Sean Kinsella

https://arrow.tudublin.ie/scthebk/1025/thumbnail.jp

Comparison of foam swabs and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a randomised split mouth study

Abstract Introduction During critical illness, dental plaque may serve as a reservoir of respiratory pathogens. This study compared the effectiveness of toothbrushing with a small-headed toothbrush or a foam-headed swab in mechanically ventilated patients. Methods This was a randomised, assessor-blinded, split-mouth trial, performed at a single critical care unit. Adult, orally intubated patients with >20 teeth, where >24 hours of mechanical ventilation was expected were included. Teeth were cleaned 12-hourly using a foam swab or toothbrush (each randomly assigned to one side of the mouth). Cleaning efficacy was based on plaque scores, gingival index and microbial plaque counts. Results High initial plaque (mean=2.1 (SD 0.45)) and gingival (mean=2.0 (SD 0.54)) scores were recorded for 21 patients. A significant reduction compared with initial plaque index occurred using both toothbrushes (mean change=−1.26, 95% CI −1.57 to −0.95; p<0.001) and foam swabs (mean change=−1.28, 95% CI −1.54 to −1.01; p<0.001). There was significant reduction in gingival index over time using toothbrushes (mean change=−0.92; 95% CI −1.19 to −0.64; p<0.001) and foam swabs (mean change=−0.85; 95% CI −1.10 to −0.61; p<0.001). Differences between cleaning methods were not statistically significant (p=0.12 for change in gingival index; p=0.24 for change in plaque index). There was no significant change in bacterial dental plaque counts between toothbrushing (mean change 3.7×104 colony-forming units (CFUs); minimum to maximum (−2.5×1010 CFUs, 8.7×107 CFUs)) and foam swabs (mean change 9×104 CFUs; minimum to maximum (−3.1×1010 CFUs, 3.0×107 CFUs)). Conclusions Patients admitted to adult intensive care had poor oral health, which improved after brushing with a toothbrush or foam swab. Both interventions were equally effective at removing plaque and reducing gingival inflammation. Trial registration number NCT01154257; Pre-results

A complex and severe encephalitis associated with four co-existing neuronal cell-surface autoantibodies

Many forms of autoimmune encephalitis are mediated by neuronal cell-surface directed autoantibodies. The co-occurrence of four neuronal cell-surface antibodies in a single patient is exceptionally rare. We report a patient who had a severe encephalitis associated with antibodies to NMDA, Glycine, GABAA and GABAB receptors. Case: A 28-year-old man on tacrolimus presented with a first seizure. Thereafter, he developed confusion, cerebellar signs, opsoclonus, neuromyotonia and medication-refractory seizures. CSF sampling revealed 826 white cells and NMDA, glycine and GABAB receptor antibodies: all were also detected in serum along with additional GABAA receptor antibodies. Neural antibodies were detected using fixed (NMDA, GABAA, GABAB receptor) or live (glycine receptor) cell-based assays at Oxford Neuroimmunology Laboratory, Oxford, UK. MRI brain demonstrated cerebellar leptomeningeal enhancement and a hyperintense lesion in the cerebellar vermis. EEG revealed extreme delta brush and needle EMG confirmed neuromyotonia. No underlying malignancy was detected. Methylprednisolone, IVIG, Rituximab, therapeutic plasma exchange, cyclophosphamide and bortezomib were administered sequentially, with minimal clinical improvement. Death secondary to respiratory sepsis occurred on the 714th hospital day. Postmortem revealed pan-cerebellar atrophy with Purkinje cell loss; dentate nucleus ganglionopathy, and thoracolumbar cord myelopathy. In summary, the detection of multiple neuronal cell-surface antibodies in autoimmune encephalitis is unusual and may result in a complex overlap syndrome with a poor response to immunotherapy

The effects of a 16-week school-based exercise program on anxiety in children with autism spectrum disorder

Physical activity interventions have been shown to decrease anxiety in children with ASD. There is little known regarding the effects of an exercise program on anxiety in both home and school settings and the optimal dosage to reduce anxiety. Therefore, the aim of this study was to assess the effects of a 16-week exercise program on the anxiety levels of children with moderate to severe symptoms of ASD in home and school settings, and to compare the effects at 8 and 16 weeks. This study was a within-subject, non-controlled design, intervention study. Twenty-four children (5−18 years) with moderate to severe ASD were included. A school-based exercise program was implemented three days a week for 16 weeks. Parents and teachers completed the Anxiety Scale for Children for ASD (ASC-ASD) at baseline, week 8, and week 16. A one-way repeated-measure ANOVA with post hoc analysis using Bonferroni adjustment was used to test for a significant effect for time (p 0.05), with Cohen’s d used to calculate the effect size. For teacher-reported anxiety, there were significant decreases from baseline to week 16 for total ASC-ASD (p 0.001), performance anxiety (p 0.001), anxious arousal (p 0.001), and uncertainty (p 0.001). There was no significant decrease in parent-reported anxiety. The findings demonstrate that a 16-week exercise program can reduce anxiety in children with ASD in school settings. Results demonstrate that 16 weeks, as opposed to 8, may be necessary to have a significant effect on in-school anxiety

Greater preservation of SARS‐CoV‐2 neutralising antibody responses following the ChAdOx1‐S (AZD1222) vaccine compared with mRNA vaccines in haematopoietic cell transplant recipients

Whilst SARS-CoV-2 mRNA vaccines generate high neutralising antibodies (nAb) in most individuals, haematopoietic stem cell transplant (HSCT) and chimeric antigen receptor T-cell (CAR-T) recipients respond poorly. HSCT/CAR-T treatment ablates existing immune memory, with recipients requiring revaccination analogous to being vaccine naive. An optimal revaccination strategy for this cohort has not been defined. Factors predicting immunogenicity following three ancestral SARS-CoV-2 vaccines were assessed in 198 HSCT/CAR-T recipients and 96 healthcare workers (HCWs) recruited to multicentre studies. Only 25% of HSCT/CAR-T recipients generated nAbs following one dose, with titres 167-fold and 7-fold lower than that in HCWs after the first and second doses, respectively. Lower post-second dose nAb titres were associated with older age, rituximab use, and previous HSCT. ChAdOx1-S recipients were more likely to generate nAbs compared with mRNA vaccines, with titres comparable to HCWs. In contrast, nAbs were significantly lower in HSCT/CAR-T recipients than HCWs after mRNA vaccination. The poor first-dose immunogenicity in HSCT/CAR-T recipients suggests a minimum licensed dosing interval could limit the period of vulnerability following HSCT/CAR-T. The relative preservation of nAbs with ChAdOx1-S vaccination highlights the importance of evaluating alternative platforms to mRNA vaccination within this highly vulnerable clinical cohort

Greater preservation of SARS-CoV-2 neutralising antibody responses following the ChAdOx1-S (AZD1222) vaccine compared with mRNA vaccines in haematopoietic cell transplant recipients.

Whilst SARS-CoV-2 mRNA vaccines generate high neutralising antibodies (nAb) in most individuals, haematopoietic stem cell transplant (HSCT) and chimeric antigen receptor T-cell (CAR-T) recipients respond poorly. HSCT/CAR-T treatment ablates existing immune memory, with recipients requiring revaccination analogous to being vaccine naive. An optimal revaccination strategy for this cohort has not been defined. Factors predicting immunogenicity following three ancestral SARS-CoV-2 vaccines were assessed in 198 HSCT/CAR-T recipients and 96 healthcare workers (HCWs) recruited to multicentre studies. Only 25% of HSCT/CAR-T recipients generated nAbs following one dose, with titres 167-fold and 7-fold lower than that in HCWs after the first and second doses, respectively. Lower post-second dose nAb titres were associated with older age, rituximab use, and previous HSCT. ChAdOx1-S recipients were more likely to generate nAbs compared with mRNA vaccines, with titres comparable to HCWs. In contrast, nAbs were significantly lower in HSCT/CAR-T recipients than HCWs after mRNA vaccination. The poor first-dose immunogenicity in HSCT/CAR-T recipients suggests a minimum licensed dosing interval could limit the period of vulnerability following HSCT/CAR-T. The relative preservation of nAbs with ChAdOx1-S vaccination highlights the importance of evaluating alternative platforms to mRNA vaccination within this highly vulnerable clinical cohort

Middle School Curriculum Unit Addressing Connecticut’s Indigenous People and European Colonization

This project considers Native American studies as a curriculum unit for middle school students and proposes lesson content for students at Rumsey Hall School in Washington Depot, Connecticut. The project examines how teachers might understand Native American studies as a discipline in and of itself and within the context of existing curriculum. Varying disciplinary approaches to Native American studies within higher education are helpful in situating Native American studies as a component of K-12 social studies education. State educational requirements for Native American studies in Connecticut public schools set for implementation in the 2023/24 school year will provide further orientation here, but this project acknowledges that private schools, including Rumsey Hall School, are exempt from these state guidelines. The project considers some of the challenges of delivering effective lesson content in the classroom, reviews approaches to Native American culture and history within textbooks, and anticipates successful approaches moving forward. Finally, the project offers specific lesson content that may be used in addition to Rumsey Hall School’s current curriculum. The lesson content is intended to encourage student awareness of Connecticut\u27s Tribal Nations and a sense of place through archeology and regional history

Sean Kinsella

https://arrow.tudublin.ie/gastirest/1020/thumbnail.jp

Attentional Bias in Relation to Negative and Expectancy Violating Stimuli: A Divergence Between Theory and Research

Aims: The purpose of this study was to compare attentional orienting responses to both negative and expectancy violating stimuli. This was done in an attempt to reconcile the information theoretic Free Energy Principle (Friston, 2010) account of attention with the established empirical literature. In addition, we sought to explore the relationship between personality traits of neuroticism and psychoticism with responses to expectancy violating stimuli. Method: Fifteen (n = 15) undergraduate psychology students viewed angry, neutral, and expectancy violating faces, while heart rate and skin temperature indices of orienting were measured. Personality traits were assessed using the Eysenck Personality Scale-Revised (EPQ-R; Eysenck, Eysenck, & Barrett, 1985). Participants also rated the valence of the presented faces using a 7-point likert scale (1 = negative; 7 = positive). Results: Expectancy violating stimuli resulted in a non-significant reduction in heart rate over negative and neutral faces, M =-2.69, SE = 2.41, p > .05. The expectancy violating faces were also rated significantly more positive than negative faces, M = 2.25, SE = .25, p < .01. No significant relationship was found between physiological measures of orienting and personality traits, although a negative trend was found between orienting and neuroticism for both heart rate (r = -.29) and skin temperature (r = -.32) measures. Conclusion: Lack of statistical power and choice of orienting measure may have precluded the detection of significant differences between stimuli. Furthermore, the heterogeneous nature of personality traits may have prevented the detection of any statistical relationship with attentional orienting. Implications are discussed below