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Disturbances in trait emotions are a predominant feature in schizophrenia. However, less is known about (a) differences in trait emotion across phases of the illness such as the clinical high-risk (CHR) phase and (b) whether abnormalities in trait emotion that are associated with negative symptoms are driven by primary (i.e. idiopathic) or secondary (e.g. depression, anxiety) factors.
To examine profiles of trait affective disturbance and their clinical correlates in individuals with schizophrenia and individuals at CHR for psychosis.
In two studies (sample 1: 56 out-patients diagnosed with schizophrenia and 34 demographically matched individuals without schizophrenia (controls); sample 2: 50 individuals at CHR and 56 individuals not at CHR (controls)), participants completed self-report trait positive affect and negative affect questionnaires, clinical symptom interviews (positive, negative, disorganised, depression, anxiety) and community-based functional outcome measures.
Both clinical groups reported lower levels of positive affect (specific to joy among individuals with schizophrenia) and higher levels of negative affect compared with controls. For individuals with schizophrenia, links were found between positive affect and negative symptoms (which remained after controlling for secondary factors) and between negative affect and positive symptoms. For individuals at CHR, links were found between both affect dimensions and both types of symptom (which were largely accounted for by secondary factors).
Both clinical groups showed some evidence of reduced trait positive affect and elevated trait negative affect, suggesting that increasing trait positive affect and reducing trait negative affect is an important treatment goal across both populations. Clinical correlates of these emotional abnormalities were more integrally linked to clinical symptoms in individuals with schizophrenia and more closely linked to secondary influences such as depression and anxiety in individuals at CHR.
Analysis of human remains and a copper band found in the center of a Late Archaic (ca. 5000–3000 cal BP) shell ring demonstrate an exchange network between the Great Lakes and the coastal southeast United States. Similarities in mortuary practices suggest that the movement of objects between these two regions was more direct and unmediated than archaeologists previously assumed based on “down-the-line” models of exchange. These findings challenge prevalent notions that view preagricultural Native American communities as relatively isolated from one another and suggest instead that wide social networks spanned much of North America thousands of years before the advent of domestication.
High-speed free-shear-flow turbulence, laden with droplets or particles, can radiate weaker pressure fluctuations than its unladen counterpart. In this study, Eulerian–Lagrangian simulations of high-speed temporally evolving shear layers laden with monodisperse, adiabatic, inertial particles are used to examine particle–turbulence interactions and their effect on radiated pressure fluctuations. An evolution equation for gas-phase pressure intensity is formulated for particle-laden flows, and local mechanisms of pressure changes are quantified over a range of Mach numbers and particle mass loadings. Particle–turbulence interactions alter the local pressure intensity directly via volume displacement (due to the flow of finite-size particles) and drag coupling (due to local slip velocity between phases), and indirectly through significant turbulence changes. The sound radiation intensity near subsonic mixing layers increases with mass loading, consistent with existing low Mach number theory. For supersonic flows, sound levels decrease with mass loading, consistent with trends observed in previous experiments. Particle-laden cases exhibit reduced turbulent kinetic energy compared to single-phase flow, providing one source of their sound changes; however, the subsonic flow does not support such an obvious source-to-sound decomposition to explain its sound intensity increase. Despite its decrease in turbulence intensity, the louder particle-laden subsonic flows show an increase in the magnitude and time-rate-of-change of fluid dilatation, providing a mechanism for its increased sound radiation. Contrasting this, the quieter supersonic particle-laden flows exhibit decreased gas-phase dilatation yet its time-rate-of-change is relatively insensitive to mass loading, supporting such a connection.
OBJECTIVES/SPECIFIC AIMS: Increased right atrial pressure is known to be a predictor of poor outcomes after LVAD implantation. Whether resolution of right heart congestion prior to LVAD implantation is associated with more favorable outcomes is not well understood. METHODS/STUDY POPULATION: We analyzed LVAD recipients from our institution from 1/1/2015 to 2/28/2018. We excluded patients bridged to LVAD with ECMO support. Patients with admission right atrial pressure (RAPadmit) and implant RAP (RAPimplant) ≥ 14 mmHg were defined as having persistent congestion, while patients with RAPadmit ≥ 14 mmHg and RAPimplant < 14 mmHg were defined as having resolved congestion. Baseline characteristics between groups were compared using the Chi-square and unpaired t-tests. Time to death or RVAD was compared between groups using Cox proportional hazards models. RESULTS/ANTICIPATED RESULTS: Of 57 LVAD recipients with RAPadmit ≥ 14 mmHg, 14 (25%) had persistent congestion at the time of LVAD implantation. While there were no statistically significant differences between groups, patients with persistent congestion were more likely to be INTERMACS profile 1 (21.4% vs 9.5%), less likely to have a destination therapy device strategy (28.6% vs 34.9%), less likely to have moderate or severe right ventricular (RV) dysfunction (64.3% vs 83.7%), and had similar RAPadmit (20.4 mmHg vs 18.9 mmHg) compared to patients with resolved congestion. Median follow up was 307 days. Patients with persistent congestion had a higher frequency of death or RVAD implantation compared to those with resolved congestion (50% vs 14%, HR 3.75, 95% CI 1.25–11.25, p=0.02). DISCUSSION/SIGNIFICANCE OF IMPACT: Among patients with elevated RAP at admission, patients with persistently elevated RAP at the time of LVAD implantation had worse outcomes than patients who were able to be decongested prior to surgery. These data support optimization of RV filling pressures prior to LVAD surgery.
OBJECTIVES/SPECIFIC AIMS: Opioids are the first-line treatment for moderate to severe cancer-related pain. Increased awareness of opioid prescription misuse and adverse outcomes has prompted statements on their use from multiple national medical groups. In this study we characterize national-level opioid prescription patterns among gynecologic oncologists treating Medicare beneficiaries. METHODS/STUDY POPULATION: The Centers for Medicare and Medicaid Services (CMS) database was used to access Medicare Part D beneficiary data (2016). All available opioid claims prescribed by gynecologic oncologists were identified. Medication type, prescription length and other prescribing factors were recorded. Physician demographics were obtained from departmental websites and accrediting bodies. Physicians with <10 opioid claims are not included in the CMS database. Bivariate statistical analysis including chi-squared, Fisher’s exact test and Wilcoxon rank-sum test were performed to compare variables with threshold for significance set at p<0.05. Linear regression modeling was also performed to examine association of gender with number of opioids prescribed. RESULTS/ANTICIPATED RESULTS: A total of 494 board-certified gynecologic oncologists were included in this analysis. In 2016, gynecologic oncologists wrote 23,584 opioid prescriptions for 267,824 days of treatment (average of 9.24 prescribed days per claim). The most commonly prescribed opioid was oxycodone/acetaminophen (41%). Male physicians had significantly more opioid prescription claims than females (p<0.01) including after adjusting for differences in years of experience. The majority of physicians had 11-50 opioid prescription claims (68%). A minority were high prescribing physicians with >100 opioid claims (11%). Of these, the overwhelming majority were male (82%) and late career (46%, >15 years since board certification). Physicians in the South had the greatest number of opioid prescription claims and significantly more than physicians in the Northeast, who had the fewest (p<0.01). Mean number of opioid claims increased with increasing years of experience (p<0.05). DISCUSSION/SIGNIFICANCE OF IMPACT: Among gynecologic oncologists, there were gender-based, regional and experience-related variations in opioid prescribing in the Medicare population in 2016. Further longitudinal studies are required to elucidate secular trends in opioid prescription practice.
OBJECTIVES/SPECIFIC AIMS: Patients are increasingly using online materials to learn about gynecologic cancer. Recent studies demonstrate that 85-96% of patients with a gynecologic malignancy utilize the Internet as a health resource. Providers can refer patients to educational materials produced by major medical associations available on their websites. However, patient educational materials (PEMs) published by professional organizations from other surgical specialties have been shown to be difficult to read for the average American. The NIH and AMA recommend that PEMs be written between a sixth and eighth grade reading level. In this study, we assess the readability of online PEMs on gynecologic cancer published by major medical associations. METHODS/STUDY POPULATION: Seven national medical association websites with PEMs on gynecologic malignancy were surveyed: American College of Obstetricians and Gynecologists, Center for Disease Control, Foundation for Women’s Cancer, National Cancer Institute, National Cervical Cancer Coalition, National Ovarian Cancer Coalition, and Society of Gynecologic Oncology. Online PEMs were identified and analyzed using five validated readability indices. One-way ANOVA and Tukey’s test were performed to detect differences in readability between publishers. RESULTS/ANTICIPATED RESULTS: Two hundred and thirty PEMs were included in this analysis. Mean readability grade levels with standard deviation were: 11.3 (2.8) for Coleman-Liau index; 11.8 (3.2) for Flesch-Kincaid; 11.1 (1.2) for FORCAST formula; 12.5 (2.7) for Gunning FOG formula; 12.1 (2.6) for New Dale-Chall formula; and 13.5 (2.5) for SMOG formula. Overall, PEMs were written at a mean 12th grade reading level. Only 4.3% of articles were written at an 8th grade reading level or below. ANOVA demonstrated a significant difference in readability between publishing associations (p<0.01). PEMs from the Center for Disease Control had a mean 10th grade reading level and were significantly lower than all other organizations. PEMs from The Foundation for Women’s Cancer had a mean 13th grade reading level and were significantly higher than most other organizations. DISCUSSION/SIGNIFICANCE OF IMPACT: Gynecologic oncology PEMs available from major medical association are written well above the recommended sixth to eight grade reading level. Simplifying PEMs may improve patient understanding of their disease and facilitate physician-patient communication.
OBJECTIVES/SPECIFIC AIMS: Industry payments to physicians can present a conflict of interest. The Physician Payments Sunshine Act mandates the disclosure of these financial relationships to increase transparency. Recent studies in other surgical specialties have shown that research productivity is associated with greater industry funding. In this study, we characterize the relationship between academic influence and industry funding among academic gynecologic oncologists. METHODS/STUDY POPULATION: Departmental websites were used to identify academic gynecologist oncologists and their demographic information. The Hirsch index (h-index) relates an author’s number of publications to number of times referenced by other publications, a validated measure of an author’s academic influence. This was obtained from the Scopus database. The Center for Medicaid and Medicare Services Open Payments online database was searched for all industry payments in 2017. The NIH Reporter online database was searched for active grants. Goodness of fit testing showed that all variables followed nonparametric distributions. Medians were compared using Mann-Whitney U tests and Kruskal-Wallis analysis of variance with post-hoc Dunn’s test. RESULTS/ANTICIPATED RESULTS: Four hundred and sixty-six academic gynecologic oncologists were included in the analysis. In 2017, 89.7% of this group received industry funding totaling $41.4 million. Median industry funding was $453 [IQR $67-19684] and median h-index was 14 [IQR 8-26]. Only 8.1% of gynecologic oncologists were NIH grant recipients and they received significantly higher industry payments ($357 vs. 11,168, P<0.01). Gender and academic rank were not associated with industry funding. Gynecologic oncologists in the highest decile of industry funding received a median payment of $447,651[N=46, IQR $285,770 – 896,310] totaling $36.5 million. The median h-index for this top-earning decile was 23 [N=46, IQR 16.5-30.3]. When stratified by payment amount, median h index increased but only reached statistical significance in the highest cohort receiving >$100,000 (N = 63, P<0.05). DISCUSSION/SIGNIFICANCE OF IMPACT: The majority of academic gynecologic oncologists receive industry funding although there are large variations in payments. Those receiving the largest payments are more likely to hold NIH grants and have greater academic influence.
Emerging literature suggests fathers may contribute uniquely to child development and emotional health through play. In the present study, a multiple mediational model was analyzed using data from 476 families that participated in the NICHD Study of Early Child Care and Youth Development. After accounting for infant–mother attachment, infant temperament, and family income and stability, a significant indirect effect from father–child play quality to adolescent internalizing symptoms was found through father-reported child emotional dysregulation, B = –.05, 95% confidence interval; CI [–.14, –.01]. Specifically, in first grade, dyads where fathers were rated highly on sensitivity and stimulation during play, and children demonstrated high felt security and affective mutuality during play, had children with fewer father-reported emotional dysregulation problems in third grade, B = –.23, 95% CI [–.39, –.06]. Children with fewer emotional dysregulation problems had lower self-reported internalizing symptoms at age 15, B = .23, 95% CI [.01, .45]. Mothers’ ratings of children's emotional dysregulation were not a significant mediator. Results are discussed regarding the importance of father–child play for children's adjustment as well as the usefulness of inclusion of fathers in child developmental research.
A new optical delivery system has been developed for the (scanning) transmission electron microscope. Here we describe the in situ and “rapid ex situ” photothermal heating modality of the system, which delivers >200 mW of optical power from a fiber-coupled laser diode to a 3.7 μm radius spot on the sample. Selected thermal pathways can be accessed via judicious choices of the laser power, pulse width, number of pulses, and radial position. The long optical working distance mitigates any charging artifacts and tremendous thermal stability is observed in both pulsed and continuous wave conditions, notably, no drift correction is applied in any experiment. To demonstrate the optical delivery system’s capability, we explore the recrystallization, grain growth, phase separation, and solid state dewetting of a Ag0.5Ni0.5 film. Finally, we demonstrate that the structural and chemical aspects of the resulting dewetted films was assessed.
Background: A need exists to characterise the long-term cognitive outcomes in patients who recovered from autoimmune encephalitis and to identify the modifiable factors associated with improved outcomes. Methods: We retrospectively analysed data from patients diagnosed with autoimmune encephalitis in our outpatient autoimmune encephalitis clinic over a 5-year period, where the Montreal Cognitive Assessment (MoCA) is routinely administered. Results: In total, 21 patients met the inclusion criteria, of whom 52% had persistent cognitive impairment at their latest follow-up (median delay to testing=20 months, range 13-182). Visuospatial and executive abilities, language, attention, and delayed recall were predominantly affected. Patients with status epilepticus at presentation had lower total MoCA scores at their last follow-up (median total score 21, range 15-29) compared with patients without status epilepticus at presentation (median total score 27.5, range 21-30; r2=0.366, p=0.004). Patients who experienced delays of more than 60 days from symptom onset to initiation of treatment (either immunosuppression or tumour removal) were more likely to have a MoCA score compatible with cognitive impairment at their last follow-up (r2=0.253, p=0.0239; z-score=−2.01, p=0.044). Conclusions: Our study suggests that the MoCA may be used to evaluate cognition in recovering patients with autoimmune encephalitis. Delays to treatment shorter than 60 days and absence of status epilepticus at onset were associated with better performance on the MoCA obtained more than 1 year after symptom onset, and may predict better long-term cognitive outcomes.
Background: Glioblastoma is the most common adult malignant glioma, with poor prognosis and adverse neurological sequelae. Physical activity improves outcomes in patients with other cancers, but has not been evaluated in GBM. This prospective, single-arm intervention trial examines feasibility and preliminary efficacy of exercise on PFS, cognition and QOL in newly diagnosed GBM patients. Method: Participants are English-speaking GBM patients scheduled for concurrent chemoradiation at PMH, 18-65 years old, ECOG ≤ 2. The 3-month home-based exercise program includes aerobic and resistance training, tailored to prior fitness level, current physical status, and individual interests. Assessments of physical and neurocognitive functions, mood, fatigue, sleep, and QOL, occur within 2 weeks of starting chemoradiation, and approximately 3, 6, 12, and 18 months later, or until tumor progression. Feasibility will be assessed by accrual, retention, and adherence rates. Outcomes include PFS (RANO criteria), change in cognition (reliable change index method), physical activity and sleep (actigraphy, self-report questionnaires). Time-to-event outcomes will be estimated (Kaplan-Meier), and mixed modelling will explore individual and disease variables that contribute to outcomes. Results: During the first five months of recruitment, 13 of 19 eligible patients consented. Nine completed the exercise program. One patient died after the intervention and none of the others progressed. No exercise-related serious adverse events occurred. Preliminary results will be presented at the meeting. Discussion: Exercise appears feasible for GBM patients. Effects on survival, performance status, cognition, sleep, mood, and QOL are ongoing. Results may guide physical activity recommendations in GBM and generate avenues for translational research.
Fe is an essential nutrient for many bacteria, and Fe supplementation has been reported to affect the composition of the gut microbiota in both Fe-deficient and Fe-replete individuals outside pregnancy. This study examined whether the dose of Fe in pregnancy multivitamin supplements affects the overall composition of the gut microbiota in overweight and obese pregnant women in early pregnancy. Women participating in the SPRING study with a faecal sample obtained at 16 weeks’ gestation were included in this substudy. For each subject, the brand of multivitamin used was recorded. Faecal microbiome composition was assessed by 16S rRNA sequencing and analysed with the QIIME software suite. Dietary intake of Fe was assessed using a FFQ at 16 weeks’ gestation. Women were grouped as receiving low (<60 mg/d, n 94) or high (≥60 mg/d; n 65) Fe supplementation. The median supplementary Fe intake in the low group was 10 (interquartile range (IQR) 5–10) v. 60 (IQR 60–60) mg/d in the high group (P<0·001). Dietary Fe intake did not differ between the groups (10·0 (IQR 7·4–13·3) v. 9·8 (IQR 8·2–13·2) mg/d). Fe supplementation did not significantly affect the composition of the faecal microbiome at any taxonomic level. Network analysis showed that the gut microbiota in the low Fe supplementation group had a higher predominance of SCFA producers. Pregnancy multivitamin Fe content has a minor effect on the overall composition of the gut microbiota of overweight and obese pregnant women at 16 weeks’ gestation.
To assess general medical residents’ familiarity with antibiograms using a self-administered survey
Cross-sectional, single-center survey
Residents in internal medicine, family medicine, and pediatrics at an academic medical center
Participants were administered an anonymous survey at our institution during regularly scheduled educational conferences between January and May 2012. Questions collected data regarding demographics, professional training; further open-ended questions assessed knowledge and use of antibiograms regarding possible pathogens, antibiotic regimens, and prescribing resources for 2 clinical vignettes; a series of directed, closed-ended questions followed. Bivariate analyses to compare responses between residency programs were performed.
Of 122 surveys distributed, 106 residents (87%) responded; internal medicine residents accounted for 69% of responses. More than 20% of residents could not accurately identify pathogens to target with empiric therapy or select therapy with an appropriate spectrum of activity in response to the clinical vignettes; correct identification of potential pathogens was not associated with selecting appropriate therapy. Only 12% of respondents identified antibiograms as a resource when prescribing empiric antibiotic therapy for scenarios in the vignettes, with most selecting the UpToDate online clinical decision support resource or The Sanford Guide. When directly questioned, 89% reported awareness of institutional antibiograms, but only 70% felt comfortable using them and only 44% knew how to access them.
When selecting empiric antibiotics, many residents are not comfortable using antibiograms as part of treatment decisions. Efforts to improve antibiotic use may benefit from residents being given additional education on both infectious diseases pharmacotherapy and antibiogram utilization.
Background: High comorbidity rates among emotional disorders have led researchers to examine transdiagnostic factors that may contribute to shared psychopathology. Bifactor models provide a unique method for examining transdiagnostic variables by modelling the common and unique factors within measures. Previous findings suggest that the bifactor model of the Depression Anxiety and Stress Scale (DASS) may provide a method for examining transdiagnostic factors within emotional disorders. Aims: This study aimed to replicate the bifactor model of the DASS, a multidimensional measure of psychological distress, within a US adult sample and provide initial estimates of the reliability of the general and domain-specific factors. Furthermore, this study hypothesized that Worry, a theorized transdiagnostic variable, would show stronger relations to general emotional distress than domain-specific subscales. Method: Confirmatory factor analysis was used to evaluate the bifactor model structure of the DASS in 456 US adult participants (279 females and 177 males, mean age 35.9 years) recruited online. Results: The DASS bifactor model fitted well (CFI = 0.98; RMSEA = 0.05). The General Emotional Distress factor accounted for most of the reliable variance in item scores. Domain-specific subscales accounted for modest portions of reliable variance in items after accounting for the general scale. Finally, structural equation modelling indicated that Worry was strongly predicted by the General Emotional Distress factor. Conclusions: The DASS bifactor model is generalizable to a US community sample and General Emotional Distress, but not domain-specific factors, strongly predict the transdiagnostic variable Worry.
To minimize the potential impact of conflicts of interest on health recommendations, several health institutions may be reluctant to recruit academic physicians due to their potential close relationship with industry. The present study aimed at evaluating the influence of academic physicians (AP) on the “rate of deport” due to financial support in the national commission of the HAS assessing medical devices.
After the renewal of this commission in November 2015, introducing patients representatives and more academic physicians, two periods of 12 months immediately before and after that date have been compared regarding the rate of deport during the sessions. Deport were decided by the legal section of our institution one week before each meeting according to a complete analysis of potential financial conflict of interest related to the medical device assessed. Only members without significant financial conflicts were allowed to participate to the discussion and the vote. The assessment of potential conflict of interest of all members followed the same criteria during the two periods.
The number of physicians increased in the second period (nineteen versus twenty-three) with a significant higher rate of academic physicians (63 percent versus 82 percent, p = .001). The mean attendance of physicians was significantly lower during the second period (80 percent versus 65 percent, p = .03). During the two periods, the number of meetings (n = 22) was similar and the number of dossiers assessing new products was comparable (96 versus 104, p = .872). The decision to reimburse the medical devices was similar in the two periods (78 percent versus 73 percent, p = .681). The number of cases when physicians’ members were deported for conflict of interest was similar during the two periods (30 versus 28, p = .482) with not any increase among academic physicians.
This study showed that it is possible to recruit several academic physicians without major financial conflicts of interest providing that their status could alter their assiduity.
The isotopic and chemical signatures for ice-age and Holocene ice from Summit, Greenland, and Penny Ice Cap, Baffin Island, Canada, are compared. the usual pattern of low δ18O, high Ca2+ and high Cl– is presented in the Summit records, but Penny Ice Cap has lower than present Cl– in its ice-age ice. A simple extension of the Hansson model (Hansson, 1994) is developed and used to simulate these signatures. the low ice-age Cl– from Penny Ice Cap is explained by having the ice-age ice originating many thousands of km inland near the centre of the Laurentide ice sheet and much further from the marine sources. Summit’s flowlines all start close to the present site. the Penny Ice Cap early-Holocene δ18O’s had to be corrected to offset the Laurentide meltwater distortion. the analysis suggests that presently the Summit and Penny Ice Cap marine impurity originates about 500 km away, and that presently Penny Ice Cap receives a significant amount of local continental impurity.
Tree-ring cross-dates of 46 glacially killed trees show that the tidewater Nellie Juan Glacier, Alaska, advanced seaward during the 16th and 17th centuries AD. Ice-scarred trees at the late-Holocene end moraine indicate that the terminus was at its recent maximum from 1842 to 1893. Historical observations and photographs show that subsequent slow retreat changed to rapid iceberg-calving retreat after 1935, and that the tidewater terminus had withdrawn about 3.3 km from the late-Holocene maximum by 1992. Comparison with paleoclimate records from nearby land-terminating glaciers and an 850 year tree-ring-width chronology indicates that the timing of the 19th-century maximum stand of Nellie Juan Glacier was controlled by changes in summer temperature and radiation. However, rapid iceberg-calving retreat did not begin until 40 years of slow retreat had brought the tidewater terminus back from the terminal moraine shoal. Therefore, both the dimensions of the terminal moraine shoal and the magnitude and duration of climate change were important in initiating rapid retreat of this tidewater glacier system.