Equal Prevalence of Depression in Men and Women with Parkinson's Disease Revealed by Online Assessment.

OBJECTIVE: Identifying persons needing mental health services is hampered by stigma-related underreporting of symptoms, especially by men. Men with Parkinson's disease (PD) consistently report lower rates of depression than women in in-person studies. We predicted that online anonymity would elicit more gender-based parity in depression endorsement. METHOD: We administered the Beck Depression Inventory-II (BDI-II) online to 344 participants with PD (52% women). Depression was defined as BDI-II score >13 and/or use of antidepressant medications. RESULTS: Overall depression prevalence was consistent with in-person studies, but with no significant difference between men and women. CONCLUSIONS: Online methods may circumvent barriers to depression identification in men with PD.

Censoring Trace-Level Environmental Data: Statistical Analysis Considerations to Limit Bias.

Trace-level environmental data typically include values near or below detection and quantitation thresholds where health effects may result from low-concentration exposures to one chemical over time or to multiple chemicals. In a cook stove case study, bias in dibenzo[a,h]anthracene concentration means and standard deviations (SDs) was assessed following censoring at thresholds for selected analysis approaches: substituting threshold/2, maximum likelihood estimation, robust regression on order statistics, Kaplan-Meier, and omitting censored observations. Means and SDs for gas chromatography-mass spectrometry-determined concentrations were calculated after censoring at detection and calibration thresholds, 17% and 55% of the data, respectively. Threshold/2 substitution was the least biased. Measurement values were subsequently simulated from two log-normal distributions at two sample sizes. Means and SDs were calculated for 30%, 50%, and 80% censoring levels and compared to known distribution counterparts. Simulation results illustrated (1) threshold/2 substitution to be inferior to modern after-censoring statistical approaches and (2) all after-censoring approaches to be inferior to including all measurement data in analysis. Additionally, differences in stove-specific group means were tested for uncensored samples and after censoring. Group differences of means tests varied depending on censoring and distributional decisions. Investigators should guard against censoring-related bias from (explicit or implicit) distributional and analysis approach decisions.

Protection Motivation and the COVID-19 Virus.

The current study examined the role of the components of the Protection Motivation Theory of Health (PMT) in predicting protective health behaviors related to the COVID-19 virus. Through a snowball sampling procedure, in Wave 1 424 respondents completed a survey in March 2020. One hundred thirteen of these participants completed the same survey in Wave 2 in May 2020. Consistent with research on SARS, females and older individuals engaged in the behaviors more often than men and younger individuals. After accounting for these variables in predicting frequency of protective health behaviors, components of the PMT accounted for an additional 12% of the variance in Wave 1 and 16% in Wave 2, with perceived severity and outcome efficaciousness correlating positively with frequency. Anticipatory regret mediated the relationship between PMT and protective health behavior frequency. The results suggest that public health announcements that are tailored toward the severity of the virus and the efficacy of the health behaviors in decreasing the spread of the virus may meet with more success than those that heighten people's vulnerability to the disease.

Pediatric pain management in the emergency department.

Adequate analgesia is critical in the management of pediatric patients in the emergency department. Suboptimal treatment of pain can have deleterious effects in the short term, and it can also affect a patient's development and reaction to future painful experiences. Tools exist to quantify a patient's pain level regardless of age or developmental stage. Both pharmacologic and nonpharmacologic methods can be effective in the management of pediatric pain. Emergency clinicians must remain vigilant in the recognition, treatment, and reassessment of pediatric pain, as patients' developmental level may limit their ability to independently express their pain experience without prompting or tools. This issue reviews pain scales that are suitable for pediatric patients and discusses pediatric pain management using nonpharmacologic methods, topical, local, and regional anesthesia as well as systemic agents.

Biological control via "ecological" damping: An approach that attenuates non-target effects.

In this work we develop and analyze a mathematical model of biological control to prevent or attenuate the explosive increase of an invasive species population, that functions as a top predator, in a three-species food chain. We allow for finite time blow-up in the model as a mathematical construct to mimic the explosive increase in population, enabling the species to reach "disastrous", and uncontrollable population levels, in a finite time. We next improve the mathematical model and incorporate controls that are shown to drive down the invasive population growth and, in certain cases, eliminate blow-up. Hence, the population does not reach an uncontrollable level. The controls avoid chemical treatments and/or natural enemy introduction, thus eliminating various non-target effects associated with such classical methods. We refer to these new controls as "ecological damping", as their inclusion dampens the invasive species population growth. Further, we improve prior results on the regularity and Turing instability of the three-species model that were derived in Parshad et al. (2014). Lastly, we confirm the existence of spatiotemporal chaos.

Wound management.

The care of wounds is common in pediatric practice. Most simple wounds can be handled by clinicians in the office or by trained emergency medicine clinicians. Knowledge of appropriate wound care, wound repair techniques, and judicious use of antibiotics for prophylaxis ensures the best possible long-term outcomes. The following review describes appropriate recommendations for acute and long-term wound care, management, and special circumstances common to pediatric practice.

Variation in pediatric emergency department care of sickle cell disease and fever.

OBJECTIVES: The objective was to study the variation in pediatric emergency department (PED) practice patterns for evaluation and management of children with sickle cell disease (SCD) and fever in U.S. children's hospitals. METHODS: A cross-sectional study of visits by children 3 months to 18 years of age with SCD and fever evaluated in 36 U.S. children's hospital PEDs within the 2010 Pediatric Health Information System database. The main outcome measures were the proportions of SCD visits that received evaluation (laboratory testing and chest radiographs [CXRs]) and treatment (parenteral administration of antibiotics) and were admitted for fever. RESULTS: Of the 4,853 PED visits for SCD and fever, 91.7% had complete blood counts (CBCs), 93.8% had reticulocyte counts, 93% had blood cultures obtained, 68.5% had CXRs, and 91.7% received antibiotics. Most (81.4%) patients received the recommended National Heart, Lung and Blood Institute evaluation (CBC, reticulocyte count, and blood culture) and treatment (parenteral antibiotics). In multivariate regression modeling controlling for hospital- and patient-level effects, age groups ≥1 to <5 years (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.25 to 0.40) and ≥5 to <13 years (OR = 0.40, 95% CI = 0.32 to 0.50), and those visits that did not have CXRs had lower odds of hospital admission. After adjusting for age, payor status, receipt of laboratory testing, antibiotics, and CXRs, admission rates varied by sevenfold across U.S. children's hospitals (p < 0.001). CONCLUSIONS: Standardization of practice exists across children's hospitals regarding obtaining laboratory studies and administering antibiotics for patients with SCD and fever. However, admission rates vary significantly. Evaluating the causes and consequences of such significant variation needs further exploration to improve the quality of care for patients with SCD.

Management of febrile neonates in US pediatric emergency departments.

BACKGROUND: Blood, urine, and cerebrospinal fluid cultures and admission for antibiotics are considered standard management of febrile neonates (0-28 days). We examined variation in adherence to these recommendations across US pediatric emergency departments (PEDs) and incidence of serious infections (SIs) in febrile neonates. METHODS: Cross-sectional study of neonates with a diagnosis of fever evaluated in 36 PEDs in the 2010 Pediatric Health Information System database. We analyzed performance of recommended management (laboratory testing, antibiotic use, admission to hospital), 48-hour return visits to PED, and diagnoses of SI. RESULTS: Of 2253 neonates meeting study criteria, 369 (16.4%) were evaluated and discharged from the PED; 1884 (83.6%) were admitted. Recommended management occurred in 1497 of 2253 (66.4%; 95% confidence interval, 64.5-68.4) febrile neonates. There was more than twofold variation across the 36 PEDs in adherence to recommended management, recommended testing, and recommended treatment of febrile neonates. There was significant variation in testing and treatment between admitted and discharged neonates (P < .001). A total of 269 in 2253 (11.9%) neonates had SI, of whom 223 (82.9%; 95% confidence interval, 77.9-86.9) received recommended management. CONCLUSIONS: There was wide variation across US PEDs in adherence to recommended management of febrile neonates. One in 6 febrile neonates was discharged from the PED; discharged patients were less likely to receive testing or antibiotic therapy than admitted patients. A majority of neonates with SI received recommended evaluation and management. High rates of SI in admitted patients but low return rates for missed infections in discharged patients suggest a need for additional studies to understand variation from the current recommendations.

A decision support framework for science-based, multi-stakeholder deliberation: a coral reef example.

We present a decision support framework for science-based assessment and multi-stakeholder deliberation. The framework consists of two parts: a DPSIR (Drivers-Pressures-States-Impacts-Responses) analysis to identify the important causal relationships among anthropogenic environmental stressors, processes, and outcomes; and a Decision Landscape analysis to depict the legal, social, and institutional dimensions of environmental decisions. The Decision Landscape incorporates interactions among government agencies, regulated businesses, non-government organizations, and other stakeholders. It also identifies where scientific information regarding environmental processes is collected and transmitted to improve knowledge about elements of the DPSIR and to improve the scientific basis for decisions. Our application of the decision support framework to coral reef protection and restoration in the Florida Keys focusing on anthropogenic stressors, such as wastewater, proved to be successful and offered several insights. Using information from a management plan, it was possible to capture the current state of the science with a DPSIR analysis as well as important decision options, decision makers and applicable laws with a the Decision Landscape analysis. A structured elicitation of values and beliefs conducted at a coral reef management workshop held in Key West, Florida provided a diversity of opinion and also indicated a prioritization of several environmental stressors affecting coral reef health. The integrated DPSIR/Decision landscape framework for the Florida Keys developed based on the elicited opinion and the DPSIR analysis can be used to inform management decisions, to reveal the role that further scientific information and research might play to populate the framework, and to facilitate better-informed agreement among participants.