Prediction of ADHD diagnosis using brief, low-cost, clinical measures: a competitive model evaluation

Proper diagnosis of ADHD is costly, requiring in-depth evaluation via interview, multi-informant and observational assessment, and scrutiny of possible other conditions. The increasing availability of data may allow the development of machine-learning algorithms capable of accurate diagnostic predictions using low-cost measures. We report on the performance of multiple classification methods used to predict a clinician-consensus ADHD diagnosis. Classification methods ranged from fairly simple (e.g., logistic regression) to more complex (e.g., random forest), and also included a multi-stage Bayesian approach. All methods were evaluated in two large (N>1000), independent cohorts. The multi-stage Bayesian classifier provides an intuitive approach that is consistent with clinical workflows, and is able to predict ADHD diagnosis with high accuracy (>86%)—though not significantly better than other commonly used classifiers, including logistic regression. Results suggest that data from parent and teacher surveys is sufficient for high-confidence classifications in the vast majority of cases using relatively straightforward methods.

Magnetoencephalography Studies of the Envelope Following Response During Amplitude-Modulated Sweeps: Diminished Phase Synchrony in Autism Spectrum Disorder

Prevailing theories of the neural basis of at least a subset of individuals with autism spectrum disorder (ASD) include an imbalance of excitatory and inhibitory neurotransmission. These circuitry imbalances are commonly probed in adults using auditory steady-state responses (ASSR, driven at 40 Hz) to elicit coherent electrophysiological responses (EEG/MEG) from intact circuitry. Challenges to the ASSR methodology occur during development, where the optimal ASSR driving frequency may be unknown. An alternative approach (more agnostic to driving frequency) is the amplitude-modulated (AM) sweep in which the amplitude of a tone (with carrier frequency 500 Hz) is modulated as a sweep from 10 to 100 Hz over the course of ∼15 s. Phase synchrony of evoked responses, measured via intra-trial coherence, is recorded (by EEG or MEG) as a function of frequency. We applied such AM sweep stimuli bilaterally to 40 typically developing and 80 children with ASD, aged 6–18 years. Diagnoses were confirmed by DSM-5 criteria as well as autism diagnostic observation schedule (ADOS) observational assessment. Stimuli were presented binaurally during MEG recording and consisted of 20 AM swept stimuli (500 Hz carrier; sweep 10–100 Hz up and down) with a duration of ∼30 s each. Peak intra-trial coherence values and peak response frequencies of source modeled responses (auditory cortex) were examined. First, the phase synchrony or inter-trial coherence (ITC) of the ASSR is diminished in ASD; second, hemispheric bias in the ASSR, observed in typical development (TD), is maintained in ASD, and third, that the frequency at which the peak response is obtained varies on an individual basis, in part dependent on age, and with altered developmental trajectories in ASD vs. TD. Finally, there appears an association between auditory steady-state phase synchrony (taken as a proxy of neuronal circuitry integrity) and clinical assessment of language ability/impairment. We concluded that (1) the AM sweep stimulus provides a mechanism for probing ASSR in an unbiased fashion, during developmental maturation of peak response frequency, (2) peak frequencies vary, in part due to developmental age, and importantly, (3) ITC at this peak frequency is diminished in ASD, with the degree of ITC disturbance related to clinically assessed language impairment.

The enablers and barriers to facilitating the development of reflective practice skills of third level allied health professional students through technology: A scoping review

BACKGROUND: The ability to reflect on one’s own performance, attitudes, and knowledge is an essential attribute of a competent allied health professional (AHP). Traditionally, reflective practice skills have been fostered during clinical placements via dyadic or narrative means (e.g. face-to-face supervision, journal writing, and observational assessment). However, with the onset of the Covid-19 pandemic, students face reduced opportunities for traditional clinical learning experiences, and embraced telepractice, simulation-based learning and other technology-based learning opportunities. OBJECTIVE: Research is limited regarding the use of digital technologies to facilitate the development of students’ reflective practice skills, therefore the best ways to facilitate this novel learning are not fully known and students may be disadvantaged as a result. As such, a scoping review was conducted to identify studies addressing the enablers and barriers to facilitating reflective practice skills of third level healthcare students, including speech and language therapy students, through technological means. METHODS: Five electronic databases were searched for studies published between 2016 to 2020. Identified records were imported into Covidence and titles and abstracts were screened by two independent reviewers. Data charting and critical analysis was completed by both authors independently. RESULTS: Six studies were ultimately included in data charting. These were of heterogeneous design and mixed quality. Four themes and a range of subthemes were identified regarding enablers and barriers to the facilitation of reflective practice via technological means. CONCLUSIONS: This research has provided critical information which may support the future use of technology in facilitating reflective practice among students. Competency in reflective practice is crucial to the professional development of students, yet Covid-19 and resultant restrictions present challenges to implementing the processes traditionally involved in developing such skills. This research highlights potential avenues for future developments in higher education which may overcome these barriers and augment the professional development of students.

WATER ACTIVITIES WITH THREE AND FOUR-YEAR-OLD CHILDREN:

Contextualization of the objective: Motor experiences in the liquid or terrestrial environment are part of children's behavior, helping children to master the environment, making them autonomous and self-assured. Objective: To report the experience of six months of intervention with water activities for 21 children, of both sexes, aged between three and four years old in an academy in São Luís. Method: The water activities classes lasted forty minutes, they were held twice a week and the classes had an average of eight to ten children aged three to four years. The class was divided into three moments: setting with the environment and with people, the second moment of displacements with floating material and the third moment there were jumps and dives followed by displacements. After a period of six months of intervention, an observational assessment consisting of eight items, with four sub-items each, was applied. The evaluation was applied during a class and the teachers selected a group of children to make the observations and apply the proposed exercises according to the evaluated item. Results: It was found that all children developed the skills proposed in the assessment items, receiving excellent ratings, with the exception of the item "backstroke legs propulsion" in which seven students, four of which had a good rating, three had a very good result. Final considerations: after six months of intervention, it was noticed that there were positive results in the expansion of learning the contents and refinement of the proposed movements, confirming the hypothesis that, within the proposed period, there were benefits in learning to swim.

Kinetic energy transfers between mesoscale and submesoscale motions in the open ocean’s upper layers

Mesoscale eddies contain the bulk of the ocean’s kinetic energy (KE), but fundamental questions remain on the cross-scale KE transfers linking eddy generation and dissipation. The role of submesoscale flows represents the key point of discussion, with contrasting views of submesoscales as either a source or a sink of mesoscale KE. Here, the first observational assessment of the annual cycle of the KE transfer between mesoscale and submesoscale motions is performed in the upper layers of a typical open-ocean region. Although these diagnostics have marginal statistical significance and should be regarded cautiously, they are physically plausible and can provide a valuable benchmark for model evaluation. The cross-scale KE transfer exhibits two distinct stages, whereby submesoscales energize mesoscales in winter and drain mesoscales in spring. Despite this seasonal reversal, an inverse KE cascade operates throughout the year across much of the mesoscale range. Our results are not incompatible with recent modeling investigations that place the headwaters of the inverse KE cascade at the submesoscale, and that rationalize the seasonality of mesoscale KE as an inverse cascade-mediated response to the generation of submesoscales in winter. However, our findings may challenge those investigations by suggesting that, in spring, a downscale KE transfer could dampen the inverse KE cascade. An exploratory appraisal of the dynamics governing mesoscale-submesoscale KE exchanges suggests that the upscale KE transfer in winter is underpinned by mixed-layer baroclinic instabilities, and that the downscale KE transfer in spring is associated with frontogenesis. Current submesoscale-permitting ocean models may substantially understate this downscale KE transfer, due to the models’ muted representation of frontogenesis.

Natural Observation of Alcohol Price and Promotions at Bars: Implications for Alcohol Misuse Prevention

Alcohol misuse among young adults remains a primary public health concern given the wide range of short- and long-term physical, social, and societal consequences of the behavior. On-premise drinking establishments, which allow alcohol consumption on site (i.e., bars), are frequent locations for young adult alcohol use. Risks for alcohol misuse within the bar setting are key factors to identify for prevention. Notably, alcohol price and promotions are associated with alcohol consumption among young adults. This study sought to develop and pilot test an observational protocol to assess the alcohol environment at on-premise drinking establishments. Following qualitative exploration of salient risk factors in these settings through focus groups with young adults, an observational tool was adapted and tested in a feasibility study. The refined tool was then pilot tested with two independent data collectors conducting natural observation at 13 establishments in the downtown nightlife district of a small, southeastern city. High interrater reliability was noted. Descriptive summary statistics of bar characteristics demonstrate low alcohol prices with variability across types of alcohol (e.g., beer, wine, and liquor), greater numbers of alcohol promotions inside rather than outside the building, and higher rates of manual versus electronic age verification procedures. Observational assessment of alcohol price and marketing at on-premise drinking establishments as described in this study is needed to inform prevention policy and programs to reduce harms associated with young adult alcohol misuse.

Refractory ineffective triggering during pressure support ventilation: effect of proportional assist ventilation with load-adjustable gain factors

Background Ineffective triggering is frequent during pressure support ventilation (PSV) and may persist despite ventilator adjustment, leading to refractory asynchrony. We aimed to assess the effect of proportional assist ventilation with load-adjustable gain factors (PAV+) on the occurrence of refractory ineffective triggering. Design Observational assessment followed by prospective cross-over physiological study. Setting Academic medical ICU. Patients Ineffective triggering was detected during PSV by a twice-daily inspection of the ventilator’s screen. The impact of pressure support level (PSL) adjustments on the occurrence of asynchrony was recorded. Patients experiencing refractory ineffective triggering, defined as persisting asynchrony at the lowest tolerated PSL, were included in the physiological study. Interventions Physiological study: Flow, airway, and esophageal pressures were continuously recorded during 10 min under PSV with the lowest tolerated PSL, and then under PAV+ with the gain adjusted to target a muscle pressure between 5 and 10 cmH2O. Measurements Primary endpoint was the comparison of asynchrony index between PSV and PAV+ after PSL and gain adjustments. Results Among 36 patients identified having ineffective triggering under PSV, 21 (58%) exhibited refractory ineffective triggering. The lowest tolerated PSL was higher in patients with refractory asynchrony as compared to patients with non-refractory ineffective triggering. Twelve out of the 21 patients with refractory ineffective triggering were included in the physiological study. The median lowest tolerated PSL was 17 cmH2O [12–18] with a PEEP of 7 cmH2O [5–8] and FiO2 of 40% [39–42]. The median gain during PAV+ was 73% [65–80]. The asynchrony index was significantly lower during PAV+ than PSV (2.7% [1.0–5.4] vs. 22.7% [10.3–40.1], p < 0.001) and consistently decreased in every patient with PAV+. Esophageal pressure–time product (PTPes) did not significantly differ between the two modes (107 cmH2O/s/min [79–131] under PSV vs. 149 cmH2O/s/min [129–170] under PAV+, p = 0.092), but the proportion of PTPes lost in ineffective triggering was significantly lower with PAV+ (2 cmH2O/s/min [1–6] vs. 8 cmH2O/s/min [3–30], p = 0.012). Conclusions Among patients with ineffective triggering under PSV, PSL adjustment failed to eliminate asynchrony in 58% of them (21 of 36 patients). In these patients with refractory ineffective triggering, switching from PSV to PAV+ significantly reduced or even suppressed the incidence of asynchrony.

Observational analysis of Birth, Neonatal Intensive Care Unit and Deaths in Brazil during the first year of the New Corona Virus Pandemic

The Brazilian healthcare structure has evolved in recent decades, but there are still shortages of beds in Intensive Care Units, especially in Neonatal Units. In early December 2019 they reported the first cases of a new infectious coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The present work makes an observational assessment of the number of deaths in the year 2020 related to the New Coronavirus Pandemic, the number of births and the panorama of Neonatal Intensive Care Unit (NICU) in the last decade. The results showed an increase in the number of deaths, with a predilection for elderly men; reduction in the number of births evaluated by the civil registry and an increase in NICUs in the last decade. This ratio was 2.6 beds per thousand births in 2010, rising to 2.9 per thousand in 2019 and reaching 3.4 beds per thousand births in 2020. Thus, the forced increase in the number of beds in the therapy unit The intensive care unit approached the proportion recommended by the Brazilian Society of Pediatrics, which is 4 beds for every thousand births.

Prevalence of Scapular Dyskinesis in Breastfeeding Postnatal Women in Satara District - An Observational Study

BACKGROUND Poor posture like hunching forward is one of the most commonly practiced postures by women during breastfeeding. The maintenance of such postures for prolonged period can result in progressive weakness of the scapular muscles and subsequent increase in the kyphotic curve. Both lordosis and kyphosis increase during pregnancy and are observed to be maintained for up to 2 months postnatally. The thoracic spine position and slouched position significantly affects the scapular dynamics during scapular abduction resulting in decreased muscle forces. Thus, scapular dyskinesis, defined as an alteration of normal position or motion of the scapula during coupled scapulohumeral movements can occur as a result of decreased muscle forces. Thus, this gives rise to the need for evaluating scapular dyskinesis and its prevalence in postnatal women. The purpose of the study was to find the prevalence of scapular dyskinesis in breastfeeding postnatal women. METHODS An observational analytical study was undertaken at Krishna Institute of Medical Sciences, including a total of 40 subjects within the age group of (15 - 40) yrs. who had been breastfeeding for 6 months or more. These subjects were assessed for scapular dyskinesis using Yes / No test and the lateral scapular slide test (LSST). Kyphosis was assessed on observational basis through postural assessment in these individuals. Statistical analysis was done using the InStat app. RESULTS 67 % and 75 % of the subjects were found to be positive for scapular dyskinesis through Yes / No Test and LSST test respectively. Observational assessment showed that 55 % of the subjects were positive for kyphosis. Subjects demonstrated significant prevalence of scapular dyskinesis and subsequent kyphosis in postnatal females due to wrong ergonomic practice of breastfeeding. CONCLUSIONS The study shows that women lack proper knowledge about the breastfeeding ergonomics leading to weakness of scapular muscles. Thus, a significant prevalence of scapular dyskinesis was seen in breastfeeding postnatal women. KEY WORDS Breastfeeding, Scapular Muscle Weakness, Kyphosis, Ergonomics, Scapular Dyskinesis