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Few studies have investigated the patterns of posttraumatic stress disorder (PTSD) symptom change in prolonged exposure (PE) therapy. In this study, we aimed to understand the patterns of PTSD symptom change in both PE and present-centered therapy (PCT).
Participants were active duty military personnel (N = 326, 89.3% male, 61.2% white, 32.5 years old) randomized to spaced-PE (S-PE; 10 sessions over 8 weeks), PCT (10 sessions over 8 weeks), or massed-PE (M-PE; 10 sessions over 2 weeks). Using latent profile analysis, we determined the optimal number of PTSD symptom change classes over time and analyzed whether baseline and follow-up variables were associated with class membership.
Five classes, namely rapid responder (7–17%), steep linear responder (14–22%), gradual responder (30–34%), non-responder (27–33%), and symptom exacerbation (7–13%) classes, characterized each treatment. No baseline clinical characteristics predicted class membership for S-PE and M-PE; in PCT, more negative baseline trauma cognitions predicted membership in the non-responder v. gradual responder class. Class membership was robustly associated with PTSD, trauma cognitions, and depression up to 6 months after treatment for both S-PE and M-PE but not for PCT.
Distinct profiles of treatment response emerged that were similar across interventions. By and large, no baseline variables predicted responder class. Responder status was a strong predictor of future symptom severity for PE, whereas response to PCT was not as strongly associated with future symptoms.
Terrorism and natural catastrophes have made disaster preparedness a critical issue. Despite the documented vulnerabilities of children during and following disasters, gaps remain in health care systems regarding pediatric disaster preparedness. This research study examined changes in knowledge acquisition of pediatric disaster preparedness among medical and non-medical personnel at a children’s hospital who completed an online training course of five modules: planning, triage, age-specific care, disaster management, and hospital emergency code response.
A multi-disciplinary team within the Pediatric Disaster Resource and Training Center at Children’s Hospital Los Angeles (Los Angeles, California USA) developed an online training course. Available archival course data from July 2009 to August 2012 were analyzed through linear growth curve multi-level modeling, with module total score as the outcome (0 to 100 points), attempt as the Level 1 variable (any module could be repeated), role in the hospital (medical or non-medical) as the Level 2 variable, and attempt by role as the cross-level effect.
A total of 44,115 module attempts by 5,773 course participants (3,686 medical personnel and 2,087 non-medical personnel) were analyzed. The average module total score upon first attempt across all participants ranged from 60.28 to 80.11 points, and participants significantly varied in how they initially scored. On average in the planning, triage, and age-specific care modules: total scores significantly increased per attempt across all participants (average rate of change ranged from 0.59 to 1.84 points) and medical personnel had higher total scores initially and through additional attempts (average difference ranged from 13.25 to 16.24 points). Cross-level effects were significant in the disaster management and hospital emergency code response modules: on average, total scores were initially lower among non-medical personnel compared to medical personnel, but non-medical personnel increased their total scores per attempt by 3.77 points in the disaster management module and 6.40 points in the hospital emergency code response module, while medical personnel did not improve their total scores through additional attempts.
Medical and non-medical hospital personnel alike can acquire knowledge of pediatric disaster preparedness. Key content can be reinforced or improved through successive training in an online course.
PhamPK, BeharSM, BergBM, UppermanJS, NagerAL. Pediatric Online Disaster Preparedness Training for Medical and Non-Medical Personnel: A Multi-Level Modeling AnalysisPrehosp Disaster Med.2018;33(4):349–354.
Simulation is used in many aspects of medical training but less so for echocardiography instruction in paediatric cardiology. We report our experience with the introduction of simulator-based echocardiography training at Weill Cornell Medicine for paediatric cardiology fellows of the New York–Presbyterian Hospital of Columbia University and Weill Cornell Medicine. Knowledge of CHD and echocardiographic performance improved following simulation-based training. Simulator training in echocardiography can be an effective addition to standard training for paediatric cardiology trainees.
Gorgona National Park (GNP) protects the only known feeding aggregation of juvenile green turtles Chelonia mydas on the Pacific coast of Colombia. This study was undertaken to compare the diet of the two known C. mydas morphotypes (black and yellow), and to determine availability, selectivity, and quality of food resources at GNP. Oesophageal lavages and isotopic analysis of epidermal tissue were performed on turtles captured between February and December 2012. Food quantity was estimated by determining per cent cover in quadrats randomly placed on the reefs. Food quality of algae species was estimated by proximate analysis. Food selection was estimated using Ivlev's electivity index, and the trophic level of sea turtles at GNP was calculated. A total of 30 black (mean = 63.9 cm SCL) and 47 yellow (mean = 54.3 cm SCL) morphotype turtles were lavaged. Eight invertebrate and nine algae food items were identified in oesophageal contents. The most frequently found and abundant items in lavages were terrestrial plants, plastic fibres, invertebrates and algae. A total of 27 items, including 15 algae species, were identified on the reefs, of which Cladophora sp. was selected by black turtles, and Hypnea pannosa and Dictyota sp. were selected by both morphotypes; the latter species had the highest protein and lipid content, and low lignin content. A trophic level of 3.5 for black and 3.4 for yellow turtles was calculated. No significant difference in diet between the two morphotypes could be determined through lavage or isotopic analysis.
Doveweed is a problematic weed of lawns and sod production, as well as golf course roughs, fairways, and tees. End-user reports of selective POST control options are inconsistent and control is often short-lived. In addition, inconsistent control with non-selective herbicides such as glyphosate is common. The goals of this research were: (1) evaluate selective POST doveweed control options in ‘Tifway’ hybrid bermudagrass turf; (2) compare efficacy of single vs. sequential applications of selective POST herbicides; (3) quantify doveweed tolerance to glyphosate; and (4) quantify recovery of foliar applied glyphosate following treatment with a C14-glyphosate solution. A single application of sulfentrazone+metsulfuron; thiencarbazone+iodosulfuron+dicamba or 2,4-D+MCPP+dicamba+carfentrazone; or thiencarbazone+foramsulfuron+halosulfuron provided >60% control 2 weeks after initial treatment (WAIT). A second application of these treatments 3 WAIT improved control 6 WAIT. Two applications of 2,4-D+MCPP+dicamba+carfentrazone or thiencarbazone+foramsulfuron+halosulfuron provided ~80% control 6 WAIT. Doveweed was tolerant to glyphosate application up to 5.68 kgaeha-1. Absorption of 14C-glyphosate was compared between doveweed with cuticle intact, doveweed with a disturbed cuticle, and smooth crabgrass. 14C-glyphosate recovery from the leaf surface of doveweed plants with an intact cuticle was 93.6%. In comparison, 14C-glyphosate recovery from the leaf surface of doveweed plants with a disrupted cuticle and the leaf surface of crabgrass plants was 79.1 and 70.5%, respectively.
Following release by emergency department (ED) for acute heart failure (AHF), returns to ED represent important adverse health outcomes. The objective of this study was to document relapse events and factors associated with return to ED in the 14-day period following release by ED for patients with AHF.
The primary outcome was the number of return to ED for patients who were release by ED after the initial visit, for any related medical problem within 14 days of this initial ED visit.
Return visits to the EDs occurred in 166 (20%) patients. Of all patients who returned to ED within the 14-day period, 77 (47%) were secondarily admitted to the hospital. The following factors were associated with return visits to ED: past medical history of percutaneous coronary intervention or coronary artery bypass graft (aOR=1.51; 95% CIs [1.01-2.24]), current use of antiarrhythmics medications (1.96 [1.05-3.55]), heart rate above 80 /min (1.89 [1.28-2.80]), systolic blood pressure below 140 mm Hg (1.67[1.14-2.47]), oxygen saturation (SaO2) above 96% (1.58 [1.08-2.31]), troponin above the upper reference limit of normal (1.68 [1.15-2.45]), and chest X-ray with pleural effusion (1.52 [1.04-2.23]).
Many heart failure patients (i.e. 1 in 5 patients) are released from the ED and then suffer return to ED. Patients with multiple medical comorbidities, and those with abnormal initial vital signs are at increased risk for return to ED and should be identified.
Avian malaria is a vector transmitted disease caused by Plasmodium and recent studies suggest that variation in its prevalence across avian hosts is correlated with a variety of ecological traits. Here we examine the relationship between prevalence and diversity of Plasmodium lineages in southeastern Amazonia and: (1) host ecological traits (nest location, nest type, flocking behaviour and diet); (2) density and diversity of avian hosts; (3) abundance and diversity of mosquitoes; and (4) season. We used molecular methods to detect Plasmodium in blood samples from 675 individual birds of 120 species. Based on cytochrome b sequences, we recovered 89 lineages of Plasmodium from 136 infected individuals sampled across seven localities. Plasmodium prevalence was homogeneous over time (dry season and flooding season) and space, but heterogeneous among 51 avian host species. Variation in prevalence among bird species was not explained by avian ecological traits, density of avian hosts, or mosquito abundance. However, Plasmodium lineage diversity was positively correlated with mosquito abundance. Interestingly, our results suggest that avian host traits are less important determinants of Plasmodium prevalence and diversity in southeastern Amazonia than in other regions in which they have been investigated.
Parasites of the genera Plasmodium and Haemoproteus (Apicomplexa: Haemosporida) are a diverse group of pathogens that infect birds nearly worldwide. Despite their ubiquity, the ecological and evolutionary factors that shape the diversity and distribution of these protozoan parasites among avian communities and geographic regions are poorly understood. Based on a survey throughout the Neotropics of the haemosporidian parasites infecting manakins (Pipridae), a family of Passerine birds endemic to this region, we asked whether host relatedness, ecological similarity and geographic proximity structure parasite turnover between manakin species and local manakin assemblages. We used molecular methods to screen 1343 individuals of 30 manakin species for the presence of parasites. We found no significant correlations between manakin parasite lineage turnover and both manakin species turnover and geographic distance. Climate differences, species turnover in the larger bird community and parasite lineage turnover in non-manakin hosts did not correlate with manakin parasite lineage turnover. We also found no evidence that manakin parasite lineage turnover among host species correlates with range overlap and genetic divergence among hosts. Our analyses indicate that host switching (turnover among host species) and dispersal (turnover among locations) of haemosporidian parasites in manakins are not constrained at this scale.
Lung disease affects more than 600 million people worldwide. While some of these lung diseases have an obvious developmental component, there is growing appreciation that processes and pathways critical for normal lung development are also important for postnatal tissue homeostasis and are dysregulated in lung disease. This book provides an authoritative review of fetal and neonatal lung development and is designed to provide a diverse group of scientists, spanning the basic to clinical research spectrum, with the latest developments on the cellular and molecular mechanisms of normal lung development and injury-repair processes, and how they are dysregulated in disease. The book covers genetics, omics, and systems biology as well as new imaging techniques that are transforming studies of lung development. The reader will learn where the field of lung development has been, where it is presently, and where it is going in order to improve outcomes for patients with common and rare lung diseases.
Session types describe and constrain the input/output behaviour of systems. Existing session typing systems have limited support for polymorphism. For example, existing systems cannot provide the most general type for a generic proxy process that forwards messages between two channels. We provide a polymorphic session typing system for the π calculus, and demonstrate the utility of session-type-level functions in combination with polymorphic session typing. The type system guarantees subject reduction and safety properties, but not deadlock freedom. We describe a formalization of the type system in Coq. The proofs of subject reduction and safety properties, as well as typing of example processes, have been mechanically verified.
American burnweed is an early successional summer annual species in the Asteraceae. This weed is a poor competitor; however, it rapidly colonizes disturbed and low-maintenance areas, especially following an environmental disturbance. Recently, turfgrass managers have made adjustments to maintenance practices to satisfy budget requirements and address environmental concerns. This has resulted in reduced mowing frequency in some golf course rough and out-of-play turf areas, and has allowed establishment of broadleaf weed species such as American burnweed which would otherwise be controlled by frequent mowing. The purpose of this study was to evaluate PRE and POST herbicide treatments for American burnweed control in an unmown bermudagrass golf course rough. Single PRE applications of simazine at 2.24 kg ai ha−1 and indaziflam at 0.06 kg ai ha−1 provided > 80% American burnweed control 24 wk after treatment (WAT) in 2012 and 2013. Sequential combination applications of liquid formulations of dimethenamid-p + pendimethalin (2.24 + 1.68 kg ai ha−1) provided 95% American burnweed control 24 wk after initial treatment in 2012 and 2013. Other PRE treatments did not provide consistent control of American burnweed across rating dates and years. Regardless of year, four POST treatments provided ≥ 87% control at 8 and 16 WAT. These included thiencarbazone + foramsulfuron + halosulfuron (0.02 + 0.044 + 0.07 kg ai ha−1), thiencarbazone + iodosulfuron + dicamba (0.02 + 0.15 + 0.005 kg ai ha−1), triclopyr + clopyralid (0.88 + 0.32 kg ai ha−1), and sulfentrazone + metsulfuron (0.4 + 0.04 kg ai ha−1). Several PRE and POST American burnweed control solutions exist for low maintenance bermudagrass areas. Future research should continue to screen other herbicides for control efficacy and focus on application timing to balance season-long control with minimal chemical inputs.