Psychiatric emergencies during the height of the COVID-19 pandemic in the suburban New York City area.

BACKGROUND: This report characterizes patients presenting for psychiatric emergencies during the COVID-19 pandemic and describes COVID-19-related stressors. METHODS: Patients seen for emergency psychiatric evaluation during the height of the COVID-19 period (March 1-April 30, 2020; N = 201) were compared with those in the immediate Pre-COVID-19 period (January 1-February 28, 2020; N = 355), on sociodemographic characteristics, psychiatric diagnoses, symptoms, and disposition. Patients tested positive for COVID-19 were compared with those that tested negative on the same outcomes. Prevalence and nature of COVID-19-stressors that influenced the emergency presentation were rated. OUTCOME: The most common psychiatric diagnoses and presenting symptoms during both periods were depression and suicidal ideation. Comparing the Pre-COVID-19 and COVID-19 periods, a significant decline in emergency psychiatric volume was observed in children and adolescents (C/A), but not adults. COVID-19 period C/A patients had more new onset disorders and were more likely to be admitted to inpatient care, but were less likely to present with suicide attempts, impulse control disorders and agitation/aggression. Adults were more likely to have no access to outpatient care, present with anxiety disorders, and were also more likely to be admitted for inpatient care. COVID-19 directly affected the psychiatric emergency in 25% of patients, with the more severe stressors triggered by fear of COVID infection (including psychosis), actual COVID infection in self or family members, including death of a loved one. COVID-positive patients were more likely to have psychosis, including new-onset, and were less likely to be depressed/suicidal compared to their COVID-negative counterparts. CONCLUSION: This report demonstrates the need for emergency psychiatric services throughout the COVID-19 pandemic and the need for clinical and diagnostic COVID-19 screening of psychiatric emergency patients. New and severe pathology underscore the need for enhanced outpatient access to tele-mental health, crisis hotline and on-line psychotherapeutic services, as well as psychiatric inpatient services with capacity to safely care for COVID-19 patients.

Scalable growth of single-walled carbon nanotubes with a highly uniform structure.

Here, a scalable floating catalyst chemical vapor deposition (FCCVD) method is developed for the production of single-walled carbon nanotubes (SWCNTs) with a controlled structure. For the first time, water is used as the growth promoter in the FCCVD process to modulate the growth of SWCNTs. At an optimum water concentration of ca. 115 ppm, the water-assisted FCCVD process synthesizes SWCNTs with a significantly narrow chirality distribution. In particular, the proportion of (9,8) and (8,7) semiconducting tubes was dramatically enhanced to 45% with 27% of the (9,8) tube in the end product. This is attributed to the changes in both the SWCNT diameter and the chiral angle. The experiment results and accurate quantum chemical molecular dynamics simulations show that the addition of water affects the nucleation and the size distribution of nanoparticle catalysts, thus resulting in the growth of SWCNTs with a highly uniform structure. This direct and continuous water-assisted FCCVD provides the possibility for the mass production of high-quality SWCNTs with a controlled structure.

Coronary CT angiography by modifying tube voltage and contrast medium concentration: Evaluation of image quality and radiation dose.

BACKGROUND: Currently, there is an increasing interest in noninvasive imaging of cardiovascular system such as computed tomography coronary angiography (CCTA). The risks of radiation-induced cancer and contrast-induced nephropathy (CIN) have always been regarded as concerns which increased demand for CCTA using reduced radiation dose and iodine intake. We aimed to evaluate the image quality and radiation dose of CCTA by modifying tube voltage and concentration of contrast media. METHODS: The present study includes 105 patients who underwent CCTA for clinical indications. Specific inclusion and exclusion criteria in terms of patient's weight, body mass index, calcium score, and stenting were used. First group of patients scanned by 120 kV and 370 mg I/mL contrast medium, compared with second and third groups for which scanning was performed using 100 kV and 370 mg I/mL and 100 kV and 300 mg I/mL, respectively. Image quality was evaluated both subjectively and objectively. The effective dose and iodine intake were also measured. RESULTS: Using low kV protocols led to radiation dose reduction up to 38% and applying low contrast medium concentration with consequent reduced iodine intake up to 21%. Moreover, there were significant differences in image quality of new scanning protocols. CONCLUSION: Reduction in tube voltage with lowering of contrast medium concentration can reduce radiation dose and iodine intake with acceptable image quality.

Effect of different surface treatment on the shear bond strength of metal brackets to bleached and desensitized enamel.

INTRODUCTION: The aim of this study was to determine the effect of bleaching and desensitizing on shear bond strength (SBS) of metal brackets to enamel. METHODS: One hundred extracted human premolar were randomly assigned to 5 groups of 20. In the first group (control), no bleaching or desensitizing agent was used. Groups 2 to 5 were bleached with 37.5% hydrogen peroxide and desensitized with 6.0% potassium nitrate. Surface treatment comprised of etching for 15seconds in groups 1, 2 and 3, Er:yag laser irradiation and etching in group 4 and sandblasting and etching in group 5. Premolar brackets were bonded with Transbond XT and cured for 20seconds and the SBS was tested using a universal testing machine. Adhesive remnant index (ARI) score was used to record the mode of bond failure. RESULTS: No significant difference was found between the mean SBS (MPa) in groups 1(15.22), 4(14.02), and 5(12.62). SBS in group 4 was significantly higher than group 2 (8.15) (P<0.001). Also, SBS in groups 2 (P<0.001) and 3(11.74) (P=0.012) were significantly lower than group 1. An increased frequency of ARI score of 2 and 3 was observed in groups 1, 4 and 5. CONCLUSIONS: Bleaching plus desensitizing significantly decreased the SBS of orthodontic brackets. Delaying the bonding procedure for at least 2 weeks or alternative surface treatment methods such as combined laser and acid etching or combined sand blasting and acid etching can improve the SBS.

Catalyst Support Effect on the Activity and Durability of Magnetic Nanoparticles: toward Design of Advanced Electrocatalyst for Full Water Splitting.

Earth-abundant element-based inorganic-organic hybrid materials are attractive alternatives for electrocatalyzing energy conversion reactions. Such material structures do not only increase the surface area and stability of metal nanoparticles (NPs) but also modify the electrocatalytic performance. Here, we introduce, for the first time, multiwall carbon nanotubes (MWNTs) functionalized with nitrogen-rich emeraldine salt (ES) (denoted as ES-MWNT) as a promising catalyst support to boost the electrocatalytic activity of magnetic maghemite (γ-Fe2O3) NPs. The latter component has been synthesized by a simple and upscalable one-step pulsed laser ablation method on Ni core forming the core-shell Ni@γ-Fe2O3 NPs. The catalyst (Ni@γ-Fe2O3/ES-MWNT) is formed via self-assembly as strong interaction between ES-MWNT and Ni@γ-Fe2O3 results in NPs' encapsulation in a thin C-N shell. We further show that Ni does not directly function as an active site in the electrocatalyst but it has a crucial role in synthesizing the maghemite shell. The strong interaction between the NPs and the support improves notably the NPs' catalytic activity toward oxygen evolution reaction (OER) in terms of both onset potential and current density, ranking it among the most active catalysts reported so far. Furthermore, this material shows a superior durability to most of the current excellent OER electrocatalysts as the activity, and the structure, remains almost intact after 5000 OER stability cycles. On further characterization, the same trend has been observed for hydrogen evolution reaction, the other half-reaction of water splitting.

Using Predictive Model for Screening Bacterial Meningitis in National Surveillance System in Iran.

Bacterial meningitis is a dangerous infectious disease that the entire community can be influenced by its epidemics. The objective of this study is to develop a predictive model as a screening tool to accelerate distinguishing between patients with acute bacterial meningitis and non-bacterial ones to prevent bacterial meningitis epidemics in Iran. This study was conducted on Iranian meningitis registry, which consists of 7,945 suspected cases of the disease between 2009 and 2011. Each sample has 8 predictive and a target variables. The predictive model was developed by decision tree algorithm and, the overall accuracy was 78%, with a sensitivity of 87%, and a specificity of 70%, respectively. This model can help health policymakers and epidemiologists to identify bacterial meningitis outbreaks and support them to make a decision in infection dynamics. In conclusion, we developed and validated a predictive model that can be used in meningitis surveillance system in Iran. However, further research is needed to use the model in practice with different pathogen types of bacterial meningitis in order to proper antimicrobial therapy planning.

Gastaut-Geschwind Syndrome, Faciobrachial Dystonic Seizure, and Autoimmune Limbic Encephalitis.

Here we report a case of a 55-year-old male who had presented with recent falls and behavioral changes, including a heightened religious preoccupation, hypergraphia, and paranoid ideations. He was initially treated for psychosis but soon exhibited absence-like seizures, which were consistent with faciobrachial dystonic seizures. Workup for underlying infectious, immunodeficiency, and autoimmune causes revealed antibodies towards the leucine-rich glioma inactivated subunit of the voltage-gated potassium complex. The patient was treated with steroids and intravenous immune globulin with symptomatic relief. In retrospect, the patient met criteria for Gastaut-Geschwind (GG) syndrome, with notable features of hypergraphia and hyperreligiosity. This case illustrates how the GG syndromal pattern contributes to the suspicion of autoimmune limbic encephalitis and may expedite diagnosis and prevent the accumulation of disability.

Dosimetric and Radiobiological Evaluation of Multiparametric MRI-Guided Dose Painting in Radiotherapy of Prostate Cancer.

Radiotherapy is one of the treatment options for locally advanced prostate cancer; however, with standard radiation doses, it is not always very effective. One of the strategies to improve the efficiency of radiotherapy is increasing the dose. In this study, to increase tumor local control rates, a new radiotherapy method, known as dose painting (DP), was investigated. To compare 3-dimensional conformal radiotherapy (3D-CRT) and intensity modulated radiotherapy (IMRT) plans with DP for prostate cancer. Twenty-four consecutive patients with locally advanced prostate cancer who underwent an multiparametric-magnetic resonance imaging (MP-MRI) (T2w, diffusion weighted image, dynamic contrast enhancement, and MRS) scan before a diagnostic biopsy from September 2015 to April 2016 were invited to take part in this study. The tumor local control probability (TCP) values for 3D-CRT, IMRT, and DP techniques were 45, 56, and 77%, respectively. The DP technique had a 37.5 and 71% higher TCP than IMRT and 3D-CRT, and these differences were statistically significant (P = 0.001). The mean normal tissue complication probability (NTCP) values of the organ at risks for 3D-CRT, IMRT, and DP showed that there were statistically significant differences among them in three plans (P = 0.01). DP by contours using MP-MRI is technically feasible. This study evaluated biological modeling based on both MP-MRI defined subvolumes and pathologically defined subvolumes. The MP-MRI-guided DP results in better TCP/NTCP than 3D-CRT and IMRT.

Evaluation of blood lead level in methamphetamine users in Tehran.

BACKGROUND: Given the increasing number of lead poisoning in opioids users and since no study has been conducted so far to review lead poisoning in methamphetamine (crystal) users, this study aimed to investigate blood lead level in methamphetamine addicts. METHODS: This study was conducted on 20 patients with methamphetamine poisoning and their blood lead level was measured. The subjects were selected from among patients with a history of continuous use of methamphetamine, without a history of using opiates in the past 6 months confirmed by a negative urine tests, and without a history of heavy metal poisoning. RESULTS: Of all, 18 patients were male and the mean age was 32 ± 10 years; 17 patients were abusing the drug via inhalation and three persons via oral administration. The mean blood lead level was 2.3 ± 1.1 µg/dL and poisoning was not observed in any of the cases. Blood lead level was not associated with age, sex, dosage, and route of administration. CONCLUSION: Although blood lead level was not at poisoning level in people who only used methamphetamine in Iran, due to the simultaneous use of other substances and because of non-specific symptoms, lead poisoning must be suspected in all cases of substances poisoning.

Examining Asphaltene Solubility on Deposition in Model Porous Media.

Asphaltenes are known to cause severe flow assurance problems in the near-wellbore region of oil reservoirs. Understanding the mechanism of asphaltene deposition in porous media is of great significance for the development of accurate numerical simulators and effective chemical remediation treatments. Here, we present a study of the dynamics of asphaltene deposition in porous media using microfluidic devices. A model oil containing 5 wt % dissolved asphaltenes was mixed with n-heptane, a known asphaltene precipitant, and flowed through a representative porous media microfluidic chip. Asphaltene deposition was recorded and analyzed as a function of solubility, which was directly correlated to particle size and Péclet number. In particular, pore-scale visualization and velocity profiles, as well as three stages of deposition, were identified and examined to determine the important convection-diffusion effects on deposition.

Single-shell carbon-encapsulated iron nanoparticles: synthesis and high electrocatalytic activity for hydrogen evolution reaction.

Efficient hydrogen evolution reaction (HER) through effective and inexpensive electrocatalysts is a valuable approach for clean and renewable energy systems. Here, single-shell carbon-encapsulated iron nanoparticles (SCEINs) decorated on single-walled carbon nanotubes (SWNTs) are introduced as a novel highly active and durable non-noble-metal catalyst for the HER. This catalyst exhibits catalytic properties superior to previously studied nonprecious materials and comparable to those of platinum. The SCEIN/SWNT is synthesized by a novel fast and low-cost aerosol chemical vapor deposition method in a one-step synthesis. In SCEINs the single carbon layer does not prevent desired access of the reactants to the vicinity of the iron nanoparticles but protects the active metallic core from oxidation. This finding opens new avenues for utilizing active transition metals such as iron in a wide range of applications.

Caring for persons with early childhood trauma, PTSD, and HIV: a curriculum for clinicians.

Access and adherence to medical care enable persons with HIV to live longer and healthier lives. Adherence to care improves quality of life, prevents progression to AIDS, and also has significant public health implications. Early childhood trauma-induced posttraumatic stress disorder (PTSD) is one factor that has been identified as an obstacle to adherence to both risk reduction and HIV care. The authors developed a 4-h curriculum to provide clinicians with more confidence in their ability to elicit a trauma history, diagnose PTSD, and address trauma and its sequelae in persons with HIV to improve adherence to medical care, antiretroviral medications, and risk reduction. The curriculum was designed to address the educational needs of primary care physicians, infectious disease specialists, psychiatrists, other specialists, psychologists, social workers, nurses, residents, medical students, and other trainees who provide care for persons infected with and affected by HIV.

Depression and fatigue in chronic hepatitis C patients with and without HIV co-infection.

BACKGROUND: Depression and fatigue are common in chronic hepatitis C (CHC). OBJECTIVE: We report clinical predictors of these conditions in patients seen in a university clinic. METHODS: A total of 167 CHC patients completed the Patient Health Questionnaire-9 (PHQ-9) and Fatigue Severity Scale (FSS). Major depressive disorder (MDD) suggested by PHQ-9 was confirmed by clinical interview. FSS scores ≥41 were considered clinically significant fatigue. Logistic and multiple regression models were employed for analysis. RESULTS: Thirty-three percent of patients had MDD and 52% had clinically significant fatigue. Sixty-one percent were HIV-infected, among whom both MDD and clinically significant fatigue were significantly less prevalent (OR = 0.47 and 0.46, respectively). MDD was least common in patients without a history of IV drug use (OR = 0.28), and highest in methadone users (OR = 3.57). Compared with methadone users, patients with no history of IV drug use and former IV drug users had less severe fatigue (coefficients = -31.0, -34.0, respectively). Lack of a history of hepatitis treatment was also associated with less severe fatigue (coefficient= -7.6). CONCLUSION: Our study confirms high prevalence of fatigue and depression in CHC. HIV-positivity was associated with lower rates of MDD and clinically significant fatigue, arguably due to support systems for people living with HIV. Higher rates of depression in methadone users might be due to intrinsically higher rates of psychopathology in this group. Being on hepatitis treatment was associated with higher rates of fatigue, probably due to the adverse effects of interferon. Our findings emphasize the importance of routine screening and evaluation of depression and fatigue in CHC populations.

Evaluation of Cone Beam Computed Tomography (CBCT) System: Comparison with Intraoral Periapical Radiography in Proximal Caries Detection.

BACKGROUND AND AIMS: With the introduction of Cone Beam Computed Tomography (CBCT) in dentistry, a question has been raised whether the technique significantly increases the diagnostic accuracy in comparison with other techniques or not. Therefore, the present study was undertaken to assess the accuracy of CBCT modality in detecting proximal carious lesions as compared to conventional periapical radiographs. MATERIALS AND METHODS: This diagnostic study was carried out on 84 human extracted molars and premolars. The teeth were mounted and divided in 28 blocks of 3 teeth. Periapical and CBCT images of teeth were obtained. Five observers scored the images for the detection of proximal carious lesions using a 2-point scale (caries, present; caries, absent). The gold standard was determined by histopathologic sections. Sensitivity, specificity, PPV, NPV and receiver operating charac-teristics (ROC) curves were traced for observers in both systems. The results were analyzed by paired t-test. RESULTS: The area under the ROC curve, sensitivity, specificity, accuracy, positive and negative predictive values of CBCT images were 0.568, 0.835, 0.637, 0.714, 0.598 and 0.856, respectively. These parameters were 0.432, 0.837, 0.722, 0.77, 0.687 and 0.858 for the periapical conventional technique, respectively. CONCLUSION: The CBCT images did not enhance detection of proximal caries in comparison with periapical images.

Bias in observational studies of prevalent users: lessons for comparative effectiveness research from a meta-analysis of statins.

Randomized clinical trials (RCTs) are usually the preferred strategy with which to generate evidence of comparative effectiveness, but conducting an RCT is not always feasible. Though observational studies and RCTs often provide comparable estimates, the questioning of observational analyses has recently intensified because of randomized-observational discrepancies regarding the effect of postmenopausal hormone replacement therapy on coronary heart disease. Reanalyses of observational data that excluded prevalent users of hormone replacement therapy led to attenuated discrepancies, which begs the question of whether exclusion of prevalent users should be generally recommended. In the current study, the authors evaluated the effect of excluding prevalent users of statins in a meta-analysis of observational studies of persons with cardiovascular disease. The pooled, multivariate-adjusted mortality hazard ratio for statin use was 0.77 (95% confidence interval (CI): 0.65, 0.91) in 4 studies that compared incident users with nonusers, 0.70 (95% CI: 0.64, 0.78) in 13 studies that compared a combination of prevalent and incident users with nonusers, and 0.54 (95% CI: 0.45, 0.66) in 13 studies that compared prevalent users with nonusers. The corresponding hazard ratio from 18 RCTs was 0.84 (95% CI: 0.77, 0.91). It appears that the greater the proportion of prevalent statin users in observational studies, the larger the discrepancy between observational and randomized estimates.

Prognosis of traumatic injuries to the anterior teeth (treated in shahid beheshti and tehran dental schools during 1996-2001).

INTRODUCTION: Traumatic injuries to the teeth are among the most serious dental accidents, with the anterior teeth being mostly affected. Some consequences of dental trauma include misshaping, speech defects, psychological and social effects. The knowledge of the field can reduce the suffering, cost, and the time for patients, parents, and health care providers. The aim of this study was to investigate the treatment prognosis of anterior traumatized teeth in patients referred to Endodontics and pediatrics Departments of Shahid Behesthi and Tehran Dental Schools during 1996-2001. MATERIALS AND METHODS: Fifty patients participated in this descriptive study. All affected by trauma to the teeth and completing the proposed treatment. Retrospective data, based on trauma forms as well as the clinical notes a questionnaire prepared for the study and analyzed in terms of age, gender, the type of trauma and etiology. RESULTS: Eighty four percent of the studied traumatized teeth were maxillary centrals. Falling-outs are most frequent cause of the traumas (56.5%), followed by sport and play events (30.4%). Enamel- dentin fractures with and without pulpal involvement were the most prevalent trauma types. Most of the selected treatment procedures were involved with pulp and periapical areas. CONCLUSION: Based on the finding of the study, the prognosis of traumatized anterior teeth in patients referred to the studied centers was estimated to be good.