The Clinician's Subjective Experience during the Interaction with Adolescent Psychiatric Patients: Validity and Reliability of the Assessment of Clinician's Subjective Experience.

INTRODUCTION: The last decade has witnessed a resurgence of interest in the clinician's subjectivity and its role in the diagnostic assessment. Integrating the criteriological, third-person approach to patient evaluation and psychiatric diagnosis with other approaches that take into account the patient's subjective and intersubjective experience may bear particular importance in the assessment of very young patients. The ACSE (Assessment of Clinician's Subjective Experience) instrument may provide a practical way to probe the intersubjective field of the clinical examination; however, its reliability and validity in child and adolescent psychiatrists seeing very young patients is still to be determined. METHODS: Thirty-three clinicians and 278 first-contact patients aged 12-17 years participated in this study. The clinicians completed the ACSE instrument and the Brief Psychiatric Rating Scale after seeing the patient, and the Profile of Mood State (POMS) just before seeing the patient and immediately after. The ACSE was completed again for 45 patients over a short (1-4 days) retest interval. RESULTS: All ACSE scales showed high internal consistency and moderate to high temporal stability. Also, they displayed meaningful correlations with the changes in conceptually related POMS scales during the clinical examination. DISCUSSION: The findings corroborate and extend previous work on adult patients and suggest that the ACSE provides a valid and reliable measure of the clinician's subjective experience in adolescent psychiatric practice, too. The instrument may prove to be useful to help identify patients in the early stages of psychosis, in whom subtle alterations of being with others may be the only detectable sign. Future studies are needed to determine the feasibility and usefulness of integrating the ACSE within current approaches to the evaluation of at-risk mental states.

Risk assessment of natural and synthetic fibers in aquatic environment: A critical review.

Marine microplastics, categorized as primary and secondary, including synthetic microfibers like polyethylene terephthalate (PET), polypropylene (PP) and acrylic (PC), represent a potential environmental concern. The complex classification of these fibers, originating from diverse sources such as textiles and many others commercial goods, prompts a need for understanding their impact on aquatic organisms. This study assesses the ecological risks associated with both natural and synthetic fibers in aquatic ecosystems, focusing on toxicity data and their effects on taxonomic groups like Mollusca, Arthropoda, Echinodermata, Cnidaria, and Chordata. To carry out species sensitivity distribution (SSD) curves, a comprehensive analysis of scientific literature was conducted, collecting toxicity data related to various fibers. The resulting SSDs provide insights into the relative sensitivity of different taxonomic groups. The potential ecological risks were evaluated by comparing measured concentrations in diverse aquatic environments with Predicted No-Effect Concentration (PNEC) values. The calculation of Risk Quotient (RQ) allowed to indicate areas where fibers abundance poses a potential threat to aquatic organisms. The study reveals that nylon fibers can pose the highest toxicity risk, especially in Atlantic and Pacific Ocean, Arabian Gulf and VietNam river. Mollusca emerged as particularly sensitive to different fiber types, likely due to their body structure facilitating the accumulation of microfibers. The research emphasizes the urgent need for further studies to get data to human health risk analysis and to address comprehensive environmental management strategies to address the global issue of microfiber pollution.

Children with neurodevelopmental disorders: how do they sleep?

PURPOSE OF REVIEW: In this review we summarized the available evidence on sleep disorders in children with neurodevelopmental disorders (NDDs) in particular: intellectual disability (including some genetic conditions such as Prader-Willi Syndrome, Smith-Magenis Syndrome), Autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), Developmental Coordination Disorder, language disorders, and specific learning disorders. RECENT FINDINGS: Children with NDDs frequently suffer from sleep disturbances, with a higher prevalence than that of the general pediatric population. SUMMARY: These problems tend to be chronic and may cause additional cognitive and behavioral difficulties, often affecting the whole family's well-being. Sleep behaviors are also related to other important developmental skills, such as attention and listening. Investigating sleep disorders in children with NDDs is therefore crucial in clinical practice. For a systematic approach in clinical practice, we propose the use of a short and easy to remember sleep screening tool.

Efficacy of tigecycline pleurodesis: a comparative experimental study.

BACKGROUND: We investigated whether tigecycline (TIGE) is more effective than talc in inducing pleurodesis in rabbits. METHODS: Fifty-six New Zealand rabbits were utilized in a two-phase study: Effects at 14 d (phase I) and at 28 d (phase II) were assessed. Saline solution (SAL n = 3), talc slurry (TALC 200 mg/kg, n = 5), and TIGE at different concentrations (mg/kg): TIGE0.5 (n = 5); TIGE1 (n = 5); TIGE3 (n = 5); TIGE25 (n = 5); TIGE50 (n = 5) were randomly injected, for each phase, through a right chest drainage. TIGE0.5 and TIGE1 were ineffective during phase I and were thus excluded from further investigation. At post mortem examination, pleurodesis was graded grossly and microscopically by three observers blinded to treatment groups. RESULTS: Phase I: pleurodesis was more effective in TIGE25 and TIGE50 (P < 0.001); TALC was better than TIGE0.5 (P < 0.001), and TIGE1 (P = 0.49), macroscopically. Pleural thickness was significantly higher in TIGE25 compared with SAL, TALC, TIGE0.5, TIGE1, and TIGE3 (P < 0.01). No significant differences were evident between TALC and TIGE3, both macroscopically (P = 0.90) and microscopically (inflammation P = 0.99, fibrosis P = 0.96, pleural thickness P = 0.99). Phase II: better effectiveness of TIGE50 compared with all other groups (P < 0.001) except TIGE 25 (P = 0.29); results similar to phase I for TALC and TIGE3 (P = 0.99), macroscopically. Microscopically greater inflammation in TALC compared with TIGE3 (P < 0.05) and in TIGE50 to TIGE3 (P = 0.05). Significant complications occurred in all TIGE50 group. One of TIGE25 and one of TIGE50 died of respiratory distress and of right hemothorax+ascites, respectively. CONCLUSIONS: Intrapleural TIGE3 mg/kg is as effective as talc in inducing pleurodesis in rabbits. The intrapleural TIGE toxicity threshold was reached at TIGE25 mg/kg concentration.

Validity and reliability of Italian version of the Non-Communicating Children's Pain Checklist: revised version.

BACKGROUND: The Non-Communicating Children Pain Check List-Revised (NCCPC-R) is a clinical assessment tool used to assess and measure pain in children aged 3 to 18 years, with mental and intellectual disabilities, incapable to speak. AIM: Aim of our study was to test the validity and reliability of the Italian version of the NCCPC-R in children with cognitive impairment, in order to obtain a valid tool for pain assessment in these children. DESIGN: Prospective observational study. SETTING: Pediatric Outpatient of Physical and Rehabilitative Medicine Department, and Pediatrics, Child Neurology and Psychiatry Department, Sapienza University, Rome. POPULATION: 55 non-communicating children, with severe intellectual disability, aged 3-18 years. METHODS: The guidelines for "translation, adaptation, and validation of instruments or scales for cross-cultural healthcare research" were used to translate the scale, which was administered by the parents/caregivers twice for 2 consecutive days, in association with NRS (Numerical Rating Scale). The reliability of the scale was evaluated using the intra and inter-class correlation coefficient (ICCs); Cronbach alpha coefficient was used to test the internal validity of the scale; "Receiver Operating Characteristic" (ROC) curves were used to compare pain-free scores with pain scores, determining threshold scores; Pearson correlation between NCCPC-R and NRS values was measured. RESULTS: The InterCC between the first and the second interviewer at T0 was 0,97, the IntraCC of the first interviewer at T0-T1 was 0,89, showing a high correlation; the Cronbach alpha coefficient at T0 was 0,97, showing a high scale's validity. Pearson correlation between NRS and NCCPC-R values at T0 was 0,54 showing a medium level of agreement (P<0,0001). AUC (area under the curve) obtained by ROC curve at T0 was 0,807 (P=0,001), with sensitivity 95,2 and specificity 55,6, while a T1 AUC was 0,814 (P<0,001), with sensitivity 86,49, specificity 78,57. CONCLUSIONS: The Italian version of NCCPC-R scale could be used to asses pain in non-communicating patients with mental and intellectual disabilities, showing a good correlation when compared to the NRS. CLINICAL REHABILITATION IMPACT: The use of NCCPC-R scale in daily life made parents/caregivers able to discriminate the presence/absence of pain in non-communicating children, based on the scores obtained with the questionnaire.

Management of Candida guilliermondii joint infection in a dog.

BACKGROUND: Candida spp. are dimorphic fungi in the family Cryptococcaceae. Infections with Candida spp. are usually rare conditions in dogs, but immunocompromised patients have a higher risk for developing invasive candidal infections. CASE PRESENTATION: A 5-year-old male Boxer, positive to Leishmania infantum, was referred to the Veterinary Teaching Hospital of the Department of Veterinary Medicine, University of Perugia, Italy for examination of a non-weight bearing left hind limb lameness of a duration of at least 3 months. During this period, treatment involved systemic anti-inflammatory medications and intra-articular corticosteroid administration. On presentation, clinical examination and radiographic findings were suggestive of cranial cruciate ligament deficiency. To support this diagnosis a stifle arthroscopy was performed: it confirmed a partial rupture of cranial cruciate ligament. Samples culture of synovial fluid and membrane was routinely collected as well, and revealed Candida guilliermondii joint infection. Treatment for the C. guilliermondii joint infection involved systemic anti-fungal therapy, joint lavage and intra-articular administration of antifungal drugs. Lameness improved markedly during this treatment, but lameness did not resolve completely, probably due to cranial cruciate ligament deficiency. Tibial tuberosity advancement (TTA) was chosen in order to treat stifle instability and was performed 4 weeks following cessation of treatment of the C. guilliermondii joint infection. Six month after TTA the dog showed a completely recovery with no lameness. CONCLUSIONS: To the authors' knowledge, this is the first case of Candida spp. joint infection reported in dogs. The cause of the progression of the joint C. guilliermondii infection remains unclear but it may be associated with leishmaniasis or intra-articular corticosteroid injections. Treatment with systemic and intra-articular anti-fungal therapies was successful. In the evaluation of hind limb lameness in a chronically immunocompromised dog, it would be advisable to consider also an intra-articular Candida spp.