An Evaluation of Item Harmonization Strategies Between Assessment Tools of Psychopathology in Children and Adolescents.

Data aggregation in mental health is complicated by using different questionnaires, and little is known about the impact of item harmonization strategies on measurement precision. Therefore, we aimed to assess the impact of various item harmonization strategies for a target and proxy questionnaire using correlated and bifactor models. Data were obtained from the Brazilian High-Risk Study for Mental Conditions (BHRCS) and the Healthy Brain Network (HBN; N = 6,140, ages 5-22 years, 39.6% females). We tested six item-wise harmonization strategies and compared them based on several indices. The one-by-one (1:1) expert-based semantic item harmonization presented the best strategy as it was the only that resulted in scalar-invariant models for both samples and factor models. The between-questionnaires factor correlation, reliability, and factor score difference in using a proxy instead of a target measure improved little when all other harmonization strategies were compared with a completely at-random strategy. However, for bifactor models, between-questionnaire specific factor correlation increased from 0.05-0.19 (random item harmonization) to 0.43-0.60 (expert-based 1:1 semantic harmonization) in BHRCS and HBN samples, respectively. Therefore, item harmonization strategies are relevant for specific factors from bifactor models and had little impact on p-factors and first-order correlated factors when the child behavior checklist (CBCL) and strengths and difficulties questionnaire (SDQ) were harmonized.

Comparing mental health semi-structured diagnostic interviews and symptom checklists to predict poor life outcomes: an 8-year cohort study from childhood to young adulthood in Brazil.

BACKGROUND: Semi-structured diagnostic interviews and symptom checklists present similar internal reliability. We aim to investigate whether they differ in predicting poor life outcomes in the transition from childhood to young adulthood. METHODS: For this longitudinal study, we used data from the Brazilian High Risk Cohort Study for Childhood Mental Health Conditions. Eligible participants were aged 6-14 years on the day of study enrolment (January to February, 2010) and were enrolled in public schools by a biological parent in Porto Alegre and São Paulo, Brazil. 2511 young people and their caregivers were assessed at baseline in 2010-11, and 1917 were assessed 8 years later (2018-19; 76·3% retention). Clinical thresholds were derived using semi-structured parent-report interview based on the Diagnostic and Statistical Manual of Mental Disorders, according to the Developmental and Well-being Assessment (DAWBA), and clinical scores as defined by the Child Behavior Checklist (CBCL; T-score ≥70 considered positive caseness). At 8 years, participants were assessed for a composite life-threatening outcome (a composite of death, suicide attempts, severe self-harm, psychiatric inpatient admission, or emergency department visits) and a composite poor life chances outcome (a composite of any criminal conviction, substance misuse, or school dropout). We evaluated the accuracy of DAWBA and CBCL to predict these outcomes. Logistic regression models were adjusted for age, sex, race or ethnicity, study site, and socioeconomic class. FINDINGS: DAWBA and CBCL had similar sensitivity, specificity, predictive values, and test accuracy for both composite outcomes and their components. Any mental health problem, as classified by DAWBA and CBCL, was independently associated with the composite life-threatening outcome (DAWBA adjusted odds ratio 1·62, 95% CI 1·20-2·18; CBCL 1·66, 1·19-2·30), but only CBCL independently predicted poor life chances (1·56, 1·19-2·04). Participants classified by both approaches did not have higher odds of the life-threatening outcome when compared with participants classified by DAWBA or CBCL alone, nor for the poor life chances outcome when compared with those classified by CBCL alone. INTERPRETATION: Classifying children and adolescents based on a semi-structured diagnostic interview was not statistically different to symptom checklist in terms of test accuracy and predictive validity for relevant life outcomes. Classification based on symptom checklist might be a valid alternative to costly and time-consuming methods to identify young people at risk for poor life outcomes. FUNDING: Conselho Nacional de Desenvolvimento Científico e Tecnológico; Fundação de Amparo à Pesquisa do Estado de São Paulo; and Medical Research Council, European Research Council. TRANSLATION: For the Portuguese translation of the abstract see Supplementary Materials section.

Impact of body mass index on surgical case durations in an academic medical center.

STUDY OBJECTIVE: To investigate the association between patient body mass index (BMI) and operating room duration. DESIGN: Retrospective cohort analysis. SETTING: Demographic data and anesthesia/surgical times for adult surgical patients at University of Virginia Health between August 2017 and February 2019 were collected and analyzed. PATIENTS: A total of 31,548 cases were included in the final analysis. 55% of patients were female, and 51% were classified as ASA Physical Status 2. The mean operating room (OR) duration was 144.2 min ± 112.7 (median = 118, IQR = 121). Orthopedic surgery (32%) was the most common surgery. MEASUREMENTS: Linear mixed effects models were used to examine whether procedure intervals differed across three BMI categories (BMI < 30, 30 ≤ BMI < 40, BMI ≥ 40), considering within-surgeon correlations. Surgical times were log-transformed to correct for positive skewness. MAIN RESULTS: The average time in the operating room was longer for patients with higher BMI (mean ± SD [median, IQR] = 139.5 ± 111.2 [113.0, IQR = 114], 150.2 ± 115.4 [125, IQR = 127], and 153.1 ± 111.1 [130, IQR = 134] for BMI < 30, 30 ≤ BMI < 40, and BMI ≥ 40), respectively. We found a 2% [95% CI = 1-3%] and 3% [95% CI = 1-5%] increase in OR time for 30 ≤ BMI < 40 and BMI ≥ 40, respectively, compared to BMI < 30, after controlling for within-surgeon correlations and covariates. The excess time was primarily determined by anesthesia times. CONCLUSION: In an academic hospital, patients with BMI ≥ 30 required more time in the operating room than patients with BMI < 30, when controlling for confounders. This information can be incorporated into modern-day OR scheduling software, potentially resulting in more accurate case duration estimates that reduce waiting and improve OR efficiency.

Severe COVID-19 Pneumonia in a Three-Year-Old with Congenital Iron and B12 Deficiency Anemia of Unknown Etiology: A Case Report.

Since COVID-19 first emerged in Wuhan, China, and was declared a global pandemic by the WHO, researchers have been meticulously studying the disease and its complications. Studies of severe COVID-19 disease among pediatric populations are scarce, leading to difficulty in establishing a comprehensive management approach. Case presentation: This report outlines a case of a long-standing combined iron and vitamin B12 deficiency anemia in a three-year-old treated at the Children's Clinical University Hospital due to severe COVID-19 disease. The patient's clinical condition coincided with the derangement of biomarkers described in the literature, including lymphopenia, increased neutrophil/lymphocyte ratio (NLR), decreased lymphocyte/C-reactive protein ratio (LCR), as well as elevated inflammatory markers such as CRP and D-dimers. The patient developed severe bilateral pneumonia requiring invasive ventilation, high-flow oxygen, immunosuppressive therapy with dexamethasone and tocilizumab, and supplementation of anemia deficits with blood transfusion and vitamin B12 administration. Conclusions: Our findings are consistent with the most important biomarkers reported in the literature indicative of severe disease progression. Additionally, poorly controlled anemia may be suggested as a potentially important risk factor for severe COVID-19 disease among children. However, additional quantitative research is required to establish the nature and severity of the risk.

Harmonizing bifactor models of psychopathology between distinct assessment instruments: Reliability, measurement invariance, and authenticity.

OBJECTIVES: Model configuration is important for mental health data harmonization. We provide a method to investigate the performance of different bifactor model configurations to harmonize different instruments. METHODS: We used data from six samples from the Reproducible Brain Charts initiative (N = 8,606, ages 5-22 years, 41.0% females). We harmonized items from two psychopathology instruments, Child Behavior Checklist (CBCL) and GOASSESS, based on semantic content. We estimated bifactor models using confirmatory factor analysis, and calculated their model fit, factor reliability, between-instrument invariance, and authenticity (i.e., the correlation and factor score difference between the harmonized and original models). RESULTS: Five out of 12 model configurations presented acceptable fit and were instrument-invariant. Correlations between the harmonized factor scores and the original full-item models were high for the p-factor (>0.89) and small to moderate (0.12-0.81) for the specific factors. 6.3%-50.9% of participants presented factor score differences between harmonized and original models higher than 0.5 z-score. CONCLUSIONS: The CBCL-GOASSESS harmonization indicates that few models provide reliable specific factors and are instrument-invariant. Moreover, authenticity was high for the p-factor and moderate for specific factors. Future studies can use this framework to examine the impact of harmonizing instruments in psychiatric research.

The Biochemical Alteration of Enzymatically Hydrolysed and Spontaneously Fermented Oat Flour and Its Impact on Pathogenic Bacteria.

Avena sativa (A. sativa) oats have recently made a comeback as suitable alternative raw materials for dairy substitutes due to their functional properties. Amylolytic and cellulolytic enzyme-assisted modifications of oats produce new products that are more appealing to consumers. However, the biochemical and functional alteration of products and extracts requires careful selection of raw materials, enzyme cocktails, and technological aspects. This study compares the biochemical composition of different A. sativa enzyme-assisted water extracts and evaluates their microbial growth using spontaneous fermentation and the antimicrobial properties of the ferment extracts. Fibre content, total phenolic content, and antioxidant activity were evaluated using traditional methodologies. The degradation of A. sativa flour was captured using scanning electron microscopy (SEM); moreover, sugar and oligosaccharide alteration were identified using HPLC and HPLC-SEC after INFOGEST in vitro digestion (IVD). Additionally, taste differentiation was performed using an electronic tongue with principal component analysis. The oat liquid extracts were continuously fermented using two ancient fermentation starters, birch sap and Tibetan kefir grains. Both starters contain lactic acid bacteria (LAB), which has major potential for use in bio-preservation. In fermented extracts, antimicrobial properties against Gram-positive Staphylococcus aureus and group A streptococci as well as Gram-negative opportunistic bacteria such as Escherichia coli and Pseudomonas aeruginosa were also determined. SEM images confirmed the successful incorporation of enzymes into the oat flour. The results indicate that using enzyme-assisted extraction significantly increased TPC and antioxidant activity in both the extract and residues. Additionally, carbohydrates with a molecular mass (MM) of over 70,000 kDa were reduced to 7000 kDa and lower after the incorporation of amylolytic and cellulolytic enzymes. The MM impacted the variation in microbial fermentation, which demonstrated favourable antimicrobial properties. The results demonstrated promising applications for developing functional products and components using bioprocessing as an innovative tool.

Reliability and validity of bifactor models of dimensional psychopathology in youth.

Bifactor models are a promising strategy to parse general from specific aspects of psychopathology in youth. Currently, there are multiple configurations of bifactor models originating from different theoretical and empirical perspectives. We aimed to test the reliability, validity, measurement invariance, and the correlation of different bifactor models of psychopathology using the Child Behavior Checklist (CBCL). We used data from the Reproducible Brain Charts (RBC) initiative (N = 7,011, ages 5 to 22 years, 40.2% females). Factor models were tested using the baseline data. To address our aim, we (a) searched for the published item-level bifactor models using the CBCL; (b) tested their global model fit; (c) calculated model-based reliability indices; (d) tested associations with symptoms' impact in everyday life; (e) tested measurement invariance across many characteristics, and (f) analyzed the observed factor correlation across the models. We found 11 bifactor models ranging from 39 to 116 items. Their global model fit was broadly similar. Factor determinacy and H index were acceptable for the p-factors, internalizing, externalizing, and somatic specific factors in most models. However, only the p- and attention factors predicted daily life symptoms' impact in all models. Models were broadly invariant across different characteristics. P-factors were highly correlated across models (r = .88 to .99) and homotypic specific factors were highly correlated. These results suggest that regardless of item selection and strategy to compose CBCL bifactor models, they assess very similar constructs. Taken together, our results support the robustness of the p-factor across distinct bifactor models and studies of distinct characteristics. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Attention control and its emotion-specific association with cognitive emotion regulation in depression.

Individuals with major depression show impaired control of attention and emotions. Both processes are conceptually similar and might share common mechanisms. The current study aims to examine attention control and its association with cognitive emotion regulation in depression. 26 patients with a history of major depression (14 females) and 26 healthy controls (14 females) performed an emotional face-word Stroop task and a cognitive emotion regulation task while undergoing fMRI. Patients and controls showed a similar behavioral performance in both tasks. Across groups, participants who were less distracted from happy faces by the incongruent word "sadness" (Stroop task) were better at regulating their happiness (emotion regulation task). Notably, both the Stroop and emotion regulation task recruited the left supramarginal gyrus. Additionally, only patients showed a relative attentional disengagement from positive compared to negative stimuli in the Stroop task. Attention control and cognitive emotion regulation capabilities appear to be linked at both the behavioral and neural level. Shared mechanisms suggest that emotional disturbances in depression may be improved by interventions that target attention control, particularly regarding the processing of positive stimuli.