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Several research teams have previously traced patterns of emerging conduct problems (CP) from early or middle childhood. The current study expands on this previous literature by using a genetically-informed, experimental, and long-term longitudinal design to examine trajectories of early-emerging conduct problems and early childhood discriminators of such patterns from the toddler period to adolescence. The sample represents a cohort of 731 toddlers and diverse families recruited based on socioeconomic, child, and family risk, varying in urbanicity and assessed on nine occasions between ages 2 and 14. In addition to examining child, family, and community level discriminators of patterns of emerging conduct problems, we were able to account for genetic susceptibility using polygenic scores and the study's experimental design to determine whether random assignment to the Family Check-Up (FCU) discriminated trajectory groups. In addition, in accord with differential susceptibility theory, we tested whether the effects of the FCU were stronger for those children with higher genetic susceptibility. Results augmented previous findings documenting the influence of child (inhibitory control [IC], gender) and family (harsh parenting, parental depression, and educational attainment) risk. In addition, children in the FCU were overrepresented in the persistent low versus persistent high CP group, but such direct effects were qualified by an interaction between the intervention and genetic susceptibility that was consistent with differential susceptibility. Implications are discussed for early identification and specifically, prevention efforts addressing early child and family risk.
This study investigates suicide risk in late childhood and early adolescence in relation to a family-centered intervention, the Family Check-Up, for problem behavior delivered in early childhood. At age 2, 731 low-income families receiving nutritional services from Women, Infants, and Children programs were randomized to the Family Check-Up intervention or to a control group. Trend-level main effects were observed on endorsement of suicide risk by parents or teachers from ages 7.5 to 14, with higher rates of suicide risk endorsement in youth in the control versus intervention condition. A significant indirect effect of intervention was also observed, with treatment-related improvements in inhibitory control across childhood predicting reductions in suicide-related risk both at age 10.5, assessed via diagnostic interviews with parents and youth, and at age 14, assessed via parent and teacher reports. Results add to the emerging body of work demonstrating long-term reductions in suicide risk related to family-focused preventive interventions, and highlight improvements in youth self-regulatory skills as an important mechanism of such reductions in risk.
Building on prior work using Tom Dishion's Family Check-Up, the current article examined intervention effects on dysregulated irritability in early childhood. Dysregulated irritability, defined as reactive and intense response to frustration, and prolonged angry mood, is an ideal marker of neurodevelopmental vulnerability to later psychopathology because it is a transdiagnostic indicator of decrements in self-regulation that are measurable in the first years of life that have lifelong implications for health and disease. This study is perhaps the first randomized trial to examine the direct effects of an evidence- and family-based intervention, the Family Check-Up (FCU), on irritability in early childhood and the effects of reductions in irritability on later risk of child internalizing and externalizing symptomatology. Data from the geographically and sociodemographically diverse multisite Early Steps randomized prevention trial were used. Path modeling revealed intervention effects on irritability at age 4, which predicted lower externalizing and internalizing symptoms at age 10.5. Results indicate that family-based programs initiated in early childhood can reduce early childhood irritability and later risk for psychopathology. This holds promise for earlier identification and prevention approaches that target transdiagnostic pathways. Implications for future basic and prevention research are discussed.
This is a copy of the slides presented at the meeting but not formally
written up for the volume.
As in vivo cellular imaging becomes the necessary norm for understanding
cancer and other diseases, new non-toxic nanoprobes are going to be
required to replace the high quality cadmium based nanoprobes in use
today. We are developing less toxic probes based on two types of
luminescent ceramic nanoparticles: naturally occurring fluorescent (NOF)
mimics and Ln-based ceramic oxide materials. The NOF minerals of interest
and that have demonstrated initial luminosity of sufficient brightness
for use in cellular studies that include sphalerite, scheelite, manganoan
and perovskite nanoparticles. For Ln-based materials we have shown that
Ln-doped zincite will also luminesce enough to allow for quantification
in cellular activity. Once formed, these probes are functionalized such
that they can be delivered to desired cellular targets. Probe
derivatization has focused on surface capping with functionalized
poly(ethyleneglycol) molecules/lipids to yield water soluble NCs and
polyarginine-based transporters for transmembrane delivery. The probes
are being evaluated for their luminescent properties, as well as their
non-toxicity and ability to report on cell-signaling events with various
cell lines using multi-spectral, confocal microscopy, and other
techniques. Preliminary interdisciplinary studies have validated the
basic approaches for the synthesis of NOF nanoprobes and the bio-delivery
and imaging of nanoparticles. Work to optimize the design, delivery, and
imaging of these new nanoprobes is expected to achieve the NIH directed
goal of increasing in the sensitivity and specificity of molecular probes
for imaging. Details of the synthesis, functionalization and biological
imaging using these probes will be presented. This work partially
supported by the United States Department of Energy under contract number
DE-AC04-94AL85000. Sandia is a multi-program laboratory operated by
Sandia Corporation, a Lockheed-Martin Company, for the United States
Department of Energy and by the National Institutes of health through the
NIH Roadmap for Medical Research, Grant #1 R21 EB005365-01. Information
on this RFA (Innovation in Molecular Imaging Probes) can be found at http://grants.nih.gov/grants/guide/rfa-files/RFA-RM-04-021.html.
People with cerebral palsy (CP) are less physically active than the general population and, consequently, are at increased risk of preventable disease. Evidence indicates that low-moderate doses of physical activity can reduce disease risk and improve fitness and function in people with CP. Para athletes with CP typically engage in ‘performance-focused’ sports training, which is undertaken for the sole purpose of enhancing sports performance. Anecdotally, many Para athletes report that participation in performance-focused sports training confers meaningful clinical benefits which exceed those reported in the literature; however, supporting scientific evidence is lacking. The aim of this paper is to describe the protocol for an 18-month study evaluating the clinical effects of a performance-focused swimming training programme for people with CP who have high support needs.
This study will use a concurrent multiple-baseline, single-case experimental design across three participants with CP who have high support needs. Each participant will complete a five-phase trial comprising: baseline (A1); training phase 1 (B1); maintenance phase 1 (A2); training phase 2 (B2); and maintenance phase 2 (A3). For each participant, measurement of swim velocity, health-related quality of life and gross motor functioning will be carried out a minimum of five times in each of the five phases.
The study described will produce Level II evidence regarding the effects of performance-focused swimming training on clinical outcomes in people with CP who have high support needs. Findings are expected to provide an indication of the potential for sport to augment outcomes in neurological rehabilitation.
Starting in 2016, we initiated a pilot tele-antibiotic stewardship program at 2 rural Veterans Affairs medical centers (VAMCs). Antibiotic days of therapy decreased significantly (P < .05) in the acute and long-term care units at both intervention sites, suggesting that tele-stewardship can effectively support antibiotic stewardship practices in rural VAMCs.
Background: Cervical sponylotic myelopathy (CSM) may present with neck and arm pain. This study investiagtes the change in neck/arm pain post-operatively in CSM. Methods: This ambispective study llocated 402 patients through the Canadian Spine Outcomes and Research Network. Outcome measures were the visual analogue scales for neck and arm pain (VAS-NP and VAS-AP) and the neck disability index (NDI). The thresholds for minimum clinically important differences (MCIDs) for VAS-NP and VAS-AP were determined to be 2.6 and 4.1. Results: VAS-NP improved from mean of 5.6±2.9 to 3.8±2.7 at 12 months (P<0.001). VAS-AP improved from 5.8±2.9 to 3.5±3.0 at 12 months (P<0.001). The MCIDs for VAS-NP and VAS-AP were also reached at 12 months. Based on the NDI, patients were grouped into those with mild pain/no pain (33%) versus moderate/severe pain (67%). At 3 months, a significantly high proportion of patients with moderate/severe pain (45.8%) demonstrated an improvement into mild/no pain, whereas 27.2% with mild/no pain demonstrated worsening into moderate/severe pain (P <0.001). At 12 months, 17.4% with mild/no pain experienced worsening of their NDI (P<0.001). Conclusions: This study suggests that neck and arm pain responds to surgical decompression in patients with CSM and reaches the MCIDs for VAS-AP and VAS-NP at 12 months.
Consumption of certain berries appears to slow postprandial glucose absorption, attributable to polyphenols, which may benefit exercise and cognition, reduce appetite and/or oxidative stress. This randomised, crossover, placebo-controlled study determined whether polyphenol-rich fruits added to carbohydrate-based foods produce a dose-dependent moderation of postprandial glycaemic, glucoregulatory hormone, appetite and ex vivo oxidative stress responses. Twenty participants (eighteen males/two females; 24 (sd 5) years; BMI: 27 (sd 3) kg/m2) consumed one of five cereal bars (approximately 88 % carbohydrate) containing no fruit ingredients (reference), freeze-dried black raspberries (10 or 20 % total weight; LOW-Rasp and HIGH-Rasp, respectively) and cranberry extract (0·5 or 1 % total weight; LOW-Cran and HIGH-Cran), on trials separated by ≥5 d. Postprandial peak/nadir from baseline (Δmax) and incremental postprandial AUC over 60 and 180 min for glucose and other biochemistries were measured to examine the dose-dependent effects. Glucose AUC0–180 min trended towards being higher (43 %) after HIGH-Rasp v. LOW-Rasp (P=0·06), with no glucose differences between the raspberry and reference bars. Relative to reference, HIGH-Rasp resulted in a 17 % lower Δmax insulin, 3 % lower C-peptide (AUC0–60 min and 3 % lower glucose-dependent insulinotropic polypeptide (AUC0–180 min) P<0·05. No treatment effects were observed for the cranberry bars regarding glucose and glucoregulatory hormones, nor were there any treatment effects for either berry type regarding ex vivo oxidation, appetite-mediating hormones or appetite. Fortification with freeze-dried black raspberries (approximately 25 g, containing 1·2 g of polyphenols) seems to slightly improve the glucoregulatory hormone and glycaemic responses to a high-carbohydrate food item in young adults but did not affect appetite or oxidative stress responses at doses or with methods studied herein.
Introduction: Recently there have been many studies performed on the effectiveness of implementing LEAN principals to improve wait times for emergency departments (EDs), but there have been relatively few studies on implementing these concepts on length of stay (LOS) in the ED. This research aims to explore the initial feasibility of applying the LEAN model to length-of-stay metrics in an ED by identifying areas of non-value added time for patients staying in the ED. Methods: In this project we used a sample of 10,000 ED visits at the Health Science Centre in St. John's over a 1-year period and compared patients’ LOS in the ED on four criteria: day of the week, hour of presentation, whether laboratory tests were ordered, and whether diagnostic imaging was ordered. Two sets of analyses were then performed. First a two-sided Wilcoxon rank-sum test was used to evaluate whether ordering either lab tests or diagnostic imaging affected LOS. Second a generalized linear model (GLM) was created using a 10-fold cross-validation with a LASSO operator to analyze the effect size and significance of each of the four criteria on LOS. Additionally, a post-test analysis of the GLM was performed on a second sample of 10,000 ED visits in the same 1-year period to assess its predictive power and infer the degree to which a patient's LOS is determined by the four criteria. Results: For the Wilcoxon rank-sum test there was no significant difference in LOS for patients who were ordered diagnostic imaging compared to those who were not (p = 0.6998) but there was a statistically significant decrease in LOS for patients who were ordered lab tests compared to those who were not (p = 2.696 x 10-10). When assessing the GLM there were two significant takeaways: ordering lab tests reduced LOS (95% CI = 42.953 - 68.173min reduction), and arriving at the ED on Thursday increased LOS significantly (95% CI = 6.846 – 52.002min increase). Conclusion: This preliminary analysis identified several factors that increased patients’ LOS in the ED, which would be suitable for potential LEAN interventions. The increase in LOS for both patients who are not ordered lab tests and who visit the ED on Thursday warrant further investigation to identify causal factors. Finally, while this analysis revealed several actionable criteria for improving ED LOS the relatively low predictive power of the final GLM in the post-test analysis (R2 = 0.00363) indicates there are more criteria that influence LOS for exploration in future analyses.
The prehospital disaster and emergency medical services community stands on the front-line in the response to events such as novel influenza, multi-drug resistant tuberculosis, and other high consequence diseases such as the Ebola Virus Disease.
To address provider and community safety, we developed an online educational program utilizing a Multi-Pathogen Approach to infectious disease personal protective equipment (PPE) deployment by prehospital providers. Such vigilance starts with syndromic recognition and quickly transcends to include operational issues, clinical interventions, and public health integration.
The University of Maryland, Baltimore County (Maryland, USA), Department of Emergency Health Services partnered with the Maryland State Department of Health (USA), to develop an online educational curriculum. The curriculum was developed through an expert panel consensus group including prehospital providers and is hybrid in design and includes awareness level training and procedural guidance.
Currently deployed online, this educational content demonstrating the use of the Multi-Pathogen Approach is accessible open-access via YouTube worldwide on computers, tablets, and smartphones. This curriculum is also accessible for continuing medical education to over 50,000 prehospital, hospital, and clinic personnel throughout Maryland and the National Capital Region of the United States. The curriculum consists of twelve modules of didactic and live videotaped demonstrations.
The development of the Multi-Pathogen Approach for the deployment of PPE and the use of online education modules has given prehospital providers an easily accessible open-access tool for high consequence disease management. The development of educational efforts such as these can help ensure better patient care and prehospital EMS system readiness.
Introduction: Acute aortic syndrome (AAS) is a time sensitive aortic catastrophe that is often misdiagnosed. There are currently no Canadian guidelines to aid in diagnosis. Our goal was to adapt the existing American Heart Association (AHA) and European Society of Cardiology (ESC) diagnostic algorithms for AAS into a Canadian evidence based best practices algorithm targeted for emergency medicine physicians. Methods: We chose to adapt existing high-quality clinical practice guidelines (CPG) previously developed by the AHA/ESC using the GRADE ADOLOPMENT approach. We created a National Advisory Committee consisting of 21 members from across Canada including academic, community and remote/rural emergency physicians/nurses, cardiothoracic and cardiovascular surgeons, cardiac anesthesiologists, critical care physicians, cardiologist, radiologists and patient representatives. The Advisory Committee communicated through multiple teleconference meetings, emails and a one-day in person meeting. The panel prioritized questions and outcomes, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations. The algorithm was prepared and revised through feedback and discussions and through an iterative process until consensus was achieved. Results: The diagnostic algorithm is comprised of an updated pre test probability assessment tool with further testing recommendations based on risk level. The updated tool incorporates likelihood of an alternative diagnosis and point of care ultrasound. The final best practice diagnostic algorithm defined risk levels as Low (0.5% no further testing), Moderate (0.6-5% further testing required) and High ( >5% computed tomography, magnetic resonance imaging, trans esophageal echocardiography). During the consensus and feedback processes, we addressed a number of issues and concerns. D-dimer can be used to reduce probability of AAS in an intermediate risk group, but should not be used in a low or high-risk group. Ultrasound was incorporated as a bedside clinical examination option in pre test probability assessment for aortic insufficiency, abdominal/thoracic aortic aneurysms. Conclusion: We have created the first Canadian best practice diagnostic algorithm for AAS. We hope this diagnostic algorithm will standardize and improve diagnosis of AAS in all emergency departments across Canada.
Geophysical survey and excavations from 2010–2016 at Lawrenz Gun Club (11CS4), a late pre-Columbian village located in the central Illinois River valley in Illinois, identified 10 mounds, a central plaza, and dozens of structures enclosed within a stout 10 hectare bastioned palisade. Nineteen radiocarbon (14C) measurements were taken from single entities of wood charcoal, short-lived plants, and animal bones. A site chronology has been constructed using a Bayesian approach that considers the stratigraphic contexts and feature formation processes. The village was host to hundreds of years of continuous human activity during the Mississippi Period. Mississippian activity at the site is estimated to have begun in cal AD 990–1165 (95% probability), ended in cal AD 1295–1450 (95% probability), and lasted 150–420 yr (95% probability) in the primary Bayesian model with similar results obtained in two alternative models. The palisade is estimated to have been constructed in cal AD 1150–1230 (95% probability) and was continuously repaired and rebuilt for 15–125 yr (95% probability), probably for 40–85 yr (68% probability). Comparison to other studies demonstrates that the bastioned palisade at Lawrenz was one of the earliest constructed in the midcontinental United States.
Declining mortality following invasive pneumococcal disease (IPD) has been observed concurrent with a reduced incidence due to effective pneumococcal conjugate vaccines. However, with IPD now increasing due to serotype replacement, we undertook a statistical analysis to estimate the trend in all-cause 30-day case fatality rate (CFR) in the North East of England (NEE) following IPD. Clinical, microbiological and demographic data were obtained for all laboratory-confirmed IPD cases (April 2006–March 2016) and the adjusted association between CFR and epidemiological year estimated using logistic regression. Of the 2510 episodes of IPD included in the analysis, 486 died within 30 days of IPD (CFR 19%). Increasing age, male sex, a diagnosis of septicaemia, being in ⩾1 clinical risk groups, alcohol abuse and individual serotypes were independently associated with increased CFR. A significant decline in CFR over time was observed following adjustment for these significant predictors (adjusted odds ratio 0.93, 95% confidence interval 0.89–0.98; P = 0.003). A small but significant decline in 30-day all-cause CFR following IPD has been observed in the NEE. Nonetheless, certain population groups remain at increased risk of dying following IPD. Despite the introduction of effective vaccines, further strategies to reduce the ongoing burden of mortality from IPD are needed.
Most people can readily identify a forest, or a grassland, or a wetland - these are the simple labels we give different plant communities. The aim of this book is to move beyond these simple descriptions to investigate the 'hidden' structure of vegetation, asking questions such as how do species in a community persist over time? What prevents the strongest species from taking over? And, are there rules that confer stability and produce repeatable patterns? Answers to these questions are fundamental to community ecology, and for the successful management of the world's varied ecosystems, many of which are currently under threat. In addition to reviewing and synthesising our current knowledge of species interactions and community assembly, this book also seeks to offer a different viewpoint - to challenge the reader, and to stimulate ecologists to think differently about plant communities and the processes that shape them.