Miracle-dz/UniFAR-FTUs huggingface dataset:
False positive diagnosis of malingering due to the use of multiple effort tests

Abstract Objective: Effort indicators are used to determine if neuropsychological test results are valid measures of a patient’s cognitive abilities. The use of multiple effort measures is often advocated, but the false positive rate for multiple indicators depends on the number of measures used and the correlation among indicators. This study presents a meta-analysis of correlations among effort measures. False positive rates for multiple correlated indicators are then estimated using Monte Carlo simulations. Methods: a literature search of published studies identified 22 independent samples in which 407 correlations among 31 effort measures were available in 3564 participants with normal effort. Participants were patients with neurological or psychiatric disorders and healthy volunteers. Results: Meta-analysis showed a mean correlation among effort indicators of 0.31. Monte Carlo simulation based on a 15% false positive rate for individual indicators showed that, when 10 effort indicators are used together, 38% of patients with valid performance will be incorrectly identified as malingering if two failures is the diagnostic standard. Failure on five of 10 measures is required for a false positive rate of 10% or less. If five effort indicators are interpreted, a false positive rate of 19% results when two test failures are assumed to characterize poor effort and failure on three measures is required to maintain 90% specificity. Conclusions: False positive rates for effort tests increase significantly as the number of indicators that are administered is increased.
Coping and distress in caregivers of patients with disorders of consciousness

Abstract Objectives: To study depression, anxiety, maladjustment and coping in caregivers of patients in vegetative state (VS) or minimally conscious state (MCS). Materials and methods: Fifty-three caregivers of 43 patients with VS or MCS were assessed using Beck Anxiety Inventory, Beck Depression Inventory, maladjustment scale and Brief Coping Orientation of Problems Experienced (COPE-28). Results: There were 15 clinical cases (cut-off ≥ 21) of anxiety (28.30%); 16 cases (cut-off ≥ 21) of depression (30.20%); and 45 cases (cut-off ≥ 12) of maladjustment (84.8%). Active and problem-focused (Active coping, Instrumental support, Planning and Acceptance) were the most frequently used coping strategies. Acceptance predicted the absence of depression (p = 0.000, Cohen’s d = 1.08) and anxiety (p = 0.000, Cohen’s d = 1.08). Denial was associated with depression (p = 0.000, Cohen’s d = 1.65) and anxiety (p = 0.000, Cohen’s d = 1.23). Self-blame was associated with greater anxiety (p = 0.001, Cohen’s d = 1.06) and depression (p = 0.001, Cohen’s d = 1.07). Emotion-focused coping was associated with anxiety (p = 0.000, Cohen’s d = 1.29) and depression (p = 0.001, Cohen’s d = 1.11). Conclusions: Caregivers of patients with VS or MCS presented high levels of distress. Psychological support for caregivers of patients with VS or MCS is necessary. The most frequently used coping strategies were Active and Problem-focused. Acceptance was highly protective, but Denial, Self-blame and Emotion-focused strategies were very negative.
Peripheral vs. central blockade of the renin-angiotensin system in spontaneously hypertensive rats: comparison of novel AT1 receptor antagonist TCV-116 with angiotensin converting enzyme inhibitor delapril

In the present study, we evaluated the hemodynamic and metabolic profiles derived from oral administration of the angiotensin converting enzyme inhibitor, delapril 50mg/kg/day, and the non-peptide angiotensin II type I (AT1) receptor antagonist, TCV-116 1mg/kg/day, for five days, to try to discriminate AT1 receptor-related responses from the depressor properties of chronic treatment with delapril in spontaneously hypertensive rats (SHRs). Both TCV-116 and delapril oral administrations significantly decreased blood pressure without any changes in heart rate. Delapril induced dipsogenic response and natriuresis associated with augmentation of urinary catecholamine excretion, while TCV-116 did not cause any changes in these variables. Neither delapril nor TCV-116 changed urinary excretion of prostaglandin (PG) E2 and 6-keto PG F1α. We also examined the effects of centrally administered angiotensin converting enzyme inhibitor and AT1 receptor antagonist to determine the central role of these drugs.Either the active metabolite of delapril, delapril-M1 1 mg/kg/day, or the active form of TCV-116, CV-11974 0.1mg/kg/day, were administered intracerebroventricularly for five days. Both treatments significantly decreased the blood pressure, in association with augmentation of the baroreceptor reflex control of heart rate, in response to phenylephrine injection. These findings suggest that the depressor properties of orally administered delapril are more complex than those of TCV-116, while central blockade by both angiotensin converting enzyme and AT1 receptor decreases blood pressure in part through baroreceptor sensitization. (Hypertens Res;1993 16: 239-246)
Domestic Violence as a Risk Factor for Maternal Depression and Neonatal Outcomes: A Hospital-Based Cohort Study

Objectives: This study attempted to follow up a cohort of women who presented to a tertiary hospital to investigate the effect of domestic violence on maternal and neonatal outcomes. Materials and Methods: Women, between 26-34 weeks of gestation, attending the obstetrics outpatient department, were recruited and followed up until delivery. They were assessed at recruitment and after delivery using the Edinburgh Postnatal Depression Scale, the Abuse Assessment Screen, and a pro forma to assess socio-demographic and clinical characteristics. Bivariate and multivariate statistics were employed to assess statistical significance. Results: One hundred and fifty women were recruited, 132 delivered in the hospital and were followed up. Domestic violence was associated with antenatal and postnatal depression, spouse's insistence of a boy baby, medical complications during pregnancy, preterm delivery, and lower birth-weight. Conclusion: Domestic violence has a significant impact on maternal and neonatal outcomes. Screening for domestic violence and interventions should be part of all antenatal programs. India should also employ public health approaches to change its patriarchal culture.
COMPARATIVE STUDY ON TEACHING OF BIOETHICS TO HEALTH CARE PERSONS USING DIFFERENT METHODOLOGIES

Introduction: Bioethics has gained lots of importance in the present days and especially very important in the field of medical research. Doctors, medical students, nursing staff and other paramedical staff are directly or indirectly involved in the clinical and research activities. A proper training in bioethics is very essential especially for medical students nursing and other paramedical staff. There are various teaching methodologies like a black board (lecturing), power point presentations, case discussions, group discussions and film/movie clipping related to bioethics . Each of the teaching methodology is effective in a particular group. Materials and methods: Four different teaching methodologies were used to teach bioethics in four different categories namely MBBS students, doctors/interns, nurses and lab technicians. All were exposed to all types of teaching methodology. An evaluation was done by performance based and choice based evaluation system. Results: Case discussion was most popular choice of MBBS students and Doctors/Interns. Among nurses and lab technician’s film discussion was best in terms of performance and choice. Conclusion: Bioethics covers more about abstract issues related to the health discussion on this topic help in better understanding and clarification.
The psychological effects of ostracism following traumatic brain injury

Abstract Primary objective: This study examines the psychological effects of ostracism. It was predicted that adults with brain injury would have an attenuated response to an acute experience of ostracism. Research design: A within-subject, fixed order design was used. The two conditions were ostracism and inclusion. Methods and procedures: A group of 20 adults with severe traumatic brain injury (TBI) were compared with a group of 19 matched control participants. Both groups participated in a pseudo online ball tossing game, Cyberball. On one occasion they were excluded from the game and on the following occasion they were included fairly. Following each game they completed a self-report questionnaire about their experience. Main outcomes and results: Persons with brain injury self-reported negative psychological effects of ostracism including a lower sense of belonging, self-esteem and meaningful existence, however, were affected to a lesser degree than control participants [F(1,37) = 5.39, p = 0.026]. Persons with brain injury also reported that their feelings were hurt to a lesser extent than did control participants, t(37) = 2.10, p = 0.04. Conclusions: These results are discussed in terms of the role of the negative experience of ostracism in motivating and guiding behaviour to re-establish group membership to prevent future social isolation.
Changes in Distressing Behavior Perceived by Family of Persons with Schizophrenia at Home — 25 Years Later

Background: Schizophrenia disorders as well as their symptoms cause distress to the family members or caregivers, which may cause poor quality of life. However, there have been advances in management, which could possibly alter this family distress. Aims: To determine if there was any change in the perception of distressful symptoms of schizophrenia, by the family members, now, 25 years after the initial studies in the same centre. Materials and Methods: Fifty-six consecutive and consenting new cases diagnosed as schizophrenia were administered the Scale for Assessment of Family Distress to identify the amount of distress caused by each of the symptoms reported. These findings were then compared with those reported by 50 patients, 25 years earlier. Results: Symptoms like does not do work and earn, does not sleep, and does not do household tasks were reported as the commonest distressing symptoms in both the samples, however, in the 1988 sample, negative symptoms like, slow in doing things, social withdrawal and has few leisure interests, were the commonest, in the present sample behavioral symptoms like beats and assaults others, threatens, is abusive and talks nonsense were the commonest distressing symptoms. Conclusions: The relatives of patients with schizophrenia suffer from considerable amount of distress and burden. There are some changes in the type of behaviours considered distressful in the current period. Assessing family distress is helpful in providing support to caregivers of persons with schizophrenia
Ability to manage everyday technology after acquired brain injury

Abstract Purpose: To investigate and describe how persons with an acquired brain injury (ABI) manage everyday technology (ET) in their daily activities and to explore whether the ability to manage ET was related to the severity of the disability. Method: Eighty-one persons with ABI were observed while managing ET by using the Management of Everyday Technology Assessment (META). The Glasgow Outcome Scale-Extended (GOSE) was used to assess the severity of disability after the ABI. A computer application of a Rasch measurement model was used to generate measures of the participants’ ability to manage ET and the measures were compared groupwise with analysis of covariance (ANCOVA). Results: The degree of severity of disability had a significant main effect on the ability to manage ET. The groups with severe and moderate disability exhibited a significantly lower ability to manage ET compared to the group with good recovery. Conclusion: The result indicates that the ability to manage ET in daily activities can be related to the global severity of disability after ABI. This demonstrates the importance of considering the ability to manage ET to support the performance of activities at home, at work and in society in persons with ABI.
From scapegoating to thinking and finding a home: delivering therapeutic work in schools

Abstract This paper discusses how the child psychotherapist's core skills can be usefully applied in a school setting. It outlines some of the important policy changes that have necessitated a move towards delivering therapeutic work in community settings such as schools. It is argued that the role of the child psychotherapist in schools has much in common with the role played by the psychotherapist in a therapeutic community. The paper suggests that therapy in schools is in many ways less simple than therapy in clinic settings, and in particular it is often unclear who exactly the client is and at what level to intervene when a referral is made. The referred patient is not necessarily the ‘problem’, so that the child psychotherapist must be prepared to tackle issues in the system to ensure that splitting and projection are reduced, and systems around children can become more containing. Clinical vignettes and one main clinical illustration are used to try to illustrate these points.
Evaluation of Readability of Health Leaflets and Health Literacy of Elderly Inpatients in a Medical Center

Purpose: The purpose of this study was to evaluate the readability of health information leaflets (C. T. consent form and hospital guidelines) and health literacy of elderly inpatients. Methods: The participants were 138 elderly Korean inpatients aged 60 years and over admitted to an advanced general hospital. Readability was assessed by having participants check leaflets for difficulty in reading and then classifying their checked vocabulary by Korean Vocabulary Level book. Health literacy was measured with five open questions on comprehension of the leaflets. Results: The readability for informed consent form was more difficult than that of hospital guidelines because of specialized medical vocabulary. The mean score for health literacy was 1.9 on a 5-point scale. There were statistically significant differences in readability and health literacy by education and religion. The scores for readability of health leaflets and health literacy were negatively correlated, implying that the easier it is to read the vocabulary of the leaflets, the higher the comprehension of the material. The factor that most highly influenced health literacy of elderly inpatients was readability. Conclusion: Health leaflets in medical centers should be written for easy reading by using simpler vocabulary for elderly inpatients to improve their health literacy.
Intentional Self-harm in Children and Adolescents: A Study from Psychiatry Consultation Liaison Services of a Tertiary Care Hospital

Objective: The objective of this study was to evaluate the socio-demographic and the clinical profile of children and adolescents presenting with Intentional self-harm. Materials and Methods: Records of all children and adolescents (≤19 years) seen by the consultation liaison (CL) services during the period of 2000-2012 were screened. Patients with a diagnosis of intentional self-harm (at the time of assessment) were taken up for this study. Data was extracted from the records, to study the socio-demographic and clinical profile. Results: During the study period, 101 patients aged ≤19 years and diagnosed with intentional self-harm at the time of admission were evaluated by the psychiatry CL services in various emergency and medical surgical wards. In the study population, females (N = 61; 60.4%) outnumbered males. The age of the patients ranged from 12 to 19 with a median and mean of 17.0 years (standard deviation-1.6 years; interquartile range 16-18 years). Children and adolescent with self harm were more commonly females, from nuclear families, middle socio-economic status and Hindu by religion. The common method of self-harm in adolescents is by ingestion of insecticides (65%) and the self-harm behavior was often precipitated by interpersonal problems in the family context. About one-fifth of the patients have psychiatric morbidity. Conclusion: Findings suggest that the most common method of intentional self-harm in children and adolescents is consumption of insecticides and precipitated by interpersonal problems in the family context.
Preservation of urine free catecholamines and their free O-methylated metabolites with citric acid as an alternative to hydrochloric acid for LC-MS/MS-based analyses

Abstract Background: Measurements of urinary fractionated metadrenalines provide a useful screening test to diagnose phaeochromocytoma. Stability of these compounds and their parent catecholamines during and after urine collection is crucial to ensure accuracy of the measurements. Stabilisation with hydrochloric acid (HCl) can promote deconjugation of sulphate-conjugated metadrenalines, indicating a need for alternative preservatives. Methods: Urine samples with an intrinsically acidic or alkaline pH (5.5–6.9 or 7.1–8.7, respectively) were used to assess stability of free catecholamines and their free O-methylated metabolites over 7 days of room temperature storage. Stabilisation with HCl was compared with ethylenediaminetetraacetic acid/metabisulphite and monobasic citric acid. Catecholamines and metabolites were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Results: Free catecholamines and their O-methylated metabolites were stable in acidic urine samples over 7 days of room temperature storage, independent of the presence or absence of any stabilisation method. In contrast, free catecholamines, but not the free O-methylated metabolites, showed rapid degradation within 24 h and continuing degradation over 7 days in urine samples with an alkaline pH. Adjustment of alkaline urine samples to a pH of 3–5 with HCl or 4.8–5.4 with citric acid completely blocked degradation of catecholamines. Ethylenediaminetetraacetic acid/metabisulphite, although reducing the extent of degradation of catecholamines in alkaline urine, was largely ineffectual as a stabiliser. Conclusions: Citric acid is equally effective as HCl for stabilisation of urinary free catecholamines and minimises hazards associated with use of strong inorganic acids while avoiding deconjugation of sulphate-conjugated metabolites during simultaneous LC-MS/MS measurements of free catecholamines and their free O-methylated metabolites.
IQ in Autism: Is there an Alternative Global Cognitive Index?

Background: Intelligence quotient (IQ) but not the core symptoms have been known to predict outcomes in autism. Besides resource issues in India, assessing IQ in presence of autistic symptoms is challenging in general. Materials and Methods: In a pilot study, we explored different global indices of development in 30 children with confirmed autism. These included Wechsler intelligence scale for children or Wechsler preprimary scale of intelligence-revised (n = 10), Raven's progressive matrices (RPM) (n = 10), Vineland adaptive behavior scales II, parent report version (VABS) (n = 30) and teacher's estimate of mental age (TIQ) (n = 30). Three subgroups (Group A) with Wechsler's scales derived IQ (WISIQ), (Group B) with RPM derived IQ and (Group C) those without a formal IQ measure were compared. Results: All groups were comparable on age and their scores on Childhood Autism Rating Scale and Indian Scale for Assessment of Autism Adaptive behavior composite scores (Ad Bh composite) derived from VABS and WISIQ showed significant correlations with each other in Group A; TIQ significantly correlated with Ad Bh composite scores, but not with the WISIQ, although the latter two scores themselves did not significantly differ from each other. RPM consistently overestimated children's performance compared to Ad Bh composite or TIQ in Group B, but the Ad Bh composite and TIQ were themselves significantly correlated. In Group C, there were poor correlations between Ad Bh composite and TIQ. The Ad Bh composite score in this group was significantly different from the other two groups. Conclusion: There is a need to fine tune the assessment for global cognitive measures in autism and explore their real world importance.
Psychiatric and Medical Disorders in the after Math of the Uttarakhand Disaster: Assessment, Approach, and Future Challenges

Purpose: To present the descriptive data on the frequency of medical and psychiatric morbidity and also to discuss various pertinent issues relevant to the disaster management, the future challenges and psychosocial needs of the 2013 floods in Uttarakhand, India. Materials and Methods: Observation was undertaken by the disaster management team of National Institute of Mental Health and Neurosciences in the worst affected four districts of Uttarakhand. Qualified psychiatrists diagnosed the patients using the International Classification of Diseases-10 criteria. Data were collected by direct observation, interview of the survivors, group sessions, individual key-informant interview, individual session, and group interventions. Results: Patients with physical health problems formed the majority of treatment seekers (39.6%) in this report. Only about 2% had disaster induced psychiatric diagnoses. As was expected, minor mental disorders in the form of depressive disorders and anxiety disorders formed majority of the psychiatric morbidity. Substance use disorders appear to be very highly prevalent in the community; however, we were not able to assess the morbidity systematically. Conclusions: The mental health infrastructure and manpower is abysmally inadequate. There is an urgent need to implement the National Mental Health Program to increase the mental health infrastructure and services in the four major disaster-affected districts.
Treatment of Acute Ischemic Stroke With Piracetam

Background and Purpose Piracetam, a nootropic agent with neuroprotective properties, has been reported in pilot studies to increase compromised regional cerebral blood flow in patients with acute stroke and, given soon after onset, to improve clinical outcome. We performed a multicenter, randomized, double-blind trial to test whether piracetam conferred benefit when given within 12 hours of the onset of acute ischemic stroke to a large group of patients. Methods Patients received placebo or 12 g piracetam as an initial intravenous bolus, 12 g daily for 4 weeks and 4.8 g daily for 8 weeks. The primary end point was neurologic outcome after 4 weeks as assessed by the Orgogozo scale. Functional status at 12 weeks as measured by the Barthel Index was the major secondary outcome. CT scan was performed within 24 hours of the onset of stroke but not necessarily before treatment. Analyses based on the intention to treat were performed in all randomized patients (n=927) and in an “early treatment” population speci.
Maxillofacial trauma due to a horse hoof kick: Report of a case

Horses have been identified as the major cause of animal-related farm injuries. Interaction with horses may cause severe dental and orofacial trauma, mostly caused by falls, collision with branches when riding in forests or by horse kicks. Children are uniquely prone to animal-related injuries because of inexperience, incomplete physical and cognitive development and a lack of proper training. Horse-related injuries account for a large percentage of injuries of head/maxillofacial trauma in pediatric farm populations. Although soft tissue contusions, lacerations and abrasions are the most common horse-related injures, head/maxillofacial trauma remains the predominant cause of death, especially in pediatric farm populations. The objective of this case report is to describe a case of severe maxillofacial injuries due to a horse hoof kick.