Checklist Scores Research Articles

The Factor Structure of Child Behavior Checklist Scores With Elementary School Students Referred to Counseling Within Low-Income Communities

The Child Behavior Checklist (CBCL) is one of the most frequently used assessments of social, emotional, and behavioral functioning; however, previous research has noted inconsistency in the factor structure and items included on the Child Behavior Checklist for Ages 6 to 18 Years (CBCL/6-18) when tested with diverse samples of client populations. Thus, the purpose of our investigation was to examine the factor structure of CBCL/6-18 scores ( N = 459) with diverse American children referred to receive school-based mental health counseling enrolled in five Title I elementary schools in the Southeastern United States. We performed confirmatory factor analysis (CFA) and principal component analysis (PCA) on CBCL/6-18 scores to examine the factor structure and internal consistency reliability of the data. Results demonstrated an inadequate fit for model and further data analyses resulted in a three-factor, 32-item model (41.40% of the variance explained). Implications of the findings support a new conceptual framework of the CBCL/6-18 to provide a more parsimonious model when working with diverse populations, specifically children from low-income families.

An effective snakebite first aid training method for medics in the Chinese troops: a RCT

BackgroundSnakebites can lead to lifelong consequences and is one of the main causes of death among military troops worldwide. However, few Chinese military medics know the proper first aid procedures for snakebites. Therefore, this study aimed to explore the impact of the Standard Operation Procedure (SOP) and checklist on Chinese military medics’ ability to manage snakebite first aid.MethodsThis study was a prospective single-blind randomized controlled trial conducted in a military medical university of China from May to June 2017. A questionnaire-based survey was performed to collect the participants’ socio-demographic profiles before the baseline measurement. During the baseline measurement, participants were requested to provide corresponding first aid that was responsive to the simulative situation portrayed by the SPs (standardized patients) and the evaluators then scored their performances according to a checklist for snakebite first aid scoring table. After the baseline measurement, they were randomly assigned to one of three intervention groups after stratification according to their baseline performance scores: group A received a self-learning course with textbooks (n = 27), group B received a self-learning training on the SOP and checklist (n = 27) and group C was engaged in an interactive discussion panel regarding the SOP and checklist (n = 26). After the interventions, participants received outcome measurements about snakebite first aid key points capability from the same evaluator and SP for each group to avoid observational error. The reviewers were blinded about the grouping in the trial.ResultsThe baseline measurement yielded no significant difference (H = 1.647, P = 0.439) among the three groups. The post-intervention scores were higher than the pre-intervention scores for all three (A, B and C) groups (P = 0.008, P < 0.001 and P < 0.001, respectively). There was significant difference of the post-intervention scores among the three groups (F = 8.841, P < 0.001). Both post-intervention scores of group B and group C were higher than that of group A (P < 0.001 and P = 0.001, respectively), but no difference was found between group B and C (P = 0.695). The acceptance questionnaire score of SOP and checklist was mostly very satisfied, as the final scores of group B and group C were 4.62 ± 0.61 and 4.82 ± 0.45, respectively.ConclusionsIn this study, the implementation of an SOP and checklist for snakebite first aid was shown to update and improve first aid treatment concepts in military medics. These intervention methods played an important role in improving the medics’ cognition and understanding of snakebite first aid. Therefore, this finding suggests that SOP and checklist training should be further implemented in Chinese troops for snakebite care.

Incentive-Based Game for Allaying Preoperative Anxiety in Children: A Prospective, Randomized Trial.

Induction of anesthesia can be distressing both for children and their parents. Nonpharmacological behavioral interventions can reduce the anxiety of children without significant adverse effects as seen with sedative medications. We hypothesized that the use of incentive-based game therapy in conjunction with parental involvement would be a simple and cost-effective intervention in reducing the preoperative anxiety in children. Eighty children between the age group of 4 and 8 years scheduled to undergo surgery were randomly assigned to a control group (n = 40) and intervention group (n = 40). Children in the intervention group participated in an incentive-based game in the preoperative room. Anesthesia was induced with parental presence in both the groups. The modified Yale Preoperative Anxiety Scale (mYPAS) score to measure the anxiety of the children during induction was taken as the primary outcome. Induction Compliance Checklist score and parental satisfaction were assessed as secondary outcomes. The mYPAS score of children in the intervention group was significantly less than the control group during anesthesia induction. The mean difference (95% confidence interval [CI]) of the mYPAS at induction between the 2 groups was 20 (95% CI, 16-24; P < .001). Fourteen (35%) children in the intervention group and 2 (5%) children in control group displayed no anxiety (mYPAS score <30) (difference of -30%; 95% CI, -11% to -49%; P < .001). Children in the intervention group were more compliant with mask induction and had a significantly less Induction Compliance Checklist score compared to the control (P < .001). Thirty (75%) parents in the intervention group were satisfied at the end of surgery compared to 6 (15%) in the control group (difference of -60%; 95% CI, -39% to -73%; P < .001). The use of incentive-based game therapy reduces the anxiety scores during induction of anesthesia and improves the compliance to facemask induction in children undergoing surgery. It can form a simple, cost-effective, and easy-to-administer technique that can be easily applied in low-income settings.

The Validation of a Provider-Reported Fidelity Measure for the Transdiagnostic Sleep and Circadian Intervention in a Community Mental Health Setting

Monitoring treatment fidelity is essential to check if patients receive adequate doses of treatment and to enhance our theoretical understanding of how psychosocial treatments work. Developing valid and efficient measures to assess fidelity is a priority for dissemination and implementation efforts. The present study reports on the psychometric properties of the Provider-Rated TranS-C Checklist—a provider-reported fidelity measure for the Transdiagnostic Sleep and Circadian Intervention (TranS-C). Adults with severe mental illness (SMI; N = 101) seeking treatment in a community mental health setting received eight sessions of TranS-C. Therapists completed the Provider-Rated TranS-C Checklist at the end of each treatment session (N = 808) to indicate which modules they delivered during that session. To assess convergent validity, independent raters scored modules delivered from audio recordings of a subset of sessions (n = 257) for the modules delivered using the Independent-Rater TranS-C Checklist. Using exploratory factor analysis, a unidimensional scale composed of TranS-C’s modules was identified. Provider-Rated TranS-C Checklist scores were positively associated with the Independent-Rater TranS-C Checklist scores demonstrating convergent validity. Results indicate that the Provider-Rated TranS-C Checklist yields reliable and valid scores of providers’ delivery of TranS-C.

Sexual function, menopausal symptoms, depression and cancer worry in women with BRCA mutations.

Assess sexual function, menopausal symptoms, and depression in women with BRCA mutations associated with oophorectomy and menopause status. Women age 40 and older with BRCA mutations completed a questionnaire with validated measures of sexual activity, menopausal symptoms, depression, and cancer worry. These measures were compared between those with intact ovaries and those who had undergone pre- or post-menopausal risk-reducing salpingo-oophorectomy (RRSO). Of the 244 women, 21 had intact ovaries and 223 had undergone RRSO. Women with intact ovaries had less menopausal symptoms (Menopausal Symptom Checklist (MSCL) score 14 versus 23, P = .01) but more cancer worry than women who had undergone RRSO (median Cancer Worry Scale (CWS) score 5 versus 4, P < .0001) with no significant difference in sexual activity or function. Compared with women with postmenopausal RRSO, women with premenopausal RRSO were more likely to be sexually active (56.3% versus 42.0%, P =.04) but had similar sexual functioning, including frequency, pleasure and discomfort. Women with premenopausal RRSO were also more likely to report menopausal symptoms (MSCL score 26 versus 19, P = .04) and depression (PHQ-8 score 4 versus 2, P < .001). Factors associated with sexual activity included younger age, lower BMI, living with a partner, and lower depression scores. Higher current depression score was associated with history of depression and more menopausal symptoms. Risk-reducing surgery decreases cancer risk and worry in women with BRCA mutations. Among women undergoing oophorectomy, factors such as age and history of depression were related to reduced sexual activity and increased depression, but menopausal status was not related.

Setting defensible standards in small cohort OSCEs: Understanding better when borderline regression can ‘work’

Introduction: Borderline regression (BRM) is considered problematic in small cohort OSCEs (e.g. n < 50), with institutions often relying on item-centred standard setting approaches which can be resource intensive and lack defensibility in performance tests.Methods: Through an analysis of post-hoc station- and test-level metrics, we investigate the application of BRM in three different small-cohort OSCE contexts: the exam for international medical graduates wanting to practice in the UK, senior sequential undergraduate exams, and Physician associates exams in a large UK medical school.Results: We find that BRM provides robust metrics and concomitantly defensible cut scores in the majority of stations (percentage of problematic stations 5, 14, and 12%, respectively across our three contexts). Where problems occur, this is generally due to an insufficiently strong relationship between global grades and checklist scores to be confident in the standard set by BRM in these stations.Conclusion: This work challenges previous assumptions about the application of BRM in small test cohorts. Where there is sufficient spread of ability, BRM will generally provide defensible standards, assuming careful design of station-level scoring instruments. However, extant station cut-scores are preferred as a substitute where BRM standard setting problems do occur.

Effects of a water-based exercise program on disability prevention in older Japanese adults.

This study aimed to evaluate the potential preventive effects of a water-based exercise program on disability in community-dwelling older adults. The study design was a propensity score-matched retrospective study. Older adults were contacted through a mail survey carried out by City Hall, and those who scored ≥3 points on the physical domain of the Kihon Checklist were encouraged to participate in the water-based exercise program. The program consisted of aerobic and walking exercises in the water for 1 h, once a week for 6 months. Propensity scores were used to match individuals who participated in the exercise program with control individuals based on age, sex, height, weight, body mass index and Kihon Checklist score. Among matched pairs, the study included 278 participants (control group 139, intervention group 139). The main outcome was the number of participants who received a new long-term care insurance certification during the first follow-up year, which was used to indicate disability. Of the 278, 13 participants (5.5%) required long-term care insurance certification. A significantly smaller proportion of intervention group members required long-term care insurance certification (intervention group 0.7% [1/139 participants] vs control group 8.6% [12/139 participants], P = 0.003). Water-based exercise program appears to effectively prevent disability in community-dwelling older adults. Because water-based exercise program is associated with a minimal burden on joints and lower risk of falling, it might particularly enable the prevention of disability in older adults with chronic pain and restricted mobility. Geriatr Gerontol Int 2019; 19: 1282-1288.

422. Pooling Strategy for Chlamydia trachomatis and Neisseria gonorrhoeae Reduces Cost of GeneXpert Molecular STI Screening in Two Limited-Resource Clinics in Zambia

BackgroundRisk of heterosexual HIV-1 transmission is elevated in the presence of sexually transmitted infections (STIs) such as chlamydia (CT) and gonorrhea (NG). Syndromic management is a common, low-resource, approach to detecting STIs. However, CT and/or NG infections in women are often asymptomatic and therefore missed by syndromic management. Molecular testing for STIs is highly sensitive, but time and cost restraints preclude implementation of these technologies in resource-limited settings. Pooling samples for testing together in GeneXpert cartridges is one strategy for reducing the cost per individual tested.MethodsThis project describes the development of a pooling strategy based on social and demographic factors associated with CT/NG prevalence rates in a cohort of high-risk women in Zambia. Logistic regression modeling was used to predict the probability of a positive CT/NG test result in the presence of various factors. Data from a 2016 cross-sectional sub-study on intra-vaginal practices in 509 women was examined and an easy-to-use diagnostic screening checklist was created to categorize women by probability of testing positive on the GeneXpert. An algorithm considering cost of each test and prevalence of disease in each group determined the optimal pool size for each risk category.ResultsLogistic regression identified CT/NG to be associated with: city, age, education, long-acting reversible contraception usage, and laboratory results for bacterial vaginosis, Trichomonas vaginalis, and incident syphilis on the day of CT/NG testing. Signs and symptoms were not found to be associated. The overall prevalence of either CT and/or NG infection in this population was 17%. Low, middle, and high-risk groups could be separated based on checklist score with 7.52%, 18.30%, and 46.51% CT/NG prevalence, respectively.ConclusionPooling women with similar CT/NG predictive factors together, or testing those at highest risk individually, reduces the cost per test. Further implementation of this tool to guide presumptive treatment, in lieu of molecular testing, increases the cost-saving potential. The strategies described in this study are applicable to other low-resource clinical settings seeking to provide the accuracy of molecular testing with a reduced financial burden.Disclosures All authors: No reported disclosures.

Probable Posttraumatic Stress Disorder and Lower Respiratory Symptoms Among Rescue/Recovery Workers and Community Members After the 9/11 World Trade Center Attacks-A Longitudinal Mediation Analysis.

Posttraumatic stress disorder (PTSD) and lower respiratory symptoms (LRS) often coexist among survivors of the September 11, 2001 (9/11) World Trade Center (WTC) attacks. Research in police and nontraditional responders suggests that PTSD mediates the relationship between 9/11 physical exposures and LRS, but not vice versa. We replicated these findings in WTC rescue/recovery workers (R/R workers), extended them to exposed community members, and explored the interplay between both physical and psychological 9/11 exposures, probable PTSD, and LRS over a 10-year follow-up. Participants were 12,398 R/R workers and 12,745 community members assessed in three WTC Health Registry surveys (2003-2004, 2006-2007, and 2011-2012). LRS and 9/11 exposures were self-reported. Probable PTSD was defined as a PTSD Checklist score ≥44. Probable PTSD predicted LRS (R/R workers: β = 0.88-0.98, p < .001; community members: β = 0.67-0.86, p < .001) and LRS predicted PTSD (R/R workers: β = 0.83-0.91, p < .001; community members: β = 0.68-0.75, p < .001) at follow-ups, adjusting for prior symptoms and covariates. In both R/R workers and community members, probable PTSD mediated the relationship between 9/11 physical exposures (dust cloud, long duration of work) and LRS (indirect effects, p = .001-.006), and LRS mediated the physical exposure-PTSD relationship (indirect effects, p = .001-.006). In R/R workers, probable PTSD mediated the psychological exposure (losing friends or loved ones, witnessing horrific events)-LRS relationship (indirect effect, p < .001), but LRS did not mediate the psychological exposure-PTSD relationship (indirect effect, p = .332). In community members, high 9/11 psychological exposure predicted both probable PTSD and LRS at follow-ups; probable PTSD mediated the psychological exposure-LRS relationship (indirect effect, p < .001), and LRS mediated the psychological exposure-PTSD relationship (indirect effect, p = .001). Probable PTSD and LRS each mediated the other, with subtle differences between R/R workers and community members. A diagnosis of either should trigger assessment for the other; treatment should be carefully coordinated.

An assessment of Information disclosures by Pharmaceutical Industry: Evidence from India

&lt;p&gt;The information disclosed by the companies in their annual reports reveals much about company’s performance and prospects. Investors take the information as base for decision for investment. Under such circumstance, companies choose to disclose beyond what is mandatorily required. Theories like agency theory, capital need theory and signaling theory support the need of voluntary disclosure. This study is about investigating the extent of Voluntary disclosure in pharmaceutical sector of India which is 3&lt;sup&gt;rd&lt;/sup&gt; in World in terms of Volume of Trade.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective&lt;/strong&gt;: To investigate the extent of voluntary disclosure practices prevailing in pharma sector of India, for the year 2010-11 to 2017-18.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Significance of the study:&lt;/strong&gt; This study aims to explore the corporate aspect of pharmaceutical sector. Any growing avenue is a potential opportunity for investors looking for parking their money to get adequate returns. Thus, Indian Pharma sector has come up in flying colors as an avenue for investors to place their money owing to its 100% FDI . Investors have been looking for more and more information from this sector to ensure the safety of funds. Thus the extent of disclosures is worth studying to place a suggestion for the policymakers to introduce the changes in the present set of disclosure practices in pharmaceutical sector.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Research Methodology&lt;/strong&gt;: To understand the extent of voluntary disclosure, a disclosure checklist is constructed and descriptive statistics are carved out to reach the results. The checklist consists of 55 items which are not mandatory by law. The checklist is based on dichotomous scale of ‘1’ and ‘0’ representing presence and absence of the checklist item respectively. The cross sectional analysis is carried out to investigate the year wise and company wise disclosure for eight years.&lt;/p&gt;&lt;div&gt;&lt;p&gt;&lt;strong&gt;Findings:&lt;/strong&gt; Though the study observes an increasing trends in the disclosure scores, but the findings are alarming to state that the highest score attained by any company throughout the period of 8 years was 37 (out of 55) not even meeting 80% of the total checklist score. This shows that pharmaceutical sector is not so friendly at disclosures. The probable reasons for such startling results are discussed in the study.&lt;/p&gt;&lt;/div&gt;

Advancing Our Understanding of Narrative Comments Generated by Direct Observation Tools: Lessons From the Psychopharmacotherapy-Structured Clinical Observation.

While prior research has focused on the validity of quantitative ratings generated by direct observation tools, much less is known about the written comments. This study examines the quality of written comments and their relationship with checklist scores generated by a direct observation tool, the Psychopharmacotherapy-Structured Clinical Observation (P-SCO). From 2008 to 2012, faculty in a postgraduate year 3 psychiatry outpatient clinic completed 601 P-SCOs. Twenty-five percent were randomly selected from each year; the sample included 8 faculty and 57 residents. To assess quality, comments were coded for valence (reinforcing or corrective), behavioral specificity, and content. To assess the relationship between comments and scores, the authors calculated the correlation between comment and checklist score valence and examined the degree to which comments and checklist scores addressed the same content. Ninety-one percent of the comments were behaviorally specific. Sixty percent were reinforcing, and 40% were corrective. Eight themes were identified, including 2 constructs not adequately represented by the checklist. Comment and checklist score valence was moderately correlated (Spearman's rho = 0.57, P < .001). Sixty-seven percent of high and low checklist scores were associated with a comment of the same valence and content. Only 50% of overall comments were associated with a checklist score of the same valence and content. A direct observation tool such as the P-SCO can generate high-quality written comments. Narrative comments both explain checklist scores and convey unique content. Thematic coding of comments can improve the content validity of a checklist.

Comparing associations found between unannotated and annotated metabolomics in a study of behavioral outcomes in children with cerebral malaria

OPS 59: The Exposome: progress in methods and applications, Room 412, Floor 4, August 28, 2019, 1:30 PM - 3:00 PM Background: Untargeted metabolomics analyses include unannotated feature sets in which a subset of features are annotated. In a cohort of preschool (<5 years old; n=99) Ugandan children with cerebral malaria (CM), the cerebrospinal fluid (CSF) metabolome was measured during hospitalization. CM is the most severe form of malaria and has been associated with long-term behavioral impairment. Child Behavior Checklist (CBCL) scores were measured in children with CM 12 months after the children’s hospitalization to analyze behavioral outcomes. Our objectives are to detect CSF metabolome features associated with CBCL scores, and to determine the overlap between analyses using only annotated features and the full feature set. Methods: CSF metabolomic features were measured using liquid chromatography mass spectrometry (LC-MS). We assessed full feature sets separately from annotated metabolites with 80% detection across samples. We performed single-chemical analyses using false discovery rates for multiple comparisons. To accommodate the correlation among the components, we included a weighted quantile sum regression with a random subset ensemble step (WQSRS). Covariates included subject age, sex, socioeconomic status, z-scores of both weight and height, and retinopathy status. Results: In the unannotated feature set, we found 3 features significantly related to CBCL scores. In the annotated features set, 12 metabolites had significant linear associations with CBCL scores. In the mixtures WQSRS index, the unannotated features in the top 10% of weights included components that were not annotated, demonstrating that the annotated analysis missed key features. Conclusion: Our results indicate that considering only annotated metabolites misses features in the full features set in a study of children with CM in the association between a CSF metabolome and behavioral outcomes. The unknown features identified to be linked to CBCL scores and not included in the annotated set provide potentially important future areas of inquiry.

Cost and cost-effectiveness of childhood cancer treatment in low-income and middle-income countries: a systematic review

IntroductionA major barrier to improving childhood cancer survival is the perception that paediatric oncology services are too costly for low-income and middle-income country (LMIC) health systems. We conducted a systematic...

Doctor YouTube: A Quality Analysis Of Medical Information Videos On The Video Platform YouTube On Ankle Sprain

Category:Ankle, Sports, TraumaIntroduction/Purpose:The video portal YouTube has evolved from pure entertainment to professional and semi-professional video tutorials and medical video channels in the recent past. As a result, YouTube today is a source of information that is widely used by patients and relatives. Ankle sprains are one of the most common musculoskeletal injuries, this study was designed to analyze the quality of informational videos available on YouTube and to identify potential hazards as well as content errors.Methods:In July 2016, YouTube was searched for the terms “ankle sprain”, “high ankle sprain”, “ankle pain” and “ankle pain distortion”. The analysis was limited to the first 5 result pages for each search term. Only English and German videos were included. The videos were found by 2 independent evaluators (MZ, SP) using a multi-dimensional score checklist for the sections anatomy, risk factors and symptoms (max 8 pts), biomechanics (max 3 pts), imaging (max 2 pts), clinical examination (max 6 pts), treatment (max 5 pts), rehabilitation measures (max 2 pts) and prevention (max 2 pts) with a maximum scores per contribution of 31 pts evaluated.Results:The mean score of the video quality was 11.5 ± 4.5 pts. Distribution of points by subgroup: anatomy, risk factors and symptoms 3.7 ± 1.4, biomechanics 1,8 ± 1.2, imaging 0.9 ± 0.8, clinical examination 1.3 ± 1.2, treatment 2 ± 1.3, rehabilitation 1.1 ± 0.9, prevention 0.6 ± 1.No evaluated contribution achieved “very good” Quality Assessment Score of 25-31 pts, one video was rated ”good” with 21-26 pts, 2 videos were “satisfactory” (20-16 pts), 14 videos ”sufficient” (15-10 pts.). 7 videos were rated as “insufficient” (9-4 pts). One clip (2.5 pts) was rated as a promotional video.A slight correlation between views by videos and score (r = 0.11) and a small correlation between the total score and Likes occured (r = 0.15).Conclusion:Patients watching online video tutorials on ankle injuries are seeking valid information. YouTube gives an extensive video footage of low quality. The defective and incorrect information analyzed by us must be corrected by medical advice.Furthermore, the presented investigation shows an average to bad quality so that the introduction of a seal of approval by the AOFAS for digital content, based on an evidence-based quality control should be discussed in the future.

The Relation between Mental Verbs Utilization and Child Pragmatic Language Checklist Scores in a Story Retelling Task: 6 to 9 Aged Children

The Relation between Mental Verbs Utilization and Child Pragmatic Language Checklist Scores in a Story Retelling Task: 6 to 9 Aged Children

Observing and Identifying Hospitalist Best Communication Practices in Patient Interactions

This study identifies actual hospitalist best communication practices that optimize patient interactions in a busy hospital context. We observed and rated 36 hospitalists and 206 patient encounters using the Kalamazoo Essential Elements of Communication Checklist-Adapted (KEECC-A). We collected descriptive statistics of checklist scores and thematically analyzed fieldnotes to identify communication patterns. Results show hospitalists score highest and most frequently use three of seven KEECC-A dimensions: builds a relationship, shares information, and gathers information. We first identify exemplar behaviors and then provide statistical comparisons by professional and hospital tenure, gender, and day of rounding observed for these three dimensions. Male hospitalists scored higher than females for shares information and significant differences were found for gender between cross-sex patient-hospitalist interactions. Hospitalists early in their professional and hospital tenure received significantly lower ratings than mid-to-late career hospitalists in the three KEECC dimensions. Hospitalists observed on the first day of rounding received significantly higher ratings than those observed on a middle or last day. We offer interpretations to explain study findings and suggest interventions to help hospitalists with less-than-desirable communication skills.

Peripheral Blood Mononuclear Cell Oxytocin and Vasopressin Receptor Expression Positively Correlates with Social and Behavioral Function in Children with Autism

The peptide hormone oxytocin is an established regulator of social function in mammals, and dysregulated oxytocin signaling is implicated in autism spectrum disorder (ASD). Several clinical trials examining the effects of intranasal oxytocin for improving social and behavioral function in ASD have had mixed or inclusive outcomes. The heterogeneity in clinical trials outcomes may reflect large inter-individual expression variations of the oxytocin and/or vasopressin receptor genes OXTR and AVPR1A, respectively. To explore this hypothesis we examined the expression of both genes in peripheral blood mononuclear cells (PBMC) from ASD children, their non-ASD siblings, and age-matched neurotypical children aged 3 to 16 years of age as well as datamined published ASD datasets. Both genes were found to have large inter-individual variations. Higher OXTR and AVPR1A expression was associated with lower Aberrant Behavior Checklist (ABC) scores. OXTR expression was associated with less severe behavior and higher adaptive behavior on additional standardized measures. Combining the sum expression levels OXTR, AVPR1A, and IGF1 yielded the strongest correlation with ABC scores. We propose that future clinical trials in ASD children with oxytocin, oxytocin mimetics and additional tentative therapeutics should assess the prognostic value of their PBMC mRNA expression of OXTR, AVPR1A, and IGF1.

Educational Impact of a Pulsatile Human Cadaver Circulation Model for Endovascular Training

The face and construct validity of a novel pulsatile human cadaver model (PHCM) was recently demonstrated for endovascular training. This study aimed to assess the model's educational impact. Twenty-four endovascular novices were recruited and split into two equal training groups: PHCM and virtual reality simulator (VRS). Each candidate performed eight consecutive training attempts of endovascular renal artery catheterisation on their designated model, and a final crossover attempt on the alternate model. Performances were video recorded and scored using a validated scoring tool by two independent endovascular experts, blinded to the candidate's identity and attempt number. Each participant was given a task specific checklist score (TSC), global rating score (GRS), and overall procedure score (OPS). In the PHCM group average OPS improved gradually from 19.42 (TSC 8.58, GRS 10.83) to 39.50 (TSC 15.00, GRS 24.5) over eight attempts (p<.0005). In the VRS group OPS improved from 20.54 (TSC 10.29, GRS 10.25) to 36.04 (TSC 14.21, GRS 21.88) between the first and eighth attempts (p<.0005), with limited improvement after the second attempt. PHCM training significantly improved OPS on their VRS crossover attempt (p≤.0001), achieving a similar OPS to candidates who had completed VRS training (p=.398). VRS training significantly improved OPS on PHCM (p<0.05); however, OPS was significantly worse than candidates who had completed PHCM training (p≤.001). PHCM training has a longer learning curve, with gradual improvement, reflecting the enhanced difficulty of a more realistic model. These results support the use of PHCM preceded by VRS training, prior to performing endovascular surgery on patients.

Large posttraumatic stress disorder improvement and antidepressant medication adherence

BackgroundPatients with vs. without posttraumatic stress disorder (PTSD) are more likely to have poor antidepressant medication (ADM) adherence but it is unclear if improved PTSD is associated with ADM adherence. We determined if clinically meaningful PTSD symptom reduction was associated with ADM adherence. MethodsElectronic health record data (2008–2015) was obtained from 742 Veterans Health Affairs (VHA) patients using PTSD specialty clinics with a PTSD diagnosis and PTSD checklist (PCL) score ≥50. The last PCL in the exposure year after the first PCL≥50 was used to identify patients with a clinically meaningful PCL decrease (≥20 point) versus those without (< 20 point). Patients had a depression diagnosis in the 12-months before the exposure year and received an ADM in the exposure year. Proportion of days covered ≥80% in exposure year defined adherence. Confounding was controlled using propensity scores and inverse probability of treatment weighting. ResultsPatients were 42.2 ± 13.1 years of age, 63.9% white and 18.9% had a clinically meaningful PCL decrease. After controlling for confounding variables, patients with vs. without a clinically meaningful PCL decrease were significantly more likely to be adherent (OR = 1.78; 95% CI:1.16–2.73). However, adherence remained low in both patients with and without meaningful PCL decrease (53.5% vs. 39.3%). LimitationsThe sample was limited to VHA patients. Patients may not have taken medication as prescribed. ConclusionsLarge reductions in PTSD symptoms are associated with ADM adherence. Prior literature suggests ADM adherence improves depression symptoms. Thus, PTSD symptom reduction may lead to better depression outcomes.

Parent Perspectives on Sleep and Sleep Habits Among Young Children Living With Economic Adversity.

To examine the perspectives of ethnically diverse, low-income parents of young children regarding sleep, sleep habits, and preferences for sleep promotion for themselves and their children. We recruited a sample of mothers who had a 15- to 60-month-old child enrolled in the Special Supplemental Nutritional Program for Women, Infants and Children in a Northeastern U.S. city. We used a convergent mixed-methods design to conduct semistructured interviews and questionnaires to measure parent sleep quality (Pittsburgh Sleep Quality Index), sleep apnea (Berlin Apnea Questionnaire), mood (Centers for Epidemiological Studies of Depression), children's sleep (Children's Sleep Habits Questionnaire), and behavior (Child Behavior Checklist). Thirty-two mothers (M age = 30.97 [SD 6.34] years; n = 21 [65%] African American) and children (N = 14 [44% female]; M age =38 [SD 12.63] months) participated. Children's average sleep duration was 10 hr, which is below the recommendation for this age group; overall sleep difficulty was high despite most mothers reporting that their children had normal sleep. Five children had abnormal Child Behavior Checklist scores, suggesting internalizing and externalizing behaviors. More than half of the mothers had poor sleep quality and 24 (75%) were at high risk for sleep apnea. Mothers viewed sleep as important for themselves and their children and identified both effective and ineffective practices to promote sleep, including practices learned from their own families. Ethnically diverse mothers who are living with economic adversity value sleep for themselves and their children. The high value placed on sleep, despite misconceptions about normal sleep, suggest opportunities to promote sleep interventions. The content and delivery methods should be tailored to their knowledge, preferences, and cultural practices.