Bullying Victimization, Future Orientation, and Suicidal Ideation of African American Youth in an Under-Resourced Community: A Moderated-Mediation Approach.

African American youth living in low-resourced communities are at high risk for bullying victimization which is positively associated with suicidal ideation. This study explored whether positive future orientation mediated the relationship between bullying victimization and suicidal ideation. This study engaged 627 African American adolescents and measured bullying victimization, internalizing problems, suicidal ideation, future orientation, and several covariates. Major findings indicated that controlling for gender, socioeconomic status, school motivation, and perceived teacher support, internalizing problems mediated the relationship between bullying victimization and suicidal ideation. Furthermore, both the effect of bullying victimization on suicidal ideation and the mediating effect of internalizing problems were moderated by future orientation. The effects were weakened when the level of future orientation increased. The implications for future research and supporting resiliency are discussed based on these findings.

Exploring the linkage between family financial struggle and children's bullying victimization: Implications for nursing and psychotherapeutic practices.

PURPOSE: A few studies have found that children whose families are economically disadvantaged and financially struggling are at an elevated risk of victimization by their peers. However, extant research is largely descriptive. To address this gap, this study empirically tested the proposed pathways from family financial struggle to children's bullying victimization, including the role of barriers to healthcare access in this association using a nationally representative sample. DESIGN AND METHODS: The study utilizes the 2016 National Survey of Children's Health, a survey of a cross-sectional, weighted probability sample of US children (ages 0-17 years) living in 50 states and the District of Columbia, and their caregivers. The sample used for the current study included 14,374 racially and ethnically diverse caregivers of children, aged 6-11 years. RESULTS: Positive significant associations between family financial struggle and children's bullying victimization, and between financial struggle and barriers to healthcare access were found. Barriers to healthcare access mediated the association between family financial struggle and bullying victimization. PRACTICE IMPLICATIONS: Given the documented effects of bullying victimization on children, findings point to the importance of developing psychotherapeutic practices that are appropriate for children who are flagged as "high-risk."

Investigating the Potential for Clinical Decision Support in Sub-Saharan Africa With AFYA (Artificial Intelligence-Based Assessment of Health Symptoms in Tanzania): Protocol for a Prospective, Observational Pilot Study.

BACKGROUND: Low- and middle-income countries face difficulties in providing adequate health care. One of the reasons is a shortage of qualified health workers. Diagnostic decision support systems are designed to aid clinicians in their work and have the potential to mitigate pressure on health care systems. OBJECTIVE: The Artificial Intelligence-Based Assessment of Health Symptoms in Tanzania (AFYA) study will evaluate the potential of an English-language artificial intelligence-based prototype diagnostic decision support system for mid-level health care practitioners in a low- or middle-income setting. METHODS: This is an observational, prospective clinical study conducted in a busy Tanzanian district hospital. In addition to usual care visits, study participants will consult a mid-level health care practitioner, who will use a prototype diagnostic decision support system, and a study physician. The accuracy and comprehensiveness of the differential diagnosis provided by the diagnostic decision support system will be evaluated against a gold-standard differential diagnosis provided by an expert panel. RESULTS: Patient recruitment started in October 2021. Participants were recruited directly in the waiting room of the outpatient clinic at the hospital. Data collection will conclude in May 2022. Data analysis is planned to be finished by the end of June 2022. The results will be published in a peer-reviewed journal. CONCLUSIONS: Most diagnostic decision support systems have been developed and evaluated in high-income countries, but there is great potential for these systems to improve the delivery of health care in low- and middle-income countries. The findings of this real-patient study will provide insights based on the performance and usability of a prototype diagnostic decision support system in low- or middle-income countries. TRIAL REGISTRATION: ClinicalTrials.gov NCT04958577; http://clinicaltrials.gov/ct2/show/NCT04958577. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34298.

Study protocol for a pilot prospective, observational study investigating the condition suggestion and urgency advice accuracy of a symptom assessment app in sub-Saharan Africa: the AFYA-'Health' Study.

INTRODUCTION: Due to a global shortage of healthcare workers, there is a lack of basic healthcare for 4 billion people worldwide, particularly affecting low-income and middle-income countries. The utilisation of AI-based healthcare tools such as symptom assessment applications (SAAs) has the potential to reduce the burden on healthcare systems. The purpose of the AFYA Study (AI-based Assessment oF health sYmptoms in TAnzania) is to evaluate the accuracy of the condition suggestions and urgency advice provided by a user on a Swahili language Ada SAA. METHODS AND ANALYSIS: This study is designed as an observational prospective clinical study. The setting is a waiting room of a Tanzanian district hospital. It will include patients entering the outpatient clinic with various conditions and age groups, including children and adolescents. Patients will be asked to use the SAA before proceeding to usual care. After usual care, they will have a consultation with a study-provided physician. Patients and healthcare practitioners will be blinded to the SAA's results. An expert panel will compare the Ada SAA's condition suggestions and urgency advice to usual care and study provided differential diagnoses and triage. The primary outcome measures are the accuracy and comprehensiveness of the Ada SAA evaluated against the gold standard differential diagnoses. ETHICS AND DISSEMINATION: Ethical approval was received by the ethics committee (EC) of Muhimbili University of Health and Allied Sciences with an approval number MUHAS-REC-09-2019-044 and the National Institute for Medical Research, NIMR/HQ/R.8c/Vol. I/922. All amendments to the protocol are reported and adapted on the basis of the requirements of the EC. The results from this study will be submitted to peer-reviewed journals, local and international stakeholders, and will be communicated in editorials/articles by Ada Health. TRIAL REGISTRATION NUMBER: NCT04958577.

Integration of an electronic Drug Burden Index risk assessment tool into Home Medicines Reviews: deprescribing anticholinergic and sedative medications.

BACKGROUND: Our aim in this research was to establish whether integrating an electronically generated calculation and report on the Drug Burden Index (DBI) in the Home Medicines Review (HMR) setting is an accurate, feasible and useful risk assessment tool to assess risk of anticholinergic and sedative medications; and to establish whether the intervention of DBI together with HMR is associated with a reduced use of anticholinergic and sedative medications in older community-dwelling adults in Australia. METHODS: An interventional feasibility study was conducted. Accredited clinical pharmacists (APs) were recruited to participate. Each AP was educated on implementation of the DBI into HMR practice and given access to the DBI Calculator© web-based software to generate the DBI report for inclusion in HMR reports for general practitioners (GPs). APs recruited patients (⩾65 years) who were referred to them for HMRs. Patients were sent a letter about their DBI exposure, and a prompt to visit their GP to discuss their medication management options. GPs, APs and patients were asked to evaluate the feasibility and utility of the DBI report. A medication inventory was collected from patients at the time of the HMR and at 3 months to determine whether the intervention affected deprescribing of medications with anticholinergic and sedative effects. RESULTS: Regarding the feasibility of the DBI report as a risk assessment tool within HMR, 89% of APs and 67% of GPs agreed that it would be feasible. The DBI Calculator© was potentially inaccurate, as 26% of DBI scores were underestimated and 7% were overestimated (at baseline). At 3 months, the median (interquartile range) DBI for patients (n = 100) significantly decreased from 0.82 (0-1.33) to 0.67 (0-1.29) (p = 0.014). Additionally, of patients with a DBI > 0 (n = 66), 36.4% had their DBI score decrease, and 6.1% had a score increase. CONCLUSION: This study demonstrated that integration of the DBI Calculator© into HMR is a feasible and useful method to prompt deprescribing of anticholinergic and sedative medications in older adults. There is potential for the accuracy of the web-based platform to be improved. REGISTRATION OF TRIAL: Name: Feasibility study of the Drug Burden Index with Home Medicines Review.Website: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368523Trial ID: ACTRN 12615000539538.

Assessment of Multiplate platelet aggregometry using citrate, heparin or hirudin in Rhesus macaques.

Electrical impedance aggregometry (EIA) has gained popularity in clinical and research applications. Nonhuman primates are used to study disease and drug-related mechanisms that affect hemostasis, therefore establishing normal EIA parameters are necessary. The anticoagulants sodium heparin, hirudin and sodium citrate and three agonists, ADP, ASPI, and collagen were evaluated. Whole blood from 12 adult male rhesus macaques was collected to evaluate anticoagulants, sodium heparin, hirudin and sodium citrate using three agonists (ADP, ASPI and collagen), on the Multiplate® 5.0 Analyzer. Platelet function was reported for three parameters: Area under the curve (AUC), aggregation, and aggregation velocity. There was a significant difference in mean AUC between citrate and heparin samples, and citrate and hirudin samples regardless of the agonist used. There was no difference in AUC between heparin and hirudin. ADP-activated samples showed an increase in impedance with hirudin samples compared to citrate. Furthermore, heparin and hirudin out-perform citrate as the anticoagulant for EIA in the macaque. Finally, this study demonstrates the utility of the Multiplate® system in this model and provides important insight into anticoagulant choice when using EIA.