From everyday life predictions to suicide prevention: Clinical and ethical considerations in suicide predictive analytic tools.

Advances in artificial intelligence and machine learning have fueled growing interest in the application of predictive analytics to identify high-risk suicidal patients. Such application will require the aggregation of large-scale, sensitive patient data to help inform complex and potentially stigmatizing health care decisions. This paper provides a description of how suicide prediction is uniquely difficult by comparing it to nonmedical (weather and traffic forecasting) and medical predictions (cancer and human immunodeficiency virus risk), followed by clinical and ethical challenges presented within a risk-benefit conceptual framework. Because the misidentification of suicide risk may be associated with unintended negative consequences, clinicians and policymakers need to carefully weigh the risks and benefits of using suicide predictive analytics across health care populations. Practical recommendations are provided to strengthen the protection of patient rights and enhance the clinical utility of suicide predictive analytics tools.

ON Time Mobility: Advocating for Mobility Equity.

Mobility is a human right. The traditional definition of mobility in physical therapy practice is centered on translocation and, while accurate, is not comprehensive. In this article, we propose the ON Time Mobility framework: that all children have the right to be mobile throughout their development to explore, engage in relationships, and develop agency to cocreate their lives. This perspective highlights interconnected principles of timing, urgency, multimodal, frequency, and sociability to begin discussions on supporting the right to hours of active mobility each day for all children. We propose critical evaluation and discussion of these principles followed by a call to action to shift our conceptualization and enactment of mobility. This mobility rights perspective challenges current medical systems, industry, and government to collaborate with children with disabilities, their families and communities to support mobility as a source of physical and social interactions that define and develop individuals (see Supplemental Digital Content 1, the Video Abstract, available at: http://links.lww.com/PPT/A398 ).

Deficiency of the zinc finger protein ZFP106 causes motor and sensory neurodegeneration.

Zinc finger motifs are distributed amongst many eukaryotic protein families, directing nucleic acid-protein and protein-protein interactions. Zinc finger protein 106 (ZFP106) has previously been associated with roles in immune response, muscle differentiation, testes development and DNA damage, although little is known about its specific function. To further investigate the function of ZFP106, we performed an in-depth characterization of Zfp106 deficient mice (Zfp106(-/-)), and we report a novel role for ZFP106 in motor and sensory neuronal maintenance and survival. Zfp106(-/-) mice develop severe motor abnormalities, major deficits in muscle strength and histopathological changes in muscle. Intriguingly, despite being highly expressed throughout the central nervous system, Zfp106(-/-) mice undergo selective motor and sensory neuronal and axonal degeneration specific to the spinal cord and peripheral nervous system. Neurodegeneration does not occur during development of Zfp106(-/-) mice, suggesting that ZFP106 is likely required for the maintenance of mature peripheral motor and sensory neurons. Analysis of embryonic Zfp106(-/-) motor neurons revealed deficits in mitochondrial function, with an inhibition of Complex I within the mitochondrial electron transport chain. Our results highlight a vital role for ZFP106 in sensory and motor neuron maintenance and reveal a novel player in mitochondrial dysfunction and neurodegeneration.

Utilization of an interprofessional integrated clinical education experience to improve medical and physical therapy student comfort in treating patients with disabilities.

Purpose: The purpose of this study is to examine the impact of an interprofessional education (IPE) clinical experience for medical and physical therapy students on students' comfort levels and attitudes toward patients with disabilities. Methods: Forty students were recruited for this study, 20 from the College of Medicine and 20 from the Doctor of Physical Therapy Program at University of Central Florida with 10 students from each program self-selected into a control group or an experimental group. The experimental group attended an IPE clinical experience that included an encounter with a patient with a disability. Students completed standardized inventories on their perceptions of difficult rehabilitation situations, comfort levels, and attitudes prior to, and immediately following, the clinical experience. The control group completed the same standardized assessments. Results: Using the rehabilitation situations inventory (RSI) statistically significant changes in scores from the pre- to the post-intervention (P < 0.001) were observed. In addition, a statistically significant (P < 0.05) improvement in comfort levels was found in five of the six RSI subscales which include staff-staff interactions, families, motivation/adherence, aggression, and sexual situations. Attitudes toward disabled persons (ATDP) and interactions with disabled persons (IDP) failed to find statistically significant changes in respondent scores due to the intervention (P > 0.05). Conclusion: Both medical and physical therapy students reported increased comfort in dealing with rehabilitation situations after attending the IPE clinical experience. This supports the use of clinical encounters with individuals with disabilities as component of education on treating patients with disabilities.

Smoke-Free Policies in the World's 50 Busiest Airports - August 2017.

Exposure to secondhand smoke from burning tobacco products causes premature death and disease, including coronary heart disease, stroke, and lung cancer among nonsmoking adults and sudden infant death syndrome, acute respiratory infections, middle ear disease, exacerbated asthma, respiratory symptoms, and decreased lung function in children (1,2). The U.S. Surgeon General has concluded that there is no risk-free level of exposure to secondhand smoke (1). Previous CDC reports on airport smoke-free policies found that most large-hub airports in the United States prohibit smoking (3); however, the extent of smoke-free policies at airports globally has not been assessed. CDC assessed smoke-free policies at the world's 50 busiest airports (airports with the highest number of passengers traveling through an airport in a year) as of August 2017; approximately 2.7 billion travelers pass through these 50 airports each year (4). Among these airports, 23 (46%) completely prohibit smoking indoors, including five of the 10 busiest airports. The remaining 27 airports continue to allow smoking in designated smoking areas. Designated or ventilated smoking areas can cause involuntary secondhand smoke exposure among nonsmoking travelers and airport employees. Smoke-free policies at the national, city, or airport authority levels can protect employees and travelers from secondhand smoke inside airports.

Reliability of Common Lower Extremity Biomechanical Measures of Children With and Without Obesity.

PURPOSE: To determine intrarater and interrater reliability of common measures of lower extremity alignment among children with obesity. METHODS: The Craig test for femoral anteversion, tibiofemoral angle, Foot Posture Index-6, and sit-and-reach test were performed on 25 children without obesity and 25 children with obesity. RESULTS: Intrarater reliability of all measures in both groups was high. The Craig test demonstrated greatest variability with slight interrater reliability in children who were nonobese [intraclass correlation coefficient [ICC] (95% confidence interval [CI]), 0.372 (-0.051 to 0.6420)] and moderate reliability in children who were obese [ICC (95% CI), 0.527 (0.242 to 0.717)]. Interrater reliability for the tibiofemoral angle and Foot Posture Index-6 was moderate to substantial and for the sit-and-reach test was substantial (ICC >0.99) and highly correlated. Measurement of lower extremity alignment among children with obesity was more reproducible than among children who were not obese. CONCLUSIONS: Measures of lower extremity alignment and general flexibility in children with obesity are both reproducible and reliable.

The BMP signaling gradient patterns dorsoventral tissues in a temporally progressive manner along the anteroposterior axis.

Patterning of the vertebrate anteroposterior (AP) axis proceeds temporally from anterior to posterior. How dorsoventral (DV) axial patterning relates to AP temporal patterning is unknown. We examined the temporal activity of BMP signaling in patterning ventrolateral cell fates along the AP axis, using transgenes that rapidly turn "off" or "on" BMP signaling. We show that BMP signaling patterns rostral DV cell fates at the onset of gastrulation, whereas progressively more caudal DV cell fates are patterned at progressively later intervals during gastrulation. Increased BMP signal duration is not required to pattern more caudal DV cell fates; rather, distinct temporal intervals of signaling are required. This progressive action is regulated downstream of, or in parallel to, BMP signal transduction at the level of Smad1/5 phosphorylation. We propose that a temporal cue regulates a cell's competence to respond to BMP signaling, allowing the acquisition of a cell's DV and AP identity simultaneously.

The patient experience with fatigue and content validity of a measure to assess fatigue severity: qualitative research in patients with ankylosing spondylitis (AS).

BACKGROUND: Ankylosing spondylitis (AS) is an autoimmune disorder characterized by inflammation of the spine and large joints. Fatigue is a common symptom that many AS patients find significantly impacts their health-related quality of life. The Worst Fatigue - Numeric Rating Scale (WF-NRS) assesses the severity of this symptom during the previous 24-hour period. The objective of this study was to perform qualitative research to support the development and content validity of the WF-NRS. METHODS: Patients with AS were recruited from clinical sites in the U.S. for a qualitative study which first entailed concept elicitation interviews to gain understanding of the patients' experience with AS and fatigue. Subsequently, cognitive debriefing interviews were undertaken to assess the understandability, clarity, and appropriateness from the patient's perspective, of the content of a measure of fatigue severity. RESULTS: Thirteen patients with AS participated in concept elicitation interviews and cognitive debriefing of the Brief Fatigue Inventory (BFI) fatigue severity subscale. The WF-NRS was developed from the worst fatigue item of the BFI as patients generally reported it to be understandable and covered an important concept, the completion instructions were modified, but the response scale remained as it was familiar and readily completed, and the recall period was appropriate. CONCLUSIONS: Patient responses resulted in the development of and supported the content validity of the WF-NRS. Further quantitative evaluation of the WF-NRS is warranted in order to assess its psychometric properties and confirm its usefulness as a clinical trial tool.

Antiviral IFN-γ responses of monocytes at birth predict respiratory tract illness in the first year of life.

BACKGROUND: Viral respiratory tract infections are the leading cause of acute illness during infancy and are closely linked to chronic inflammatory airway diseases later in life. However, the determinants of susceptibility to acute respiratory tract infections still need to be defined. OBJECTIVE: We investigated whether the individual variation in antiviral response at birth determines the risk for acute respiratory tract illness in the first year of life. METHODS: We studied 82 children who were enrolled in a birth cohort study of inner-city children with at least 1 parent with allergy or asthma. We cultured cord blood monocytes and assessed IFNG and CCL5 mRNA production at 24 hours after inoculation with respiratory syncytial virus. We also monitored the frequency of acute respiratory tract illness at 3-month intervals and analyzed nasal lavage samples for respiratory tract viruses at the time of illness during the first year. RESULTS: Respiratory tract infection was reported for 88% of subjects, and respiratory tract viruses were recovered in 74% of symptomatic children. We observed a wide range of antiviral responses in cord blood monocytes across the population. Furthermore, a decrease in production of IFNG (but not CCL5) mRNA in response to respiratory syncytial virus infection of monocytes was associated with a significant increase in the frequency of upper respiratory tract infections (r = -0.42, P < .001) and the prevalence of ear and sinus infections, pneumonias, and respiratory-related hospitalizations. CONCLUSION: Individual variations in the innate immune response to respiratory tract viruses are detectable even at birth, and these differences predict the susceptibility to acute respiratory tract illness during the first year of life.

The association of hemoglobin A1c with the prevalence of stenosing flexor tenosynovitis.

PURPOSE: Diabetic patients are susceptible to stenosing flexor tenosynovitis (FTS) and may have a diminished response to treatment. The purpose of this study was to determine whether elevated hemoglobin A1c (HbA1c) levels are associated with the development of FTS. METHODS: A review of our diabetic registry identified a cohort of patients with diabetes mellitus. We stratified this cohort to those with and without a diagnosis of FTS during 2008 based on International Classification of Diseases-9 coding (727.00-727.05J). We reviewed charts to confirm the diagnosis. For patients diagnosed with FTS, we used the HbA1c measurement made closest to the date of diagnosis for analysis. We assessed patients without FTS using an average of HbA1c measurements during the same time period and performed subgroup analysis based on specified HbA1c levels (group A, HbA1c level < 7.0%; group B, HbA1c 7.0% to 7.9%; group C, HbA1c 8.0% to 8.9%; group D, HbA1c ≥ 9.0%). Statistical testing consisted of chi-square analysis, odds ratios, and multivariate regression analysis. RESULTS: There were 259,927 patients in 2008 identified with diabetes mellitus, 3,952 of whom were diagnosed with FTS. The period prevalence of FTS in this diabetic population was 1.5%. Multivariate regression analysis revealed that HbA1c greater than 7% was an independent risk factor for FTS (odds ratio/confidence interval: group B, 1.31/1.20-1.42; group C, 1.35/1.21-1.51; group D, 1.23/1.10-1.38). CONCLUSIONS: The prevalence of FTS in this diabetic population was considerably lower than expected and may represent a more accurate assessment given the power of this population-based study. In addition, the development of FTS appears to be associated with higher HbA1c levels. Although further study is necessary, this association may be relevant when evaluating and treating diabetic patients with trigger finger.

Shot to the heart: a case of traumatic ventricular septal aneurysm and review of the literature.

Traumatic cardiac injuries are an uncommon diagnosis in the pediatric population. Of the traumatic cardiac injuries, more than 95% are contusions. Traumatic ventricular aneurysms are exceptionally rare, and most are detected during long-term follow-up. They are usually successfully managed medically but can require emergent surgical intervention. We report the case of a 6-year-old boy who was in a motor vehicle collision. He was found to have profound sinus bradycardia during initial resuscitation with hypotension. An electrocardiogram showed complete heart block. A cardiologist was consulted, and an echocardiogram was performed, which revealed a ventricular septal aneurysm. The case is followed by a review of the literature on traumatic cardiac injuries and ventricular septal aneurysms in the pediatric population.

Assessing the benefits of a geropsychiatric home-visit program for medical students.

OBJECTIVE: Authors assessed the benefit of including medical students on geropsychiatric home-visits. METHOD Medical students, during their psychiatry clerkship, were assigned to a home-visit group (N=43) or control group (N=81). Home-visit participants attended the initial visit of a home-bound geriatric patient. The Maxwell-Sullivan Attitude Scale (MSAS), measuring attitudes about geriatric patients, was administered to all students before and after the clerkship. Home-visit participants received a questionnaire to rate the experience. RESULTS: There were no significant differences between the groups with regard to change from baseline to follow-up on the MSAS. On the home-visit questionnaire, participants rated positively the overall experience (mean of 3.5 on a 4-point scale). Most home-visit participants commented positively about their experience. CONCLUSION: No significant effect of the home visit on medical student attitudes was demonstrated. However, the student questionnaire responses suggested that the students found the experience useful.

Clinical shadowing experience PIF rubric.

BACKGROUND: The purpose of this study was to develop and evaluate a tool for documenting professional identity formation (PIF) among preclinical medical students, via reflective writings (RWs) about their clinical shadowing experiences. APPROACH: To address our key questions, stakeholders conducted comprehensive literature analysis, and the authors developed an analytic rubric through an iterative immersion/crystallisation process. EVALUATION: Rubric iterations were empirically tested, assessed for interrater reliability, refined and then applied in successive development phases to medical student RW narratives. Twenty-nine first-year RWs on their shadowing experiences were included for this developmental evaluation. IMPLICATIONS: The clinical shadowing experience PIF rubric is a theory-informed analytic tool that demonstrates feasibility of measuring PIF in preclinical medical students' RWs. Reliable use of this tool currently requires a team approach that could be improved by machine learning.

An Innovative Approach to Health Promotion and Wellness for University Students with Intellectual and Physical Disabilities: A Case Series.

A university setting offers a unique opportunity to address physical activity for individuals with disabilities. The purpose of this case series was to highlight the development of a formal student-assisted exercise program and examine its impact on the perceived quality of life, exercise confidence, and functional mobility of college-aged individuals with intellectual and physical disabilities. Data from twelve participants was analyzed. Seven participants demonstrated an improvement in scores on the Self-Efficacy to Exercise scale and eight improved in functional measures associated with strength. Thus, a collaborative assisted exercise program in a university setting may positively impact health and physical activity, and exercise participation in young adults with physical and/or intellectual disabilities.

The Relationship Between Interprofessional Collaborative Practice Experience and Interprofessional Attitudes in Students from Health Professions.

Interprofessional collaborative practice (IPCP) can be achieved through purposeful interprofessional education of healthcare students within a clinical environment. The purpose of this study was to examine the relationship between past participation of students in IPCP with interprofessional attitudes of students, as measured by the Interprofessional Attitudes Scale (IPAS). It further examined differences in IPAS based on profession. A Pearson correlation examined association of IPCP experience with IPAS scores. An analysis of covariance evaluated group differences, with post-hoc tests examining pairwise differences. Participants (n=170) consisted of students from medicine, physical therapy, social work, nursing, and pharmacy. A positive relationship existed for IPAS scores and IPCP experiences for medical students and pharmacy students, but no other profession. Medical students scored lower on interprofessional attitudes when compared with other professions. Further, when controlling for IPCP experience, IPAS scores differed between medical students and all other professions for total score as well as the teamwork, roles and responsibilities subdomain. Results indicate that the volume of IPCP experience may have a relationship with interprofessional attitudes among health professional students. Evidence supports the need for continued strategic curricular design to cultivate interprofessional behaviors in students through implementation of greater amounts of IPCP experiences for students.

Assessment of effectiveness of deworming options in recently weaned beef cattle utilizing different anthelmintic programs in the southeast.

This study evaluated the effects of three different anthelmintic strategies on animal performance and anthelmintic effectiveness in weaned calves during a 42-d preconditioning period. The study was conducted at four locations over 2 yr and included a total of 797 recently weaned spring-born calves (initial BW 260 ± 37.7 kg). At the start of each year, at each location, calves were weaned and randomly assigned to one of four treatments: 1) oxfendazole (ORAL); 2) transdermal eprinomectin (POUR); 3) both anthelmintic treatments (BOTH); and 4) the control (CONT) group who did not receive treatment. Anthelmintic was applied per the manufacturer recommendation, the transdermal eprinomectin was administered at 1 mL per 10 kg and oxfendazole was administered orally at 1 mL per 50 kg. Weights were measured at the start of the study (day 0) and again at the end of the preconditioning phase (day 42). Fecal samples were collected at the start of the study prior to treatment application (day 0) and again on day 14. Rumen fluid was collected at the start of the study prior to treatment (day 0) and again on day 6. There were treatment effects for all performance metrics (P < 0.001). All treatments had greater weight gain and value of weight gained (P < 0.024), and all three strategies did not differ from each other (P > 0.420). On day 0, there were no (P = 0.795) treatment effects detected for fecal eggs per gram (EPG) counts. On day 14, there were (P < 0.001) treatment effects for EPG counts with feces from CONT calves containing greater (P < 0.014) EPG than feces from treated calves. EPG in feces from BOTH calves did not differ (P > 0.123) from the other two treated groups and feces from POUR calves tended (P = 0.052) to contain greater EPG counts than feces from ORAL calves. Volatile fatty acids were similar across treatments on days 0 and 6 (P > 0.115). Butyrate tended (P = 0.063) to be lower in ORAL on day 6. These results suggest that using eprinomectin and oxfendazole in combination was an effective strategy for reducing EPG and improving performance during a 42-d preconditioning phase.

The impact of maturity stages on yield, quality, and nutritive value of ensiled Johnsongrass [Sorghum halepense (L.) Pers].

Johnsongrass [Sorghum halepense (L.) Pers.] is a non-native, invasive species that causes substantial losses in row crops and hay fields, which could be minimized by using Johnsongrass as a conserved forage. Two experiments were conducted to evaluate the yield and quality of Johnsongrass ensiled at four maturities: harvested every 3 weeks (3WK), boot stage (BOOT), flower stage (FLOWER), and dough (DOUGH) stages. In experiment 1, yield, botanical composition, nutritive value, and fermentation characteristics of Johnsongrass were measured. In experiment 2, Johnsongrass silage was incubated for 48 h for assessment of gas production, pH, in vitro dry matter digestibility (IVDMD), and volatile fatty acids. The experimental area consisted of 16 plots (2.74 m × 4.57 m) divided into four blocks, and treatment was randomly assigned to plot within block. Each year, silage was prepared for each plot from the two cutting closest to July 1. After 10 weeks, the silos were opened, and silage samples were frozen for further analysis. Data from both experiments were tested for the effects of maturity stage and harvest timing (first and second harvest). The results from experiment 1 showed an increase (P < 0.0001) in dry matter yield from 3WK stage to DOUGH. Johnsongrass, as a proportion of the total botanical composition, declined at the end of the growing season for 3WK but increased in FLOWER (P = 0.0010). In the first harvest, 3WK and BOOT stage silages had the greatest concentrations of crude protein and total digestible nutrients and lowest of fiber (neutral detergent fiber and acid detergent fiber; P < 0.0001). In the second harvest, differences in nutrient content were significant only for 3WK silages, which showed the best nutritive value (P < 0.0001). In experiment 2, IVDMD of silage followed the same trends described for nutritive value from experiment 1. Overall, these results demonstrate that Johnsongrass can be successfully ensiled, but to optimize forage nutritive value and quantity, Johnsongrass should be ensiled before it reaches the flower stage.

Indirect standardization for rare events and a dynamic standard population rate: An analysis and simulation of U.S. military suicide mortality rates.

INTRODUCTION: Comparing suicide mortality rates between the U.S. military and U.S. general populations is common in lay and professional literature. Standardization is required for this comparison to account for differences in the population structure, but small event counts complicate the analysis. METHODS: We demonstrated the performance of direct, indirect, and reverse-direct standardization using U.S. military and U.S. general population suicide mortality data from 2011 to 2018. We also used simulations of direct and indirect standardization in annual comparisons, and over time for the standardized mortality ratio in Poisson regression. RESULTS: Indirect standardization outperformed direct standardization for annual rate standardization. Direct standardization with combined subgroups can produce a biased estimate. Reverse-direct standardization was unbiased, but it generally yields incorrect interval estimates. Over 2011-2018, the U.S. military suicide mortality data were very consistent with the U.S. general population. CONCLUSION: Indirect standardization provides more flexibility in rate standardization with rare outcomes. For comparisons between the U.S. military and the U.S. general populations, it can provide valid point and interval estimates of standardized rates and ratios both within a single year and between years without combining categories to account for sparseness.

Efficacy of Various Facial Protective Equipment for Infection Control in a Healthcare Setting.

INTRODUCTION: The coronavirus 2019 (COVID-19) pandemic has reinforced the importance of facial protection against droplet transmission of diseases. Healthcare workers wear personal protection equipment (PPE), including face shields and masks. Plastic face shields may have advantages over regular medical masks. Although many designs of face shields exist, there is a paucity of evidence regarding the efficacy of shield designs against droplet transmissions. There is even less published evidence comparing various face shields. Due to the urgency of the pandemic and the health and safety of healthcare workers, we aimed to study the efficacy of various face shields against droplet transmission. METHODS: We simulated droplet transmission via coughing using a heavy-duty chemical spray bottle filled with fluorescein. A standard-adult sized mannequin head was used. The mannequin head wore various face shields and was positioned to face the spray bottle at either a 0°, 45°, or 90° angle. The spray bottle was positioned at and sprayed from 30 centimeters (cm), 60 cm, or 90 cm away from the head. These steps were repeated for all face shields used. Control was a mannequin that wore no PPE. A basic mask was also tested. We collected data for particle count, total area of particle distribution, average particle size, and percentage area covered by particles. We analyzed percent covered by particles using a repeated measures mixed-model regression with Tukey-Kramer pairwise comparison. RESULTS: We used least square means to estimate the percentage area covered by particles. Wearing PPE regardless of the design reduced particle transmission to the mannequin compared to the control. The LCG mask had the lowest square means of 0.06 of all face-shield designs analyzed. Tukey-Kramer pairwise comparison showed that all PPEs had a decrease in particle contamination compared to the control. LCG shield was found to have the least contamination compared to all other masks (P < 0.05). CONCLUSION: Results suggest the importance of wearing a protective covering against droplet transmission. The LCG shield was found to decrease facial contamination by droplets the most of any tested protective equipment.