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Objective Method Results Conclusions The aim of this study was to examine predictors and moderators of behavioral improvement in children with Oppositional Defiant Disorder (ODD) following treatment with Parent Management Training (PMT) and Collaborative and Proactive Solutions (CPS). Initial problem severity, inconsistent discipline, parental attributions of child misbehavior, and child lagging cognitive skills were examined.One hundred and forty-five children aged between 7 and 14 (103 males, M = 8.88 years, ethnicity representative of the wider Australian population) were randomly assigned to PMT and CPS. Assessment was conducted at baseline, post-intervention, and at 6-month follow-up, using independently rated semi-structured diagnostic interviews and parent-ratings of ODD symptoms. Using an intent-to-treat sample in this secondary analysis (Murrihy et al., 2022), linear regressions and PROCESS (Hayes, 2017) were used to examine these predictors and possible moderators of treatment.Higher pre-treatment levels of conduct problems, lagging skills, and inconsistent discipline predicted poorer behavioral outcomes following both treatments. The only characteristic that moderated treatment outcome was child-responsible attributions – mothers who were more likely to attribute their child’s problematic behaviors to factors in the child had significantly poorer outcomes in PMT than CPS at 6-month follow-up.CPS may be a more beneficial treatment than PMT for families who have been identified as having higher levels of child-responsible attributions before commencing treatment for ODD. While tentative, this provides promising insights as to how treatment outcomes for children with ODD may be improved. [ABSTRACT FROM AUTHOR]

Heavy metals including Cd, Pb, and Zn are prevalent stormwater and groundwater contaminants derived from natural and human activities, and there is a lack of cost-effective treatment for their removal. Recently, biochar has been increasingly recognized as a promising low-cost sorbent that can be used to remediate heavy metal contaminated water. This study evaluates the immobilization/release performance of dairy manure-derived biochar (DM-BC) as a sustainable material for competitive removal of coexisting heavy metal ions from water and explains the underlying mechanism for regeneration/reusability of biochar. Results showed that the metal ions exhibited competitive removal in the order of Pb2+≫Zn2+>Cd2+. The pH played a decisive role in influencing metal ion speciation affecting the electrostatic attraction/repulsion and surface complexation. Higher pH led to greater removal for Pb2+ and Cd2+ , whereas Zn2+ showed maximum removal at pH≈7.5. Diffuse reflectance infrared spectroscopy, scanning electron microscopy, and X-ray diffraction confirmed the interactions and precipitation reactions of oxygen-containing functional groups (e.g., ─ OH, CO32− , and Si─ O) as key participants in metal immobilization. Langmuir, Freundlich, and Redlich–Peterson isotherm modeling data showed varied and unique results depending on the metal ion and concentration. The removal kinetics and model fitting showed that the three steps of intraparticle diffusion might be more representative for describing the immobilization processes of metal ions on the external surface and internal pores. In the flow-through columns, DM-BC effectively retained the mixed metal ions of Cd2+ , Pb2+ , and Zn2+ showing 100% removal for the duration of the column run over three cycles of regeneration and reuse. [ABSTRACT FROM AUTHOR]

Background: Chronic pain in young people is prevalent in the UK. Young people are digital natives, yet there has not been any online intervention developed in a UK context to help them manage chronic pain. Key to understanding the context in which young people engage with online interventions is better understanding their internet use for chronic pain management. The overarching aim of this study was to explore young peoples' experiences of searching for information about chronic pain using the internet. This included experiences of using search engines (e.g. Google), health information websites (e.g. the National Health Service [NHS] website) and social media (e.g. Facebook and Instagram). Methods: Semi-structured interviews were conducted with young people aged 16–24-years (n = 24), online, via Microsoft (MS) Teams. The study was advertised online and via patient partner charities. Interview data was analysed using reflexive thematic analysis. Results: Participants presented with a variety of chronic pain conditions, including joint hypermobility syndrome (n = 6), chronic headache and/or migraine (n = 4) and fibromyalgia (n = 3). Four themes were generated: 'Trustworthy information, or experiences?', 'Diagnostic labels in a digital world', 'The online chronic pain community' and 'A mind and body approach to self-management'. Young people trust advice from others in their online community and having a diagnostic label help them find relevant pain management strategies and support networks online. Conclusions: This study is the first qualitative exploration of internet use in UK-based young people with chronic pain. Findings highlight the importance of considering internet use when developing new online interventions for young people with pain and that internet use, particularly social media use, is an important psychosocial consideration in pain management. Young people should be encouraged to verify practical pain management techniques found online with their doctor and be empowered in the safe use of appropriate psychology-based self-management resources. [ABSTRACT FROM AUTHOR]

As online education for the MLIS becomes widespread, one challenge for reference and user services instructors is that traditional exercises used to promote clinical intuition and metacognition in reference work may be more difficult in online classrooms. This article uses concept analysis to better understand clinical judgment for reference, suggesting that learners' clinical intuition may be developed through a combination of emphasizing types of reasoning skills in reference work and the use of experiential learning theory. Investigative video games are presented as a case for providing practice with reasoning skills and rules testing in contexts adjacent to reference work. The authors provide examples of how types of reasoning are used in these video games and how, when practiced, these can offer a complementary approach to instruction for reference work. [ABSTRACT FROM AUTHOR]

Background: Proximal femoral fractures are often treated with cephalomedullary nails. Although nail breakages following fracture repair are infrequent, a recent implant retrieval study suggested that the TFN-ADVANCED (TFNA) Proximal Femoral Nailing System (DePuy Synthes) was susceptible to post-implant breakage. It is unclear whether the risk of breakage among patients who receive the TFNA implant is higher than patients who receive other comparable cephalomedullary nails. The current study was designed to evaluate the comparative risk of breakage of the TFNA nail.Methods: Using data from a large U.S. health-care database, the current study was designed to determine whether TFNA nails have equal, lower, or higher risk of breakage relative to all other comparable, single-head-element (with no additional lag screws), cephalomedullary nails, the Stryker Gamma3 and the Zimmer Natural Nail, referred to in this study as the non-TFNA group. Data were from patients who received the TFNA implant or non-TFNA nails in 365 hospitals between February 1, 2014, and September 30, 2019. Analysis of nail breakage post-implantation was prespecified as the difference between the TFNA group and the non-TFNA group in cumulative incidence at 18 months, with a prespecified equivalence margin of 0.5%, using data balanced on measured covariates by propensity score weighting.Results: Within the first 18 months of implantation, in 14,370 patients with TFNA nails, there were 27 nail breakages, and in 8,260 patients with non-TFNA nails, there were 29 nail breakages. The mean time to nail breakage was 4.72 months for the TFNA group and 4.05 months for the non-TFNA group. In the balanced data, the risk of breakage at 18 months was 0.26% (95% confidence interval [CI], 0.17% to 0.36%) for the TFNA group and 0.25% (95% CI, 0.05% to 0.45%) for the non-TFNA group, with a risk difference of 0.01% (95% CI, -0.21% to 0.24%). This result indicates that the cumulative incidence of nail breakage was equivalent (between -0.5% and 0.5%) for both nail groups. The risk differences were also within the equivalence margin in subgroup analyses: pertrochanteric fractures only (-0.08% [95% CI, -0.34% to 0.19%]), pertrochanteric or subtrochanteric fractures (-0.04% [95% CI, -0.29% to 0.21%]), and those with International Classification of Diseases, Tenth Revision (ICD-10) data only (0.03% [95% CI, -0.18% to 0.25%]).Conclusions: The risk of nail breakage was equivalent for TFNA and comparator cephalomedullary nails.Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Adolescent chronic pain is prevalent, and interdisciplinary treatment is recommended. Although it is well known that technology is a key part of adolescents' daily lives, there have not been any online, interdisciplinary interventions developed for adolescents with chronic pain in a UK healthcare context. Little is known about how adolescents currently use online resources to manage chronic pain, or what guidance they seek. Methods: Ninety-five participants from the community answered this mixed-methods, online survey (adolescent n = 54, parent n = 41), which assessed the needs of UK-based adolescents for a new online chronic pain management resource. Results: Findings indicated that, at the time of the survey, adolescents frequently used social media platforms, such as Instagram, for chronic pain management. Desired techniques for a new interdisciplinary resource for adolescents included 'advice on explaining chronic pain to others' (86.7% of adolescents) and sleep hygiene (82.2% of adolescents), though access to a range of pain management techniques was desired. Qualitative results indicated endorsement of a new programme by adolescents and parents. Conclusions: Adolescents and parents had a positive outlook towards the development of a UK-specific online resource to help manage chronic pain. Such an intervention should aim to be made accessible via the National Health Service. Adolescent use of social media platforms to seek support for chronic pain requires further exploration in future research. [ABSTRACT FROM AUTHOR]

Despite the established efficacy of Parent Management Training (PMT) for conduct problems in youth, evidence suggests that up to half of all treated youth still display clinical levels of disruptive behavior post-treatment. The reasons for these unsatisfactory outcomes are poorly understood. The aim of the present review was to provide an updated analysis of studies from the past 15 years that examined parental and familial predictors and moderators of improvement in PMT for conduct problems. A systematic literature review of indicated prevention (children with conduct problem symptoms) and intervention (children with clinical diagnoses) studies published between 2004 and 2019 was conducted. This 15-year time period was examined since the last systematic reviews were reported in 2006 and summarized studies completed through mid-2004 (see Lundahl et al. in Clin Psychol Rev 26(1):86–104, 2006; Reyno and McGrath in J Child Psychol Psychiatry 47(1):99–111, 2006). Risk of bias indices was also computed (see Higgins et al. in Revised Cochrane risk of bias tool for randomized trials (RoB 2.0), University of Bristol, Bristol, 2016) in our review. A total of 21 studies met inclusion criteria. Results indicated that a positive parent–child relationship was most strongly associated with better outcomes; however, little additional consistency in findings was evident. Future PMT research should routinely examine predictors and moderators that are both conceptually and empirically associated with treatment outcomes. This would further our understanding of factors that are associated with poorer treatment outcome and inform the development of treatment components or modes of delivery that might likely enhance evidence-based treatments and our clinical science. Protocol Registration Number: PROSPERO CRD42017058996. [ABSTRACT FROM AUTHOR]

This study investigated the removal of fluoride from water using a calcium-modified dairy manure–derived biochar (Ca-DM500). The Ca-DM500 showed a 3.82−8.86 times higher removal of fluoride from water than the original (uncoated) manure-derived biochar (DM500). This is primarily attributed to strong precipitation/complexation between fluoride and calcium. The Freundlich and Redlich–Peterson sorption isotherm models better described the experimental data than the Langmuir model. Additionally, the removal kinetics were well described by the intraparticle diffusion model. The Ca-DM500 showed high reactivity per unit surface area [0.0001, 0.03, 0.16 mg F per m2 for Douglas fir–derived biochar (DF-BC), DM500. and Ca-DM500, respectively] for retention of fluoride reflecting the importance of surface complexation. The copresence of anions reduced removal by Ca-DM500 in the order SO42−≈PO43−>NO3−. The sorption behavior of fluoride in a continuous fixed-bed column was consistent with the Thomas model. Column studies demonstrated that the Ca-DM500 shows a strong affinity for fluoride, a low release potential, and a stable (unreduced) removal capacity through regeneration and reuse cycles. [ABSTRACT FROM AUTHOR]

Many patients exhibit subsyndromal clinical findings of schizophrenia prior to diagnosis. Early treatment may mitigate schizophrenia development, yet little is known about comorbidities and healthcare resource utilization (HCRU) in these patients before diagnosis. This retrospective, longitudinal cohort study, conducted between January 1, 2007 and April 30, 2016, used claims data from the US HealthCore Integrated Research Database. Newly diagnosed patients with schizophrenia (International Classification of Diseases, Ninth Revision: 295.x or ICD 10 F20.%) were identified and matched (1:4) with non-schizophrenia comparators. Patients were 15–54 years of age with either ≥1 inpatient/emergency room claim with a primary schizophrenia diagnosis, or ≥2 claims in any setting with any schizophrenia diagnosis. Demographics, comorbidities, physician specialties, medications, and related services, and other HCRU were compared between cohorts for up to 5 years before diagnosis. The schizophrenia cohort included 6732 patients (57.4% male, mean age 30.3 years for males and 36.2 years for females). All outcomes were more prevalent in the schizophrenia cohort than the comparator cohort. Substantial comorbidity, medication use, and HCRU were observed in the schizophrenia cohort even 4–5 years before diagnosis with increasing findings approaching diagnosis. From 4–5 years to 0–12 months before diagnosis, resource use increased from 20.5% to 53.3% for atypical antipsychotics, 29.3% to 48.2% for antidepressants, and 15.1% to 35.5% for psychiatric diagnostic examinations. Patients with schizophrenia extensively use healthcare resources up to 5 years before diagnosis. Our findings may help with developing predictive models to identify patients at high risk of schizophrenia. [ABSTRACT FROM AUTHOR]

This study investigated the adsorptive removal of fluoride from simulated water pollution using various (hydro)oxide nanomaterials, which have the potential to be used as sorbents for surface water and groundwater remediation. Tested nanomaterials include hematite, magnetite, ferrihydrite, goethite, hematite-alpha, hydroxyapatite (HAP), brucite, and four titanium dioxides (TiO2-A [anatase], TiO2-B [rutile], TiO2-C [rutile], and TiO2-D [anatase]). Among 11 (hydro)oxide nanomaterials tested in this study, ferrihydrite, HAP, and brucite showed two to five times higher removal of fluoride than other nanomaterials from synthetic fluoride solutions. Freundlich and Redlich–Peterson adsorption isotherms better described the adsorptive capacity and mechanism than the Langmuir isotherm based on higher R2 values, indicating better fit of the regression predictions. In addition, the adsorption kinetics were well described by the intraparticle diffusion model. Column studies in a fixed bed continuous flow through system were conducted to illustrate the adsorption and desorption behavior of fluoride on ferrihydrite, HAP, or brucite. Experimental results fitted well with the Thomas model because of the R2 values at least 0.885 or higher. By comparisons of the adsorption capacity and the rate constant, columns packed with ferrihydrite exhibited not only faster rates but also higher sorption capacity than those packed with HAP or brucite. Desorption tests in deionized water showed that the adsorbed fluoride could be desorbed at a lower efficiency, ranging from 4.0% to 8.9%. The study implicated that (hydro)oxide nanomaterials of iron calcium and magnesium could be effective sorptive materials incorporated into filtration systems for the remediation of fluoride polluted water. [ABSTRACT FROM AUTHOR]

Fake websites extract an enormous financial and psychological toll on consumers across the globe, with some estimates reaching billions of dollars each year. Yet, there is a paucity of empirical data on why some consumers respond to fake websites while others remain immune. In nine studies (6 in the main text, 3 in Supplemental Materials) we tested the hypothesis that analytical reasoning promotes the ability to discriminate real from fake versions of popular consumer websites. We found evidence in support of this hypothesis in individual difference studies using both convenience (Supplemental Studies 1–2) and representative samples (Study 1) with expertise as a boundary condition of this effect (Study 2). We also found evidence for this hypothesis experimentally by inducing time pressure (Study 3) and priming participants to engage System 2 (analytic) versus System 1 (intuitive) processes (Study 4). This latter experimental effect was bounded by expertise (Study 5). Finally, we showed that the link between analytical reasoning and discriminability is mechanistically driven by memory recall (Study 6). Collectively, these studies provide convergent evidence that analytical reasoning may protect individuals from Internet fraud by helping them detect fraudulent websites. • Analytical reasoning promotes the ability to discriminate real from fake versions of popular Internet websites. • These effects emerged in correlational studies and experiments. • These effects did not emerge for participants with high levels of expertise. • These effects were mechanistically driven by memory recall. [ABSTRACT FROM AUTHOR]

Background: Accurate identification of underlying health conditions is important to fully adjust for confounders in studies using insurer claims data. Our objective was to evaluate the ability of four modifications to a standard claims-based measure to estimate the prevalence of select comorbid conditions compared with national prevalence estimates.Methods: In a cohort of 11,973 privately insured women aged 18-64 years with mastectomy from 1/04-12/11 in the HealthCore Integrated Research Database, we identified diabetes, hypertension, deficiency anemia, smoking, and obesity from inpatient and outpatient claims for the year prior to surgery using four different algorithms. The standard comorbidity measure was compared to revised algorithms which included outpatient medications for diabetes, hypertension and smoking; an expanded timeframe encompassing the mastectomy admission; and an adjusted time interval and number of required outpatient claims. A χ2 test of proportions was used to compare prevalence estimates for 5 conditions in the mastectomy population to national health survey datasets (Behavioral Risk Factor Surveillance System and the National Health and Nutrition Examination Survey). Medical record review was conducted for a sample of women to validate the identification of smoking and obesity.Results: Compared to the standard claims algorithm, use of the modified algorithms increased prevalence from 4.79 to 6.79 % for diabetes, 14.75 to 24.87 % for hypertension, 4.23 to 6.65 % for deficiency anemia, 1.78 to 12.87 % for smoking, and 1.14 to 6.31 % for obesity. The revised estimates were more similar, but not statistically equivalent, to nationally reported prevalence estimates. Medical record review revealed low sensitivity (17.86 %) to capture obesity in the claims, moderate negative predictive value (NPV, 71.78 %) and high specificity (99.15 %) and positive predictive value (PPV, 90.91 %); the claims algorithm for current smoking had relatively low sensitivity (62.50 %) and PPV (50.00 %), but high specificity (92.19 %) and NPV (95.16 %).Conclusions: Modifications to a standard comorbidity measure resulted in prevalence estimates that were closer to expected estimates for non-elderly women than the standard measure. Adjustment of the standard claims algorithm to identify underlying comorbid conditions should be considered depending on the specific conditions and the patient population studied. [ABSTRACT FROM AUTHOR]

This study with 326 girls-school teachers developed and tested a model of predictors of the likelihood that teachers will intervene in indirect bullying, and evaluated a professional development presentation. Teachers responded to bullying vignettes before and after a presentation on indirect bullying (Experimentals) or adolescent mental health (Controls). In accord with the model, perceived seriousness of indirect bullying mediated between empathy for victims and likelihood of intervening. Self-efficacy also had a direct effect on likelihood of intervention, though level of knowledge of the impact of indirect bullying made only a small contribution. Compared with Controls, the Experimental Group scored more highly, after the presentation, on perceived seriousness of indirect bullying, empathy for victims, likelihood of intervening and self-efficacy, but not on knowledge of impact. It is concluded that teacher education about indirect bullying may be most effective if it focuses on feelings rather than facts, and provides practical intervention strategies. [ABSTRACT FROM AUTHOR]

• Collaborative and Proactive Solutions is an effective treatment for defiant youth. • Findings were on par with evidence-based treatment, Parent Management Training. • Gains were maintained at 6-months follow-up. • Community-based delivery affirms relevance to real-world clients and settings. • CPS represents a possible therapeutic alternative for youth with conduct problems. The aim of this study was to examine the relative effectiveness of Collaborative and Proactive Solutions (CPS) and Parent Management Training (PMT) for youth with oppositional defiant disorder (ODD) in a community setting. Based on a semistructured diagnostic interview, 160 youth with ODD (ages 7–14; 72% male; ethnicity representative of the wider Australian population) were randomized to CPS (n = 81) or PMT (n = 79) for up to 16 weekly sessions. The primary hypothesis was that participants in the CPS group, treated in a community setting, would exhibit significant improvement in ODD, equivalent to that of an evidence-based treatment, PMT. Assessment was conducted at baseline, post-intervention, and at 6-month follow-up, using independently rated semistructured diagnostic interviews, parent ratings of ODD symptoms, and global ratings of severity and improvement. Analyses were conducted with hierarchical growth linear modeling, ANCOVA, and equivalence testing using an intent-to-treat sample. Both treatments demonstrated similar outcomes, with 45–50% of youth in the nonclinical range after treatment, and 67% considered much improved. No differences were found between groups, and group equivalency was shown on the independent clinician and parent-rated measures. Gains were maintained at the 6-month follow-up. In conclusion, CPS works as effectively as the well-established treatment, PMT, for youths with ODD, when implemented in a community-based setting. As such, CPS provides a viable choice for families who seek alternate treatments. [ABSTRACT FROM AUTHOR]

The article offers a clinical overview of gout, a metabolic disorder that most commonly presents as an acute inflammatory arthritis and usually manifesting in an acutely painful, tender, and inflamed joint. It discusses the epidemiology, stages, diagnosis, treatment, and management of gout. Patient presentation and history and the factors associated with urate underexcretion and urate overproduction are also highlighted.

Associations between obstetric and parental psychiatric variables and subjects’ Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS) domain scores were examined using linear mixed effects models. Data for the 228 families studied were provided by the Autism Genetic Resource Exchange. Hypertension ( P = 0.002), preeclampsia ( P = 0.021) and generalized edema ( P = 0.011) were associated with higher ADI-R communication scores. Hypertension ( P = 0.011), albuminuria ( P = 0.039) and generalized edema ( P = 0.009) were associated with higher ADI-R repetitive behaviors scores. Parent depression was associated with higher ADI-R repetitive behaviors scores ( P = 0.005), and parent anxiety with lower ADOS social/communication composite scores ( P = 0.025). The associations between hypertension-related obstetric conditions and autistic severity warrant further investigation and raise intriguing questions regarding potential causal and modifying factors in autism. [ABSTRACT FROM AUTHOR]

Abstract: This study aimed to examine the expression and function of P2 receptors of the rat tail and mesenteric arteries during maturation and ageing (4, 6 and 12weeks, 8 and 24months). Functional studies and receptor expression by immunohistochemistry revealed a heterogeneous phenotype of P2 receptor subtypes depending on artery age. The purinergic component of nerve-mediated responses in the tail artery was greater in younger animals; similarly responses to ATP and α,β-meATP and the expression of P2X1 receptors decreased with age. Contractile responses to 2-MeSADP decreased with age, and were absent at 8 and 24months; P2Y1 receptor expression followed this pattern. UTP-induced contractions and P2Y2 receptor expression also decreased with age. The mesenteric artery contracted to UTP, responses at 4 and 6weeks were larger than at other ages although P2Y2 receptor expression did not significantly differ with age. 2-MeSADP induced relaxation of the mesenteric artery, responses being greatest at 6weeks and decreased thereafter, which was mimicked by the P2Y1 receptor immunostaining. We speculate that the dramatic changes in expression of P2 receptors in the rat tail artery, compared to the mesenteric artery, during development and ageing are related to the role of the tail artery in temperature regulation. [Copyright &y& Elsevier]

Introduction: Many patients exhibit subsyndromal clinical findings of schizophrenia prior to diagnosis. Early treatment may mitigate schizophrenia development, yet little is known about comorbidities and healthcare resource utilization (HCRU) in these patients before diagnosis.Methods: This retrospective, longitudinal cohort study, conducted between January 1, 2007 and April 30, 2016, used claims data from the US HealthCore Integrated Research Database. Newly diagnosed patients with schizophrenia (International Classification of Diseases, Ninth Revision: 295.x or ICD 10 F20.%) were identified and matched (1:4) with non-schizophrenia comparators. Patients were 15-54 years of age with either ≥1 inpatient/emergency room claim with a primary schizophrenia diagnosis, or ≥2 claims in any setting with any schizophrenia diagnosis. Demographics, comorbidities, physician specialties, medications, and related services, and other HCRU were compared between cohorts for up to 5 years before diagnosis.Results: The schizophrenia cohort included 6732 patients (57.4% male, mean age 30.3 years for males and 36.2 years for females). All outcomes were more prevalent in the schizophrenia cohort than the comparator cohort. Substantial comorbidity, medication use, and HCRU were observed in the schizophrenia cohort even 4-5 years before diagnosis with increasing findings approaching diagnosis. From 4-5 years to 0-12 months before diagnosis, resource use increased from 20.5% to 53.3% for atypical antipsychotics, 29.3% to 48.2% for antidepressants, and 15.1% to 35.5% for psychiatric diagnostic examinations.Conclusions: Patients with schizophrenia extensively use healthcare resources up to 5 years before diagnosis. Our findings may help with developing predictive models to identify patients at high risk of schizophrenia. [ABSTRACT FROM AUTHOR]

Background. There are limited data on risk factors for surgical site infection (SSI) after open or laparoscopic cholecystectomy. Methods. A retrospective cohort of commercially insured persons aged 18-64 years was assembled using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure or Current Procedural Terminology, 4th edition codes for cholecystectomy from December 31, 2004 to December 31, 2010. Complex procedures and patients (eg, cancer, end-stage renal disease) and procedures with pre-existing infection were excluded. Surgical site infections within 90 days after cholecystectomy were identified by ICD-9-CM diagnosis codes. A Cox proportional hazards model was used to identify independent risk factors for SSI. Results. Surgical site infections were identified after 472 of 66 566 (0.71%) cholecystectomies; incidence was higher after open (n = 51, 4.93%) versus laparoscopic procedures (n = 421, 0.64%; P < .001). Independent risk factors for SSI included male gender, preoperative chronic anemia, diabetes, drug abuse, malnutrition/weight loss, obesity, smoking-related diseases, previous Staphylococcus aureus infection, laparoscopic approach with acute cholecystitis/obstruction (hazards ratio [HR], 1.58; 95% confidence interval [CI], 1.27-1.96), open approach with (HR, 4.29; 95% CI, 2.45-7.52) or without acute cholecystitis/obstruction (HR, 4.04; 95% CI, 1.96-8.34), conversion to open approach with (HR, 4.71; 95% CI, 2.74-8.10) or without acute cholecystitis/obstruction (HR, 7.11; 95% CI, 3.87-13.08), bile duct exploration, postoperative chronic anemia, and postoperative pneumonia or urinary tract infection. Conclusions. Acute cholecystitis or obstruction was associated with significantly increased risk of SSI with laparoscopic but not open cholecystectomy. The risk of SSI was similar for planned open and converted procedures. These findings suggest that stratification by operative factors is important when comparing SSI rates between facilities. [ABSTRACT FROM AUTHOR]

Background. There are limited data on risk factors for surgical site infection (SSI) after open or laparoscopic cholecystectomy. Methods. A retrospective cohort of commercially insured persons aged 18-64 years was assembled using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure or Current Procedural Terminology, 4th edition codes for cholecystectomy from December 31, 2004 to December 31, 2010. Complex procedures and patients (eg, cancer, end-stage renal disease) and procedures with pre-existing infection were excluded. Surgical site infections within 90 days after cholecystectomy were identified by ICD-9-CM diagnosis codes. A Cox proportional hazards model was used to identify independent risk factors for SSI. Results. Surgical site infections were identified after 472 of 66 566 (0.71%) cholecystectomies; incidence was higher after open (n = 51, 4.93%) versus laparoscopic procedures (n = 421, 0.64%; P < .001). Independent risk factors for SSI included male gender, preoperative chronic anemia, diabetes, drug abuse, malnutrition/weight loss, obesity, smoking-related diseases, previous Staphylococcus aureus infection, laparoscopic approach with acute cholecystitis/obstruction (hazards ratio [HR], 1.58; 95% confidence interval [CI], 1.27-1.96), open approach with (HR, 4.29; 95% CI, 2.45-7.52) or without acute cholecystitis/obstruction (HR, 4.04; 95% CI, 1.96-8.34), conversion to open approach with (HR, 4.71; 95% CI, 2.74-8.10) or without acute cholecystitis/obstruction (HR, 7.11; 95% CI, 3.87-13.08), bile duct exploration, postoperative chronic anemia, and postoperative pneumonia or urinary tract infection. Conclusions. Acute cholecystitis or obstruction was associated with significantly increased risk of SSI with laparoscopic but not open cholecystectomy. The risk of SSI was similar for planned open and converted procedures. These findings suggest that stratification by operative factors is important when comparing SSI rates between facilities. [ABSTRACT FROM AUTHOR]

This study examined whether emotional intelligence (EI) contributes to teachers' (N = 221) responses to vignettes portraying student peer conflicts characterizable as indirect bullying. They rated these vignettes (and others portraying direct bullying) on perceived seriousness, self-efficacy for intervening, and likelihood of intervening. EI was a positive predictor of seriousness of indirect bullying and self-efficacy, these two variables mediating the effect of EI on likelihood of intervening. However, the effect of EI was relatively small. Teachers also perceived indirect bullying as less serious than direct bullying, and felt less self-efficacious and less likely to intervene. Implications for teacher professional education are discussed. • Addressing indirect bullying may require teacher emotional intelligence (EI). • EI does influence how likely a teacher is to intervene. • EI operates via perceived seriousness and self-efficacy for intervening. • But seriousness and self-efficacy have much stronger effects on intervention. • Educating teachers in effective intervention methods may raise their self-efficacy. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine if a rapid albuterol delivery pathway with a breath-enhanced nebulizer can reduce emergency department (ED) length of stay (LOS), while maintaining admission rates and side effects, when compared to a traditional asthma pathway with a standard jet nebulizer.Methods: Children aged 3–18 presenting to a large urban pediatric ED for asthma were enrolled if they were determined by pediatric asthma score to have a moderate to severe exacerbation. Subjects were randomized to either a standard treatment arm where they received up to 2 continuous albuterol nebulizations, or a rapid albuterol arm where they received up to 4 rapid albuterol treatments with a breath-enhanced nebulizer, depending on severity scoring. The primary endpoint was ED LOS from enrollment until disposition decision. Asthma scores, albuterol dose, side effects, and return visits were also recorded.Results: A total of 50 subjects were enrolled (25 in each arm). The study LOS was shorter in the rapid albuterol group (118 vs. 163 minutes,p= 0.0002). When total ED LOS was analyzed, the difference was no longer statistically significant (192 vs. 203 minutes,p= 0.65). There were no statistically significant differences with respect to admission rates, asthma score changes, side effects, or return visits.Conclusion: A rapid albuterol treatment pathway that utilizes a breath-enhanced nebulizer is an effective alternative to traditional pathways that utilize continuous nebulizations for children with moderate to severe asthma exacerbations in the ED. [ABSTRACT FROM PUBLISHER]

Background: The emergence of community-associated methicillin-resistant S. aureus was associated with dramatically increased skin and soft tissue infection (SSTI) incidence in the first few years of the 21st century in the U.S. However, subsequent trends are poorly understood. Methods: We examined ambulatory and inpatient data of over 48 million persons years aged 0-64 years from the HealthCore Integrated Research Database (HIRD) between 2005 and 2010. Data were extracted from medical, pharmacy, and eligibility databases. We quantified SSTI incidence, type, and complications and comparative incidence trends for urinary tract infections (UTIs) and pneumonia. Results: A total of 2,301,803 SSTIs were identified. Most SSTIs (95 %) were treated in the ambulatory setting and most (60 %) were categorized as abscesses or cellulitis. During the study period, SSTI incidence remained relatively stable from 47.9 (95 % CI: 47.8-48.1) cases/1,000 PY in 2005 to 48.5 cases/1,000 PY (95 % CI: 48.3-48.6) in 2010). Persons aged 45-64 years had the highest incidence of both ambulatory-treated and inpatient-treated SSTIs (51.2 (95 % CI: 51.1-51.3) and 3.87 (95 % CI: 3.84-3.90) cases/1,000 PY, respectively). SSTI complications such as myositis, gangrene, and sepsis occurred in 0.93 % (95 % CI: 0.92-0.94 %) and 16.92 % (95 % CI: 16.87-16.97 %) of ambulatory-treated and inpatient-treated patients, respectively. SSTI incidence was approximately twice that of UTIs and tenfold of that of pneumonia. Conclusions: Among our large, diverse population of persons less than 65 years, SSTI incidence 2005 through 2010 has remained relatively constant at approximately 4.8 SSTIs per 100 person years, suggesting that previously observed increases in SSTI incidence remain sustained. [ABSTRACT FROM AUTHOR]

Aim Cognitive behaviour therapy ( CBT) is a clinically indicated treatment for first-episode psychosis. Despite this, CBT for early psychosis is not routinely available as part of standard mental health services in Australia. The aim of this pilot project was to develop a CBT for early psychosis service to be provided as an adjunct to existing community mental health services. This study examined the feasibility of this service model, delivered in a real-world setting. A secondary aim was to explore the effectiveness of this service, as measured by clinical and functional outcomes. Methods Participants living in northern Sydney, Australia, and who had recently experienced a first episode of psychosis, were offered up to 20 sessions of individual CBT. Service feasibility was measured via attrition rates, therapy attendance and referrer feedback. Measures of psychosis, depression, anxiety and psychosocial functioning, were assessed pretreatment, after six and 12 sessions, and at 3 months post-treatment. Results Nineteen clients attended treatment to completion. Survey feedback from referrers affirmed the positive impact of the service on clients' recovery. Additionally, clients showed improvements in symptoms of psychosis over the first three time points. Psychosocial functioning also shifted from the moderately to mildly impaired range by the end of treatment. Conclusions The CBT for early psychosis service has been successfully integrated into the mental health landscape of northern Sydney. Outcomes of this pilot project are discussed with reference to the achievements of the service, as well as the obstacles encountered, and how they were overcome. [ABSTRACT FROM AUTHOR]

BACKGROUND: Thrombotic events (TEs) are rare but often serious adverse events that could occur after administration of immune globulin (IG) products. Our study objective was to assess occurrence of recorded TEs after administration of different US-licensed IG products and investigate potential risk factors using a large administrative database. STUDY DESIGN AND METHODS: This is a retrospec-tive claims-based cohort study of individuals exposed to IG products from January 1, 2008, through September 30, 2010, using HealthCore's Integrated Research Database, a longitudinal health care database. IG prod-ucts were identified by recorded Healthcare Common Procedure Coding System codes. TEs were ascertained via International Classification of Diseases, Ninth Revi-sion, Clinical Modification diagnosis codes. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for same-day TEs by IG product, while controlling for confounders. RESULTS: Of 11,785 individuals exposed to IG prod-ucts in the study period, 122 (1%) had TE(s) recorded on the same day as IG administration. TE rates per 1000 persons exposed ranged from 6.1 to 20.5 for dif-ferent IG product groups. Vivaglobin users had an increased same-day TE risk compared to reference Gammagard Liquid users (OR, 3.56; 95% CI, 1.54-8.23). An increased TE risk was also found with older age (≥45 years), prior TE(s), and hypercoagulable state(s). CONCLUSION: The study suggests potentially elevated TE rates for different IG products, including subcutane-ous. It also identifies important recipient TE risk factors and suggests that risk-benefit profiles should be weighed before IG administration. The observed differ-ences may be due to various factors such as dosage, administration rates, and product manufacturing pro-cesses that warrant further evaluation. [ABSTRACT FROM AUTHOR]

Data from National Health and Nutrition Examination Survey (NHANES) II (1976 to 1980), NHANES III (1988 to 1994), and NHANES 1999 to 2006 were examined to assess trends in total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein cholesterol, triglycerides (TGs), lipid-lowering medication use, and obesity. Age-adjusted decreases in TC (210 to 200 mg/dl) and LDL cholesterol (134 to 119 mg/dl) were observed. Those with high TC showed a decrease of 9% from NHANES II to NHANES 1999 to 2006, whereas those with LDL cholesterol ≥160 mg/dl showed a decrease of 8%. A significant increase in mean high-density lipoprotein cholesterol was observed (50 to 53 mg/dl, p <0.001), most likely due to changes in methods. Those with TG levels ≥150 mg/dl showed a decrease from NHANES II to NHANES III from 30% to 27% but then an increase from NHANES III to NHANES 1999 to 2006 from 27% to 33%. Since NHANES III, mean TG levels have increased 12% from 130 to 146 mg/dl. In the 2 most recent surveys, self-reported “high cholesterol” increased from 17% to 27%, and self-reported lipid medication use by those with high cholesterol increased from 16% to 38%. Mean body mass index increased from 26 to 29 kg/m2, and prevalence of obesity doubled and was significantly associated with increased TG. In conclusion, recent favorable trends in TC and LDL cholesterol are likely due to increased awareness of high cholesterol and the greater use of lipid-lowering drugs. However, countertrends in obesity and TG levels, if continued, will likely have a negative impact on cardiovascular disease in the future. [ABSTRACT FROM AUTHOR]

Stress literacy is a term that refers to knowledge about stress and stress management techniques. Levels of stress literacy were examined in more than nine hundred Australian adolescents by providing a short stress-management education session and assessing stress literacy using a pre-post survey design. It was found that while adolescents had a reasonable knowledge of the symptoms of stress and effective stress management techniques, the likelihood of adolescents seeking help for stress or using these stress management techniques was low. The implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Background: Noninfectious wound complications (NIWCs) after mastectomy are not routinely tracked and data are generally limited to single-center studies. Our objective was to determine the rates of NIWCs among women undergoing mastectomy and assess the impact of immediate reconstruction (IR).Study Design: We established a retrospective cohort using commercial claims data of women aged 18 to 64 years with procedure codes for mastectomy from January 2004 through December 2011. Noninfectious wound complications within 180 days after operation were identified by ICD-9-CM diagnosis codes and rates were compared among mastectomy with and without autologous flap and/or implant IR.Results: There were 18,696 procedures (10,836 [58%] with IR) among 18,085 women identified. The overall NIWC rate was 9.2% (1,714 of 18,696); 56% required surgical treatment. The NIWC rates were 5.8% (455 of 7,860) after mastectomy only, 10.3% (843 of 8,217) after mastectomy plus implant, 17.4% (337 of 1,942) after mastectomy plus flap, and 11.7% (79 of 677) after mastectomy plus flap and implant (p < 0.001). Rates of individual NIWCs varied by specific complication and procedure type, ranging from 0.5% for fat necrosis after mastectomy only, to 7.2% for dehiscence after mastectomy plus flap. The percentage of NIWCs resulting in surgical wound care varied from 50% (210 of 416) for mastectomy plus flap, to 60% (507 of 843) for mastectomy plus implant. Early implant removal within 60 days occurred after 6.2% of mastectomy plus implant; 66% of the early implant removals were due to NIWCs and/or surgical site infection.Conclusions: The rate of NIWC was approximately 2-fold higher after mastectomy with IR than after mastectomy only. Noninfectious wound complications were associated with additional surgical treatment, particularly in women with implant reconstruction, and with early implant loss. [ABSTRACT FROM AUTHOR]