Is language translation enough in cross-cultural neuropsychological assessments of patients from Latin America?

OBJECTIVE: The purpose of this review was to highlight the need to consider factors other than language when adapting tests across cultural groups and to offer a list of tests that have been adapted for use among patients from or descended from Latin American Countries. Despite efforts in the field through publications and workshops, the authors were aware of continued errors in cross-cultural assessment of these patients, resulting in misdiagnosis and unintentional inequitable care. Thus, we sought to reinforce the existing literature. METHOD: We reviewed the literature pertaining to cross-cultural adaptation of neuropsychological measures. Relevant papers were identified by our institution's Academic Enhanced Search Option (AcESO) Database, PubMed, and Google Scholar. RESULTS: 102 papers, articles, and other published literature were reviewed describing issues related to the adaptation of tests for groups originally from or descended from Latin American Countries residing in the United States. CONCLUSIONS: It is imperative that tests be appropriately developed or adapted for the target population with appropriate normative data available, and ideally administered by a fluent speaker trained in assessment. Inappropriate use of tests not adapted for a particular patient's language and country of origin can result in misdiagnosis, potentially resulting in harm to the individual.

In vitro synergistic activity of aztreonam (AZT) plus novel and old ß-lactamase inhibitor combinations against metallo-ß-lactamase-producing AZT-resistant Enterobacterales.

The emergence of metallo-ß-lactamase (MBL)-producing Enterobacterales, mainly New Delhi metallo-ß-lactamase (NDM), represents a clinical threat due to the limited therapeutic alternatives. Aztreonam (AZT) is stable to MBLs, but most MBL-producing Enterobacterales isolates usually co-harbour other ß-lactamases that confer resistance to AZT and, consequently, its use is restricted in these isolates. We compared the ability of sulbactam (SUL), tazobactam (TAZ), clavulanic acid (CLA) and avibactam (AVI) to restore the AZT activity in MBL-producing AZT-resistant Enterobacterales isolates. A collection of 64 NDM-producing AZT-resistant Enterobacterales from five hospitals in Buenos Aires city, Argentina, were studied during the period July-December 2020. MICs were determined using the agar dilution method with Mueller-Hinton agar according to Clinical and Laboratory Standards Institute (CLSI) recommendations. AVI, SUL and TAZ were used at a fixed concentration of 4 mg l-1, whereas CLA was used at a fixed concentration of 2 mg l-1. A screening method based on disc diffusion to evaluate this synergy was also conducted. Detection of bla KPC, bla OXA, bla NDM, bla VIM, bla CTXM-1, bla PER-2 and bla CIT was performed by PCR. The AZT-AVI combination restored the AZT activity in 98.4 % of AZT-resistant strains, whereas CLA, TAZ and SUL did so in 70.3, 15.6 and 12.5 %, respectively, in isolates co-harbouring extended-spectrum ß-lactamases, but were inactive in isolates harbouring AmpC-type enzymes and/or KPC. The synergy screening test showed an excellent negative predictive value to confirm the absence of synergy, but positive results should be confirmed by a quantitative method. The excellent in vitro performance of the AZT-CLA combination represents a much more economical alternative to AZT-AVI, which could be of use in the treatment of MBL-producing, AZT-resistant Enterobacterales.

Use of natural language processing in electronic medical records to identify pregnant women with suicidal behavior: towards a solution to the complex classification problem.

We developed algorithms to identify pregnant women with suicidal behavior using information extracted from clinical notes by natural language processing (NLP) in electronic medical records. Using both codified data and NLP applied to unstructured clinical notes, we first screened pregnant women in Partners HealthCare for suicidal behavior. Psychiatrists manually reviewed clinical charts to identify relevant features for suicidal behavior and to obtain gold-standard labels. Using the adaptive elastic net, we developed algorithms to classify suicidal behavior. We then validated algorithms in an independent validation dataset. From 275,843 women with codes related to pregnancy or delivery, 9331 women screened positive for suicidal behavior by either codified data (N = 196) or NLP (N = 9,145). Using expert-curated features, our algorithm achieved an area under the curve of 0.83. By setting a positive predictive value comparable to that of diagnostic codes related to suicidal behavior (0.71), we obtained a sensitivity of 0.34, specificity of 0.96, and negative predictive value of 0.83. The algorithm identified 1423 pregnant women with suicidal behavior among 9331 women screened positive. Mining unstructured clinical notes using NLP resulted in a 11-fold increase in the number of pregnant women identified with suicidal behavior, as compared to solely reliance on diagnostic codes.

The complexity of narrative interferes in the use of conjunctions in children with specific language impairment.

PURPOSE: To verify the use of conjunctions in narratives, and to investigate the influence of stimuli's complexity over the type of conjunctions used by children with specific language impairment (SLI) and children with typical language development. METHODS: Participants were 40 children (20 with typical language development and 20 with SLI) with ages between 7 and 10 years, paired by age range. Fifteen stories with increasing of complexity were used to obtain the narratives; stories were classified into mechanical, behavioral and intentional, and each of them was represented by four scenes. Narratives were analyzed according to occurrence and classification of conjunctions. RESULTS: Both groups used more coordinative than subordinate conjunctions, with significant decrease in the use of conjunctions in the discourse of SLI children. The use of conjunctions varied according to the type of narrative: for coordinative conjunctions, both groups differed only between intentional and behavioral narratives, with higher occurrence in behavioral ones; for subordinate conjunctions, typically developing children's performance did not show differences between narratives, while SLI children presented fewer occurrences in intentional narratives, which was different from other narratives. CONCLUSION: Both groups used more coordinative than subordinate conjunctions; however, typically developing children presented more conjunctions than SLI children. The production of children with SLI was influenced by stimulus, since more complex narratives has less use of subordinate conjunctions.

The complexity of narrative interferes in the use of conjunctions in children with specific language impairment / A complexidade da narrativa interfere no uso de conjunções em crianças com distúrbio específico de linguagem

PURPOSE: To verify the use of conjunctions in narratives, and to investigate the influence of stimuli's complexity over the type of conjunctions used by children with specific language impairment (SLI) and children with typical language development. METHODS: Participants were 40 children (20 with typical language development and 20 with SLI) with ages between 7 and 10 years, paired by age range. Fifteen stories with increasing of complexity were used to obtain the narratives; stories were classified into mechanical, behavioral and intentional, and each of them was represented by four scenes. Narratives were analyzed according to occurrence and classification of conjunctions. RESULTS: Both groups used more coordinative than subordinate conjunctions, with significant decrease in the use of conjunctions in the discourse of SLI children. The use of conjunctions varied according to the type of narrative: for coordinative conjunctions, both groups differed only between intentional and behavioral narratives, with higher occurrence in behavioral ones; for subordinate conjunctions, typically developing children's performance did not show differences between narratives, while SLI children presented fewer occurrences in intentional narratives, which was different from other narratives. CONCLUSION: Both groups used more coordinative than subordinate conjunctions; however, typically developing children presented more conjunctions than SLI children. The production of children with SLI was influenced by stimulus, since more complex narratives has less use of subordinate conjunctions.

OBJETIVO: Verificar o uso de conjunções em narrativas e investigar a influência da complexidade dos estímulos sobre o tipo de conjunção utilizada, tanto em indivíduos com distúrbio específico de linguagem (DEL) quanto em sujeitos com desenvolvimento típico de linguagem. MÉTODOS: Participaram da pesquisa 40 sujeitos (20 em desenvolvimento típico de linguagem e 20 com DEL), com idades variando entre 7 e 10 anos, pareados por faixa etária. Para obter as narrativas foram utilizadas 15 sequências lógico-temporais de complexidade crescente, classificadas em mecânicas, comportamentais e intencionais, representadas por quatro cenas cada uma. As narrativas foram analisadas quanto à ocorrência e à classificação das conjunções. RESULTADOS: Ambos os grupos utilizaram mais conjunções coordenativas do que subordinativas, com significativa redução do emprego de conjunções no discurso das crianças com DEL. A utilização das conjunções variou quanto ao tipo de narrativa, sendo que para as conjunções coordenativas, ambos os grupos diferiram apenas entre as narrativas intencionais e as comportamentais, com maior ocorrência nas comportamentais. Para as conjunções subordinativas, o desempenho das crianças em desenvolvimento normal não diferiu entre as narrativas, enquanto, no grupo com DEL nas intencionais houve menor ocorrência, diferindo das outras narrativas. CONCLUSÃO: Ambos os grupos apresentaram maior uso de conjunções coordenativas do que subordinativas, porém, os sujeitos em desenvolvimento normal apresentaram mais conjunções do que os indivíduos com DEL. A produção das crianças com DEL sofreu influência do estímulo, uma vez que em narrativas mais complexas houve menor uso de conjunções subordinativas.

[Clinical classification of variable angle exotrophy]. / Clasificación clínica de la exotropía de ángulo variable.

BACKGROUND: Variable exotropia is determined by a series of mechanisms that provide different clinical characteristics to outline individual therapy. There is no specific categorization that can identify such an entity. A clinical classification is proposed that includes different clinical features in accordance with the mechanisms involved in the variability genesis of such exotropias. METHODS: Patients with a diagnosis of variable angle exotropia without previous surgery were included. A complete ophthalmic and strabismus exploration was performed. Variability characteristics were studied and grouped by entries in the classification proposed. RESULTS: Ninety patients were examined from the Pediatric Ophthalmology and Strabismus Unit of the General Hospital of Mexico O.D., with a diagnosis of variable angle exotropia. The following forms of presentations were found: secondary variable angle exotropia due to neurological alteration in 32 cases (35.5%), secondary variable angle exotropia due to monocular bad vision in 19 cases (21.2%), dissociated horizontal deviation in 14 cases (15.5%), mixed variable angle exotropia in 22 cases (4.5%) and primary variable angle exotropia in 3 cases (3.33%). CONCLUSIONS: This classification allows categorization of all patients of variable angle exotropia into proposed categories. The most common mechanism responsible for variability is neurological alteration. Primary variable angle exotropias are rare and are present in a minimum percentage.

A membrane-permeant peptide that inhibits MLC kinase restores barrier function in in vitro models of intestinal disease.

BACKGROUND & AIMS: Maintenance of the mucosal barrier is a critical function of intestinal epithelia. Myosin regulatory light chain (MLC) phosphorylation is a common intermediate in the pathophysiologic regulation of this barrier. The aim of this study was to determine whether a membrane permeant inhibitor of MLC kinase (PIK) could inhibit intracellular MLC kinase and regulate paracellular permeability. METHODS: Recombinant MLC and Caco-2 MLC kinase were used for kinase assays. T84 and Caco-2 monolayers were treated with enteropathogenic Escherichia coli (EPEC) or tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma to induce barrier dysfunction. RESULTS: PIK inhibited MLC kinase in vitro and was able to cross cell membranes and concentrate at the perijunctional actomyosin ring. Consistent with these properties, apical addition of PIK reduced intracellular MLC phosphorylation by 22% +/- 2%, increased transepithelial resistance (TER) by 50% +/- 1%, and decreased paracellular mannitol flux rates by 5.2 +/- 0.2-fold. EPEC infection induced TER decreases of 37% +/- 6% that were limited to 16% +/- 5% by PIK. TNF-alpha and IFN-gamma induced TER decreases of 22% +/- 3% that were associated with a 172% +/- 1% increase in MLC phosphorylation. Subsequent PIK addition caused MLC phosphorylation to decrease by 25% +/- 4% while TER increased to 97% +/- 6% of control. CONCLUSIONS: PIK can prevent TER defects induced by EPEC and reverse MLC phosphorylation increases and TER decreases induced by TNF-alpha and IFN-gamma. The data also suggest that TNF-alpha and IFN-gamma regulate TER, at least in part, via the perijunctional cytoskeleton. Thus, PIK may be the prototype for a new class of targeted therapeutic agents that can restore barrier function in intestinal disease states.