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Nicotine replacement therapy sampling (NRTS) refers to providing all smokers, regardless of interest in quitting, with free samples of over-the-counter NRT. NRTS has been shown to increase quit attempts and abstinence.
We conducted a pilot trial with a goal to establish the feasibility and acceptability of NRTS in a dental clinic, where providing free samples is routine and universal.
Participants (N = 30) completed a baseline survey and were randomized to receive or not receive a 2-week supply of NRT samples (14 mg patches and 4 mg lozenges) in a 3:1 ratio.
We enrolled 30 of 50 potentially eligible patients, of whom 26 completed a 4-week follow-up survey. At follow-up, 61% of the NRT group reported use of the samples and 26% said they used more NRT obtained on their own. In the No NRT group, only one patient reported using NRT. No patients reported past week abstinence, but 43% of the NRT group vs. 29% of the No NRT group reported making a quit attempt lasting longer than 24 h.
The pattern of results suggests that conducting a larger trial would be feasible and that the NRTS intervention was acceptable to dental patients.
In this paper we investigate the effect of an inhomogeneous and unsteady velocity field incident on an array of rigid circular cylinders arranged within a circular perimeter (diameter
) of varying solid fraction
, where the unsteady flow is generated by placing a cylinder (diameter
) upwind of the array. Unsteady two-dimensional viscous simulations at a moderate Reynolds number (
) and also, as a means of extrapolating to a flow with a very high Reynolds number, inviscid rapid distortion theory (RDT) calculations were carried out. These novel RDT calculations required the circulation around each cylinder to be zero which was enforced using an iterative method. The two main differences which were highlighted was that the RDT calculations indicated that the tangential velocity component is amplified, both, at the front and sides of the array. For the unsteady viscous simulations this result did not occur as the two-dimensional vortices (of similar size to the array) are deflected away from the boundary and do not penetrate into the boundary layer. Secondly, the amplification is greater for the RDT calculations as for the unsteady finite Reynolds number calculations. For the two highest solid fraction arrays, the mean flow field has two recirculation regions in the near wake of the array, with closed streamlines that penetrate into the array which will have important implications for scalar transport. The increased bleed through the array at the lower solid fraction results in this recirculation region being displaced further downstream. The effect of inviscid blocking and viscous drag on the upstream streamwise velocity and strain field is investigated as it directly influences the ability of the large coherent structures to penetrate into the array and the subsequent forces exerted on the cylinders in the array. The average total force on the array was found to increase monotonically with increasing solid fraction. For high solid fraction
, although the fluctuating forces on the individual cylinders is lower than for low
, these forces are more correlated due to the proximity of the cylinders. The result is that for mid to high solid fraction arrays the fluctuating force on the array is insensitive to
. For low
, where the interaction of the cylinders is weak, the force statistics on the individual cylinders can be accurately estimated from the local slip velocity that occurs if the cylinders were removed.
While dialectical behaviour therapy (DBT) appears efficacious in reducing suicidal and self-harming behaviour, it is unclear whether DBT reduces emotion regulation (ER) difficulties, a purported mechanism of change of treatment. This review aims to investigate and evaluate the current evidence to understand the effectiveness of DBT in improving ER difficulties. A qualitative synthesis of studies investigating the effectiveness of DBT on self-reported ER difficulties as measured by the Difficulties in Emotion Regulation Scale (DERS) was performed, identifying eligible studies using PsycINFO, PubMed, MEDLINE and EMBASE databases. Fourteen studies were identified. Current evidence indicates that DBT does not show consistent benefits relative to existing psychological treatments in improving ER difficulties. The literature is compromised by significant methodological limitations increasing risk of bias across study outcomes. Furthermore, high variability across DBT programs and a lack of investigation regarding adherence and participant engagement within interventions was observed. Further research is needed in order to conclude regarding the effectiveness of DBT in improving ER difficulties. Consistent use of active treatment conditions, greater standardisation of DBT-based interventions, in addition to further examination of participant engagement level in DBT-based interventions in the long term may assist understanding as to whether DBT improves ER difficulties.
OBJECTIVES/SPECIFIC AIMS: To examine rural-urban disparities in prevalence of diagnosed diabetes in veterans receiving care at the VA and to determine the extent to which demographic factors and obesity levels contribute to identified disparities. METHODS/STUDY POPULATION: A retrospective serial cross-sectional analysis was employed. A stratified weighted random sample of veterans who received care at a VA facility was selected each year for 2007 through 2012. Rural Urban Commuting Area (RUCA) codes were based on resident zip code. Diabetes was defined by two or more primary or secondary ICD-9 codes for diabetes (250.xx) within a 12 month period. Data were analyzed using complex survey-specific procedures. RESULTS/ANTICIPATED RESULTS: Diabetes prevalence 2007-2012 was lowest in urban (20.5%-21.0%), followed by highly rural (21.1%-22.1%) and rural (22.3%-23.0%) areas with the prevalence being significantly higher on the insular islands (31.0%-32.4%). In 2012, 41% of urban, 43% of rural and highly rural and 30% of insular island veterans were obese. Relative to urban areas, the odds ratio for prevalent diabetes was 1.10 (95% CI: 1.08, 1.12) for rural veterans, 1.19 (95% CI: 1.16, 1.23) for insular island veterans, and 1.00 (95% CI: 0.98, 1.02) for highly rural veterans. DISCUSSION/SIGNIFICANCE OF IMPACT: Prevalence of diagnosed diabetes is high in veterans residing in rural, highly rural and urban areas, but markedly higher on the insular islands. Understanding the burden of disease and factors driving disparities provides information required to develop targeted interventions.
This paper reports on a funded summit, which convened a multidisciplinary group of experts to provide consensus on the research priorities necessary for improving long-term community integration of individuals with traumatic brain injury (TBI) and their caregivers.
The 2-day summit was directed using the World Café Methodology, to engage stakeholders and collaboratively arrive at a consensus on the problems to be targeted in research. Participants (n=54), drawn from two Canadian provinces, included an interdisciplinary group of researchers, clinicians, representatives from brain injury associations, individuals with TBI, and caregivers. In small groups, participants discussed challenges to long-term community integration and potential initiatives that would address these barriers. Field notes from the discussions were analyzed using qualitative content analysis.
The consensus on prioritized research directions included developing interventions to optimize the functioning and participation of individuals with TBI, reducing caregiver burden, and evaluating how emerging technology can facilitate delivery of care.
The World Café Methodology was an effective method for developing research priorities. The breadth of expertise of participants and the collegial environment allowed for the identification of a broad perspective on important future research directions with potential to enhance the long-term community integration of individuals with brain injury.
High unemployment is a hallmark of psychotic illness. Individual placement and support (IPS) may be effective at assisting the vocational recoveries of young people with first-episode psychosis (FEP).
To examine the effectiveness of IPS at assisting young people with FEP to gain employment (Australian and Clinical Trials Registry ACTRN12608000094370).
Young people with FEP (n = 146) who were interested in vocational recovery were randomised using computer-generated random permuted blocks on a 1:1 ratio to: (a) 6 months of IPS in addition to treatment as usual (TAU) or (b) TAU alone. Assessments were conducted at baseline, 6 months (end of intervention), 12 months and 18 months post-baseline by research assistants who were masked to the treatment allocations.
At the end of the intervention the IPS group had a significantly higher rate of having been employed (71.2%) than the TAU group (48.0%), odds ratio 3.40 (95% CI 1.17–9.91, z = 2.25, P = 0.025). However, this difference was not seen at 12- and 18-month follow-up points. There was no difference at any time point on educational outcomes.
This is the largest trial to our knowledge on the effectiveness of IPS in FEP. The IPS group achieved a very high employment rate during the 6 months of the intervention. However, the advantage of IPS was not maintained in the long term. This seems to be related more to an unusually high rate of employment being achieved in the control group rather than a gross reduction in employment among the IPS group.
This review aimed to critically analyse data pertaining to the clinical presentation and treatment of neuroendocrine carcinomas of the larynx.
A PubMed search was performed using the term ‘neuroendocrine carcinoma’. English-language articles on neuroendocrine carcinoma of the larynx were reviewed in detail.
Results and conclusion
While many historical classifications have been proposed, in contemporary practice these tumours are sub-classified into four subtypes: carcinoid, atypical carcinoid, small cell neuroendocrine carcinoma and large cell neuroendocrine carcinoma. These tumours exhibit a wide range of biological behaviour, ranging from the extremely aggressive nature of small and large cell neuroendocrine carcinomas, which usually have a fatal prognosis, to the less aggressive course of carcinoid tumours. In small and large cell neuroendocrine carcinomas, a combination of irradiation and chemotherapy is indicated, while carcinoid and atypical carcinoid tumour management entails conservation surgery.
OBJECTIVES/SPECIFIC AIMS: The Indiana CTSI is investigating innovative approaches to integrate resources that will enrich scientific investigators. Our goals are to enhance the availability and communication among CTSI resources, for example internal funding, and to expand existing mentorship. METHODS/STUDY POPULATION: Developed a reviewer database that serves to streamline reviewer identification, decrease reviewer fatigue, and promote collaboration among disciplines. We started with a pool of NIH-funded investigators from across the Indiana CTSI core institutions and merged this list with previous CTSI reviewers and internal funding awardees. To expand this list, names and expertise from new faculty hires were added. RESULTS/ANTICIPATED RESULTS: Though this tool is relatively new, we have already observed an increase in junior faculty awareness and engagement with the CTSI. This database allows for increased opportunities of junior faculty to serve as reviewers and to refine grant writing skills and provides a platform for networking and collaborating across disciplines. It also allows for increased integration of programs with a shared reviewer database and promotes grant review standardization. DISCUSSION/SIGNIFICANCE OF IMPACT: Our database utilization seeks to decrease the time for junior faculty to obtain their first extramural grant, to enhance promotion and tenure packages, strengthen integration among CTSI programs, increase interactions between clinical and basic science investigators, and promote team science.
Karen A Waters, The Children's Hospital at Westmead and The University of Sydney, Camperdown, NSW, Australia,
Nicholas J Hunt, The University of Sydney, Camperdown, NSW, Australia,
Rita MacHaalani, The University of Sydney, Camperdown, NSW, Australia
Since deaths attributed to sudden infant death syndrome (SIDS) occur during sleep, failure to arouse in a stressful situation comprises one component in the proposed mechanism of death. While the infant was previously apparently healthy, the hypothesis underpinning neuropathological studies is that an underlying defect in the infant's brain has contributed to death. The defect in infants who do not arouse may be developmental, inherited, or secondary to previous non-fatal insults. The brainstem and hypothalamus are two regions housing nuclei with important roles in stress responses and arousal mechanisms. This chapter focuses on studies of the hypothalamus and how deficits in this region may contribute to SIDS.
The hypothalamus is a small but complex part of the brain with important roles in the homeostasis of energy balance, circadian rhythms, and stress responses, as well as growth and reproductive behaviors (1). As a regulatory center for so many functions, it receives input from, and transmits output to, a large number of other brain regions. Thus, as the hypothalamus controls many physiological functions, and is highly interconnected with other brain regions, it is an excellent candidate for abnormalities contributing to the pathogenesis of SIDS.
The hypothalamus was evaluated early in the 1990s in SIDS infants (2, 3). At that time, fewer neurotransmitters had been identified compared to today. But even without our current understanding (e.g. of the orexins which were discovered in 1998), the hypothalamus was of interest in SIDS because of its known role in the regulation of sleep. Findings at that time included increased tryptophan content and decreased serotonin, increased serotonin receptor binding, and increased monoamine oxidase-A (MOA) activity, with decreased choline acetyltransferase (ChAT) activity (2) (see Table 28.1).
Updating our knowledge of the hypothalamus and its potential role in SIDS is important, because our understanding of the hypothalamus is now more sophisticated with regards to its structure, functions, and development (1). In addition, a series of recent studies have made important advances in our understanding of abnormalities in the hypothalamus of SIDS infants.
Mastitis is one of most frequent and costly diseases encountered on dairy farms. In 1998 mastitis costs UK dairy farmers approximately £80 million a year and this figure increases to over £100 million when further associated losses such as somatic cell count (SCC) penalties, antibiotic residue penalties and reduced cell count and bacteria count payments are accounted for. In the 1980’s and 1990’s there has been a continuing increase in the incidence of environmental mastitis and especially due to E coli (Brand, 1999),. Increasing SCC levels are set against a background of emphasis on higher milk price for low SSC milk by purchasers has led to the need to increase milk price by reducing losses from high SCC levels. The aim of the study was to monitor bulk milk SCC levels in milk supplied to a milk producer co-operative over a 12 month period and select a sub-sample of milk producers with high SCC, analyse the clinical incidence of mastitis, establish the pathogens involved and their response to antibiotics.
The scaling of turbulent motions is investigated by considering the flow in the eigenframe of the local strain-rate tensor. The flow patterns in this frame of reference are evaluated using existing direct numerical simulations of homogeneous isotropic turbulence over a Reynolds number range from
up to 1131, and also with reference to data for inhomogeneous, anisotropic wall turbulence. The average flow in the eigenframe reveals a shear layer structure containing tube-like vortices and a dissipation sheet, whose dimensions scale with the Kolmogorov length scale,
. The vorticity stretching motions scale with the Taylor length scale,
, while the flow outside the shear layer scales with the integral length scale,
. Furthermore, the spatial organization of the vortices and the dissipation sheet defines a characteristic small-scale structure. The overall size of this characteristic small-scale structure is
in all directions based on the coherence length of the vorticity. This is considerably larger than the typical size of individual vortices, and reflects the importance of spatial organization at the small scales. Comparing the overall size of the characteristic small-scale structure with the largest flow scales and the vorticity stretching motions on the scale of
shows that transitions in flow structure occur where
and 250. Below these respective transitional Reynolds numbers, the small-scale motions and the vorticity stretching motions are progressively less well developed. Scale interactions are examined by decomposing the average shear layer into a local flow, which is induced by the shear layer vorticity, and a non-local flow, which represents the environment of the characteristic small-scale structure. The non-local strain is
in width and height, which is consistent with observations in high Reynolds number flow of a
wide instantaneous shear layer with many
-scale vortical structures inside (Ishihara et al., Flow Turbul. Combust., vol. 91, 2013, pp. 895–929). In the average shear layer, vorticity aligns with the intermediate principal strain at small scales, while it aligns with the most stretching principal strain at larger scales, consistent with instantaneous turbulence. The length scale at which the alignment changes depends on the Reynolds number. When conditioning the flow in the eigenframe on extreme dissipation, the velocity is strongly affected over large distances. Moreover, the associated peak velocity remains Reynolds number dependent when normalized by the Kolmogorov velocity scale. It signifies that extreme dissipation is not simply a small-scale property, but is associated with large scales at the same time.
Terrestrial gastropods are problematical for radiocarbon (14C) measurement because they tend to incorporate carbon from ancient sources as a result of their dietary behavior. The 14C ecology of the pulmonate land snail, Helix melanostoma in Cyrenaica, northeastern Libya, was investigated as part of a wider study on the potential of using terrestrial mollusk shell for 14C dating of archaeological deposits. H. melanostoma was selected out of the species available in the region as it has the most predictable 14C ecology and also had a ubiquitous presence within the local archaeology. The ecological observations indicate that H. melanostoma has a very homogenous 14C ecology with consistent variations in F14C across sample sites controlled by availability of dietary vegetation. The majority of dated specimens from non-urbanized sample locations have only a small old-carbon effect, weighted mean of 476±48 14C yr, with between ~1% and 9% of dietary F14C from non-organic carbonate sources. Observed instabilities in the 14C ecology can all be attributed to the results of intense human activity not present before the Roman Period. Therefore, H. melanostoma and species with similar ecological behavior are suitable for 14C dating of archaeological and geological deposits with the use of a suitable offset.
Non-linear acoustic techniques have been used to investigate the properties of a pond-ice cover. The field tests showed that the position of the lower and upper surfaces, as well as some internal bubble layers, could be located with centimetre-scale resolution. These results are presented, along with an outline of parametric array theory and a description of the instrumentation. The data indicate that dynamic modelling of the acoustic response of ice will enable remote estimation of some of the bulk physical properties of the ice such as thickness, roughness and possibly brine volume. It follows that this approach to non-destructive imaging of ice properties may find application in a wide range of ice-engineering problems.