Adaptation of the Strength and Difficulties Questionnaire for Use in the Republic of Georgia.

Background: Children in low-resource countries like Georgia often have limited access to assessment measures for mental health care services. This study adapts and validates the mental health screening tool the Strength and Difficulties Questionnaire for use in Georgian children. Methods: A total of 16 654 children were assessed by a parent and/or teacher using Georgian-adapted Strength and Difficulties Questionnaire. Receiver operating characteristic analyses were performed to assess the discriminative validity of the Strength and Difficulties Questionnaires and to establish an optimal cutoff score. Results: Data from 15 738 parents- and 13 560 teachers-administered Strength and Difficulties Questionnaire were analyzed. The internal consistency analysis showed Cronbach's alpha to be 0.625 and 0.621 for parent- and teacher-administered Strength and Difficulties Questionnaire, respectively. The area under the curve (95% CI) shows that the Strength and Difficulties Questionnaire can differentiate risk group children from typically developing peers: parent-administered questionnaires-0.629 (0.556-0.702) and teacher-administered questionnaires-0.680 (0.611-0.789). Parent-administered Strength and Difficulties Questionnaire has a cutoff value of 16 or more with 92.5% of sensitivity and teacher-administered Strength and Difficulties Questionnaire-14 or more with a sensitivity of 85.6%. Conclusion: The study finds that the Strength and Difficulties Questionnaire is a valid screening instrument and does not depend on the informant-parent or teacher. It suggests that with appropriate cultural adaptation, the SDQ can be used in the Republic of Georgia to identify children at risk for mental disorders and help guide resource allocation.

Simulation-Based Mastery Learning Course for Tube Thoracostomy.

Introduction: Tube thoracostomy is a relatively infrequent, high-risk procedure that is a required competency for emergency medicine residents. Simulation-based mastery learning is the gold standard for procedure training and has been used to successfully train residents in high-risk procedures. Methods: We developed a simulation-based mastery learning course for tube thoracostomy for PGY 2 emergency medicine residents. The course included (1) precourse work, (2) baseline assessment using a modified version of the TUBE-iCOMPT checklist, (3) anatomy/radiology review, (4) deliberate practice to master individual aspects of the procedure, and (5) final assessment. If a minimum passing score was not achieved, additional coaching and deliberate practice occurred until the learner was able to achieve a minimum passing score. Results: After piloting the course with a cohort of seven PGY 2 emergency medicine residents, we successfully trained 24 additional PGY 2 residents in the subsequent two classes. Combining all three cohorts (N = 31), there was a statistically significant increase in learners' modified TUBE-iCOMPT scores (pretest M = 61.2, SD = 10.0; posttest M = 75.5, SD = 2.9; p < .001). Learners' confidence in their ability to correctly place a chest tube increased, rated on a 10-point Likert scale (1 = not very confident, 10 = very confident; precourse M = 5.6, SD = 1.8; postcourse M = 8.3, SD = 1.1; p < .001). Discussion: This simulation-based course was well received by learners. Our assessment demonstrated that learners improved directly observed procedural skills in simulation and confidence in tube thoracostomy placement.

Nearly all thirty most frequently used emergency department drugs experienced shortages from 2006-2019.

BACKGROUND: Drug shortages contribute to avoidable medication error and patient harm; these shortages are exacerbated in the Emergency Department due to the time-sensitive nature of acute care. METHODS: We performed a cross-sectional study to describe the frequency and duration of drug shortages associated with the most frequent medications administered in the ED. We identified the most frequently used ED medications and calculated number of visits associated with these medications using the 2006-2019 National Hospital Ambulatory Medical Care Survey. We obtained the frequency and duration of shortages associated with these medications from the University of Utah Drug Information System. We calculated duration and total ED visits associated with shortages of the most frequently used ED medications. RESULTS: From 2006 through 2019, the most frequently used drugs were ondansetron (255.1 million ED visits), 0.9% normal saline (251.3 million ED visits), and ibuprofen (188.5 million ED visits). All but two of the top thirty most frequently used medications experienced a shortage. The median shortage duration was 425 days, while the longest were for injectable morphine (3,202 days). The number of ED visits associated with drugs experiencing shortages increased from 2,564,425 (2.2% of U.S. ED visits) in 2006 to 67,221,968 (60.4%) in 2019. The most common reasons for shortage include manufacturing delays and increased demand. CONCLUSIONS AND RELEVANCE: Drug shortages were more frequent and persistent from 2006 through 2019. Further studies on the clinical impact of these shortages are needed, in addition to policy interventions to mitigate shortages.

Prevalence and correlation of OXIS contacts using Cone Beam Computed Tomography (CBCT) images and photographs.

BACKGROUND: The contact areas in between primary teeth are broader, flatter, and located further cervically when compared with the contact areas of permanent molars. AIM: We investigated the prevalence of interproximal contact area types of primary molars using CBCT images in children aged 3-10 years. Our second objective was to correlate OXIS contact areas when observed with CBCT images and clinical photographs. DESIGN: A retrospective cross-sectional study was performed with 367 CBCT images of children, aged 3-10 years, obtained from Children's Dental Centre, South Korea. The type of contacts in between primary molars was scored at various levels, specifically, occlusal, middle, and cervical thirds, according to OXIS criteria. Following this, the same patient's records were checked for the presence of clinical photographs and scored according to the same criteria. Prevalence was stated as percentages along with numbers. Chi-square test was applied to determine association of contact areas across genders and arches. The correlation between the two methods was done by Cohen's Kappa correlation test. RESULTS: The prevalence of the OXIS contacts obtained from CBCT images was as follows: I (79.7%), followed by X (10.0%), S (6.6%), and, finally, O (3.7%). The overall score of all the 1343 contact areas matched with the score observed at the occlusal third. All included contacts were of O (open) type at cervical third, and 1,231 contacts were of O (open) type at the middle third. Significant results were observed with respect to arches (P < .001). The correlation between the two methods was found to be 0.958. CONCLUSIONS: The contact area observed at the occlusal level determined the overall type of contact based on OXIS criteria. Thus, reports in the literature concluded that contact areas are broad, flat, and extend further gingivally should be revised. The study also concluded almost perfect agreement between CBCT images and clinical photographs.

Left ventricular perforation with catheter decompression.

Thoracostomy tube placement is one of the more common procedures performed in the Emergency Department, most commonly for treatment of pneumothorax or hemothorax but occasionally for drainage of empyema or pleural effusion. Thoracostomy may be a life-saving procedure with a wide range of complication rates reported, ranging from 19.4-37%, most commonly extrathoracic placement. Most recent meta-analyses showed a relatively stable complication rate of 19% over the past three decades with the vast majority being benign in nature. We present a case with the rare complication of thoracostomy in which of a small-caliber thoracostomy tube was placed in the left ventricle. Although thoracotomy was performed to remove the catheter, the patient remained virtually asymptomatic and had an uneventful course.

Creating an Asynchronous Curriculum for Your Emergency Medicine Residency.

This article was migrated. The article was marked as recommended. Background An asynchronous curriculum is one in which residents complete structured learning assignments outside of the traditional Emergency Medicine conference day. As educators are challenged with filling the time in the traditional didactic classroom setting with appropriate content while maintaining the interest of learners, asynchronous learning is becoming an essential component of Emergency Medicine resident curricula. While many residencies are investigating best practices to design and implement asynchronous education, relatively little guidance exists on the creation of such a curriculum. Methods Our goal was to create an asynchronous curriculum using only a chief resident and a core faculty member. Our module-based asynchronous curriculum was formulated based on recommendations from the Council of Emergency Medicine Residency Directors (CORD) ( Sadosty et al. 2009). We focused on using free open access medical education (FOAMEd) as primary content. Results Our residency program has successfully implemented an asynchronous curriculum for two years, and it is still ongoing. We achieved an assignment completion rate of 77.0% in the first year of implementation and 88.6% in our second year. Conclusions The creation and implementation of an asynchronous curriculum is manageable and well-received by Emergency Medicine residents.

Hepatitis B virus X protein induces epithelial-mesenchymal transition by repressing E-cadherin expression via upregulation of E12/E47.

Previous reports have demonstrated that hepatitis B virus (HBV) X protein (HBx) represses E-cadherin expression to induce epithelial-mesenchymal transition (EMT), an essential component of cancer progression to more aggressive phenotypes characterized by tumour invasion, migration and metastasis; however, the underlying mechanism for this phenomenon is still unclear. In this study, we found that ectopic expression of HBx in human hepatocytes using overexpression and 1.2-mer WT HBV replicon systems upregulated levels of the transcriptional repressors E12 and E47, resulting in inactivation of the E-cadherin promoter, containing three E-box motifs, and subsequent repression of its expression. E12/E47 knockdown using a specific small interfering RNA almost completely abolished the potential of HBx to repress E-cadherin expression. HBx inhibited the ubiquitin-dependent proteasomal degradation of E12/E47 without affecting their expression at the transcriptional level. Upregulation of E12/E47 by HBx ultimately led to EMT in human hepatocytes, as demonstrated by morphological changes, altered protein levels of EMT markers, including E-cadherin, plakoglobin, fibronectin, vimentin and N-cadherin, and increased capacity for cell detachment and migration.

Three cases of pulmonary thromboembolism and extensive prayer (invocation) activity as a new possible risk factor.

Pulmonary thromboembolism (PTE) is caused when thrombi are detached from the deep vein of the lower leg. In the field of forensic medicine, it is a well-known cause of sudden death. It has been reported that risk factors for PTE include surgery, trauma, extensive bed rest, and malignant neoplasm, among others; in addition, long-haul air travel is associated with a slightly increased risk for PTE, though such cases are rare. Recently, PTE had been reported in association with different conditions, such as ethrombosis, seated immobility thromboembolism, driving for long periods, and after traveling. The authors performed autopsies on 3 patients who died suddenly after 3 to 4 days of prayer in a prayer center or hermitage. It was confirmed that all deaths were caused by thrombi that had developed in the deep vein, obstructing the pulmonary artery. It was concluded that during repeated praying activities over an extensive time period, the kneeling position might have caused PTE. It is also possible that dehydration due to fasting may affect the formation of thrombi. According to the literature, PTE cases developed in association with prayer activity and position have not been reported to date, and so PTE caused by prayer activity is thought to be a new type of PTE developed in association with a certain life style. Therefore, people should be advised that a position involving a long period of immobilization, including long periods of prayer, could raise the risk of PTE. In addition, social policies to prevent the development of this kind of PTE are needed.

Quantification of ammonia and hydrogen sulfide emitted from pig buildings in Korea.

The aim of this field study was to determine the concentrations and emissions of ammonia and hydrogen sulfide in different types of pig buildings in Korea to allow objective comparison between pig housing types in Korea and other countries. Concentrations of ammonia and hydrogen sulfide in the pig buildings averaged 7.5ppm and 286.5ppb and ranged from 0.8 to 21.4ppm and from 45.8 to 1235ppb, respectively. The mean emissions of ammonia and hydrogen sulfide per pig (normalized to 75kg liveweight) and area (m2) from pig buildings were 250.2 and 37.8mg/h/pig and 336.3 and 50.9mg/h/m2, respectively. Ammonia and hydrogen sulfide concentrations and emissions were higher in the pig buildings managed with deep-pit manure systems with slats and mechanical ventilation than in other housing types.

Advantage of support vector machine for neural spike train decoding under spike sorting errors.

Decoding of kinematic variables from neuronal spike trains is important for neuroprosthetic devices. The spike trains from single units must be extracted from extracellular neural signals and thus spike detection and sorting procedure is essential. Since the spike detection and sorting procedure may yield considerable errors, decoding algorithm should be robust against spike train errors. Here we showed that the spike train decoding algorithms employing a nonlinear mapping, especially support vector machine (SVM), may be more advantageous contrary to conventional belief that linear filter is sufficient. The advantage became more conspicuous with erroneous spike trains. Using the SVM, satisfactory performance could be obtained much more easily, compared to the case of using multilayer perceptron, which was employed for previous studies. The results suggests the possibility of neuroprosthetic device with a low-quality spike sorting preprocessor.

Release of bacteria during the purge cycles of steam-jacketed sterilizers.

The design of the steam-jacketed sterilizer includes an exterior air-gap fixture through which purged chamber aerosols potentially could escape into the ambient environment. Studies of the purge cycle in two sterilizer models tested the potential release of a genetically marked Enterococcus faecalis, together with Bacillus stearothermophilus spores introduced as exposed cultures. Direct plate counts, broth enrichment and polymerase chain reaction analysis were used to confirm any released organisms trapped in an all-glass impinger. From the retrieval of both bacterial strains, an estimated 10(3) organisms can be released from uncontained bacterial loads of 10(11) E. faecalis and 10(7) B. stearothermophilus, even from properly functioning autoclaves. The release of an opportunistic pathogen from sterilizer purge exhausts emphasises the importance of proper sterilizer location, ventilation, containment of heavily contaminated loads, and adequate sterilizer maintenance.

p15s (15-kD antimicrobial proteins) are stored in the secondary granules of Rabbit granulocytes: implications for antibacterial synergy with the bactericidal/permeability-increasing protein in inflammatory fluids.

The bactericidal potency toward complement-resistant Escherichia coli of bactericidal/permeability-increasing protein (BPI) released from polymorphonuclear leukocytes (PMNs) in glycogen-induced inflammatory peritoneal exudates of rabbits is dependent on synergy with extracellular p15s. This synergy depends on the high molar ratio of p15s to BPI in the extracellular fluid (approximately 50:1), which greatly exceeds the intracellular ratio (approximately 5:1). To explore the possible basis of the greater accumulation of p15s in inflammatory fluid, we examined the subcellular localization of BPI and p15 in PMNs. Immunogold electron microscopy confirmed the storage of BPI in primary granules and showed that p15s are stored in secondary granules. Reverse-transcription polymerase chain reaction of density-fractionated rabbit bone marrow cells verified that p15s are expressed later than BPI during myeloid differentiation. As the inflammatory response evolves, p15 mRNA appears earlier in blood and exudate cells than mRNA for BPI, consistent with release of progressively less mature precursors from bone marrow. Finally, Ca(2+)-ionophore-mediated exocytosis of p15s occurs more readily than release of BPI. We therefore propose that localization of a synergistic partner of BPI (p15s) in more readily released secondary granules allows the neutrophil to mobilize potent BPI-dependent antibacterial activity extracellularly without significant depletion of intracellular BPI stores.

[Triterpene saponins from the Chinese drug "Daxueteng" (Caulis sargentodoxae)]. / Triterpensaponine aus der chinesischen Droge "Daxueteng" (Caulis Sargentodoxae). Triterpene Saponins from the Chinese Drug "Daxueteng" (Caulis Sargentodoxae).

From the chinese drug "Daxueteng" (Caulis Sargentodoxae: Sargentodoxa cuneata (Oliv.) Rehd. et Wils.; syn. Holboellia cuneata Oliv.) (Sargentodoxaceae), catechin and two known triterpene saponins, rosamultin (7) and kajiichigoside F1 (8) have been isolated. Some hitherto unknown reaction products of the saponins are described. Both 7 and 8 show haemolytic and in vitro antiviral activity.