Enhancing the communication of functional neurological disorder diagnosis: a multidisciplinary education session.

BACKGROUND AND PURPOSE: Functional neurological disorder (FND) is a common diagnosis within neurology. Effective communication of the diagnosis is known to be an important part of treatment and can result in reduction or cessation of symptoms, as well as decreased healthcare utilisation. A single group education session, facilitated by professionals commonly involved in the care of patients with FND, was developed to further enhance patients' and relatives' understanding and acceptance of diagnosis. METHODS: Patients and relatives attending a single education session were asked to complete self-report ratings of understanding of diagnosis, acceptance of diagnosis, belief in treatability and hopefulness regarding recovery, at the beginning and end of the session. Satisfaction data were also collected. RESULTS: Data were obtained from 193 patients and 153 relatives. Patients had experienced a median duration of symptoms of 4 years, and more than 80% of patients reported more than one functional neurological symptom. There were significant increases in terms of understanding, acceptance, belief in treatability and hopefulness for patients and relatives. Effect sizes ranged from large for improved understanding of FND to small-to-medium for increased agreement with FND diagnosis. High levels of satisfaction were also reported. CONCLUSIONS: A multidisciplinary, single group education session is an effective and acceptable method of increasing understanding and acceptance of an FND diagnosis, even for patients with a long duration of symptoms and high symptom burden. It could help improve readiness for further treatment.

Aligning text mining and machine learning algorithms with best practices for study selection in systematic literature reviews.

BACKGROUND: Despite existing research on text mining and machine learning for title and abstract screening, the role of machine learning within systematic literature reviews (SLRs) for health technology assessment (HTA) remains unclear given lack of extensive testing and of guidance from HTA agencies. We sought to address two knowledge gaps: to extend ML algorithms to provide a reason for exclusion-to align with current practices-and to determine optimal parameter settings for feature-set generation and ML algorithms. METHODS: We used abstract and full-text selection data from five large SLRs (n = 3089 to 12,769 abstracts) across a variety of disease areas. Each SLR was split into training and test sets. We developed a multi-step algorithm to categorize each citation into the following categories: included; excluded for each PICOS criterion; or unclassified. We used a bag-of-words approach for feature-set generation and compared machine learning algorithms using support vector machines (SVMs), naïve Bayes (NB), and bagged classification and regression trees (CART) for classification. We also compared alternative training set strategies: using full data versus downsampling (i.e., reducing excludes to balance includes/excludes because machine learning algorithms perform better with balanced data), and using inclusion/exclusion decisions from abstract versus full-text screening. Performance comparisons were in terms of specificity, sensitivity, accuracy, and matching the reason for exclusion. RESULTS: The best-fitting model (optimized sensitivity and specificity) was based on the SVM algorithm using training data based on full-text decisions, downsampling, and excluding words occurring fewer than five times. The sensitivity and specificity of this model ranged from 94 to 100%, and 54 to 89%, respectively, across the five SLRs. On average, 75% of excluded citations were excluded with a reason and 83% of these citations matched the reviewers' original reason for exclusion. Sensitivity significantly improved when both downsampling and abstract decisions were used. CONCLUSIONS: ML algorithms can improve the efficiency of the SLR process and the proposed algorithms could reduce the workload of a second reviewer by identifying exclusions with a relevant PICOS reason, thus aligning with HTA guidance. Downsampling can be used to improve study selection, and improvements using full-text exclusions have implications for a learn-as-you-go approach.

Validation of a rapid, conservative transuranic alpha activity estimation method in air samples.

In air filter assay for radiological emergency response, radon (222Rn) and thoron (220Rn) progeny are known interferents to transuranic activity estimation. Previous work detailed a conservative, graded approach for TRU alpha activity estimation from air samples void of transuranic activity yet containing varying amounts of radon and thoron progeny. Validation of this method to produce rapid, conservative and defensible transuranic alpha activity estimates was accomplished through introduction of surrogate transuranic activity, 239Pu and 230Th check sources, along with the naturally occurring radioactive progeny from an environmental air filter. Following air collection, the filter was centre hole-punched with the transuranic check source placed underneath the filter during counting. With the surrogate transuranic activity introduced into the measurement, verification of the previously studied methodology for rapid transuranic activity estimation was determined with quantifiable conservative bias. 70 environmental filters with various levels of radon progeny and air sampling duration were collected; 35 examined with the 239Pu check source and 35 studied with the 230Th check source. To characterise the expected transuranic activity introduced to the counting experiment without the environmental interferents of radon and thoron progeny, 30 blank filters were counted using the described experimental setup with each of the respective surrogate sources. Following characterisation of the sources with blank filters, transuranic activity estimation comparison against the 70 environmental filters with natural background radioactive progeny interferents was accomplished. This work contributes to the comprehensive analysis of operational air samples by detailing validation results for a rapid and conservative transuranic alpha activity estimation methodology.

Preliminary Work Toward a Transuranic Activity Estimation Method for Rapid Discrimination of Anthropogenic from Transuranic Activity in Alpha Air Samples.

Radon (Rn) and thoron (Rn) progeny (primarily bismuth and polonium) are known interferents when rapid evaluation of transuranic content on air filters is of interest. These complexities stem from the overlapping energies of the progeny alpha particles onto the transuranic region of interest (3-5.5 MeV) where naturally-occurring alpha emitters can overwhelm the spectra. Due to the immediacy of the alpha counting methods employed, coupled with the half-life of thoron progeny dominated by Pb (t1/2=10.6 h), a conservative transuranic activity estimate with rigorous uncertainty is being sought. A successful transuranic activity estimation method will incorporate any thoron progeny present on the filter providing 95% confidence decision levels in which a filter may be evaluated for emergency response applications. Twenty-three pairs of samples of various duration having no transuranic content were taken over a 2-mo period. The resulting filters were counted in a time series before non-linear least squares decay curve fitting was applied to the decay profile. For the samples considered, a transuranic activity estimator decision level was determined at 0.2 Bq for the given geographic location and months analyzed. Validation of this method for other seasonal and geographic regions could provide enhanced emergency response capability when the presence of transuranic activity is suspected.

Improving physical and mental health in frontline mental health care providers: Yoga-based stress management versus cognitive behavioral stress management.

The need for brief, low-cost, easily disseminable and effective interventions to promote healthy lifestyles is high. This is especially true for mental health providers. We developed two studies to compare the impacts of Cognitive Behavioral Stress Management (CBSM) and Yoga Based Stress Management (YBSM) interventions for healthcare professionals. Study 1 offered an 8-week YBSM intervention to 37 mental healthcare participants and collected health data pre and post. Study 2 offered YBSM and CBSM classes to 40 randomly assigned mental healthcare providers and collected mental and physical health data at four time points. In Study 1, using t-tests, the YBSM intervention affected a number of mental and physical wellbeing indices pre to post. In Study 2, using linear mixed modeling, both YBSM and CBSM groups improved significantly (p <.05) in fruit and vegetable intake, heart rate, alcohol consumption, relaxation and awareness, professional quality of life, compassion satisfaction, burnout, depression, and stress levels. There was a group by time effect for coping confidence (CBSM increased more, p<.05, F = 4.34), physical activity (YBSM increased more, p<.05, F = 3.47), overall mental health (YBSM increased more, p<.10, F =5.32), and secondary traumatic stress (YBSM decreased more, p<.10, F = 4.89). YBSM and CBSM appear to be useful for healthcare professionals' mental and physical health. YBSM demonstrates some benefit above and beyond the extremely well-studied and empirically supported CBSM, including increased physical activity, overall mental health, and decreased secondary traumatic stress benefits.

Network meta-analysis of longitudinal data using fractional polynomials.

Network meta-analysis of randomized controlled trials (RCTs) are often based on one treatment effect measure per study. However, many studies report data at multiple time points. Furthermore, not all studies measure the outcomes at the same time points. As an alternative to a network meta-analysis based on a synthesis of the results at one time point, a network meta-analysis method is presented that allows for the simultaneous analysis of outcomes at multiple time points. The development of outcomes over time of interventions compared in an RCT is modeled with fractional polynomials, and the differences between the parameters of these polynomials within a trial are synthesized across studies with a Bayesian network meta-analysis. The proposed models are illustrated with an analysis of RCTs evaluating interventions for osteoarthritis of the knee. Fixed and random effects second order fractional polynomials were applied to the case study. Network meta-analysis with models that represent the treatment effects in terms of several parameters using fractional polynomials can be considered a useful addition to models for network meta-analysis of repeated measures previously proposed. When RCTs report treatment effects at multiple follow-up times, these models can be used to synthesize the results even if reporting times differ across the studies.

Gabapentin in the treatment of post-dural puncture headache: a case series.

Gabapentin has been reported to be useful in the management of epilepsy, neuropathic pain and post-dural puncture headache. Seventeen obstetric cases are presented in which gabapentin was used either as a primary therapy for the management of severe headache following a diagnosed dural puncture or as an analgesic adjunct in patients with dural puncture headache unresponsive to epidural blood patch. In our patients, analgesic therapy was essential to enable care of their newborns as other management options had failed or were unavailable. In nine patients we observed an excellent result with reduction of headache severity within 24 hours. Gabapentin appears potentially beneficial in the management of patients with post-dural puncture headaches.

Evaluation of novel particles as an inhalation system for GLP-1.

AIM: The feasibility of administering native glucagon-like peptide 1 (GLP-1) as GLP-1 Technosphere Inhalation Powder for diabetes therapy has been demonstrated in a rat model. METHODS: GLP-1 Technosphere Inhalation Powders containing 5, 10 and 15% GLP-1 were prepared and administered to healthy female Sprague-Dawley rats and to male Zucker diabetic obese rats. Rats received a single dose of GLP-1 Technosphere Powder by pulmonary insufflation. GLP-1 pharmacokinetic and pharmacodynamic responses were measured. RESULTS: Maximum circulating GLP-1 concentrations were achieved at approximately 10 min after dosing with detectable levels at 40 min. In a food consumption study, Sprague-Dawley rats receiving GLP-1 Technosphere Powder once-daily consumed less food than control rats for up to 24 h after dosing. Cumulative food consumption was decreased approximately 10% after 78 h. In an intraperitoneal glucose tolerance test, Zucker diabetic fatty rats receiving 2 mg GLP-1 Technosphere Powder (0.3 mg GLP-1) by pulmonary insufflation exhibited lower glucose concentrations and higher insulin concentrations than control rats. Pancreatic evaluations showed no differences in apoptotic index or cell proliferation of beta-cells. In addition, a dose-related increase in insulin expression within the pancreas was observed. CONCLUSIONS: These data demonstrate the feasibility of administering native GLP-1 as GLP-1 Technosphere Inhalation Powder for diabetes therapy.

Cardiac tamponade presenting to the emergency department after sternal wire disruption.

An unusual case of cardiac tamponade presenting to the emergency department is reported in a patient with sternal wire disruption after a pectus excavatum repair two years previously. The complication, although rare may have potentially life threatening sequelae and therefore consideration of sternal wire disruption in all patients presenting with chest pain after a previous sternotomy should be made.

Needs of the older patient in the intensive care unit following heart surgery.

Cardiac surgery among older people is becoming commonplace in Australia. However, there is little evidence that critical care nursing management has addressed the unique needs of this patient population during the postoperative recovery stage. Their specific physiologic and psychological differences identify them as having particular needs in regard to nursing care. For many years, cardiac patients were carefully screened and only those who had reduced risk factors were considered for surgery. Now there are increasing referrals of older patients with a range of conditions and increased risk factors. These people present with more difficult surgical problems and tend to have a complicated postoperative period. As a result they are proving to be a clinical management challenge. In light of the evidence presented, clear examination of the unique needs of the very elderly during the immediate postoperative phase is suggested to provide the basis for a comprehensive overhaul of patient management with positive implications for standards of care.

Host feeding of mosquitoes (Diptera: Culicidae) associated with the recurrence of Rift Valley fever in Egypt.

In 1993, Rift Valley fever (RVF) virus reappeared in Egypt. We determined the prevalence and feeding patterns of mosquitoes in 5 villages where the virus was active. Of 10 species recovered, Aedes caspius (Pallas), Culex pipiens L., Cx. antennatus (Becker), and Cx. perexiguus Theobald constituted 99% of > 35,000 mosquitoes captured in dry ice-baited CDC light traps. Ae. caspius was most prevalent, except at Nag' El Hagar where it was replaced by Cx. perexiguus. Cx. pipiens ranked 2nd, except at Nag' El Ghuneimiya, where it was replaced by Cx. antennatus. Most blood meals analyzed by an enzyme-linked immunosorbent assay reacted to > or = 1 antiserum. Cx. pipiens was mainly anthropophagic, and therefore may have been the main vector of RVF virus among humans. Ae. caspius feeds were chiefly from humans, bovines, and equines. Cx. antennatus and Cx. perexiguus fed generally on bovines. Mixed blood meals from humans and RVF virus susceptible animals were identified in the predominant mosquitoes. Prevalence and host selection, as well as predicted probability for a blood meal being interrupted, indicated that Ae. caspius may have served as a bridge vector between humans and bovines in 4 of the villages. Cx. perexiguus may have played this role at Nag' El Hagar. Because potential vectors are abundant, susceptible domestic animals are associated closely with humans, and surveillance of imported livestock is not systematic, we conclude that RVF virus sporadically will recur in Egypt.

Epidemic dengue 2 in the city of Djibouti 1991-1992.

From October 1991 to February 1992, an outbreak of acute fever (in which thick blood films were negative for malaria) spread rapidly in the city of Djibouti, Djibouti Republic, affecting all age groups and both nationals and foreigners. The estimated number of cases was 12,000. The clinical features were consistent with a non-haemorrhagic dengue-like illness. Serum samples from 91 patients were analysed serologically for flavivirus infection (dengue 1-4, West Nile, yellow fever, Zika, Banzi, and Uganda-S), and virus isolation was attempted. Twelve strains of dengue 2 virus were isolated. Dengue infection was confirmed by a 4-fold or greater rise in immunoglobulin (Ig) G antibody in paired serum specimens, the presence of IgM antibody, or isolation of the virus. Overall, 46 of the suspected cases (51%) were confirmed virologically or had serological evidence of a recent flavivirus infection. Statistical analysis showed that the presence of a rash was the best predictor of flavivirus seropositivity. In November 1992, Aedes aegypti was widespread and abundant in several districts of Djibouti city. A serological study of serum samples collected from Djiboutian military personnel 5 months before the epidemic showed that only 15/177 (8.5%) had flavivirus antibodies. These findings, together with a negative serosurvey for dengue serotypes 1-4 and yellow fever virus performed in 1987, support the conclusion that dengue 2 virus has only recently been introduced to Djibouti.