Publications by authors named "Brendan Kelly"

244 Publications

Retinal Detachment and Temporal Artery Dissection: An Elusive Case of Giant Cell Arteritis.

Cureus 2021 Jul 28;13(7):e16703. Epub 2021 Jul 28.

Internal Medicine, AtlantiCare Regional Medical Center, Atlantic City, USA.

Giant cell arteritis (GCA), also known as temporal arteritis, is the most common systemic inflammatory vasculitis occurring in the elderly. Patients usually present with vision loss, headache, jaw claudication, diplopia, myalgia and constitutional symptoms. The most common ocular manifestations are anterior ischemic optic neuropathy (AION), choroidal ischemia and central retinal artery occlusion. Here we describe a case of GCA presenting with vision changes secondary to retinal detachment and vitreous hemorrhage. Upon temporal artery biopsy, GCA was confirmed and it was found to be accompanied by temporal artery dissection as well. Patient was treated with pulse dose intravenous steroids after which her symptoms improved. Based on our literature review, this is the first reported case of GCA presenting in this manner.
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http://dx.doi.org/10.7759/cureus.16703DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8412197PMC
July 2021

A putative de novo evolved gene required for spermatid chromatin condensation in Drosophila melanogaster.

PLoS Genet 2021 Sep 3;17(9):e1009787. Epub 2021 Sep 3.

College of the Holy Cross, Worcester, Massachusetts, United States of America.

Comparative genomics has enabled the identification of genes that potentially evolved de novo from non-coding sequences. Many such genes are expressed in male reproductive tissues, but their functions remain poorly understood. To address this, we conducted a functional genetic screen of over 40 putative de novo genes with testis-enriched expression in Drosophila melanogaster and identified one gene, atlas, required for male fertility. Detailed genetic and cytological analyses showed that atlas is required for proper chromatin condensation during the final stages of spermatogenesis. Atlas protein is expressed in spermatid nuclei and facilitates the transition from histone- to protamine-based chromatin packaging. Complementary evolutionary analyses revealed the complex evolutionary history of atlas. The protein-coding portion of the gene likely arose at the base of the Drosophila genus on the X chromosome but was unlikely to be essential, as it was then lost in several independent lineages. Within the last ~15 million years, however, the gene moved to an autosome, where it fused with a conserved non-coding RNA and evolved a non-redundant role in male fertility. Altogether, this study provides insight into the integration of novel genes into biological processes, the links between genomic innovation and functional evolution, and the genetic control of a fundamental developmental process, gametogenesis.
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http://dx.doi.org/10.1371/journal.pgen.1009787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8445463PMC
September 2021

Implementation of a patient-collected audio recording audit & feedback quality improvement program to prevent contextual error: stakeholder perspective.

BMC Health Serv Res 2021 Aug 30;21(1):891. Epub 2021 Aug 30.

Pharmacy Services, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.

Background: Using patient audio recordings of medical visits to provide clinicians with feedback on their attention to patient life context in care planning can improve health care delivery and outcomes, and reduce costs. However, such an initiative can raise concerns across stakeholders about surveillance, intrusiveness and merit. This study examined the perspectives of patients, physicians and other clinical staff, and facility leaders over 3 years at six sites during the implementation of a patient-collected audio quality improvement program designed to improve patient-centered care in a non-threatening manner and with minimal effort required of patients and clinicians.

Methods: Patients were invited during the first and third year to complete exit surveys when they returned their audio recorders following visits, and clinicians to complete surveys annually. Clinicians were invited to participate in focus groups in the first and third years. Facility leaders were interviewed individually during the last 6 months of the study.

Results: There were a total of 12 focus groups with 89 participants, and 30 leadership interviews. Two hundred fourteen clinicians and 800 patients completed surveys. In a qualitative analysis of focus group data employing NVivo, clinicians initially expressed concerns that the program could be disruptive and/or burdensome, but these diminished with program exposure and were substantially replaced by an appreciation for the value of low stakes constructive feedback. They were also significantly more confident in the value of the intervention in the final year (p = .008), more likely to agree that leadership supports continuous improvement of patient care and gives feedback on outcomes (p = .02), and at a time that is convenient (p = .04). Patients who volunteered sometimes expressed concerns they were "spying" on their doctors, but most saw it as an opportunity to improve care. Leaders were supportive of the program but not yet prepared to commit to funding it exclusively with facility resources.

Conclusions: A patient-collected audio program can be implemented when it is perceived as safe, not disruptive or burdensome, and as contributing to better health care.
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http://dx.doi.org/10.1186/s12913-021-06921-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8403819PMC
August 2021

Healthcare microenvironments define multidrug-resistant organism persistence.

Infect Control Hosp Epidemiol 2021 Aug 24:1-7. Epub 2021 Aug 24.

Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Background: Multidrug-resistant organisms (MDROs) colonizing the healthcare environment have been shown to contribute to risk for healthcare-associated infections (HAIs), with adverse effects on patient morbidity and mortality. We sought to determine how bacterial contamination and persistent MDRO colonization of the healthcare environment are related to the position of patients and wastewater sites.

Methods: We performed a prospective cohort study, enrolling 51 hospital rooms at the time of admitting a patient with an eligible MDRO in the prior 30 days. We performed systematic sampling and MDRO culture of rooms, as well as 16S rRNA sequencing to define the environmental microbiome in a subset of samples.

Results: The probability of detecting resistant gram-negative organisms, including Enterobacterales, Acinetobacter spp, and Pseudomonas spp, increased with distance from the patient. In contrast, Clostridioides difficile and methicillin-resistant Staphylococcus aureus were more likely to be detected close to the patient. Resistant Pseudomonas spp and S. aureus were enriched in these hot spots despite broad deposition of 16S rRNA gene sequences assigned to the same genera, suggesting modifiable factors that permit the persistence of these MDROs.

Conclusions: MDRO hot spots can be defined by distance from the patient and from wastewater reservoirs. Evaluating how MDROs are enriched relative to bacterial DNA deposition helps to identify healthcare micro-environments and suggests how targeted environmental cleaning or design approaches could prevent MDRO persistence and reduce infection risk.
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http://dx.doi.org/10.1017/ice.2021.323DOI Listing
August 2021

Respiratory microbiome disruption and risk for ventilator-associated lower respiratory tract infection.

Clin Infect Dis 2021 Aug 7. Epub 2021 Aug 7.

Division of Infectious Diseases, Department of Medicine; , Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Background: Ventilator-associated lower respiratory tract infection (VA-LRTI) is a common among critically ill patients and has been associated with increased morbidity and mortality. In acute critical illness, respiratory microbiome disruption indices (MDIs) have been shown to predict risk for VA-LRTI, but their utility beyond the first days of critical illness is unknown. We sought to characterize how MDIs previously shown to predict VA-LRTI at initiation of mechanical ventilation change with prolonged mechanical ventilation, and if they remain associated with VA-LRTI risk.

Methods: We developed a cohort of 83 subjects admitted to a long-term acute care hospital due to their prolonged dependence on mechanical ventilation; performed dense, longitudinal sampling of the lower respiratory tract, collecting 1066 specimens; and characterized the lower respiratory microbiome by 16S rRNA sequencing as well as total bacterial abundance by 16S rRNA qPCR.

Results: Cross-sectional MDIs, including low Shannon diversity and high total bacterial abundance, were associated with risk for VA-LRTI, but the associations had wide posterior credible intervals. Persistent lower respiratory microbiome disruption showed a more robust association with VA-LRTI risk, with each day of (base e) Shannon diversity < 2.0 associated with a VA-LRTI odds ratio of 1.36 (95% credible interval 1.10 to 1.72). The observed association was consistent across multiple clinical definitions of VA-LRTI.

Conclusions: Cross-sectional MDIs have limited ability to discriminate VA-LRTI risk during prolonged mechanical ventilation, but persistent lower respiratory tract microbiome disruption, best characterized by consecutive days with low Shannon diversity, may identify a population at high risk for infection and may help target infection prevention interventions.
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http://dx.doi.org/10.1093/cid/ciab678DOI Listing
August 2021

Delineating the Ligand-Receptor Interactions That Lead to Biased Signaling at the μ-Opioid Receptor.

J Chem Inf Model 2021 07 12;61(7):3696-3707. Epub 2021 Jul 12.

Departments of Computer Science, Molecular and Cellular Physiology, and Structural Biology & Institute for Computational and Mathematical Engineering, Stanford University, Stanford, California 94305, United States.

Biased agonists, which selectively stimulate certain signaling pathways controlled by a G protein-coupled receptor (GPCR), hold great promise as drugs that maximize efficacy while minimizing dangerous side effects. Biased agonists of the μ-opioid receptor (μOR) are of particular interest as a means to achieve analgesia through G protein signaling without dose-limiting side effects such as respiratory depression and constipation. Rational structure-based design of biased agonists remains highly challenging, however, because the ligand-mediated interactions that are key to activation of each signaling pathway remain unclear. We identify several compounds for which the and enantiomers have distinct bias profiles at the μOR. These compounds serve as excellent comparative tools to study bias because the identical physicochemical properties of enantiomer pairs ensure that differences in bias profiles are due to differences in interactions with the μOR binding pocket. Atomic-level simulations of compounds at μOR indicate that and enantiomers adopt different poses that form distinct interactions with the binding pocket. A handful of specific interactions with highly conserved binding pocket residues appear to be responsible for substantial differences in arrestin recruitment between enantiomers. Our results offer guidance for rational design of biased agonists at μOR and possibly at related GPCRs.
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http://dx.doi.org/10.1021/acs.jcim.1c00585DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8317888PMC
July 2021

Pulmonary Function Tests in Very Low Birth Weight Infants Screened for Pulmonary Hypertension: A Pilot Study.

J Pediatr 2021 Jun 25. Epub 2021 Jun 25.

Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR.

Objective: To compare pulmonary function tests (PFTs), specifically respiratory system resistance (Rrs) and compliance (Crs), in very low birth weight (VLBW) infants with and without pulmonary hypertension.

Study Design: Infants were included who underwent PFTs at 34-38 weeks postmenstrual age (PMA) as part of our pulmonary hypertension screening guidelines for infants born at ≤1500 g requiring respiratory support at ≥34 weeks PMA. One pediatric cardiologist reviewed and estimated right ventricular or pulmonary arterial pressure and defined pulmonary hypertension as an estimated pulmonary arterial pressure or right ventricular pressure greater than one-half the systemic pressure. Rrs and Crs were measured with the single breath occlusion technique and functional residual capacity with the nitrogen washout method according to standardized criteria.

Results: Twelve VLBW infants with pulmonary hypertension and 39 without pulmonary hypertension were studied. Those with pulmonary hypertension had significantly lower birth weight and a trend toward a lower gestational age. There were no other demographic differences between the groups. The infants with pulmonary hypertension had significantly higher Rrs (119 vs 78 cmHO/L/s; adjusted P = .012) and significantly lower Crs/kg (0.71 vs 0.92 mL/cmHO/kg; P = .04).

Conclusions: In this pilot study of VLBW infants screened for pulmonary hypertension at 34-38 weeks PMA, those with pulmonary hypertension had significantly increased Rrs and decreased Crs compared with those without pulmonary hypertension. Additional studies are needed to further phenotype infants with evolving BPD and pulmonary hypertension.
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http://dx.doi.org/10.1016/j.jpeds.2021.06.046DOI Listing
June 2021

England's rate of involuntary psychiatric admission is double that of the Republic of Ireland: Why? A consideration of some possible causes.

Med Sci Law 2021 Jun 25:258024211029071. Epub 2021 Jun 25.

Department of Psychiatry, 8809Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Ireland.

Involuntary psychiatric admission or 'sectioning' is a serious event with clear implications for the right to liberty, among other rights. Rates of involuntary admission vary considerably across jurisdictions. The rate of involuntary admission in England is approximately double that in the Republic of Ireland. Why? This paper examines potential explanations for this difference, including the prevalence of mental disorder in the two jurisdictions, factors relating to mental health legislation, differing levels of police involvement in care-pathways, funding and resources, and attitudes to risk among the public and professionals. Overall, it appears that the relatively high rate of involuntary admission in England might be attributable to the role of perceived risk in shaping mental health law in England but not Ireland, the broader definition of 'mental disorder' in the Mental Health Act, 1983 in England, broader legal criteria for involuntary admission in the 1983 Act, differences in the operational definitions of 'voluntary patient' between the two jurisdictions and, possibly, increased involvement of police in pathways to care in England and differences in relation to different ethnic groups. The relatively higher number of inpatient beds in England could be a cause or a consequence of higher rates of involuntary admission. Future research could usefully focus on other factors that are also likely relevant: issues relating to social care, substance misuse, availability of alternative treatment options in the community and various other factors that are, as yet, unknown. The potential impact of risk aversion among mental health professionals and others merits particular attention.
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http://dx.doi.org/10.1177/00258024211029071DOI Listing
June 2021

Mental Capacity, Human Rights, and the UN's Convention on the Rights of Persons with Disabilities.

Authors:
Brendan D Kelly

J Am Acad Psychiatry Law 2021 06;49(2):152-156

Dr. Kelly is Professor of Psychiatry, Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, Ireland.

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http://dx.doi.org/10.29158/JAAPL.210025-21DOI Listing
June 2021

From nowhere to nowhere. Homelessness and incarceration: a systematic review and meta-analysis.

Int J Prison Health 2021 Jun;ahead-of-print(ahead-of-print)

School of Medicine, University of Limerick, Limerick, Ireland.

Purpose: This study aims to review international literature systematically to estimate the prevalence of homelessness among incarcerated persons at the time of imprisonment and the time of discharge.

Design/methodology/approach: A systematic review methodology was used to identify quantitative observational studies that looked at the prevalence of homelessness at the time of imprisonment, or up to 30 days prior to that point (initial homelessness), and at the time of discharge from prisons. Studies reported in English from inception to 11 September 2019 were searched for using eight databases (PsycInfo, Medline, Embase, CINAHL, PsycArticles, Scopus, Web of Science and the Campbell Collaboration), in addition to grey literature. Studies were screened independently by three researchers. Results of studies meeting inclusion criteria were meta-analysed using a random effects model to generate pooled prevalence data.

Findings: A total of 18 out of 2,131 studies met the inclusion criteria. All studies originated from the USA, Canada, UK, Ireland or Australia. The estimated prevalence of initial homelessness was 23.41% and at time of discharge was 29.94%. Substantial heterogeneity was observed among studies.

Originality/value: People in prisons are over twenty times more likely to be homeless than those in the general population. This is likely attributable to a range of health and social factors. Studies in this analysis suggest higher rates of homelessness in minority populations and among those with mental illnesses and neurodevelopmental disorders. While there was significant heterogeneity among studies, the results highlight the global burden of this issue and a clear necessity for targeted interventions to address homelessness in this population.
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http://dx.doi.org/10.1108/IJPH-01-2021-0010DOI Listing
June 2021

Quantifying the Impact of Nasopharyngeal Specimen Quality on Severe Acute Respiratory Syndrome Coronavirus 2 Test Performance.

Open Forum Infect Dis 2021 Jun 12;8(6):ofab235. Epub 2021 May 12.

Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse-transcription polymerase chain reaction (RT-PCR) cycle threshold (Ct) has been used to estimate quantitative viral load, with the goal of targeting isolation precautions for individuals with coronavirus disease 2019 (COVID-19) and guiding public health interventions. However, variability in specimen quality can alter the Ct values obtained from SARS-CoV-2 clinical assays. We sought to define how variable nasopharyngeal (NP) swab quality impacts clinical SARS-CoV-2 test sensitivity.

Methods: We performed amplification of a human gene target (β-actin) in parallel with a clinical RT-PCR targeting the SARS-CoV-2 gene for 1282 NP specimens collected from patients with clinical concern for COVID-19. We evaluated the relationship between NP specimen quality, characterized by late Ct values for the human gene target β-actin Ct, and the probability of SARS-CoV-2 detection via logistic regression, as well as the linear relationship between SARS-CoV-2 and β-actin Ct.

Results: Low-quality NP swabs are less likely to detect SARS-CoV-2 (odds ratio, 0.607 [95% credible interval {CrI}, .487-.753]). We observed a positive linear relationship between SARS-CoV-2 and β-actin Ct values (slope, 0.181 [95% CrI, .097-.264]), consistent with a reduction in detection of 0.181 cycles for each additional cycle of the β-actin target. COVID-19 disease severity was not associated with β-actin Ct values.

Conclusions: Variability in NP specimen quality significantly impacts the performance of clinical SARS-CoV-2 assays, and caution should be taken when interpreting quantitative SARS-CoV-2 Ct results. If unrecognized, low-quality NP specimens, which are characterized by a low level of amplifiable human DNA target, may limit the successful application of SARS-CoV-2 Ct values to direct infection control and public health interventions.
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http://dx.doi.org/10.1093/ofid/ofab235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136075PMC
June 2021

Psychiatrists and physical health competencies: a cross-sectional survey.

Ir J Psychol Med 2021 May 11:1-3. Epub 2021 May 11.

School of Medicine, University of Limerick, Limerick, Ireland (Email:

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http://dx.doi.org/10.1017/ipm.2021.35DOI Listing
May 2021

Allostery of atypical modulators at oligomeric G protein-coupled receptors.

Sci Rep 2021 Apr 29;11(1):9265. Epub 2021 Apr 29.

Departments of Psychiatry and Pharmacology, Hershey Medical Center, Penn State University College of Medicine, Hershey, PA, 17033, USA.

Many G protein-coupled receptors (GPCRs) are therapeutic targets, with most drugs acting at the orthosteric site. Some GPCRs also possess allosteric sites, which have become a focus of drug discovery. In the M muscarinic receptor, allosteric modulators regulate the binding and functional effects of orthosteric ligands through a mix of conformational changes, steric hindrance and electrostatic repulsion transmitted within and between the constituent protomers of an oligomer. Tacrine has been called an atypical modulator because it exhibits positive cooperativity, as revealed by Hill coefficients greater than 1 in its negative allosteric effect on binding and response. Radioligand binding and molecular dynamics simulations were used to probe the mechanism of that modulation in monomers and oligomers of wild-type and mutant M receptors. Tacrine is not atypical at monomers, which indicates that its atypical effects are a property of the receptor in its oligomeric state. These results illustrate that oligomerization of the M receptor has functional consequences.
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http://dx.doi.org/10.1038/s41598-021-88399-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085029PMC
April 2021

The Use of Point of Care Ultrasound in Hand Surgery.

J Hand Surg Am 2021 07 6;46(7):602-607. Epub 2021 Apr 6.

Department of Plastic and Reconstructive Surgery, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland. Electronic address:

Point of care ultrasound (POCUS) is the use of ultrasound (US) imaging technology by non-sonographer, non-radiologist treating clinicians. Handheld US systems are increasing in popularity and becoming widely available and easily accessible to hand surgeons in clinical practice. Adapting POCUS into the repertoire of the hand surgeon can aid in the diagnosis of many common hand surgery presentations and shorten operative times. In this review, we outline the potential uses and advantages of incorporating POCUS into hand surgery practice incuding its use in emergencies such as trauma, infections, and foreign body localization, as well as elective presentations such as nerve compression, procedural guidance, and anesthesia. Finally, this review outlines the training and curriculum development required to ensure safe implementation of POCUS into a hand surgery practice.
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http://dx.doi.org/10.1016/j.jhsa.2021.02.004DOI Listing
July 2021

Involuntary status and mental capacity for treatment decisions under Sections 4, 3, and 57 of Ireland's Mental Health Act, 2001: analysis and recommendations for reform.

Ir J Psychol Med 2021 Mar 22:1-6. Epub 2021 Mar 22.

Professor of Psychiatry and Consultant Psychiatrist, Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin 24, D24 NR0A, Ireland.

Although significant progress has been made in Irish mental health law in recent decades, the Mental Health Act, 2001 still falls short of properly protecting human rights. A consideration of human rights developments, both domestically and internationally, highlights the urgent need for reform. In this paper we consider Sections 4 ('Best interests'), 3 ('Mental disorder') and 57 ('Treatment not requiring consent') of the 2001 Act and related recommendations in the 2015 Report of the Expert Group on the Review of the Mental Health Act, 2001, and suggest specific areas for reform. Just as medicine evolves over time, so too does our understanding of human rights and law. While embracing a human rights-based approach to the extent suggested here might be seen as aspirational, it is important to balance achievable goals with higher ideals if progress is to be made and rights are to be respected.
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http://dx.doi.org/10.1017/ipm.2020.136DOI Listing
March 2021

Artificial Intelligence for COVID-19 Drug Discovery and Vaccine Development.

Front Artif Intell 2020 18;3:65. Epub 2020 Aug 18.

Department of Electrical and Computer Engineering, University of Central Florida, Orlando, FL, United States.

SARS-COV-2 has roused the scientific community with a call to action to combat the growing pandemic. At the time of this writing, there are as yet no novel antiviral agents or approved vaccines available for deployment as a frontline defense. Understanding the pathobiology of COVID-19 could aid scientists in their discovery of potent antivirals by elucidating unexplored viral pathways. One method for accomplishing this is the leveraging of computational methods to discover new candidate drugs and vaccines . In the last decade, machine learning-based models, trained on specific biomolecules, have offered inexpensive and rapid implementation methods for the discovery of effective viral therapies. Given a target biomolecule, these models are capable of predicting inhibitor candidates in a structural-based manner. If enough data are presented to a model, it can aid the search for a drug or vaccine candidate by identifying patterns within the data. In this review, we focus on the recent advances of COVID-19 drug and vaccine development using artificial intelligence and the potential of intelligent training for the discovery of COVID-19 therapeutics. To facilitate applications of deep learning for SARS-COV-2, we highlight multiple molecular targets of COVID-19, inhibition of which may increase patient survival. Moreover, we present CoronaDB-AI, a dataset of compounds, peptides, and epitopes discovered either or that can be potentially used for training models in order to extract COVID-19 treatment. The information and datasets provided in this review can be used to train deep learning-based models and accelerate the discovery of effective viral therapies.
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http://dx.doi.org/10.3389/frai.2020.00065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861281PMC
August 2020

The neurology-psychiatry interface in epilepsy.

Ir J Psychol Med 2021 03 19;38(1):9-15. Epub 2018 Dec 19.

Honorary Associate Clinical Professor, Exeter Medical School, Exeter, Consultant Neuropsychiatrist Cornwall Partnership NHS Foundation Trust, United Kingdom.

Epilepsy and mental illness have a bidirectional association. Psychiatrists are likely to encounter epilepsy as comorbidity. Seizures may present as mental illness. Equally, the management of psychiatric conditions has the potential to destabilise epilepsy. There is a need for structured epilepsy awareness and training amongst psychiatrists. This paper outlines key considerations around diagnosis, treatment and risk while suggesting practical recommendations.
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http://dx.doi.org/10.1017/ipm.2018.49DOI Listing
March 2021

Challenges for people with intellectual disabilities in law enforcement interactions in Ireland; thematic analysis informed by 1537 person-years' experience.

Int J Law Psychiatry 2021 Mar-Apr;75:101683. Epub 2021 Mar 6.

School of Medicine, University of Limerick, Limerick, Ireland.

Background: People with intellectual disabilities (PWID) are over-represented in criminal justice systems globally. This over-representation reveals itself at once in the demographic make-up of prison populations, as well as those detained in police settings as suspects of crime. While it is well-established in international literature that individuals who find themselves in the latter scenario face particular challenges in negotiating the forensic formalities routinely followed by the police at the pre-trial stage of criminal proceedings on account of their impairments, the specific difficulties experienced by PWID as suspects within Ireland's criminal justice system has yet to be explained, or indeed, understood. In seeking to address this research lacuna, this paper yields an account of a qualitative study which was aimed at identifying the unique challenges which PWID face in their interactions with Law Enforcement Officials (LEOs) in Ireland.

Aims: This study aimed to elicit perspectives across a range of disciplines with regard to barriers for PWID interacting with LEOs in Ireland, and sought viewpoints on the content of a proposed awareness programme.

Methods: A survey using purposive sampling was used to elicit viewpoints from people from representative organisations for PWID, people working with voluntary organisations for PWID, healthcare professionals working with PWID and professionals from the criminal justice system (including members of An Garda Siochana, lawyers, members of the Irish judiciary and officials within the Airport Police). Data were anonymised at the point of collection. Qualitative thematic analysis was conducted to extract themes based on the data retrieved through the survey.

Results: Ninety-five (n = 95) responses were received from individuals reporting a cumulative experience of 1537 person-years. Respondents identified themselves as members of one of three groups; people working in a voluntary or representative organisation for PWID (n = 42, 44.2%); people working in healthcare (n = 31, 32.6%); and people working in law enforcement (n = 22, 23.1%). Three themes were identified from the qualitative thematic analysis. The first theme, "Barriers to Communication", identified challenges which PWID and LEO experience in their mutual interactions and communications with one another. The second theme, "Building Awareness and Skills", identified elements of an ID awareness programme for LEOs. The third theme, "Institutional and System Change", identified possible lines of innovation with respect to contemporary police practice and the availability of supports for both PWID and the LEOs who work with them.

Originality/value: This study represents the first dedicated qualitative inquiry conducted on a multidisciplinary level into the barriers which healthcare professionals, legal professionals and disability advocacy groups perceive to be faced by PWID in their interactions with LEOs in Ireland. Consequently, the findings from this study will act as a valuable template in the direction of informing the development of an ID awareness programme for LEOs in Ireland. In addition, these research findings are expected to usefully inform the development of national policy and protocols in areas related to health, disability and justice. In offering a rich evidence-base for future policy initiatives, the timing of this study is particularly significant. The recent ratification by Ireland of the UN Convention for the Rights of People with Disabilities (UNCRPD), together with the synchronous emergence of an evolving emphasis on human rights-based policing at a national level in Ireland, has meant that Irish policymakers have a unique opportunity to re-imagine the pre-trial formalities of Ireland's criminal process in order to demonstrate an increased sensitivity to the needs of PWID. Securing equal access to justice for such individuals, it is important to emphasise, is a legal requirement pursuant to Article 13 of the UNCRPD. To the extent therefore that this study yields unique insights into the barriers faced by PWID in their interactions with LEOs, the results of this study are potentially generalisable to other jurisdictions that have ratified the UNCRPD and are developing policy to accord with Article 13.
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http://dx.doi.org/10.1016/j.ijlp.2021.101683DOI Listing
March 2021

Dynamic Changes in the Nasal Microbiome Associated With Disease Activity in Patients With Granulomatosis With Polyangiitis.

Arthritis Rheumatol 2021 09 31;73(9):1703-1712. Epub 2021 Jul 31.

University of Pennsylvania, Philadelphia.

Objective: Little is known about temporal changes in nasal bacteria in granulomatosis with polyangiitis (GPA). This study was undertaken to examine longitudinal changes in the nasal microbiome in association with relapse in GPA patients.

Methods: Bacterial 16S ribosomal RNA gene sequencing was performed on nasal swabs from 19 patients with GPA who were followed up longitudinally for a total of 78 visits, including 9 patients who experienced a relapse and 10 patients who remained in remission. Relative abundance of bacteria and ratios between bacteria were examined. Generalized estimating equation models were used to evaluate the association between bacterial composition and 1) disease activity and 2) levels of antineutrophil cytoplasmic antibody (ANCA) with specificity for proteinase 3 (PR3), adjusted for medication.

Results: Corynebacterium and Staphylococcus were the most abundant bacterial genera across all nasal samples. Patients with quiescent disease maintained a stable ratio of Corynebacterium to Staphylococcus across visits. In contrast, in patients who experienced a relapse, a significantly lower ratio was observed at the visit prior to relapse, followed by a higher ratio at the time of relapse (adjusted P < 0.01). Species-level analysis identified an association between a higher abundance of nasal Corynebacterium tuberculostearicum and 1) relapse (adjusted P = 0.04) and 2) higher PR3-ANCA levels (adjusted P = 0.02).

Conclusion: In GPA, significant changes occur in the nasal microbiome over time and are associated with disease activity. The occurrence of these changes months prior to the onset of relapse supports a pathogenic role of nasal bacteria in GPA. Our results uphold existing hypotheses implicating Staphylococcus as an instigator of disease and have generated a novel finding involving Corynebacterium as a potential mediator of disease in GPA.
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http://dx.doi.org/10.1002/art.41723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8403103PMC
September 2021

Psychiatrists and homicidal threats: a cross-sectional study.

Ir J Psychol Med 2021 Mar 8:1-5. Epub 2021 Mar 8.

Department of Psychiatry, Mid-West Mental Health Service, University Hospital Limerick, Limerick, Ireland.

Objectives: To investigate the frequency, characteristics and impact of death threats by patients towards psychiatrists.

Methods: A cross-sectional survey of psychiatrists (n = 60) was undertaken to investigate the frequency, characteristics and impact of death threats by patients in one Irish healthcare region serving a mixed urban-rural population of 470,000.

Results: Forty-nine responses (82%) were received. Thirty-one per cent of respondents experienced death threats by patients during their careers. Victims were more likely to be male and in a consultant role. Patients making the threats were more likely to be males aged 30-60 with a history of violence and diagnosis of personality disorder and/or substance misuse. A majority of threats occurred in outpatient settings and identified a specific method of killing, usually by stabbing. Prosecution of the perpetrator was uncommon. Of the victimised psychiatrists, 53% reported that such threats affected their personal lives, and 67% believed their professional lives were impacted. In half of the incidents, there were adverse incidents subsequent to the threats, involving either the patient or the clinician.

Conclusions: Death threats by patients have significant psychological and professional impacts on psychiatrists. Early liaison with employers and police and transferring the care of the patient to another clinician may be useful measures.
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http://dx.doi.org/10.1017/ipm.2021.14DOI Listing
March 2021

The association between perceived coercion on admission and formal coercive practices in an inpatient psychiatric setting.

Int J Law Psychiatry 2021 Mar-Apr;75:101680. Epub 2021 Feb 17.

Department of Psychiatry, Trinity Centre for Health Sciences, Tallaght University Hospital, Tallaght, Dublin 24 D24 NR0A, Ireland.

Involuntary care is a feature of mental health services around the world. In addition to involuntary admission and treatment, specific coercive practices include seclusion and physical restraint. Our study aimed to determine the relationships, if any, between these practices and perceived coercion on admission among psychiatry inpatients in Ireland, as well as any relationships between perceived coercion on admission and variables such as age, gender and diagnosis. We included 107 psychiatry inpatients aged 18 years or over who were admitted to the acute psychiatry admission units in Tallaght University Hospital and Connolly Hospital, Dublin, Ireland over a 30-month period between September 2017 and February 2020. Over a quarter (27.1%) of participating patients had involuntary status; nine (8.4%) had experienced at least one episode of seclusion, and ten (9.3%) had experienced at least one episode of restraint. Perceived coercion on admission was significantly associated with involuntary status and female gender; perceived negative pressures on admission were significantly associated with involuntary status and positive symptoms of schizophrenia; perceived procedural injustice on admission was significantly associated with fewer negative symptoms, involuntary status, cognitive impairment and female gender; and negative affective reactions to hospitalisation on admission were significantly associated with birth in Ireland and being employed. Total score across these four subscales was significantly associated with involuntary status and positive symptoms, and had borderline significant associations with birth in Ireland, being employed and female gender. Overall, perceived coercion on admission, assessed in retrospect by the patient, is more closely associated with involuntary status and symptoms than it is with subsequent formal coercive practices, such as seclusion and restraint. The role of gender merits particular attention in future research, especially in relation to procedural injustice on admission and perceived coercion on admission.
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http://dx.doi.org/10.1016/j.ijlp.2021.101680DOI Listing
February 2021

Homelessness amongst psychiatric Inpatients: a cross-sectional study in the mid-west of Ireland.

Ir J Med Sci 2021 Feb 15. Epub 2021 Feb 15.

School of Medicine, University of Limerick, Plassey, Limerick, Ireland.

Background: This cross-sectional study sought to establish the prevalence of homelessness amongst inpatients in two psychiatric units in Ireland and explore the perceived relationship between psychiatric illness and homelessness.

Methods: The study employed a semi-structured interview format utilising a specifically designed questionnaire which received ethical approval from the Limerick University Hospitals Group ethics committee.

Results: Fifty psychiatric inpatients were interviewed. Fifteen were either "currently" homeless (n = 8) or had experienced "past" homelessness (n = 7). Those who had experienced homelessness were more likely to have a psychotic illness. A majority of those who had experienced homelessness believed that psychiatric illness contributed to their homelessness. Involuntary admission rates were more than double for patients in the homeless group. A number of participants also reported that a lack of accommodation was preventing their discharge.

Conclusion: Homelessness affects a significant number of psychiatric patients and can be both a contributory factor to, and consequence of, mental illness. With homelessness at unprecedented levels, there is a need for the development of tailored programmes aimed at supporting these vulnerable groups.
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http://dx.doi.org/10.1007/s11845-021-02546-xDOI Listing
February 2021

Being present: Examining the efficacy of an Internet Mantram Program on RN-delivered patient-centered care.

Nurs Outlook 2021 Mar-Apr;69(2):136-146. Epub 2021 Feb 8.

Edward Hines, Jr. Veterans Affairs Hospital, Hines, IL; College of Nursing, University of Illinois at Chicago, Chicago, IL.

Background: The COVID-19 pandemic highlighted nurses' compassionate presence during stressful conditions. Strategies to reduce workplace stress are needed.

Purpose: The purpose of this study was to evaluate a stress reduction strategy, an Internet-based Mantram Repetition Program (MRP), for nurses caring for hospitalized Veterans.

Methods: A one group pre-/post-test design was used to assess change in nurses' perceived outcomes after participating in the MRP. A post-test-only design was used to assess hospitalized Veterans' perceptions of nursing presence and satisfaction with care. Qualitative interviews were used to supplement quantitative data.

Findings: Patients perceived high levels of presence and satisfaction with care. Post MRP, nurses perceived increased mindfulness, compassion satisfaction, spiritual well-being, and nursing presence. Increased mindfulness was associated with greater compassion satisfaction and less burnout.

Discussion: For nurses working on the front lines of patient care, the potential for experiencing stress and burnout is a reality. Participating in a MRP could lessen these effects and facilitate nursing presence.
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http://dx.doi.org/10.1016/j.outlook.2021.01.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869680PMC
April 2021

Dignity: The elephant in the room in psychiatric inpatient care? A systematic review and thematic synthesis.

Int J Law Psychiatry 2021 Mar-Apr;75:101672. Epub 2021 Jan 26.

Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin 24 D24 NR0A, Ireland.

Involuntary psychiatric inpatient care presents a unique ethical challenge not least because the dignity of a person whose liberty and autonomy are restricted is inherently at risk. Understanding patients' experience of voluntary and involuntary care is an important part of ensuring that dignity is upheld as a key value. This study aimed to provide the first thematic synthesis of the existing literature on patient experience of dignity in voluntary and involuntary inpatient psychiatric care. PubMed (United States National Library of Medicine), PsycInfo (American Psychological Association), the Cochrane Library and bibliographies of relevant articles were searched for peer-reviewed, English-language studies from the start date of the databases through May 2020. Systematic searches identified 202 original papers. Consensus criteria were used to determine study inclusion through abstract and manuscript review. Eighteen articles were initially identified as suitable and nine met criteria for the final analysis. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Given the high proportion of qualitative literature, a thematic synthesis approach was adopted. Critical Appraisal Skills Program (CASP) checklists were used to assess quality of papers. Familiarization and line-by-line coding were carried out on qualitative studies and a thematic framework developed using an iterative approach. Six key themes emerged: coercion; powerlessness; care environment; relationship to staff; impact of involuntary treatment, and paradoxes. These encompassed 15 subthemes, comprising 111 individual statements. Despite dignity being at the core of this review, only five of the identified papers explicitly referenced the term. Nevertheless, core similarities in patient experiences and perspectives existed across a wide variety of primary studies from multiple sites. These themes can be taken to represent the components of dignified care and used as a framework for further research and service reform.
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http://dx.doi.org/10.1016/j.ijlp.2021.101672DOI Listing
January 2021

Multi-classifier-based identification of COVID-19 from chest computed tomography using generalizable and interpretable radiomics features.

Eur J Radiol 2021 Mar 15;136:109552. Epub 2021 Jan 15.

School of Medical Informatics, China Medical University Puhe Rd, Shenbei New District, Shenyang, Liaoning, 110122, China; Department of Radiology, School of Medicine, Stanford University 1201 Welch Rd, Lucas Center, Palo Alto, CA, 94305, United States. Electronic address:

Purpose: To investigate the efficacy of radiomics in diagnosing patients with coronavirus disease (COVID-19) and other types of viral pneumonia with clinical symptoms and CT signs similar to those of COVID-19.

Methods: Between 18 January 2020 and 20 May 2020, 110 SARS-CoV-2 positive and 108 SARS-CoV-2 negative patients were retrospectively recruited from three hospitals based on the inclusion criteria. Manual segmentation of pneumonia lesions on CT scans was performed by four radiologists. The latest version of Pyradiomics was used for feature extraction. Four classifiers (linear classifier, k-nearest neighbour, least absolute shrinkage and selection operator [LASSO], and random forest) were used to differentiate SARS-CoV-2 positive and SARS-CoV-2 negative patients. Comparison of the performance of the classifiers and radiologists was evaluated by ROC curve and Kappa score.

Results: We manually segmented 16,053 CT slices, comprising 32,625 pneumonia lesions, from the CT scans of all patients. Using Pyradiomics, 120 radiomic features were extracted from each image. The key radiomic features screened by different classifiers varied and lead to significant differences in classification accuracy. The LASSO achieved the best performance (sensitivity: 72.2%, specificity: 75.1%, and AUC: 0.81) on the external validation dataset and attained excellent agreement (Kappa score: 0.89) with radiologists (average sensitivity: 75.6%, specificity: 78.2%, and AUC: 0.81). All classifiers indicated that "Original_Firstorder_RootMeanSquared" and "Original_Firstorder_Uniformity" were significant features for this task.

Conclusions: We identified radiomic features that were significantly associated with the classification of COVID-19 pneumonia using multiple classifiers. The quantifiable interpretation of the differences in features between the two groups extends our understanding of CT imaging characteristics of COVID-19 pneumonia.
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http://dx.doi.org/10.1016/j.ejrad.2021.109552DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7810032PMC
March 2021

Taking histories: joint working of disciplines in medical history scholarship.

Ir J Med Sci 2021 Jan 11. Epub 2021 Jan 11.

School of Medicine, Trinity Biomedical Sciences Institute, Trinity College, 152-160 Pearse Street, Dublin 2, D02 R590, Ireland.

Background And Aims: While there is an increasing emphasis on the value of interdisciplinarity in scholarship in the medical humanities, it is unknown to what extent there is joint working between historians and clinicians in medical history. We aimed to quantify evidence of joint working in authorship of medical history papers.

Methods: Observational survey of authorship. We studied authorship data in all papers published in the three major medical history journals between 2009 and 2019 (n = 634).

Results: The majority of medical history papers is written by single authors with single disciplinary affiliations (68%), most commonly history (65%): fewer than one paper in seven (14%) shows evidence of joint working between disciplines in authorship. A minority of papers (8%) are written by authors with primary medical affiliations. Almost three-quarters (71%) of papers have an acknowledgements section, but only 6% shows clear evidence of joint working between disciplines in the acknowledgements.

Conclusions: Scholarship engaging both historians and clinicians is rare in medical history journals. Possible solutions include enhanced research collaborations between historians and clinicians, interdisciplinary educational seminars and cross-institutional knowledge exchanges.
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http://dx.doi.org/10.1007/s11845-021-02511-8DOI Listing
January 2021

Subglottic suction frequency and adverse ventilator-associated events during critical illness.

Infect Control Hosp Epidemiol 2021 07 11;42(7):826-832. Epub 2021 Jan 11.

Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Objective: Tracheal intubation and mechanical ventilation provide essential support for patients with respiratory failure, but the course of mechanical ventilation may be complicated by adverse ventilator-associated events (VAEs), which may or may not be associated with infection. We sought to understand how the frequency of subglottic suction, an indicator of the quantity of sputum produced by ventilated patients, relates to the onset of all VAEs and infection-associated VAEs.

Design: We performed a case-crossover study including 87 patients with VAEs, and we evaluated 848 days in the pre-VAE period at risk for a VAE.

Setting And Participants: Critically ill patients were recruited from the medical intensive care unit of an academic medical center.

Methods: We used the number of as-needed subglottic suctioning events performed per calendar day to quantify sputum production, and we compared the immediate pre-VAE period to the preceding period. We used CDC surveillance definitions for VAE and to categorize whether events were infection associated or not.

Results: Sputum quantity measured by subglottic suction frequency is greater in the period immediately prior to VAE than in the preceding period. However, it does not discriminate well between infection-associated VAEs and VAEs without associated infection.

Conclusions: Subglottic suction frequency may serve as a valuable marker of sputum quantity, and it is associated with risk of a VAE. However, our results require validation in a broader population of mechanically ventilated patients and intensive care settings.
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http://dx.doi.org/10.1017/ice.2020.1298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8272736PMC
July 2021

Impact of Nasopharyngeal Specimen Quality on SARS-CoV-2 Test Sensitivity.

medRxiv 2020 Dec 11. Epub 2020 Dec 11.

Background: The SARS-CoV-2 reverse-transcription polymerase chain reaction (RT-PCR) cycle of threshold (Ct) has been used to estimate quantitative viral load, with the goal of targeting isolation precautions for individuals with COVID-19 and guiding public health interventions. However, variability in specimen quality can alter the Ct values obtained from SARS-CoV-2 clinical assays. We sought to define how variable nasopharyngeal (NP) swab quality impacts clinical SARS-CoV-2 test sensitivity.

Methods: We performed amplification of a human gene target (β-actin) in parallel with a clinical RT-PCR targeting the SARS-CoV-2 gene for 1311 NP specimens collected from patients with clinical concern for COVID-19. We evaluated the relationship between NP specimen quality, characterized by high Ct values for the human gene target β-actin Ct, and the probability of SARS-CoV-2 detection via logistic regression, as well as the linear relationship between SARS-CoV-2 and β-actin Ct.

Results: Low quality NP swabs are less likely to detect SARS-CoV-2 (odds ratio 0.654, 95%CI 0.523 to 0.802). We observed a positive linear relationship between SARS-CoV-2 and β-actin Ct values (slope 0.169, 95%CI 0.092 to 0.247). COVID-19 disease severity was not associated with β-actin Ct values.

Conclusions: Variability in NP specimen quality accounts for significant differences in the sensitivity of clinical SARS-CoV-2 assays. If unrecognized, low quality NP specimens, which are characterized by a low level of amplifiable human DNA target, may limit the application of SARS-CoV-2 Ct values to direct infection control and public health interventions.
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http://dx.doi.org/10.1101/2020.12.09.20246520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7743104PMC
December 2020

Radiology artificial intelligence, a systematic evaluation of methods (RAISE): a systematic review protocol.

Insights Imaging 2020 Dec 9;11(1):133. Epub 2020 Dec 9.

St Vincent's University Hospital, Dublin, Ireland.

Introduction: There has been a recent explosion of research into the field of artificial intelligence as applied to clinical radiology with the advent of highly accurate computer vision technology. These studies, however, vary significantly in design and quality. While recent guidelines have been established to advise on ethics, data management and the potential directions of future research, systematic reviews of the entire field are lacking. We aim to investigate the use of artificial intelligence as applied to radiology, to identify the clinical questions being asked, which methodological approaches are applied to these questions and trends in use over time.

Methods And Analysis: We will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and by the Cochrane Collaboration Handbook. We will perform a literature search through MEDLINE (Pubmed), and EMBASE, a detailed data extraction of trial characteristics and a narrative synthesis of the data. There will be no language restrictions. We will take a task-centred approach rather than focusing on modality or clinical subspecialty. Sub-group analysis will be performed by segmentation tasks, identification tasks, classification tasks, pegression/prediction tasks as well as a sub-analysis for paediatric patients.

Ethics And Dissemination: Ethical approval will not be required for this study, as data will be obtained from publicly available clinical trials. We will disseminate our results in a peer-reviewed publication. Registration number PROSPERO: CRD42020154790.
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http://dx.doi.org/10.1186/s13244-020-00929-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726044PMC
December 2020
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