Carbapenemase gene blaOXA-48 detected at six freshwater sites in Northern Ireland discharging onto identified bathing locations.

Faecal contamination of surface waters has the potential to spread not only pathogenic organisms but also antimicrobial resistant organisms. During the bathing season of 2021, weekly water samples, from six selected coastal bathing locations (n = 93) and their freshwater tributaries (n = 93), in Northern Ireland (UK), were examined for concentrations of faecal indicator bacteria Escherichia coli and intestinal enterococci. Microbial source tracking involved detection of genetic markers from the genus Bacteroides using PCR assays for the general AllBac marker, the human HF8 marker and the ruminant BacR marker for the detection of human, and ruminant sources of faecal contamination. The presence of beta-lactamase genes blaOXA-48, blaKPC, and blaNDM-1 was determined using PCR assays for the investigation of antimicrobial resistance genes that are responsible for lack of efficacy in major broad-spectrum antibiotics. The beta-lactamase gene blaOXA-48 was found in freshwater tributary samples at all six locations. blaOXA-48 was detected in 83% of samples that tested positive for the human marker and 69% of samples that tested positive for the ruminant marker over all six locations. This study suggests a risk of human exposure to antimicrobial resistant bacteria where bathing waters receive at least episodically substantial transfers from such tributaries.

Deep Learning Algorithm for Automated Cardiac Murmur Detection via a Digital Stethoscope Platform.

Background Clinicians vary markedly in their ability to detect murmurs during cardiac auscultation and identify the underlying pathological features. Deep learning approaches have shown promise in medicine by transforming collected data into clinically significant information. The objective of this research is to assess the performance of a deep learning algorithm to detect murmurs and clinically significant valvular heart disease using recordings from a commercial digital stethoscope platform. Methods and Results Using >34 hours of previously acquired and annotated heart sound recordings, we trained a deep neural network to detect murmurs. To test the algorithm, we enrolled 962 patients in a clinical study and collected recordings at the 4 primary auscultation locations. Ground truth was established using patient echocardiograms and annotations by 3 expert cardiologists. Algorithm performance for detecting murmurs has sensitivity and specificity of 76.3% and 91.4%, respectively. By omitting softer murmurs, those with grade 1 intensity, sensitivity increased to 90.0%. Application of the algorithm at the appropriate anatomic auscultation location detected moderate-to-severe or greater aortic stenosis, with sensitivity of 93.2% and specificity of 86.0%, and moderate-to-severe or greater mitral regurgitation, with sensitivity of 66.2% and specificity of 94.6%. Conclusions The deep learning algorithm's ability to detect murmurs and clinically significant aortic stenosis and mitral regurgitation is comparable to expert cardiologists based on the annotated subset of our database. The findings suggest that such algorithms would have utility as front-line clinical support tools to aid clinicians in screening for cardiac murmurs caused by valvular heart disease. Registration URL: https://clinicaltrials.gov; Unique Identifier: NCT03458806.

Popular Discourse Around Deepfakes and the Interdisciplinary Challenge of Fake Video Distribution.

This research interrogates the discourses that frame our understanding of deepfakes and how they are situated in everyday public conversation. It does so through a qualitative analysis of popular news and magazine outlets. This project analyzes themes in discourse that range from individual threat to societal collapse. This article argues how the deepfake problem discursively framed impacts the solutions proposed for stemming the prevalence of deepfake videos online. That is, if fake videos are framed as a technical problem, solutions will likely involve new systems and tools. If fake videos are framed as a social, cultural, or as an ethical problem, solutions needed will be legal or behavioral ones. As a conclusion, this article suggests that a singular solution is inadequate because of the highly interrelated technical, social, and cultural worlds, in which we live today.

Falling between two systems of care: Engaging families, behavioral health and the justice systems to increase uptake of substance use treatment in youth on probation.

Justice-involved youth (JIY) in the US have high rates of substance use (SU) problems, yet 50%-80% of these youth do not receive necessary services. There has been no systematic exploration of the use of treatment services for JIY that examines viewpoints across stakeholders in justice- and treatment-systems as well as the families. We conducted qualitative interviews and focus groups with n = 58, youth, their caregivers, SU treatment providers and probation officers in a Northeastern state. Interviews explored how families, staff- and system-level factors influence uptake of and retention in SU treatment services in youth on probation. We conducted a thematic analysis of all interview texts. Caregiver engagement is essential for youth treatment uptake and retention. Difficulties achieving caregiver engagement and agreement that treatment was necessary stemmed from distrust in the "system"; denial or minimization of youth's SU problem; relational barriers; and overburden and chaos within the family system. Structural barriers to service uptake were lack of available treatment options, SU agency practices and policies, and interagency collaboration between SU treatment agencies and probation. Enhancing family engagement at the point of referral to SU treatment is essential. Improvements in interagency collaboration and communication between SU treatment and probation agencies are necessary. Implications for policy and intervention are discussed.

Experiences and Needs of African American Children and Adolescents in Supportive Care Roles for a Relative With Breast Cancer.

PURPOSE: To explore the experiences and needs of African American (AA) children and adolescents who were identified by a cancer survivor in their family as providing substantial supportive care during diagnosis and treatment. PARTICIPANTS & SETTING: 5 AA young adults who provided care and support to a family member with cancer when they were aged 7-19 years and 4 cancer survivors from a northeastern U.S. city. METHODOLOGIC APPROACH: Focus groups and interviews were conducted, recorded, transcribed, and analyzed using content analysis until thematic saturation was reached. FINDINGS: Themes focused on AA young supporters' lack of cancer-related information, reduced ability to communicate needs, and challenged views of themselves, relationships, faith, and the future at the time that they provided support. IMPLICATIONS FOR NURSING: Nurses can support AA children and adolescents in caregiving roles by assessing their needs and providing information on diagnosis and treatment. In addition, nurses can conduct research on culturally adapted interventions that can better support AA children and adolescents caring for a parent or grandparent with cancer.

Feasibility and acceptance of the CaringGuidance web-based, distress self-management, psychoeducational program initiated within 12 weeks of breast cancer diagnosis.

OBJECTIVE: Limited clinical resources create barriers to quality management of cancer-related distress. CaringGuidance After Breast Cancer Diagnosis is a web-based, patient-controlled, psychoeducational program of cognitive-behavioral, coping and problem-solving strategies aimed at early post-diagnosis distress reduction without clinical resources. This study evaluated the feasibility of recruiting and retaining newly diagnosed women to 12 weeks of CaringGuidance and program acceptance. METHODS: Women with stage 0 to II breast cancer diagnosed within the prior 3 months were recruited from clinics and communities in four states, from 2013 to 2015 and randomized to 12 weeks of CaringGuidance plus usual care (n = 57) or usual care alone (n = 43). Recruitment, retention, and program use were tracked. Using standard and study-derived measures, demographic and psychological variables were assessed at baseline and monthly and program satisfaction at 12 weeks. RESULTS: Of 139 women screened, 100 enrolled, five withdrew, and 12 were lost to follow-up (83% retention rate). Total program engagement was positively associated with greater baseline intrusive/avoidant thoughts. Intervention participants (92%) believed CaringGuidance would benefit future women and was easy to use. Sixty-six percent believed CaringGuidance helped them cope. Women used program content to change thoughts (49%) or behaviors (40%). Stress in the previous year was positively associated with reports that CaringGuidance was reassuring and helpful. CONCLUSIONS: Feasibility and acceptance of CaringGuidance was demonstrated pointing to the program's potential as a cancer-distress self-management intervention. Future research will explore program feasibility and acceptability in other regions of the United States, leading to clinical implementation trials.

Gabapentin Enacarbil Extended-Release for Alcohol Use Disorder: A Randomized, Double-Blind, Placebo-Controlled, Multisite Trial Assessing Efficacy and Safety.

BACKGROUND: Several single-site alcohol treatment clinical trials have demonstrated efficacy for immediate-release (IR) gabapentin in reducing drinking outcomes among individuals with alcohol dependence. The purpose of this study was to conduct a large, multisite clinical trial of gabapentin enacarbil extended-release (GE-XR) (HORIZANT® ), a gabapentin prodrug formulation, to determine its safety and efficacy in treating alcohol use disorder (AUD). METHODS: Men and women (n = 346) who met DSM-5 criteria for at least moderate AUD were recruited across 10 U.S. clinical sites. Participants received double-blind GE-XR (600 mg twice a day) or placebo and a computerized behavioral intervention (Take Control) for 6 months. Efficacy analyses were prespecified for the last 4 weeks of the treatment period. RESULTS: The GE-XR and placebo groups did not differ significantly on the primary outcome measure, percentage of subjects with no heavy drinking days (28.3 vs. 21.5, respectively, p = 0.157). Similarly, no clinical benefit was found for other drinking measures (percent subjects abstinent, percent days abstinent, percent heavy drinking days, drinks per week, drinks per drinking day), alcohol craving, alcohol-related consequences, sleep problems, smoking, and depression/anxiety symptoms. Common side-effects were fatigue, dizziness, and somnolence. A population pharmacokinetics analysis revealed that patients had lower gabapentin exposure levels compared with those in other studies using a similar dose but for other indications. CONCLUSIONS: Overall, GE-XR at 600 mg twice a day did not reduce alcohol consumption or craving in individuals with AUD. It is possible that, unlike the IR formulation of gabapentin, which showed efficacy in smaller Phase 2 trials at a higher dose, GE-XR is not effective in treating AUD, at least not at doses approved by the U.S. Food and Drug Administration for treating other medical conditions.

Psychoeducational Interventions for Supporters of Women with Breast Cancer: an Integrative Review.

The purpose of this review was to identify and evaluate psychoeducational intervention studies addressing the psychological adjustment needs of family members, spouses, and friends (supporters) providing support to women with early-stage breast cancer with the goal of guiding future research and practice. This is an integrative review initiated by a systematic search conducted within the PubMed, CINAHL, and PsycINFO databases among literature published from 2003 to 2014. Articles were retained for evaluation if the sample was from a western culture, and outcomes were reported separately for supporters of women with early-stage breast cancer after receipt of a psychosocial/educational intervention. Studies using qualitative, pilot, and pre-experimental designs were included for review. Six studies meeting the inclusion criteria were identified. Of these, three were randomized controlled trials (one pilot) and three used a pre-experimental, single-group design. All of the interventions demonstrated some efficacy; however, limitations in design, sample, and reporting of outcomes were identified. The pre-experimental and pilot design of the majority of the research identified in this review limits the ability to make firm recommendations for translation to clinical practice although the psychoeducational interventions appear clinically useful. Future research should define samples of supporters consistently across studies, report behavioral and psychological outcomes separately for individuals with differing relationships with the affected woman, increase racial diversity among samples, consider time and cost when designing psychoeducational interventions, and focus interventions on specific characteristics and needs of the diverse groups of individuals who provide support for women with early-stage breast cancer.

Intra- and interrater reliability of the Modified Tardieu Scale for the assessment of lower limb spasticity in adults with neurologic injuries.

OBJECTIVE: To examine the intra- and interrater reliability of the Modified Tardieu Scale (MTS) for lower limb assessment of adults with chronic neurologic injuries. DESIGN: Single-center intra- and interrater reliability study. SETTING: Outpatient neurorehabilitation unit. PARTICIPANTS: Adults (N=30; mean age ± SD, 54.1±12.5y) with various chronic neurologic injuries and lower limb spasticity. INTERVENTIONS: Two experienced physiotherapists performed slow (R2) and fast (R1) passive movements for lower limb muscles half an hour apart on the same day (interrater reliability), while a third physiotherapist took goniometric measurements only. One physiotherapist repeated the assessment 1 to 3 days earlier or later (intrarater reliability). Assessors qualitatively rated the resistance to fast passive movements. MAIN OUTCOME MEASURES: Intraclass correlation coefficients (ICCs) and limits of agreement (LOA) were calculated for R1, R2, and R2-R1. Kappa coefficients were calculated for tibialis range of movement and qualitative spasticity ratings. RESULTS: Intra- and interrater R1 and R2 measurements showed moderate to high reliability for the affected hamstrings, rectus femoris, gastrocnemius, soleus (mean ICC ± SD, .79±.08), and tibialis anterior (mean κ ± SD, .58±.10). Only intrarater measurements of the affected tibialis posterior were moderately reliable (R1=.57, R2=.77). Seven of 16 spasticity angle measurements of the affected muscles were moderately reliable. LOA were mostly unacceptably wide. Qualitative spasticity ratings were moderately reliable for affected hamstrings, gastrocnemius, and tibialis muscles (mean κ ± SD, .52±.10). CONCLUSIONS: The MTS is reliable for assessing spasticity in most lower limb muscles of adults with chronic neurologic injuries. Repeated MTS measurements of spasticity are best based on R1 measurements rather than spasticity angle or qualitative ratings of spasticity. Optimally, MTS measurements should be undertaken by the same clinician.

Social performance and secret ritual: battling against obsessive-compulsive disorder.

This autoethnography offers an account of my experience with mental illness and provides an analysis of the performative aspects of obsessive-compulsive disorder (OCD). OCD is a genetic disorder triggered by environmental stressors involving a chemical imbalance in the brain. The resulting biologically altered state leaves individuals to steer themselves among and between "appropriate" performance and secret rituals. Analyzing my own communication practices through a performance lens highlights the importance of image management for people struggling with disability. In telling my own story, this article provides readers an in-depth look at OCD as a traumatic brain disorder whose sufferers rely on communicative performance to maintain their public and private identities, and as a disease that impedes social life for its sufferers. Implications of this account for those struggling with mental disability and for practitioners aiming to help them are discussed.

The effect of altered hand position and motor skills on stereognosis.

PURPOSE: Poor stereognosis has been considered to be indicative of abnormal cerebral sensory function, and therefore a relative contraindication for upper extremity surgery in hemiplegic cerebral palsy. The effect of hand position and motor function on stereognosis has not been studied; decreased hand mobility can decrease a person's ability to recognize objects in the hand and can be an important component of stereognosis. METHODS: Twenty-one normal subjects had their nondominant arm positioned to simulate the hemiplegic hand posture of forearm pronation and wrist and digital flexion. Subjects were asked to identify 12 common objects in 3 successive trials, with the first and third trials in the simulated hemiplegic position and the second trial in normal hand position and motor function. This accounted for a learning effect. RESULTS: Normal subjects had significantly (p < .0001) decreased stereognosis when placed in a simulated hemiplegic hand position with decreased digital and wrist extension, identifying fewer items (means 7.6 and 9.3 in successive trials) in the hemiplegic hand position than in the normal hand position (mean 11.7). CONCLUSIONS: Decreased stereognosis in cerebral palsy patients might be related to altered hand mobility and not solely to central nervous system dysfunction. It should be used cautiously when guiding surgical indication, as it may be surgically correctable.

Quality of life in osteogenesis imperfecta.

The purpose of this study was to quantify the physical and mental health of a diverse adult cohort of patients with osteogenesis imperfecta (OI) utilizing a validated health self-assessment questionnaire (SF-36). In addition, a specific demographic questionnaire and a functional questionnaire were utilized to assess more specifically the physical limitations imposed by osteogenesis imperfecta in adulthood. The results of the SF-36 revealed significantly lower physical function scores compared to the U.S. adult norms. However, the SF-36 mental component scores were equal to the U.S. adult norms. The demographic questionnaire revealed high levels of educational achievement, as well as employment, despite significant physical impairments. The functional questionnaire clearly demonstrated limitations mostly related to ambulation.