Effects of Preexisting Psychotropic Medication Use on a Cohort of Patients with Ischemic Stroke Outcome

Background: Several studies investigated the use of selective serotonin reuptake inhibitors (SSRI) after ischemic stroke to improve motor recovery. However, little is known about the effects of preexisting psychotropic medication use (PPMU), such as antidepressants, on a long-term ischemic stroke functional disability. Objective: We sought to determine the prevalence of PPMU and whether PPMU relates to the long-term clinical outcome in a cohort of patients presenting with acute ischemic strokes. Methods: We retrospectively analyzed 323 consecutive patients who presented with an acute ischemic stroke in a single institution between January 2015 and December 2017. Baseline characteristics, functional disability as measured by the modified Rankin Scale (mRS), and major adverse cardiovascular complications (MACE) within 365 days were recorded. The comparison groups included a control group of ischemic stroke patients who were not on psychotropic medications before and after the index ischemic stroke and a second group of poststroke psychotropic medication use (PoMU), which consisted of patients started on psychotropic medication during the index admission. Results: The prevalence of PPMU in the studied cohort was 21.4% (69/323). There was a greater proportion of females in the PPMU than in the comparison groups (P \u3c 0.001), while vascular risk factors were similar in all groups, except for an increased presence of posterior circulation infarcts in the PPMU (37.4% vs. 18.8%, P \u3c 0.001). Among the patients with available 1-year follow-up data (n = 246), we noted significantly greater improvement in stroke deficits, measured by National Institute of Health Stroke Scale (NIHSS) between PPMU and PoMU vs. control (3 (0-7) versus 1 (0-4), P = 0.041). The 1-year mRS was worse in PPMU and PoMU compared to the control group (2 (IQ 1-3) vs. 2 (IQ 0-3) vs. 1 (IQ 0-2), respectively, P = 0.013), but delta mRS reflecting the degree of mRS improvement showed no significant difference between any PMU and control patients (P = 0.76). There was no statistically significant difference in MACE. Conclusion: PPMU in ischemic stroke is common; it can be beneficial in ischemic stroke in the long-term clinical outcome and is not associated with increased risks of MACE

Analyzing the effect of interview time and day on emergency medicine residency interview scores

Background: When it comes to scheduling interviews, medical students may wonder if they need a strategy to increase their likelihood of matching. Previous studies examined the temporal effects of the residency interview on overall match rate; however, there are additional factors that affect the match process, including board examination scores and letters of recommendation. Only few studies have examined the effect interview time of day has on match success. The current study examines the impact date and time of interview during the interview season have on candidates\u27 respective interview scores. Methods: Interview data over a three-year period (i.e., three interview cycles) was examined at a PGY-1-3, ACGME-accredited EM residency program in Philadelphia. Date of interview and time of day of interview (i.e., morning versus afternoon) was examined. A linear regression analysis was performed to determine if there is a statistically-significant difference in overall interview scores based on date during the interview season and time of day. Results: There is no statistically-significant effect of time of day or date on residency interview scores. Conclusions: Our findings are congruent with other studies on the temporal effects of residency interviews on overall match rate. Findings should provide reassurance to students scheduling interviews, as time slots have not been found to have a significant relationship with overall interview score. Future studies should more holistically analyze the residency application process

A core outcomes set for clinical trials of interventions for young adults with type 1 diabetes: an international, multi-perspective Delphi consensus study

BACKGROUND: Achieving consensus from a range of relevant stakeholders about an agreed set of core outcomes to be measured and reported as a minimum in clinical trials has the potential to enhance evidence synthesis and make findings more relevant and applicable. Intervention research to improve outcomes for young adults with type 1 diabetes (T1DM) is hampered by inconsistent use of outcome measures. This population frequently struggles to manage their condition and reports suboptimal clinical outcomes. Our aim was to conduct an international, e-Delphi consensus study to identify a core outcome set (COS) that key stakeholders (young adults with T1DM, diabetes health professionals, diabetes researchers and diabetes policy makers) consider as essential outcomes for future intervention research. METHODS: Using a list of 87 outcomes generated from a published systematic review, we administered two online surveys to a sample of international key stakeholders. Participants in the first survey (survey 1; n = 132) and the second survey (survey 2; n = 81) rated the importance of the outcomes. Survey 2 participants received information on total mean rating for each outcome and a reminder of their personal outcome ratings from Survey 1. Survey 2 results were discussed at a consensus meeting and participants (n = 12: three young adults with T1DM, four diabetes health professionals, four diabetes researchers and one diabetes policy maker) voted on outcomes. Final core outcomes were included provided that 70% of consensus group participants voted for their inclusion. RESULTS: Eight core outcomes were agreed for inclusion in the final COS: measures of diabetes-related stress; diabetes-related quality of life; number of severe hypoglycaemic events; self-management behaviour; number of instances of diabetic ketoacidosis (DKA); objectively measured glycated haemoglobin (HbA1C); level of clinic engagement; and perceived level of control over diabetes. CONCLUSIONS: This study is the first to identify a COS for inclusion in future intervention trials to improve outcomes for young adults with T1DM. Use of this COS will improve the quality of future research and increase opportunities for evidence synthesis. Future research is necessary to identify the most robust outcome measure instruments

Analyzing the Effect of Interview Time and Day on Emergency Medicine Residency Interview Scores

Purpose: Each year, medical students go through the residency application process and are faced with the decision of where to apply. If they receive an interview offer at an institution, they are faced with another decision, when to schedule their interview. Studies have examined the possible effect of interview date on matching and on match rank. However, other variables such as examination scores, letters of recommendation, and class rank also effect match outcome. There have been no studies investigating the possible role the time of day in which the interview takes place can affect the residency interview process. The purpose of this study is to investigate the effect of date and time of day on interview score. Methods: Data for the interview cycles of 2016-2017, 2018-2019, and 2019-2020 at a PGY1-3 ACGME-accredited EM residency program in Philadelphia was obtained. A linear regression analysis was done using the date, time, and score of the residency interviews. The regression was analyzed for a statistically significant relationship between the date and time of the interview and the interview score. Results and Conclusions: There were no statistically significant differences found between the interview scores that occurred at different dates and times of day. These results align with those of similar studies. This should assure residency applicants that the interview process is working correctly and extraneous variables outside of their applications will not play a role in the match proces

Cable Heating Effects due to Harmonic Distortion in Electrical Installations

The increasing use of non-linear loads in electrical installations has exacerbated the problems of harmonic distortion in industrial and commercial electrical systems. In the UK the current practice to determine the cable size for an electric circuit is to use BS7671. However, previously the 16th edition IEE Wiring Regulations only dealt with situations where cables attain the conductor temperature generated by sinusoidal currents at the fundamental power frequency. This paper outlines the methods available to determine the minimum size of line conductors for protection against overload currents, taking into account the harmonic content of the load current, and explains the harmonic rating factor Cf introduced in 2008 for cables that are under significant harmonic influences. Since the effect of harmonic currents is to increase the joule losses in a cable, the ampacity of the cable will need to be corrected to ensure the maximum conductor operating temperature is not exceeded. An experiment on how cable temperature can be measured under harmonic influence is described, and several sets of measurements taken on a typical cable are analysed. The paper concludes that direct usage of the BS7671 rating factor for harmonics appears to be rather conservative and could lead to over-sizing of the line conductors for three-phase circuits, but is deemed beneficial in the long run

Assessing volume of accelerometry data for reliability in preschool children

Purpose: This study examines what volume of accelerometry data (h&middot;d-1) is required to reliably estimate preschool children&rsquo;s physical activity and whether it is necessary to include weekday and weekend data. Methods: Accelerometry data from 493 to 799 (depending on wear time) preschool children from the Melbourne-based Healthy Active Preschool Years study were used. The percentage of wear time each child spent in total (light&ndash;vigorous) physical activity was the main outcome. Hourly increments of daily data were analyzed. t-tests, controlling for age and clustering by center of recruitment, assessed the differences between weekday and weekend physical activity. Intraclass correlation coefficients estimated reliability for an individual day. Spearman&ndash;Brown prophecy formula estimated the number of days required to reach reliability estimates of 0.7, 0.8, and 0.9. Results: The children spent a significantly greater percentage of time being physically active on weekend compared with weekdays regardless of the minimum number of hours included (t = 12.49&ndash;16.76, P &lt; 0.001 for all). The number of days required to reach each of the predetermined reliability estimates increased as the number of hours of data per day decreased. For instance, 2.7&ndash;2.8 d of data were required to reach a reliability estimate of 0.7 with 10 or more hours of data per day; 3.3&ndash;3.4 d were required to meet the same reliability estimate for days with 7 h of data. Conclusions: Future studies should ensure they include the minimum amount of data (hours per day and number of days) as identified in this study to meet at least a 0.7 reliability level and should report the level of reliability for their study. In addition to weekdays, at least one weekend day should be included in analyses to reliably estimate physical activity levels for preschool children.<br /