Incremental Clinical Utility of ADHD Assessment Measures With Latino Families

Objective: This study examined the incremental clinical utility of parent and teacher reports of ADHD symptomatology and functional impairment in Latino youth, as well as parent and teacher agreement with the final clinical judgment on a diagnostic structured interview. Method: Participants included 70 Latino youth (47 males, 23 females; M age = 8.13 years, SD = 2.51 years) and their parents and teachers; 60 participants were diagnosed with ADHD. Correlations, percent agreement, kappas, and regressions were utilized. Results: Results demonstrated that teachers agreed with the final clinical judgment more often than did parents. Results additionally demonstrated that functional impairment did not statistically significantly improve diagnostic models already including ADHD symptoms; follow-up analyses were run and are discussed. Finally, results demonstrated that teacher reports statistically significantly improved diagnostic models already including parent reports. Conclusion: The current findings suggest the importance of including both parent and teacher reports of both ADHD symptomatology and functional impairment when assessing ADHD in Latino youth

Feasibility, Acceptability, and Preliminary Outcomes of a Culturally Adapted Evidence-Based Treatment for Latino Youth With ADHD

Objective: To advance our knowledge about the most effective way to treat Latino youth with ADHD, the current feasibility and pilot study compared a culturally adapted evidence-based treatment (CAT) for ADHD to standard evidence-based treatment (EBT). Method: Following a comprehensive ADHD assessment, 61 Latino families of school-aged children (mean age of 8 years) were randomly assigned to either CAT or standard EBT (i.e., parent management training). Results: CAT outperformed standard EBT when examining homework completion and mother-reported treatment satisfaction. Apart from two trends favoring CAT, CAT and EBT both resulted in significant improvements in parent- and teacher-reported ADHD symptoms and functional impairment, as well as mother- and father-reported parental functioning. Conclusion: CAT outperformed standard EBT when examining several engagement and acceptability outcomes. CAT and EBT were equally effective when examining traditional treatment outcomes, which is impressive considering the robustness of standard EBT, especially when delivered by culturally competent staff

Formulation and analysis of a Schur complement method for fluid-structure interaction

This work presents a strongly coupled partitioned method for fluid-structure interaction (FSI) problems based on a monolithic formulation of the system which employs a Lagrange multiplier. We prove that both the semi-discrete and fully discrete formulations are well-posed. To derive a partitioned scheme, a Schur complement equation, which implicitly expresses the Lagrange multiplier and the fluid pressure in terms of the fluid velocity and structural displacement, is constructed based on the monolithic FSI system. Solving the Schur complement system at each time step allows for the decoupling of the fluid and structure subproblems, making the method non-iterative between subdomains. We investigate bounds for the condition number of the Schur complement matrix and present initial numerical results to demonstrate the performance of our approach, which attains the expected convergence rates.Comment: 27 pages, 4 figure

Using multi-scale spatially explicit frameworks to understand the relationship between functional diversity and species richness

Understanding how ecosystem functioning is impacted by global change drivers is a central topic in ecology and conservation science. We need to assess not only how environmental change affects species richness, but also how the distribution of functional traits (i.e. functional diversity) mediate the relationship between species richness and ecosystem functioning. However, most evidence about the capacity of functional diversity to explain ecosystem functioning has been developed from studies conducted at a single spatial scale. Here, we explore theory, expectations and evidence for why and how species richness and functional diversity relationships vary with spatial scale. Despite the importance of accounting for spatial processes at multiple scales, we show that most studies of the species richness–functional diversity relationship focus on single scale analyses that ignore spatial context. Thus, we discuss the need to establish a spatially explicit, multi-scale framework for understanding the relationship between species richness and functional diversity. As a starting point to developing such a framework, we detail some expected trajectories and mechanisms by which the diversity of species and functional traits may change across increasing spatial scales. We also explore what is known about two important gaps in the literature about this relationship: 1) the influence of spatial autocorrelation on community assembly processes and 2) the variation in the structure of species interactions across spatial extents. We present some key challenges that could be addressed by integrating approaches from community and landscape ecology. This information will help improve our understanding of the relative influence of local and large-scale processes on community structure, while providing a foundation for improving biodiversity monitoring, policy and ecosystem function based conservation

Examining Latino Family Participation in Treatment for Childhood ADHD: The Role of Parental Cultural Factors and Perceptions

Attention-deficit/hyperactivity disorder (ADHD) is a common mental health disorder in childhood. Unfortunately, Latino youth and their families are at increased risk of demonstrating poor treatment outcomes. The current study examined the impact of parental cultural factors and perceptions on Latino family participation in a psychosocial intervention for childhood ADHD. Sixty-one Latino youth and at least one of their primary parents and teachers participated in the current study. Results indicated that parental acculturation, attitudes regarding treatment, and baseline severity of child symptomatology and functional impairment were related to treatment participation outcomes. Implications and future directions are discussed

Avaliação de programas educacionais nas profissões da saúde: conceitos básicos

O conceito de avaliação de programas educacionais ainda é relativamente desconhecido de muitos professores e gestores do ensino superior e, muitas vezes, é confundido com avaliação de estudantes. Avaliação é uma das áreas que mais cresceu em importância nas últimas décadas; em parte pela pressão da sociedade e também pela necessidade de mecanismos estruturados e regulares de avaliação formal para o credenciamento e recredenciamento de cursos superiores na área da saúde. Este movimento no Brasil segue uma tendência mundial de busca de sistemas comuns de certificação e acreditação. O objetivo é garantir, tanto quanto possível, altos padrões de qualidade para programas que formam profissionais da saúde. Este artigo apresenta e discute conceitos básicos e modelos de avaliação de programas educacionais, que subsidiarão qualquer profissional da saúde/educação para compreender a essência desse tema tão amplo e desafiador.The concept of evaluation in programs of health profession education (HPE) is relatively unknown to many teachers and educational managers responsible for higher education. Often, it is misunderstood with students’ assessment. The importance of evaluation in the HPE has grown in recent decades due to the pressure of society but also because structured and formal mechanisms have been required for accreditation and re-accreditation of HPE courses. The growing interest in HPE in Brazil follows a global trend of certification and accreditation programs. The objective is to ensure high quality standards for graduate health professional programs. This article presents the basic concepts and models of evaluation in HPE programs that may be used for health/educational professionals in order to better understand the essence of this broad and challenging topic

Effect of fixed-dose subcutaneous reslizumab on asthma exacerbations in patients with severe uncontrolled asthma and corticosteroid sparing in patients with oral corticosteroid-dependent asthma : results from two phase 3, randomised, double-blind, placebo-controlled trials

BACKGROUND: Reslizumab 3 mg/kg administered intravenously is approved for the treatment of severe eosinophilic asthma. We assessed the safety and efficacy of subcutaneous reslizumab 110 mg in two trials in patients with uncontrolled severe asthma and increased blood eosinophils. The aim was to establish whether subcutaneous reslizumab 110 mg can reduce exacerbation rates in these patients (study 1) or reduce maintenance oral corticosteroid dose in patients with corticosteroid-dependent asthma (study 2). METHODS: Both studies were randomised, double-blind, placebo-controlled, phase 3 studies. Entry criteria for study 1 were uncontrolled severe asthma, two or more asthma exacerbations in the previous year, a blood eosinophil count of 300 cells per μL or more (including no more than 30% patients with an eosinophil count <400 cells/μL), and at least a medium dose of inhaled corticosteroids with one or more additional asthma controllers. Patients in study 2 had severe asthma, a blood eosinophil count of 300 cells per μL or more, daily maintenance oral corticosteroid (prednisone 5-40 mg, or equivalent), and high-dose inhaled corticosteroids plus another controller. Patients were randomly assigned (1:1) to subcutaneous reslizumab (110 mg) or placebo once every 4 weeks for 52 weeks in study 1 and 24 weeks in study 2. Patients and investigators were masked to treatment assignment. Primary efficacy outcomes were frequency of exacerbations during 52 weeks in study 1 and categorised percentage reduction in daily oral corticosteroid dose from baseline to weeks 20-24 in study 2. Primary efficacy analyses were by intention to treat, and safety analyses included all patients who received at least one dose of study treatment. These studies are registered with ClinicalTrials.gov, NCT02452190 (study 1) and NCT02501629 (study 2). FINDINGS: Between Aug 12, 2015, and Jan 31, 2018, 468 patients in study 1 were randomly assigned to placebo (n=232) or subcutaneous reslizumab (n=236), and 177 in study 2 to placebo (n=89) or subcutaneous reslizumab (n=88). In study 1, we found no significant difference in the exacerbation rate between reslizumab and placebo in the intention-to-treat population (rate ratio 0·79, 95% CI 0·56-1·12; p=0·19). Subcutaneous reslizumab reduced exacerbation frequency compared with placebo in the subgroup of patients with blood eosinophil counts of 400 cells per μL or more (0·64, 95% CI 0·43-0·95). Greater reductions in annual exacerbation risk (p=0·0035) and longer time to first exacerbation were observed for patients with higher trough serum reslizumab concentrations. In study 2, we found no difference between placebo and fixed-dose subcutaneous reslizumab in categorised percentage reduction in daily oral corticosteroid dose (odds ratio for a lower category of oral corticosteroid use in the reslizumab group vs the placebo group, 1·23, 95% CI 0·70-2·16; p=0·47). The frequency of adverse events and serious adverse events with reslizumab were similar to those with placebo in both studies. INTERPRETATION: Fixed-dose (110 mg) subcutaneous reslizumab was not effective in reducing exacerbation frequency in patients with uncontrolled asthma and increased blood eosinophils (≥300 cells/μL), or in reducing the daily maintenance oral corticosteroid dose in patients with oral corticosteroid-dependent severe eosinophilic asthma. Higher exposures than those observed with 110 mg subcutaneous reslizumab are required to achieve maximal efficacy. FUNDING: Teva Branded Pharmaceutical Products R&D

Adrenal insufficiency

Os glicocorticóides apresentam um importante papel na regulação metabólica, nos sistemas cardiovascular, imune, nervoso, e na resposta adaptativa ao estresse. A insuficiência adrenal pode ser causada por uma doença primária da adrenal (baixas concentrações plasmáticas de cortisol e altas de ACTH) ou secundária a doenças do eixo hipotálamoipofisário (baixas concentrações plasmáticas de cortisol e de ACTH). A falta crônica de glicocorticóide leva a sintomas insidiosos e inespecíficos (mal-estar geral, fraqueza, inapetência, perda de peso, queixas gastrintestinais). Adicionalmente, quando há também deficiência de mineralocorticóide, a hipotensão, síncope, desidratação e choque cardiocirculatório, com hiponatremia e hipercalemia podem associar-se ao quadro clínico. O tratamento consiste na reposição de cortisol (hidrocortisona VO, 12 a 15 mg/m2&nbsp;de superfície corporal, acetato de cortisona VO, 25mg/dia e prednisona VO, 5 a 10 mg/dia) na insuficiência adrenal secundária e de cortisol e minelocorticóide (9a fluorohidrocortisona VO, 0,1mg/dia) na primária. Doenças infecciosas, traumas e cirurgias podem precipitar uma crise aguda, chamada crise addisoniana, situação esta de risco de vida, quando não tratada. O tratamento consiste de reposição do volume intravascular com cloreto de sódio (soro fisiológico 0,9% 2 L/hora) e glicocorticóides (100 mg EV de hidrocortisona a cada 6 h). Desde que a crise addisoniana é freqüentemente desencadeada por processo infeccioso, o diagnóstico de infecção deve ser confirmado e, se presente, o uso de antibioticoterapia deve ser preconizado. &nbsp;Glucocorticoids have an important role in the metabolic regulation, in the cardiovascular, immune, and nervous systems, and in the adaptive response to stress. The adrenal insufficiency can be caused by a primary disease of the adrenal (low concentration of cortisol and high ACTH levels) or secondary to the hypothalamic-pituitary dysfunction (low cortisol and ACTH levels). Chronic glucocorticoid deficiency leads to insidious and unspecific symptoms (weakness, fadigue, gastrintestinal symptoms, anorexia, loss of weight). In the presence of mineralocorticoid deficiency clinical findings are also associated to hypotension, syncope, dehydration and circulatory shock, with hiponatremia and hiperkalemia. Management consists of cortisol replacement (hydrocortisone PO, 12-15 mg/m2 cortisone acetate PO, 25mg/day or prednisone PO, 5-10 mg/day) for secondary adrenal insufficiency and cortisol and mineralocorticoid replacement (9a fluorohydrocortisone PO, 0.1mg/dia) for primary cause of adrenal insufficiency. Infections, traumas and surgeries can precipitate an acute crisis, Addisonian crisis, a life- threatening situation if not treated. Treatment consists of replacing intravascular volume with sodium chloride (0.9% NaCl 2L/h) and glucocorticoid (100 mg IV of hydrocortisone every 6 hours). Addisonian crisis is frequently associated with infection, therefore this diagnosis must be confirmed and properly treated with antibiotics