Matthew J. Hayat

Influence of a partner's HIV serostatus, use of highly active antiretroviral therapy, and viral load on perceptions of sexual risk behavior in a community sample of men who have sex with men

Objective: To assess the perceptions of gay and bisexual men concerning the risk of HIV transmission through various sexual practices with a new sex partner depending on that partners disclosed HIV status, antiretroviral treatment status, and viral load. Methods: Study participants read four different scenarios describing sexual situations with a new partner and rated each scenario for risk of HIV transmission. HIV status and antiretroviral treatment status disclosed by the new sex partner were varied across four scenarios: unknown HIV status; HIV‐negative; HIV‐positive and not taking highly active antiretroviral therapy (HAART); and HIV‐positive and taking HAART with an undetectable viral load. Results: Study participants were 472 men attending a gay pride festival who reported that they were HIV‐negative. Eighty‐nine percent of the men were white, and the mean age of the study participants was 35.8 years. Of the four scenarios, sex with an HIV‐positive partner not taking HAART was rated as posing the greatest risk. Sex with an HIV‐positive partner taking HAART who had an undetectable viral load was not consistently viewed as riskier than sex with an HIV‐negative partner or a man with an unknown HIV status. Conclusions: The current study provides preliminary evidence for the effect of disclosure of HIV serostatus, use of HAART, and the presence of an undetectable viral load on the perceptions of sexual risk for HIV‐negative men. The findings suggest that some gay and bisexual men judge risk based on the perceived HIV status of their sex partners and not on the general assumption that all sex partners entail equal risk, as many prevention campaigns have emphasized.

Targeted intervention improves knowledge but not self-care or readmissions in heart failure patients with mild cognitive impairment

Mild cognitive impairment (MCI) is prevalent in heart failure, and can contribute to poor self‐care and higher hospital readmissions. Strategies to improve self‐care in patients with MCI have not been studied. This randomized controlled trial aimed to test the effect of a targeted intervention on self‐care, heart failure knowledge, and 30‐day readmissions.

A longitudinal study of maternal attachment and infant developmental outcomes

Extant research has demonstrated that compared to adults with insecure attachment styles, more securely attached parents tend to be more responsive, sensitive, and involved parents, resulting in improved outcomes for their children. Less studied is the influence of a mothers attachment style on her attachment to her unborn child during pregnancy and the consequent developmental outcomes of the child during early childhood. Thus, the aim of this prospective longitudinal study was to examine the relationship between maternal–fetal attachment (MFA) during pregnancy and infant and toddler outcomes and the role of mothers attachment style on early childhood developmental outcomes in an economically disadvantaged sample of women and their children. Gamma regression modeling demonstrated that an avoidant maternal attachment style (bu2009=u2009.98, 95xa0% CI [.97, .98], pu2009<u20090.001) and post-partum depressive symptomatology (bu2009=u2009.97, 95xa0% CI [.96–.99], pu2009=u20090.03) were significant predictors of early childhood development. Women demonstrating higher avoidant attachment styles and greater depressive symptomatology were more likely to have children demonstrating early childhood developmental delays than those women with less avoidant attachment styles and less depressive symptomatology. Furthermore, women reporting higher MFA during pregnancy had more secure attachment styles, and their children had more optimal early childhood development than those women reporting lower MFA and less secure attachment styles. Findings have implications for enhancing early intervention programs aimed at improving maternal and childhood outcomes. An earlier identification of disruptions in attachment may be beneficial in tailoring interventions focused on the mother–child dyad.

Evaluation of Two Intensive Care Delirium Screening Tools for Non-Critically Ill Hospitalized Patients

BACKGROUNDnDelirium is a common, yet frequently under-recognized medical/psychiatric complication for hospitalized patients, associated with substantial morbidity and mortality. While easy-to-use delirium screening tools exist for ventilated patients, their use in non-critically ill, hospitalized patients has not been validated.nnnMETHODSnThis prospective 4-week comparison of daily delirium status, using screening tools (Confusion Assessment Method for the Intensive Care Unit [CAM-ICU] and Intensive Care Delirium Screening Checklist [ICDSC]) vs. a daily neuropsychiatric examination as a reference standard, was conducted in 139 inpatients in two medical oncology units at a large teaching hospital during July, 2009.nnnRESULTSnBased on neuropsychiatric examination, 36 (26%) patients had at least 1 day of delirium during their hospital admission. For 21 (15%) patients, delirium was present at the initial assessment, while 15 (11%) developed delirium at a median (IQR) of three (2-7) subsequent assessments. Delirium was present on 20% of all patient-days. For the initial evaluation, the CAM-ICU had a sensitivity of 18% (95% confidence interval [CI], 5%-44%), and a sensitivity of 18% (9% -32%) when using all assessments, adjusting for repeated measures on each patient. The ICDSC had sensitivities of 47% (24%-72%) and 62% (49%-74%). The specificity of both instruments was very high (≥98%).nnnCONCLUSIONSnThis study suggests that in non-critically ill hospitalized patients, the CAM-ICU and ICDSC intensive care delirium screening tools are not adequately sensitive for use in routine clinical practice. Further work is needed to develop more sensitive, efficient tools in this population.

PREDICTION OF FREQUENCY AND EXPOSURE LEVEL OF SOLAR PARTICLE EVENTS

For future space missions outside of the Earth’s magnetic field, the risk of radiation exposure from solar particle events (SPEs) during extra-vehicular activities (EVAs) or in lightly shielded vehicles is a major concern when designing radiation protection including determining sufficient shielding requirements for astronauts and hardware. While the expected frequency of SPEs is strongly influenced by solar modulation, SPE occurrences themselves are chaotic in nature. We report on a probabilistic modeling approach, where a cumulative expected occurrence curve of SPEs for a typical solar cycle was formed from a non-homogeneous Poisson process model fitted to a database of proton fluence measurements of SPEs that occurred during the past 5 solar cycles (19–23) and those of large SPEs identified from impulsive nitrate enhancements in polar ice. From the fitted model, we then estimated the expected frequency of SPEs at any given proton fluence threshold with energy >30 MeV (&PHgr;30) during a defined space mission period. Analytic energy spectra of 34 large SPEs observed in the space era were fitted over broad energy ranges extending to GeV, and subsequently used to calculate the distribution of mGy equivalent (mGy-Eq) dose for a typical blood-forming organ (BFO) inside a spacecraft as a function of total &PHgr;30 fluence. This distribution was combined with a simulation of SPE events using the Poisson model to estimate the probability of the BFO dose exceeding the NASA 30-d limit of 250 mGy-Eq per 30 d. These results will be useful in implementing probabilistic risk assessment approaches at NASA and guidelines for protection systems for astronauts on future space exploration missions.

Original research reportEvaluation of Two Intensive Care Delirium Screening Tools for Non-Critically Ill Hospitalized Patients⁎

BACKGROUNDnDelirium is a common, yet frequently under-recognized medical/psychiatric complication for hospitalized patients, associated with substantial morbidity and mortality. While easy-to-use delirium screening tools exist for ventilated patients, their use in non-critically ill, hospitalized patients has not been validated.nnnMETHODSnThis prospective 4-week comparison of daily delirium status, using screening tools (Confusion Assessment Method for the Intensive Care Unit [CAM-ICU] and Intensive Care Delirium Screening Checklist [ICDSC]) vs. a daily neuropsychiatric examination as a reference standard, was conducted in 139 inpatients in two medical oncology units at a large teaching hospital during July, 2009.nnnRESULTSnBased on neuropsychiatric examination, 36 (26%) patients had at least 1 day of delirium during their hospital admission. For 21 (15%) patients, delirium was present at the initial assessment, while 15 (11%) developed delirium at a median (IQR) of three (2-7) subsequent assessments. Delirium was present on 20% of all patient-days. For the initial evaluation, the CAM-ICU had a sensitivity of 18% (95% confidence interval [CI], 5%-44%), and a sensitivity of 18% (9% -32%) when using all assessments, adjusting for repeated measures on each patient. The ICDSC had sensitivities of 47% (24%-72%) and 62% (49%-74%). The specificity of both instruments was very high (≥98%).nnnCONCLUSIONSnThis study suggests that in non-critically ill hospitalized patients, the CAM-ICU and ICDSC intensive care delirium screening tools are not adequately sensitive for use in routine clinical practice. Further work is needed to develop more sensitive, efficient tools in this population.

The Role of Mental Health on Maternal‐Fetal Attachment in Low‐Income Women

OBJECTIVEnTo examine and describe the influence of maternal depressive symptoms on maternal-fetal attachment (MFA) in predominantly low-income women.nnnDESIGNnMixed method.nnnSETTINGnThree urban obstetric/gynecologic (OB/GYN) clinics serving predominantly low-income women.nnnPARTICIPANTSnA convenience sample of 166 women participated in the quantitative component and a purposeful subsample of 12 women participated in the qualitative component; all women were between 24 and 28 weeks gestation at the time of data collection.nnnMETHODSnLinear regression models were used to examine the influence of depressive symptoms and social support on MFA. Individual in-depth interviews were conducted among a subsample of women to explore the influence of maternal depressive symptoms on MFA.nnnRESULTSnFifty-nine percent (nxa0=xa098) of participants had scores that were clinically significant for depressive symptoms. In the final model of social support and depressive symptoms regressed on MFA, social support (bxa0=xa0.23, 95% CI [0.09, .37], pxa0=xa0.002) and depressive symptoms (bxa0=xa0-1.02, 95% CI [-1.32, -.73], pxa0<xa00.001) were significant predictors. This multivariate linear regression model with two variables accounted for 65.2% of the total variance in overall MFA. Qualitative participants discussed the importance of social support in contributing to their mood state and MFA.nnnCONCLUSIONSnFindings from this study highlight the importance of assessing for depressive symptoms during pregnancy given its influence on MFA. By understanding how important it was for these women to have a supportive person to experience their pregnancies with, nurses can improve the pregnancy experience for vulnerable populations.

The influence of maternal–fetal attachment and health practices on neonatal outcomes in low‐income, urban women

Maternal-fetal attachment (MFA) has been associated with health practices during pregnancy, but less is known about this relationship in low-income women, and no identified studies have examined this relationship to neonatal outcomes. This longitudinal descriptive study was conducted to examine the relationships among MFA, health practices during pregnancy, and neonatal outcomes in a sample of low-income, predominantly African-American women and their neonates. MFA was associated with health practices during pregnancy and adverse neonatal outcomes. Health practices during pregnancy mediated the relationships of MFA and adverse neonatal outcomes. The results support the importance of examining MFA in our efforts to better understand the etiology of health disparities in neonatal outcomes.

Accuracy of advanced versus strictly conventional 12-lead ECG for detection and screening of coronary artery disease, left ventricular hypertrophy and left ventricular systolic dysfunction

BackgroundResting conventional 12-lead ECG has low sensitivity for detection of coronary artery disease (CAD) and left ventricular hypertrophy (LVH) and low positive predictive value (PPV) for prediction of left ventricular systolic dysfunction (LVSD). We hypothesized that a ~5-min resting 12-lead advanced ECG test (A-ECG) that combined results from both the advanced and conventional ECG could more accurately screen for these conditions than strictly conventional ECG.MethodsResults from nearly every conventional and advanced resting ECG parameter known from the literature to have diagnostic or predictive value were first retrospectively evaluated in 418 healthy controls and 290 patients with imaging-proven CAD, LVH and/or LVSD. Each ECG parameter was examined for potential inclusion within multi-parameter A-ECG scores derived from multivariate regression models that were designed to optimally screen for disease in general or LVSD in particular. The performance of the best retrospectively-validated A-ECG scores was then compared against that of optimized pooled criteria from the strictly conventional ECG in a test set of 315 additional individuals.ResultsCompared to optimized pooled criteria from the strictly conventional ECG, a 7-parameter A-ECG score validated in the training set increased the sensitivity of resting ECG for identifying disease in the test set from 78% (72-84%) to 92% (88-96%) (P < 0.0001) while also increasing specificity from 85% (77-91%) to 94% (88-98%) (P < 0.05). In diseased patients, another 5-parameter A-ECG score increased the PPV of ECG for LVSD from 53% (41-65%) to 92% (78-98%) (P < 0.0001) without compromising related negative predictive value.ConclusionResting 12-lead A-ECG scoring is more accurate than strictly conventional ECG in screening for CAD, LVH and LVSD.

Understanding statistical significance.

Background: Statistical significance is often misinterpreted as proof or scientific evidence of importance. This article addresses the most common statistical reporting error in the biomedical literature, namely, confusing statistical significance with clinical importance. Objective: The aim of this study was to clarify the confusion between statistical significance and clinical importance by providing a historical perspective of significance testing, presenting a correct understanding of the information given by p values and significance testing, and offering recommendations for the correct use and reporting of statistical results. Approach: The correct interpretation of p values and statistical significance is given, and the recommendations provided include a description of the current recommended guidelines for statistical reporting of the size of an effect. Results: This article provides a comprehensive overview of p values and significance testing and an understanding of the need for measures of importance and magnitude in statistical reporting. Discussion: Statistical significance is not an objective measure and does not provide an escape from the requirement for the researcher to think carefully and judge the clinical and practical importance of a studys results.