Increasing compliance with wearing a medical device in children with autism

Health professionals often recommend the use of medical devices to assess the health, monitor the well-being, or improve the quality of life of their patients. Children with autism may present challenges in these situations as their sensory peculiarities may increase refusals to wear such devices. To address this issue, we systematically replicated prior research by examining the effects of differential reinforcement of other behavior (DRO) to increase compliance with wearing a heart rate monitor in 2 children with autism. The intervention increased compliance to 100% for both participants when an edible reinforcer was delivered every 90 s. The results indicate that DRO does not require the implementation of extinction to increase compliance with wearing a medical device. More research is needed to examine whether the reinforcement schedule can be further thinned

Atrial fibrillation is an independent predictor for in-hospital mortality in patients admitted with SARS-CoV-2 infection.

Background Atrial fibrillation (AF) is the most encountered arrhythmia and has been associated with worse in-hospital outcomes. Objective This study was to determine the incidence of AF in patients hospitalized with coronavirus disease 2019 (COVID-19) as well as its impact on in-hospital mortality. Methods Patients hospitalized with a positive COVID-19 polymerase chain reaction test between March 1 and April 27, 2020, were identified from the common medical record system of 13 Northwell Health hospitals. Natural language processing search algorithms were used to identify and classify AF. Patients were classified as having AF or not. AF was further classified as new-onset AF vs history of AF. Results AF occurred in 1687 of 9564 patients (17.6%). Of those, 1109 patients (65.7%) had new-onset AF. Propensity score matching of 1238 pairs of patients with AF and without AF showed higher in-hospital mortality in the AF group (54.3% vs 37.2%; P \u3c .0001). Within the AF group, propensity score matching of 500 pairs showed higher in-hospital mortality in patients with new-onset AF as compared with those with a history of AF (55.2% vs 46.8%; P = .009). The risk ratio of in-hospital mortality for new-onset AF in patients with sinus rhythm was 1.56 (95% confidence interval 1.42-1.71; P \u3c .0001). The presence of cardiac disease was not associated with a higher risk of in-hospital mortality in patients with AF (P = .1). Conclusion In patients hospitalized with COVID-19, 17.6% experienced AF. AF, particularly new-onset, was an independent predictor of in-hospital mortality

Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders

Background For patients with psychiatric illnesses remaining refractory to \u27tandard\u27 therapies, neurosurgical procedures may be considered. Guidelines for safe and ethical conduct of such procedures have previously and independently been proposed by various local and regional expert groups. Methods To expand on these earlier documents, representative members of continental and international psychiatric and neurosurgical societies, joined efforts to further elaborate and adopt a pragmatic worldwide set of guidelines. These are intended to address a broad range of neuropsychiatric disorders, brain targets and neurosurgical techniques, taking into account cultural and social heterogeneities of healthcare environments. Findings The proposed consensus document highlights that, while stereotactic ablative procedures such as cingulotomy and capsulotomy for depression and obsessive-compulsive disorder are considered \u27stablished\u27 in some countries, they still lack level I evidence. Further, it is noted that deep brain stimulation in any brain target hitherto tried, and for any psychiatric or behavioural disorder, still remains at an investigational stage. Researchers are encouraged to design randomised controlled trials, based on scientific and data-driven rationales for disease and brain target selection. Experienced multidisciplinary teams are a mandatory requirement for the safe and ethical conduct of any psychiatric neurosurgery, ensuring documented refractoriness of patients, proper consent procedures that respect patient\u27s capacity and autonomy, multifaceted preoperative as well as postoperative long-term follow-p evaluation, and reporting of effects and side effects for all patients. Interpretation This consensus document on ethical and scientific conduct of psychiatric surgery worldwide is designed to enhance patient safety

ECOPLAN-SE: Ruimtelijke analyse van ecosysteemdiensten in Vlaanderen, een Q-GIS plugin

ECOPLAN-SE is een ruimtelijk expliciete tool (QGIS) voor het beoordelen van de impact van landgebruikveranderingen op de levering van ecosysteemdiensten. De ontwikkeling van deze tool kadert in het het SBO-project “ECOPLAN” (Planning for Ecosystem Services). ECOPLAN ontwikkelt ruimtelijk expliciete informatie en instrumenten voor de beoordeling van ecosysteemdiensten. Het ontwerpt instrumenten voor de evaluatie van functionele ecosystemen als een kostenefficiënte strategie om de landgebruiksefficiëntie en milieukwaliteit te verbeteren. Het ontwikkelt open source eindproducten voor het identificeren, kwantificeren, waarderen, valideren en monitoren van ecosysteemdiensten. Deze producten kunnen door administraties en consultants worden ingezet in projectontwikkeling, kosten-baten analyses, milieueffecten rapportering, etc

The Effect of Chloroquine, Hydroxychloroquine and Azithromycin on the Corrected QT Interval in Patients with SARS-CoV-2 Infection

Background - The novel SARs-CoV-2 coronavirus is responsible for the global COVID-19 pandemic. Small studies have shown a potential benefit of chloroquine/hydroxychloroquine ± azithromycin for the treatment of COVID-19. Use of these medications alone, or in combination, can lead to a prolongation of the QT interval, possibly increasing the risk of Torsade de pointes (TdP) and sudden cardiac death. Methods - Hospitalized patients treated with chloroquine/hydroxychloroquine ± azithromycin from March 1st through the 23rd at three hospitals within the Northwell Health system were included in this prospective, observational study. Serial assessments of the QT interval were performed. The primary outcome was QT prolongation resulting in TdP. Secondary outcomes included QT prolongation, the need to prematurely discontinue any of the medications due to QT prolongation and arrhythmogenic death. Results - Two hundred one patients were treated for COVID-19 with chloroquine/hydroxychloroquine. Ten patients (5.0%) received chloroquine, 191 (95.0%) received hydroxychloroquine and 119 (59.2%) also received azithromycin. The primary outcome of TdP was not observed in the entire population. Baseline QTc intervals did not differ between patients treated with chloroquine/hydroxychloroquine (monotherapy group) vs. those treated with combination group (chloroquine/hydroxychloroquine and azithromycin) (440.6 ± 24.9 ms vs. 439.9 ± 24.7 ms, p =0.834). The maximum QTc during treatment was significantly longer in the combination group vs the monotherapy group (470.4 ± 45.0 ms vs. 453.3 ± 37.0 ms, p = 0.004). Seven patients (3.5%) required discontinuation of these medications due to QTc prolongation. No arrhythmogenic deaths were reported. Conclusions - In the largest reported cohort of COVID-19 patients to date treated with chloroquine/hydroxychloroquine {plus minus} azithromycin, no instances of TdP or arrhythmogenic death were reported. Although use of these medications resulted in QT prolongation, clinicians seldomly needed to discontinue therapy. Further study of the need for QT interval monitoring is needed before final recommendations can be made

The inland water macro-invertebrate occurrences in Flanders, Belgium

The Flanders Environment Agency (VMM) has been performing biological water quality assessments on inland waters in Flanders (Belgium) since 1989 and sediment quality assessments since 2000. The water quality monitoring network is a combined physico-chemical and biological network, the biological component focusing on macro-invertebrates. The sediment monitoring programme produces biological data to assess the sediment quality. Both monitoring programmes aim to provide index values, applying a similar conceptual methodology based on the presence of macro-invertebrates. The biological data obtained from both monitoring networks are consolidated in the VMM macro-invertebrates database and include identifications at family and genus level of the freshwater phyla Coelenterata, Platyhelminthes, Annelida, Mollusca, and Arthropoda. This paper discusses the content of this database, and the dataset published thereof: 282,309 records of 210 observed taxa from 4,140 monitoring sites located on 657 different water bodies, collected during 22,663 events. This paper provides some background information on the methodology, temporal and spatial coverage, and taxonomy, and describes the content of the dataset. The data are distributed as open data under the Creative Commons CC-BY license