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1.
J Acoust Soc Am ; 153(5): 2659, 2023 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-37130002

RESUMO

The Beaufort duct (BD) is a subsurface sound channel in the western Arctic Ocean formed by cold Pacific Winter Water (PWW) sandwiched between warmer Pacific Summer Water (PSW) and Atlantic Water (AW). Sound waves can be trapped in this duct and travel long distances without experiencing lossy surface/ice interactions. This study analyzes BD vertical and temporal variability using moored oceanographic measurements from two yearlong acoustic transmission experiments (2016-2017 and 2019-2020). The focus is on BD normal mode propagation through observed ocean features, such as eddies and spicy intrusions, where direct numerical simulations and the mode interaction parameter (MIP) are used to quantify ducted mode coupling strength. The observations show strong PSW sound speed variability, weak variability in the PWW, and moderate variability in the AW, with typical time scales from days to weeks. For several hundreds Hertz propagation, the BD modes are relatively stable, except for rare episodes of strong sound speed perturbations. The MIP identifies a resonance condition such that the likelihood of coupling is greatest when there is significant sound speed variability in the horizontal wave number band 1/11

2.
J Acoust Soc Am ; 151(1): 106, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35105017

RESUMO

Sea-surface acoustic scattering is investigated using observations from the 2016-2017 Canada Basin Acoustic Propagation Experiment. The motions of the low-frequency acoustic source and/or receiver moorings were measured using long-baseline acoustic navigation systems in which the signals transmitted once per hour by the mooring instruments triggered high-frequency replies from the bottom-mounted transponders. The moorings recorded these replies, giving the direct path and single-bounce surface-reflected arrivals, which have grazing angles near 50°. The reflected signals are used here to quantify the surface scattering statistics in an opportunistic effort to infer the changing ice characteristics as a function of time and space. Five scattering epochs are identified: (1) open water, (2) initial ice formation, (3) ice solidification, (4) ice thickening, and (5) ice melting. Significant changes in the ice scattering observables are seen using the arrival angle, moment of reflected intensity and its probability density function, and pulse time spread. The largest changes took place during the formation, solidification, and melting. The statistical characteristics across the experimental region are similar, suggesting consistent ice properties. To place the results in some physical context, they are interpreted qualitatively using notions of the partial and fully saturated wave fields, a Kirchhoff-like approximation for the rough surface, and a thin elastic layer reflection coefficient model.

3.
Learn Behav ; 48(1): 96-103, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31965461

RESUMO

Cerebral laterality, via hemispheric specialisation, has been evidenced across the animal kingdom and linked to cognitive performance in a number of species. Previously it has been suggested that cognitive processing is more efficient in brains with stronger hemispheric differences in processing, which may be the key fitness benefit driving the evolution of laterality. However, evidence supporting a positive association between cognitive performance and lateralization is mixed: data from studies of fish and birds show a positive relationship whereas more limited data from studies of mammals suggest a weak or even negative relationship, suggesting the intriguing possibility of a mammal/non-mammal divide in the nature of this relationship. Here, we report an empirical test examining the relationship between lateralization and cognitive performance in wild grey squirrels (Sciurus carolinensis) by measuring left/right paw preference as a behavioural assay of cerebral lateralization and learning speed as an assay of cognitive efficiency. We carried out a motor-based laterality test using a reaching paradigm and measured learning speed on a problem-solving task. In accordance with the suggestion of a mammal/non-mammal divide, we found a negative relationship between strength of paw preference and performance on the learning task. We discuss this finding in light of niche-specific adaptations, task-specific demands and cognitive flexibility.


Assuntos
Lateralidade Funcional , Aprendizagem , Animais , Encéfalo , Resolução de Problemas , Sciuridae
4.
Am J Psychother ; 73(3): 72-84, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32306748

RESUMO

OBJECTIVE: New technologies incorporating genetics and neuroimaging into psychiatric care offer the possibility of illuminating associations among genetic alleles, neural functioning, and patients' response to various psychotherapeutic modalities. In this review, the authors survey the literature on the emerging field of genetic predictors of psychotherapy response, particularly in relation to the 5-HTTLPR polymorphism and individual response to manualized psychotherapy. METHODS: The extant literature was reviewed, with PubMed serving as the primary database. RESULTS: Several polymorphisms have been linked with response or resistance to treatment. Given the number of studies assessing the relevance of the 5-HTTLPR polymorphism to treatment response, this review focuses on this genetic variation. CONCLUSIONS: Because individual genetic endowments may predict nonresponse to manualized treatment modalities, it may become possible to identify individuals who would benefit from insight-oriented, open-ended psychotherapy tailored to their individual distress tolerance levels, rather than from shorter manualized treatment.


Assuntos
Vias Neurais , Polimorfismo Genético , Psicoterapia , Humanos , Prognóstico , Proteínas da Membrana Plasmática de Transporte de Serotonina/genética , Resultado do Tratamento
5.
Acad Psychiatry ; 43(4): 417-424, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30997655

RESUMO

OBJECTIVE: This paper sought to compile an annotated bibliography for the outpatient year of adult psychiatry residents, providing resources for a foundation in psychodynamic theory which can be utilized in supervision to aid in ongoing psychotherapeutic work. METHODS: In selecting the readings, the ACGME Milestones sub-competencies considered were (i) empathy and process, (ii) boundaries, (iii) alliance and provision of psychotherapies, (iv) seeking and providing supervision, and (v) knowledge of psychotherapy (theories, practice, and evidence base). Once the readings were selected, two authors independently reviewed the articles to determine which key sub-competencies each article addressed. Chance corrected agreement between the reviewers was assessed using the Cohen kappa statistic. The kappa for interrater agreement was 0.83. RESULTS: A list of 32 readings was compiled sequentially, allowing for theoretical concepts to be progressively built upon. The content of the papers aligned well with multiple sub-competencies in the medical knowledge (MK) and patient care (PC) domains. The bibliography allows for close examination of therapeutic frame; active listening and reflecting on the meaning of the therapist's interventions; transference and the use of countertransference as a diagnostic/therapeutic tool; defense mechanisms; patient pressures towards reenactment; theoretical viewpoints on therapeutic action (e.g., ego psychology, self-psychology, relational therapy, object relations, classical/modern Kleinian); and meaning of lateness, treatment breaks, and termination. CONCLUSIONS: This list serves as an ancillary resource which can augment discussions in therapy supervision, while also aiding in standardizing the minimal knowledge base achieved in psychodynamic theory.


Assuntos
Bibliografias como Assunto , Internato e Residência , Psiquiatria/educação , Psicoterapia Psicodinâmica/educação , Humanos
6.
J Trauma Stress ; 31(1): 125-133, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29388709

RESUMO

Posttraumatic stress disorder (PTSD) is a chronic and debilitating condition for which clinicians sometimes turn to anticonvulsants as a treatment for symptoms. This study was a systematic review and meta-analysis of randomized controlled trials (RCT) that have assessed the efficacy of topiramate as monotherapy or adjunctive therapy, compared to placebo, for the treatment of PTSD in adults. Prescribers may be reluctant to turn to topiramate, given the commonly reported side effects of impaired cognition, sedation, fatigue, and headache. We searched PubMed, PsycInfo, and Cochrane Central databases for relevant trials. Five studies were identified as RCTs and thus met inclusion criteria; one additional nonpublished study was identified via phone contact with its authors. Of these six studies, one was excluded from the statistical meta-analysis due to its high dropout rate (16 of 40 participants). One of these studies was excluded from a stratified analysis of symptom types because this subscale data were unavailable.  For overall symptomatology, topiramate showed a medium, but not significant effect, standardized mean difference (SMD) = 0.55, p = .082. Topiramate showed a small and significant reduction of hyperarousal symptoms, SMD = 0.35, 95% CI [0.029, 0.689], p = .033. Topiramate did not significantly reduce reexperiencing symptoms, SMD = 0.29, 95% CI [-0.019, 0.597], p = .067, or avoidance symptoms, SMD = 0.20, 95% CI [-0.105, 0.509], p = .198. Results did not differ significantly between veteran and nonveteran subjects, or between topiramate as monotherapy and adjunctive therapy. Further studies on topiramate will clarify its role in PTSD treatment.


Assuntos
Anticonvulsivantes/uso terapêutico , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Transtornos de Estresse Pós-Traumáticos/psicologia , Topiramato/uso terapêutico , Nível de Alerta , Aprendizagem da Esquiva , Quimioterapia Adjuvante , Quimioterapia Combinada , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
J Trauma Dissociation ; 17(4): 494-510, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26835889

RESUMO

UNLABELLED: Although sleep disturbances occur commonly in patients with posttraumatic stress disorder (PTSD) and are associated with adverse outcomes and increased suicidality, they are often inadequately addressed by antidepressant medications. OBJECTIVE: This review aims to assess whether prazosin reduces nightmares, sleep disturbances, and illness severity in adults with PTSD. METHOD: Electronic databases (PubMed, PsycINFO) were searched in September 2014 for randomized controlled trials in adults. Search terms included posttraumatic stress disorder, prazosin, nightmares, and sleep disturbance. Included studies used prazosin and provided objective outcome data related to nightmares and/or sleep quality. RESULTS: Six studies (191 participants) met the criteria for inclusion. Prazosin was more effective than placebo in improving nightmares (standardized mean difference [SMD] = 1.022, 95% confidence interval [CI] [0.41, 1.62], p = .001), sleep quality (SMD = 0.93, 95% CI [-0.02, 1.88], p = .054; and SMD = 1.14, 95% CI [0.24, 2.03], p = .01), and illness severity (SMD = 1.20, 95% CI [0.79, 1.61], p = .001, with no significant effect on systolic (SMD = -0.01, 95% CI [-0.40, 0.37], p = .94) or diastolic (SMD = 0.30, 95% CI [-0.09, 0.68], p = .154) blood pressure. CONCLUSION: PTSD-related nightmares, sleep disturbances, and overall illness severity showed a significant response to treatment with prazosin. With careful dose titration, prazosin was well tolerated and had no significant sustained effect on blood pressure.


Assuntos
Antagonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Sonhos/efeitos dos fármacos , Prazosina/uso terapêutico , Transtornos do Sono-Vigília/tratamento farmacológico , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Adulto , Humanos
8.
Opt Express ; 23(15): A779-90, 2015 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-26367680

RESUMO

Colloidal quantum dot (CQD) solar cells have attracted tremendous attention mostly due to their wide absorption spectrum window and potentially low processability cost. The ultimate efficiency of CQD solar cells is highly limited by their high trap state density. Here we show that the overall device power conversion efficiency could be improved by employing photonic structures that enhance both charge generation and collection efficiencies. By employing a two-dimensional numerical model, we have calculated the characteristics of patterned CQD solar cells based of a simple grating structure. Our calculation predicts a power conversion efficiency as high as 11.2%, with a short circuit current density of 35.2 mA/cm2, a value nearly 1.5 times larger than the conventional flat design, showing the great potential value of patterned quantum dot solar cells.

9.
Appl Opt ; 54(26): 7933-9, 2015 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-26368966

RESUMO

Colloidal quantum dot (CQD) solar cells have attracted tremendous attention because of their tunable absorption spectrum window and potentially low processing cost. Recently reported quantum junction solar cells represent a promising approach to building a rectifying photovoltaic device that employs CQD layers on each side of the p-n junction. However, the ultimate efficiency of CQD solar cells is still highly limited by their high trap state density in both p- and n-type CQDs. By modeling photonic structures to enhance the light absorption within the carrier transport length and by ensuring that the carrier generation and collection efficiencies were both augmented, our work shows that overall device current density could be improved. We utilized a two-dimensional numerical model to calculate the characteristics of patterned CQD solar cells based on a simple grating structure. Our calculation predicts a short circuit current density as high as 31 mA/cm2, a value nearly 1.5 times larger than that of the conventional flat design, showing the great potential value of patterned quantum junction solar cells.

10.
Appl Opt ; 53(13): C32-44, 2014 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-24921888

RESUMO

We report on application of multi-frame super-resolution (SR) to sampling limited imagery that models space objects (SOs). The difficulties of multi-frame image processing of SOs include abrupt illumination changes and complex in scene SO motion. These conditions adversely affect the accuracy of motion estimation necessary for resolution enhancement. We analyze the motion estimation errors from the standpoint of an optical flow (OF) interpolation error metric and show dependence of the object tracking accuracy on brightness changes and on the pixel displacement values between subsequent images. Despite inaccuracies of motion estimation, we demonstrate spatial acuity enhancement of the pixel limited resolution of model SO motion imagery by applying a SR algorithm that accounts for OF errors. In addition to visual inspection, image resolution improvement attained in the experiments is assessed quantitatively; a 1.8× resolution enhancement is demonstrated.

11.
Psychoanal Q ; 93(2): 349-383, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38776426

RESUMO

King Lear is a timeless exposition of humankind's attempt to find meaning amidst the ceaseless turbulence of existence. This entails navigating the disintegrating pulls of nature and harmful human action that exist alongside affiliative, life-promoting gestures shown toward one another. As the predictability and safety afforded by social and two-dimensional psychic constructs collapse, several characters in this play are forced to reckon with the untamed, less organized realms of the mind and natural world. This leads to movements toward psychic paralysis and disintegration, as well as toward growth and interpersonal healing, dynamics that hinge on the characters' internal structuring.

12.
Biol Open ; 13(2)2024 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-38288786

RESUMO

The third International Student Symposium on Animal Behaviour and Cognition (ISSABC) aimed to address barriers for early career researchers, hosting a conference both in-person and online at the Universidad Nacional Autónoma de México (UNAM). The conference, attended by 101 in-person and 79 virtual participants from 24 countries, featured 81 presentations, 29 posters, five plenary talks, three workshops, and a career development round-table discussion. A user-friendly website and digital platforms facilitated communication and real-time discussions between in-person and online participants. Transparent fund management, support from sponsors and societies, and sustainable practices ensured financial accountability and minimised environmental impact. The conference emphasised sustainability measures, including eco-friendly catering and local reusable mugs. Future organisers of similar events are encouraged to prioritise local representation, plan contingencies, select plenary speakers rigorously, and employ effective marketing. With this meeting review, we highlight how hybrid conferences like the third ISSABC, through innovative approaches and sustainable practices, enhance accessibility, inclusivity, and empower the next generation of scientists.


Assuntos
Estudantes , Humanos , Congressos como Assunto
13.
Int J Psychoanal ; 103(2): 395-412, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35440275

RESUMO

The natural world has always been integral to our existence; currently, we are compelled to reckon with our assumptions about this connection with mounting urgency. Individual reactions to the environment are influenced not only by the sociocultural surround, but also by one's internal world, particularly whether one's internal objects are felt to have been irreparably damaged or are potentially salvageable. Excessive guilt about destructive impulses can limit one's ability to recognize individual responsibility for the current situation without catastrophizing the weight of one's ecological footprint. Delusional solutions may be adopted, valorizing extreme forms of engagement. The film First Reformed illustrates what appear to be divergent approaches to the planet: ruthless exploitation by an industrialist versus an impassioned objection to destruction of the environment for economic gain. In this narrative, both are underpinned by a paranoid-schizoid mindset. We investigate the dynamics of this psychic state, which results in a constricted perception and an absence of constructive agency with respect to the environmental crisis. We present an alternative conceptualization of the natural world's place within a person's psychic equilibrium. We emphasize that a more integrated relationship with the environment can facilitate concerned, preservative action on behalf of the natural world and ourselves.


Assuntos
Culpa , Meios de Comunicação de Massa , Humanos , Paralisia
14.
Harv Rev Psychiatry ; 29(4): 303-317, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34049337

RESUMO

ABSTRACT: The impact of stress and trauma on biological systems in humans can be substantial. They can result in epigenetic changes, accelerated brain development and sexual maturation, and predisposition to psychopathology. Such modifications may be accompanied by behavioral, emotional, and cognitive overtones during one's lifetime. Exposure during sensitive periods of neural development may lead to long-lasting effects that may not be affected by subsequent environmental interventions. The cumulative effects of life stressors in an individual may affect offspring's methylome makeup and epigenetic clocks, neurohormonal modulation and stress reactivity, and physiological and reproductive development. While offspring may suffer deleterious effects from parental stress and their own early-life adversity, these factors may also confer traits that prove beneficial and enhance fitness to their own environment. This article synthesizes the data on how stress shapes biological and behavioral dimensions, drawing from preclinical and human models. Advances in this field of knowledge should potentially allow for an improved understanding of how interventions may be increasingly tailored according to individual biomarkers and developmental history.


Assuntos
Epigênese Genética , Psicopatologia , Epigênese Genética/genética , Humanos , Pais
15.
Neurosci Biobehav Rev ; 127: 520-530, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33992695

RESUMO

The historical association between respiratory infections and neuropsychiatric symptoms dates back centuries, with more recent literature highlighting a link between viral infections and schizophrenia. Maternal influenza infection during pregnancy has been associated with the development of schizophrenia in offspring. Viral infections in neonates, children, and adolescents have also been associated with later development of schizophrenia. Neuroinvasive and/or systemic infections are thought to increase risk for psychopathology via inflammatory mechanisms, particularly when exposure occurs during critical neurodevelopmental windows. Several human coronaviruses (HCoVs) have been associated with psychotic disorders and increasing reports of the neuropsychiatric manifestations of COVID-19 suggest it has neuroinvasive properties similar to those of other HCoVs. These properties, in conjunction with its ability to generate a massive inflammatory response, suggest that COVID-19 may also contribute to future psychopathology. This review will summarize the psychopathogenic mechanisms of viral infections and discuss the neuroinvasive and inflammatory properties of COVID-19 that could contribute to the development of psychotic disorders, with a focus on in utero, neonatal, and childhood exposure.


Assuntos
COVID-19 , Transtornos Psicóticos , Esquizofrenia , Viroses , Adolescente , Criança , Feminino , Humanos , Recém-Nascido , Gravidez , SARS-CoV-2 , Viroses/complicações
16.
Case Rep Psychiatry ; 2021: 4177263, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34635875

RESUMO

INTRODUCTION: Haloperidol is a dopamine receptor antagonist used to treat patients with psychotic disorders. Especially at high doses, haloperidol carries a higher risk of extrapyramidal symptoms (EPS) compared to second-generation antipsychotics. Few cases of haloperidol misuse are found in the medical literature. Case Presentation. We describe a patient with schizophrenia who smoked marijuana mixed with crushed haloperidol tablets. After the smoking of cannabis and haloperidol, the patient presented to the emergency department (ED) with suicidal ideation, psychosis, and acute dystonia. With the administration of intramuscular diphenhydramine at the ED, the dystonia resolved in less than an hour. To our knowledge, this is the first report on haloperidol misuse by smoking. CONCLUSION: Clinicians should be aware that patients might misuse prescribed antipsychotics via unconventional routes, potentially combined with other substances.

17.
Chempluschem ; 86(6): 875-878, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34114374

RESUMO

The synthesis of 3-(1,2,4-oxadiazolyl)-5-nitratomethyl isoxazole (C6 H4 N4 O5 ), its physical properties, and its theoretical performances are described. This energetic material was found to have a melting point range of 76.6-79.2 °C, and a thermal onset decomposition temperature of 184.5 °C. These thermal features put this material into the standalone melt-castable explosive class. The material was found to have TNT performance, and was found to be insensitive to impact, friction, and electrostatic discharge, despite having a nitric ester functionality. A critical reaction in making this molecule was the desymmetrization of diaminoglyoxime. The optimization of this transformation is described. Previous reports of this desymmetrization were found to be inaccurate, as the desymmetrization reaction produces a co-crystal of mono- and bi-1,2,4-oxadiazole products.

18.
West J Emerg Med ; 21(4): 841-848, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32726254

RESUMO

INTRODUCTION: Managing agitation in the clinical setting is a challenge that many practitioners face regularly. Our evolving understanding of the etiological factors involved in aggressive acts has better informed our interventions through pharmacologic and behavioral strategies. This paper reviews the literature on the neurobiological underpinnings of aggressive behaviors, linking psychopathology with proposed mechanisms of action of psychiatric medications shown to be effective in mitigating agitation. METHODS: We performed a review of the extant literature using PubMed as a primary database. Investigation focused on neurobiology of agitation and its relation to the current evidence base for particular interventions. RESULTS: There are well-established pathways that can lead to increased autonomic response and the potential for violence. Psychopathology and substance-induced perceptual distortions may lead to magnification and overestimation of environmental threat, heightening the potential for aggression. Additional challenges have arisen with the advent of several novel drugs of abuse, many of which lead to atypical clinical presentations and which can elude standard drug screens. Our interventions still lean on the evidence base found in Project BETA (Best Practices in Evaluation and Treatment of Agitation). Although not a new drug and not included in the Project BETA guidelines, ketamine and its use are also discussed, given its unique pharmacology and potential benefits when other protocoled interventions have failed. CONCLUSION: Aggression can occur due to manifold reasons in the clinical setting. Having an informed understanding of the possible determinants of agitation can help with more tailored responses to individual patients, limiting the unnecessary use of medications or of interventions that could be deemed forceful.


Assuntos
Agitação Psicomotora , Psicotrópicos/farmacologia , Agressão/efeitos dos fármacos , Agressão/fisiologia , Agressão/psicologia , Humanos , Agitação Psicomotora/tratamento farmacológico , Agitação Psicomotora/etiologia
19.
Harv Rev Psychiatry ; 27(3): 193-200, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31082994

RESUMO

Olfactory reference syndrome (ORS) describes a constellation of emotional and behavioral symptoms that cause clinically significant distress or impairment arising from the false belief that one is emitting an offensive odor. Despite cases of ORS reported throughout the world over the last century, our knowledge and understanding of ORS remain relatively poor because of the limited literature-mostly case studies and series, but no clinical trials. ORS continues to pose significant diagnostic challenges within our current frameworks of categorizing mental disorders, including the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases. We review the ORS literature and discuss diagnostic parallels and challenges of placing ORS within specific categories. We also review the current research on the neurocircuitry of olfaction and of disorders with potential clinical relevance to patients presenting with ORS. While no primary neuroscientific research has specifically investigated ORS, an overlapping circuitry has been implicated in the neurobiology of obsessive-compulsive, trauma and stressor, and psychotic spectrum disorders, suggesting that the phenomenology of ORS can best be understood through a dimensional, rather than categorical, approach.


Assuntos
Transtorno Obsessivo-Compulsivo/psicologia , Odorantes , Transtornos do Olfato/psicologia , Transtornos Psicóticos/psicologia , Humanos , Neurobiologia/tendências , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtornos do Olfato/epidemiologia , Transtornos Psicóticos/epidemiologia , Síndrome
20.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31171587

RESUMO

BACKGROUND: Overuse of laboratory testing contributes substantially to health care waste, downstream resource use, and patient harm. Understanding patterns of variation in hospital-level testing across common inpatient diagnoses could identify outliers and inform waste-reduction efforts. METHODS: We conducted a multicenter retrospective cohort study of pediatric inpatients at 41 children's hospitals using administrative data from 2010 to 2016. Initial electrolyte testing was defined as testing occurring within the first 2 days of an encounter, and repeat testing was defined as subsequent testing within an encounter in which initial testing occurred. To examine if testing rates correlated across diagnoses at the hospital level, we compared risk-adjusted rates for gastroenteritis with a weighted average of risk-adjusted rates in other diagnosis cohorts. For each diagnosis, linear regression was performed to compare initial and subsequent testing. RESULTS: In 497 719 patient encounters, wide variation was observed across hospitals in adjusted, initial, and repeat testing rates. Hospital-specific rates of testing in gastroenteritis were moderately to strongly correlated with the weighted average of testing in other conditions (initial: r = 0.63; repeat r = 0.83). Within diagnoses, higher hospital-level initial testing rates were associated with significantly increased rates of subsequent testing for all diagnoses except gastroenteritis. CONCLUSIONS: Among children's hospitals, rates of initial and repeat electrolyte testing vary widely across 8 common inpatient diagnoses. For most diagnoses, hospital-level rates of initial testing were associated with rates of subsequent testing. Consistent rates of testing across multiple diagnoses suggest that hospital-level factors, such as institutional culture, may influence decisions for electrolyte testing.


Assuntos
Técnicas de Laboratório Clínico/estatística & dados numéricos , Eletrólitos/análise , Laboratórios Hospitalares/estatística & dados numéricos , Procedimentos Desnecessários/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Técnicas de Laboratório Clínico/economia , Feminino , Gastroenterite/diagnóstico , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Laboratórios Hospitalares/economia , Masculino , Utilização de Procedimentos e Técnicas , Melhoria de Qualidade , Estudos Retrospectivos , Procedimentos Desnecessários/economia
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