching intent of any educational intervention.

Background Tobacco consumption is a significant public health challenge, particularly among young adults. Despite the presence of anti-tobacco laws and control measures, awareness and compliance remain suboptimal. This study aims to assess the awareness, knowledge, and perceptions regarding anti-tobacco laws among young adults, along with their attitudes towards potential interventions for effective tobacco control. Materials andMethods A cross-sectional study was conducted among 500 young adults aged 18-25 years across colleges and public spaces in a metropolitan city. A structured questionnaire was used to collect data on participants' awareness of anti-tobacco laws, knowledge of the harmful effects of tobacco, and their perceptions of intervention strategies. The questionnaire included multiple-choice and Likert-scale questions. Data were analyzed using descriptive statistics and chi-square tests to assess the association between awareness levels and demographic factors. Results Out of the 500 participants, 65% (n=325) were aware of the existence of anti-tobacco laws, but only 40% (n=200) could recall specific provisions like the ban on smoking in public places. Approximately 58% (n=290) recognized the significance of warning labels on tobacco products. However, only 30% (n=150) were aware of penalties for violations of these laws. Participants indicated a strong preference (75%, n=375) for educational campaigns over punitive measures for effective tobacco control. Awareness levels were significantly higher among urban participants compared to those from semi-urban areas (p < 0.05). Conclusion The findings suggest that while awareness of anti-tobacco laws is moderate among young adults, there are gaps in specific knowledge about legal provisions. Educational interventions, including awareness campaigns and peergroup initiatives, are likely to be more effective than punitive measures in promoting tobacco control. There is a need for collaborative efforts involving policymakers, educational institutions, and healthcare professionals to enhance the reach and impact of anti-tobacco programs. [ABSTRACT FROM AUTHOR]

Background. This study aimed to evaluate and analyze the distribution of stresses on the palatal micro-implants and the cortical bone at the micro-implant site with optimal orthodontic retraction force in lingual orthodontics. Methods. ANSYS 12.1 software was used to construct the finite element model of the maxillary bone, teeth and the periodontal ligament along with the lingual bracket set-up with wire and the micro-implant. Six- and 8-mm micro-implants were constructed. The final model consisted of 99190 nodes and 324364 elements. A 200-gram of retraction force was applied from the micro-implant to the anterior retraction hook. The micro-implant was embedded between the second premolar and the first molar. Hyper-view software was used to get the results in X-Y-Z dimensions. Results. The maximum von Mises stresses detected were 52.543 MPa for 6-mm micro-implant and 54.489 MPa for 8-mm micro-implant. Maximum stress was at the neck of the micro-implant. The 8-mm implant model showed 6×10-3 mm of lingual displacement. The least displacement of 1×10-3 mm was noticed for both the implant models in the apico-occlusal direction. The maximum von Mises stresses in the cortical bone at the micro-implant site was 18.875 MPa for 6-mm micro-implant and 21.551 MPa for 8-mm micro-implant. Conclusion. Six-mm micro-implant can be the choice for the implant-supported lingual orthodontic retraction as it produced minimal stresses on the cortical bone, and the initial stress displacements produced on the micro-implant were also minimal.

The present work emphasizes on citric acid production from distillery spent wash containing carbohydrates that has been tested to be novel and potential substrate. Pre-treatment of distillery spent wash was studied in an anaerobic digestion by suspended growth system under shifting hydraulic retention time and organic loading rate as well as physicochemical parameters. Fungi strain PN12 was applied for citric acid production using raw post methanated waste (treated spent wash). A potent fungus was identified by molecular characterization (18S rRNA). To find phylogenetic relatedness gene sequence of potent culture PN12 has been compared with other sp. gene sequences registered at database of NCBI and the phylogenetic tree was created by software. For enhancement of citric acid production was carried out in different nutritional and environmental parameters such as inoculum size (2 to 10 %), incubation period (24 to 144 h), pH (2 to 7), temperature (25 to 37°C), nitrogen source (organic and inorganic 0.1 g/L), phosphorus source (0.1g/L). The detection of enzymes activities specified that the pathway of pyruvate carboxylation enhanced, which proposed carbon flux to citric acid it was reorganized in strains. Analysis of biosynthesized products by UV/Vis spectrophotometer and HPLC. Initial sugar and consumed sugar determined by DNSA method and also estimated cell dry weight.

Introduction: During a hospital-based active shooter (AS) event, clinicians may be forced to choose between saving themselves or their patients. The Hartford Consensus survey of clinicians and the public demonstrated mixed feelings on the role of doctors and nurses in these situations. Our objective was to evaluate the effect of simulation on ethical dilemmas during a hospital-based AS simulation. The objective was to determine whether a hospital-based AS event simulation and debrief would impact the ethical beliefs of emergency physicians relating to personal duty and risk. Methods: Forty-eight emergency physicians and physicians-in-training participated in this cohort study based in an urban academic hospital. Simulation scenarios presented ethical dilemmas for participants (eg, they decided between running a code or hiding from a shooter). Surveys based upon the Hartford Consensus were completed before and after the simulation. Questions focused on preparedness and ethical duties of physicians to their patients during an AS incident. We evaluated differences using a chi-squared test. Results: Preparedness for an AS event significantly improved after the simulation (P = 0.0001). Pre-simulation, 56% of participants felt that doctors/nurses have a special duty like police to protect patients who cannot hide/run, and 20% reported that a provider should accept a very high/high level of personal risk to protect patients who cannot hide/run. This was similar to the findings of the Hartford Consensus. Interestingly, post-simulation, percentages decreased to 25% (P = 0.008) and 5% (P = 0.041), respectively. Conclusion: Simulation training influenced ethical beliefs relating to the duty of emergency physicians during a hospital-based AS incident. In addition to traditional learning objectives, ethics should be another important design consideration for planning future simulations in this domain.

In this work we present CitiSense, a new kind of "citizeninfrastructure" for the monitoring of pollution and environmental conditionsthat users are exposed to. By utilizing mobile phones and affordable, smallsensors placed in the environment and carried by users, data about pollutantssuch as ozone and carbon monoxide is collected and used to provide real-timefeedback to users and enable them to make healthy changes in their behavior.Results can be reported to a back-end server for further processing andlearning, allowing other stakeholders to better understand how diseases such asasthma develop and to help coordinate efforts within a user's community toimprove conditions. What differentiates CitiSense from previous projects ofthis sort is the design of a complete system that addresses issues of mobilepower management, data security, privacy, inference with commodity sensors, andintegration into a highly extensible and adaptive infrastructure comprising ofOpen Rich Services (ORS). We discuss the design goals of the CitiSense project,our progress towards the vision of ubiquitous environmental sensing in SanDiego, and preliminary results for energy management policies for sensor nodesand mobile phones.Pre-2018 CSE ID: CS2011-0961