Miracle-dz/UniFAR-FTUs huggingface dataset:
Low rate of performance validity failures among individuals with bipolar disorder

Abstract Objective: Assessing performance validity is imperative in both clinical and research contexts as data interpretation presupposes adequate participation from examinees. Performance validity tests (PVTs) are utilized to identify instances in which results cannot be interpreted at face value. This study explored the hit rates for two frequently used PVTs in a research sample of individuals with and without histories of bipolar disorder (BD). Method: As part of an ongoing longitudinal study of individuals with BD, we examined the performance of 736 individuals with BD and 255 individuals with no history of mental health disorder on the Test of Memory Malingering (TOMM) and the California Verbal Learning Test forced choice trial (CVLT-FC) at three time points. Results: Undiagnosed individuals demonstrated 100% pass rate on PVTs and individuals with BD passed over 98% of the time. A mixed effects model adjusting for relevant demographic variables revealed no significant difference in TOMM scores between the groups, a = . 07, SE = . 07, p = . 31. On the CVLT-FC, no clinically significant differences were observed (ps < .001). Conclusions: Perfect PVT scores were obtained by the majority of individuals, with no differences in failure rates between groups. The tests have approximately >98% specificity in BD and 100% specificity among non-diagnosed individuals. Further, nearly 90% of individuals with BD obtained perfect scores on both measures, a trend observed at each time point.
Evaluation of pharmacist time dedicated to vancomycin dosing in adult patients using a 24-hour AUC nomogram or trough monitoring approach: A time motion study.

DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Evidence-based guideline recommendations for vancomycin dosing recently shifted from a trough-based strategy to an area under the curve (AUC) approach. While several AUC dosing methods exist, the optimal approach has not been determined. Literature characterizing time requirements for various vancomycin dosing strategies remains limited. METHODS A time and motion study was conducted to measure the time spent by clinical pharmacists dosing vancomycin using an AUC nomogram. Pharmacists who dosed and monitored vancomycin for adult patients on the general medical ward (GMW) or intensive care unit (ICU) of a large academic medical center consented to study participation. Vulnerable patients and vancomycin orders for surgical infection prophylaxis were excluded. The primary outcome was the median amount of time clinical pharmacists dedicated to vancomycin-related clinical activities during an 8-hour weekday shift. Secondary outcomes included the proportion of patients prescribed vancomycin at the beginning of each shift and factors contributing to greater than average time spent on vancomycin-related responsibilities. RESULTS Seven clinical pharmacists collected data on 178 vancomycin orders. The estimated amount of time a clinical pharmacist spent on daily vancomycin responsibilities averaged 10.45 minutes (interquartile range [IQR], 6.94-15.8 minutes). The overall median time requirement per vancomycin assessment was 3.45 minutes (IQR, 1.95-6.7 minutes). The only factor independently associated with prolonged dosing time was follow-up dosing from a previous day. CONCLUSION The study elucidated time requirements associated with an AUC nomogram-based vancomycin dosing approach. This data could be used to compare time requirements associated with other existing vancomycin dosing strategies, which may help healthcare systems determine the optimal AUC dosing method for their specific practice model.
Shiitake dermatitis: experience of the Poison Control Centre Network in France from 2014 to 2019

Abstract Objective Shiitake mushrooms (Lentinus edodes) are an edible fungus, initially grown in Japan and China that are increasingly marketed in Europe. We previously presented 15 shiitake dermatitis cases reported to Poison Control Centres (PCCs) in France from January 2000 to December 2013. The aim of this study was to describe changes in the number of shiitake dermatitis cases since 2014, and to better describe the clinical characteristics and risk factors of this reaction. Case series This observational study is a retrospective review of cases in the French PCCs database between 1 January 2014 and 31 December 2019. Out of 125 shiitake exposures, we identified 59 cases of dermatitis: sex ratio of 1.80 M/F; ages ranging from 19 to 69 years (median: 39 years). Dermatitis occurred after raw or undercooked shiitake consumption (e.g., from the wok, in soup, or on pizza). The rash appeared 1–168 h (median: 48 h) after shiitake ingestion. Linear, erythematous, urticarial papules and plaques developed across the trunk, arms, and legs within a few hours and persisted for 1–40 d (median 10 d). The amount of shiitake eaten (low vs. medium vs. high) significantly increased the duration of dermatitis (median days 4 vs. 7 vs. 15, respectively; p = .007). In all, 38 patients received corticosteroids, antihistamine drugs, or both without demonstrated benefit. All patients made a complete recovery. Conclusions The mechanism of shiitake dermatitis is thought to involve lentinan, a heat-labile polysaccharide component. Inadequate cooking clearly seems to be a driver of the occurrence of shiitake dermatitis. This study highlighted a dose-dependent response, suggesting a partial toxic mechanism or a th1-type hypersensitivity mechanism. Treatment is focused on symptom management. Health professionals and the general population should be aware of both the risk associated with inadequately cooked shiitake consumption and the favourable prognosis of this still poorly known toxic dermatitis.
Blood flow restriction during self-paced aerobic intervals reduces mechanical and cardiovascular demands without modifying neuromuscular fatigue

ABSTRACT This study examined cardiovascular, perceptual and neuromuscular fatigue characteristics during and after cycling intervals with and without blood flow restriction (BFR). Fourteen endurance cyclists/triathletes completed four 4-minute self-paced aerobic cycling intervals at the highest sustainable intensity, with and without intermittent BFR (60% of arterial occlusion pressure). Rest interval durations were six, four and four minutes, respectively. Power output, cardiovascular demands and ratings of perceived exertion (RPE) were averaged over each interval. Knee extension torque and vastus lateralis electromyography responses following electrical stimulation of the femoral nerve were recorded pre-exercise, post-interval one (+1, 2 and 4-minutes) and post-interval four (+1, 2, 4, 6 and 8-minutes). Power output during BFR intervals was lower than non-BFR (233 ± 54 vs 282 ± 60 W, p < 0.001). Oxygen uptake and heart rate during BFR intervals were lower compared to non-BFR (38.7 ± 4.5 vs 44.7 ± 6.44 mL kg−1 min−1, p < 0.001; 160 ± 14 vs 166 ± 10 bpm, p < 0.001), while RPE was not different between conditions. Compared to pre-exercise, maximal voluntary contraction torque and peak twitch torque were reduced after the first interval with further reductions following the fourth interval (p < 0.001) independent of condition (p = 0.992). Voluntary activation (twitch interpolation) did not change between timepoints (p = 0.375). Overall, intermittent BFR reduced the mechanical and cardiovascular demands of self-paced intervals without modifying RPE or knee-extensor neuromuscular characteristics. Therefore, BFR reduced the cardiovascular demands while maintaining the muscular demands associated with self-paced intervals. Self-paced BFR intervals could be used to prevent cardiovascular and perceptual demands being the limiting factor of exercise intensity, thus allowing greater physiological muscular demands compared to intervals without BFR. Highlights The use of blood flow restriction (BFR) during self-paced intervals (at the highest perceived sustainable intensity) causes a reduction in power output, pulmonary oxygen uptake and heart rate compared with non-restricted self-paced intervals. Despite lower mechanical and physiological demands during BFR cycling, the magnitude and aetiology of neuromuscular fatigue were not different to intervals without BFR, indicating the internal muscular load during BFR was elevated and potentially equivalent compared to without BFR. Self-paced intervals could be a suitable model to prescribe aerobic BFR exercise as an adjunct training stimulus for endurance cyclists.
Helping Children to Participate in Human Papillomavirus–Related Discussions: Mixed Methods Study of Multimedia Messages

Background Human papillomavirus (HPV) can cause several types of cancers and genital warts. A vaccine is available to prevent HPV infections, and several efforts have been made to increase HPV education and, eventually, vaccination. Although previous studies have focused on the development of messages to educate children about HPV and the existence of the HPV vaccine, limited research is available on how to help children better communicate with their parents and health care professionals about the HPV vaccination. In addition, limited research is available on the target audience of this study (Italian children). Objective This manuscript describes a study assessing the feasibility of using an evidence-based animated video and a web-based game to help children (aged 11-12 years) participate in discussions about their health—in particular when such conversations center around the HPV vaccination—and improve several HPV-related outcomes. The study also compares the effects of these 2 educational multimedia materials on children’s knowledge and perceptions of HPV prevention. Methods A mixed methods approach consisting of focus group discussions and an experiment with children (N=35) was used to understand children’s experiences with, and perceptions of, the animated video and the game and to measure possible improvements resulting from their interaction with these materials. Results Both the animated video and a web-based game increased children’s knowledge and positive perceptions about HPV and HPV vaccination. Any single message was not more effective than the others. The children discussed aspects of the features and characters they liked and those that need improvements. Conclusions This study shows that both materials were effective for improving children’s education about the HPV vaccine and for helping them to feel more comfortable and willing to communicate with their parents and health care professionals about their health. Several elements emerged that will allow further improvements in the design and development of the messages used in this study as well as the creation of future campaigns.
Efficiency of a randomized confirmatory basket trial design constrained to control the family wise error rate by indication

Basket trials pool histologic indications sharing molecular pathophysiology, improving development efficiency. Currently, basket trials have been confirmatory only for exceptional therapies. Our previous randomized basket design may be generally suitable in the resource-intensive confirmatory phase, maintains high power even with modest effect sizes, and provides nearly k-fold increased efficiency for k indications, but controls false positives for the pooled result only. Since family wise error rate by indications may sometimes be required, we now simulate a variant of this basket design controlling family wise error rate at 0.025k, the total family wise error rate of k separate randomized trials. We simulated this modified design under numerous scenarios varying design parameters. Only designs controlling family wise error rate and minimizing estimation bias were allowable. Optimal performance results when k = 3 , 4 . We report efficiency (expected # true positives/expected sample size) relative to k parallel studies, at 90% power (“uncorrected”) or at the power achieved in the basket trial (“corrected,” because conventional designs could also increase efficiency by sacrificing power). Efficiency and power (percentage active indications identified) improve with a higher percentage of initial indications active. Up to 92% uncorrected and 38% corrected efficiency improvement is possible. Even under family wise error rate control, randomized confirmatory basket trials substantially improve development efficiency. Initial indication selection is critical.
Structural patterns in class 1 major histocompatibility complex‐restricted nonamer peptide binding to T‐cell receptors

The startling diversity in αβ T‐cell receptor (TCR) sequences and structures complicates molecular‐level analyses of the specificity and sensitivity determining T‐cell immunogenicity. A number of three‐dimensional (3D) structures are now available of ternary complexes between TCRs and peptides: major histocompatibility complexes (pMHC). Here, to glean molecular‐level insights we analyze structures of TCRs bound to human class I nonamer peptide–MHC complexes. Residues at peptide positions 4–8 are found to be particularly important for TCR binding. About 90% of the TCRs hydrogen bond with one or both of the peptide residues at positions 4 and 8 presented by MHC allele HLA‐A2, and this number is still ~79% for peptides presented by other MHC alleles. Residue 8, which lies outside the previously‐identified central peptide region, is crucial for TCR recognition of class I MHC‐presented nonamer peptides. The statistics of the interactions also sheds light on the MHC residues important for TCR binding. The present analysis will aid in the structural modeling of TCR:pMHC complexes and has implications for the rational design of peptide‐based vaccines and T‐cell‐based immunotherapies.
Verbal Memory Interference in Attention-Deficit Hyperactivity Disorder: A Meta-Analytic Review

Objective: Interference control is used to overcome conflict among competing memory representations and may contribute to memory difficulties in ADHD. This meta-analytic review examined memory interference to evaluate susceptibility to proactive, retroactive, and memory control interference among those with ADHD. Method: Twenty studies (1987–2019) examining verbal memory interference in ADHD met inclusion criteria (age: 8–36 years). Proactive and retroactive interference indices were extracted from list-learning tasks, and memory control indices were extracted from experimental paradigms (e.g., directed-forgetting). Results: Children with ADHD were less affected by proactive interference (g=−0.53, 95% CI [−0.75, −0.31]), whereas no significant differences were found in adults (g=0.13, 95% CI [−0.02, 0.28]). Adults and children with ADHD exhibited more retroactive interference (g=0.17, 95% CI [0.05, 0.29]) and performed worse on memory control tasks (g=0.35, 95% CI [0.08, 0.62]) relative to controls. Conclusion: Differences in verbal memory interference control in ADHD were observed but effects were different depending upon interference type and participant age.
Risk Factors and Multidimensional Assessment of Long-COVID Fatigue: A Nested Case-Control Study

Abstract Summary Long-COVID fatigue substantially correlates with depression and poorer sleep. Decreased peak exercise heart rate, which may reflect mild autonomic dysfunction, and long-COVID memory impairment, are independent risk factors for long-COVID fatigue. Background Fatigue is the most prevalent and debilitating long-COVID (coronavirus disease) symptom; however, risk factors and pathophysiology of this condition remain unknown. We assessed risk factors for long-COVID fatigue and explored its possible pathophysiology. Methods This was a nested case-control study in a COVID recovery clinic. Individuals with (cases) and without (controls) significant fatigue were included. We performed a multidimensional assessment evaluating various parameters, including pulmonary function tests and cardiopulmonary exercise testing, and implemented multivariable logistic regression to assess risk factors for significant long-COVID fatigue. Results A total of 141 individuals were included. The mean age was 47 (SD: 13) years; 115 (82%) were recovering from mild coronavirus disease 2019 (COVID-19). Mean time for evaluation was 8 months following COVID-19. Sixty-six (47%) individuals were classified with significant long-COVID fatigue. They had a significantly higher number of children, lower proportion of hypothyroidism, higher proportion of sore throat during acute illness, higher proportions of long-COVID symptoms, and of physical limitation in daily activities. Individuals with long-COVID fatigue also had poorer sleep quality and higher degree of depression. They had significantly lower heart rate [153.52 (22.64) vs 163.52 (18.53); P = . 038] and oxygen consumption per kilogram [27.69 (7.52) vs 30.71 (7.52); P = . 036] at peak exercise. The 2 independent risk factors for fatigue identified in multivariable analysis were peak exercise heart rate (OR: .79 per 10 beats/minute; 95% CI: .65–.96; P = .019) and long-COVID memory impairment (OR: 3.76; 95% CI: 1.57–9.01; P = .003). Conclusions Long-COVID fatigue may be related to autonomic dysfunction, impaired cognition, and decreased mood. This may suggest a limbic-vagal pathophysiology. Clinical Trials Registration clinicaltrials.gov; NCT04851561.
Experiences of participation in activities among girls with juvenile idiopathic arthritis: A qualitative study

This study aimed to describe how girls with juvenile idiopathic arthritis (JIA) experience participation in activities in relation to their disease. Semi-structured interviews of eight girls with JIA in ages 12–15 were recorded and transcribed as a whole. Data have been analysed with qualitative content analysis. Participation was influenced by disease symptoms, which could result in absence and exclusion from participation in activities. The experience of participation was affected by the participant’s choice of using strategies and making adjustments during activities. Social environment could both increase and decrease participation through treatment and type of knowledge about the disease. Also the physical environment could affect participation due to the climate or road and ground conditions. We could conclude that the experience of participation among girls with JIA was affected by disease symptoms, perceptions of selves, disease and the use of strategies, and also the social and physical environment. This indicates the need to address participation in clinical practice and the importance to include different health professionals, teachers and other personnel involved in the child’s schooling.
Integrated skin sensitization assessment based on OECD methods (I): Deriving a point of departure for risk assessment.

Three guidelines covering key events in the skin sensitization adverse outcome pathway are endorsed by the Organisation for Economic Co-operation and Development (OECD). A recent guideline covers Defined Approaches (DA) to combine data from these tests for regulatory (sub)-classification. These methods provide continuous data that could characterize the sensitization potency on a more granular scale beyond (sub)-classifications. We assembled a comprehensive database on in vitro and in vivo tests in OECD methods. Building on a previous approach using regression models, we provide quantitative models using input data from the kinetic Direct Peptide Reactivity Assay (kDPRA), the KeratinoSens™ (KS) assay and the human Cell Line Activation Test (h-CLAT) to calculate a point of departure (PoD) in the form of a predicted Local Lymph Node Assay (LLNA) EC3 value for use in risk assessment. Predictive models include results from either two or all three assays. Detailed analysis vs. in vivo data estimates redundancy between different tests and helps guide model selection. All models were tested on a set of case studies selected on their availability of multiple LLNA reference data in the OECD database. The predicted PoD were within or close to the area of the variation of the historical LLNA data for most of these cases studies, and overall, the models predict the in vivo value with a median fold-misprediction of a factor of around 2.5. The robustness of the models was characterized by comparing a comprehensive historical database vs. the curated dataset provided by the OECD working group on DA.
Realist review of interprofessional education for health care students: What works for whom and why

ABSTRACT Interprofessional education (IPE) programs, are complex, logistically challenging, and can be expensive to deliver, but these matters are offset by the perceived benefits of IPE. There is little clarity regarding how IPE contributes to the desirable development of collaborative practitioners. To guide educators in the design of IPE programs there is a need to understand the elements that promote optimal learning. A realist review was conducted to identify the mechanisms and resources that contribute to IPE outcomes. Four databases were searched until April 2020 for empirical studies describing mandatory IPE for pre-registration medical, nursing and other health professional students. Twelve articles met the inclusion criteria. Two novel learning design elements were identified; interdependence, where there is a need for genuine contribution of skills and knowledge from the professions learning together to successfully complete tasks, and embodiment, where through being immersed in an authentic scenario, learners feel what it is like to work in their professions. Other observations supported previous research findings such as the importance of skilled facilitators to promote interaction and reflection. Interprofessional interventions incorporating these specific learning design features seem likely to enhance the impact of IPE, thus making the best use of limited institutional resources and student time.