Cognitive Flexibility and Academic Performance in College Students with ADHD: An fMRI Study

Cognitive flexibility, or the ability to change behavior or cognitive action appropriately in response to context shifts, is crucial to college-level learning, as it is needed for solving problems that require a transfer of familiar knowledge to novel concepts. Cognitive flexibility is known to involve neural areas concentrated in the frontal lobes, such as the inferior and superior frontal gyri and the anterior cingulate cortex, but the activation of this network is typically weaker in the ADHD population. In academic settings, individuals with ADHD tend to perform below healthy peers, have lower GPAs, are more likely to be on academic probation, and have decreased motivation. While most of these downfalls are attributed to attentional deficits, no investigations have been done to assess any effects of cognitive flexibility on academic performance. Therefore, this study used the Wisconsin Card Sorting Task (WCST) in the fMRI to assess cognitive flexibility in college students with and without ADHD and compared task performance to academic performance to determine if there is any relationship. We found that the ADHD group presented more perseverative errors on the WCST, and this performance was negatively correlated to GPA, suggesting that cognitive flexibility deficits impair academic performance. We also observed decreased activation of the anterior cingulate cortex and inferior and superior frontal gyri in subjects with ADHD as compared to controls, suggesting a possible neural network involved in these behavioral deficits

Risk factors associated with heel pressure ulcer development in adult population: A systematic literature review

Aims The main aim of this systematic literature review was to identify risk factors for development of heel pressure ulcers and quantify their effect. Background Pressure ulcers remain one of the key patient safety challenges across all health care settings and heels are the second most common site for developing pressure ulcers after the sacrum. Design Quantitative systematic review. Methods Data sources: Electronic databases were searched for studies published between 1809 to March 2020 using keywords, Medical Subject Headings, and other index terms, as well as combinations of these terms and appropriate synonyms. Study eligibility criteria: Previous systematic literature reviews, cohort, case control and cross-sectional studies investigating risk factors for developing heel pressure ulcers. Only articles published in English were reviewed with no restrictions on date of publication. Participants: patients aged 18 years and above in any care setting. Study selection, data extraction, risk of bias and quality assessment were completed by two independent reviewers. Disagreements were resolved by discussion. Results Eleven studies met the eligibility criteria and several potential risk factors were identified. However, eligible studies were mainly moderate to low quality except for three high quality studies. Conclusions There is a paucity of high quality evidence to identify risk factors associated with heel pressure ulcer development. Immobility, diabetes, vascular disease, impaired nutrition, perfusion issues, mechanical ventilation, surgery, and Braden subscales were identified as potential risk factors for developing heel pressure ulcers however, further well-designed studies are required to elucidate these factors. Other risk factors may also exist and require further investigation

Evaluating the impact of a ward environment with 20 single occupancy rooms and two four-bedded bays on patient and staff experiences and outcomes in an acute NHS Trust: A mixed methods study protocol.

Introduction Traditionally, wards in acute care hospitals consist predominately of multi-occupancy bays with some single rooms. There is an increasing global trend towards a higher proportion of single rooms in hospitals, with the United Kingdom (UK) National Health Service (NHS) advocating for single room provision in all new hospital builds. There is limited evidence on the impact of a ward environment incorporating mostly single and some multi-occupancy bays on patient care and organisational outcomes. Methods and analyses This study will assess the impact of a newly designed 28-bedded ward environment, with 20 single rooms and two four-bedded bays, on patient and staff experiences and outcomes in an acute NHS Trust in East England. The study is divided into two work packages (WP) – WP1 is a quantitative data extraction of routinely collected patient and staff data, while WP2 is a mixed methods process evaluation consisting of one-to-one, in-depth, semi-structured interviews with staff, qualitative observations of work processes on the ward and a quantitative data evaluation of routinely collected process evaluation data from patients and staff. Ethics and dissemination Ethical approval was obtained from the UK Health Research Authority (IRAS ID: 334395). Study findings will be shared with key stakeholders, published in peer-reviewed high impact journals, and presented at relevant conferences. Strengths and Limitations of this Study • A multi-method study using innovative and interdisciplinary approaches to explore the impact of a new ward environment on patient and staff experiences and outcomes. • Using a mixed methods approach provides an opportunity to gain rich and meaningful data from patients and staff over three different clinical areas. • Study findings will inform future hospital design at the research setting and potentially, other NHS Trusts. • Being a single site study and the sampling technique in qualitative interviews may limit transferrability and applicability of study findings

A predictive model for identifying patients at risk of delayed transfer of care: a retrospective, cross-sectional study of routinely collected data

Background: Delays to the transfer of care from hospital to other settings represent a significant human and financial cost. This delay occurs when a patient is clinically ready to leave the inpatient setting but is unable to because other necessary care, support or accommodation is unavailable. The aim of this study was to interrogate administrative and clinical data routinely collected when a patient is admitted to hospital following attendance at the emergency department, to identify factors related to delayed transfer of care when the patient is discharged. We then used these factors to develop a predictive model for identifying patients at risk for delayed discharge of care. Methods: This is a single centre, retrospective, cross-sectional study of patients admitted to an English National Health Service university hospital following attendance at the emergency department between January 2018 and December 2020. Clinical information (e.g., NEWS scores), as well as administrative data that had significant associations with admissions that resulted in delayed transfers of care, were used to develop a predictive model using a mixed-effects logistic model. Detailed model diagnostics and statistical significance, including receiver operating characteristic analysis, were performed. Results: Three-year (2018-20) data were used; a total of 92,444 admissions (70%) were used for model development and 39,877 (30%) admissions for model validation. Age, gender, ethnicity, National Early Warning Score, Glasgow admission prediction score (GAPS), Index of Multiple Deprivation decile, arrival by ambulance and admission within the last year were found to have a statistically significant association with delayed transfers of care. The proposed eight-variable predictive model showed good discrimination with 79% sensitivity (95% confidence intervals: 79%, 81%), 69% specificity (95% CI: 68%, 69%) and 70% (95% confidence intervals: 69%, 70%) overall accuracy of identifying patients who experienced a delayed transfer of care. Conclusion: Several demographic, socio-economic and clinical factors were found to be significantly associated with whether a patient experiences a delayed transfer of care or not following an admission via the emergency department. An eight-variable model has been proposed, which is capable of identifying patients who experience delayed transfers of care with 70% accuracy. The eight-variable predictive tool calculates the probability of a patient experiencing a delayed transfer accurately at the time of admission

Measurement of gender and sexuality in the Adolescent Brain Cognitive Development (ABCD) study.

The Adolescent Brain Cognitive DevelopmentSM (ABCD) study is a longitudinal study of adolescent brain development and health that includes over 11,800 youth in the United States. The ABCD study includes broad developmental domains, and gender and sexuality are two of these with noted changes across late childhood and early adolescence. The Gender Identity and Sexual Health (GISH) workgroup recommends measures of gender and sexuality for the ABCD study, prioritizing those that are developmentally sensitive, capture individual differences in the experience of gender and sexuality, and minimize participant burden. This manuscript describes the gender and sexuality measures used in ABCD and provides guidance for researchers using these data. Data showing the utility of these measures and longitudinal trends are presented. Including assessment of gender and sexuality in ABCD allows for characterization of developmental trajectories of gender and sexuality, and the broad scope of ABCD data collection allows examination of identity development in an intersectional manner

Early adolescent gender diversity and mental health in the Adolescent Brain Cognitive Development study

BackgroundThere are known associations between mental health symptoms and transgender identity among adults. Whether this relationship extends to early adolescents and to gender domains other than identity is unclear. This study measured dimensions of gender in a large, diverse, sample of youth, and examined associations between diverse gender experiences and mental health.MethodsThe ABCD study is an ongoing, longitudinal, US cohort study. Baseline data (release 2.0) include 11,873 youth age 9/10 (48% female); and the 4,951 1-year follow-up visits (age 10/11; 48% female) completed prior to data release. A novel gender survey at the 1-year visit assessed felt-gender, gender noncontentedness, and gender nonconformity using a 5-point scale. Mental health measures included youth- and parent-reports.ResultsRoughly half a percent of 9/10-year-olds (n = 58) responded 'yes' or 'maybe' when asked, 'Are you transgender' at baseline. Recurrent thoughts of death were more prevalent among these youth compared to the rest of the cohort (19.6% vs. 6.4%, χ2  = 16.0, p < .001). At the 1-year visit, when asked about the three dimensions of gender on a 5-point scale, 33.2% (n = 1,605) provided responses that were not exclusively and totally aligned with one gender. Significant relationships were observed between mental health symptoms and gender diversity for all dimensions assessed.ConclusionsSimilar to adult studies, early adolescents identifying as transgender reported increased mental health symptoms. Results also point to considerable diversity in other dimensions of gender (felt-gender, gender noncontentedness, gender nonconformity) among 10/11-year-olds, and find this diversity to be related to critical mental health symptoms. These findings add to our limited understanding of the relationship between dimensions of gender and wellness for youth