Applying the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents to Misophonia: A Case Example

Misophonia is a condition in which individuals suffer a wide range of intense emotions in response to sound triggers. Emotions such as anxiety, irritability, and disgust may lead individuals to engage in avoidance behaviors to escape or suppress sound triggers. Transdiagnostic treatment may serve as a practical intervention for misophonia as it addresses a broad scope of emotions and physiological sensations. This paper presents the first reported case example of misophonia treated with a transdiagnostic treatment protocol, the Unified Protocol for Emotional Disorders in Adolescents (UP-A). In this case, the UP-A was efficacious in treating a client with autism spectrum disorder, comorbid misophonia and anxiety symptoms. The client evidenced reliable change in misophonia and related problems. Future research should investigate the efficacy of the UP-A in a larger sample of youth with misophonia, as well as assess mechanisms of change in transdiagnostic treatment of this disorder in youth.Copyright © 2022 Society of Clinical Child & Adolescent Psychology.

Four cases of acute comitant esotropia associated with diffuse intrinsic pontine glioma in children.

BACKGROUND: Acute acquired concomitant esotropia (AACE) is usually a benign form of strabismus that infrequently is associated with intracranial pathology. Clinicians have noted an increase in its incidence and theorize that it may be related to public health "lockdown" measures taken in response to the COVID-19 pandemic. With an increased incidence of AACE clinicians must firstly differentiate AACE from common accommodative esotropia and secondly recognize AACE as a possible sign of serious neuropathology.Diffuse Intrinsic Pontine Glioma (DIPG) is a devastating diagnosis for affected families. Children typically present at age 6-7 years with cranial nerve palsies, long tract signs, and/or cerebellar signs. Diagnosis is made from characteristic findings on magnetic resonance brain imaging (MRI brain) and treatment includes radiotherapy and palliative care. Two years from diagnosis, 90% of affected children will have died from their disease. CASE SERIES: We present four cases that attended our pediatric ophthalmology clinic with AACE either as a presenting sign of DIPG or as a clinical finding following a DIPG diagnosis. Patient A (age 5 years) presented to the emergency eye clinic with sudden onset diplopia and intermittent esotropia. Suppression later developed, they had 0.00 logMAR visual acuity either eye, and bilateral physiological hypermetropia. MRI brain imaging requested as a result of the unusual presentation led to the DIPG diagnosis. The other 3 cases (ages 11, 5 & 5 years) were assessed post DIPG diagnosis and found to have an esotropia measuring bigger on 1/3-meter fixation than 6-meter fixation, full ocular motility, physiological hypermetropia or emmetropia, and visual acuity normal for age. Other than patient B (age 11 years), who had papilledema and gaze evoked nystagmus when they were assessed 2 weeks prior to death, no patient had any other clinical eye findings. CONCLUSIONS: This small series of 4 patients attending our clinic within a 12-month period supports the notion that children presenting with AACE should routinely be offered brain MRI. Not all children with DIPG-associated AACE have significant ophthalmic findings indicative of intracranial pathology. With the potential for increased incidence of AACE related to lockdowns, clinicians should be reminded of the infrequent possibility their patient has a more serious condition.

Medical misinformation: A primer and recommendations for pharmacists

Medical misinformation is more pervasive today because of widespread and near instantaneous dissemination of information via the internet and social media platforms. Consequences of medical misinformation may include decreased uptake of needed health care resources, delays in seeking care, vaccine hesitancy, medication non-compliance, increased disease outbreaks and/or burden, and increased hospitalization and mortality. It disproportionately impacts underserved populations, including Black patients, those who identify as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and more), and patients with reduced health literacy skills or who are digitally disadvantaged. Medical misinformation challenges health care professionals not only to provide the best care possible, but to assist patients in finding accurate information. Preprint publications, although potentially beneficial in rapidly disseminating new scientific discoveries, often have not undergone peer review and may contribute to the widespread propagation of inaccurate or overstated results, thereby perpetuating the spread of medical misinformation when it exists. The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of practicing evidence-based medicine and the need for cautious review of preprint publications and articles from predatory publishers in addition to usual and customary literature evaluation techniques. Everyone plays a role in preventing the spread of medical misinformation, with pharmacists uniquely positioned as trusted and highly accessible professionals who may help combat its spread. The goal of this article is to define medical misinformation and related terms, outline mechanisms by which it is spread, describe its clinical impact, highlight how it disproportionately impacts underserved populations, provide actionable strategies to prevent its spread, and give examples of practical tactics to help identify, correct, and alert individuals about the possible presence of medical misinformation.Copyright © 2023 Pharmacotherapy Publications, Inc.

Enabling low-resource transfer learning across COVID-19 corpora by combining event-extraction and co-training

Social-science investigations can benefit from a direct comparison of heterogenous corpora: in this work, we compare U.S. state-level COVID-19 policy announcements with policy discussions on Twitter. To perform this task, we require classifiers with high transfer accuracy to both (1) classify policy announcements and (2) classify tweets. We find that co-training using event-extraction views significantly improves the transfer accuracy of our RoBERTa classifier by 3% above a RoBERTa baseline and 11% above other baselines. The same improvements are not observed for baseline views. With a set of 576 COVID-19 policy announcements, hand-labeled into 1 of 6 categories, our classifier observes a maximum transfer accuracy of .77 f1-score on a hand-validated set of tweets. This work represents the first known application of these techniques to an NLP transfer learning task and facilitates cross-corpora comparisons necessary for studies of social science phenomena. © ACL 2020.All right reserved.

Guillain-Barré Syndrome and Unilateral Optic Neuritis Following Vaccination for COVID-19: A Case Report and Literature Review.

A 71-year-old woman presented 2 weeks after vaccination with the first dose of Vaxzevria (AstraZeneca, Oxford) for COVID-19 with a left lower motor neuron facial nerve palsy, which progressed to bilateral involvement. This was accompanied by bilateral proximal leg weakness. She was diagnosed with the 'facial diplegia with paraesthesia' variant of Guillain-Barré syndrome. Seven weeks post vaccination she developed painless loss of vision in the right eye. The visual acuity in that eye was light perception only with a right relative afferent pupillary defect and right optic disc swelling. A diagnosis of optic neuritis was made and she received pulsed intravenous methylprednisolone for 3 days, followed by oral prednisolone. The optic neuritis recurred following initial cessation of steroids requiring an extended course of steroids. Despite this, she made a good visual recovery to 6/6 in the affected eye. We present this case and a review of the literature surrounding vaccination and the development of these conditions.

Use of the Hefesto v2.0 methodology to implement a Data warehouse: Case applied COVID-19

The objective of this article is to present the proposal for the design and construction of a data repository with the intention of storing facts related to the current situation of COVID-19 and obtaining relevant and precise information for decision-making in the face of the latent risk of contagion. The motivation for this study arises from the need to centralize reliable and easily accessible information for monitoring cases in the face of the pandemic. Likewise, the use of the Hephaestus v2.0 methodology is proposed to guide the development of the Data warehouse step by step, which guarantees the success of the implementation. As an added value, the use of emerging technologies Microsoft SQL server 2019 and Visual Studio 2022 are integrated. The results presented will serve as an applied case study for information system administrators in the construction of data repositories and business intelligence solutions. Likewise, it contributes to the research line of scientific studies that integrate accepted and recognized methodologies or standards with emerging technologies.

Use of the Hefesto v2.0 methodology to implement a Data warehouse: Case applied COVID-19

The objective of this article is to present the proposal for the design and construction of a data repository with the intention of storing facts related to the current situation of COVID-19 and obtaining relevant and precise information for decision-making in the face of the latent risk of contagion. The motivation for this study arises from the need to centralize reliable and easily accessible information for monitoring cases in the face of the pandemic. Likewise, the use of the Hephaestus v2.0 methodology is proposed to guide the development of the Data warehouse step by step, which guarantees the success of the implementation. As an added value, the use of emerging technologies Microsoft SQL server 2019 and Visual Studio 2022 are integrated. The results presented will serve as an applied case study for information system administrators in the construction of data repositories and business intelligence solutions. Likewise, it contributes to the research line of scientific studies that integrate accepted and recognized methodologies or standards with emerging technologies. © 2022 IEEE Computer Society. All rights reserved.

Development, Implementation, and Delivery of a Remote Burnout Prevention Elective Course in an Accelerated Doctor of Pharmacy Program During COVID-19

Purpose: There is limited evidence describing burnout among graduate health professions students, including pharmacy students, and there is a need for educational institutions to mitigate burnout and promote future healthcare provider wellness. Methods: A burnout prevention elective course was developed within an accelerated Doctor of Pharmacy program. Course faculty transitioned from live to fully remote instruction in April 2020. The modified course format combined discussion-based lectures, burnout self-assessments, reflective writing assignments, and applications-based presentations. Results: Twentyone second-year pharmacy students completed the elective, and 13 completed post-course evaluations (61.9% response rate). Evaluations indicated substantial student support, with 92.3% "strongly agree" and 7.7% "agree" responses for all questions. Students suggested incorporating this course into the core didactic curriculum rather than offering it as an elective. Conclusion: Pharmacy programs considering piloting similar courses may effectively implement them even under the modified learning conditions imposed by COVID-19.

A research agenda for youth policies and investments

Given the current and future weight of youth in the global population, youth issues have mobilized the attention of policymakers and researchers around the world. However, new challenges will determine the prospects of young people, namely the destruction of traditional jobs due to new technologies, the disruptions brought about by the emergence of new epidemics (e.g., the coronavirus COVID-19), and the potential impact of climate change. This chapter first examines the definitions of youth and youth sub-groups as well as data access. The chapter then turns to the challenges that youth confront, namely human capital formation, the issue of jobs, the capturing of a first demographic dividend, and the linkages between youth and national security. Finally, the chapter analyzes the assets and opportunities that youth could benefit from, namely the transition from youth to adulthood and citizenship as well as the achievement of the Sustainable Development Goals (SDGs). © Jennifer D. Sciubba 2021.

Choosing Non-Malignant Hematologic Care Wisely: An Educational Pilot Study for Internal Medicine Residents

Introduction: Choosing Wisely ® (CW ®)is an initiative of the American Board of Internal Medicine Foundation created to guide the selection of care that is 1) supported by evidence, 2) not duplicative, 3) free from harm, and 4) truly necessary. Between 2013-14, the American Society of Hematology (ASH) published 10 recommendations in accordance with CW ® principles relevant to hematologic care. Previous studies have demonstrated that clinical exposure to non-malignant hematology (NMH) improves trainee understanding of evidence-based, cost effective care as outlined by ASH CW ®. However, dedicated clinical rotations in NMH for internal medicine (IM) residents are not consistently available. Therefore, we created a condensed educational curricular experience using a small group, case-based structure designed to teach the fundamentals of ASH CW ® in NMH to first year IM residents. With a pilot of 6 sessions, we investigated resident baseline knowledge, evaluated the curricular session, and assessed knowledge retention. Methods: The educational intervention focused on 3 content areas in ASH CW ®: venous thromboembolism (VTE), heparin-induced thrombocytopenia (HIT), and sickle cell disease (SCD) (Table 1). Participants included 21 first year IM residents at a large academic medical center. A 1-hour small group teaching session was scheduled monthly as an assigned didactic for the 2020-21 academic year. A total of 6 sessions were provided, and each session had 2-4 residents assigned. The first 4 sessions were in-person and the final 2 were virtual due to the COVID-19 pandemic. The first author was the instructor at all sessions. To assess baseline knowledge of the 3 content areas, participants completed an online assessment with 5 case-based multiple-choice questions at the beginning of the session. The instructor then guided participants to again complete the questionnaire together, now using internet access via a personal computer and a recommended list of online resources, including ASH Clinical Practice Guidelines and Pocket Guides. The instructor then led discussion on how each correct answer or guideline recommendation achieves the 4 CW ® principles. At the conclusion of the session, participants completed an online survey to evaluate the educational intervention using a modified Likert scale. To assess knowledge retention, participants received the original online multiple-choice assessment by email 3 months later. Results: All participants (21/21, 100%) completed the baseline knowledge assessment. The average number of questions correct out of 5 total was 3.3 (67%), with a range of correct answers from 1 to 5. Table 2 includes the content area of each question and the number of correct responses. The question with the lowest total correct (9/21, 43%) addressed the use of transfusion in an uncomplicated pain crisis in SCD. Seventeen participants (81%) completed the curricular evaluation. All respondents (17/17, 100%) either agreed or strongly agreed 1) that the session filled a gap in their NMH training and 2) that they learned something that would change their clinical practice. Only 1 participant (5%) reported completing a rotation in NMH prior to the session. Six participants (29%) completed the repeat knowledge assessment at 3 months. All respondents (100%) achieved a perfect score on the multiple choice questions. When asked if the knowledge gained had influenced their clinical practice, 3 (50%) strongly agreed, 2 (33%) agreed, 1 (17%) was neutral, and none disagreed or strongly disagreed. Conclusion: Our results demonstrate a successful educational pilot to improve the knowledge of ASH CW ® initiatives in NMH for first year IM residents using small group interactive case-based learning. Participants were overwhelmingly receptive to this intervention, expressed high satisfaction and confirmed that the session positively influenced their clinical practice. Although participation in the repeat assessment of knowledge was limited, those that did participate demonstrated high knowledge retention. We intend to expand this pilot initiative by providing the educational session for all incoming IM residents at our institution. We then plan to assess its impact on clinical practice (i.e. use of transfusion in SCD, use of thrombophilia testing, documentation of 4Ts score calculation) to apply the principles of ASH CW ® for improved patient care. [Formula presented] Disclosures: No relevant conflicts of interest to declare.

Rapid implementation of a novel embedded senior medical student program, as a response to the educational challenges of covid-19

As with many OECD countries, graduating medical students have been choosing specialist careers at a greater rate than ever before. Generalism in the form of family (general practice) and more generalist medical specialties have been trending down resulting in distributional geographic challenges. With the advent of COVID-19 in March 2020, medical schools and in particular the Joint Medical Program situated in a regional and rural area in NSW Australia had the unique opportunity to rethink the penultimate year curriculum when the previous rapid rotation model through numerous medical specialities became untenable. The need to vision a new practical pragmatic curriculum spurred a rapid revaluation of assessment, placement length and model with a pivot to an "embedded senior student placement" agnostic of discipline and supported by a competency-based learning portfolio. This article explores the barriers and enablers and identifies the potential elements of this type of placement which can be adapted to community and smaller rural sites. The positive student and supervisor experience also enabled an employment model to be woven into the students learning and ensured on hand medical student workforce for hospitals throughout the rural footprint. The capacity of these placements to celebrate variation in experience and support students to learn on the job have now caused a revision of the penultimate year with expectation of gains in students' satisfaction and in employability. It has also opened up options to deliver and increase the inherent value of generalist placements with likely long term workforce benefit. © 2021 Coventry University. All rights reserved.

Hematology oncology COllaborativeVIDeoconferencing (COVID) Learning Initiative: A multi-institutional trainee alliance to rapidly disseminateemerging SARS-CoV2 and cancer best practices

Introduction: The SARS-CoV2 pandemic impacted numerous aspects of medical practice, including continuingmedical education. In-person and single-institution educational formats could not address the challenges of socialdistancing, heterogeneous regional experiences, and continuously emerging data. The vulnerability of cancerpatients to SARS-CoV2 added further urgency to overcoming these barriers. To fulfill these unmet educational andpatient care needs, we established a novel cross-institutional trainee-driven, on-line collaborative for the purpose ofgenerating multidisciplinary seminars on emerging best practices for the acute management of patients with SARS-CoV2. Methods: The COVID Learning Initiative is currently managed by clinical trainees and faculty from 13 institutionsacross 10 states. Weekly Zoom conferences were led by a rotating team consisting of 2-3 fellows overseen by 4-5expert faculty from throughout the country. Format consisted of two 15-minute instructional segments presented bytrainees, followed by a concluding 30-minute faculty Q&A panel moderated by a trainee. Attendees completedbaseline demographics, SARS-CoV2 experience surveys, and pre/post conference knowledge questions.Conferences were recorded and archived to enhance access and dissemination of knowledge. Results: Within 6 weeks and beginning just 2 weeks after inception we produced five 1-hour-longmultidisciplinary video conferences covering emerging antiviral therapies, coagulopathy, pulmonary complications, provider resilience, and ethics of resource scarcity. On average, there were 100 participants per seminar. Post-conference questioning consistently demonstrated acquisition of knowledge across topics and disciplines. Attendeesalso improved in their self-assessed comfort managing multidisciplinary aspects of SARS-CoV2. Overall, presentingcollaborations involved 11 fellows and 28 faculty representing 6 medical specialties and 17 institutions. Severalcollaborations persisted, resulting in further dissemination of knowledge with tangible outcomes such as generationof peer-reviewed manuscripts. Conclusions: The COVID Learning Initiative demonstrated a novel continuing medical education platform capableof rapidly disseminating knowledge at a national scale, while realizing new opportunities for remote traineementoring and skills development. With initial feasibility and continued interest among participating institutions, COVID Learning Initiative plans to evolve to Fellows ACHIEVE: Alliance for Collaborative Hematology OncologyInter-Institutional Education through Videoconferencing to conduct an extended multi-institutional educational serieson adapting cancer management and training program best practices.

The S1 protein of SARS-CoV-2 crosses the blood-brain barrier in mice.

It is unclear whether severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019, can enter the brain. Severe acute respiratory syndrome coronavirus 2 binds to cells via the S1 subunit of its spike protein. We show that intravenously injected radioiodinated S1 (I-S1) readily crossed the blood-brain barrier in male mice, was taken up by brain regions and entered the parenchymal brain space. I-S1 was also taken up by the lung, spleen, kidney and liver. Intranasally administered I-S1 also entered the brain, although at levels roughly ten times lower than after intravenous administration. APOE genotype and sex did not affect whole-brain I-S1 uptake but had variable effects on uptake by the olfactory bulb, liver, spleen and kidney. I-S1 uptake in the hippocampus and olfactory bulb was reduced by lipopolysaccharide-induced inflammation. Mechanistic studies indicated that I-S1 crosses the blood-brain barrier by adsorptive transcytosis and that murine angiotensin-converting enzyme 2 is involved in brain and lung uptake, but not in kidney, liver or spleen uptake.