Ultrasound Measurements of the Median Nerve at the Distal Wrist Crease Correlate With Electrodiagnostic Studies

Background: Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy and is commonly evaluated using electrodiagnostic studies (EDSs). Ultrasound (US) has emerged as a potentially easier and more comfortable alternative to EDSs. The purpose of this study is to evaluate whether measurements of the cross-sectional area (CSA) of the median nerve via US correlate with the severity rating of CTS based on EDSs. Methods: A retrospective review of patients aged 18 years or older who underwent US and EDSs of the median nerve for CTS was performed. Sensory nerve action potential, distal motor latency, and compound muscle action potential were measured, and severity was graded on American Association of Neuromuscular and Electrodiagnostic Medicine guidelines. Cross-sectional area of the median nerve was measured via US at the wrist crease. Results: There was a significant association between increasing CSA and increasing EDS severity ( P < .0001). The mean CSA for normal, mild, moderate, and severe CTS was 7.48 ± 2.00, 10.36 ± 2.53, 12.01 ± 3.64, and 14.34 ± 4.77 mm2, respectively. The area under the curve demonstrated the ability of median nerve CSA to discriminate between normal and abnormal EDSs with an optimal cutoff CSA of ≥10 mm2, as well as, the ability to discriminate between mild CTS and moderate to severe CTS at a cutoff CSA of greater than or equal to 12 mm2. Conclusions: The results of this study show that US measurements of the median nerve at the distal wrist crease discriminate between normal and abnormal EDSs, and between mild CTS and moderate to severe CTS.

The Relationship Between Family Caregivers’ Anticipatory Grief and Severity of Dementia

Background/Objective: Anticipatory grief is the process of experiencing normal bereavement before the physical death of a significant person. To date, anticipatory grief has been related to higher levels of caregiver depression, anxiety, subjective burden, and poorer problem solving. Additionally, higher levels anticipatory grief are observed in caregivers of those with Alzheimer’s Disease and Related Dementias (ADRD) compared to caregivers of other conditions. The primary objective of this analysis is to determine the relationship between caregiver anticipatory grief and dementia severity, as measured by the Anticipatory Grief Scale (AGS) and Dementia Severity Rating Scale (DSRS), respectively. Methods: Multiple regression analyses were performed on data for ADRD caregivers (n=56) enrolled in the IU Telephone Acceptance and Commitment Therapy for Caregivers (TACTICs) trial; an RCT testing an ACT intervention for ADRD caregiver anxiety. Inclusion criteria included identifying as the primary caregiver of an ADRD patient and clinically significant anxiety (GAD7 score >10). Results: The average age of caregivers was 61.9 years, 41.1% were spouses, 83.9% were white and 14.3% were black. Mean anticipatory grief scores were notably higher (84.6) compared to the previously reported means across the literature. Multiple regression models showed a caregivers’ anticipatory grief is not significantly associated with the patients’ dementia severity as measured by the Dementia Severity Rating Scale (t=0.87). Results also revealed that higher levels of caregiver burden, as measured by the Zarit Burden Index, are significantly associated with more anticipatory grief (t=< 0.1). Conclusion and Potential Impact: Understanding these relationships contributes to better understanding ADRD caregivers, identifying “high-risk” caregivers, and informing future interventions and care.

Evaluating the Validity of the Columbia-Suicide Severity Rating Scale for Lonely Older Adults

The risk of suicide death represents a significant problem facing older adults. They are less likely to disclose suicidal ideation (SI) and more likely to die from a suicide attempt compared to younger populations. Accurate screening tools for suicide risk are necessary to identify high-risk individuals who could benefit from intervention. The Columbia-Suicide Severity Rating Scale (C-SSRS), considered the gold standard for clinician-administered suicide risk assessments, was not developed for use with older adults. The purpose of this investigation is to evaluate the C-SSRS’s sensitivity in capturing previous suicidal behavior (behavior subscale) and current intent (severity subscale), both of which are highly predictive of suicide in older adults. 105 adults 60 years and older (M=72.10, SD=9.16; 68.6% female) who endorsed loneliness or feeling like a burden in the past two weeks were enrolled in a larger controlled trial and completed baseline C-SSRS, Quick Inventory of Depressive Symptoms (QIDS), and Geriatric Suicide Ideation Scale (GSIS). Exclusion criteria included significant cognitive impairment. Concurrent validity will be evaluated using random-effects mixed linear regression to test associations between C-SSRS scores and GSIS and QIDS scores, respectively. Baseline responses indicate that 14.9% of participants reported at least one lifetime suicide attempt. Within the last month, 66.7% wished to be dead, 20% had active SI without a plan, 6.7% had active SI with some intent to act, and 6.7% had active SI with a specific plan and intent. Findings from this project will help guide safety assessment recommendations and inform interventions targeting older adult suicide risk.

The Relationship Between Family Caregivers’ Anticipatory Grief and Severity of Dementia

Anticipatory grief is the process of experiencing normal bereavement before the physical death of a significant person. To date, anticipatory grief has been related to higher levels of caregiver depression, anxiety, subjective burden, and poorer problem solving. Additionally, higher levels anticipatory grief are observed in caregivers of those with Alzheimer’s Disease and Related Dementias (ADRD) compared to caregivers of those with mild cognitive impairment, implying a relationship between disease severity and caregiver anticipatory grief. Analyses were performed on data for ADRD caregivers (n=56) enrolled in the IU Telephone Acceptance and Commitment Therapy for Caregiver (TACTICs) trial; an RCT evaluating an ACT intervention for ADRD caregivers with anxiety. Inclusion criteria included identifying as the primary caregiver of an ADRD patient, and clinically significant anxiety (GAD7 score &gt;10). The average age of caregivers was 61.9 years, 41.1% were spouses, 83.9% were white and 14.3% were black. Mean anticipatory grief scores were notably higher (84.6) compared to the previously reported means across the literature (74.9). Using multiple regression models, we determined a caregivers’ anticipatory grief, as measured by the anticipatory grief scale, is not significantly associated with the patients’ dementia severity, as measured by the Dementia Severity Rating Scale (DSRS) (p=0.66), Results revealed that higher levels of caregiver burden, as measured by the Zarit Burden Index, are significantly associated with more anticipatory grief (p&lt; 0.01). Understanding these relationships contributes to a better understanding of ADRD caregivers, identifying “high-risk” caregivers, and informing future interventions and care.

Population Dynamics of Fall Armyworm, Spodoptera frugiperda (J. E. Smith) on Sorghum

The study on seasonal incidence of fall armyworm was carried out during kharif, 2019 at Agricultural college farm, Bapatla. The oviposition of fall armyworm was observed from 34th SMW (Standard Meterological Week) and reached its peak during 40th SMW (0.03 egg masses plant-1). The larval population of fall armyworm was commenced during 35th SMW and increased gradually to a peak of 1.67 larvae plant-1 during 41st SMW. The maximum plant infestation (60.00%) and leaf damage severity rating (3.13) of fall armyworm was observed during 41st SMW. The peak activity of natural enemies was observed during 41st SMW which coincides with the larval population of fall armyworm. The correlation analysis indicated that eggmasses of fall armyworm was positively correlated with minimum temperature(r= 0.668) and wind speed (r= 0.529) while, the larval population showed significant positive correlation with maximum temperature (r= 0.029). The plant infestation caused by fall armyworm had shown significant negative correlation with maximum temperature (r= -0.633) and positive correlation with morning relative humidity (r= 0.678) and evening relative humidity (r= 0.664) whereas, the leaf damage severity rating exhibited significant positive correlation with evening relative humidity (r= 0.691). The multiple regression analysis revealed that the influence of weather parameters on the incidence of fall armyworm and natural enemies in sorghum ecosystem was more than 65% and 40%, respectively.

Similarity and Consistency Assessment of Three Major Online Drug-Drug Interaction Resources

AIM: To explore the level of agreement on drug-drug interaction (DDI) information listed in three major online drug information resources (DIRs) in terms of: (1) interacting drug pairs; (2) severity rating; (3) evidence rating and (4) clinical management recommendations. METHODS: We extracted DDI information from the British National Formulary (BNF), Thesaurus, and Micromedex. Following drug name normalisation, we estimated the overlap of the DIRs. We annotated clinical management recommendations either manually, where possible, or through application of a machine learning algorithm. RESULTS: The DIRs contained 51,481 (BNF), 38,037 (Thesaurus), and 65,446 (Micromedex) drug pairs involved in DDIs. The number of common DDIs across the three DIRs was 6,970 (13.54% of BNF, 18.32% of Thesaurus, and 10.65% of Micromedex). Micromedex and Thesaurus overall showed higher levels of similarity in their severity ratings, while the BNF agreed more with Micromedex on the critical severity ratings and with Thesaurus on the least significant ones. Evidence rating agreement between BNF and Micromedex was generally poor. Variation in clinical management recommendations was also identified, with some categories (i.e. Monitor and Adjust dose) showing higher levels of agreement compared to others (i.e. Use with caution, Wash-out, Modify administration). CONCLUSIONS: There is considerable variation in the DDIs included in the examined DIRs, together with variability in categorisation of severity and clinical advice given. DDIs labelled as critical are more likely to appear in multiple DIRs. Such variability in information could have deleterious consequences for patient safety, and there is a need for harmonisation and standardisation.

Usability of Telemedicine Mobile Applications during COVID-19 in Saudi Arabia: A Heuristic Evaluation of Patient User Interfaces

The coronavirus disease 2019 (COVID-19) pandemic has impacted the use of telemedicine application (apps), which has seen an uprise. This study evaluated the usability of the user interface design of telemedicine apps deployed during the COVID-19 pandemic in Saudi Arabia. It also explored changes to the apps’ usability based on the pandemic timeline. Methods: We screened ten mHealth apps published by the National Digital Transformation Unit and selected three telemedicine apps: (1) governmental “Seha”® pp, (2) stand-alone “Cura”® app, and (3) private “Dr. Sulaiman Alhabib”®app. We conducted the evaluations in April 2020 and in June 2021 by identifying positive app features, using Nielsen’s ten usability heuristics with a five-point severity rating scale, and documenting redesign recommendations. Results: We identified 54 user interface usability issues during both evaluation periods: 18 issues in “Seha” 14 issues in “Cura”, and 22 issues in “Dr. Sulaiman Alhabib”. The two most heuristic items violated in “Seha”, were “user control and freedom” and “recognition rather than recall”. In “Cura”, the three most heuristic items violated were “consistency and adherence to standards”, “esthetic and minimalist design”, and “help and documentation” In “Dr. Sulaiman Alhabib” the most heuristic item violated was “error prevention”. Ten out of the thirty usability issues identified from our first evaluation were no longer identified during our second evaluation. Conclusions: our findings indicate that all three apps have a room for improving their user interface designs to improve the overall user experience and to ensure the continuity of these services beyond the pandemic.

Detecting Forest Fire Area using Landsat Images: A Case Study of Manang District, Nepal

Background: Wildfires are on the rise for various reasons, including hunting, the growth of new plants, and the encroachment of forest regions, particularly in developing countries. As a result, it will lose its environment, property, wildlife, and human life. Methods: It generates a burn severity map that can estimate the extent of wildfire damage. The nine bands and vegetation indices are derived using Google Earth Engine (GEE) and the Quantum Geographic Information System (QGIS) platform from Landsat 8 satellite imagery. The Manang district employs wavelengths near-infrared (NIR) and shortwave-infrared (SWIR) to determine burnt patches and burn severity. Results: According to the evaluation, 26 percent of forest fires have moderate, low, high, and higher severity; however, 30 percent of unburned and low-severity fires receive a severity rating of 37 percent. Thus, it shows a considerable rise in wildfires in the Manang area. Conclusion: In general, it has been a novel technique for recognizing wildfire hotspots and mapping their intensity in higher elevations that takes fewer resources and time. Such necessary data assists vital stakeholders, communities, and decision-makers in making well-informed decisions.

The Efficacy and Acceptability of Exposure Therapy for the Treatment of Post-Traumatic Stress Disorder in Children and Adolescents: A Systematic Review and Meta-Analysis

BackgroundPosttraumatic stress disorder (PTSD) is common among children and adolescents who have experienced traumatic events. Exposure therapy (ET) has been shown to be effective in treating PTSD in adults. However, it remains uncertain in children and adolescents. AimsTo evaluate the efficacy and acceptability of ET in children and adolescents with PTSD.MethodWe searched PubMed, EMBASE, Cochrane, Web of Science, PsycINFO, CINAHL, ProQuest, LILACS, international trial registries, and others for randomised controlled trials (RCTs) assessed ET in children and adolescents (aged ≤ 18 years) with PTSD up to August 31, 2020. The primary outcomes were efficacy (the endpoint score from PTSD symptom severity rating scales) and acceptability (all-cause discontinuation), secondary outcomes included efficacy at follow-up (score from PTSD scales at the longest point of follow-up), depressive symptoms (end-point score on depressive symptom severity rating scales) and quality of life/social functioning (end-point score on quality of life/social functioning rating scales).This study was registered with PROSPERO (CRD42020150859).ResultA total of six RCTs including 278 patients assessed ET. The results showed that ET was statistically more efficacious than control groups (standardized mean differences [SMD]: −0.47, 95% confidence interval [CI]: −0.91 to −0.03). In subgroup analysis, exposure therapy was more efficacious for patients with single type of trauma (SMD: −1.04, 95%CI: −1.43 to −0.65), and the intervention using prolonged exposure therapy (PE) (SMD: −1.04, 95%CI: −1.43 to −0.65) was superior. Results for secondary outcomes of efficacy at follow-up (SMD: −0.64, 95%CI: −1.17 to −0.10) and depressive symptoms (SMD: −0.58, 95%CI: −0.93 to −0.22) were similar to the findings for efficacy outcome. No statistically significant effects for acceptability and quality of life/social functioning were found.ConclusionET showed superiority in efficacy at post-treatment/follow-up and depressive symptoms improvement in children and adolescents with PTSD. Patients with single type of trauma may benefit more from ET. Moreover, PE could be a better choice.