Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting

The study presented here was performed in order to create a rule that identifies subjects at high risk for invasive candidiasis in the intensive care setting. Retrospective review and statistical modelling were carried out on 2,890 patients who stayed at least 4 days in nine hospitals in the USA and Brazil; the overall incidence of invasive candidiasis in this group was 3% (88 cases). The best performing rule was as follows: Any systemic antibiotic (days 1–3) OR presence of a central venous catheter (days 1–3) AND at least TWO of the following—total parenteral nutrition (days 1–3), any dialysis (days 1–3), any major surgery (days −7–0), pancreatitis (days −7–0), any use of steroids (days −7–3), or use of other immunosuppressive agents (days −7–0). The rate of invasive candidiasis among patients meeting the rule was 9.9%, capturing 34% of cases in the units, with the following performance: relative risk 4.36, sensitivity 0.34, specificity 0.90, positive predictive value 0.01, and negative predictive value 0.97. The rule may identify patients at high risk of invasive candidiasis. Results of this project were partially presented at Focus on Fungal Infections 14, New Orleans, LA, USA, 2004. Abstract no. 51.     

Harnessing innovative technologies to advance children's mental health: Behavioral parent training as an example

Disruptive behaviors of childhood are among the most common reasons for referral of children to mental health professionals. Behavioral parent training (BPT) is the most efficacious intervention for these problem behaviors, yet BPT is substantially underutilized beyond university research and clinic settings. With the aim of addressing this research-to-practice gap, this article highlights the considerable, but largely unrealized, potential for technology to overcome the two most pressing challenges hindering the diffusion of BPT: (1). The dearth of BPT training and supervision opportunities for therapists who work with families of children with disruptive behaviors; and (2). The failure to engage and retain families in BPT services when services are available. To this end, this review presents a theoretical framework to guide technological innovations in BPT and highlights examples of how technology is currently being harnessed to overcome these challenges. This review also discusses recommendations for using technology as a delivery vehicle to further advance the field of BPT and the potential implications of technological innovations in BPT for other areas of children's mental health are discussed.     

Outcome expectancy as a moderator of mental fatigue influence on cardiovascular response

Female undergraduates performed an easy (fatigue low) or difficult (fatigue high) scanning task and then were presented mental arithmetic problems with instructions that they would earn a high or low chance of winning a prize if they did as well as or better than 50% of those who had performed previously. As expected, blood pressure responses in the second work period rose or tended to rise with fatigue where the chance of winning was high. By contrast, the responses tended weakly to decline with fatigue where the chance of winning was low. The pressure findings support the suggestion of a recent fatigue analysis that success importance should moderate fatigue influence on CV responses to a challenge so long as fatigued performers view success as possible. They also conceptually replicate previous fatigue results and provide a special class of evidence that fatigue influence on CV response is mediated by effort.     

Self-reported prevalence and factors associated with nonadherence with glaucoma medications in veteran outpatients

Objective: The purpose of the current study was to determine the self-reported prevalence of and factors associated with nonadherence with glaucoma medications in veteran outpatients.Methods: This survey study was conducted at a Veterans Affairs (VA) clinic. A survey was administered to patients with glaucoma. We calculated the percentage of self-reported adherence with glaucoma medications in each patient. Logistic regression was used to assess whether patient characteristics and difficulties with using glaucoma medications were related to patients' reporting that they were <100% adherent with their glaucoma medications in the previous week.Results: The survey was completed by 141 patients (men, 91.5%; mean [SD] age, 70.22 [11.60] years [range, 37–93 years]; black race, 45.4%; white race, 44.0%; “other” or data unavailable, 10.6%). Nonwhite patients were significantly less adherent in the previous week than were white patients (27.0% vs 11.3%; P < 0.05). A total of 67.4% patients reported ≥1 difficulty in using their glaucoma medications. The 3 most commonly reported difficulties were “drops fall on cheek” (29.1%), “too many drops come out” (20.6%), and “hard to read print” (17.0%). A total of 19.1% of patients self-reported using <100% of their glaucoma medications in the previous week. The number of difficulties reported was significantly associated with reporting being <100% adherent in the previous week (P<0.05).Conclusion: In this small sample of VA patients with glaucoma, adherence to glaucoma medications could be improved, especially among those who reported difficulties using their medications and those who were nonwhite.     

Feasibility of using interpolated contours of targets and organs at risk in intensity‐modulated radiation therapy treatment planning for advanced‐stage nasopharyngeal carcinoma

To assess the dosimetric effect of using interpolated contours in planning intensity‐modulated radiation therapy (IMRT) for advanced T‐stage nasopharyngeal carcinoma. The present study focused on T3–T4 tumours where the proximity of targets to neurological organs poses a stringent test on the feasibility of such an approach. Contours of targets and organs were delineated on CT images of 2.5‐mm interval and a reference IMRT plan was generated. An investigative (INV) IMRT plan was then generated with the same planning protocol, but based on interpolated contours that replaced deleted contours on alternate slices. The reference and INV plans were compared. Regarding target coverage, all targets in the INV plans met the acceptance criteria except for the PTV in one case. Regarding organs, the mean dose to 1% volume of the brainstem and spinal cord in the INV plans were kept below their dose limits. No significant differences in the mean doses to others organs were found. Satisfactory target coverage and protection of critical organs to a degree similar to full‐scale contouring could be achieved with use of interpolated contours. The saving in manpower time for contouring is expected to significantly improve the throughput of the IMRT planning process.     

Colonoscopic withdrawal technique is associated with adenoma miss rates

BACKGROUND: Clinical studies have documented differences in detection rates of colorectal cancers and adenomas between experienced colonoscopists, the basis of which is unknown. The aim of this study was to determine whether colonoscopic withdrawal technique varies between 2 colonoscopists with known differences in adenoma detection rates. METHODS: Ten consecutive colonoscopic withdrawals by each of the 2 colonoscopists were videotaped and then assessed according to specific criteria by 4 experts blinded to who had performed the colonoscopies. RESULTS: Each of the 4 experts scored the colonoscopist with the lower miss rate significantly higher (p < 0.001) for each of 4 quality criteria: (1) examining the proximal sides of flexures, folds and valves, (2) cleaning and suctioning, (3) adequacy of distention, and (4) adequacy of time spent viewing. CONCLUSION: Higher quality colonoscopic withdrawal technique as determined by expert observers was associated with a colonoscopist with a previously documented lower miss rate for adenomas. Colonoscopic withdrawal technique should be subjected to further study and standards for withdrawal technique should be developed.     

The Transition to Adolescence: the Role of Gender and Stress in Problem Behavior and Competence

The differential change of boys and girls across pre-adolescence, early adolescence, and middle adolescence was examined. The participants were 259 children, their mothers, and their social studies teachers. The children completed a measure of internalizing problems and adults completed measures of the child's externalizing and internalizing problems and competence. Relative to girls, boys had more problems and less competence at pre-adolescence and/or less problems and more competence by mid-adolescence. A stressor, parental divorce, did not exacerbate the gender by developmental age period interaction. The differential vulnerability of boys and girls at different developmental periods is considered.     

Bioavailability of reduced nicotinamide-adenine-dinucleotide (NADH) in the central nervous system of the anaesthetized rat measured by laser-induced fluorescence spectroscopy

Drugs intended to increase wellness or quality of life ("lifestyle drugs") have gained popularity and/or importance over recent years. Biogenic substances like nicotinamide adenine dinucleotide (NADH) are supposed to increase the physical and intellectual performance without side-effects. NADH is an energy-delivering co-substrate in the respiratory chain. Clinical studies showed positive effects of peripherally given NADH in Morbus Parkinson and major depression. NADH can be measured by its fluorescence. In this study a pulsed N2-laser combined with a fibre-optic probe and photomultipliers was used to induce and measure NADH fluorescence in the rat cortex. The aims of the study were to assess the suitability of the laser-induced spectroscopy for in vivo and on-line measurement of NADH in neuroscience and the assessment of the central availability of NADH after peripheral administration. NADH (50 mg/kg) but not the precursor nicotinamide caused a significant rise of the NADH fluorescence intensity indicating an increase of the NADH concentration in the rat cortex. In conclusion, the results suggest that NADH given orally or intraperitoneally increases the amounts of NADH in the brain. The results may thus help to explain the clinical effects reported.