Longitudinal Interplay Between Alcohol Use, Mood, and Functioning in Bipolar Spectrum Disorders.

Importance: Alcohol use disorder (AUD) is present in nearly half of individuals with bipolar disorder (BD) and is associated with markedly worsening outcomes. Yet, the concurrent treatment of BD and AUD remains neglected in both research and clinical care; characterizing their dynamic interplay is crucial in improving outcomes. Objective: To characterize the longitudinal alcohol use patterns in BD and examine the temporal associations among alcohol use, mood, anxiety, and functioning over time. Design, Setting, and Participants: This cohort study selected participants and analyzed data from the Prechter Longitudinal Study of Bipolar Disorder (PLS-BD), an ongoing cohort study that recruits through psychiatric clinics, mental health centers, and community outreach events across Michigan and collects repeated phenotypic data. Participants selected for the present study were those with a diagnosis of BD type I (BDI) or type II (BDII) who had been in the study for at least 5 years. Data used were extracted from February 2006 to April 2022, and follow-up ranged from 5 to 16 years. Main Outcomes and Measures: Alcohol use was measured using the Alcohol Use Disorders Identification Test. Depression, mania or hypomania, anxiety, and functioning were measured using the 9-Item Patient Health Questionnaire, the Altman Self-Rating Mania Scale, the 7-item Generalized Anxiety Disorder assessment scale, and the Life Functioning Questionnaire, respectively. Results: A total of 584 individuals (386 females (66.1%); mean [SD] age, 40 [13.6] years) were included. These participants had a BDI (445 [76.2%]) or BDII (139 [23.8%]) diagnosis, with or without a lifetime diagnosis of AUD, and a median (IQR) follow-up of 9 (0-16) years. More problematic alcohol use was associated with worse depressive (ß = 0.04; 95% credibility interval [CrI], 0.01-0.07) and manic or hypomanic symptoms (ß = 0.04; 95% CrI, 0.01-0.07) as well as lower workplace functioning (ß = 0.03; 95% CrI, 0.00-0.06) over the next 6 months, but increased depressive and manic or hypomanic symptoms were not associated with greater subsequent alcohol use. These latter 2 associations were more pronounced in BDII than BDI (mania or hypomania: ß = 0.16 [95% CrI, 0.02-0.30]; workplace functioning: ß = 0.26 [95% CrI, 0.06-0.45]). Alcohol use was not associated with anxiety over time. Conclusions and Relevance: This study found that alcohol use, regardless of diagnostic status, was associated with mood instability and poorer work functioning in BD, but increased mood symptoms were not associated with subsequent alcohol use. Given its prevalence and repercussions, dimensional and longitudinal assessment and management of alcohol use are necessary and should be integrated into research and standard treatment of BD.

Comparing parent-child interaction during wordless book reading, print book reading and imaginative play.

This study investigated differences in adult-child language interactions when parents and their three-to-four-year old children engage in wordless book reading, text-and-picture book reading and a small-world toy play activity. Twenty-two parents recorded themselves completing each activity at home with their child. Parent input was compared across contexts, focusing on interactive and conceptual domains: use of open prompts, expansions or extensions of children's utterances, and use of decontextualised (abstract) language. Use of linguistic expansions was greater during book reading than toy play. Parents used open questions and added contingent conceptual information more often when reading wordless books than in both other conditions. Findings suggest that wordless books may combine the benefits of open-endedness and linguistic content based around a narrative. Parents' use of abstract language also varied by condition. This study extends understanding of the role of activity context in shaping children's language learning environments.

Systematic review of the efficacy and purpose of student surgical interest groups.

BACKGROUND: There is concern around projected unmet need in the surgical workforce internationally. Current barriers to medical students pursuing surgical careers include lack of early exposure, low confidence in surgical skills, and perceived lifestyle barriers. This review aimed to examine both the purpose of student surgical interest groups (SIGs) globally, and their effect on metrics representing student surgical career interest. barriers. METHODS: MEDLINE, EMBASE, PubMed, and Google Scholar were searched for papers analysing surgical interest group purpose and efficacy. Risk of bias was assessed for survey-based papers using a 20-point checklist. Descriptive analysis was performed based on qualitative data. RESULTS: Twenty-eight papers were included in the analysis including 13 surveys. These were of moderate quality. The analysed SIGs had 100-1000 student members and a diverse range of funding sources. Purpose of SIGs was described by 26 of 28 papers with common themes including promotion of surgical career choice and developing theoretical/practical surgical skills. Common initiatives of SIGs included surgical lectures/teaching and practical skills workshops. Data from 15 papers analysing efficacy of SIGs suggested they positively influenced self-reported student interest in surgical careers (78.6%) and confidence in surgical knowledge (80%), as well as confidence in practical skills, knowledge about surgical careers/lifestyle, mentorship opportunity, and research involvement. CONCLUSION: Student SIGs make a unique contribution to early medical student experience through positive effect on promoting surgical careers. They target relevant metrics such as surgical knowledge and confidence that are known to influence surgical career choice in the modern surgical landscape.

Daily huddle best practice: An Evidence-Based guide.

BACKGROUND: Daily huddles positively influence staff satisfaction and perception; standardization of a daily huddle should be prioritized to benefit from its effects. AIM: The aim of this project initiative was to implement an evidence-based, standardized daily huddle on an inpatient medical-surgical oncology unit. IMPLEMENTATION PLAN: A searchable question was developed, and the identified literature was critically appraised and synthesized for evidence-based recommendations. The recommendations for the structure and content of a daily huddle were implemented using a standardized format. OUTCOMES: Pre-implementation and post-implementation staff perception and satisfaction surveys yielded positive results. Improvements in effective communication and staff satisfaction were identified. IMPLICATIONS FOR PRACTICE: An effective daily huddle is essential for communicating pertinent information that can affect workflows and patient safety, as well as promoting teamwork and staff satisfaction.

Measuring knowledge of multiple word meanings in children with English as a first and an additional language and the relationship to reading comprehension.

Polysemy, or the property of words having multiple meanings, is a prevalent feature of vocabulary. In this study we validated a new measure of polysemy knowledge for children with English as an additional language (EAL) and a first language (EL1) and examined the relationship between polysemy knowledge and age, language status, and reading comprehension. Participants were 112 British children aged 5 to 6 (n = 61) or 8 to 9 years (n = 51), 37% of whom had EAL (n = 41). Participants completed the new measure of knowledge of polysemes, along with other measures of language, literacy and cognitive ability. The new measure was reliable and valid with EAL and EL1 children. Age and language status predicted children's polyseme knowledge. Polyseme knowledge uniquely contributed to reading comprehension after controlling for age, language status, non-verbal intelligence, time reading in English, and breadth of vocabulary. This research underscores the importance of polysemy for children's linguistic development.

The efficacy and safety of acetaminophen use following liver resection: a systematic review.

PURPOSE: Acetaminophen is commonly used for post-operative analgesia following liver resection. It is metabolised by the liver and appropriate administration and dosage is in question in in patients undergoing hepatectomy. A systematic review was conducted to investigate safety and efficacy of acetaminophen use. METHODS: MEDLINE, EMBASE, PubMed, Web of Science, and Google Scholar were searched for instances of toxicity, liver dysfunction, and analgesic efficacy in patients undergoing hepatectomy. RESULTS: Two randomised controlled trials and four prospective observational studies were included. The studies were of moderate quality. Four studies investigated post-operative levels of acetaminophen and its urinary metabolites, finding no evidence of toxicity. One study noted that glutathione levels decreased but not to clinically deficient levels. Administration of acetaminophen plus morphine versus morphine alone did not increase adverse events and a morphine sparing effect of acetaminophen was demonstrated in two studies. CONCLUSION: Use of acetaminophen for adult patients undergoing liver resection surgery as post-operative analgesia at a standard dosage is safe for baseline analgesia. All studies analysed support that toxicity is not reached; and that acetaminophen provides a morphine sparing effect without adverse effects. Acetaminophen dose reduction should be considered in patients where extra risk factors for hepatotoxicity are present.

Patch testing to plants: sensitisation associated with exposure to plants, essential oils and botanicals in cosmetics.

BACKGROUND: Contact allergy to plants, particularly Compositae, presents with dermatitis and is diagnosed with skin patch testing. Sesquiterpene lactone mix is a common screening allergen for plant allergy. The rate of plant allergen sensitisation in New Zealand, which is affected by local horticultural factors, has not previously been documented. AIMS: To investigate the rate of plant allergen sensitisation in New Zealand's regional population, characterise common allergens and reassess appropriate allergens for patch testing. METHODS: Retrospective analysis of patient demographics and patch-test results over an eight-year period (2012 to 2020) was performed at a tertiary patch-test clinic in Auckland, New Zealand. RESULTS: 820 patients completed patch testing. There was a 12.9% sensitivity rate (a positive reaction on patch testing) to at least one plant allergen and a 6.2% plant allergy rate (positive reaction of current relevance). The most frequent positive reactions were Myroxylon pereirae (n=38), colophonium (n=35) and sesquiterpene lactone mix (n=14). Of patients with a plant allergy (n=51), the allergy source was a botanical in a cosmetic product in 27 cases (52.9%), a plant in ten (19.6%) and an essential oil in two (3.9%). CONCLUSIONS: Reactions to plant allergens were related to botanicals in cosmetics and creams, plants and essential oils. Rates of plant sensitisation in our cohort are comparable with international data.

SEROPREVALENCE OF TOXOPLASMA GONDII IN MARKET HOGS COLLECTED FROM U.S. SLAUGHTERHOUSES.

Foodborne pathogens continue to pose a public health risk and can cause serious illness and outbreaks of disease in consumers. The consumption of raw or undercooked infected meat, such as pork containing infectious stages of Toxoplasma gondii, may be a major route of transmission to humans. Given the occasional presence of T. gondii in pork meat and the frequent use of pork for products not intended to be cooked, such as dry-cured ham, a potential risk exists for T. gondii transmission to consumers of these products. The purpose of this study was to determine the seroprevalence of T. gondii in U.S. market hogs and sows at slaughter. A total of 20,209 sera samples collected from 22 U.S. slaughterhouses, including 15 of the top 25 largest slaughter plants in the United States, were tested for T. gondii antibodies using a commercial ELISA assay. Seroprevalence in this study was 0.74%, with a herd prevalence of 10.86%. We compared seroprevalence of T. gondii in market hogs vs. sows from a separate but geographically similar set of slaughterhouse locations, with serum samples screened using the T. gondii modified agglutination test. This set of market hogs demonstrated 0% seroprevalence for T. gondii, while sows from geographically similar but separate slaughter facilities demonstrated a seroprevalence of 1.03%. Overall, both analyses show low seroprevalence of T. gondii in U.S market hogs and sows, respectively, and a marked drop in prevalence in market hogs and sows compared to previous studies.

Topical corticosteroid allergy: Results of sequential testing to a corticosteroid series in New Zealand.

BACKGROUND: Our institution tests the European Baseline Series (EBS) and a steroid series sequentially in all patients presenting for patch testing. The rate of steroid sensitization in New Zealand has not previously been documented. OBJECTIVES: To investigate the rate of corticosteroid sensitization and assess additional benefit of testing the full steroid series over the steroid allergy markers in the EBS. METHODS/PATIENTS: Retrospective analysis of all patient demographics and patch test results over a 5-year period (2014 to 2019) was performed at a tertiary patch test clinic in Auckland, New Zealand. RESULTS: A total of 319 patients completed patch testing, and 4.4% were sensitized to one or more corticosteroids. As much as 79% of positive reactions were of current relevance; 11/14 reactions were to tixocortol pivalate or budesonide. The "number needed to test" to detect one additional case of corticosteroid sensitization by using the full corticosteroid series over the EBS alone was 107. CONCLUSIONS: Although corticosteroid sensitization was not uncommon in our population, the results suggest that sequential testing with the corticosteroid markers (budesonide and tixocortol) in the standard series alone is adequate. The additional corticosteroid series should be added if the markers are positive or where there is a clinical suspicion of corticosteroid allergy.

Use of social media for surgical education in Australia and New Zealand.

BACKGROUND: Social media are an increasingly important tool for educators, although their use for surgical education in Australia and New Zealand (ANZ) has not been quantified. This study aimed to determine the social media presence of surgical training institutions in ANZ, quantify the proportion of their social media content that is educational, compare engagement between educational and non-educational content, and determine perspectives on using social media for education. METHODS: An online search was conducted in October 2018 to determine the social media presence of surgical training institutions accredited to deliver under- and post-graduate surgical education in ANZ. All their posts on Facebook and Twitter from November 2017 to October 2018 were categorized as educational or non-educational. Engagement on Twitter was analysed using retweets. An online survey was distributed to each institution to investigate their social media strategy and opinions on the use of social media for surgical education. RESULTS: Seven out of 37 (19%) surgical training institutions had active social media accounts. Educational content accounted for 677/4615 (14.7%) of their posts. Educational content was retweeted more often than non-educational content (17.2 versus 5.4, P = 0.002). Seven out of 37 (19%) institutions responded to the survey, with one respondent having a policy for and utilising social media for surgical education. CONCLUSIONS: Social media are being used by a minority of surgical training institutions for educational purposes in ANZ. Social media content is primarily non-educational although educational posts attract more engagement. Further research is required to assess the efficacy of surgical education on social media.

Understanding how time flies and what it means to be on cloud nine: English as an Additional Language (EAL) learners' metaphor comprehension.

We explored the vocabulary and metaphor comprehension of learners of English as an additional language (EAL) in the first two years of UK primary school. EAL vocabulary knowledge is believed to be a crucial predictor of (reading) comprehension and educational attainment (Murphy, 2018). The vocabulary of five- to seven-year-old children with EAL was compared to that of English monolinguals (N = 80). Comprehension was assessed for both verbal (e.g., time flies) and nominal metaphors (be on cloud nine) of varying frequency. Results showed that children in year 2 (age six to seven years) had better comprehension than their younger (age five to six) peers, particularly for low-frequency metaphors. Children with EAL had weaker metaphor comprehension than their monolingual peers, particularly on a reasoning task. The results document how metaphor comprehension develops over the first critical years of schooling and indicates where learners with EAL differ from monolingual peers, thereby supporting targeted vocabulary teaching at primary schools.

Morphosyntax in children with word finding difficulties.

Children with word finding difficulties (CwWFDs) are slower and less accurate at naming monomorphemic words than typically developing children (Dockrell, Messer & George, 2001), but their difficulty in naming morphologically complex words has not yet been investigated. One aim of this paper was to identify whether CwWFDs are similar to typically developing children at producing inflected (morphologically complex) words. A second aim was to investigate whether the dual-mechanism model could account for the use of morphology in a sample of CwWFDs, exemplifying the notion that regular inflections are part of a rule-based system and computed on-line, while irregular inflections are retrieved directly from the associative system (Pinker, 1999). The inflectional knowledge of a group of CwWFDs was compared against a group of language age-matched typically developing peers in three experiments. In Experiment 1 children produced the past tenses of high- and low-frequency regular and irregular English verbs. In Experiment 2 children generalized their knowledge of the past tense system onto nonsense verbs and in Experiment 3 children produced past tenses of verbs used in either a denominal or a verb root context. In each of these three studies, the CwWFDs performed similarly to matched typical children, suggesting that they do not have a selective problem with morphosyntactic features of words. The findings provide mixed support for the dual-mechanism model.

Rule learning by rats.

Using rules extracted from experience to solve problems in novel situations involves cognitions such as analogical reasoning and language learning and is considered a keystone of humans' unique abilities. Nonprimates, it has been argued, lack such rule transfer. We report that Rattus norvegicus can learn simple rules and apply them to new situations. Rats learned that sequences of stimuli consistent with a rule (such as XYX) were different from other sequences (such as XXY or YXX). When novel stimuli were used to construct sequences that did or did not obey the previously learned rule, rats transferred their learning. Therefore, rats, like humans, can transfer structural knowledge from sequential experiences.

Reduced specificity of autobiographical memory and depression: the role of executive control.

It has been widely established that depressed mood states and clinical depression, as well as a range of other psychiatric disorders, are associated with a relative difficulty in accessing specific autobiographical information in response to emotion-related cue words on an Autobiographical Memory Test (AMT; J. M. G. Williams & K. Broadbent, 1986). In 8 studies the authors examined the extent to which this relationship is a function of impaired executive control associated with these mood states and clinical disorders. Studies 1-4 demonstrated that performance on the AMT is associated with performance on measures of executive control, independent of depressed mood. Furthermore, Study 1 showed that executive control (as measured by verbal fluency) mediated the relationship between both depressed mood and a clinical diagnosis of eating disorder and AMT performance. Using a stratified sample in Study 5, the authors confirmed the positive association between depressed mood and impaired performance on the AMT. Studies 6-8 involved experimental manipulations of the parameters of the AMT designed to further indicate that reduced executive control is to a significant extent driving the relationship between depressed mood and AMT performance. The potential role of executive control in accounting for other aspects of the AMT literature is discussed.

When answer-phone makes a difference in children's acquisition of English compounds.

Over the course of acquiring deverbal compounds like truck driver, English-speaking children pass through a stage when they produce ungrammatical compounds like drive-truck. These errors have been attributed to canonical phrasal ordering (Clark, Hecht & Mulford, 1986). In this study, we compared British and Canadian children's compound production. Both dialects have the same phrasal ordering but some different lexical items (e.g. answer-phone exists only in British English). If influenced by these lexical differences, British children would produce more ungrammatical Verb-Object (VO) compounds in trying to produce the more complex deverbal (Object-Verb-er) than the Canadian children. 36 British children between the ages of 3;6 and 5;6 and 36 age-matched Canadian children were asked to produce novel compounds (like sun juggler). The British children produced more ungrammatical compounds and fewer grammatical compounds than the Canadian children. We argue that children's errors in deverbal compounds may be due in part to competing lexical structures.

Modality effects in compounding with English inflectional morphology.

The treatment of plural morphemes in English noun-noun compounds is significant because it provides a test case for competing theories of language acquisition and representation. Even when the first noun in a compound refers to plural items, native speakers frequently use the singular form (Murphy, 2000). Sometimes, they will use the irregular plural form ('mice chaser') but very rarely are regular plurals ('rats chaser') used as the first noun in a compound. This effect has been found with native English-speaking children (Gordon, 1985; Nicoladis, 2000; Oetting & Rice, 1993; van der Lely & Christian, 2000); native English-speaking teenagers (van der Lely & Christian, 2000); and native English-speaking adults (Lardiere & Schwartz, 1997; Murphy, 2000). The apparent dissociation between regular and irregular plurals (i.e.that irregular plurals are included before a second noun but regular plurals are almost never included before a second noun) is thought to be due to innate morphological constraints (Marcus, Brinkmann, Clahsen, Weise, & Pinker, 1995). Such constraints predict that all items of regular morphology should be treated differently from all items of irregular morphology by language users in all situations. However, if external factors such as input and response modality affect the number of plurals included in compounds, then this questions the internal constraint-based explanations of compounding and encourages investigation of how external factors might influence the number of plurals included in compounds.

Serial order of conditional stimuli as a discriminative cue for Pavlovian conditioning.

The serial order in which events occur can be a signal for different outcomes and therefore might be a determinant of how an animal should respond. In this report, we propose a novel design for studying serial order learning in Pavlovian conditioning. In both Experiments 1a and 1b, hungry rats were trained with successively presented pairs of auditory and visual stimuli (e.g., A --> B) using four different stimuli (A-D). Four orders were paired with food (A --> B, B --> C, C --> D, D --> A) while the reversals were extinguished (B --> A, C --> B, D --> C, A --> D). An analysis of responding from the second element of each pair showed that the rats discriminated trial types that preceded food from those that did not. A replication of the effect using a completely counterbalanced design is described in Experiment 1b. These results suggest that rats can use the serial or temporal order of two sequentially presented non-overlapping elements as the basis for discrimination. Two associative accounts are suggested as possible mechanisms for solving the discrimination.

Level-ordering does not constrain children's ungrammatical compounds.

English-speaking children typically avoid using regular plurals in novel grammatical deverbal compounds as in rat eater but allow irregular plurals as in mice eater (Gordon, 19985). To explain these data, it has been argued that level-ordering model constrains the production of morphologically complex words, including those with which children have had little to no experience. If level-ordering can be supported, children should avoid regular plurals in their ungrammatical deverbal compounds like a breaker-bottle. Seventy-two English-speaking children were included in the present study, 36 from Britain and 36 from Canada. The results showed that 50% of the children who produced ungrammatical compounds included regular plurals in the compounds they produced. Conversely, none of the children who produced grammatical compounds included regular plurals. These results indicate that level-ordering does not constrain children's production of ungrammatical compounds. These results raise the possibility that level-ordering may not be a valid constraint of children's compounding in general.