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Self-confidence in doing forensic mental testimonials among basic psychiatrists throughout Belgium.
BACKGROUND Competence in Point-of-Care Ultrasound (PoCUS) is widely recommended by several critical care societies. Despite numerous introductory short-courses, very few doctors attain PoCUS competence, due to the challenges in establishing longitudinal competence programs. RESEARCH QUESTION To evaluate the methodological quality of the literature on basic PoCUS competence processes in critical care. STUDY DESIGN and Methods A systematic review to identify manuscripts meeting predefined inclusion criteria was performed using three medical databases (PubMed, OVID Embase, Web of Science), extra references from original articles, review articles and expert panel guidelines, and directly contacting authors for further information if required. The objectives, domains, and inclusion and exclusion criteria of the review were determined during discussions between experienced PoCUS educators. Data extraction and analyses were performed independently by 3 reviewers. RESULTS Of the 5408 abstracts extracted, 42 met the inclusion criteria for longitudinal PoCUS competence. Each study was described along four broad categories general information, study design and trainee characteristics; description of introductory course; description of longitudinal competence program; grading of overall methodological quality on a 4-point Likert scale. Thirty-nine studies (92.9%) were from a single center. Most studies lacked important details on study methodology such as prior ultrasound experience, pre-and post-course tests, models for hands-on sessions, ratio of instructor to trainee, competence assessment criteria, number of scans performed by individual trainees, and formative and summative assessments. The studies were rated as follows Poor = 19 (45.2%), Average = 15 (35.7%), Good = 4 (9.5%) and Excellent = 4 (9.5%). INTERPRETATION There is very little high-quality evidence on PoCUS competence. To help frame policy guidelines to improve PoCUS education, there is a need for well-designed longitudinal studies on PoCUS competence. check details BACKGROUND Noninvasive ventilation (NIV) is an effective form of treatment in obesity hypoventilation syndrome (OHS) with severe obstructive sleep apnea (OSA). However, there is paucity of evidence in OHS patients without severe OSA phenotype. RESEARCH QUESTIONS Is NIV effective in OHS without severe OSA phenotype? STUDY DESIGN AND METHODS In this multicenter, open-label parallel group clinical trial performed at 16 sites in Spain, we randomly assigned 98 stable ambulatory patients with untreated OHS and apnea-hypopnea index less then 30 events/hour (i.e., no severe OSA) to NIV or lifestyle modification (control group) using simple randomization through an electronic database. The primary end point was hospitalization days/year. Secondary endpoints included other hospital resource utilization, incident cardiovascular events, mortality, respiratory functional tests, blood pressure, quality of life, sleepiness and other clinical symptoms. Both investigators and patients were aware of the treatment allocation; NIV. In the subgroup with high NIV adherence the time until the first event of hospital admission, emergency department visits and mortality were longer than in the low adherence subgroup. Adverse events were similar between arms. INTERPRETATION In stable ambulatory patients with OHS without severe OSA, NIV and lifestyle modification had similar long-term hospitalization days-year. A more intensive program aimed at improving NIV adherence may lead to better outcomes. Larger studies are necessary to better determine the long-term benefit of NIV in this subgroup of OHS. BACKGROUND Pulmonary complications, including infections, are highly prevalent in patients after hematopoietic cell transplant with chronic graft-versus-host disease. These comorbid diseases can make the diagnosis of early lung graft-versus-host disease (bronchiolitis obliterans syndrome) challenging. A quantitative method to differentiate among these pulmonary diseases can address diagnostic challenges and facilitate earlier and more targeted therapy. METHODS We conducted a single center study of 66 patients with computed tomography chest scans analyzed with a quantitative imaging tool known as parametric response mapping. Parametric response mapping results were correlated with pulmonary function tests and clinical characteristics. Five parametric response mapping metrics were applied to K-means clustering and support vector machine models to distinguish among post-transplant lung complications solely from quantitative output. RESULTS Compared to parametric response mapping, spirometry showed a moderate correlation with radiographic air trapping, and total lung capacity and residual volume showed a strong correlation with radiographic lung volumes. K-means clustering analysis distinguished 4 unique clusters. Clusters 2 and 3 represented obstructive physiology (encompassing 81% of patients with bronchiolitis obliterans syndrome) in increasing severity (percent air trapping 15.6% and 43.0%, respectively). Cluster 1 was dominated by normal lung, and cluster 4 was characterized by patients with parenchymal opacities. A support vector machine algorithm differentiated bronchiolitis obliterans syndrome with specificity of 88%, sensitivity of 83%, accuracy of 86% and an area under the receiver operating characteristic curve of 0.85. INTERPRETATION Our machine learning models offer a quantitative approach for the identification of bronchiolitis obliterans syndrome versus other lung diseases, including late pulmonary complications after hematopoietic cell transplant. Cellular membrane potential plays a key role in the formation and retrieval of memories in the metazoan brain, but it remains unclear whether such memory can also be encoded in simpler organisms like bacteria. Here, we show that single-cell-level memory patterns can be imprinted in bacterial biofilms by light-induced changes in the membrane potential. We demonstrate that transient optical perturbations generate a persistent and robust potassium-channel-mediated change in the membrane potential of bacteria within the biofilm. The light-exposed cells respond in an anti-phase manner, relative to unexposed cells, to both natural and induced oscillations in extracellular ion concentrations. This anti-phase response, which persists for hours following the transient optical stimulus, enables a direct single-cell resolution visualization of spatial memory patterns within the biofilm. The ability to encode robust and persistent membrane-potential-based memory patterns could enable computations within prokaryotic communities and suggests a parallel between neurons and bacteria. BACKGROUND & AIMS JNJ-56136379 (JNJ-6379), a capsid assembly modulator that blocks hepatitis B virus (HBV) replication, was well tolerated and demonstrated dose-proportional pharmacokinetics in healthy participants in part 1 of its first clinical trial. In part 2, we have evaluated the safety, pharmacokinetics, and antiviral activity of multiple doses of JNJ-6379 in patients with chronic HBV infection. METHODS We performed a double-blind study of 57 treatment-naïve patients with HB e antigen-positive or -negative (74%) chronic HBV infection without cirrhosis. Patients were randomly assigned to groups given JNJ-6379 at 25 mg (100 mg loading dose), 75 mg, 150 mg or 250 mg or placebo daily for 4 weeks with an 8-week follow-up period. RESULTS Twenty-three of 41 patients (56%) given JNJ-6379 had at least 1 adverse event (AE) during treatment, compared with 10/16 patients (63%) given placebo. No serious AEs were reported during the treatment period. Three patients (7%) given JNJ-6379 vs none given placebo had grade 3 AEs; of these, 1 patient (150 mg) also had an isolated grade 4 increase in level of alanine aminotransferase that led to treatment discontinuation. JNJ-6379 exposure increased with dose, with time-linear pharmacokinetics. HBV-DNA and HBV-RNA decreased from baseline in patients receiving all doses of JNJ-6379, independently of viral genotype and HB e antigen status. On day 29, 13/41 patients (32%) had levels of HBV DNA below the lower limit of quantification. No clinically significant changes in levels of HB surface antigen were observed. CONCLUSIONS In a phase 1 study of treatment-naïve patients with chronic HBV infection, all doses tested of JNJ-6379 were well tolerated, showed dose-dependent pharmacokinetics, and had potent antiviral activity in patients with CHB. The findings support a phase 2a study to evaluate JNJ-6379±nucleos(t)ide analogs in patients with chronic HBV infection, which is underway. ClinicalTrials.gov identifier NCT02662712. PURPOSE Arthrocentesis is a common treatment for temporomandibular joint disorders. Although modifications of the standard double-puncture technique have been described, no consensus has been reached regarding which is the best. The aim of the present study was to compare the outcomes of the single- and double-puncture arthrocentesis techniques (SPT and DPT, respectively). MATERIALS AND METHODS A systematic review following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines was performed. Two independent reviewers conducted electronic searches in the MEDLINE/PubMed, Cochrane Library, and Scopus databases for relevant studies reported up to January 2019. Studies comparing type I SPT (only 1 cannula) or type II SPT (2 soldered cannulas) to conventional DPT were considered. Data regarding the maximal mouth opening (MMO), joint pain, and operative time were extracted for the meta-analysis. In the case of statistically significant heterogeneity (P less then .10), a random effects model was used to assess the significance of the treatment effects. Otherwise, a fixed effects model was used. The included randomized controlled trials (RCTs) were assessed for methodologic quality using the Cochrane Collaboration tool. RESULTS Nine studies were included for qualitative synthesis. Two were suitable for quantitative synthesis per outcome. The meta-analysis did not find any differences between SPT and DPT in relation to the MMO. However, in relation to joint pain, the results slightly favored the use of DPT. No differences in operative time were found between type I SPT and DPT (P = .49). CONCLUSIONS The present study found no differences between the SPT and DPT in relation to the MMO, and no difference was found in operative time between the DPT and type I SPT. Because of the heterogeneity between studies, it might be interesting to conduct more homogeneous RCTs to elucidate which technique results in better clinical outcomes. Heart failure (HF) is a chronic, complex condition with increasing incidence worldwide, necessitating the development of novel therapeutic strategies. This has led to the current clinical strategies, which only treat symptoms of HF without addressing the underlying causes. Multiple animal models have been developed in an attempt to recreate the chronic HF phenotype that arises following a variety of myocardial injuries. While significant strides have been made in HF research, an understanding of more specific mechanisms will require distinguishing models that resemble HF with preserved ejection fraction (HFpEF) from those with reduced ejection fraction (HFrEF). Therefore, current mouse models of HF need to be re-assessed to determine which of them most closely recapitulate the specific etiology of HF being studied. This will allow for the development of therapies targeted specifically at HFpEF or HFrEF. This review will summarize the commonly used mouse models of HF and discuss which aspect of human HF each model replicates, focusing on whether HFpEF or HFrEF is induced, to allow better investigation into pathophysiologic mechanisms and treatment strategies.
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