First episode psychosis caregiver perspectives on motivational interviewing for loved ones training: A qualitative study

BACKGROUND

Past research has found that family involvement in psychosis treatment leads to better patient outcomes. Thus, caregiver communication skills training can be a viable approach to reducing caregiver stress and increasing self-efficacy and communication.

AIM

The purpose of this qualitative study was to describe family caregivers' perceptions of changes in themselves and their family member with psychosis following their participation in Motivational Interviewing in Loved Ones (MILO), a brief four to five-hour psychoeducational intervention for caregivers.

METHODS

Sixty-three participants in the MILO trials provided written qualitative responses to the prompt, "Since learning the ideas and techniques in this course, what is the most significant change you noticed in yourself, your family, or your relationships?" Responses were collected immediately following MILO participation and 12 weeks later. Qualitative themes were identified through an iterative consensus process.

RESULTS

Most participants reported positive changes in multiple domains of their lives. Major themes included: (1) Changes in Self, (2) Changes in Relationships, (3) Changes in Mindset, (4) Use of MILO Skills, and (5) Challenges.

CONCLUSION

Qualitative results support and add context to the previously reported quantitative results from this study. MILO is a promising family intervention that positively influenced family environment and communication in pilot trials. Adaptations of MILO for families outside of a highly educated North American context should be considered.

A Rare Cause of Low Back Pain

This is the case of a 60-year-old man with no known medical history who presented with progressively worsening lumbar pain and was found to have idiopathic dorsal epidural lipomatosis. The patient's condition improved significantly with pain management. Therefore, no surgical intervention was warranted at the time, but the patient was advised to keep close follow-up as an outpatient. Being familiar with this potential cause of lumbar pain is vital, as it can lead to severe morbidity if left unrecognized.

Red cell haemolysis secondary to intraosseous (IO) blood transfusion in adult patients with major trauma: a systematic review

INTRODUCTION

Intraosseous (IO) administration of medications and blood products is accepted practice in major trauma when intravenous access is not immediately available. However, there is a concern that the high infusion pressures required for IO transfusion may increase the risk of red cell haemolysis and its associated complications. The aim of this systematic review is to synthesise the existing evidence describing the risks of red cell haemolysis in IO blood transfusion.

METHODS

We undertook a systematic search of MEDLINE, CINAHL and EMBASE using the search terms: "intraosseous transfusion" and "haemolysis". Two authors independently screened abstracts, and reviewed full-text articles against the inclusion criteria. Reference lists of included studies were reviewed and a grey literature search undertaken. Studies were assessed for risk of bias. Inclusion criteria were: all human and animal study types that reported novel data on IO-associated red cell haemolysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was used.

RESULTS

Twenty-three abstracts were identified; n=9 full papers met the inclusion criteria. No further studies were identified from reference lists or grey literature. These papers included: seven large animal translational studies, a prospective and a retrospective human study. The overall risk of bias was high. One animal study with good translatability to adult patients with trauma demonstrated haemolysis. Other animal studies had methodological constraints that limit their human applicability. No haemolysis was observed in low-density flat bones (sternum), whereas haemolysis was reported in long bones (humerus, tibia). IO infusion using a three-way tap was associated with haemolysis. Conversely, pressure bag transfusion was not associated with haemolysis, but this method may result in insufficient flow rates for effective resuscitation.

CONCLUSIONS

There is a paucity of high-quality evidence surrounding the risks of red cell haemolysis in IO blood transfusion. However, evidence from one study suggests that the likelihood is increased by use of a three-way tap to administer blood transfusion to young adult male patients with trauma. Further research is needed to address this important clinical question.

PROSPERO REGISTRATION NUMBER

CRD42022318902.

Prehospital emergency care in a humanitarian environment: an overview of the ethical considerations

Recent history has demonstrated that UK Defence personnel can be used, potentially with little notice, in humanitarian disaster zones. The provision of prehospital emergency care (PHEC) in a humanitarian environment requires an innovative approach to overcome the technical challenges of a resource-limited setting. In addition to technical challenges, prehospital practitioners working in a humanitarian environment can expect to be faced with ethically testing situations that they are not familiar with in their usual practice. The organisational and individual ethical decision-making burden can result in significant harms. Therefore, the aim of this paper is to discuss the ethical considerations relevant to providing PHEC during a humanitarian disaster in order that personnel can be more prepared to optimally deliver care. This is a paper commissioned as a part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.

Ergonomics and Work-Related Musculoskeletal Disorders: Characteristics Among Female Interventionists

Interventional radiology is a procedural specialty that performs minimally invasive operations under image guidance. Currently, there are inadequate ergonomic protocols for work-related musculoskeletal disorder (WMSD) prevention in interventional radiology (IR), and there is a paucity of information discerning gender differences in WMSDs. This article reviews current literature that addresses WMSDs in female physicians practicing interventional and fluoroscopic procedures, including interventional radiology, interventional cardiology, electrophysiology, vascular surgery, orthopedic surgery, neurosurgery, and gastroenterology. We searched PubMed and EBSCOhost databases for ergonomic studies that reported female physician WMSDs in the specialties listed above. After a thorough evaluation for inclusion based on eligibility criteria, 11 studies were included. From this search, there was poor female representation, averaging 25.7% of respondents. Several characteristics identified across the studies were that women were generally shorter, wore smaller glove sizes, and were younger than their male colleagues. Seventy-two percent of female proceduralists reported WMSDs versus 46.6% of their male colleagues. Additionally, women may experience more upper extremity pain than lumbar pain, which men commonly reported. Potential contributing factors to WMSDs are the size and design of procedural tools and the possible predisposition of female physicians to experience upper extremity WMSDs while performing the same operations as men. As more women enter medicine and pursue careers in procedural fields like interventional radiology, it is essential to address these discrepancies and develop ergonomically sound solutions for women.

Hemothorax and Pneumothorax Secondary to Costal Involvement in Hereditary Multiple Exostoses: A Systematic Review of Reported Cases in the Literature

Hereditary multiple exostoses (HME) are an autosomal dominant skeletal disorder characterized by the development of multiple benign osteochondromas (exostoses) that frequently involve long bones of the body. Less commonly, the ribs are a site of involvement, and long-term friction between an exostosis and pleura can produce a hemothorax or pneumothorax. The purpose of this study is to provide a comprehensive review of existing literature on pneumothorax or hemothorax secondary to costal exostosis in HME patients. We reviewed the databases of PubMed and Embase and included data as current as of February 15, 2021. All case reports included cases of hemothorax or pneumothorax in patients with a known personal or family history of HME. After evaluation for inclusion based on eligibility criteria, 18 cases were included. The average age at presentation was 11.7 years (range: 3-32), and most patients were male (83%). Hemothoraces occurred in 15 cases, while pneumothoraces occurred in three cases. All cases were evaluated using chest X-ray and CT scan, and the majority of the cases were treated with surgical resection of the exostosis, either with video-assisted thoracoscopic surgery (VATS; 61%) or thoracotomy (22%). Outcomes were successful with no cases of recurrence after surgical intervention. Although rare, costal exostosis should be considered as a differential in patients presenting with pneumothorax or hemothorax and past medical history or physical exam findings suggestive of HME. Immediate evaluation and surgical intervention to resect costal exostosis are essential to reduce the risk of recurrent life-threatening injury.

The impact of the COVID-19 pandemic on healthcare acquired infections with multidrug resistant organisms

This retrospective, cross-sectional study was conducted in four community hospitals in Los Angeles County, California. The assumption of this study was, coronavirus disease-19 (COVID-19) contributed to the increase in healthcare workers compliance with infection prevention measures. IP initiatives fostered among HCWs have increased awareness of effective hand washing, cleaning equipment after use and appropriate personal protective equipment use which has subsequently decreased healthcare acquired infections with multidrug-resistant organisms.

P.R.I.D.E.-preventing respiratory infectious disease exposures: An improvement project in a Northern Californian emergency room

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Preventing occupational health exposures in the emergency room.

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Prompt isolation of infectious patients.

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Performance Improvement project to prevent disease transmission.

Background

Preventing respiratory infectious disease exposures is a performance improvement project to reduce the incidence of occupational health exposures among health care workers. This project encouraged registered nurses to quickly identify and isolate potentially infectious patients in the emergency room, to prevent exposures to airborne and droplet transmitted communicable diseases, including meningitis, tuberculosis, and measles.

Methods

This pre- and postintervention model implemented a quasi-experimental designed project in the emergency room (ER). The Centers for Disease Control's empiric transmission-based isolation precautions were implemented to prevent occupational health exposures. Eighty registered nurses (RN's) received education on the new intervention. The assumption of this project was, the new process will decrease occupational health exposures.

Results

Eight ER RNs reported an occupational health exposure, preintervention in quarter 2 of 2019, compared to zero occupational health exposures, postintervention in quarter 3 of 2019. A χ² independence test was used to determine if the categorical variables of the capstone intervention and disease exposure were related in the same RN population. An association between the capstone intervention and disease exposure was observed, X² (1) = 8.421, P = .004, indicating the result is statistically significant.

Conclusions

The preventing respiratory infectious disease exposures project effectively reduced occupational health exposures to airborne and droplet transmitted diseases in the emergency room by 100%. These results should encourage Infection Preventionists to adapt the Centers for Disease Control's empiric transmission isolation precautions in their emergency rooms and urgent cares to prevent airborne and droplet transmitted disease exposures.

Predicting Drug Release From Degradable Hydrogels Using Fluorescence Correlation Spectroscopy and Mathematical Modeling

Predicting release from degradable hydrogels is challenging but highly valuable in a multitude of applications such as drug delivery and tissue engineering. In this study, we developed a simple mathematical and computational model that accounts for time-varying diffusivity and geometry to predict solute release profiles from degradable hydrogels. Our approach was to use time snapshots of diffusivity and hydrogel geometry data measured experimentally as inputs to a computational model which predicts release profile. We used two model proteins of varying molecular weights: bovine serum albumin (BSA; 66 kDa) and immunoglobulin G (IgG; 150 kDa). We used fluorescence correlation spectroscopy (FCS) to determine protein diffusivity as a function of hydrogel degradation. We tracked changes in gel geometry over the same time period. Curve fits to the diffusivity and geometry data were used as inputs to the computational model to predict the protein release profiles from the degradable hydrogels. We validated the model using conventional bulk release experiments. Because we approached the hydrogel as a black box, the model is particularly valuable for hydrogel systems whose degradation mechanisms are not known or cannot be accurately modeled.

Behavioral Responses to Sensory Stimuli During Play at Community-Based Events

Date Presented 04/06/19

An observation tool was developed and used to record children’s responses to sensory stimuli during play in the community setting. Results suggest significant relationships between high intensity tactile and movement stimuli, and affect. These findings are important for helping to better understand a child’s sensory processing in natural play environments, selecting activities based on sensory properties, and supporting the development of sensory friendly times in the community.

Primary Author and Speaker: Kelle DeBoth

Additional Authors and Speakers: Paige Brown, Emily Barnard

The role of the skin microbiota in acne pathophysiology

BACKGROUND

The role of skin microbiota in acne remains to be fully elucidated. Initial culture-based investigations were hampered by growth rate and selective media bias. Even with less biased genomic methods, sampling, lysis and methodology, the task of describing acne pathophysiology remains challenging. Acne occurs in sites dominated by Cutibacterium acnes (formerly Propionibacterium acnes) and Malassezia species, both of which can function either as commensal or pathogen.

OBJECTIVES

This article aims to review the current state of the art of the microbiome and acne.

METHODS

The literature regarding the microbiome and acne was reviewed.

RESULTS

It remains unclear whether there is a quantitative difference in microbial community distribution, making it challenging to understand any community shift from commensal to pathogenic nature. It is plausible that acne involves (i) change in the distribution of species/strains, (ii) stable distribution with pathogenic alteration in response to internal (intermicrobe) or external stimuli (host physiology or environmental) or (iii) a combination of these factors.

CONCLUSIONS

Understanding physiological changes in bacterial species and strains will be required to define their specific roles, and identify any potential intervention points, in acne pathogenesis and treatment. It will also be necessary to determine whether any fungal species are involved, and establish whether they play a significant role. Further investigation using robust, modern analytic tools in longitudinal studies with a large number of participants, may make it possible to determine whether the microbiota plays a causal role, is primarily involved in exacerbation, or is merely a bystander. It is likely that the final outcome will show that acne is the result of complex microbe-microbe and community-host interplay.

Backpropagation neural nets with one and two hidden layers

The differences in classification and training performance of three- and four-layer (one- and two-hidden-layer) fully interconnected feedforward neural nets are investigated. To obtain results which do not merely reflect performance on a particular data set, the networks are trained on various distributions, which are themselves drawn from a distribution of distributions. Experimental results indicate that four-layered networks are more prone to fall into bad local minima, but that three- and four-layered networks perform similarly in all other respects.

Backpropagation uses prior information efficiently

The ability of neural net classifiers to deal with a priori information is investigated. For this purpose, backpropagation classifiers are trained with data from known distributions with variable a priori probabilities, and their performance on separate test sets is evaluated. It is found that backpropagation employs a priori information in a slightly suboptimal fashion, but this does not have serious consequences on the performance of the classifier. Furthermore, it is found that the inferior generalization that results when an excessive number of network parameters are used can (partially) be ascribed to this suboptimality.

Spatial relationships between nitrogen status and pitch canker disease in slash pine planted adjacent to a poultry operation

Pitch canker disease (Fusarium circinatum Nirenberg & O'Donnell) causes serious shoot dieback, reduced growth and mortality in pines found in the southern and western USA, and has been linked to nutrient imbalances. Poultry houses with forced-air ventilation systems produce nitrogen (N) emissions. This study analyzed spatial correlations between pitch canker disease and foliar, forest floor, soil, and throughfall N in a slash pine (Pinus elliottii var. elliottii Engelm.) plantation adjacent to a poultry operation in north Florida, USA. Tissue and throughfall N concentrations were highest near the poultry houses and remained elevated for 400 m. Disease incidence ranged from 57-71% near the poultry houses and was spatially correlated with N levels. Similarly, stem mortality ranged from 41-53% in the most heavily impacted area, and declined to 0-9% at distances greater than 400 m. These results suggest that nutritional processes exacerbate changes in disease susceptibility and expression in slash pine.

Process modeling with the regression network

A new connectionist network topology called the regression network is proposed. The structural and underlying mathematical features of the regression network are investigated. Emphasis is placed on the intricacies of the optimization process for the regression network and some measures to alleviate these difficulties of optimization are proposed and investigated. The ability of the regression network algorithm to perform either nonparametric or parametric optimization, as well as a combination of both, is also highlighted. It is further shown how the regression network can be used to model systems which are poorly understood on the basis of sparse data. A semi-empirical regression network model is developed for a metallurgical processing operation (a hydrocyclone classifier) by building mechanistic knowledge into the connectionist structure of the regression network model. Poorly understood aspects of the process are provided for by use of nonparametric regions within the structure of the semi-empirical connectionist model. The performance of the regression network model is compared to the corresponding generalization performance results obtained by some other nonparametric regression techniques.

Comments on ;Bayes statistical behavior and valid generalization of pattern classifying neural networks' [with reply]

In the above-titled paper (ibid., vol.2, p.471-475, July 1991), the authors claim that neural network classifiers duplicate the decision rule created by the empirical Bayes rule. The commenter states that this statement is, in fact, not generally true and points out an error in the proof. The commenter also shows that the related true statement about the relation between neural and Bayes classifiers is of no practical use. In reply, the authors show that the example that the commenter uses to disprove the equation is misleading. They refute the commenter's second point as well.

Adaptive-clustering optical neural net

Pattern recognition techniques (for clustering and linear discriminant function selection) are combined with neural net methods (that provide an automated method to combine linear discriminant functions into piecewise linear discriminant surfaces). The resulting adaptive-clustering neural net is suitable for optical implementation and has certain desirable properties in comparison with other neural nets. Simulation results are provided.

Optical correlation CGHs with modulated error diffusion

Error diffusion presents a very attractive method for manufacturing computer-generated holograms. However, it has certain defects that make it unsuitable for various optical processing applications, such as correlation. We present an extension of error diffusion which makes it suitable for the implementation of correlation filters.

Optical neural net for classifying imaging spectrometer data

A problem in surface mineralogy is addressed; namely, how does one determine the composition of a mixture from its spectrum? A neural net algorithm arises naturally, and we detail the state equations of this net. An optical architecture and simulation results are presented.

Optical neural net for matrix inversion

A novel optical neural net for performing matrix inversion is presented. This algorithm does not suffer from accumulative round-off error. Various optical architectures are introduced, and the circumstances in which each of them is advantageous are investigated.

Multitarget tracking with cubic energy optical neural nets

A neural net processor and its optical realization are described for a multitarget tracking application. A cubic energy function results and a new optical neural processor is required. Initial simulation data are presented.

Optical production systems using neural networks and symbolic substitution

Two optical implementations of production systems are advanced. The production systems operate on a knowledge base where facts and rules are encoded as formulas in propositional calculus. The first implementation is a binary neural network. An analog neural network is used to include reasoning with uncertainties. The second implementation uses a new optical symbolic substitution correlator. This implementation is useful when a set of similar situations has to be handled in parallel on one processor.

Parallel holographic generation of multiple Hough transform slices

Many uses for the Hough transform (HT) require only several theta slices, not the entire 2-D Hough space. A new holographic optical architecture is advanced to achieve this in parallel. The computer-generated holograms and holographic optical elements used are discussed, and laboratory results are provided. As a case study, we consider determining printing skew and other defects on cigarette packs. We also discuss how these holograms can produce the entire 2-D HT space.

Improvements in glass capillary gas chromatographic polychlorobiphenyl analysis

Separation of a 1:1:1:1 calibration mixture of Aroclors 1221, 1016, 1254, and 1260 on soda glass capillaries coated with Apolane (C-87) or Apiezon L is described. Polychlorobiphenyl congener structures are assigned to 112 separated and partially separated zones. The quantitative composition of Aroclor 1221 is reported. The performance of the two stationary phases on different lengths of laboratory and commercially prepared capillaries is compared and found to be very similar. Aroclors 1221, 1016, 1254, and 1260 are employed (1:1:1:1) for the primary calibration mixture because they contain all components of the commercial materials which pollute the environment; they are also easily obtained from the U.S. EPA Repository so that the method can be used in any laboratory by employing the calibration data given here.

BACTERIAL CONCENTRATIONS IN RAW MILK, IMMEDIATELY AFTER LABORATORY PASTEURIZATION AND FOLLOWING 10 DAYS STORAGE AT 7.2 C1

No relationship was found among bacterial counts on raw milk samples, the thermoduric counts following laboratory pasteurization, or subsequent growth in pasteurized portions held at 7.2 C for 10 days. Considerable variation in numbers of bacteria in raw milk samples from farms supplying various plants was found. Also, thermoduric count ranges varied greatly among various plant supplies. No psychrophilic organisms were recovered from 1 ml portions of freshly pasteurized samples. After 10 days storage at 7.2 C, 10.4% of the samples showed viable psychrophilic organisms. This agrees with findings by others and suggests that temperatures below 7.2 C should be recommended for storage of pasteurized milk. The number of organisms surviving pasteurization and subsequently growing in refrigerated samples varied widely among the eight plant supplies. This suggests that quality programs advocated by the various plants may have a selective action in bacterial destruction and survival of organisms able to grow at a low temperature.