A New Approach to Staging Diabetic Eye Disease: Staging of Diabetic Retinal Neurodegeneration and Diabetic Macular Edema

Topic

The goal of this review was to summarize the current level of evidence on biomarkers to quantify diabetic retinal neurodegeneration (DRN) and diabetic macular edema (DME).

Clinical relevance

With advances in retinal diagnostics, we have more data on patients with diabetes than ever before. However, the staging system for diabetic retinal disease is still based only on color fundus photographs and we do not have clear guidelines on how to incorporate data from the relatively newer modalities into clinical practice.

Methods

In this review, we use a Delphi process with experts to identify the most promising modalities to identify DRN and DME. These included microperimetry, full-field flash electroretinogram, spectral-domain OCT, adaptive optics, and OCT angiography. We then used a previously published method of determining the evidence level to complete detailed evidence grids for each modality.

Results

Our results showed that among the modalities evaluated, the level of evidence to quantify DRN and DME was highest for OCT (level 1) and lowest for adaptive optics (level 4).

Conclusion

For most of the modalities evaluated, prospective studies are needed to elucidate their role in the management and outcomes of diabetic retinal diseases.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Phage Therapy in Korea: A Prescribers' Survey of Attitudes Amongst Korean Infectious Diseases Specialists Towards Phage Therapy

BACKGROUND

Concerns about the rise in antimicrobial resistance have led to renewed interest in phage therapy worldwide, but perceptions among relevant medical professionals in Korea remain largely unknown.

MATERIALS AND METHODS

We conducted a semi-quantitative online survey to evaluate the Korean infectious disease specialists' perception of phage therapy.

RESULTS

We sent out the link to the questionnaire to 380 subjects and received 91 replies, with 90/91 respondents identifying as Korean infectious diseases specialists or trainees. Ten out of 91 (11.0%) respondents scored themselves as well-informed about phage therapy. The majority (93.4%) of respondents would consider using phage therapy if the safety of the phage formulation is guaranteed, and 80% of respondents would consider participating in clinical trials with phage therapy given adequate support. The biggest concern was uncertainty about safety (73.6%) and efficacy (65.9%). Acinetobacter baumannii was ranked as a high priority for phage therapy research, as were bone and joint infections.

CONCLUSION

Korean infectious diseases specialists are receptive to phage therapy, but a better understanding of safety, efficacy and clinical trials are warranted to progress phage therapy within the Korean healthcare system.

Therapeutic Phage Monitoring: A Review

With the global rise in antimicrobial resistance, there has been a renewed interest in the application of therapeutic phages to treat bacterial infections. Therapeutic phage monitoring (TPM) is proposed as an essential element of phage therapy (PT) protocols to generate data and fill knowledge gaps regarding the in vivo efficacy of therapeutic phages, patients' immune responses to PT, and the wider ecological effects of PT. By monitoring phage concentrations in blood and tissues, together with immune responses and possible ecological changes during PT, TPM may enable the optimization of dosing and the implementation of precision medicine approaches. Furthermore, TPM can validate diagnostic surrogates of efficacy, direct research efforts, and establish quality assurance indicators for therapeutic phage products. Thus, TPM holds great potential for enhancing our understanding of the multidirectional phage-bacteria-host interactions and advancing "best practice" PT, ultimately improving patient care.

Refractory Pseudomonas aeruginosa infections treated with phage PASA16: A compassionate use case series

BACKGROUND

A growing number of compassionate phage therapy cases were reported in the last decade, with a limited number of clinical trials conducted and few unsuccessful clinical trials reported. There is only a little evidence on the role of phages in refractory infections. Our objective here was to present the largest compassionate-use single-organism/phage case series in 16 patients with non-resolving Pseudomonas aeruginosa infections.

METHODS

We summarized clinical phage microbiology susceptibility data, administration protocol, clinical data, and outcomes of all cases treated with PASA16 phage. In all intravenous phage administrations, PASA16 phage was manufactured and provided pro bono by Adaptive Phage Therapeutics. PASA16 was administered intravenously, locally to infection site, or by topical use to 16 patients, with data available for 15 patients, mainly with osteoarticular and foreign-device-associated infections.

FINDINGS

A few minor side effects were noted, including elevated liver function enzymes and a transient reduction in white blood cell count. Good clinical outcome was documented in 13 out of 15 patients (86.6%). Two clinical failures were reported. The minimum therapy duration was 8 days with a once- to twice-daily regimen.

CONCLUSIONS

PASA16 with antibiotics was found to be relatively successful in patients for whom traditional treatment approaches have failed previously. Such pre-phase-1 cohorts can outline potential clinical protocols and facilitate the design of future trials.

FUNDING

The study was funded in part by The Israeli Science Foundation IPMP (ISF_1349/20), Rosetrees Trust (A2232), United States-Israel Binational Science Foundation (2017123), and the Milgrom Family Support Program.

Preclinical validation of the advection diffusion flow estimation method using computational patient specific coronary tree phantoms

Coronary computed tomography angiography (CCTA) does not allow the quantification of reduced blood flow due to coronary artery disease (CAD). In response, numerical methods based on the CCTA image have been developed to compute coronary blood flow and assess the impact of disease. However to compute blood flow in the coronary arteries, numerical methods require specification of boundary conditions that are difficult to estimate accurately in a patient-specific manner. We describe herein a new noninvasive flow estimation method, called Advection Diffusion Flow Estimation (ADFE), to compute coronary artery flow from CCTA to use as boundary conditions for numerical models of coronary blood flow. ADFE uses image contrast variation along the tree-like structure to estimate flow in each vessel. For validating this method we used patient specific software phantoms on which the transport of contrast was simulated. This controlled validation setting enables a direct comparison between estimated flow and actual flow and a detailed investigation of factors affecting accuracy. A total of 10 CCTA image data sets were processed to extract all necessary information for simulating contrast transport. A spectral element method solver was used for computing the ground truth simulations with high accuracy. On this data set, the ADFE method showed a high correlation coefficient of 0.998 between estimated flow and the ground truth flow together with an average relative error of only 1 % . Comparing the ADFE method with the best method currently available (TAFE) for image-based blood flow estimation, which showed a correlation coefficient of 0.752 and average error of 20 % , it can be concluded that the ADFE method has the potential to significantly improve the quantification of coronary artery blood flow derived from contrast gradients in CCTA images.

General Practitioner referrals to Child and Adolescent Mental Health Services: Did they differ during Covid-19?

OBJECTIVES

The COVID pandemic has been associated with poorer mental health in youth. This study aimed to evaluate any change in General Practitioner (GP) referral pattern to Child and Adolescent Mental Health (CAMH) services during the first 10 months of Covid-19 and compare with a similar time frame in 2019.

METHODS

All accepted referrals to a CAMH Service in Dublin during the study time frame were reviewed. Referral letters were batch anonymised and clinical data extracted using a study specific proforma for analysis.

RESULTS

Referral numbers between the two time periods did not statistically differ. Proportionally more females were referred during the pandemic, increasing to 56.9%, n = 99, compared to 43.1%, n = 75 in 2019 (p = 0.01). Referrals were more often designated by the clinician as urgent during the pandemic (61.3%, n = 98) than before (39%, n = 62, p < 0.001). Referrals outlining self-harm or suicidal ideation increased significantly, from 42.1% (n = 67) to 55.9% (n = 90) (p = 0.014). Referrals for externalising problems fell from 2019 rates; ADHD (21.4%, n = 34 vs 11.1%, n = 18; p = 0.013), ASD (26.4%, n = 42 vs 16.1%, n = 26; p = 0.038) and conduct problems (23.3%, n = 37 vs 7.4%, n = 12; p < 0.001). Although numbers for psychosis in 2019 were low (10.7%, n = 17), these also fell significantly in 2020 (2.5%, n = 4; p < 0.001).

DISCUSSION

The finding of reduced referrals for ADHD and ASD has not previously been reported. With concerns regarding educational loss linked to online learning, it is crucial that these youth are not doubly disadvantaged by delayed referral and education decline.

Outcomes of shared institutional review board compared with multiple individual site institutional review board models in a multisite clinical trial

BACKGROUND

Institutional review boards play a crucial role in initiating clinical trials. Although many multicenter clinical trials use an individual institutional review board model, where each institution uses their local institutional review board, it is unknown if a shared (single institutional review board) model would reduce the time required to approve a standard institutional review board protocol.

OBJECTIVE

This study aimed to compare processing times and other processing characteristics between sites using a single institutional review board model and those using their individual site institutional review board model in a multicenter clinical trial.

STUDY DESIGN

This was a retrospective study of sites in an open-label, multicenter randomized control trial from 2014 to 2021. Participating sites in the multicenter Chronic Hypertension and Pregnancy trial were asked to complete a survey collecting data describing their institutional review board approval process.

RESULTS

A total of 45 sites participated in the survey (7 used a shared institutional review board model and 38 used their individual institutional review board model). Most sites (86%) using the shared institutional review board model did not require a full-board institutional review board meeting before protocol approval, compared with 1 site (3%) using the individual institutional review board model (P<.001). Median total approval times (41 vs 56 days; P=.42), numbers of submission rounds (1 vs 2; P=.09), and numbers of institutional review board stipulations (1 vs 4; P=.12) were lower for the group using the shared institutional review board model than those using the individual site institutional review board model; however, these differences were not statistically significant.

CONCLUSION

The findings supported the hypothesis that the shared institutional review board model for multicenter studies may be more efficient in terms of cumulative time and effort required to obtain approval of an institutional review board protocol than the individual institutional review board model. Given that these data have important implications for multicenter clinical trials, future research should evaluate these findings using larger or multiple multicenter trials.

A theoretically based STEM talent development program that bridges excellence gaps

The pipeline of highly trained STEM (science, technology, engineering, and mathematics) professionals has narrowed in recent decades, forcing society to re-examine how schools are discovering and developing STEM talent. Of particular concern is the finding that rural students attend post-secondary schools at lower rates than their urban counterparts, and when they do attend, they are less likely to graduate from STEM programs. One reason may be that they are not prepared for advanced STEM coursework because they lack access to essential STEM talent-development programs in middle or high school. This creates excellence gaps, which exacerbate the narrowing STEM pipeline to the workforce. To address this, we formed a university-school partnership to develop an outside-of-school STEM talent development program, called STEM Excellence, for rural middle-school students who attend under-resourced schools. The aim of STEM Excellence was to increase students' achievement and aspirations while empowering their teachers to develop local STEM programs grounded in developmental psychology theories. STEM Excellence integrated the Talent Development Megamodel Principles of ability, domains of talent, opportunity, and psychosocial variables. STEM Excellence also recognized the interplay of multiple person-environment systems as presented in the Bioecological Systems Model.

Prevalence of mental health disorders in children and adolescents in the Republic of Ireland: a systematic review

Referrals to Child and Adolescent Mental Health Services (CAMHS) have increased in recent years. Services are already under-resourced and the adverse psychological impact of Covid-19 is likely to increase demand. Accordingly, an understanding of prevalence of mental health (MH) disorders among youth is imperative to help inform and plan services.

AIM

To establish prevalence of MH disorders among youth (under 18) in Ireland.

METHOD

A systematic review using pre-defined search terms in PubMed, PsycInfo, Embase and CINAHL was conducted. Empirical studies conducted in Ireland, in youth and focusing on MH disorders were included.

RESULTS

From a total of 830 papers identified, 38 papers met inclusion criteria. Significant variation in rates of MH disorders was evident based on study methodology. Screening questionnaires for general psychopathology reported rates of 4.8-17.8% scoring above clinical cut-offs, with higher rates for ADHD (7.3%). Studies examining depression ranged from 4% to 20.8%, while rates for 'current' MH disorder, determined by semi-structured interview, were 15.5%, while 'lifetime' rates varied from 19.9% to 31.2%. Fewer than half (44%) of those identified as 'in need' of specialist MH services were accessing CAMHS.

CONCLUSION

Data on MH disorders among Irish youth is limited, and studies showed significant variance in rates, making service planning difficult. There is an urgent need for serial epidemiological surveys, with clear operational criteria for clinically impairing MH difficulties. Such studies are essential to understand potential demand and service planning. This is most urgent given the expected increased demand post Covid-19.

Risk Factors for Retinal Detachment in Acute Retinal Necrosis

PURPOSE

Retinal detachment (RD) is associated with poor visual outcome in patients with acute retinal necrosis (ARN). This research was undertaken to assess risk factors for RD in ARN.

DESIGN

Retrospective cohort study SUBJECTS: Patients diagnosed with ARN at a tertiary referral center from 2010-2020.

METHODS

Chart review was performed for all clinical and surgical encounters. Univariate and multivariate logistic analysis of demographic and clinical variables associated with RD was performed. Survival analysis with Kaplan-Meier estimates were performed to compare time to RD in HSV- and VZV-associated ARN.

MAIN OUTCOME MEASURES

Demographic information, clinical information including visual acuity, intraocular pressure (IOP), intraocular inflammation level, extent of retinitis, incidence and timing of retinal detachment, date of diagnosis, and treatments performed including intravitreal injections of antiviral medications.

RESULTS

Fifty-four eyes of 47 patients who were diagnosed with ARN were included with equal proportions of eyes (27, 50%) with VZV-ARN and HSV-ARN. Subjects with VZV-ARN were on average older, more likely to be male, and more likely to be immunosuppressed compared with subjects with HSV-ARN. Clinical characteristics were similar between eyes with VZV- and HSV-ARN, including initial visual acuity (VA), initial IOP, anterior segment inflammation, clock hours and posterior extent of retinitis. In univariate analysis of clinical and demographic variables associated with development of RD, initial VA (p = 0.0083) and greater clock hours of retinitis (p = 0.009) were significantly associated with RD. These two variables remained significant in multivariate logistic regression; worse VA at presentation had an odds ratio of 2.34 (95% CI: 1.01 - 5.44) (p = 0.042) and greater clock hours of retinitis had an odds ratio of 1.23 (95% CI: 1.02 - 1.47) (p = 0.025). Kaplan Meier survival analysis demonstrated no statistical difference in RD-free survival between HSV- and VZV-ARN.

CONCLUSION

Patients with VZV-ARN were more likely to be older, male, and immunosuppressed compared to HSV-ARN although no clear difference was observed in RD by viral etiology. Poor initial VA and clock-hours of retinitis were significantly associated with RD development and may be relevant for patient counseling and prognosis.

Phage-Encoded Endolysins

Due to the global emergence of antibiotic resistance, there has been an increase in research surrounding endolysins as an alternative therapeutic. Endolysins are phage-encoded enzymes, utilized by mature phage virions to hydrolyze the cell wall from within. There is significant evidence that proves the ability of endolysins to degrade the peptidoglycan externally without the assistance of phage. Thus, their incorporation in therapeutic strategies has opened new options for therapeutic application against bacterial infections in the human and veterinary sectors, as well as within the agricultural and biotechnology sectors. While endolysins show promising results within the laboratory, it is important to document their resistance, safety, and immunogenicity for in-vivo application. This review aims to provide new insights into the synergy between endolysins and antibiotics, as well as the formulation of endolysins. Thus, it provides crucial information for clinical trials involving endolysins.

Positive Choices: Addressing the evidence-practice gap in alcohol and other drug prevention

Issue

Alcohol and other drug (AOD) use during adolescence puts young people at risk of juvenile offending, poor educational outcomes, school dropout, and mental health issues. Since parents and school teachers are the primary source of contact for adolescents, it is important that they are equipped with accurate and up-to-date response strategies. There are a number of effective drug prevention strategies, however, they are not widely implemented.

Description of the practice

To address this evidence-practice gap, the Positive Choices initiative was launched in 2015. Positive Choices supports implementation of evidence-based and prevention strategies through provision of training and a centralised information and resources portal for young people, their parents and teachers. The portal contains information factsheets and webinars and was developed in consultation with AOD experts and target users. Drug education resources and curriculum programs meeting pre-specified criteria for relevance, quality and evidence-base are listed in the resources database.

Results

Positive Choices has been accessed by one-million Australian and international users. The most popular resources are videos, factsheets, webinars. In 2019, 71% parents and 65% teachers said that they would continue using the website. Half (54%) of school staff were not currently implementing evidence-based prevention strategies, of these 89% intended to shift to evidence-based practice after using Positive Choices. The majority of the users have said they would recommend the website to their colleagues and friends.

Lessons

Positive Choices is effective in changing users' intentions to implement evidence-based strategies. Drug education programs need to engage parents and teachers if they are to be effective.

Key messages

Positive Choices has increased users’ awareness of evidence-based prevention strategies. Positive Choices has increased users’ intentions to implement evidence-based prevention strategies.

Determination of Methylcellulose and Hydroxypropyl Methylcellulose Food Gums in Food and Food Products: Collaborative Study

A collaborative study was performed to determine the reproducibility of a method for the determination of methylcellulose (MC) and hydroxypropyl methylcellulose (HPMC) in food. These widely used food gums possess unusual solubility characteristics and cannot accurately be determined by existing dietary fiber methods. The new method uses the enzyme-digestion procedure of AOAC Official Method 991.43. Digestate solutions must be refrigerated to fully hydrate MC or HPMC. The chilled solutions are filtered and analyzed by size-exclusion liquid chromatography. Collaborating laboratories received 28 samples containing MC or HPMC in the range of 0100%. The sample set included blind duplicates of 5 food matrixes (bread, milk, fish, potato, and powdered juice drink). Cochran and Grubbs tests were used to eliminate outliers. For food samples containing MC, values for within-laboratory precision, repeatability relative standard deviation (RSDr), ranged from 4.2 to 16%, and values for among-laboratories precision, reproducibility relative standard deviation (RSDR), ranged from 11 to 20%. For HPMC samples, RSDr values ranged from 6.4 to 27%, and RSDR values ranged from 17 to 39%. Recoveries of MC and HPMC from the food matrixes ranged from 78 to 101%. These results show acceptable precision and reproducibility for the determination of MC and HPMC, for which no Official AOAC Methods exist. It is recommended that this method be adopted as AOAC Official First Action.

Validation of a Weight Threshold–Based Vancomycin Dosing Protocol for Patients Undergoing Intermittent Hemodialysis

ABSTRACTBackground: Patients receiving intermittent hemodialysis (IHD) are at high risk of acquiring gram-positive infections, which are often treated with IV vancomycin. Despite frequent use of vancomycin in the IHD setting, there is variability in dosing and monitoring practices among clinicians at the study institution. There is also a paucity of evidence regarding optimal vancomycin dosing to achieve target pre-IHD serum concentration. Objectives: The primary objective was to compare the percentage of treatment courses with a serum vancomycin concentration between 15 and 20 mg/L, measured before the third IHD session, before and after implementation of a weight threshold–based dosing protocol. The secondary objectives were to compare the percentage of treatment courses with a pre–third IHD vancomycin concentration between 10 and 22 mg/L and the number of vancomycin measurements per treatment day, before and after protocol implementation. Methods: This quasi-experimental, single-centre study included inpatients and outpatients who underwent IHD and received at least 2 IV doses of vancomycin, with vancomycin being measured in an appropriately drawn sample before the third IHD session. Before protocol implementation, vancomycin dosing was at the clinician’s discretion (usual care). After protocol implementation, each patient received a loading dose of 1000, 1500, or 2000 mg and a maintenance dose of 500, 750, or 1000 mg, depending on body weight.Results: The percentage of treatment courses with a pre–third IHD vancomycin concentration between 15 and 20 mg/L was greater after implementation of the protocol than with usual care, but the difference was nonsignificant (44% [8/18] versus 20% [3/15], p = 0.27). However, the percentage of treatment courses with a pre–third IHD vancomycin concentration between 10 and 22 mg/L was significantly higher after protocol implementation (94% [17/18] versus 53% [8/15], p = 0.012). There was no difference in the median number of vancomycin measurements per treatment day before and after protocol implementa-tion (0.133 versus 0.125, p = 0.99). Conclusions: At the study institution, the likelihood of achieving recommended vancomycin concentration increased (relative to previous practice) after implementation of a simplified vancomycin dosing protocol for patients undergoing IHD.RÉSUMÉContexte : Les patients recevant une hémodialyse intermittente (HDI) présentent un risque élevé de contracter des infections à Gram positif, souvent traitées à l’aide de vancomycine par intraveineuse (IV). Malgré l’utilisation fréquente de la vancomycine dans les environnements d’HDI, les pratiques portant sur le dosage et le suivi varient entre les cliniciens de l’institution où l’étude s’est déroulée. Il existe également peu de données probantes sur la dose optimale de vancomycine permettant d’atteindre la concentration sérique cible avant l’HDI. Objectifs : L’objectif principal visait à comparer le pourcentage de traitements à la vancomycine, dont la concentration sérique se situait entre 15 et 20 mg/L, lors de la mesure prise avant la troisième séance de HDI, avant et après la mise en place d’un protocole de dosage basé sur le poids. Les objectifs secondaires visaient à comparer le pourcentage de traitements, dont la concentration de vancomycine mesurée avant la troisième séance d’HDI était comprise entre 10 et 22 mg/L, et le nombre de mesures de vancomycine par jour de traitement, avant et après la mise en place du protocole. Méthodes : Cette étude quasi expérimentale, menée dans un seul centre, comprenait des patients hospitalisés et ambulatoires ayant subi une HDI et reçu au moins deux doses de vancomycine par IV et dont un échantillon prélevé de manière appropriée avant la troisième séance d’HDI a permis de mesurer la vancomycine. Avant la mise en place du protocole, le dosage de vancomycine était laissé à la discrétion du clinicien (soins habituels). Après sa mise en place, chaque patient recevait une dose de charge de 1000, 1500 ou 2000 mg et une dose de maintenance de 500, 750 ou 1000 mg selon sa masse corporelle.Résultats : Le pourcentage de traitements dont la concentration de vancomycine mesurée avant la troisième séance d’HDI était comprise entre 15 et 20 mg/L était plus élevé après la mise en place du protocole qu’après les soins habituels, mais la différence n’était pas significative (44 % [8/18] contre 20 % [3/15], p = 0,27). Cependant, le pourcentage de traitements dont la concentration de vancomycine mesurée avant la troisième séance d’HDI était comprise entre 10 et 22 mg/L était significativement plus élevé après la mise en place du protocole (94 %[17/18] contre 53 % [8/15], p = 0,012). Le nombre moyen de mesures de vancomycine par traitement n’avait pas varié entre le jour précédant et le jour suivant la mise en place du protocole (0,133 contre 0,125, p = 0,99).Conclusions : Dans l’institution où l’étude s’est déroulée, la probabilité d’atteindre la concentration de vancomycine recommandée avait augmenté après la mise en place d’un protocole simplifié de dosage de vancomycine pour les patients recevant une HDI comparativement à une pratique antérieure. 

Validation of a Weight Threshold-Based Vancomycin Dosing Protocol for Patients Undergoing Intermittent Hemodialysis

BACKGROUND

Patients receiving intermittent hemodialysis (IHD) are at high risk of acquiring gram-positive infections, which are often treated with IV vancomycin. Despite frequent use of vancomycin in the IHD setting, there is variability in dosing and monitoring practices among clinicians at the study institution. There is also a paucity of evidence regarding optimal vancomycin dosing to achieve target pre-IHD serum concentration.

OBJECTIVES

The primary objective was to compare the percentage of treatment courses with a serum vancomycin concentration between 15 and 20 mg/L, measured before the third IHD session, before and after implementation of a weight threshold-based dosing protocol. The secondary objectives were to compare the percentage of treatment courses with a pre-third IHD vancomycin concentration between 10 and 22 mg/L and the number of vancomycin measurements per treatment day, before and after protocol implementation.

METHODS

This quasi-experimental, single-centre study included inpatients and outpatients who underwent IHD and received at least 2 IV doses of vancomycin, with vancomycin being measured in an appropriately drawn sample before the third IHD session. Before protocol implementation, vancomycin dosing was at the clinician's discretion (usual care). After protocol implementation, each patient received a loading dose of 1000, 1500, or 2000 mg and a maintenance dose of 500, 750, or 1000 mg, depending on body weight.

RESULTS

The percentage of treatment courses with a pre-third IHD vancomycin concentration between 15 and 20 mg/L was greater after implementation of the protocol than with usual care, but the difference was nonsignificant (44% [8/18] versus 20% [3/15], p = 0.27). However, the percentage of treatment courses with a pre-third IHD vancomycin concentration between 10 and 22 mg/L was significantly higher after protocol implementation (94% [17/18] versus 53% [8/15], p = 0.012). There was no difference in the median number of vancomycin measurements per treatment day before and after protocol implementation (0.133 versus 0.125, p = 0.99).

CONCLUSIONS

At the study institution, the likelihood of achieving recommended vancomycin concentration increased (relative to previous practice) after implementation of a simplified vancomycin dosing protocol for patients undergoing IHD.

Converging Cultures: Partnering in Affirmative and Inclusive Health Care for Members of the Lesbian, Gay, Bisexual, and Transgender Community

BACKGROUND: Members of the lesbian, gay, bisexual, and transgender (LGBT) community suffer from disproportionate rates of physical and mental illness. This population experiences enhanced vulnerability to illness as a result of societal marginalization, known as minority stress, which is compounded by insufficient LGBT education for health care professionals and stigmatizing experiences within medical institutions. AIMS: The aims of this study were to review the literature on LGBT cultural competence interventions; evaluate the effect of a 4-hour pilot workshop, "Converging Cultures," on the development of cultural competence; and make recommendations for best practices in developing LGBT cultural competence among health care providers. METHOD: The study used a repeated-measures pre-/posttest design among a sample of 130 hospital employees and undergraduate nursing students. The GAP (Gay Affirmative Practice scale) scale, a measure of LGBT-affirmative practice beliefs, and an objective Knowledge Quiz were administered before and directly following the training. The posttest included three open-ended questions to elicit self-reflection and capture the development of cultural competence according to Campinha-Bacote's theory, the process of cultural competence in the delivery of healthcare services. RESULTS: Paired sample t tests revealed significant improvement on the GAP and Knowledge Quiz. Open-ended responses reflected the five constructs of Campinha-Bacote's theory. CONCLUSIONS: Self-reflection is an essential component of LGBT cultural competence education to uncover personal biases that affect clinical behavior. Future educational efforts for sexual and gender minorities should strive to avoid inadvertent marginalization of LGBT people through integration of concepts with existing curricula and workplace training.

Adolescent Stress Treatment Study: A Cluster Randomized Trial

High school students experience a variety of stressors. Mental health issues are critical to their health. The "Adolescent Stress Treatment (AST) Study: A Cluster Randomized Trial" compared the efficacy of two stress reduction devices, the EnergyPod™ and the SleepWing™. The EnergyPod™ is a device that provides a semiprivate acoustical and visual environment for rest, stress reduction, and sleep. The SleepWing™ is a smaller device offering similar benefits. High school students were offered the opportunity to participate in the AST study when they exhibited signs of agitation. The students completed the Profile of Mood States-Short Form (POMS-SF) pre- and postintervention. Total Mood Disturbance (TMD) was measured from the POMS-SF and significant improvement postintervention (p < .001), regardless of intervention used. POMS-SF subscales were all significantly improved no matter which device was used. All participants in the study dramatically improved their mood after being in either therapeutic device.

Characteristics of patients in a psychiatric follow-up clinic

Out-patient clinics are widely used to asssess and treat patients. In psychiatric practice, out-patient clinics are used both to assess new referrals and follow up existing patients. More than three-quarters of psychiatric out-patient attendances are for follow-up (DHSS, 1984). With modern emphasis on community psychiatry, the role of out-patient clinics may become less prominent and more refined. Very little appears to have been published on the subject of psychiatric follow-up clinics.

Effect of Enzogenol® Supplementation on Cognitive, Executive, and Vestibular/Balance Functioning in Chronic Phase of Concussion

This study examined the feasibility of Enzogenol® as a potential treatment modality for concussed individuals with residual symptoms in the chronic phase. Forty-two student-athletes with history of sport-related concussion were enrolled, comparing Enzogenol® versus placebo. Testing was conducted using virtual reality (VR) and electroencephalography (EEG), with neuropsychological (NP) tasks primarily used to induce cognitive challenges. After six weeks, the Enzogenol® group showed enhanced frontal-midline theta, and decreased parietal theta power, indicating reduced mental fatigue. Subjects enrolled in the Enzogenol® group also self-reported reduced mental fatigue and sleep problems. This suggests that Enzogenol® has the potential to improve brain functioning in the chronic phase of concussion.

Utilization of a Mobile App to Assess Psychiatric Patients With Limited English Proficiency

The interactions in mental health involve a significant exchange of information to identify symptoms and formulate a working diagnosis. The inability of patients to communicate due to language limitations may lead to situations that will be detrimental, such as receiving the wrong diagnosis or treatment due to the inadequate translation from English to Spanish. A practice change was proposed where health care personnel utilized mobile technology such as the Canopy Translation App to assess the psychiatric symptoms of Spanish-speaking patients with limited English proficiency. Participants completed the System Usability Scale (SUS) to determine whether they found the Canopy Translation App useful during their assessments of Spanish-speaking patients. According to the SUS scores, participants found the Canopy Translation App useful during their interactions with Spanish-speaking patients. The findings emphasize the importance of exploring new resources and technologies to ameliorate language barriers.

Measurements of the [Formula: see text] production cross section in lepton+jets final states in pp collisions at 8 [Formula: see text] and ratio of 8 to 7 [Formula: see text] cross sections

A measurement of the top quark pair production ([Formula: see text]) cross section in proton-proton collisions at the centre-of-mass energy of 8[Formula: see text] is presented using data collected with the CMS detector at the LHC, corresponding to an integrated luminosity of 19.6[Formula: see text]. This analysis is performed in the [Formula: see text] decay channels with one isolated, high transverse momentum electron or muon and at least four jets, at least one of which is required to be identified as originating from hadronization of a b quark. The calibration of the jet energy scale and the efficiency of b jet identification are determined from data. The measured [Formula: see text] cross section is [Formula: see text]. This measurement is compared with an analysis of 7[Formula: see text] data, corresponding to an integrated luminosity of 5.0[Formula: see text], to determine the ratio of 8[Formula: see text] to 7[Formula: see text] cross sections, which is found to be [Formula: see text]. The measurements are in agreement with QCD predictions up to next-to-next-to-leading order.

A prospective randomized controlled trial of point-of-care testing on the coronary care unit

Background: We report the results of a prospective randomized controlled trial comparing point-of-care testing (POCT) with central laboratory testing (CLT) in a six-bed coronary care unit in a district general hospital.

Methods: 263 consecutive admissions with chest pain and suspected acute coronary syndrome were randomized to measurement of cardiac troponin T by POCT or CLT only. Patient management was according to a pre-specified protocol utilizing clinical features, electrocardiographic changes and cardiac biomarkers (creatine kinase and cardiac troponin T) to define management. Outcome measures were diagnostic accuracy compared with CLT as 'gold standard', result turnaround time, mortality and length of stay in all patients and those with a protocol-driven early discharge policy.

Results: Diagnostic accuracy and mortality was equivalent in the POCT and CLT arm. Overall there was no difference in length of stay. In the pre-specified early discharge group ( n = 64) there was a significant reduction in median length of non-coronary care unit stay (145.3 h versus 79.5 h) and overall hospital stay (209.3 h versus 149.9 h) in those randomized to POCT.

Conclusion: A combination of rapid biochemical diagnosis and structured decisionmaking reduces length of hospital stay.

Measurement of the [Formula: see text] cross section in pp collisions at [Formula: see text] TeVand limits on anomalous gauge couplings

A measurement of the W boson pair production cross section in proton-proton collisions at [Formula: see text] TeV is presented. The data collected with the CMS detector at the LHC correspond to an integrated luminosity of 19.4[Formula: see text]. The [Formula: see text] candidates are selected from events with two charged leptons, electrons or muons, and large missing transverse energy. The measured [Formula: see text] cross section is [Formula: see text], consistent with the standard model prediction. The [Formula: see text] cross sections are also measured in two different fiducial phase space regions. The normalized differential cross section is measured as a function of kinematic variables of the final-state charged leptons and compared with several perturbative QCD predictions. Limits on anomalous gauge couplings associated with dimension-six operators are also given in the framework of an effective field theory. The corresponding 95 % confidence level intervals are [Formula: see text], [Formula: see text], [Formula: see text], in the HISZ basis.

Measurement of [Formula: see text] production with additional jet activity, including [Formula: see text] quark jets, in the dilepton decay channel using pp collisions at [Formula: see text]

Jet multiplicity distributions in top quark pair ([Formula: see text]) events are measured in pp collisions at a centre-of-mass energy of 8 TeV with the CMS detector at the LHC using a data set corresponding to an integrated luminosity of 19.7[Formula: see text]. The measurement is performed in the dilepton decay channels ([Formula: see text], [Formula: see text], and [Formula: see text]). The absolute and normalized differential cross sections for [Formula: see text] production are measured as a function of the jet multiplicity in the event for different jet transverse momentum thresholds and the kinematic properties of the leading additional jets. The differential [Formula: see text] and [Formula: see text] cross sections are presented for the first time as a function of the kinematic properties of the leading additional [Formula: see text] jets. Furthermore, the fraction of events without additional jets above a threshold is measured as a function of the transverse momenta of the leading additional jets and the scalar sum of the transverse momenta of all additional jets. The data are compared and found to be consistent with predictions from several perturbative quantum chromodynamics event generators and a next-to-leading order calculation.

Forward-backward asymmetry of Drell-Yan lepton pairs in pp collisions at [Formula: see text][Formula: see text]

A measurement of the forward-backward asymmetry [Formula: see text] of oppositely charged lepton pairs ([Formula: see text] and [Formula: see text]) produced via [Formula: see text] boson exchange in pp collisions at [Formula: see text] [Formula: see text] is presented. The data sample corresponds to an integrated luminosity of 19.7[Formula: see text] collected with the CMS detector at the LHC. The measurement of [Formula: see text] is performed for dilepton masses between 40[Formula: see text] and 2[Formula: see text] and for dilepton rapidity up to 5. The [Formula: see text] measurements as a function of dilepton mass and rapidity are compared with the standard model predictions.

Search for massive WH resonances decaying into the [Formula: see text] final state at [Formula: see text][Formula: see text]

A search for a massive resonance [Formula: see text]decaying into a W and a Higgs boson in the [Formula: see text] ([Formula: see text], [Formula: see text]) final state is presented. Results are based on data corresponding to an integrated luminosity of 19.7[Formula: see text] of proton-proton collisions at [Formula: see text] [Formula: see text], collected using the CMS detector at the LHC. For a high-mass ([Formula: see text]1[Formula: see text]) resonance, the two bottom quarks coming from the Higgs boson decay are reconstructed as a single jet, which can be tagged by placing requirements on its substructure and flavour. Exclusion limits at 95 % confidence level are set on the production cross section of a narrow resonance decaying into WH, as a function of its mass. In the context of a little Higgs model, a lower limit on the [Formula: see text] mass of 1.4[Formula: see text] is set. In a heavy vector triplet model that mimics the properties of composite Higgs models, a lower limit on the [Formula: see text] mass of 1.5[Formula: see text] is set. In the context of this model, the results are combined with related searches to obtain a lower limit on the [Formula: see text] mass of 1.8[Formula: see text], the most restrictive to date for decays to a pair of standard model bosons.

Measurement of the [Formula: see text] production cross section in the all-jets final state in pp collisions at [Formula: see text][Formula: see text]

The cross section for [Formula: see text] production in the all-jets final state is measured in pp collisions at a centre-of-mass energy of 8 [Formula: see text] at the LHC with the CMS detector, in data corresponding to an integrated luminosity of 18.4 [Formula: see text]. The inclusive cross section is found to be [Formula: see text] [Formula: see text]. The normalized differential cross sections are measured as a function of the top quark transverse momenta, [Formula: see text], and compared to predictions from quantum chromodynamics. The results are reported at detector, parton, and particle levels. In all cases, the measured top quark [Formula: see text] spectra are significantly softer than theoretical predictions.

Study of B Meson Production in p+Pb Collisions at √[S(NN)]=5.02 TeV Using Exclusive Hadronic Decays

The production cross sections of the B^{+}, B^{0}, and B_{s}^{0} mesons, and of their charge conjugates, are measured via exclusive hadronic decays in p+Pb collisions at the center-of-mass energy sqrt[s_{NN}]=5.02  TeV with the CMS detector at the CERN LHC. The data set used for this analysis corresponds to an integrated luminosity of 34.6  nb^{-1}. The production cross sections are measured in the transverse momentum range between 10 and 60  GeV/c. No significant modification is observed compared to proton-proton perturbative QCD calculations scaled by the number of incoherent nucleon-nucleon collisions. These results provide a baseline for the study of in-medium b quark energy loss in Pb+Pb collisions.

Measurement of differential cross sections for Higgs boson production in the diphoton decay channel in pp collisions at [Formula: see text]

A measurement is presented of differential cross sections for Higgs boson (H) production in pp collisions at [Formula: see text][Formula: see text]. The analysis exploits the [Formula: see text] decay in data corresponding to an integrated luminosity of 19.7[Formula: see text] collected by the CMS experiment at the LHC. The cross section is measured as a function of the kinematic properties of the diphoton system and of the associated jets. Results corrected for detector effects are compared with predictions at next-to-leading order and next-to-next-to-leading order in perturbative quantum chromodynamics, as well as with predictions beyond the standard model. For isolated photons with pseudorapidities [Formula: see text], and with the photon of largest and next-to-largest transverse momentum ([Formula: see text]) divided by the diphoton mass [Formula: see text] satisfying the respective conditions of [Formula: see text] and [Formula: see text], the total fiducial cross section is [Formula: see text][Formula: see text].

Measurement of the differential cross section for top quark pair production in pp collisions at [Formula: see text]

The normalized differential cross section for top quark pair ([Formula: see text]) production is measured in pp collisions at a centre-of-mass energy of 8[Formula: see text] at the CERN LHC using the CMS detector in data corresponding to an integrated luminosity of 19.7[Formula: see text]. The measurements are performed in the lepton[Formula: see text]jets ([Formula: see text][Formula: see text]jets) and in the dilepton ([Formula: see text], [Formula: see text], and [Formula: see text]) decay channels. The [Formula: see text] cross section is measured as a function of the kinematic properties of the charged leptons, the jets associated to b quarks, the top quarks, and the [Formula: see text] system. The data are compared with several predictions from perturbative quantum chromodynamic up to approximate next-to-next-to-leading-order precision. No significant deviations are observed relative to the standard model predictions.

Measurements of the [Formula: see text][Formula: see text] production cross sections in the [Formula: see text] channel in proton-proton collisions at [Formula: see text] and [Formula: see text] and combined constraints on triple gauge couplings

Measurements of the [Formula: see text][Formula: see text] production cross sections in proton-proton collisions at center-of-mass energies of 7 and 8[Formula: see text] are presented. Candidate events for the leptonic decay mode [Formula: see text], where [Formula: see text] denotes an electron or a muon, are reconstructed and selected from data corresponding to an integrated luminosity of 5.1 (19.6)[Formula: see text] at 7 (8)[Formula: see text] collected with the CMS experiment. The measured cross sections, [Formula: see text] at 7[Formula: see text], and [Formula: see text] at 8[Formula: see text], are in good agreement with the standard model predictions with next-to-leading-order accuracy. The selected data are analyzed to search for anomalous triple gauge couplings involving the [Formula: see text][Formula: see text] final state. In the absence of any deviation from the standard model predictions, limits are set on the relevant parameters. These limits are then combined with the previously published CMS results for [Formula: see text][Formula: see text] in 4[Formula: see text] final states, yielding the most stringent constraints on the anomalous couplings.