Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 12 de 12
Filter
Add more filters










Publication year range
1.
Public Health Rep ; 137(2_suppl): 29S-34S, 2022.
Article in English | MEDLINE | ID: mdl-35786066

ABSTRACT

During summer 2020, the Maricopa County Department of Public Health (MCDPH) responded to a surge in COVID-19 cases. We used internet-based platforms to automate case notifications, prioritized investigation of cases more likely to have onward transmission or severe COVID-19 based on available preinvestigation information, and partnered with Arizona State University (ASU) to scale investigation capacity. We assessed the speed of automated case notifications and accuracy of our investigation prioritization criteria. Timeliness of case notification-the median time between receipt of a case report at MCDPH and first case contact-improved from 11 days to <1 day after implementation of automated case notification. We calculated the sensitivity and positive predictive value (PPV) of the investigation prioritization system by applying our high-risk prioritization criteria separately to data available pre- and postinvestigation to determine whether a case met these criteria preinvestigation, postinvestigation, or both. We calculated the sensitivity as the percentage of cases classified postinvestigation as high risk that had also been classified as high risk preinvestigation. We calculated PPV as the percentage of all cases deemed high risk preinvestigation that remained so postinvestigation. During June 30 to July 31, 2020, a total of 55 056 COVID-19 cases with an associated telephone number (94% of 58 570 total cases) were reported. Preinvestigation, 8799 (16%) cases met high-risk criteria. Postinvestigation, 17 037 (31%) cases met high-risk criteria. Sensitivity was 52% and PPV was 98%. Automating case notifications, prioritizing investigations, and collaborating with ASU improved the timeliness of case contact, focused public health resources toward high-priority cases, and increased investigation capacity. Establishing partnerships between health departments and academia might be a helpful strategy for future surge capacity planning.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Arizona/epidemiology , Public Health , Forecasting , Automation , Contact Tracing
3.
Am J Geriatr Psychiatry ; 28(8): 820-825, 2020 08.
Article in English | MEDLINE | ID: mdl-32245677

ABSTRACT

OBJECTIVES: Alzheimer's Disease (AD)-related behavioral symptoms (i.e. agitation and/or pacing) develop in nearly 90% of AD patients. In this N = 1 study, we provide proof-of-concept of detecting changes in movement patterns that may reflect underlying behavioral symptoms using a highly novel radio sensor and identifying environmental triggers. METHODS: The Emerald device is a Wi-Fi-like box without on-body sensors, which emits and processes radio-waves to infer patient movement, spatial location and activity. It was installed for 70 days in the room of patient 'E', exhibiting agitated behaviors. RESULTS: Daily motion episode aggregation revealed motor activity fluctuation throughout the data collection period which was associated with potential socio-environmental triggers. We did not detect any adverse events attributable to the use of the device. CONCLUSION: This N-of-1 study suggests the Emerald device is feasible to use and can potentially yield actionable data regarding behavioral symptom management. No active or potential device risks were encountered.


Subject(s)
Alzheimer Disease , Cognitive Dysfunction , Monitoring, Physiologic , Psychomotor Agitation , Radio Frequency Identification Device , Remote Sensing Technology , Aged , Alzheimer Disease/complications , Alzheimer Disease/diagnosis , Alzheimer Disease/psychology , Behavioral Symptoms/diagnosis , Behavioral Symptoms/psychology , Cognitive Dysfunction/etiology , Cognitive Dysfunction/psychology , Environmental Psychology , Female , Humans , Male , Monitoring, Physiologic/instrumentation , Monitoring, Physiologic/methods , Proof of Concept Study , Psychomotor Agitation/diagnosis , Psychomotor Agitation/psychology , Remote Sensing Technology/instrumentation , Remote Sensing Technology/methods
4.
Clin Infect Dis ; 71(15): 807-812, 2020 07 28.
Article in English | MEDLINE | ID: mdl-32240285

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) causes a range of illness severity. Mild illness has been reported, but whether illness severity correlates with infectivity is unknown. We describe the public health investigation of a mildly ill, nonhospitalized COVID-19 case who traveled to China. METHODS: The case was a Maricopa County resident with multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive specimens collected on 22 January 2020. Contacts were persons exposed to the case on or after the day before case diagnostic specimen collection. Contacts were monitored for 14 days after last known exposure. High-risk contacts had close, prolonged case contact (≥ 10 minutes within 2 m). Medium-risk contacts wore all US Centers for Disease Control and Prevention-recommended personal protective equipment during interactions. Nasopharyngeal and oropharyngeal (NP/OP) specimens were collected from the case and high-risk contacts and tested for SARS-CoV-2. RESULTS: Paired case NP/OP specimens were collected for SARS-CoV-2 testing at 11 time points. In 8 pairs (73%), ≥ 1 specimen tested positive or indeterminate, and in 3 pairs (27%) both tested negative. Specimens collected 18 days after diagnosis tested positive. Sixteen contacts were identified; 11 (69%) had high-risk exposure, including 1 intimate contact, and 5 (31%) had medium-risk exposure. In total, 35 high-risk contact NP/OP specimens were collected for SARS-CoV-2 testing; all 35 pairs (100%) tested negative. CONCLUSIONS: This report demonstrates that SARS-CoV-2 infection can cause mild illness and result in positive tests for up to 18 days after diagnosis, without evidence of transmission to close contacts. These data might inform public health strategies to manage individuals with asymptomatic infection or mild illness.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Adult , Arizona , Betacoronavirus/pathogenicity , COVID-19 , COVID-19 Testing , China , Clinical Laboratory Techniques , Contact Tracing/methods , Coronavirus Infections/virology , Humans , Male , Pandemics , Pneumonia, Viral/virology , SARS-CoV-2 , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/virology , Specimen Handling/methods , Travel
6.
J Med Internet Res ; 21(7): e13218, 2019 07 12.
Article in English | MEDLINE | ID: mdl-31301127

ABSTRACT

BACKGROUND: Obtaining collateral information from a patient is an essential component of providing effective psychiatric and psychotherapeutic care. Research indicates that patients' social and electronic media contains information relevant to their psychotherapy and clinical care. However, it remains unclear to what degree this content is being actively utilized by clinicians as a part of diagnosis or therapy. Moreover, clinicians' attitudes around this practice have not been well characterized. OBJECTIVE: This survey aimed to establish the current attitudes and behaviors of outpatient clinicians regarding the incorporation of patients' social and electronic media into psychotherapy. METHODS: A Web-based survey was sent to outpatient psychotherapists associated with McLean Hospital in Belmont, Massachusetts. The survey asked clinicians to indicate to what extent and with which patients they reviewed patients' social and electronic media content as part of their clinical practice, as well as their reasons for or against doing so. RESULTS: Of the total 115 respondents, 71 (61.7%) indicated that they had viewed at least one patient's social or electronic media as part of psychotherapy, and 65 of those 71 (92%) endorsed being able to provide more effective treatment as a result of this information. The use of either short message service text messages or email was significantly greater than the use of other electronic media platforms (χ21=24.1, n=115, P<.001). Moreover, the analysis of survey responses found patterns of use associated with clinicians' years of experience and patient demographics, including age and primary diagnosis. CONCLUSIONS: The incorporation of patients' social and electronic media into therapy is currently common practice among clinicians at a large psychiatric teaching hospital. The results of this survey have informed further questions about whether reviewing patient's media impacts the quality and efficacy of clinical care.


Subject(s)
Psychiatry/methods , Psychotherapy/methods , Social Media/standards , Telemedicine/methods , Female , Humans , Male , Surveys and Questionnaires , Treatment Outcome
8.
Curr Psychiatry Rep ; 20(8): 64, 2018 07 24.
Article in English | MEDLINE | ID: mdl-30043234

ABSTRACT

PURPOSE OF REVIEW: Recent advances in technology have changed the landscape of treatment for adults with mental illness. This review highlights technological innovations that may improve care for older adults with mental illness and neurocognitive disorders through the measurement and assessment of physical motion. These technologies include wearable sensors (such as smart watches and Fitbits), passive motion sensors, and smart home models that incorporate both active and passive motion technologies. RECENT FINDINGS: Clinicians have evaluated motion measurement technologies in older adults with depression, dementia, anxiety, and schizophrenia. Results from studies in dementia populations suggest that motion measurement technologies can assist clinicians in diagnosing dementia earlier through the evaluation of gait, balance, and postural kinematics. Motion detection technologies can also be used to identify mood episodes at an earlier stage by detecting subtle behavioral changes. Clinicians may use the objective data provided by technologies such as accelerometers to identify illnesses earlier, which may inform treatment decisions. The data may be used as a suitable surrogate marker for detecting depression in older adults, predicting the likelihood of falls, or quantifying physical activity in older adults with chronic mental illnesses or anxiety. Motion-based technologies also have the potential to detect physical activity for older adults residing in nursing homes. Wearable technologies are generally well tolerated in older adults, although the use of new technology and electronic health data could involve privacy and security concerns among this vulnerable population.


Subject(s)
Exercise/psychology , Mental Disorders/diagnosis , Movement , Wearable Electronic Devices , Accidental Falls/statistics & numerical data , Aged , Anxiety Disorders/diagnosis , Anxiety Disorders/physiopathology , Dementia/diagnosis , Dementia/physiopathology , Depressive Disorder/diagnosis , Depressive Disorder/physiopathology , Humans , Mental Disorders/physiopathology , Schizophrenia/diagnosis , Schizophrenia/physiopathology
9.
Burns ; 41(3): 421-30, 2015 May.
Article in English | MEDLINE | ID: mdl-25443440

ABSTRACT

INTRODUCTION: This article aims to discover which variables influence the development of post-traumatic stress disorder in patients with burn injuries. It will also consider whether it is possible to predict which burns patients will develop PTSD. BACKGROUND: Post-traumatic stress disorder is an important psychopathology for burned patients as it can affect both physical outcomes and quality of life for those affected. Research states that PTSD may be identified in up to 30% of burns patients, making it relatively common. METHODS: A systematic review of the literature was carried out using four databases. Eleven articles were identified from these searches, and were then analysed thematically to draw out common ideas. RESULTS: Gender, extraversion and neuroticism, attribution of blame, capacity for forgiveness, the event as a disaster or non-disaster, alcohol consumption and peri-traumatic emotional response were all found to influence burns patients' risk of developing PTSD. CONCLUSION: While it is possible to identify the factors that put burns patients are greater risk of developing PTSD, it is not possible to accurately predict who will go on to develop PTSD due to the interplay between variables and individual differences. Focus should instead be on screening for PTSD and timely recognition of intrusive symptoms.


Subject(s)
Burns/psychology , Personality , Stress Disorders, Post-Traumatic/psychology , Alcohol Drinking/psychology , Anxiety Disorders/psychology , Emotional Adjustment , Extraversion, Psychological , Female , Humans , Male , Neuroticism , Risk Factors , Sex Factors
10.
Biol Psychiatry ; 63(5): 465-74, 2008 Mar 01.
Article in English | MEDLINE | ID: mdl-17689500

ABSTRACT

BACKGROUND: Shared neuropathological characteristics of patients with schizophrenia and their siblings might represent intermediate phenotypes that could be used to investigate genetic susceptibility to the illness. We sought to discover previously unidentified gray matter volume differences in patients with schizophrenia and their siblings with optimized voxel-based morphometry. METHODS: We studied 169 patients with schizophrenia, 213 of their unaffected siblings, and 212 healthy volunteers from the Clinical Brain Disorders Branch/National Institute of Mental Health Genetic Study of Schizophrenia with magnetic resonance imaging. RESULTS: Patients with schizophrenia had significant regional gray matter decreases in the frontal, temporal, and parietal cortices compared with healthy volunteers. Their unaffected siblings tended to share gray matter decreases in the medial frontal, superior temporal, and insular cortices, but these decreases were not significant after correction for multiple comparisons, even when we looked at a subgroup of siblings with a past history of mood disorder. As an exploratory analysis, we estimated heritability with regions of interest from the VBM analysis as well as from the hippocampus. Hippocampal volume was significantly correlated within sibling-pairs. CONCLUSIONS: Our findings confirm and extend previous voxel-based morphometry analyses in ill subjects with schizophrenia. Furthermore, these data argue that although siblings might share some regional gray matter decreases with their affected siblings, the pattern of regional differences might be a weak intermediate phenotype for schizophrenia.


Subject(s)
Brain/pathology , Cerebral Cortex/pathology , Genetic Predisposition to Disease/genetics , Hippocampus/pathology , Image Processing, Computer-Assisted/methods , Imaging, Three-Dimensional/methods , Magnetic Resonance Imaging/methods , Phenotype , Psychotic Disorders/genetics , Schizophrenia/genetics , Adult , Dominance, Cerebral/genetics , Female , Genetic Testing , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Psychotic Disorders/diagnosis , Risk Factors , Schizophrenia/diagnosis , Schizotypal Personality Disorder/genetics , Siblings , Software
12.
Microsc Res Tech ; 59(1): 23-40, 2002 Oct 01.
Article in English | MEDLINE | ID: mdl-12242694

ABSTRACT

Retinoids and retinoic acid receptors (RARs) are important mediators of normal epithelial cell homeostasis. To assess the role of retinoids and RARs in regulating growth arrest and apoptosis in benign and malignant mammary epithelial cells, two model systems were developed: 1) RAR function was suppressed in retinoid-sensitive normal human mammary epithelial cells (HMECs) by the dominant-negative retinoic acid receptor, RARalpha403 (DNRAR), and 2) retinoid-resistant MCF-7 breast cancer cells were transduced with a functional RARbeta2. Inhibition of RAR function by the DNRAR in HMECs resulted in retinoid-resistance, increased proliferation, and dysregulated growth when cells were cultured in reconstituted extracellular matrix (rECM). Expression of RARbeta2 in MCF-7 cells resulted in sensitivity to retinoid-induced growth arrest and apoptosis. The CREB-binding protein (CBP) and the homologous protein p300 are tightly regulated, rate-limiting integrators of diverse signaling pathways and are recruited during retinoid-mediated transcriptional activation. The relationship between retinoid receptor expression, growth regulation, and transcriptional regulation of CBP/p300 is poorly understood. Inhibition of RAR function in HMECs by DNRAR suppressed expression of CBP/p300 and expression of RARbeta2 in MCF-7 cells promoted induction of CBP/p300 when cells were treated with 1.0 microM all-trans-retinoic acid (ATRA). These results suggest that ATRA and RARs regulate growth arrest of HMECs and modulate CBP/p300 protein expression. Since CBP and p300 are normally present in limiting amounts, their regulation by ATRA and RARs may be an important element in the control of transcriptional activation of genes regulating growth arrest and apoptosis.


Subject(s)
Apoptosis , Breast/cytology , Cell Division , Epithelial Cells/physiology , Nuclear Proteins/metabolism , Receptors, Retinoic Acid/metabolism , Retinoids/metabolism , Trans-Activators/metabolism , Breast/pathology , Breast Neoplasms/pathology , Epithelial Cells/pathology , Female , Gene Expression Regulation , Humans , Nuclear Proteins/genetics , Trans-Activators/genetics , Tumor Cells, Cultured
SELECTION OF CITATIONS
SEARCH DETAIL
...