Prehospital stratification and prioritisation of non-ST-segment elevation acute coronary syndrome patients (NSTEACS): the MARIACHI scale.

OBJECTIVE: The objective of this study was to develop and validate a risk scale (MARIACHI) for patients classified as non-ST-segment elevation acute coronary syndrome (NSTEACS) in a prehospital setting with the ability to identify patients at an increased risk of mortality at an early stage. METHODS: A retrospective observational study conducted in Catalonia over two periods: 2015-2017 (development and internal validation cohort) and Aug 2018-Jan 2019 (external validation cohort). We included patients classified as prehospital NSTEACS, assisted by an advanced life support unit and requiring hospital admission. The primary outcome was in-hospital mortality. Cohorts were compared using logistic regression and a predictive model was created using bootstrapping techniques. RESULTS: The development and internal validation cohort included 519 patients. The model is composed of five variables associated with hospital mortality: age, systolic blood pressure, heart rate > 95 bpm, Killip-Kimball III-IV and ST depression ≥ 0.5 mm. The model showed good overall performance (Brier = 0.043) and consistency in discrimination (AUC 0.88, 95% CI 0.83-0.92) and calibration (slope = 0.91; 95% CI 0.89-0.93). We included 1316 patients for the external validation sample. There was no difference in discrimination (AUC 0.83, 95% CI 0.78-0.87; DeLong Test p = 0.071), but there was in calibration (p < 0.001), so it was recalibrated. The finally model obtained was stratified and scored into three groups according to the predicted risk of patient in-hospital mortality: low risk: < 1% (-8 to 0 points), moderate risk: 1-5% (+ 1 to + 5 points) and high risk: > 5% (6-12 points). CONCLUSION: The MARIACHI scale showed correct discrimination and calibration to predict high-risk NSTEACS. Identification of high-risk patients may help with treatment and low referral decisions at the prehospital level.

School-Age Child Routines: Adaptation and Validation Studies of the Portuguese Version of the Child Routines Questionnaire.

Child routines have been recognized as positive contributors to children's development. However, in Portugal there is still a lack of instruments available to assess school-age child routines. The purpose of this study was to present the translation, adaptation, and validation studies of the Portuguese version of the Child Routines Questionnaire (CRQ), a parent self-report measure developed to assess school-age child routines. A total of 460 parents of children aged between 6 and 12 years-old participated in the study. Two studies were conducted to define the CRQ-PT factor structure. In Study 1 (n = 204 children from 6 to 12 years-old), findings from the exploratory factor analysis provided evidence for a four-factor structure (for 32 items), which explained 43.53% of the total variance. In Study 2 (n = 256 children from 6 to 9 years-old), results from confirmatory factor analysis showed good model fit indices (CFI = 0.84, RMSEA = 0.06). The total scale of the CRQ-PT (α = 0.89) and its subscales showed good internal consistency. Further evidence of construct validity was shown by weak to moderate correlations with measures of parental sense of competence and family mealtime routines. Relevant contributions of the study are underscored, namely the availability and usefulness of a reliable and valid assessment tool to evaluate the routines of Portuguese school-age children for clinical practice and research purposes.

Bedtime Routines of Young Children, Parenting Stress, and Bedtime Resistance: Mediation Models.

This study examined if inconsistent bedtime routines are a mechanism through which high levels of parenting stress are related to bedtime resistant behaviors. Bedtime resistant behavior is a common problem in young children. Although previous studies have linked parenting stress to problematic behaviors at bedtime, understanding how and why that may be has been subject to limited empirical investigation. Caregivers (N = 118) of a child age 2-5 were recruited on Amazon's mechanical turk. There was a significant indirect effect of parenting stress on bedtime resistance through bedtime routines as well as a significant indirect effect of bedtime routines on bedtime resistant behavior through parenting stress. These findings suggest that there is a bidirectional relationship between inconsistent routines and parenting stress. Clinically, these results suggest that implementing a consistent routine at bedtime may improve both parent (less stress) and child (less bedtime resistance) functioning.

Selecting Privacy-Enhancing Technologies for Managing Health Data Use.

Privacy protection for health data is more than simply stripping datasets of specific identifiers. Privacy protection increasingly means the application of privacy-enhancing technologies (PETs), also known as privacy engineering. Demands for the application of PETs are not yet met with ease of use or even understanding. This paper provides a scope of the current peer-reviewed evidence regarding the practical use or adoption of various PETs for managing health data privacy. We describe the state of knowledge of PETS for the use and exchange of health data specifically and build a practical perspective on the steps needed to improve the standardization of the application of PETs for diverse uses of health data.

Reducing readmission rates for individuals discharged from acute psychiatric care in Alberta using peer and text message support: Protocol for an innovative supportive program.

BACKGROUND: Individuals discharged from inpatient psychiatry units have the highest readmission rates of all hospitalized patients. These readmissions are often due to unmet need for mental health care compounded by limited human resources. Reducing the need for hospital admissions by providing alternative effective care will mitigate the strain on the healthcare system and for people with mental illnesses and their relatives. We propose implementation and evaluation of an innovative program which augments Mental Health Peer Support with an evidence-based supportive text messaging program developed using the principles of cognitive behavioral therapy. METHODS: A pragmatic stepped-wedge cluster-randomized trial, where daily supportive text messages (Text4Support) and mental health peer support are the interventions, will be employed. We anticipate recruiting 10,000 participants at the point of their discharge from 9 acute care psychiatry sites and day hospitals across four cities in Alberta. The primary outcome measure will be the number of psychiatric readmissions within 30 days of discharge. We will also evaluate implementation outcomes such as reach, acceptability, fidelity, and sustainability. Our study will be guided by the Consolidated Framework for Implementation Research, and the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. Data will be extracted from administrative data, surveys, and qualitative methods. Quantitative data will be analysed using machine learning. Qualitative interviews will be transcribed and analyzed thematically using both inductive and deductive approaches. CONCLUSIONS: To our knowledge, this will be the first large-scale clinical trial to assess the impact of a daily supportive text message program with and without mental health peer support for individuals discharged from acute psychiatric care. We anticipate that the interventions will generate significant cost-savings by reducing readmissions, while improving access to quality community mental healthcare and reducing demand for acute care. It is envisaged that the results will shed light on the effectiveness, as well as contextual barriers and facilitators to implementation of automated supportive text message and mental health peer support interventions to reduce the psychological treatment and support gap for patients who have been discharged from acute psychiatric care. TRIAL REGISTRATION: clinicaltrials.gov, NCT05133726 . Registered 24 November 2021.

"What Next?": Toward telebehavioral health sustainability in couple and family therapy.

As a response to the COVID-19 global crisis, many in the couple/marital and family therapy (CMFT) professional community quickly met the challenge of providing services to clients via telebehavioral health (TBH) services. As this public health emergency endures, family therapists must continue to engage in TBH practice professionally and ethically. The rapid adoption of TBH with minimal training and experience during this public health emergency can result in crises for both individual therapists as well as for the profession in implementing electronic record-keeping, conducting virtual sessions, and communicating online with various clinical populations. The risk of insufficient training and supervision create a challenge to new and experienced family therapists. This article summarizes the work done by the profession thus far to respond to this public health emergency and presents a roadmap of recommendations for navigating those challenges into the future and offers ideas about how to sustain quality TBH practice.

Solution-focused brief therapy for Chilean primary care patients: Exploring a linguistic adaptation.

Solution-focused brief therapy (SFBT) is a resource-based, future-oriented therapeutic approach that focuses on finding exceptions to problems and identifying coping strategies to build solutions. SFBT has been efficacious with individuals with alcohol use disorders. Chile experiences high levels of alcohol consumption and alcohol-related health consequences. Despite the international dissemination of SFBT, this is the first study to attempt a linguistic adaptation of SFBT in a Latin American country. We conducted 9 cognitive interviews to examine 13 translated main SFBT tools and 3 focus groups to gather information on cultural aspects of alcohol use in primary care. Results suggest that Chileans understood most SFBT tools, albeit with some linguistic modifications of original translations, and that family, gender, and meaningful issues should be considered when working with individuals with alcohol use disorders.

Development and Validation of the Pediatric Diabetes Routines Questionnaire for Adolescents.

This study describes the development and psychometric evaluation of an adolescent self-report version of the Pediatric Diabetes Routines Questionnaire (PDRQ:A), a measure of diabetes-specific routines for youth with type 1 diabetes, and further validation of the parent-version (PDRQ:P) in an adolescent sample. Participants included 120 parent-adolescent dyads (ages 12-17) and an additional 24 parents who completed measures of diabetes-specific adolescent routines, general adolescent routines, diabetes self-care, and family support of youth diabetes care. The PDRQ:P/A demonstrated good internal consistency, test-retest reliability, and parent-child agreement, and adequate validity coefficients. Confirmatory factor analysis supported a one-factor model. Promising results were obtained. The PDRQ:P/A is a clinically feasible parent- and self-report measure that can provide valuable information regarding how frequently adolescents engage in their diabetes management tasks in a consistent manner. Addition of an adolescent report format will enhance the utility of the measure for clinical and research use.

Structural abnormalities in the primary somatosensory cortex and a normal behavioral profile in Contactin-5 deficient mice.

Contactin-5 (Cntn5) is an immunoglobulin cell adhesion molecule that is exclusively expressed in the central nervous system. In view of its association with neurodevelopmental disorders, particularly autism spectrum disorder (ASD), this study focused on Cntn5-positive areas in the forebrain and aimed to explore the morphological and behavioral phenotypes of the Cntn5 null mutant (Cntn5-/-) mouse in relation to these areas and ASD symptomatology. A newly generated antibody enabled us to elaborately describe the spatial expression pattern of Cntn5 in P7 wild type (Cntn5+/+) mice. The Cntn5 expression pattern included strong expression in the cerebral cortex, hippocampus and mammillary bodies in addition to described previously brain nuclei of the auditory pathway and the dorsal thalamus. Thinning of the primary somatosensory (S1) cortex was found in Cntn5-/- mice and ascribed to a misplacement of Cntn5-ablated cells. This phenotype was accompanied by a reduction in the barrel/septa ratio of the S1 barrel field. The structure and morphology of the hippocampus was intact in Cntn5-/- mice. A set of behavioral experiments including social, exploratory and repetitive behaviors showed that these were unaffected in Cntn5-/- mice. Taken together, these data demonstrate a selective role of Cntn5 in development of the cerebral cortex without overt behavioral phenotypes.

Moderators of the Relations Between Mothers' and Fathers' Parenting Practices and Children's Prosocial Behavior.

Using multilevel modeling, we separately examined the relations between mothers' and fathers' parenting practices and children's prosocial behavior, as well as the moderating roles of child sex, age, and ethnicity. Participants included a diverse community sample of 129 cohabiting couples with a child aged 6-17. Results indicated that paternal positivity and corporal punishment were significantly related to girls', but not boys', prosocial behavior, and paternal involvement was related to prosocial behavior in school-aged children but not adolescents. Greater levels of positivity in both parents were related to more prosocial behavior in Caucasian children and less in African American children. Overall, the findings suggest that fathers' parenting is important and may differentially influence children of different sexes and ages, underscoring the importance of examining both mothers' and fathers' parenting in relation to child outcomes and with diverse samples. Findings also highlight the need for culturally appropriate measures of parenting.

Clarifying the concept of the "Social" in risk assessments for human subjects research.

International guidelines for the conduct of research with human participants, such as those put forth by the Council for International Organizations of Medical Sciences (CIOMS, 2002), recommend that research review committees account for social risk and benefits to society in their review of proposed research. What do the concepts of the "social" and "society" mean in the context of the review of human participants research? Here we analyze concepts of social and society to define the terms: social harm, social risk, social benefit, and benefits to society. We argue that use of these terms invite more questions than answers and beg for difficult empirical research to determine the nature, likelihood, and magnitude of this category of risk and benefit. Until more research is done and these questions are answered, we advise reviewers to adopt an attitude of provisionalism and caution in their review of specifically "social" risks and benefits and "benefits to society."

INCIDENCE AND RELATION WITH ANATOMICAL AND FUNCTIONAL VARIABLES OF POSTOPERATIVE MACULAR DISPLACEMENT IN RHEGMATOGENOUS RETINAL DETACHMENT.

PURPOSE: To investigate the incidence of postsurgical retinal displacement in patients treated with pars plana vitrectomy for rhegmatogenous retinal detachment and to assess the influence of displacement on macular function. METHODS: Observational prospective study of 20 consecutive cases of rhegmatogenous retinal detachment who underwent 23-G pars plana vitrectomy with gas (C3F8 or SF6) tamponade, and prone resting. Three months after surgery, retinal displacement was evaluated by fundus autofluorescence. Macular function was evaluated with optical coherence tomography, multifocal electroretinogram, best-corrected visual acuity, and stereopsis. RESULTS: Postoperative retinal displacement was observed in 60% of cases. No correlation between the type of tamponade used and retinal displacement was observed. Similarly, no association between retinal displacement and postoperative stereopsis or visual acuity was found. A lower amplitude in P1 wave on the multifocal electroretinogram was observed in eyes with rhegmatogenous retinal detachment compared with the contralateral eye. However, no statistically significant differences between groups with or without retinal displacement were found. CONCLUSION: Retinal displacement in patients who undergo pars plana vitrectomy to treat rhegmatogenous retinal detachment is common. However, this displacement does not seem to affect macular function.

Developmental role of the cell adhesion molecule Contactin-6 in the cerebral cortex and hippocampus.

The gene encoding the neural cell adhesion molecule Contactin-6 (Cntn6 a.k.a. NB-3) has been implicated as an autism risk gene, suggesting that its mutation is deleterious to brain development. Due to its GPI-anchor at Cntn6 may exert cell adhesion/receptor functions in complex with other membrane proteins, or serve as a ligand. We aimed to uncover novel phenotypes related to Cntn6 functions during development in the cerebral cortex of adult Cntn6(-/-) mice. We first determined Cntn6 protein and mRNA expression in the cortex, thalamic nuclei and the hippocampus at P14, which decreased specifically in the cortex at adult stages. Neuroanatomical analysis demonstrated a significant decrease of Cux1+ projection neurons in layers II-IV and an increase of FoxP2+ projection neurons in layer VI in the visual cortex of adult Cntn6(-/-) mice compared to wild-type controls. Furthermore, the number of parvalbumin+ (PV) interneurons was decreased in Cntn6(-/-) mice, while the amount of NPY+ interneurons remained unchanged. In the hippocampus the delineation and outgrowth of mossy fibers remained largely unchanged, except for the observation of a larger suprapyramidal bundle. The observed abnormalities in the cerebral cortex and hippocampus of Cntn6(-/-) mice suggests that Cntn6 serves developmental functions involving cell survival, migration and fasciculation. Furthermore, these data suggest that Cntn6 engages in both trans- and cis-interactions and may be involved in larger protein interaction networks.

Swept source optical coherence tomography imaging of a series of choroidal tumours.

OBJECTIVE: This pilot study aimed to describe the swept-source optical coherence tomography (SS-OCT) features of a series of choroidal tumours. DESIGN: This was an observational case series. PARTICIPANTS: Patients in our ocular oncology unit were recruited: 32 eyes belonging to 31 patients. METHODS: All of the patients underwent fundus photography, ultrasonography (US), fundus autofluorescence (FAF), and SS-OCT. The main assessed characteristics were maximal tumour diameter and thickness, inner structure, and disturbances in the choroidal layers, sclera, retinal pigment epithelium, and retina. RESULTS: The tumours examined consisted of 16 nevi, 6 lesions with risk factors for growth, 4 melanomas, 4 hemangiomas, and 2 choroidal metastases. SS-OCT provided an accurate measurement of the tumour's maximum diameter in every case. Choroidal nevi displayed a compact, regular structure with a preserved choriocapillaris. Choroidal melanomas showed a more irregular inner structure, with an ablated choriocapillaris. Choroidal hemangiomas had a regular spongelike pattern. Choroidal metastases had an irregular inner structure organized in clumps and an ablated outer retina. In most of the pigmented tumours, the sclerochoroidal interface was not identifiable by SS-OCT. The presence of lipofuscin, detected by funduscopy and FAF, was also correlated with the SS-OCT findings. CONCLUSIONS: SS-OCT provided a view of the inner structures of a series of choroidal tumours and assessed their associated structural anomalies, as well as obtained measurements of the diameter and thickness in most cases.

Training direct care staff to increase positive interactions with individuals with developmental disabilities.

This study tested the effects of direct training on direct care staff's initiation of positive interactions with individuals with developmental disabilities who resided in an intermediate care facility. Participants included four direct care staff and their residents. Direct training included real-time prompts delivered via a one-way radio, and data were collected for immediate and sustained increases in rates of direct care staff's positive interactions. Additionally, this study evaluated the link between increased rates of positive interactions and concomitant decreases in residents' challenging behaviors. A multiple baseline design across participants was used and results indicated that all direct care staff increased their rates of positive interactions during direct training. Moreover, all but one participant continued to engage residents in positive interactions at levels above the criterion during the maintenance phase and follow-up phases. The direct care staff member who did not initially meet the criterion improved to adequate levels following one brief performance feedback session. With regard to residents' challenging behaviors, across phases, residents engaged in low levels of challenging behaviors making those results difficult to evaluate. However, improvements in residents' rate of positive interactions were noted.

Methylation of human papillomavirus 16, 18, 31, and 45 L2 and L1 genes and the cellular DAPK gene: Considerations for use as biomarkers of the progression of cervical neoplasia.

During progression of cervical cancer, human papillomavirus genomes and cellular tumor suppressor genes can become methylated. Toward a better understanding of these biomarkers, we studied 104 samples with HPV16, 18, 31, and 45 representing five pathological categories from asymptomatic infection to cancer. We grouped all samples by HPV type and pathology and measured the overall methylation of informative amplicons of HPV late genes and the cellular DAPK gene. Methylation of all four HPV types as well as of the DAPK gene is lowest in asymptomatic infection and increases successively in all four pathological categories during progression to cancer. 27 out of 28 cancer samples showed methylation both in the L2/L1 genes as well as in DAPK, but a much lower fraction in all other pathological categories. We discuss the problem to develop diagnostic tests based on complex methylation patterns that make it difficult to classify amplicons as "methylated" or "unmethylated".

Reporting ethics committee approval in public administration research.

While public administration research is thriving because of increased attention to social scientific rigor, lingering problems of methods and ethics remain. This article investigates the reporting of ethics approval within public administration publications. Beginning with an overview of ethics requirements regarding research with human participants, I turn to an examination of human participants protections for public administration research. Next, I present the findings of my analysis of articles published in the top five public administration journals over the period from 2000 to 2012, noting the incidences of ethics approval reporting as well as funding reporting. In explicating the importance of ethics reporting for public administration research, as it relates to replication, reputation, and vulnerable populations, I conclude with recommendations for increasing ethics approval reporting in public administration research.

Public service quality improvements: a case for exemption from IRB review of public administration research.

Should the exemption from Institutional Review Board (IRB) evaluations currently in place for quality improvements research be extended to public administration research that addresses questions of improving the quality of public service delivery? As a means to both reduce the level of disdain held by a group of social science researchers for IRBs and to reduce the cost of review for minimal risk studies, I argue here that much of the current public administration research should also be exempted from normal processes of review by IRBs on the basis of their similarity to Quality Improvements (QI) research, a category of studies already granted exemption. This argument dovetails provisions currently in place for studies of public service and public benefit, but reframes these exemptions in the language of "quality improvements," which may be a more comfortable language for IRBs concerned to demonstrate compliance for review of all fields. To expedite this argument into the practices of IRBs, I included a checklist that researchers could use to self-identify their studies as QI, not research as such.