bluuebunny/crossref_metadata_2025 huggingface dataset:
Affective Disorders
Authors: Rogers Cynthia , Luby Joan L.
Published: December 2019

There is substantial evidence for symptoms of affective distrubances in high-risk infants and toddlers. Significant progress has been made in characterizing and validating clinical depression in the preschool period. Identification of affective disorders in the infancy and preschool periods may be critical to early and potentially more effective intervention. However, the accurate identification of affective disorders in this very young age group is complicated by several factors. A central issue was the basic developmental question of whether the emotional repertoire was itself sufficiently differentiated to encompass true “depressive” and/or “elated” affect during early life. However, empirical studies have shown that many of these emotional capacities are present in early childhood. Further, a significant limitation was the fact that many standard assessment tools failed to describe the developmentally specific manifestations of symptoms, an issue that measures described in this chapter now address. The fact that the symptoms of depressive disorders are internalizing, and therefore less apparent to caregivers, is an obstacle to appropriate referral. For these reasons, an assessment for the symptoms of affective disorders in infants and toddlers should include direct observational play assessment, parental interview that probes for developmental manifestation of affective symptoms and consideration of normative variations in affect that must be distinguished from clinical symptoms.

This chapter will discuss strategies useful for the assessment of affective symptoms and disorders in infants and toddlers. Data supporting major depressive disorder criteria for preschoolers will be reviewed. Case examples of preschool children with depression and a presumptive bipolar subsyndrome will be presented.
Social Processes and Risk for Autism
Authors: Klaiman Cheryl , Saulnier Celine A. , Rubin Emily , Chawarska Katarzyna , Klin Ami
Published: December 2019

This chapter provides an overview of early milestones for social development and discusses the markers for social disabilities, such as autism spectrum disorder, that can be identified in children at risk. The principles and elements of a comprehensive clinical evaluation of infants and toddlers at risk for autism spectrum disorder will be discussed, including how to differentiate social disabilities from non–autism spectrum disorder developmental disorders. While some of these principles can build on proven experience in the assessment of older children (Klin, Carter, & Sparrow, 1997), there is an emphasis on unique challenges and opportunities associated with our attempt to intuit, measure, and explain social development at these tender ages (Chawarska, Klin, Paul, Macari, & Volkmar, 2009; Macari et al., 2012; Zwaigenbaum et al., 2009).
Epilogue and Future Directions
Authors: Carter Alice S. , DelCarmen-Wiggins Rebecca
Published: December 2019

The second edition of the Oxford Handbook of Infant, Toddler, and Preschool Mental Health Assessment offers historical understandings and highlights recent enhancements in the assessment of infant, toddler, and preschool mental health. Authors present empirical findings across a variety of assessment methods and measures developed to capture variability in normative and psychopathological social-emotional development, including assessments of multiple dimensions of temperament, emotion regulation and dysregulation, behavior problems, social-emotional competencies, diagnostic symptoms, and diagnostic conditions. Notable in this edition is the consensus regarding the importance of identifying and assessing the relevant relational contexts in which early development is fostered. Also emphasized is the need for professionals to enhance their cultural awareness and responsiveness. Finally, greater dissemination of evidence-based young child mental health assessment methods is encouraged, which will require training interdisciplinary professionals in the cultural and domain expertise to identify and evaluate children with and at risk for clinically significant psychopathology.
Introduction
Authors: DelCarmen-Wiggins Rebecca , Carter Alice S.
Published: December 2019

This chapter introduces the revised volume and notes that the book highlights the most recent empirical data and conceptual developments in the field. Each chapter is introduced within four major sections of the volume including (1) Contextual Factors in Early Assessment; (2) Temperament and Regulation in Assessment of Young Children; (3) Early Problems and Disorders; and (4) Translation and Varied Applied Settings for Assessment. It notes that developmental, social, and cultural contexts in relation to the assessment of early problems and disorders are included in the volume in hopes that the field will continue to generate and empirically test multilevel, systemic models that can be applied to the assessment and understanding of mental disorders in infants, toddlers, preschoolers, and their families.
Historical Background of the Study of Temperament and New Perspectives on Assessment
Authors: Putnam Samuel P. , Gartstein Maria A. , Rothbart Mary K.
Published: December 2019

Although developmental scientists have acknowledged the importance of early-appearing, relatively stable, biologically rooted individual differences in the behavior of infants and children for nearly 100 years, advances continue to be made in the measurement of temperament. A fundamental challenge in this endeavor concerns the difficulty of assessing the same underlying constructs in persons of different ages because the behaviors that indicate a given trait may change over the life span. Questionnaires and interviews, particularly with parents, are frequently used and can efficiently provide deep and broad information on child behavior, but concerns have been raised regarding bias in reporting. Structured observations allow observation of specific behaviors of individuals in standardized situations, but are often brief and artificial. This chapter describes and critiques the various methodologies used to assess multiple aspects of reactivity and regulation in infants and children and recommends new directions for temperament measurement.
Infant Temperament and Early Self-Regulation
Authors: Tan Patricia , Cole Pamela M.
Published: December 2019

This chapter provides a clinically informed review of the available methods for assessing individual differences in young children’s emotional reactivity and regulation. Self-report and informant report as well as behavioral observations are reviewed in terms of strengths and challenges. The authors highlight the advantages of a multimethod approach for assessing temperamental influences on important developmental outcomes, including emotion regulation. A multimethod approach may produce more reliable measures and, critically, can advance our understanding of the development of emotion regulation and psychopathology. For example, multimethod assessment approaches are more amenable to statistical approaches that can quantify the effects of context on relations between temperament, emotion regulation, and developmental outcomes. If a multimethod approach that combines informant report and behavioral assessment methods is not feasible, it is especially important to choose a questionnaire or behavioral episode that is thought to elicit the temperamental dimensions and emotion regulation skills that are particularly relevant for certain disorders.
Inclusive Music Classrooms and Programs
Authors: Jellison Judith A.
Published: December 2019

This article focuses on the musical development of students in inclusive music settings. Five broad guidelines for inclusive music programs are discussed: inclusive programs are those where (1) students with disabilities attend regular music classrooms in their schools, and are not isolated from their peers without disabilities; (2) students with disabilities interact with their same-age, typically developing peers and participate with them in regular music classes and other age-appropriate school music activities; (3) music and music-related goals are flexible and individualized and instruction is not solely based on disability categories; (4) progress is assessed in a variety of contexts; and (5) music teachers, professionals, and parents collaborate in determining what is important for students to learn and ways to incorporate special supports and services into age-appropriate school, home, and community music activities and experiences. The ultimate goal for inclusive music programs is to develop learning environments where students both with and without disabilities participate successfully and happily in meaningful music experiences.
Elders and Music: Empowering Learning, Valuing Life Experience, and Considering the Needs of Aging Adult Learners
Authors: Dabback William M. , Smith David S.
Published: December 2019

Evidence suggests that music participation and learning provides meaningful engagement for elders as well as biological, social, and psychosocial benefits. This article examines important threads in aging, music research, and music education practice with regards to the older adult populations. It presents guiding principles of music teaching and learning for older adults, and examples of programs and models from around the world.
Music and the Arts: As Ubiquitous and Fundamental as the Air We Breathe
Authors: Upitis Rena B.
Published: December 2019

This article begins with a brief discussion of music as a ubiquitous art form. It then considers the disconnect between music curriculum and the music enjoyed by students and pre-service teachers. It suggests that if educators ignore the personal connections students have to music, then they are missing an opportunity to expand music literacy beyond the music forms that are already ubiquitous in their lives. Such expansion can help ensure that music is experienced deeply. And it is the deep connections that enable students to develop the sensibilities and skills needed to thrive in the world.
Implicature
Authors: Davis Wayne A.
Published: December 2019

Implicature as applied to speakers is the act of meaning that one thing is the case by saying that something else is. It is an indirect speech act closely related to implying. Semantic implicatures are determined by the meaning of the sentence used, whereas conversational implicatures depend on the context of utterance. General forms of implicature, used frequently with a wide variety of sentences and languages, include figures of speech (irony, hyperbole, meiosis, litotes, metonymy, synecdoche, metaphor) and modes of speech (relevance, strengthening, limiting, and metalinguistic implicature, damning with faint praise, and loose use). These forms are conventional ways of using and understanding speech, essential for fully understanding speakers, and acquired at an early age along with lexical and semantic conventions. A sentence has an implicature when speakers conventionally use sentences of that form with the corresponding implicature. In addition to the semantic implicatures, sentences have a variety of generalized conversational implicatures, including some limiting implicatures, strengthening implicatures, ignorance implicatures, common metaphors, and embedded implicatures. Implicatures become idioms when they cease to be indirect. There are many reasons why speakers implicate things. Some also apply to saying (communication, self-expression, record creation) while some distinguish implicating from saying (verbal efficiency, misleading without lying, veiling, good social relations, style, and entertainment). A sentence has an implicature today because that use became self-perpetuating and was picked up by today’s speakers from previous speakers. Traditional pragmatic theories maintain that conversational implicatures can be derived from various principles governing conversation, but the dependence of implicature on intention and convention, and the variety of conflicting goals implicature serves, make such derivations unsound and invalid. Like understanding sentences, interpreting implicatures is largely the automatic exercise of a competence acquired with one’s native language rather than derivation from general principles.
The impact of the Luton social prescribing programme on mental well-being: a quantitative before-and-after study
Authors: Pescheny Julia V , Gunn Laura H , Pappas Yannis , Randhawa Gurch
Published: December 2019

Background

Social prescribing programmes expand the range of options available to primary care health professionals to address patients’ psychosocial needs, impacting on their health and well-being. The objective of this study was to assess the change in the mental well-being of service users after participation in the Luton social prescribing programme.

Methods

Skew-normal (SN) regression was applied to analyse the change in mental well-being post-intervention (N = 63). The short Warwick–Edinburgh mental well-being scale was used as the outcome measure.

Results

The SN regression found a statistically significant change (P < 0.0001) in the average difference score between baseline and post-intervention measures. However, the observed change does not appear to be of clinical relevance. No significant associations in mental well-being scores by gender, age or working status were found.

Conclusion

Findings of this study indicate that social prescribing may have the potential to improve the mental well-being of service users. The study findings contribute to the sparse evidence base on social prescribing outcomes by socio-demographic characteristics of participants and highlight the importance of considering subgroup analysis in future research.
COMPARISON OF METHODS FOR NEUTRON DETECTION SYSTEM NON-LINEARITY ASSESSMENT
Authors: Bílý T , Keltnerová L
Published: December 2019

Linearity of response belongs to fundamental characteristics of neutron detection systems. Research reactors are valuable tools for neutron detector non-linearity studies as they offer a wide range of neutron fluxes. For neutron detection systems working in pulse mode they enable to characterise detector response non-linearity from some hundreds of cps up to the maximum reachable count rates. The paper presents comparison of two methods for neutron pulse-mode detector non-linearity characterisation using VR-1 zero power reactor: (1) comparative method utilising the comparison of studied pulse-mode detection system with a response of gamma compensated ionisation chamber working in current mode, and (2) kinetics method utilising the asymptotic exponential power rise after positive reactivity insertion as a source of information on true signal. Further several approaches for dead time determination based on theoretical formulae describing paralysable and non-paralysable dead time behaviour of detectors were studied and their usability to characterise the count-rate dependent detector response was analysed.
Local Bankruptcy and Geographic Contagion in the Bank Loan Market*
Authors: Addoum Jawad M , Kumar Alok , Le Nhan , Niessen-Ruenzi Alexandra
Published: December 2019

We examine whether corporate bankruptcies influence bank loan characteristics of geographically proximate firms. Controlling for industry contagion and local economic conditions, firms headquartered near a bankruptcy event experience a 7 basis point increase in loan spreads. The effect is transitory and cannot be fully explained by local correlated information or lenders’ financial health. Instead, the effect is more pronounced for informationally opaque bankruptcies and borrowers, and weakened among loans with relationship lenders and lenders with significant local presence.
Exploring Mechanistic Toxicity of Mixtures Using PBPK Modeling and Computational Systems Biology
Authors: Ruiz Patricia , Emond Claude , McLanahan Eva D , Joshi-Barr Shivanjali , Mumtaz Moiz
Published: December 2019

Mixtures risk assessment needs an efficient integration of in vivo, in vitro, and in silico data with epidemiology and human studies data. This involves several approaches, some in current use and others under development. This work extends the Agency for Toxic Substances and Disease Registry physiologically based pharmacokinetic (PBPK) toolkit, available for risk assessors, to include a mixture PBPK model of benzene, toluene, ethylbenzene, and xylenes. The recoded model was evaluated and applied to exposure scenarios to evaluate the validity of dose additivity for mixtures. In the second part of this work, we studied toluene, ethylbenzene, and xylene (TEX)-gene-disease associations using Comparative Toxicogenomics Database, pathway analysis and published microarray data from human gene expression changes in blood samples after short- and long-term exposures. Collectively, this information was used to establish hypotheses on potential linkages between TEX exposures and human health. The results show that 236 genes expressed were common between the short- and long-term exposures. These genes could be central for the interconnecting biological pathways potentially stimulated by TEX exposure, likely related to respiratory and neuro diseases. Using publicly available data we propose a conceptual framework to study pathway perturbations leading to toxicity of chemical mixtures. This proposed methodology lends mechanistic insights of the toxicity of mixtures and when experimentally validated will allow data gaps filling for mixtures’ toxicity assessment. This work proposes an approach using current knowledge, available multiple stream data and applying computational methods to advance mixtures risk assessment.
High diversity in the Pseudechiniscus suillus–facettalis complex (Heterotardigrada: Echiniscidae) with remarks on the morphology of the genus Pseudechiniscus
Authors: Grobys Daria , Roszkowska Milena , Gawlak Magdalena , Kmita Hanna , Kepel Andrzej , Kepel Marta , Parnikoza Ivan , Bartylak Tomasz , Kaczmarek Łukasz
Published: December 2019

Pseudechiniscus is a morphologically homogeneous genus of tardigrades. The morphological features commonly used for species discrimination in this genus are the dorsal sculpture, the shape and number of dorsal plates and trunk appendages. Species of the Pseudechiniscus suillus–facettalis complex are one of the most challenging tardigrades to identify. All species are similar in their general appearance and all lack trunk appendages. Moreover, not only the nominal Pseudechiniscus suillus, but also other members of the suillus–facettalis complex have been insufficiently described. In our study, we examined several populations from the Northern and the Southern Hemispheres that could be traditionally attributed to Pse. suillus. These populations were analysed using integrative taxonomy – a combination of classical morphology and morphometry with molecular data. Besides the differences in the dorsal sculpture and morphometry, we also found species-specific differences in ventral sculpture, which were originally used for discrimination of Pseudechiniscus species. Moreover, we provide an extensive discussion on all morphological and morphometric differences used in Pseudechiniscus taxonomy and indicate main taxonomic problems with this genus. Finally, we redescribe the nominal Pse. suillus from Italy.
Postoperative Nausea and Vomiting After Craniotomy: An Evidence-based Review of General Considerations, Risk Factors, and Management
Authors: Uribe Alberto A. , Stoicea Nicoleta , Echeverria-Villalobos Marco , Todeschini Alexandre B. , Esparza Gutierrez Alan , Folea Antonia R. , Bergese Sergio D.
Published: December 2019

One of the most common and distressing symptoms after craniotomy is postoperative nausea and vomiting (PONV). PONV could generate delayed postanesthesia care and hospitalization discharge, lower patient satisfaction, and an increase in overall hospitalization costs. The incidence of reported PONV after craniotomy is 22% to 70% without prophylaxis, and a multimodal regimen of medication has been recommended. We conducted a comprehensive literature review of the clinical evidence related to PONV prevention and management after craniotomy. All clinical trials in adult populations relevant to PONV after craniotomy available in English language and indexed in PubMed, Google Scholar and Cochrane Library databases from January 1997 up to September 2018 were retrieved using a combination of free-text words related to PONV in craniotomy. After screening manuscripts identified in the initial search, 23 clinical trials investigating systemic pharmacological intervention versus placebo or active control in patients undergoing craniotomy under general anesthesia met the criteria for inclusion in this comprehensive narrative review. The pathophysiology and mechanisms of PONV after craniotomy could be multifactorial in etiology. Therefore, based on current evidence, PONV management after craniotomy should focus on perioperative patient assessment, surgical, and anesthesia-related risk factors and the selection of systemic pharmacological considerations to reduce its incidence and complications. A multimodal regimen of medication targeting different chemoreceptors in the vomiting center is recommended. Ondansetron and dexamethasone, or their combination, are the most frequently used and effective agents. Further randomized clinical trials comparing different regimens that significantly reduce the incidence of PONV in craniotomy would provide relevant evidence-based data for PONV management in this patient population.
Review of the effect of air pollution exposure from industrial point sources on asthma-related effects in childhood
Authors: Buteau Stéphane , Geng Xiaohui , Labelle Remi , Smargiassi Audrey
Published: December 2019

We reviewed epidemiologic studies of the association between exposure to air pollution from industries and asthma-related outcomes in childhood. We searched bibliographic databases and reference lists of relevant articles to identify studies examining the association between children’s exposure to air pollution from industrial point-sources and asthma-related outcomes, including asthma, asthma-like symptoms, wheezing, and bronchiolitis. We extracted key characteristics of each study and when appropriate we performed a random-effects meta-analysis of results and quantified heterogeneity (I
2). Thirty-six studies were included in this review. Meta-analysis was generally not possible and limited to a few studies because of substantial variation across design characteristics and methodologies. In case-crossover studies using administrative health data, pooled odds ratio (OR) of hospitalization for asthma and bronchiolitis in children <5 years were 1.02 [95% confidence intervals (CI): 0.96, 1.08; I
2 = 56%] and 1.01 (95% CI: 0.97, 1.05; I
2 = 64%) per 10 ppb increase in the daily mean and hourly maximum concentration of sulfur dioxide (SO2), respectively. For PM2.5, pooled ORs were 1.02 (95% CI: 0.93, 1.10; I
2 = 56%) and 1.01 (95% CI: 0.98, 1.03 I
2 = 33%) per 10 μg/m3 increment in the daily mean and hourly maximum concentration. In cross-sectional studies using questionnaires, pooled ORs for the prevalence of asthma and wheezing in relation to residential proximity to industry were 1.98 (95% CI: 0.87, 3.09; I
2 =71%) and 1.33 (95% CI: 0.86, 1.79; I
2= 65%), respectively. In conclusion, this review showed substantial heterogeneity across study designs and methods. Meta-analysis results suggested no evidence of an association for short-term asthma-related effects and an indication for long-term effects, but heterogeneity between results and limitations in terms of design and exposure assessment preclude drawing definite conclusions. Further well-conducted studies making use of a longitudinal design and of refined exposure assessment methods are needed to improve risk estimates.
Dried Blood Microsampling-Based Therapeutic Drug Monitoring of Antiepileptic Drugs in Children With Nodding Syndrome and Epilepsy in Uganda and the Democratic Republic of the Congo
Authors: Velghe Sofie , Delahaye Lisa , Ogwang Rodney , Hotterbeekx An , Colebunders Robert , Mandro Michel , Idro Richard , Stove Christophe P.
Published: December 2019

Nodding syndrome is a highly debilitating, generalized seizure disorder, affecting children in subregions of sub-Saharan Africa. Despite numerous efforts to uncover the etiology, the exact cause of this syndrome still remains obscure. Therefore, to date, patients only receive symptomatic care, including the administration of first-generation antiepileptic drugs for seizure control. As data on the efficacy of drugs within this population are completely lacking, the aim of this study was to explore how therapeutic drug monitoring could help to understand the differential response to therapy. Considering the challenging environment in which sampling had to be performed (remote areas, devoid of electricity, running water, etc), dried blood matrices [ie, dried blood spots (DBSs)] and volumetric absorptive microsampling (VAMS) were considered fit-for-purpose. In addition, owing to the similarities between the syndrome and other forms of epilepsy, samples originating from patients suffering from (onchocerciasis-associated) epilepsy were included. In total, 68 patients with Nodding syndrome from Uganda, 58 Ugandan patients with epilepsy, and 137 patients with onchocerciasis-associated epilepsy from the Democratic Republic of the Congo were included. VAMS samples and DBS were analyzed using validated methods, involving manual extraction or fully automated extraction, respectively, before quantification using liquid chromatography coupled with tandem mass spectrometry. Analysis revealed that serum concentrations (calculated from DBS) within the respective reference ranges were attained in only 52.9% of the 68 Nodding syndrome patients treated with valproic acid, in 21.4% of the 56 Ugandan epilepsy patients treated with carbamazepine, and in 65.7% of the 137 onchocerciasis-associated epilepsy patients from the Democratic Republic of the Congo treated with phenobarbital. In all other instances, concentrations were subtherapeutic. Furthermore, on comparing DBS with VAMS concentrations, an inexplicable overestimation was observed in the latter. Finally, no obvious link could be observed between the obtained drug concentrations and the number of seizures experienced during the last month before sampling, elaborating the fact that the level of improvement in some patients cannot simply be linked to reaching therapeutic concentrations.
Cumulative Burden of Illness in Veterans With Tardive Dyskinesia and Serious Mental Disorders
Authors: Caroff Stanley N. , Leong Shirley H. , Roberts Christopher , Berkowitz Rosalind M. , Campbell E. Cabrina
Published: December 2019

Purpose/Background

To inform cost-benefit decisions for veterans, the risk of tardive dyskinesia (TD) and its impact on comorbidities and outcomes were assessed.

Methods/Procedures

In a retrospective study, veterans with schizophrenia/schizoaffective, and bipolar and major depressive disorders receiving antipsychotics during the period October 1, 2014, to September 30, 2015, were identified. Tardive dyskinesia was determined by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Correlates of TD were examined using χ2 or t tests. Odds ratios (ORs) and β parameters with 95% confidence intervals (CIs) for categorical and continuous variables associated with TD were derived from a multivariate logistic and linear regression, respectively.

Findings/Results

Among 7985 veterans, 332 (4.2%) were diagnosed as having possible TD. The odds of having TD were higher for older veterans (OR, 1.04; 95% CI, 1.03–1.05; P < 0.0001) and veterans with schizophrenia/schizoaffective disorder (OR, 1.54; 95% CI, 1.23–1.91; P < 0.0001) or diabetes (OR, 1.64; 95% CI, 1.30–2.06; P < 0.0001). Veterans with TD received more antipsychotic prescriptions (mean ± SD, 18.4 ± 30.3 vs 13.3 ± 26.4; P = 0.003) and days of supply (233.9 ± 95.4 vs 211.4 ± 102.0; P < 0.0001). They were more likely to have received 2 or more antipsychotics (27.1% vs 19.7%, P = 0.0009) and benztropine (OR, 2.25: 95% CI 1.73–2.91; P < 0.0001). Veterans with TD had a higher Charlson Comorbidity Index score (β = 0.32; SE, 0.09; 95% CI, 0.14–0.49; P = 0.0003) and higher odds of any medical hospitalization (OR, 1.45; 95% CI, 1.07–1.95; P = 0.001).

Implications/Conclusions

The diagnosis of possible TD was associated with older age, schizophrenia/schizoaffective disorder, medical comorbidity, and hospitalization. Tardive dyskinesia may be a marker for patients at risk of adverse health care outcomes and diminished quality of life.
Trends in the Use of Long-Acting Injectable Antipsychotics in the Province of Manitoba, Canada
Authors: Janzen Donica , Bolton James , Kuo I fan , Leong Christine , Alessi-Severini Silvia
Published: December 2019

Background

Long-acting injectable antipsychotics (LAIAs) have advantages over oral antipsychotics but are not widely used. We aimed to evaluate the impact of market entry of second-generation LAIAs on prescribing trends.

Methods

We used administrative health databases to describe trends in LAIA use from 1995 to 2015 in the Canadian province of Manitoba. Age- and sex-specific incident and prevalent use were determined using prescription dispensation records for the entire population. We used interrupted time series analysis with Poisson regression to estimate change in LAIA use attributable to the market entry of the second-generation LAIA risperidone.

Results

We observed 3380 prevalent LAIA users and 2375 incident users in our cohort. Long-acting injectable antipsychotic use was higher in males. Incidence proportions declined from 21.5 users per 100,000 in 1996 to 4.8 in 2004 and then climbed to 14.7 by 2015. First-generation LAIA use peaked at 94.6 prevalent users per 100,000 in 1998 but fell to 40.9 in 2015. Long-acting injectable antipsychotic use increased 1.4% per quarter after the market entry of risperidone long-acting injectable.

Conclusions

Risperidone risperidone long-acting injectable market entry had a positive impact on LAIA prescribing.
Metabolic Syndrome Rather Than Body Mass Index Is Associated With Treatment Response to Ketamine Infusions
Authors: Dale Roman M. , Bryant Kelly A. , Thompson Nicolas R.
Published: December 2019

Purpose

There is a practical need for the identification of pretreatment clinical and epidemiological response predictors to repeat ketamine infusions. Response predictors can serve to guide clinical inclusion of patients and weigh risks versus benefits for those receiving maintenance ketamine. Previous studies indicate a link between obesity, depression, and treatment response. We sought to investigate if body mass index (BMI) or metabolic syndrome could predict treatment response to ketamine.

Methods

Patients aged 18 to 72 years who were electroconvulsive therapy nonresponders were given a subanesthetic ketamine hydrochloride dose of 0.5 mg/kg delivered intravenously for 40 minutes for an acute series of 3 to 6 infusions every other day. If patients reported at least a 50% decrease in depression symptoms after the acute series, they were moved to a maintenance series of infusions, on an individualized basis. To assess if BMI or metabolic syndrome could predict response, logistic regression models were run to analyze initial responders, sustained responders, and nonresponders. Models were adjusted for age, sex, and baseline depression severity.

Results

Of the 150 patients analyzed, 56 did not respond to the acute phase, 38 initially responded to the acute phase but relapsed during the maintenance phase, and 56 sustained their response for 1 year. In unadjusted models, BMI was not shown to be a predictor of initial or sustained response. Alternatively, metabolic syndrome defined by a diagnosis of hypertension, hyperglycemia, or hyperlipidemia was determined to be significantly associated with diminished initial response but not sustained response.

Conclusions

In our patient group, results support the literature that outcome in antidepressant therapy is affected by the presence of metabolic syndrome rather than obesity itself. Although BMI did not predict initial response to ketamine, the presence of metabolic syndrome was significantly negatively associated with the initial response to an acute series of ketamine infusions.
Service Provider Perspectives on Female Forensic Mental Health Services in Zimbabwe: An Interpretative Phenomenological Analysis
Authors: Dube-Mawerewere Virgininia , Ncube-Sibanda Sinqobile Patience
Published: December 2019

Introduction

Service providers' perspectives on female forensic mental health services have not been explored in Zimbabwe. This study examined how health service providers in forensic mental health in Zimbabwe understand and interpret rehabilitation of female forensic psychiatric patients.

Methods

An interpretive phenomenological study was completed. Service provider participants were selected via purposive sampling from two main Special Institutions. Data were collected using audio-recorded semistructured interviews and subjected to interpretive phenomenological analysis.

Findings

Two master themes evolved from interview data: (a) conflicting legal documents of care and management of female forensic psychiatric patients; and (b) the forensic mental health system's processes, procedures, and resources impacting female forensic psychiatric rehabilitation.

Discussion

Findings of the study call for the need to balance between public safety interests and fulfilling clinical rehabilitation objectives.
Results From a Second-Generation Vestibular Implant in Human Subjects: Diagnosis May Impact Electrical Sensitivity of Vestibular Afferents
Authors: Rubinstein Jay T. , Ling Leo , Nowack Amy , Nie Kaibao , Phillips James O.
Published: December 2019

Objective:

Auditory and vestibular outcomes after placement of a vestibular-cochlear implant in subjects with varying causes of vestibular loss.

Study Design:

Prospective case study.

Setting:

Tertiary referral center.

Patients:

Three human subjects received a vestibular-cochlear implant. Subject 1 had sudden hearing and vestibular loss 10 years before implantation. Subjects 2 and 3 had bilateral Menière's disease with resolution of acute attacks. All subjects had severe-profound deafness in the implanted ear and bilateral vestibular loss.

Intervention:

Vestibular-cochlear implant with electrode positions confirmed by CT.

Main Outcome Measures:

Electrically-evoked vestibular and cochlear compound action potentials (ECAPs), speech perception, and electrically-evoked slow-phase eye velocities.

Results:

Subject 1 had no vestibular ECAP, but normal cochlear ECAPs and cochlear implant function. She had minimal eye-movement with vestibular stimulation. Subject 2 had vestibular ECAPs. This subject had the largest eye velocities from electrical stimulation that we have seen in humans, exceeding 100 degrees per second. Her cochlear implant functions normally. Subject 3 had vestibular and cochlear ECAPs, and robust eye-movements and cochlear implant function.

Conclusion:

The etiology of vestibular loss appears to have a profound impact on sensitivity of vestibular afferents in distinction to cochlear afferents. If this dichotomy is common, it may limit the application of vestibular implants to diagnoses with preserved sensitivity of vestibular afferents. We speculate it is due to differences in topographic organization of Scarpa's versus the spiral ganglion. In two subjects, the second-generation device can produce higher velocity eye movements than seen in the four subjects receiving the first-generation device.
Serum visfatin level as a noninvasive marker for nonalcoholic fatty liver disease in children and adolescents with obesity: relation to transient elastography with controlled attenuation parameter
Authors: Elkabany Zeinab Anwar , Hamza Rasha Tarif , Ismail Eman Abdel Rahman , Elsharkawy Aisha , Yosry Ayman , Musa Sherief , Khalaf Marwa Ahmad , Elgawesh Roba Maher , Esmat Gamal
Published: December 2019

Background

Obesity is associated with an increased risk of nonalcoholic fatty liver disease (NAFLD). Visfatin is an adipokine produced by visceral fat tissue and liver cells. Transient elastography with controlled attenuation parameter (CAP) noninvasively assesses liver fibrosis and steatosis.

Aim

To measure visfatin level in 80 children and adolescents with obesity as a potential biomarker for NAFLD and assess its relation to transient elastography.

Methods

Abdominal ultrasound, liver stiffness and CAP measurements were performed for all patients. Fasting lipid profile, fasting blood glucose, insulin level, liver and kidney functions, coagulation profile and serum visfatin levels were assessed.

Results

Among patients with obesity, 31 (38.8%) had NAFLD and 16 (20%) patients had elevated alanine aminotransferase (ALT), while 9 (11.2%) had both NAFLD and elevated ALT. Transient elastography showed that 12.5% had fibrosis stage F1, 2.5% had F2 and another 2.5% had F3 while none had F4. Using CAP, 23.8, 13.8 and 17.5% had S1, S2 and S3, respectively. Serum visfatin levels were significantly elevated in all patients compared with nonobese controls. Higher visfatin levels were found among patients with dyslipidemia, NAFLD, elevated ALT and steatosis defined by CAP. Serum visfatin was related to the degree of fibrosis and steatosis. Visfatin cutoff value 18 ng/mL could significantly detect the presence of NAFLD with 83.9% sensitivity and 81.4% specificity. Serum visfatin was positively correlated to BMI, waist circumference, waist/hip ratio, ALT, total cholesterol, liver stiffness and CAP.

Conclusions

Visfatin could be a promising serum biomarker for monitoring liver disease among pediatric patients with obesity.
Insulin Therapy in Hospitalized Patients
Authors: Pérez Antonio , Ramos Analia , Carreras Gemma
Published: December 2019

Background:

Hyperglycemia is prevalent and is associated with an increase in morbidity and mortality in hospitalized patients. Insulin therapy is the most appropriate method for controlling glycemia in hospital, but is associated with increased risk of hypoglycemia, which is a barrier to achieving glycemic goals.

Areas of Uncertainty:

Optimal glycemic targets have not been established in the critical and noncritical hospitalized patients, and there are different modalities of insulin therapy. The primary purpose of this review is to discuss controversy regarding appropriate glycemic targets and summarize the evidence about the safety and efficacy of insulin therapy in critical and noncritical care settings.

Data Sources:

A literature search was conducted through PubMed with the following key words (inpatient hyperglycemia, inpatient diabetes, glycemic control AND critically or non-critically ill patient, Insulin therapy in hospital).

Results:

In critically ill patient, blood glucose levels >180 mg/dL may increase the risk of hospital complications, and blood glucose levels <110 mg/dL have been associated with an increased risk of hypoglycemia. Continuous intravenous insulin infusion is the best method for achieving glycemic targets in the critically ill patient. The ideal glucose goals for noncritically ill patients remain undefined and must be individualized according to the characteristics of the patients. A basal-bolus insulin strategy resulted in better glycemic control than sliding scale insulin and lower risk of hypoglycemia than premixed insulin regimen.

Conclusions:

Extremes of blood glucose lead to poor outcomes, and target glucose range of 110–180 mg/dL may be appropriate for most critically ill patients and noncritically ill patients. Insulin is the most appropriate pharmacologic agent for effectively controlling glycemia in hospital. A continuous intravenous insulin infusion and scheduled basal-bolus-correction insulin are the preferred modalities for glycemic control in critically and noncritically ill hospitalized patients, respectively.
Insulin Pump Therapy
Authors: Nimri Revital , Nir Judith , Phillip Moshe
Published: December 2019

Background:

Advances in pump technology have increased the popularity of this treatment modality among patients with type 1 diabetes and recently also among patients with type 2 diabetes.

Areas of Uncertainty:

Four decades after the incorporation of the insulin pump in clinical use, questions regarding its efficacy, occurrence rate of short-term complications as hypoglycemia and diabetes ketoacidosis, timing of pump initiation, and selected populations for use remain unanswered.

Data Sources:

A review of the literature was performed using the PubMed database to identify all articles published up till December 2018, with the search terms including insulin pump therapy/continuous subcutaneous insulin delivery. The Cochrane database was searched for meta-analysis evaluating controlled randomized trials. Consensuses guidelines published by the International Society for Pediatric and Adolescent Diabetes, American Diabetes Association, and Advanced Technologies and Treatments for Diabetes year books were additionally reviewed for relevant cited articles.

Therapeutic Advances:

Insulin pump therapy offers flexible management of diabetes. It enables adjustment of basal insulin to daily requirements and circadian needs, offers more precise treatment for meals and physical activity, and, when integrated with continuous glucose monitoring, allows glucose responsive insulin delivery. The ability to download and transmit data for analysis allow for treatment optimization. Newer pumps are simple to operate and increase user experience. Studies support the efficacy of pump therapy in improving glycemic control and reducing the occurrence of hypoglycemia without increasing episodes of diabetes ketoacidosis. They also improve quality of life. Recent evidence suggests a role for pump therapy in reducing microvascular and macrovascular diabetes-related complications.

Conclusions:

Insulin pump therapy appears to be effective and safe in people with T1D regardless of age. Future advancements will include incorporation of closed loop and various decision support systems to aid and improve metabolic control and quality of life.
The Lived Experience of Work-Related Issues Among Oncology Nurses
Authors: Diaw Marielle , Sibeoni Jordan , Manolios Emilie , Gouacide Jean-Marc , Brami Cloé , Verneuil Laurence , Revah-Levy Anne
Published: December 2019

Background

Many qualitative studies have focused on the experience of nurses specialized in oncology and the ways they describe and understand that experience.

Objective

We aimed to perform a metasynthesis, a systematic review, and an analysis of qualitative studies focused on the experiences and perspectives of oncology nurses about work-related issues.

Methods

We searched international publications to identify relevant qualitative research exploring oncology nurses’ experiences. Thematic analysis was used to identify key themes and synthesize them.

Results

We identified 63 articles from 61 studies (>1000 nurses) from 23 countries. Two main themes emerged: (1) the relational dimension of work-related issues, on the one hand with other professionals and on the other hand with patients and families; and (2) the strategies for coping with the work-related difficulties, including partnership, communication and support, and training.

Conclusions

Our results revealed the central place of loneliness. The nurses simultaneously described feeling lonely due to their individual stance and being alone due to the absence of institutional support, with a confusion between these 2 forms of loneliness. This finding echoes specific aspects of oncology.

Implications for Practice

Specific training and support group appear to be relevant ways to help oncology nurse to cope better with this loneliness and to bear the stress of this difficult field.
Novice Nurse Support Group
Authors: Coyne Danielle , Tuer Amy , McCulloh Nair Julie
Published: December 2019

Supportive measures, including mentorship, are essential for novice nurses in relation to job satisfaction and retention rates. A novice nurse support group was designed and implemented over 12 months to determine job satisfaction and retention outcomes. A pre/post survey design using the Casey–Fink Nurse Retention Survey provided descriptive data. Findings demonstrated overall job satisfaction; all participants were retained within the organization and suggested continuation of the support group.
Differentiating Parkinson Disease Subtypes Using Clinical Balance Measures
Authors: Prime Morgane , McKay J. Lucas , Bay Allison A. , Hart Ariel R. , Kim Chaejin , Abraham Amit , Hackney Madeleine E.
Published: December 2019

Background and Purpose:

People with Parkinson disease (PD) present phenotypes that are characterized as tremor-dominant (TD) or postural instability/gait difficulty (PIGD) subtypes. Differentiation of subtypes allows clinicians to predict disease course and adjust treatment. We examined whether brief mobility and balance measures can discriminate PIGD from TD phenotypes.

Methods:

We performed a cross-sectional study with individuals with PD (n = 104). Blinded raters assessed participants with the Unified Parkinson's Disease Rating Scale (UPDRS) or Movement Disorders Society revision (MDS-UPDRS), and balance assessments: 360° turn test, one-leg stance, a reactive postural control test, and tandem walk. Participants were classified as PIGD or TD based on the UPDRS or MDS-UPDRS assessment results. Differences in balance variables between subtypes were assessed with univariate analyses. Receiver operating characteristic (ROC) curve analyses were performed to investigate the ability of balance variables to differentiate PD subtypes.

Results:

No differences between subtypes were observed for tandem walk or reactive postural control. Participants with PIGD performed worse on number of steps and time to complete the 360° turn test and on one-leg stance time. ROC curves showed only the 360° turn test discriminated PIGD from TD with high specificity (0.84). Post hoc analyses revealed that the 360° turn test is the most discriminatory for classifying PD subtypes in early stages of the disease. ROC analyses based on combined models including both the 360° test and tandem walk test performance increased the specificity to 0.97.

Discussion and Conclusions:

The 360° turn test requires minimal time to administer and may be useful in mild-moderate PD for distinguishing PIGD from TD subtypes.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A295).