Neurological Pupillary Index (NPi) Measurement Using Pupillometry and Outcomes in Critically Ill Children.

Aim/objective Neurological Pupil Index (NPi), measured by automated pupillometry (AP), allows the objective assessment of pupillary light reflex (PLR). NPi ranges from 0 (non-reactive) to 5 (normal). In this study, we aimed to compare neurologic and functional outcomes in children admitted for neurologic injury with normal (≥3) versus abnormal (<3) NPi measured during their pediatric intensive care unit (PICU) stay. Materials and methods We conducted a retrospective chart review of children between one month and 18 years admitted to our PICU with a diagnosis of neurologic injury between January 2019 and June 2022. We collected demographic, clinical, pupillometer, and outcome data, including mortality, Pediatric Cerebral Performance Category (PCPC), Pediatric Overall Performance Category (POPC), and Functional Status Score (FSS) at admission, at discharge, and at the three to six-month follow-up. We defined abnormal pupil response as any NPi <3 at any point during the PICU stay. Using the student's t-test and chi-square test, we compared the short-term and long-term outcomes of children with abnormal NPi (<3) versus those with normal NPi (≥3). Results There were 49 children who met the inclusion criteria and who had pupillometry data available for analysis. The mean (SD) Glasgow Coma Scale (GCS) in the study cohort was 5.6 (4.3), and 61% had low (<3) NPi during ICU stay. Mortality was significantly higher among patients with an abnormal NPi as compared to those with normal NPi. Children with abnormal NPi exhibited significant worsening of neurologic and functional status (ΔPCPC, ΔPOPC, and ΔFSS) from admission to discharge (mean (SD): 3.55(1.5), 3.45(1.43), 16.75(7.85), p<0.001) as compared to those with normal NPi (mean (SD): 1.45(0.93), 1.73(0.90), 3.55(2.07), p>0.05). The significant difference in neurologic and functional status persisted at the three to six-month follow-up between the two groups - children with abnormal NPi (mean (SD): 2.0(1.41), 2.08(1.38), 6.92(6.83), p<0.01) and children with normal NPi (mean (SD): 0.82(1.01), 0.94(1.03), 1.53(1.70), p>0.05). Conclusion In our retrospective cohort study, children admitted to the PICU for a neuro injury and with abnormal NPi (< 3) have higher mortality, and worse short-term and long-term neurologic and functional outcomes as compared to those with normal NPi (≥ 3) measured during the PICU course. AP provides an objective assessment of PLR and has potential applications for neuro-prognostication. More research needs to be done to elucidate the prognostic value of NPi in pediatrics.

Is mirror therapy combined with a routine physiotherapy protocol effective for children with obstetrical upper brachial plexus palsy?

STUDY DESIGN: Randomized controlled study. INTRODUCTION: Mirror therapy is a rehabilitation strategy based on the repeated use of the mirror illusion and also one of the treatment choice of brachial plexus injuries. PURPOSE: We aimed to determine the effects of mirror therapy combined with a routine rehabilitation program on upper limb motor function in children with obstetric brachial plexus injury. METHODS: Twenty children with obstetric brachial palsy were included in this study. They were randomly allocated to either control (n = 10) or mirror therapy (n = 10) group. The following clinical tools were used to assess the upper extremity function: Active Movement Scale (AMS), Modified Mallet Scale (MMS), Hand Grip Strength (HGS) Test, Finger Grip Strength (FGSM) Test, Box and Block Test (BBT), Nine Hole Peg Test (9-HPT), and goniometric measurement. Both groups received the same routine physiotherapy program for 8 weeks. The study group underwent mirror therapy in addition to the rehabilitation program. RESULTS: The mean age of the study population was 11.35 ± 4.12 years. There was no change in the goniometric values, AMS and MMS scores after the treatment in both groups (p > 0.05), except for the improvement of the wrist extension in the study group (p < 0.05). There was an increase in both HGS and FGS scores in the study group. Only FGS scores improved in the control group after the intervention (p < 0.05). 9-HPT and BBT scores improved in both groups (p < 0.05). All other parameters tested were comparable between the two groups after the treatment. CONCLUSIONS: The results of this study did not show any additional benefits of mirror therapy combined with a rehabilitation protocol compared to routine physiotherapy treatment, but was not adequately powered to do so.

Effects of Academic Motivation on School Burnout in Turkish College Students.

School burnout refers to psychological reactions to academic stress and loads and has been identified as a risk factor contributing to academic failure and subsequent mental health challenges. However, academic motivation, hope, and meaning in life can be potential combating factors against school burnout. This study aimed to examine the effects of academic motivation on school burnout in college students and explore mediator roles of hope and meaning in life. A path analysis was performed with the data collected from 544 Turkish college students to test the direct and indirect effects. The results showed that the direct effects from the three academic motivation variables to school burnout variables were larger than the indirect effects. Both mediators played roles in the relations between amotivation and efficacy and intrinsic motivation and efficacy. The last finding was that hope played more significant mediator roles than meaning in life. The results were discussed, along with implications for faculty, college counselors, and future studies.

Health Anxiety in the Early Phase of COVID-19 Outbreak in Turkey: Investigation of Predictive Variables / Ansiedad relacionada con la salud en la fase inicial del brote de COVID-19 en Turquía: Investigación de las variables predictivas

Objective: Health anxiety can be a risk factor for mental health and well-being. People can experience higher levels of health anxiety during pandemic outbreaks because such pandemic outbreaks can cause additional stress and threats. In this sense, people can be more vulnerable to health anxiety during the COVID-19 outbreak. To better understand and overcome health anxiety, it is important to examine factors that affect health anxiety during the COVID-19 outbreak. This study aimed to examine the effects of age, gender, perceived risk, exposure to media, depression, anxiety, and stress on health anxiety during the early phase of the COVID-19 outbreak in Turkey. Materials and Method: The participants included 1473 adults and the data were collected via an online tool. The demographic questions, the Depression Anxiety Stress Scale, and the Short Health Anxiety Scale were used to collect data. Multiple linear regression analysis was implemented to analyze the data using R program. Results: The results showed that anxiety was the strongest positive predictor of health anxiety, following stress, TV News and social media, depression, and risk perception. Age and gender were not found to be significant predictors. Conclusions: This study showed that the significant predictors of health anxiety can escalate health anxiety during the COVID-19 outbreak. The results and limitations are discussed along with implications for future research and intervention and prevention planning.(AU)

Objetivo: La ansiedad relacionada con la salud puede ser un factor de riesgo para la salud mental y el bienestar, particularmente en brotes pandémicos debido a la naturaleza desafiante de la pandemia. En este sentido, las personas pueden ser más vulnerables a la ansiedad relacionada con la salud durante el brote de COVID-19. Para entender mejor y superar la ansiedad de la salud es importante examinar los factores que afectan la ansiedad. Este estudio busca examinar los efectos de género, percepción de riesgo, exposición a medios de comunicación, depresión, ansiedad y estrés sobre la ansiedad de la salud durante la fase temprana del brote de COVID-19 en Turquía. Método: Los participantes incluidos fueron 1473 adultos y la información fue recolectada por medio de una herramienta en Internet. Las preguntas demográficas, la escala DAS y la escala corta de la ansiedad de salud fueron utilizadas para recolectar los datos. El método de regresión lineal múltiple fue aplicado para analizar los datos utilizando el programa R. Resultados: Los resultados mostraron que la ansiedad fue el indicador positivo más importante de la ansiedad de la salud, seguido del estrés, las noticias en televisión y las redes sociales, depresión y la percepción del riesgo. No se encontró que la edad y el género fueran indicadores relevantes. Conclusión: Este estudio reveló que los predictores más importantes de la ansiedad de la salud pueden intensificar la ansiedad de la salud durante el brote de COVID-19. Los resultados y las limitaciones son discutidas junto con las implicaciones para investigaciones futuras y posibles programas de prevención e intervención.(AU)

Imputation Methods to Deal With Missing Responses in Computerized Adaptive Multistage Testing.

Routing examinees to modules based on their ability level is a very important aspect in computerized adaptive multistage testing. However, the presence of missing responses may complicate estimation of examinee ability, which may result in misrouting of individuals. Therefore, missing responses should be handled carefully. This study investigated multiple missing data methods in computerized adaptive multistage testing, including two imputation techniques, the use of full information maximum likelihood and the use of scoring missing data as incorrect. These methods were examined under the missing completely at random, missing at random, and missing not at random frameworks, as well as other testing conditions. Comparisons were made to baseline conditions where no missing data were present. The results showed that imputation and the full information maximum likelihood methods outperformed incorrect scoring methods in terms of average bias, average root mean square error, and correlation between estimated and true thetas.

What Information Works Best?: A Comparison of Routing Methods.

There are many item selection methods proposed for computerized adaptive testing (CAT) applications. However, not all of them have been used in computerized multistage testing (ca-MST). This study uses some item selection methods as a routing method in ca-MST framework. These are maximum Fisher information (MFI), maximum likelihood weighted information (MLWI), maximum posterior weighted information (MPWI), Kullback-Leibler (KL), and posterior Kullback-Leibler (KLP). The main purpose of this study is to examine the performance of these methods when they are used as a routing method in ca-MST applications. These five information methods under four ca-MST panel designs and two test lengths (30 items and 60 items) were tested using the parameters of a real item bank. Results were evaluated with overall findings (mean bias, root mean square error, correlation between true and estimated thetas, and module exposure rates) and conditional findings (conditional absolute bias, standard error of measurement, and root mean square error). It was found that test length affected the outcomes much more than other study conditions. Under 30-item conditions, 1-3 designs outperformed other panel designs. Under 60-item conditions, 1-3-3 designs were better than other panel designs. Each routing method performed well under particular conditions; there was no clear best method in the studied conditions. The recommendations for routing methods in any particular condition were provided for researchers and practitioners as well as the limitations of these results.

Differential Item Functioning Detection Across Two Methods of Defining Group Comparisons: Pairwise and Composite Group Comparisons.

This study compares two methods of defining groups for the detection of differential item functioning (DIF): (a) pairwise comparisons and (b) composite group comparisons. We aim to emphasize and empirically support the notion that the choice of pairwise versus composite group definitions in DIF is a reflection of how one defines fairness in DIF studies. In this study, a simulation was conducted based on data from a 60-item ACT Mathematics test (ACT; Hanson & Béguin). The unsigned area measure method (Raju) was used as the DIF detection method. An application to operational data was also completed in the study, as well as a comparison of observed Type I error rates and false discovery rates across the two methods of defining groups. Results indicate that the amount of flagged DIF or interpretations about DIF in all conditions were not the same across the two methods, and there may be some benefits to using composite group approaches. The results are discussed in connection to differing definitions of fairness. Recommendations for practice are made.