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While negative affect reliably predicts binge eating, it is unknown how this association may decrease or ‘de-couple’ during treatment for binge eating disorder (BED), whether such change is greater in treatments targeting emotion regulation, or how such change predicts outcome. This study utilized multi-wave ecological momentary assessment (EMA) to assess changes in the momentary association between negative affect and subsequent binge-eating symptoms during Integrative Cognitive Affective Therapy (ICAT-BED) and Cognitive Behavior Therapy Guided Self-Help (CBTgsh). It was predicted that there would be stronger de-coupling effects in ICAT-BED compared to CBTgsh given the focus on emotion regulation skills in ICAT-BED and that greater de-coupling would predict outcomes.
Adults with BED were randomized to ICAT-BED or CBTgsh and completed 1-week EMA protocols and the Eating Disorder Examination (EDE) at pre-treatment, end-of-treatment, and 6-month follow-up (final N = 78). De-coupling was operationalized as a change in momentary associations between negative affect and binge-eating symptoms from pre-treatment to end-of-treatment.
There was a significant de-coupling effect at follow-up but not end-of-treatment, and de-coupling did not differ between ICAT-BED and CBTgsh. Less de-coupling was associated with higher end-of-treatment EDE global scores at end-of-treatment and higher binge frequency at follow-up.
Both ICAT-BED and CBTgsh were associated with de-coupling of momentary negative affect and binge-eating symptoms, which in turn relate to cognitive and behavioral treatment outcomes. Future research is warranted to identify differential mechanisms of change across ICAT-BED and CBTgsh. Results also highlight the importance of developing momentary interventions to more effectively de-couple negative affect and binge eating.
Pinoxaden is a POST acetyl coenzyme A carboxylase (ACCase) inhibitor in the phenylpyrazolin chemical family and was labelled for turfgrass use in 2018 at broadcast rates of 35.5 to 71 g ai ha-1 and spot spray rates of 156 to 310 g ai ha-1. A greenhouse rate response study was conducted in order to characterize the efficacy of pinoxaden against common grassy weeds. Weed species examined in this study were yellow foxtail, southern sandbur, annual bluegrass, roughstalk bluegrass, large crabgrass, dallisgrass, bahiagrass, goosegrass and perennial ryegrass. Nonlinear regressions were modelled to determine visual injury (I50 and I90 rates) and weight reduction (WR50 and WR90 rates) for each weed species. Only annual bluegrass, bahiagrass and goosegrass had visual injury I90 values greater than the maximum labelled spot spray rate of 310 g ai ha-1. Annual bluegrass, bahiagrass, southern sandbur and goosegrass all had weight reduction WR90 values greater than the maximum labelled spot spray rate of 310 g ai ha-1. Results from this study indicate that weed species evaluated can be ranked, according to visual injury I90 values, from most to least susceptible: perennial ryegrass > yellow foxtail > dallisgrass > large crabgrass > southern sandbur > roughstalk bluegrass > bahiagrass > goosegrass > annual bluegrass.
Cross-national studies have found, unexpectedly, that mental disorder prevalence is higher in high-income relative to low-income countries, but few rigorous studies have been conducted in very low-income countries. This study assessed mental disorders in Nepal, employing unique methodological features designed to maximize disorder detection and reporting.
In 2016–2018, 10714 respondents aged 15–59 were interviewed as part of an ongoing panel study, with a response rate of 93%. The World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI 3.0) measured lifetime and 12-month prevalence of selected anxiety, mood, alcohol use, and impulse control disorders. Lifetime recall was enhanced using a life history calendar.
Lifetime prevalence ranged from 0.3% (95% CI 0.2–0.4) for bipolar disorder to 15.1% (95% CI 14.4–15.7) for major depressive disorder. The 12-month prevalences were low, ranging from 0.2% for panic disorder (95% CI 0.1–0.3) and bipolar disorder (95% CI 0.1–0.2) to 2.7% for depression (95% CI 2.4–3.0). Lifetime disorders were higher among those with less education and in the low-caste ethnic group. Gender differences were pronounced.
Although cultural effects on reporting cannot be ruled out, these low 12-month prevalences are consistent with reduced prevalence of mental disorders in other low-income countries. Identification of sociocultural factors that mediate the lower prevalence of mental disorders in low-income, non-Westernized settings may have implications for understanding disorder etiology and for clinical or policy interventions aimed at facilitating resilience.
Generalization of conditioned-fear, a core feature of post-traumatic stress disorder (PTSD), has been the focus of several recent neuroimaging studies. A striking outcome of these studies is the frequency with which neural correlates of generalization fall within hubs of well-established functional networks including salience (SN), central executive (CEN), and default networks (DN). Neural substrates of generalization found to date may thus reflect traces of large-scale brain networks that form more expansive neural representations of generalization. The present study includes the first network-based analysis of generalization and PTSD-related abnormalities therein.
fMRI responses in established intrinsic connectivity networks (ICNs) representing SN, CEN, and DN were assessed during a generalized conditioned-fear task in male combat veterans (N = 58) with wide-ranging PTSD symptom severity. The task included five rings of graded size. Extreme sizes served as conditioned danger-cues (CS+: paired with shock) and safety-cues (CS−), and the three intermediate sizes served as generalization stimuli (GSs) forming a continuum-of-size between CS+ and CS–. Generalization-gradients were assessed as behavioral and ICN response slopes from CS+, through GSs, to CS–. Increasing PTSD symptomatology was predicted to relate to less-steep slopes indicative of stronger generalization.
SN, CEN, and DN responses fell along generalization-gradients with levels of generalization within and between SN and CEN scaling with PTSD symptom severity.
Neural substrates of generalized conditioned-fear include large-scale networks that adhere to the functional organization of the brain. Current findings implicate levels of generalization in SN and CEN as promising neural markers of PTSD.
Introduction: eCTAS is a real time electronic triage decision-support tool designed to improve patient safety and quality of care by standardizing the application of the Canadian Triage and Acuity Scale (CTAS). The tool dynamically calculates a recommended CTAS score based on the presenting complaint, vital signs and selected clinical modifiers. The primary objective was to assess consistency of CTAS score distributions across 35 emergency departments (EDs) by 16 presenting complaints pre and post eCTAS implementation. Methods: This retrospective cohort study used population-based administrative data from January 2016 to December 2018 from all hospital EDs in Ontario that had implemented eCTAS with at least 9 months of data. Following a 3-month stabilization period, we compared data for 6 months post-eCTAS implementation to the same 6-month period the previous year (pre-implementation) to account for potential seasonal variation, patient volume and case-mix. We included triage encounters of adult (≥18 years) patients if they had one of 16 pre-specified high-volume, presenting complaints. A paired-samples t-test was used to determine consistency by estimating the absolute difference in CTAS distribution for each presenting complaint, by each hospital, pre and post eCTAS implementation, compared to the overall average of the 35 EDs. Results: There were 183,231 triage encounters in the pre-eCTAS cohort and 179,983 in the post-eCTAS cohort from 35 EDs across the province. Triage scores were more consistent with the overall average after eCTAS implementation in 6 (37.5%) presenting complaints: chest pain (cardiac features) (p < 0.001), extremity weakness/symptoms of cerebrovascular accident (p < 0.001), fever (p < 0.001), shortness of breath (p < 0.001), syncope (p = 0.02), and hyperglycemia (p = 0.03). Triage consistency was similar pre and post eCTAS implementation for the presenting complaints of altered level of consciousness, anxiety/situational crisis, confusion, depression/suicidal/deliberate self-harm, general weakness, head injury, palpitations, seizure, substance misuse/intoxication or vertigo. Conclusion: A standardized, electronic approach to performing triage assessments increased consistency in CTAS scores across many, but not all, high-volume CEDIS complaints. This does not reflect triage accuracy, as there are no known benchmarks for triage accuracy. Improvements in consistency were greatest for sentinel presenting complaints with a minimum allowable CTAS score.
Background: Trauma care represents a complex patient journey, requiring multi-disciplinary coordinated care. Team members are human, and as such, how they feel about their colleagues and their work affects performance. The challenge for health service leaders is enabling culture that supports high levels of collaboration, cooperation and coordination across diverse groups. Aim Statement: We aimed to define and set the agenda for improvement of the relational aspects of trauma care at a large tertiary care hospital. Measures & Design: We conducted a mixed-methods collaborative ethnography using the Relational Coordination survey – an established tool to analyze the relational dimensions of multidisciplinary teamwork – participant observation, interviews, and narrative surveys. Findings were presented to clinicians in working groups for further interpretation and to facilitate co-creation of targeted interventions designed to improve team relationships and performance. Evaluation/Results: We engaged a complex multidisciplinary network of ~500 care providers dispersed across seven core interdependent clinical disciplines. Initial findings highlighted the importance of relationships in trauma care and opportunities to improve. Narrative survey and ethnographic findings further highlighted the centrality of a translational simulation program in contributing positively to team culture and relational ties. A range of 16 interventions – focusing on structural, process and relational dimensions – were co-created with participants and are now being implemented and evaluated by various trauma care providers. Discussion/Impact: Through engagement of clinicians spanning organizational boundaries, relational aspects of care can be measured and directly targeted in a collaborative quality improvement process. We encourage health care leaders to consider relationship-based quality improvement strategies, including translational simulation and relational coordination processes, in their efforts to improve care for patients with complex, interdependent journeys.
Amazon's Mechanical Turk is widely used for data collection; however, data quality may be declining due to the use of virtual private servers to fraudulently gain access to studies. Unfortunately, we know little about the scale and consequence of this fraud, and tools for social scientists to detect and prevent this fraud are underdeveloped. We first analyze 38 studies and show that this fraud is not new, but has increased recently. We then show that these fraudulent respondents provide particularly low-quality data and can weaken treatment effects. Finally, we provide two solutions: an easy-to-use application for identifying fraud in the existing datasets and a method for blocking fraudulent respondents in Qualtrics surveys.
Carrot weevil, Listronotus oregonensis (LeConte) (Coleoptera: Curculionidae), is a pest of carrot (Daucus carota var. sativus Hoffmann; Apiaceae) throughout eastern Canada. Carrot weevil emergence and oviposition were monitored in commercial carrot fields in Nova Scotia. Cumulative degree days were calculated using a base temperature of 7 °C (DD7), and models were developed to predict cumulative emergence and oviposition using nonlinear regression. Cumulative emergence and oviposition were adequately explained as functions of DD7 by a three-parameter sigmoidal Hill equation. Our emergence model predicted initial and peak adult emergence at 35 and 387 DD7, respectively, with oviposition on carrot baits occurring as early as 42 DD7. Models were then validated to evaluate how well they performed. Oviposition on carrot plants began at the fourth true-leaf stage (342 DD7) and continued until eleventh true-leaf stage. Growers using these models can identify their window of opportunity to manage their carrot weevil populations targeting the majority of emerged adults before oviposition begins in the field.
For the past six years, the Pueblo of Pojoaque and University of Colorado Boulder have been working together to investigate ancestral sites on and adjacent to Pojoaque land. Through our partnership, we believe we have learned some important lessons about the potential of archaeology for tribal communities, how archaeologists and tribal members can work together as coinvestigators, how such partnerships improve archaeological practice, and how the incorporation of traditional knowledge leads to better archaeology in both its humanistic and scientific dimensions. In addition, we believe it is a more sustainable and ethical model to engage the cultures in which archaeologists work. In this article, we share the story of our partnership, consider how it relates to existing perspectives on archaeology and Native communities, present a few results from our work at the ancestral site of K'uuyemugeh, and offer some reflections on our efforts to put a partnership model into practice.
In this work, the correlation between composition and relative evaporation field was investigated by tracking the statistics of multi-hit detector events in atom probe tomography (APT). This approach is applied systematically to a GaN-based nitride heterostructure with five AlxGa1−xN layers of varying Al composition. The relative field evaporation and the percentage of multi-hit events were found to increase with higher Al concentration. Furthermore, the comparison of the relative evaporation fields of AlN with respect to the constituent ions is found to be less than GaN with respect to its constituent ions. Despite equivalent compositions between opposing interfaces of the same AlxGa1−xN interlayer, the rate of change in multiplicity exhibits a consistent asymmetric trend with a steeper slope across the AlxGa1−xN/GaN interface compared to the GaN/AlxGa1−xN interface. The AlxGa1−xN/GaN heterostructure serves as a test structure for exploring field evaporation and neighborhood chemistry, which can be applied to any material chemistry and particularly other nitride systems.
Reading and language abilities are critical for educational achievement and success in adulthood. Variation in these traits is highly heritable, but the underlying genetic architecture is largely undiscovered. Genetic studies of reading and language skills traditionally focus on children with developmental disorders; however, much larger unselected adult samples are available, increasing power to identify associations with specific genetic variants of small effect size. We introduce an Australian adult population cohort (41.7–73.2 years of age, N = 1505) in which we obtained data using validated measures of several aspects of reading and language abilities. We performed genetic association analysis for a reading and spelling composite score, nonword reading (assessing phonological processing: a core component in learning to read), phonetic spelling, self-reported reading impairment and nonword repetition (a marker of language ability). Given the limited power in a sample of this size (~80% power to find a minimum effect size of 0.005), we focused on analyzing candidate genes that have been associated with dyslexia and developmental speech and language disorders in prior studies. In gene-based tests, FOXP2, a gene implicated in speech/language disorders, was associated with nonword repetition (p < .001), phonetic spelling (p = .002) and the reading and spelling composite score (p < .001). Gene-set analyses of candidate dyslexia and speech/language disorder genes were not significant. These findings contribute to the assessment of genetic associations in reading and language disorders, crucial for understanding their etiology and informing intervention strategies, and validate the approach of using unselected adult samples for gene discovery in language and reading.
Healthcare personnel (HCP) were recruited to provide serum samples, which were tested for antibodies against Ebola or Lassa virus to evaluate for asymptomatic seroconversion.
From 2014 to 2016, 4 patients with Ebola virus disease (EVD) and 1 patient with Lassa fever (LF) were treated in the Serious Communicable Diseases Unit (SCDU) at Emory University Hospital. Strict infection control and clinical biosafety practices were implemented to prevent nosocomial transmission of EVD or LF to HCP.
All personnel who entered the SCDU who were required to measure their temperatures and complete a symptom questionnaire twice daily were eligible.
No employee developed symptomatic EVD or LF. EVD and LF antibody studies were performed on sera samples from 42 HCP. The 6 participants who had received investigational vaccination with a chimpanzee adenovirus type 3 vectored Ebola glycoprotein vaccine had high antibody titers to Ebola glycoprotein, but none had a response to Ebola nucleoprotein or VP40, or a response to LF antigens.
Patients infected with filoviruses and arenaviruses can be managed successfully without causing occupation-related symptomatic or asymptomatic infections. Meticulous attention to infection control and clinical biosafety practices by highly motivated, trained staff is critical to the safe care of patients with an infection from a special pathogen.
Unlike Eastern monastic historiography, for which historians have never constructed a coherent narrative, the story of central medieval Latin monasticism once seemed to be simplicity itself. The sixth-century Rule produced at Benedict of Nursia’s Montecassino (RB), which observers likened to Mount Sinai as a source of sacred law, was said to have been quickly adopted in all Western monasteries outside Iberia. However, “the rule came to be far too laxly followed in many Benedictine monasteries, and in 910 the order of Cluny was founded to renew its strict observance.” The efforts of tenth-century monastic reformers associated with Cluny transformed decadent monasteries into observant institutions and guaranteed that the RB “became for three centuries the uncontested source of all European religious life.” Thus, one survey of medieval Western monasticism covered the central Middle Ages in eight pages devoted to “the formation of a Benedictine tradition and the contribution of Cluny.”
Myelomeningocele (MMC), the most common congenital abnormality of the central nervous system (CNS), occurs due to failure of the neural tube to close in the first 4 weeks after conception and is characterized by a fluid-filled sac containing an exposed spinal cord and nerves. Myeloschisis is similar to MMC except that a membranous sac is not present and the defect is wider (Figure 44.1). The consequence of an open neural tube defect is abnormal development of the CNS. The neural elements become damaged from exposure to the toxic effects of amniotic fluid, leading to associated long-term morbidity and mortality. Cerebrospinal fluid (CSF) leaks out through the MMC and as a consequence the hindbrain herniates into the cervical spinal canal and blocks CSF circulation, leading to hydrocephalus and brain damage. Although 75% of individuals affected with spina bifida survive to adulthood, the one-year survival rate for infants is 88–96% [1, 2]. More than 80% of affected individuals require a ventriculo-peritoneal shunt to divert CSF in order to decompress the associated hydrocephalus, and this is dependent upon lesion level, with the need being greater for those with higher level lesions . The need for a shunt is associated with complications including infection, obstruction, displacement, and shunt revisions [3, 4]. More than 75% of patients have radiographic evidence of the Chiari II malformation (hindbrain herniation, brain stem abnormalities, and a small posterior fossa) that can manifest clinically as apnea, swallowing difficulties, quadriparesis, and coordination difficulties in up to one-third of affected individuals [5–7]. Functional motor levels correlate with lesion level in approximately 39% of patients, but in over half the functional level correlates to anatomic lesions two levels higher . Wheelchair use correlates with lesion level; 90% of patients with a thoracic lesion use a wheelchair while 45% with a lumbar lesion and 17% with a sacral lesion use a wheelchair . Bladder and bowel incontinence are also associated with MMC, necessitating the use of bowel and bladder regimens including clean intermittent catheterization and enemas. Urologic complications include recurrent urinary tract infections, vesicoureteral reflux, and upper urinary tract dilation . Additionally, the overwhelming majority of infants will require intervention for a foot deformity . For those living long term with spina bifida, up to one-third of adults require daily assistance and a high rate of unexpected death has been noted [11, 12].
In addition to student assessment, curriculum assessment is a critical element to any pedagogy. It helps the educator assess the teaching of concepts, determine what may be lacking, and make changes for continual improvement. Meaningful assessment can be complicated when disciplines converge or when new approaches are implemented. To facilitate this, we present a network-based visualization schema to represent a materials informatics curriculum that combines materials science and data science concepts. We analyze the curriculum using network representations and relevant concepts from graph theory. This reveals established connections, linkages between materials science and data science, and the extent to which different concepts are connected. We also describe how some materials science topics are introduced from a data perspective, and present an illustrative case study from the curriculum.
Intermittent explosive disorder (IED) is characterised by impulsive anger attacks that vary greatly across individuals in severity and consequence. Understanding IED subtypes has been limited by lack of large, general population datasets including assessment of IED. Using the 17-country World Mental Health surveys dataset, this study examined whether behavioural subtypes of IED are associated with differing patterns of comorbidity, suicidality and functional impairment.
IED was assessed using the Composite International Diagnostic Interview in the World Mental Health surveys (n = 45 266). Five behavioural subtypes were created based on type of anger attack. Logistic regression assessed association of these subtypes with lifetime comorbidity, lifetime suicidality and 12-month functional impairment.
The lifetime prevalence of IED in all countries was 0.8% (s.e.: 0.0). The two subtypes involving anger attacks that harmed people (‘hurt people only’ and ‘destroy property and hurt people’), collectively comprising 73% of those with IED, were characterised by high rates of externalising comorbid disorders. The remaining three subtypes involving anger attacks that destroyed property only, destroyed property and threatened people, and threatened people only, were characterised by higher rates of internalising than externalising comorbid disorders. Suicidal behaviour did not vary across the five behavioural subtypes but was higher among those with (v. those without) comorbid disorders, and among those who perpetrated more violent assaults.
The most common IED behavioural subtypes in these general population samples are associated with high rates of externalising disorders. This contrasts with the findings from clinical studies of IED, which observe a preponderance of internalising disorder comorbidity. This disparity in findings across population and clinical studies, together with the marked heterogeneity that characterises the diagnostic entity of IED, suggests that it is a disorder that requires much greater research.
The Minnesota Center for Twin and Family Research (MCTFR) comprises multiple longitudinal, community-representative investigations of twin and adoptive families that focus on psychological adjustment, personality, cognitive ability and brain function, with a special emphasis on substance use and related psychopathology. The MCTFR includes the Minnesota Twin Registry (MTR), a cohort of twins who have completed assessments in middle and older adulthood; the Minnesota Twin Family Study (MTFS) of twins assessed from childhood and adolescence into middle adulthood; the Enrichment Study (ES) of twins oversampled for high risk for substance-use disorders assessed from childhood into young adulthood; the Adolescent Brain (AdBrain) study, a neuroimaging study of adolescent twins; and the Siblings Interaction and Behavior Study (SIBS), a study of adoptive and nonadoptive families assessed from adolescence into young adulthood. Here we provide a brief overview of key features of these established studies and describe new MCTFR investigations that follow up and expand upon existing studies or recruit and assess new samples, including the MTR Study of Relationships, Personality, and Health (MTR-RPH); the Colorado-Minnesota (COMN) Marijuana Study; the Adolescent Brain Cognitive Development (ABCD) study; the Colorado Online Twins (CoTwins) study and the Children of Twins (CoT) study.