Nonspecific Criteria Research Articles

Antibiotic treatment to prevent pediatric acute otitis media infectious complications: A meta-analysis.

Most US children with acute otitis media [AOM] receive prompt antibiotic treatment, though guidelines encourage watchful waiting. Previous systematic reviews of antibiotics versus watchful waiting have focused on symptom resolution and RCTs, limiting the assessment of serious, rare complications. We sought to evaluate these complications by including observational studies. RCTs and observational studies that compared antibiotics to placebo or watchful waiting for pediatric clinician diagnosed AOM were identified [PubMed/MEDLINE, Embase, Cochrane Database of Systematic Reviews, Central Register of Controlled Trials, and Web of Science] and reviewed for meta-analysis. Two reviewers independently extracted study characteristics, patient characteristics, and outcomes. We assessed publication bias, study bias with ROBINS-1 and RoB-2 and used random-effects models to assess treatment effects. 24 studies were included. Antibiotics decreased the risk of acute mastoiditis [incidence 0.02%, RR 0.48, 95% CI 0.40-0.59; NNT 5,368]. This protective effect may be underestimated because of misclassification of non-suppurative conditions as AOM. Intracranial complications remained too rare to assess. Antibiotics markedly increased the risk of adverse effects [incidence 10.5%, RR 1.49, 1.27-1.73; NNH 23]. Studies used non-specific criteria for acute mastoiditis, potentially underestimating treatment effects. Prompt antibiotic therapy reduces the risk for some AOM complications. The NNT to prevent serious, rare complications is high, while the NNH is relatively low. Large-scale population-based observational studies using real-world datasets with validated measures of severe complications are needed to improve understanding of risk factors for serious AOM complications, facilitate more selective antibiotic therapy, and optimize individual outcomes and public health.

Anterior cervical surgery for the treatment of cervigonenic headache caused by cervical spondylosis

Cervicogenic headache (CEH) is a common disorder with cervical spine-specific nociceptive headache symptoms. Cervicogenic headaches have been studied for years, but diagnosis and treatment are continually evolving. Due to non-specific criteria and its relationship with cervical degenerative illness, diagnosis may be underestimated. In many situations, it contributes to myelopathy or radiculopathy. Local anaesthetic blocks are used to confirm the diagnosis, however, non-invasive methods are being explored. Identifying the nociceptive origin improves pain management. Physical therapy and percutaneous interventional procedures are used to treat isolated CEH. However, cervical decompression and/or fusion are often performed in situations of cervical myelopathy and/or radiculopathy. Here we report a 57-year-old female with cervicogenic headache treated with anterior lower cervical discectomy to relieve cervical myelopathy and/or radiculopathy headaches.

Frailty identification and management among Brazilian healthcare professionals: a survey

BackgroundNational and international guidelines on frailty assessment and management recommend frailty screening in older people. This study aimed to determine how Brazilian healthcare professionals (HCPs) identify and manage frailty in practice.MethodsAn anonymous online survey on the assessment and management of frailty was circulated virtually through HCPs across Brazil.ResultsMost of the respondants used non-specific criteria such as gait speed (45%), handgrip strength (37.6%), and comprehensive geriatric assessment (33.2%). The use of frailty-specific criteria was lower than 50%. The most frequently used criteria were the Frailty Index (19.1%), Frailty Phenotype (13.2%), and FRAIL (12.5%). Only 43.5% felt confident, and 40% had a plan to manage frailty. In the multivariate-adjusted models, training was the most crucial factor associated with assessing frailty, confidence, and having a management plan (p < 0.001 for all). Those with fewer years of experience were more likely to evaluate frailty (p = 0.009). Being a doctor increased the chance of using a specific tool; the opposite was true for dietitians (p = 0.03). Those who assisted more older people had a higher likelihood of having a plan (p = 0.011).ConclusionFrailty assessment was heterogeneous among healthcare professions groups, predominantly using non-specific criteria. Training contributed to frailty assessment, use of specific criteria, confidence, and having a management plan. This data informs the need for standardized screening criteria and management plans for frailty, in association with increasing training at the national level for all the HCPs who assist older people.

Identification of tumour regression in neoadjuvantly treated pancreatic cancer is based on divergent and nonspecific criteria.

Following the increased use of neoadjuvant therapy for pancreatic cancer, grading of tumour regression (TR) has become part of routine diagnostics. However, it suffers from marked interobserver variation, which is mainly ascribed to the subjectivity of the defining criteria of the categories in TR grading systems. We hypothesized that a further cause for the interobserver variation is the use of divergent and nonspecific morphological criteria to identify tumour regression. Twenty treatment-naïve pancreatic cancers and 20 pancreatic cancers treated with neoadjuvant chemotherapy were reviewed by three experienced pancreatic pathologists who, blinded for treatment status, categorized each tumour as treatment-naïve or neoadjuvantly treated, and annotated all tissue areas they considered showing tumour regression. Only 50%-65% of the cases were categorized correctly, and the annotated tissue areas were highly discrepant (only 3%-41% overlap). When the prevalence of various morphological features deemed to indicate TR was compared between treatment-naïve and neoadjuvantly treated tumours, only one pattern, characterized by reduced cancer cell density and prominent stroma affecting a large area of the tumour bed, occurred significantly more frequently, but not exclusively, in the neoadjuvantly treated group. Finally, stromal features, both morphological and biological, were investigated as possible markers for tumour regression, but failed to distinguish TR from native tumour stroma. There is considerable divergence in opinion between pathologists when it comes to the identification of tumour regression. Reliable identification of TR is only possible if it is extensive, while lesser degrees of treatment effect cannot be recognized with certainty.

Возможности магнитно-резонансной томографии в диагностике воспалительных изменений парауретральных желез у женщин.

Introduction. Inflammation of the paraurethral glands (skеneitis) is a complex urological disease, often hidden under the guise of other pathological conditions and causing recurrent lower urinary tract infection (UTI) in women. A significant problem for the diagnosis of skineitis at present is the absence or extremely low sensitivity and specificity of available laboratory, instrumental and radiation methods. Thus, the search for new ways to examine patients with recurrent UTI caused by chronic inflammation of the Skene’s glands is an important clinical and socio-economic task of modern healthcare. Materials and methods. The study involved 30 patients aged from 24 to 51 years who underwent magnetic resonance imaging (MRI) of the pelvis with contrast enhancement and targeted examination of the urethra and periurethral area using a device with a 3T fi ld strength. To study the MR semiotics of chronic inflammation of the gallbladder, in addition to standard MR protocols, high-resolution T2-weighted images with a slice thickness of 2 mm and T2-weighted Space 3D images in a sagittal projection with a slice thickness of 1 mm were used. The first group consisted of 16 urologically healthy women without complaints of dysuria, who underwent an assessment of the MRI anatomy of the normal female urethra. MRI of 14 respondents with chronic infl mmation of the paraurethral glands (second group) was performed to search for recurring (natural) changes characteristic of this disease. Such parameters as the diameter of the urethra, the separate thickness of its anterior and posterior walls, clarity at the boundary of the layers, and the presence of pathological changes and formations were studied. Results. Analysis of the obtained tomograms showed that urologically healthy respondents are characterized by symmetrical thickness of the walls of the urethra without pathological formations in it, as well as evenness and clarity of the contour at the boundary of the layers. When studying the results of examination of patients with chronic skeneitis, all of them (100%) noted the following recurring changes: an increase in the diameter of the urethra due to thickening of its posterior wall, in particular the submucosal layer, impaired differentiation at the border of the submucosal and muscular layers, the presence of small cystic changes in the structure of the posterior wall of the urethra (85.7%) or fragmentarily dilated ducts of the urinary tract (14%). Hypertrophy of the bulbospongiosus muscles, detected in 85.7% of respondents in the second group, is likely an indicator of frequent exacerbations and duration of the disease, and can be considered as an additional nonspecific criterion for this disease. Conclusions. These changes can tentatively, given the small sample, be considered pathognomonic MR signs of chronic skineitis. Thus, MRI of the pelvis with a targeted examination of the urethra and periurethral area can help in the differential diagnosis of patients with suspected inflammation of the paraurethral glands, establishing the correct diagnosis and prescribing adequate treatment.

480. Alternate Diagnoses in Children Evaluated for Multisystem Inflammatory Syndrome in Children (MIS-C)

BackgroundSARS-CoV-2 infection is typically a mild illness in children. Multisystem inflammatory syndrome in children (MIS-C) is a rare, post-infectious, hyperinflammatory condition associated with SARS-CoV-2 infection. The presentation of MIS-C is nonspecific and diagnostic criteria is broad. The Centers for Disease Control (CDC) defines MIS-C as a hospitalized patient < 21 years presenting with fever, laboratory evidence of inflammation, no alternative plausible diagnosis, and with positive exposure history or testing for current or recent SARS-CoV-2 infection. Since there is no single diagnostic test for MIS-C, there are other disease processes that can mimic its presentation and delay prompt diagnosis and management. MethodsBetween March 2020 and February 2021, we reviewed 282 charts of patients admitted for evaluation of MIS-C at our institution. Results101 were found to have MIS-C, 45 found to have Kawasaki Disease (KD), and 129 were ruled out. Of the ruled-out group, the most common final diagnoses were viral infection, urinary tract infection, and acute SARS-CoV-2 infection. Other diagnoses included rickettsial infections, pneumonia, rheumatologic conditions, and bloodstream infection. Rhinovirus/enterovirus, adenovirus, Epstein-Barr virus (EBV), and Herpes Simplex Virus (HSV) were the most common viruses other than SARS-CoV-2 identified.ConclusionThese findings highlight the importance of maintaining a broad differential when evaluating a patient for MIS-C, especially as community seroprevalence rises, making antibody presence less predictive of MIS-C. Disclosures Susan Wu, MD, Eli Lilly (Shareholder)

59 Artificial Intelligence Occult Sepsis Detection in the Emergency Department: A Large, Multicenter Real-World Data Study

Various sepsis alerts are used to reduce time-to-antibiotics in the emergency department (ED), but existing algorithms are primarily based on readily recognizable and non-specific criteria, leading to alert fatigue while adding little new information for frontline providers. Our purpose was to determine if artificial intelligence (AI) models can learn physiological patterns associated with sepsis before it is evident by current practice, based solely on objective and routine ED data.

Selecting the Right Criteria and Proper Classification to Diagnose Mast Cell Activation Syndromes: A Critical Review

In recent years, knowledge about mechanisms underlying mast cell activation (MCA) and accumulation in various pathologic conditions increased substantially. In addition, criteria and a classification of MCA syndromes (MCASs) have been set forth. MCAS is defined by typical clinical symptoms, a substantial increase in serum tryptase level during an attack over the patient's baseline tryptase, and a response of the symptoms to drugs targeting mast cells, mediator production, and/or mediator effects. Alternative diagnostic criteria of MCAS have also been suggested, but these alternative criteria often lack specificity and validation. In this report, we critically review the contemporary literature relating to MCAS and compare the specificity, sensitivity, and strength of MCAS-related parameters within proposals to diagnose and classify MCAS and its variants. Furthermore, we highlight the need to apply specific consensus criteria in the evaluation and classification of MCAS in individual patients. This is an urgent and important medical necessity because as an increasing number of patients are being given a misdiagnosis of MCAS based on nonspecific criteria, which contributes toconfusion and frustration by patients and caregivers andsometimes may delay recognition and treatment of correct medical conditions that often turn out to be unrelatedto MCA.

Recognizing the Misuse of Probabilistic Language and False Certainty in False Accusations of Child Abuse

Probabilistic language is language used to convey mathematical probabilities in narrative form including terms like “highly likely”, “concerning for”, “suspicious of”, and many others). PL can be used in conformance with standards elucidated in Forensic Epidemiology or misused with intentional imprecision, when not justified, to promote a misdiagnosis of abuse, with dire consequences. The application of actual probability analysis using tested mathematical models, like Bayes Theorem, is essential to an analysis of the actual probability of abuse in a specific case to avoid false accusations of abuse. Consideration of the prior odds of abuse combined with calculations the reliability of nonspecific and/or unreliable criteria or “indicators”, is being disregarded by child abuse pediatricians to justify diagnosing abuse with statements of false certainty that depend on the misuse of probabilistic language. These suppositious statements of false certainty are the sine qua non of accusatory expert opinion. Currently, and unfortunately, false certainty is only detected by scientists and physicians with the requisite advanced knowledge of these issues. When probabilities and evidence based science are studied and applied, deep flaws in the fund of knowledge of child abuse pediatrics have been exposed. On balance, there is an emerging reality that the collective suffering of falsely accused families may dwarf the horrific impacts associated with real abuse. It also exposes iatrogenic abuse as possibly the most common form of prosecuted child abuse in the legal system. A false accusation of child abuse is child abuse. The misuse of probabilistic language to convey false certainty and its ramifications for innocent caregivers is discussed herein and must be prevented.

Comprehensive infectious disease screening in a cohort of unaccompanied refugee minors in Germany from 2016 to 2017: A cross-sectional study.

Information regarding the prevalence of infectious diseases (IDs) in child and adolescent refugees in Europe is scarce. Here, we evaluate a standardized ID screening protocol in a cohort of unaccompanied refugee minors (URMs) in a municipal region of southwest Germany. From January 2016 to December 2017, we employed a structured questionnaire to screen a cohort of 890 URMs. Collecting sociodemographic information and medical history, we also performed a standardized diagnostics panel, including complete blood count, urine status, microbial stool testing, tuberculosis (TB) screening, and serologies for hepatitis B virus (HBV) and human immunodeficiency virus (HIV). The mean age was 16.2 years; 94.0% were male, and 93.6% originated from an African country. The most common health complaints were dental problems (66.0%). The single most frequent ID was scabies (14.2%). Of the 776 URMs originating from high-prevalence countries, 7.7% and 0.4% tested positive for HBV and HIV, respectively. Nineteen pathogens were detected in a total of 119 stool samples (16.0% positivity), with intestinal schistosomiasis being the most frequent pathogen (6.7%). Blood eosinophilia proved to be a nonspecific criterion for the detection of parasitic infections. Active pulmonary TB was identified in 1.7% of URMs screened. Of note, clinical warning symptoms (fever, cough >2 weeks, and weight loss) were insensitive parameters for the identification of patients with active TB. Study limitations include the possibility of an incomplete eosinophilia workup (as no parasite serologies or malaria diagnostics were performed), as well as the inherent selection bias in our cohort because refugee populations differ across Europe. Our study found that standardized ID screening in a URM cohort was practicable and helped collection of relevant patient data in a thorough and time-effective manner. However, screening practices need to be ameliorated, especially in relation to testing for parasitic infections. Most importantly, we found that only a minority of infections were able to be detected clinically. This underscores the importance of active surveillance of IDs among refugees.

Osteoarthritis classifications : Modification proposal for the criteria of Kellgren and Vallotton

In imaging diagnostics, classification schemes are very common. As far as osteoarthritis is concerned, the Kellgren classification is the most popular. However, the Kellgren classification, which has been used for more than 50years, is based on nonspecific criteria; thus, high interobserver variability has been reported. In addition, the Kellgren classifications have not been coordinated with magnetic resonance imaging (MRI)-based classification schemes, e.g., Vallotton. In this paper, we present some modifications concerning the criteria for both the Kellgren classification and its comparison with the MRI-based Vallotton classification. The current surgical and imaging classifications and the precision of the nomenclature are analyzed. X‑ray and MRI findings are compared. Suggestions for both amodification of the Kellgren classification as far as the criteria are concerned and ahierarchy (ranking) of X‑ray and MRI findings to make clinical decisions more valuable are proposed. These proposed modifications (Kellgren and ranking) would be helpful for routine reporting and allow for better interobserver reliability, in particular for special reports (e.g. consultations, expert opinions, advanced diagnostics).

Interne Diagnosevalidierung von Patienten mit einer floriden chronischen Wunde - Möglichkeiten der Identifizierung auf der Basis von Routinedaten

ObjectiveThere are still few epidemiological data on patients with chronic wounds (leg ulcers, diabetic foot ulcers and pressure ulcers). Statutory health insurance (SHI) data is increasingly being used for questions relating to healthcare science. When using this data, which is primarily collected for billing purposes, the methodological procedure for defining cases must be presented transparently. Here, it must be checked whether the target group can be validly defined using the coded diagnoses and, if necessary, further information from routine data. Therefore, the aim of this contribution is, on the one hand, to develop criteria with the help of which patients with a florid (active) chronic wound can be identified safely or as doubtful cases in routine data and, on the other hand, to determine the corresponding frequency estimates. MethodsInitially, a literature research was carried out to identify parameters relevant to care in patients with chronic wounds. In the next step, these were divided into specific, less specific and non-specific criteria (visual validity) in a multi-stage consensus procedure with regard to the specificity for wound care. On this basis, three different case definitions are used to identify florid chronic wounds. Based on an SHI sample of insured persons, frequency estimates were made for various case definitions (safe and questionable cases). ResultsOf the 21 parameters identified in the literature, eight were classified as specific, six as less specific and eight as non-specific criteria for the identification of patients with chronic florid wounds. Using diagnostic coding alone for the target diseases, an administrative prevalence of chronic wounds of 1.13% was observed for the year 2010. If a case is defined using the less specific and/or the specific criteria, prevalence drops to 0.79%; if only the specific criteria are used, prevalence drops only marginally to 0.78%. These changes were observed in patients with leg ulcers and diabetic foot ulcers, but not in patients with pressure ulcers. Here, the lowest administrative prevalence (0.18%) can be seen when only looking at the diagnoses, but this increases slightly when taking wound-relevant treatments into account (specific and less specific criteria: 0.25%). ConclusionIt is possible to define patients with a chronic florid wound on the basis of wound-relevant treatments using SHI data and to make estimates of administrative prevalence. Depending on the question, the criteria for defining cases can be narrowed down or broadened. The comparison provides information on the internal validity of diagnostic coding. However, further studies are needed to verify external validity.

Transplant Associated Thrombotic Microangiopathy (TA-TMA): Lessons Learned from a Large Pediatric Center

Background Transplant associated thrombotic microangiopathy (TA-TMA) is a well-recognized complication of hematopoietic cell transplantation (HCT) but is very challenging to diagnose. Outcomes are historically poor, though it is unclear if this is secondary to TA-TMA or to concurrent morbid conditions. We aimed to describe the prevalence and outcomes of TA-TMA at a single large pediatric center. Methods In this retrospective study, medical records of all children who received an HCT at Boston Children's Hospital from 1/2015-08/2017 were reviewed for evidence of TA-TMA in the first 100 days after HCT. Patients were diagnosed using probable diagnostic TA-TMA (Cho et al, 2010). Patients who were both clinically diagnosed and retrospectively met criteria for TA-TMA were grouped together for analysis. Results 275 HCTs were performed in 232 patients. 37 patients (16%) met criteria for TA-TMA; 6 were clinically diagnosed and 31 retrospectively met criteria. TA-TMA was diagnosed a median of 26 days (range 11-97 days) after cell infusion. Patients with TA-TMA had significantly higher rates of aGVHD, ICU admissions, engraftment failure, bacterial and or viral infections in the first 100 days and were more likely to have an unrelated donor HCT, an HLA-loci mismatch of OS was significantly lower in patients with TA-TMA, with a one-year OS of 63.1% (95% CI=46.8-79.3%) vs 92.1% (87.9-96.2%), (p Of the 6 patients diagnosed with TA-TMA by providers, 4/6 were treated with eculizumab; 2 died of multiorgan failure and 2 remained dependent on eculizumab for ³2 years to maintain control of disease. The other 2 patients changed aGVHD prophylaxis resulting in TA-TMA resolution. Of the 31 patients who retrospectively met criteria none received TA-TMA directed therapy. One-year TRM was not significantly different between those diagnosed clinically versus retrospectively. Conclusion Most patients who met criteria for TA-TMA were retrospectively identified while being treated for another transplant complication (31/37), highlighting the challenge of a clinical diagnosis in the setting of non-specific criteria. Patients with TA-TMA had worse OS and increased TRM, even when adjusting for the development of aGVHD and engraftment failure (HR 9.1). It is important to develop multi-institutional, prospective studies to identify risk factors for TA-TMA and further study therapies and outcomes.

Transplant Associated Thrombotic Microangiopathy (TA-TMA): Lessons Learned from a Large Pediatric Center

Background: Transplant associated thrombotic microangiopathy (TA-TMA) is a well-recognized complication of hematopoietic cell transplantation (HCT) and in a pediatric cohort, a prevalence rate of 39% is reported (Jodele, et al 2016). However, TA-TMA is challenging to diagnose as features are common to and may occur concurrently with many post HCT complications, i.e. acute graft versus host disease (aGVHD) and infection. Outcomes are historically poor, though it is unclear if this is secondary to TA-TMA or to concurrent morbid conditions. We aimed to describe the prevalence and outcomes of TA-TMA at a single large pediatric center.Methods: In this retrospective study, data were extracted from the medical records of all children who received an HCT at Boston Children's Hospital from 1/2015-08/2017. Records were reviewed for evidence of TA-TMA in the first 100 days after HCT. According to “probable diagnostic TA-TMA criteria” (Cho et al, 2010), all the following had to occur concurrently and during at least 2 consecutive time points: 1) elevated lactate dehydrogenase, 2) platelet count <50 × 109/L or a ≥50% decrease, 3) anemia or requiring transfusions, 4) schistocytes in the peripheral blood, and 5) absence of a coagulopathy and a negative Coombs test. Patients who were both clinically diagnosed and retrospectively met criteria for TA-TMA were grouped together for analysis. Fisher's exact test (categorical variables) and Wilcoxon rank-sum test (continuous variables) were used for comparison. Kaplan-Meier curves were generated for overall survival (OS). All non-relapse deaths were considered transplant-related (TRM). Competing risk analysis was performed using Gray's test. Multivariable competing risks analysis was performed using a proportional hazards model for TRM.Results: 275 HCTs were performed in 232 patients. Among allogenic transplants (n=163), cell source was largely bone marrow (87%). Median follow up time of survivors was 1.3 years (range 0.04-2.9 years). Thirty-seven patients (16%) met criteria for TA-TMA; 6 were clinically diagnosed and 31 retrospectively met criteria. TA-TMA was diagnosed a median of 26 days (range 11-97 days) after cell infusion. Patients who met criteria for TA-TMA had significantly higher rates of aGVHD, ICU admissions, engraftment failure, bacterial and or viral infections in the first 100 days and were more likely to have an unrelated donor HCT, an HLA-loci mismatch of <10/10, and ³2 HCT (p<0.05). There were no differences in age at HCT, cell source, sex and HCT indication.OS was significantly lower in patients with TA-TMA, with a one-year OS of 63.1% (95% CI=46.8-79.3%) vs 92.1% (87.9-96.2%), (log-rank p<0.0001; Figure 1A). TRM was significantly higher both at 100 days 16.2% (6.5-29.9%) versus 2.4% (0.8-5.6%), and one year 37% vs 2.4%. (Gray's test p<0.0001; Figure 1B). In a multivariable model adjusting for the development of grade 4 aGVHD (Hazard ratio [HR]=4.4, 95% CI=1.2 - 15.7, p=0.02) and engraftment failure (HR=2.1, 95% CI=0.4-9.9, p=0.4), the risk of TRM was significantly higher when screening positive for TA-TMA (HR=9.1, 95% CI=3.2-25.8, p<0.0001).Of the 6 patients diagnosed with TA-TMA by providers, 4/6 were treated with eculizumab; 2 died of multiorgan failure and 2 remained dependent on eculizumab for ³2 years to maintain control of disease. The other 2 patients had aGVHD prophylaxis switched from cyclosporine to a different agent, resulting in TA-TMA resolution. TRM at 1 year was 33%. Of the 31 patients who retrospectively met criteria none received TA-TMA directed therapy. All were treated for the primary condition at the time of positive screening: aGVHD (n=9), engraftment failure (n=4), infection (n=6), multiorgan failure of unclear etiology (n=2) and other (n=16). One-year TRM was 38.2%.Conclusion: The prevalence of TA-TMA at our institution is 16%, lower than other reports using the same diagnostic criteria. 83% (31/37) of patients who met criteria for TA-TMA were retrospectively identified while being treated for another transplant complication, highlighting the challenge of a clinical diagnosis in the setting of non-specific criteria. Patients with TA-TMA had worse overall survival and increased TRM, even when adjusting for the development of aGVHD and engraftment failure (HR 9.1). It is important to develop multi-institutional, prospective studies to identify risk factors for TA-TMA and further study therapies and outcomes. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Категоричность в оценках себя, других и ситуации у старшеклассников, употребляющих наркотические вещества

Introduction. Mechanisms and factors for psychoactive substance dependence and also psychological methods for its treatment and prevention have been widely researched. However, early diagnostics and prevention of psychoactive substance dependence among schoolchildren remain important today. The paper presents the results of the study of (a) categoricity in self-estimation and estimation of other people and situations in adolescents using drugs and (b) its relationship with other psychological risk factors for involvement in drug use. Categorical answers indicate the way of thinking when a person makes conclusions before considering all the possible alternatives. Such a way of thinking derives from difficulties in voluntary regulation with insufficient regard for possible solutions and future prospects. The present study is the first attempt to reveal associations among categoricity and psychological risk factors for involvement in drug use.&#x0D; Methods. The participants comprised 108 high school students using drugs, 637 high school students from various regions of Russia, and 540 middle school students. A methodical complex of psychological diagnostics of risk factors for adolescent involvement in drug use was employed in the study.&#x0D; Results. High school students’ categorical estimates indicated the risk of drug use and were associated with difficulties in voluntary regulation with unwillingness to plan the future and consider the alternatives in the clinical group. A defensive strategy of answers manifested itself in the association among categoricalness, overestimation of voluntary self-regulation, and denial of problems. On the contrary, the association between categoricity and accepting difficulties characterized an open strategy of answers when using drugs. High school students in the control groups had no such associations.&#x0D; Discussion. Categorical answers can be a nonspecific criterion for assessing the risk of drug involvement among high school students.

Representation and reporting of kidney disease in cerebrovascular disease: A systematic review of randomized controlled trials.

Patients with kidney disease (KD) are at increased risk for cerebrovascular disease (CVD) and CVD patients with KD have worse outcomes. We aimed to determine the representation of KD patients in major randomized controlled trials (RCTs) of CVD interventions. We searched MEDLINE for reports of major CVD trials published through February 9, 2017. We excluded trials that did not report mortality outcomes, enrolled fewer than 100 participants, or were subgroup, follow-up, or post-hoc analyses. Two independent reviewers performed study selection and data extraction. We included 135 RCTs randomizing 194,977 participants. KD patients were excluded in 48 (35.6%) trials, but were less likely to be excluded from trials of class I/II recommended interventions (n = 7; 15.9%; p = 0.001) and more likely to be excluded in trials with registered protocols (45.5% vs. 22.4%; p = 0.007). Exclusion was lower in trials supported by academic or governmental grants compared to industry or combined funding (21.2% vs. 42.0% and 47.8%; p = 0.033 and 0.028, respectively). Among trials excluding KD patients, 24 (50.0%) used serum creatinine, 7 (14.6%) used estimated glomerular filtration rate or creatinine clearance, 7 (14.6%) used renal replacement therapy, and 19 (39.6%) used non-specific kidney-related criteria. Only 4 (3.0%) trials reported baseline renal function. No trials prespecified or reported subgroup analyses by baseline renal function. Although 19 (14.1%) trials reported the incidence of acute kidney injury, no trial examined adverse event rates according to renal function. In summary, more than one third of major CVD trials excluded patients with KD, primarily based on serum creatinine or non-specific criteria, and outcomes were not stratified by renal parameters. Therefore, purposeful efforts to increase inclusion of KD patients in CVD trials and evaluate the impact of renal function on efficacy and safety are needed to improve the quality of evidence for interventions in this vulnerable population.

Interpersonal Skills in MBA Admissions: How Are They Conceptualized and Assessed?

Employers and students concur that soft skills or interpersonal skills are critical to managerial success, yet we know little about how MBA program admissions professionals conceptualize and assess these skills in the context of global management education. Such practices have key implications for interpersonal skills curriculum and training in MBA programs around the globe. A survey of 182 MBA admissions professionals from 24 countries revealed surprising agreement in how interpersonal skills were conceptualized, and suggest interpersonal skills and soft skills are not synonymous. Results also indicated that only 30% of U.S. and international MBA programs use specific criteria to assess applicants’ interpersonal skills, with the remainder using nonspecific criteria or no assessment method. We discuss the need for more rigorous assessment of interpersonal skills in MBA admissions, closer coordination between admissions officers and curriculum developers, and tighter alignment between interpersonal skills assessment and MBA curriculum and learning outcomes.

Interventions for music performance anxiety: results from a systematic literature review

Background Music performance anxiety (MPA) is characterised by fears related to performing music. It may result in damages to personal life and professional career, so treatment and prevention are very important. Objective To undertake a systematic literature review on the effectiveness/efficacy of MPA interventions and to integrate these findings to those in the literature reviewed previously. Methods We used PubMed, PsycINFO and SciELO databases and keywords music*, performance anxiety, treatment, therapy and intervention and manual research. We selected articles published between October-2002/July-2016. Results Out of 97 articles, 23 were reviewed. Sixteen studies presented inter-group experimental design, and seven presented pre-post experimental design. The intervention modalities reviewed were cognitive behavioural therapy (CBT), virtual reality exposure, biofeedback, yoga, meditation, music therapy and the Alexander technique. Although the interventions presented some indicators of efficacy in the MPA outcomes and improvement in performance quality, important methodological limitations were observed: low number of individuals and non-specific criteria for their inclusion/exclusion. This reinforces previous findings regarding methodological fragilities associated with this context. Discussion CBT is the most frequently studied modality and with the greatest number of effectiveness indicators. The remaining modalities indicate tendencies in positive outcomes that require further and efficient investigation in more rigorous studies with greater methodological control.

Regional lung response to bronchodilator reversibility testing determined by electrical impedance tomography in chronic obstructive pulmonary disease.

Patients with obstructive lung diseases commonly undergo bronchodilator reversibility testing during examination of their pulmonary function by spirometry. A positive response is defined by an increase in forced expiratory volume in 1 s (FEV1). FEV1 is a rather nonspecific criterion not allowing the regional effects of bronchodilator to be assessed. We employed the imaging technique of electrical impedance tomography (EIT) to visualize the spatial and temporal ventilation distribution in 35 patients with chronic obstructive pulmonary disease at baseline and 5, 10, and 20 min after bronchodilator inhalation. EIT scanning was performed during tidal breathing and forced full expiration maneuver in parallel with spirometry. Ventilation distribution was determined by EIT by calculating the image pixel values of FEV1, forced vital capacity (FVC), tidal volume, peak flow, and mean forced expiratory flow between 25 and 75% of FVC. The global inhomogeneity indexes of each measure and histograms of pixel FEV1/FVC values were then determined to assess the bronchodilator effect on spatial ventilation distribution. Temporal ventilation distribution was analyzed from pixel values of times needed to exhale 75 and 90% of pixel FVC. Based on spirometric FEV1, significant bronchodilator response was found in 17 patients. These patients exhibited higher postbronchodilator values of all regional EIT-derived lung function measures in contrast to nonresponders. Ventilation distribution was inhomogeneous in both groups. Significant improvements were noted for spatial distribution of pixel FEV1 and tidal volume and temporal distribution in responders. By providing regional data, EIT might increase the diagnostic and prognostic information derived from reversibility testing.

Investigating a design validation process: how jurors handle criteria in a design competition

This article attempts to look into the dynamics involved in the use of criteria to evaluate projects in a big Brazilian design competition. An ethnographic approach was carefully adopted to collect empirical information about the agents who performed in the competition context. Every impression about the dynamics and the actions of those who performed during the competition was taken into consideration. The evaluation of the projects revealed itself as an ongoing process in which criteria had to be actualised in order to work properly. That is, throughout the jury deliberation, the initial abstract and non-specific given criteria became more distinct, allowing for a coherent ranking of the projects. This study also observed the important role played by criteria, jurors and projects, possibly forming a kind of a hybrid agent, and affecting the competition's results.