Entia Non Sunt Multiplicanda … Shall I look for clusters in my cognitive data?

Unsupervised clustering methods are increasingly being applied in psychology. Researchers may use such methods on multivariate data to reveal previously undetected sub-populations of individuals within a larger population. Realistic research scenarios in the cognitive science may not be ideally suited for a successful use of these methods, however, as they are characterized by modest effect sizes, limited sample sizes, and non-orthogonal indicators. This combination of characteristics even presents a high risk of detecting non-existing clusters. A systematic review showed that, among 191 studies published in 2016–2020 that used different clustering methods to classify human participants, the median sample size was only 322, and a median of 3 latent classes/clusters were detected. None of them concluded in favor of a one-cluster solution, potentially giving rise to an extreme publication bias. Dimensionality reduction techniques are almost never used before clustering. In a subsequent simulation study, we examined the performance of popular clustering techniques, including Gaussian mixture model, a partitioning, and a hierarchical agglomerative algorithm. We focused on their ability to detect the correct number of clusters, and on their classification accuracy. Under a reasoned set of scenarios that we considered plausible for the cognitive research, none of the methods adequately discriminates between one vs two true clusters. In addition, non-orthogonal indicators lead to a high risk of incorrectly detecting multiple clusters where none existed, even in the presence of only modest correlation (a frequent case in psychology). In conclusion, it is hard for researchers to be in a condition to achieve a valid unsupervised clustering for inferential purposes with a view to classifying individuals

Combined NMDA Inhibitor Use in a Patient With Multisubstance-induced Psychotic Disorder

This document is an Accepted Manuscript reprinted from Journal of Addiction Medicine, Vol. 12 (3): 247-251, May 2018, with permission of Kluwer Law International. Under embargo until 1 May 2019. The Version of Record is available online at DOI: https://doi.org/10.1097/ADM.0000000000000390: Novel psychoactive substance use is a major social concern. Their use may elicit or uncover unpredictably as yet undescribed clinical pictures. We aimed to illustrate a multisubstance use case indistinguishable from paranoid schizophrenia, so to alert clinicians on possibly misdiagnosing substance-induced psychotic disorders. CASE REPORT: We describe a case of a 32-year-old man who started at 18 years with cannabinoids and ketamine, and is currently using N-methyl-D-aspartate (NMDA) antagonists. At age 23, he developed social withdrawal after being assaulted by a stranger, but did not consult psychiatrists until age 26; during this period, he was using internet-purchased methoxetamine and ketamine, and was persecutory, irritable, suspicious, and insomniac and discontinued all received medical prescriptions. He added dextromethorphan to his list of used substances. At age 31, while using phencyclidine, and, for the first time, methoxphenidine, he developed a religious delusion, involving God calling him to reach Him, and the near-death experiences ensured by NMDA antagonists backed his purpose. He received Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnosis of multisubstance-induced psychotic disorder and was hospitalized 8 times, 6 of which after visiting the emergency room due to the development of extreme anguish, verbal and physical aggression, and paranoia. He reportedly used methoxphenidine, methoxyphencyclidine, ethylnorketamine, norketamine, and deschlorketamine, to achieve near-death experiences, and eventually to reach God in heavens. CONCLUSIONS: This case points to the need for better control of drugs sold on the internet. It also illustrates that people using NMDA antagonists may present clinical pictures indistinguishable from those of major psychoses and are likely to be misdiagnosed.Peer reviewe

Joint analysis of the intention to vaccinate and to use contact tracing app during the COVID-19 pandemic

Pharmacological and non-pharmacological measures will overlap for a period after the onset of the pandemic, playing a strong role in virus containment. We explored which factors influence the likelihood to adopt two different preventive measures against the COVID-19 pandemic. An online snowball sampling (May–June 2020) collected a total of 448 questionnaires in Italy. A Bayesian bivariate Gaussian regression model jointly investigated the willingness to get vaccinated against COVID-19 and to download the national contact tracing app. A mixed-effects cumulative logistic model explored which factors affected the motivation to adopt one of the two preventive measures. Despite both COVID-19 vaccines and tracing apps being indispensable tools to contain the spread of SARS-CoV-2, our results suggest that adherence to the vaccine or to the national contact tracing app is not predicted by the same factors. Therefore, public communication on these measures needs to take in consideration not only the perceived risk associated with COVID-19, but also the trust people place in politics and science, their concerns and doubts about vaccinations, and their employment status. Further, the results suggest that the motivation to comply with these measurements was predominantly to protect others rather than self-protection

Improvement of Tuberculosis Laboratory Capacity on Pemba Island, Zanzibar: A Health Cooperation Project.

Low-income countries with high Tuberculosis burden have few reference laboratories able to perform TB culture. In 2006, the Zanzibar National TB Control Programme planned to decentralize TB diagnostics. The Italian Cooperation Agency with the scientific support of the "L. Spallanzani" National Institute for Infectious Diseases sustained the project through the implementation of a TB reference laboratory in a low-income country with a high prevalence of TB. The implementation steps were: 1) TB laboratory design according to the WHO standards; 2) laboratory equipment and reagent supplies for microscopy, cultures, and identification; 3) on-the-job training of the local staff; 4) web- and telemedicine-based supervision. From April 2007 to December 2010, 921 sputum samples were received from 40 peripheral laboratories: 120 TB cases were diagnosed. Of all the smear-positive cases, 74.2% were culture-positive. During the year 2010, the smear positive to culture positive rate increased up to 100%. In March 20, 2010 the Ministry of Health and Social Welfare of Zanzibar officially recognized the Public Health Laboratory- Ivo de Carneri as the National TB Reference Laboratory for the Zanzibar Archipelago. An advanced TB laboratory can represent a low cost solution to strengthen the TB diagnosis, to provide capacity building and mid-term sustainability

Demographic and socio-economic determinants of poor HIV-risk perception at first HIV diagnosis: analysis of the HIV Surveillance data, Italy 2010-2016

HIV infections in Italy has not undergone a substantial decline over recent years. For this reason, we analysed risk-factors and socio-economic indicators of HIV-risk perception in HIV surveillance data

Impact of Previous ART and of ART Initiation on Outcome of HIV-Associated Tuberculosis

Background. Combination antiretroviral therapy (cART) has progressively decreased mortality of HIV-associated tuberculosis .To date, however, limited data on tuberculosis treatment outcomes among coinfected patients who are not ART-naive at the time of tuberculosis diagnosis are available. Methods. A multicenter, observational study enrolled 246 HIV-infected patients diagnosed with tuberculosis, in 96 Italian infectious diseases hospital units, who started tuberculosis treatment. A polytomous logistic regression model was used to identify baseline factors associated with the outcome. A Poisson regression model was used to explain the effect of ART during tuberculosis treatment on mortality, as a time-varying covariate, adjusting for baseline characteristics. Results. Outcomes of tuberculosis treatment were as follows: 130 (52.8%) were successfully treated, 36 (14.6%) patients died in a median time of 2 months (range: 0–16), and 80 (32.6%) had an unsuccessful outcome. Being foreign born or injecting drug users was associated with unsuccessful outcomes. In multivariable Poisson regression, cART during tuberculosis treatment decreased the risk of death, while this risk increased for those who were not ART-naive at tuberculosis diagnosis. Conclusions. ART during tuberculosis treatment is associated with a substantial reduction of death rate among HIV-infected patients. However, patients who are not ART-naive when they develop tuberculosis remain at elevated risk of death

A critical appraisal on AIT in childhood asthma

Abstract: Allergen immunotherapy (AIT) is the only disease-modifying treatment approved for allergic rhinitis and allergic asthma and represents a suitable therapeutic option, especially in childhood, to modify the progression of respiratory allergic diseases. Starting from the previous \u201cgeneric class efect\u201d evaluation, as testifed by the numerous meta analyses, AIT is now considered a product-specifc pathogenic-oriented treatment. Background: AIT was empirically proposed more than one century ago in the subcutaneous form (SCIT), but the IgE-mediated mechanism of allergy was elucidated only after 50 years of clinical use of the treatment. The sublingual administration (SLIT) was developed during the 1980 ties, to achieve an improvement in safety and convenience. While SCIT is approved in the United States for the treatment of asthmatic patients with more than 12 years, so far few trials evaluated the clinical efcacy and safety of SLIT in children with allergic asthma, although the indications and some aspects remain unclear. Certainly, due to compliance problems, the age below 3 years may be reasonably considered a practical contraindication. Conclusions: Given that some specifc AIT products are efective and approved as drugs (AIFA, EMA, FDA), the use in children is still debated. Some aspects still need robust confrm: (a) the safety of AIT in asthma; (b) the optimal regimen of administration; (c) the role of AIT as preventative treatment for asthma development

PREVALÊNCIA DE COMPLICAÇÕES E ACIDENTES EM EXODONTIAS NO PÓS E TRANSOPERATÓRIO.

Tooth extractions are routine procedures in which complications and accidents can occur during and after their execution. Many of these cases are associated with factors such as the patient's age, incorrect technique, lack of planning and inadequate anamnesis. These accidents and complications are classified as unsatisfactory procedural developments and the most prevalent are alveolitis, root fracture, suture dehiscence, edema, oral communication, hemorrhage, trismus and bone fracture. The present work aims to report the prevalence of complications and accidents that occurred in the trans and post-operative period in surgeries carried out in the Dentistry course at the University Center of Serra Gaúcha (FSG). The research presents 26 patients undergoing 47 extractions in which complications and accidents will be reported in association with the variables age, technique used, teeth extracted, systemic condition (ASA) of the patient.As extrações dentárias são procedimentos rotineiros nos quais podem ocorrer complicações e acidentes durante e após a sua execução. Muitos destes casos estão associados a alguns fatores como idade do paciente, técnica incorreta, falta de planejamento e anamnese inadequada. Estes acidentes e complicações são classificados como evoluções de procedimentos de modo insatisfatório e os mais prevalentes são alveolite, fratura de raíz, deiscência de sutura, edema, comunicação bucosinusal, hemorragia, trismo e fratura óssea. O presente trabalho tem por objetivo relatar a prevalência de complicações e acidentes que ocorreram no período trans e pós operatório em cirurgias realizadas no curso de Odontologia do Centro Universitário da Serra Gaúcha (FSG). A pesquisa apresenta 26 pacientes submetidos a 47 exodontias em que serão relatadas as complicações e acidentes com associação as varíaveis idade, técnica usada, dentes extraído, condição sistémica (ASA) do paciente