Poor specificity of National Early Warning Score (NEWS) in spinal cord injuries (SCI) population: a retrospective cohort study

Study design: Retrospective chart audit. Objectives: The National Early Warning Score (NEWS) is based on seven physiological parameters which can be altered in some individuals with spinal cord injuries (SCI). The aim was to start the development of adapted NEWS suitable for SCI population. The objective was to determine the SBP NEWS specificity based on neurological level of injury (NLI) and completeness of injury. Setting: Tertiary centre in the UK. Methods: Adult patients admitted for the first time to the National Spinal Injuries Centre between 1st January 2015 and 31st December 2016 were included if they were > 6 months post-injury. Data were extracted retrospectively including the last ten consecutive BP and heart rate readings before discharge. Data were analysed based on different AIS grades, completeness of injury and NLI. Results: 191 patients were admitted in 2015 and 2016 and 142 patients were included in the primary analysis. The mean SBP ranged between 92 and 151 mmHg. Patients with the NLI of T6 and above (≥ T6) motor complete lesions had a significantly lower SBP than motor incomplete lesions. The specificity of the SBP NEWS was 35.3% in ≥ T6 motor complete individuals versus 80.3 % in ≥ T6 motor incomplete individuals. Conclusion: The baseline BP is significantly lower in the ≥ T6 motor complete SCI individuals (> 6 months post-injury) resulting in a very low specificity of 35.3 % to SBP NEWS which could lead to mismatch between clinical deterioration and NEWS resulting in lack of timely clinical response

The application of physiologically based pharmacokinetic modelling to assess the impact of antiretroviral-mediated drug-drug interactions on piperaquine antimalarial therapy during pregnancy

Antimalarial therapy during pregnancy poses important safety concerns due to potential teratogenicity and maternal physiological and biochemical changes during gestation. Piperaquine (PQ) has gained interest for use in pregnancy in response to increasing resistance towards sulfadoxine-pyrimethamine in sub-Saharan Africa. Coinfection with HIV is common in many developing countries, however, little is known about the impact of antiretroviral (ARV) mediated drug-drug interaction (DDI) on piperaquine pharmacokinetics during pregnancy. This study applied mechanistic pharmacokinetic modelling to predict pharmacokinetics in non-pregnant and pregnant patients, which was validated in distinct customised population groups from Thailand, Sudan and Papua New Guinea. In each population group, no significant differences in day 7 concentrations were observed during different gestational weeks (GW) (weeks 10-40), supporting the notion that piperaquine is safe throughout pregnancy with consistent pharmacokinetics, although possible teratogenicity may limit this. Antiretroviral-mediated DDIs (efavirenz and ritonavir) had moderate effects on piperaquine during different gestational weeks with a predicted AUCratioin the range 0.56-0.8 and 1.64-1.79 for efavirenz and ritonavir, respectively, over GW 10-40, with a reduction in circulating human serum albumin significantly reducing the number of subjects attaining the day 7 (post-dose) therapeutic efficacy concentrations under both efavirenz and ritonavir DDIs. This present model successfully mechanistically predicted the pharmacokinetics of piperaquine in pregnancy to be unchanged with respect to non-pregnant women, in the light of factors such as malaria/HIV co-infection. However, antiretroviral-mediated DDIs could significantly alter piperaquine pharmacokinetics. Further model refinement will include collation of relevant physiological and biochemical alterations common to HIV/malaria patients

Differences in Nutrient Requirements Imply a Non-Linear Emergence of Leaders in Animal Groups

Collective decision making and especially leadership in groups are among the most studied topics in natural, social, and political sciences. Previous studies have shown that some individuals are more likely to be leaders because of their social power or the pertinent information they possess. One challenge for all group members, however, is to satisfy their needs. In many situations, we do not yet know how individuals within groups distribute leadership decisions between themselves in order to satisfy time-varying individual requirements. To gain insight into this problem, we build a dynamic model where group members have to satisfy different needs but are not aware of each other's needs. Data about needs of animals come from real data observed in macaques. Several studies showed that a collective movement may be initiated by a single individual. This individual may be the dominant one, the oldest one, but also the one having the highest physiological needs. In our model, the individual with the lowest reserve initiates movements and decides for all its conspecifics. This simple rule leads to a viable decision-making system where all individuals may lead the group at one moment and thus suit their requirements. However, a single individual becomes the leader in 38% to 95% of cases and the leadership is unequally (according to an exponential law) distributed according to the heterogeneity of needs in the group. The results showed that this non-linearity emerges when one group member reaches physiological requirements, mainly the nutrient ones – protein, energy and water depending on weight - superior to those of its conspecifics. This amplification may explain why some leaders could appear in animal groups without any despotism, complex signalling, or developed cognitive ability

Sicily statement on classification and development of evidence-based practice learning assessment tools

<p>Abstract</p> <p>Background</p> <p>Teaching the steps of evidence-based practice (EBP) has become standard curriculum for health professions at both student and professional levels. Determining the best methods for evaluating EBP learning is hampered by a dearth of valid and practical assessment tools and by the absence of guidelines for classifying the purpose of those that exist. Conceived and developed by delegates of the Fifth International Conference of Evidence-Based Health Care Teachers and Developers, the aim of this statement is to provide guidance for purposeful classification and development of tools to assess EBP learning.</p> <p>Discussion</p> <p>This paper identifies key principles for designing EBP learning assessment tools, recommends a common taxonomy for new and existing tools, and presents the Classification Rubric for EBP Assessment Tools in Education (CREATE) framework for classifying such tools. Recommendations are provided for developers of EBP learning assessments and priorities are suggested for the types of assessments that are needed. Examples place existing EBP assessments into the CREATE framework to demonstrate how a common taxonomy might facilitate purposeful development and use of EBP learning assessment tools.</p> <p>Summary</p> <p><it>The widespread adoption of EBP into professional education requires valid and reliable measures of learning. Limited tools exist with established psychometrics. This international consensus statement strives to provide direction for developers of new EBP learning assessment tools and a framework for classifying the purposes of such tools</it>.</p

The Activities of Current Antimalarial Drugs on the Life Cycle Stages of Plasmodium: A Comparative Study with Human and Rodent Parasites

Michael Delves and colleagues compare the activity of 50 current and experimental antimalarials against liver, sexual blood, and mosquito stages of selected human and nonhuman parasite species, including Plasmodium falciparum, Plasmodium berghei, and Plasmodium yoelii

A Program for At-Risk High School Students Informed by Evolutionary Science

Improving the academic performance of at-risk high school students has proven difficult, often calling for an extended day, extended school year, and other expensive measures. Here we report the results of a program for at-risk 9th and 10th graders in Binghamton, New York, called the Regents Academy that takes place during the normal school day and year. The design of the program is informed by the evolutionary dynamics of cooperation and learning, in general and for our species as a unique product of biocultural evolution. Not only did the Regents Academy students outperform their comparison group in a randomized control design, but they performed on a par with the average high school student in Binghamton on state-mandated exams. All students can benefit from the social environment provided for at-risk students at the Regents Academy, which is within the reach of most public school districts

Internet-based interventions for adults with hearing loss, tinnitus and vestibular disorders: protocol for a systematic review

Background: Internet-based interventions are emerging as an alternative way of delivering accessible healthcare for various conditions including hearing and balance disorders. A comprehensive review regarding the evidence-base of Internet-based interventions for auditory-related conditions is required to determine the existing evidence of their efficacy and effectiveness. The objective of the current protocol is to provide the methodology for a systematic review regarding the effects of Internet-based interventions for adults with hearing loss, tinnitus and vestibular disorders. Method: This protocol was developed according to the Preferred Reporting Items for Systematic reviews and Meta-analyses for Protocols (PRISMA-P) 2015 guidelines. Electronic database searches will include EBSCOhost, PubMed and Cochrane Central Register performed by two researchers. This will be complemented by searching other resources such as the reference lists for included studies to identify studies meeting the eligibility for inclusion with regard to study designs, participants, interventions, comparators and outcomes. The Cochrane risk of bias tool (RoB 2) for randomised trials will be used for the bias assessments in the included studies. Criteria for conducting meta-analyses were defined. Discussion: The result of this systematic review will be of value to establish the effects of Internet-based interventions for hearing loss, tinnitus and vestibular disorders. This will be of importance to guide future planning of auditory intervention research and clinical services by healthcare providers, researchers, consumers and stakeholders

Describing knowledge encounters in healthcare: a mixed studies systematic review and development of a classification

This review was self-funded

Reaktioaika identiteetin valehtelun paljastajana maahantulon yhteydessä

Tutkimuksen tavoitteena oli selvittää, voidaanko identiteetin valehtelua paljastaa reaktioajan perusteella. Lähtökohtana aiheen valinnalle oli matkustajaliikenteen turvallisuusuhkien li-sääntyminen ja toisaalta rajavalvontamenetelmien automatisoituminen. Nykyään edellytetään yhä enemmän älykkäitä automatisoituja ratkaisuja turvallisuusuhkien paljastamiseksi samalla kun viranomaisten resursseja vähennetään. Rikollisten profilointi ja identiteetin valehtelun paljastaminen suuresta matkustajavirrasta on haasteellista matkustajamäärien kasvaessa. Tutkimuksen viitekehyksessä käsiteltiin ihmisen käyttäytymisen moninaisuutta kuten identiteetin muodostumista, tunteita ja muistia. Toisena keskeisenä aiheena tarkasteltiin valehtelua ja sen paljastamiseen liittyviä menetelmiä ja vaikeuksia. Tutkimuksen keskeisenä osana oli luoda merkityskartta jokaiselle koehenkilölle. Merkityskartalla tarkoitetaan tässä tutkimuksessa henkilön lapsuuden ja nuoruuden aikaisia emotionaalisesti merkitseviä muistoja, jotka voivat liittyä henkilöihin, paikkoihin, tavaroihin ja tapahtumiin. Identiteetin valehtelua ei ole aiemmin tutkittu henkilökohtaisiin emotionaalisiin muistoihin perustuen. Tutkimus toteutettiin kolmessa vaiheessa. Ensimmäinen vaihe oli haastattelukysymysten laa-timinen, haastattelu merkityskartan luomista varten ja merkityskartan luominen. Toinen vaihe käsitti valeidentiteetin luomisen ja koehenkilöiden valmistamisen kokeeseen. Kolmas vaihe sisälsi identiteettikokeen valmistelun ja identiteettikokeen. Tutkimuksen haastatteluvaiheeseen osallistui 30 koehenkilöä, joista 22 oli naisia ja 8 miehiä. Näistä näyttelijäopiskelijoita oli 10 ja muita opiskelijoita 20. Lopullisessa kokeessa koehenkilöitä oli 22, joista 16 oli naisia ja 6 miehiä, sekä näistä näyttelijäopiskelijoita oli 6. Koehenkilöiden keski-ikä oli 24 vuotta 6 kuukautta. Koehenkilöt haastateltiin yksitellen, jonka jälkeen jokaiselle luotiin merkityskartta. Koevaihetta varten luotiin sekä oikean että valeidentiteetin osiot. Oikea identiteetti rakentui jokaisen omasta merkityskartasta ja valeidentiteetti keksittiin ja se oli sama kaikille. Valeidentiteetti lähetettiin koehenkilöille sähköpostilla ja heitä pyydettiin opettelemaan se ulkoa. Reaktioaikaa mittaavassa kokeessa koehenkilöt vastasivat sekä oikeaa että valeidentiteettiä koskeviin kysymyksiin, joita kokeessa oli 26 kappaletta kummassakin identiteettiosiossa. Haastatteluaineisto litteroitiin sanatarkasti ja analysoitiin laadullisesti. Identiteettikokeen vastausten reaktioajat käsiteltiin määrällisesti. Reaktioajoista laskettiin keskiarvot ja reaktioaikoja verrattiin t-testeillä. Tutkimuksen tuloksista selviää, että vastausten reaktioaika kolmeen kysymykseen on tilastollisesti erittäin merkitseviä ja kahteen kysymykseen tilastollisesti merkitseviä. Nämä kysymykset liittyivät perheeseen ja tärkeisiin henkilöihin sekä lapsuuden kokemuksiin. Tutkimus osoittaa, että tilastollisesti merkitseviä eroavaisuuksia voidaan löytää totta puhuvan ja valehtelijan välillä, kun esitetään emotionaalisia kysymyksiä lapsuuteen ja perheeseen liittyen. Siten sensitiivisen aivoalueen emotionaalinen aktivointi voi paljastaa identiteetin valehtelijan nopeampana reaktioaikana. Tutkimustuloksia voidaan hyödyntää, kun kehitetään älykkäitä maahantulon valvontajärjestelmiä. Tutkimusta voidaan laajentaa liittämällä koevaiheeseen aivokuvantaminen, jonka avulla selvitetään, aktivoituvatko aivojen eri alueet esitettäessä oikeaan ja valeidentiteettiin liittyviä emotionaalisesti latautuneita kysymyksiä.The purpose of this study was to investigate whether identity deception can be detected on the basis of response time. Increased security threats in passenger traffic and the automation of border surveillance systems were motivating factors in carrying out this experiment. As the authorities’ operational resources decrease, more and more intelligent automatic solutions are required in order to expose security threats. The profiling of criminals and the detection of identity deception from growing passenger traffic is challenging. The theoretical part of this study focused on matters related to the complexity of human behaviour such as how identity is formed, emotions and memory. Another essential topic was deception, including how it is detected and the difficulties involved in detection. An important part of this study was to develop a Mean Map for each subject. By Mean Map we mean in this study emotional memories associated with persons, places, belongings and happenings during the subject’s childhood and youth. Similar identity deception research into personal emotional memories has not been conducted before. The study was carried out in three phases. The first phase consisted of drafting interview questions, the interview and the creation of the Mean Map. The second phase comprised the creation of a false identity and the subject´s preparation for the experiment. The third phase consisted of the preparation of the identity experiment as well as the experiment itself. Altogether 30 subjects took part in the interview phase of which 22 were women and 8 men. Out of the 30 subjects 10 were acting students. 22 subjects participated in the experiment, 16 of whom were women and 6 men as well as 6 acting students. The mean age was 24 years and 6 months. All subjects were interviewed one by one after which a Mean Map was created. For the experiment phase a true and false identity were formed. The true identity was based on the subject’s Mean Map. The false identity was made up and it was the same for all the subjects. The false identity was sent via email and the subjects were asked to learn it by heart. During the experiment that measured the response time, the subjects answered questions concerning true and false identity. There were 26 questions in both identity roles and the order was chosen randomly. The interviews were written literally and they were analysed qualitatively. The response times of the experiment phase were analysed quantitatively. The mean response time was calculated and they were compared with a T-test. The findings of this study demonstrated significant differences between the true and false period when emotional questions concerning childhood are presented. There were five answers in which response times were of significance. The questions regarding family, important persons and experiences were found to be meaningful. Thus emotional activation of sensitive brain areas can detect identity deception with a faster response time. The results of this study can be utilised when developing intelligent control systems that can be used at the point of entry. The study can be expanded by an experiment using functional Magnetic Resonance Imaging in order to investigate whether different brain areas will be activated when presenting emotional charged questions regarding true and false identity