bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the severity of psychiatric disorders using the Health of the Nation Outcome Scales: An equipercentile linking analysis
Authors: Egger Stephan T , Bobes Julio , Theodoridou Anastasia , Seifritz Erich , Vetter Stefan 
Published: October 2020

Objective: The Health of the Nation Outcome Scales was developed as an overall measure of mental health, applicable to the complete range of psychiatric disorders. Meanwhile, it is a benchmark tool for service providers and is also used for the allocation of costs and funding. The ability of the Health of the Nation Outcome Scales to assess and differentiate the severity of psychiatric disorders is largely unknown, as it is the interpretation of a change in score. We aim to establish Health of the Nation Outcome Scales cut-off and benchmark values for severity and improvement – respectively change, using equipercentile linking to the Clinical Global Impression scales. Methods: In a clinical sample of 30,616 individuals with a psychiatric disorder, we used a multivariate regression analysis to determine the correlation between the scales and possible confounders. We used an equipercentile linking analysis of the Clinical Global Impressions severity scale with the Health of the Nation Outcome Scales sum score to establish cut-off values for severity. The linking of the Health of the Nation Outcome Scales sum score difference and the percentage of change to the Clinical Global Impression improvement scale determined benchmark values for change (i.e. improvement or deterioration). Results: The Health of the Nation Outcome Scales and Clinical Global Impression scales showed a Spearman correlation of 0.38 ( p < 0.000). Clinical Global Impression–Severity: ‘borderline-ill’ corresponded to Health of the Nation Outcome Scales score 3–5; ‘mildly ill’ to 6–10; ‘moderately ill’ to 11–16; ‘markedly ill’ to 17–25; ‘severely ill’ to 26–35; and ‘extremely ill’ to a score ⩾36. The Spearman correlation between the percentage change of the Health of the Nation Outcome Scales was 0.39 ( p > 0.000); Clinical Global Impression–Improvement: ‘minimally improved’ corresponded to Health of the Nation Outcome Scales reduction of 4 points or 9%; ‘much-improved’ to 12 points or 48%; ‘very-much-improved’ to ⩾20 points or ⩾90%. Clinical Global Impression–Improvement: ‘minimally worse’ corresponded to an increase of 6 points or 25%; ‘much-worse’ to 12 points or 54%; and finally, ‘very-much-worse’ to >18 points or ⩾82%. Conclusion: Our results allow for the comparison of severity and response to treatment of patients with a psychiatric disorder, independent of diagnosis.
Dreams, songs and letters: Sectarian networks and musical archives in eighteenth-century North India
Authors: Williams Richard David 
Published: October 2020

Early modern poets conventionally began their compositions by praising and invoking the blessings of their higher authorities, be they their gods, gurus or courtly patrons. In the eighteenth century, North Indian society was particularly unstable, and the relationships between these different power brokers proved volatile. This article considers how intellectuals attached to religious households navigated the challenges of the period, particularly invading armies, religious reforms and forced migration. I examine the works of Vrindavandas (c. 1700–87), a Brajbhasha poet and lay devotee of the Radhavallabh Sampraday, and provide contextualised readings of two of his poems, concerned with recent history and the contemporary political climate. Vrindavandas was not a scribe or chronicler in a conventional sense; however, closer examination of his works reveals the porous boundaries between scribes-cum-recorders and other kinds of intellectuals. Here, I consider how Vrindavandas’ literary activity included copying archival sources, recording recent history, documenting dreams and emotions, and folding different senses of temporality into a single work. This article asks how far his poetic works gesture to a distinctively eighteenth-century mode of literary expression and reflexivity, and how performing these poetic archives through reading, singing, and musical accompaniment provided the sect with tools to navigate a turbulent political landscape.
Stigmatising attitude and reflections towards mental illness at community setting, population-based approach, Baghdad City 2020
Authors: Younis Maha Sulaiman , Anwer Arjan Hidayat , Hussain Hamid Yahay 
Published: October 2020

Background: Addressing the social stigma of mental illness is of importance in Iraq where mentally ill patients experience the compounded disadvantages of inadequate health services and illness stigma. Aims: To study the prevalence and magnitude of the social stigma towards mental illnesses. Method: A cross-sectional study has been carried out on 300 male and female participants at shopping malls and public cafes in Baghdad, Iraq. A self-administered questionnaire made data collection. Descriptive, and analytic statics procedure was operated as far as a convenience by using Excel 365 version as a data management tool. Results: About (80%) of the respondents revealed a moderate degree of stigmatising attitude towards mental illness with a Likert scale total equivalent score range of (2.34–3.669). About (20%) of respondents showed a low degree of stigmatising attitude towards mental illness, with a Likert scale total equivalent score range of (1–2.339). P-value was highly significant (=0.011798) <0.05 among gender variables while it is not significant among age, income, education, and positive family of mental illnesses. 83% of the respondents prefer the medical management of mental illnesses. Conclusions: There were no clear roles of socio-demographic factors in the stigmatic attitude towards mental illnesses. This finding warrants a more in-depth look into the Iraqi community’s cultural, social, and moral contexts.
Applying Video Modeling to Promote the Handwriting Accuracy of Students with Low Vision Using Mobile Technology
Authors: Chang Chia-Jui , Lo C. Owen , Chuang Su-Chen 
Published: October 2020

Introduction: In Taiwan, although many school-aged students with low vision struggle with poor handwriting, there is a lack of evidence-based educational practices for handwriting enhancement. Since the use of mobile technology has increased recently, iPads have been identified as an effective tool to deliver video-based instruction to individuals. In this study, iPads were used to deliver video modeling to provide instruction designed to enhance the handwriting accuracy among students with low vision. Methods: A multiple-baseline-across-participants-probe design was used in this study to assess the success of the intervention with three individuals with low vision who were 9, 12, and 14 years of age. Results: During the baseline phase, the accuracy for each of the participants was under 50%. After intervention, their handwriting accuracy increased. The participants were also able to maintain their performance during follow-up sessions. Moreover, the study demonstrated good social validity, since the stakeholders all indicated a high level of treatment acceptability for this intervention. Discussion: The outcome of this study demonstrates that iPads used with video modeling can lead to improved accuracy in handwriting for students with low vision. The findings also support video modeling as an effective strategy for teaching new skills and may be applied to students with different special learning needs. Implications for practitioners: Video modeling is an effective and feasible instructional strategy for practitioners as it can be easily implemented. Additionally, given its built-in visual support, the iPad is an effective instrument that can help students with low vision reach a higher potential for handwriting accuracy. It is worth noting that, in addition to the presence of video modeling, proper instruction, as well as opportunities to practice, is needed for students to produce accurate word formation. Thus, short daily practices combined with the intervention method presented in this study are likely to gain better results for students with low vision.
The Role of Tracheotomy and Timing of Weaning and Decannulation in Patients Affected by Severe COVID-19
Authors: Botti Cecilia , Lusetti Francesca , Peroni Stefano , Neri Tommaso , Castellucci Andrea , Salsi Pierpaolo , Ghidini Angelo 
Published: October 2020

Objectives: Patients with acute respiratory failure due to coronavirus disease 2019 (COVID-19) have a high likelihood of needing prolonged intubation and may subsequently require tracheotomy. Indications and timing for performing tracheotomy in patients affected by severe COVID-19 pneumonia are still elusive. The aim of this study is to analyze the role of tracheotomy in the context of this pandemic. Moreover, we report the timing of the procedure and the time needed to complete weaning and decannulation in our center. Methods: This retrospective, observational cohort study included adults (≥18 years) with severe COVID-19 pneumonia who were admitted to the intensive care unit (ICU) of the tertiary care center of Reggio Emilia (Italy). All patients underwent orotracheal intubation with invasive mechanical ventilation, followed by percutaneous or open surgical tracheotomy. Indications, timing of the procedure, and time needed to complete weaning and decannulation were reported. Results: Forty-four patients were included in the analysis. Median time from orotracheal intubation to surgery was 7 (range 2-17) days. Fifteen (34.1%) patients died during the follow-up period (median 22 days, range 8-68) after the intubation. Weaning from the ventilator was first attempted on median 25th day (range 13-43) from orotracheal intubation. A median of 35 (range 18-79) days was required to complete weaning. Median duration of ICU stay was 22 (range 10-67) days. Mean decannulation time was 36 (range 10-77) days from surgery. Conclusions: Since it is not possible to establish an optimal timing for performing tracheotomy, decision-making should be made on case-by-case basis. It should be adapted to the context of the pandemic, taking into account the availability of intensive care resources, potential risks for health care workers, and benefits for the individual patient.
Selective activation of D1 dopamine receptors exerts antidepressant-like activity in rats
Authors: Desormeaux Cleo , Demars Fanny , Davenas Elisabeth , Jay Therese M , Lavergne Francis 
Published: October 2020

Background: Major depressive disorder is a common illness that severely decreases psychosocial functioning. Due to the major limitations of current treatments including response failure, it is crucial to develop better therapy strategies. Evidence suggests that dopamine dysregulation might play a major role in major depressive disorder physiopathology. Aims: This study investigates whether the dopamine D1 receptor agonist A77636 modulates antidepressant-like activity in rats. Methods: Rats were injected with an acute single dose of A77636 (0.75, 1.5 or 3 mg/kg), a potent and selective dopamine D1-like receptor agonist. Their locomotor activity, social interactions and behavioural response to the forced swim test were analysed 30 min after the injection. Results: During the forced swim test, the D1 agonist dose dependently reduced the immobility while the time of bursting was increased. Social interactions were significantly increased in the animals exposed to 3 mg/kg of A77636 whereas no significant changes were measured in general motor activity. Conclusions: The present results provide evidence that pharmacological modulation of D1 receptor by the selective agonist A77636 induces antidepressant-like effects in rats, which encourages further studies regarding D1-specific modulation in major depressive disorder treatment.
Continued gefitinib retreatment beyond progression in patients with advanced non-small cell lung cancer harboring sensitive EGFR mutations
Authors: Jiang Xuhong , Li Xiaoqing , Tu Lingli , Cai Jin , Wei Man , Wu Zhongjun , Sun Lan 
Published: October 2020

Purpose To evaluate the effectiveness and safety of gefitinib retreatment beyond disease progression in patients with advanced non-small cell lung cancer (NSCLC) with sensitive epidermal growth factor receptor ( EGFR) mutations. Methods Data from patients with stage III/IV NSCLC were analyzed retrospectively. Patients with sensitive EGFR mutations received first-line treatment with gefitinib followed by retreatment with gefitinib after disease progression. Progression-free survival (PFS) after the first treatment (PFS-1) was defined as the time to progression or death using the Response Evaluation Criteria in Solid Tumors criteria (RECIST) v1.1 criteria. The second PFS (PFS-2) was defined as the interval between the first and second progressions, at the investigator’s discretion. Toxicities were recorded in accordance with the National Cancer Institute (NCI)-Common Terminology Criteria (CTC) version 4.0. Results Sixteen patients aged 53 to 80 years (median 66 years) were included in the analysis. The median PFS-1 and PFS-2 were 10.0 months and 14.0 months, respectively. The median overall survival (OS) was 36.0 months. No toxicity of grade 3 or worse was observed. Conclusions Our findings suggest that gefitinib retreatment beyond disease progression may be an effective and tolerable approach for NSCLC patients with sensitive EGFR mutations.
Lactate levels and clearance rate in neonates undergoing mechanical ventilation in Tibet
Authors: Chen Dan , Liu Xiuxiu , Li Jiujun 
Published: October 2020

Objective This study aimed to examine the characteristics of blood lactate in neonates undergoing mechanical ventilation in Tibet. Methods We recruited 67 neonates undergoing mechanical ventilation in Naqu People’s Hospital as the plateau observation group and 94 neonates undergoing mechanical ventilation in Shengjing Hospital as the control group. We analyzed the differences in lactate levels between the two groups. Results The lactate clearance rates of neonates with asphyxia and those with respiratory distress syndrome were significantly lower in the plateau group than in the control group. Lactate levels in neonates who died in the plateau group were significantly higher and the lactate clearance rate was significantly lower than those in neonates who survived. The cut-off point for the lactate clearance rate at 6 hours for predicting mortality was 6.09% in the plateau group. Conclusion The lactate clearance rate of neonates on mechanical ventilation in the plateau area is lower than that in neonates in the non-plateau area. The lactate clearance rate at 6 hours is important for evaluating the prognoses of critical neonates in plateau areas.
Provider-Documented Anxiety in the ICU: Prevalence, Risk Factors, and Associated Patient Outcomes
Authors: May Andrew D. , Parker Ann M. , Caldwell Ellen S. , Hough Catherine L. , Jutte Jennifer E. , Gonzalez Mayra Sanchez , Needham Dale M. , Hosey Megan M. 
Published: October 2020

Purpose: To determine the prevalence of provider-documented anxiety in critically ill patients, associated risk factors, and related patient outcomes. Method: Chart review of 100 randomly sampled, adult patients, with a length of stay ≥48 hours in a medical or trauma/surgical intensive care unit (ICU). Provider-documented anxiety was identified based on a comprehensive retrospective chart review of the ICU stay, searching for any acute episode of anxiety (e.g., documented words related to anxiety, panic, and/or distress). Results: Of 100 patients, 45% (95% confidence interval: 35%-55%) had documented anxiety, with similar prevalence in medical vs. trauma/surgical ICU. Patients with documented anxiety more frequently had history of anxiety (22% vs. 4%, p = .004) and substance abuse (40% vs. 22%, p = .048). In the ICU, they had greater severity of illness (median (IQR) Acute Physiology Score 16(13,21) vs. 13(8,19), p = .018), screened positive for delirium at least once during ICU stay, (62% vs. 31%, p = .002), benzodiazepines and antipsychotics use (87% vs. 58%, p = .002; 33% vs. 13%, p = .013, respectively), and mental health consultation (31% vs. 18%, p = .132). These patients also had longer ICU and hospital lengths of stay (6(4,11) vs. 4(3,6), p<.001 and 18(10,30) vs. 10(6,16) days, p<.001, respectively) and less frequent discharge back to home (27% vs. 44%, p = .079). Conclusions: Documented anxiety, occurring in almost half of ICU patients with length of stay ≥48 hours, was associated with a history of anxiety and/or substance abuse, and greater ICU severity of illness, delirium, psychiatric medications, and length of stay. Increased awareness along with more standardized protocols for assessment of anxiety in the ICU, as well as greater evaluation of non-pharmacological treatments for anxiety symptoms in the ICU are warranted.
Magnetic resonance imaging study of safe needling depth and angulation for acupuncture at BL40
Authors: Hou Hai-Kun , Liu Cun-Zhi , Lin Lu-Lu 
Published: October 2020

Objectives: The objectives of this study were to identify the mean safe needling depth and angle at BL40 between subjects, taking into account variables including sex and body mass index (BMI). Methods: One hundred and twenty-four participants who had undergone magnetic resonance imaging (MRI) examination of the knee region for clinical indications were included in this study. BL40 needling sites were localized by World Health Organization (WHO) standards and were measured by MRI. As much as 70% of the value of AN (from the needle insertion point to the popliteal artery) was considered to represent the safe depth, and angle alpha between the BL40 straight line and the AN line was regarded as the safe angle. Results: Overall, mean safe depth regardless of BMI and sex was 18.51 ± 3.56 mm (95% confidence interval (CI), 17.88%–19.14%). Mean safe depth was 17.24 ± 3.14 mm in the low and normal BMI group, 18.76 ± 2.90 mm in the overweight group, and 22.01 ± 3.71 mm in the obese group. Thirteen patients (10.5%) had internal deviation of angle alpha (95% CI, 5.6%–15.3%), while 111 patients (89.5%) had external deviation (95% CI, 84.7%–94.4%). The mean internal and external deviations of angle alpha were 8.78° ± 2.92° (95% CI, 7.01°–10.55°) and 9.75° ± 3.46° (95% CI, 9.10°–10.41°), respectively. Conclusion: We would suggest that, when using a straight needle insertion at BL40, it is safe to advance a 25-mm needle approximately 12.5 mm, and 17.5 mm should be safe for patients with BMI greater than 28 kg/m2. Practitioners should decrease the depth of penetration when treating patients of low body weight or height.
Arterial lactate as a prognostic tool to predict mortality and disposition in the emergency department: A prospective observational single-centre study
Authors: Wilson William , Selvaraj Dhiraj Ravindran , Ramya Kumar MV , Jain Vinayak , Umra Simran , Murty Shakuntala 
Published: October 2020

Background: Point-of-care tools are invaluable in the emergency department. Arterial lactate has been used for prognostication in subsets of population in the emergency department but not often for a heterogeneous population. Objectives: We aimed to study the use of arterial lactate as a prognostication and disposition tool in an undifferentiated population presenting to the emergency department. Methods: We conducted a prospective study among all consenting emergency department patients with age >18 years, who had an arterial blood gas performed as a part of routine care and had a lactate value ⩾2 mmol/L. We collected data on demographics, comorbidities and patient disposition from the emergency department and 28-day mortality as a follow-up telephonically. Results: We included 469 patients with a median age of 37 years. Sixteen provisional diagnoses were made in the emergency department, and pneumonia/lower respiratory tract infection was relatively higher (13.6%). The median lactate was 4.6 (interquartile range = 3.2–7) with 155 patients (33%) being transferred to intensive care unit and 62 deaths (13.2%) recorded at 28 days. Furthermore, we observed optimum values for lactates at 5 mmol/L predicted intensive care unit admissions and 6 mmol/L predicted mortality. A unit increase in arterial lactate in the emergency department significantly increased mortality by 66% (95% confidence interval = 1.45–1.88; p < 0.001) and had a 2.15 times (95% confidence interval = 1.63–2.83; p < 0.001) significantly higher chance of being transferred to the intensive care unit. Conclusion: Arterial lactate can be used as a prognostication tool for a heterogeneous population presenting to the emergency department. Clinical significance: Point-of-care investigations such as arterial lactate can help the emergency physician make quick decisions on the floor and guide prognostication and disposition.
Training novice in ultrasound-guided venipuncture: A randomized controlled trial comparing out-of-plane needle-guided versus free-hand ultrasound techniques on a simulator
Authors: Raft Julien , Dupanloup Danièle , Clerc-Urmès Isabelle , Baumann Cédric , Richebé Philippe , Bouaziz Hervé 
Published: October 2020

Background: Peripheral intravenous access is a common medical procedure, however, it can be difficult to perform in some patients. Success rates have proved greater with ultrasound guidance. Peripheral intravenous access using ultrasound requires specific training, especially for new ultrasound users. To overcome these difficulties, guidance devices on ultrasound probes are able to control the angle of penetration into tissues. We hypothesized that, and particularly for new ultrasound users, the use of a needle guide (NG) paired with the out-of-plane approach would facilitate puncture of a simulation model of vessel more effectively than similar free hand (FH) techniques. Methods: A prospective controlled randomized study was conducted of new ultrasound users using a guide wire introducer needle on gelatine phantom. After a 30-min lecture, one group performed the FH technique and the other group performed the NG technique both in an out-of-plane approach. The main criterion was the number of attempts before success of catheterization of this model of vessel. Results: Thirty-four nurse anesthetist students participated in the study. The number of attempts before success using the NG technique was significantly lower: 3.7 (±0.9) in the NG group versus 6.7 (±3.3) in the FH group ( p = 0.01). In the NG group, 100% of the participants achieved success after the sixth attempt. In the FH group, only 81.25% ( n = 13/16) reached success. Conclusion: NG technique has been proved to have a steeper learning curve compared with the FH technique. A study on a learning curve in clinical practice is needed to confirm these results.