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OBJECTIVES/GOALS: Adolescents with congenital heart defects (CHD) have an elevated risk for future cardiovascular events, but information about their risk for e-cigarette use (“vaping”) is unknown. This study aims to present preliminary findings on gender differences in the association of impulsive behavior and vaping susceptibility from an ongoing investigation. METHODS/STUDY POPULATION: Adolescents with CHD (12-18 years; N=63) reported their vaping susceptibility and completed subjective (UPPS-P)/objective (Iowa Gambling Task; IGT) assessments of impulsive behavior previously associated with tobacco use. The UPPS-P includes 5 facets: 1) negative urgency (impulsivity under negative emotions), 2) positive urgency (impulsivity under positive emotions), 3) lack of premeditation (acting without thinking), 4) lack of perseverance (inability to focus), and 5) sensation seeking (seeking thrilling experiences). The IGT is a computerized task that creates conflict between immediate reward and delayed punishment via selections from advantageous/disadvantageous card decks. Linear regressions stratified by gender determined associations between vaping susceptibility and impulsivity. RESULTS/ANTICIPATED RESULTS: Nearly 30% (29.7%) of adolescents with CHD were susceptible to vaping. Negative urgency was associated with vaping susceptibility among females (Î² = 0.44, p = .035) but not males (Î² = 0.25, p = .128). Positive urgency was associated with vaping susceptibility among males (Î² = 0.37, p = .021) and trended toward significance among females (Î² = 0.40, p = .058). Lack of premeditation was associated with vaping susceptibility among males (Î² = 0.36, p = .025) but not females (Î² = 0.15, p = .490). The association between lack of perseverance and vaping susceptibility trended toward significance among males (Î² = 0.30, p = .064) but not females (Î² = -0.18, p = .413). IGT performance was not associated with susceptibility to vaping among either gender. UPPS-P facets and IGT performance were not significantly correlated. DISCUSSION/SIGNIFICANCE: The association of impulsivity and vaping susceptibility appears to be characterized by emotion-based rash action (positive/negative urgency) for females and by decreased conscientiousness (lack of premeditation/perseverance) for males. If replicated, the findings have implications for assessment of vaping risk and tailored intervention.
Conduct disorder (CD) has been associated with dysfunction in reinforcement-based decision-making. Two forms of affective traits that reflect the components of CD severity are callous-unemotional (CU; reduced guilt/empathy) traits and irritability. The form of the reinforcement-based decision-making dysfunction with respect to CD and CU traits remains debated and has not been examined with respect to irritability in cases with CD. The goals of the current study were to determine the extent of dysfunction in differential (reward v. punishment) responsiveness in CD, and CU traits and irritability in participants with CD.
The study involved 178 adolescents [typically developing (TD; N = 77) and cases with CD (N = 101)]. Participants were scanned with fMRI during a passive avoidance task that required participants to learn to respond to (i.e. approach) stimuli that engender reward and refrain from responding to (i.e. passively avoid) stimuli that engender punishment.
Adolescents with CD showed reduced differential reward-punishment responsiveness within the striatum relative to TD adolescents. CU traits, but not irritability, were associated with reduced differential reward-punishment responsiveness within the striatum, rostromedial, and lateral frontal cortices.
The results suggest CD is associated with reduced differential reward-punishment responsiveness and the extent of this dysfunction in participants with CD is associated with the severity of CU traits but not irritability.
Universal depression screening in youth typically focuses on strategies for identifying current distress and impairment. However, these protocols also play a critical role in primary prevention initiatives that depend on correctly estimating future depression risk. Thus, the present study aimed to identify the best screening approach for predicting depression onset in youth.
Two multi-wave longitudinal studies (N = 591, AgeM = 11.74; N = 348, AgeM = 12.56) were used as the ‘test’ and ‘validation’ datasets among youth who did not present with a history of clinical depression. Youth and caregivers completed inventories for depressive symptoms, adversity exposure (including maternal depression), social/academic impairment, cognitive vulnerabilities (rumination, dysfunctional attitudes, and negative cognitive style), and emotional predispositions (negative and positive affect) at baseline. Subsequently, multi-informant diagnostic interviews were completed every 6 months for 2 years.
Self-reported rumination, social/academic impairment, and negative affect best predicted first depression onsets in youth across both samples. Self- and parent-reported depressive symptoms did not consistently predict depression onset after controlling for other predictors. Youth with high scores on the three inventories were approximately twice as likely to experience a future first depressive episode compared to the sample average. Results suggested that one's likelihood of developing depression could be estimated based on subthreshold and threshold risk scores.
Most pediatric depression screening protocols assess current manifestations of depressive symptoms. Screening for prospective first onsets of depressive episodes can be better accomplished via an algorithm incorporating rumination, negative affect, and impairment.
Oral treatment (targeted or chemotherapy) for cancer is being increasingly used. While fatigue is a known side effect of intravenous chemotherapy, the rate of fatigue and the impact of fatigue on other patient-reported outcomes are not well described.
At Massachusetts General Hospital Cancer Center, 180 adult patients prescribed oral targeted or chemotherapy for various malignancies enrolled in a randomized controlled trial of adherence and symptom management. Patients completed baseline self-reported measures of fatigue (Brief Fatigue Inventory; BFI), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale; HADS), and quality of life, including subscales for physical, social, emotional, and functional well-being ([QOL] Functional Assessment of Cancer Therapy — General; FACT-G). We examined clinically relevant fatigue using a validated cut-off score for moderate-severe fatigue (BFI global fatigue ≥4) and tested the associations with anxiety symptoms, depressive symptoms, and QOL with independent samples t-tests.
At baseline, 45 of 180 participants (25.0%) reported moderate-severe fatigue. Fatigued patients experienced more anxiety symptoms (mean diff. 3.73, P < 0.001), more depressive symptoms (mean diff. 4.14, P < 0.001), and worse QOL on the total FACT-G score (mean diff. −19.58, P < 0.001) and all subscales of the FACT-G compared to patients without moderate-severe fatigue.
Significance of results
One in four patients on oral treatment for cancer experienced clinically relevant fatigue that is associated with greater anxiety and depressive symptoms and worse QOL.
Wearable devices such as a wrist actigraph may have a potential to objectively estimate patients’ functioning and may supplement performance status (PS). This proof-of-concept study aimed to evaluate whether actigraphy data are significantly associated with patients’ functioning and are predictive of their survival in patients with metastatic non-small cell lung cancer.
We collected actigraphy data for a three-day period in ambulatory patients with stage IV non-small cell lung cancer. We computed correlations between actigraphy data (specifically, proportion of time spent immobile while awake) and clinician-rated PS, subjective report of physical activities, quality of life (the Functional Assessment of Cancer Therapy – Trial Outcome Index), and survival.
Actigraphy data (the proportion of time awake spent immobile) were significantly correlated with Functional Assessment of Cancer Therapy – Trial Outcome Index (r = −0.53, p < 0.001) and with the Eastern Cooperative Oncology Group PS (ECOG PS) (r = 0.37, p < 0.001). The proportion of time awake spent immobile was significantly associated with worse survival. For each 10% increase in this measure, the hazard ratio (HR) was 1.48 (95% confidence interval [CI95%] = 1.06, 2.06) for overall mortality, and odds ratio was 2.99 (CI95% = 1.27, 7.05) for six-month mortality. ECOG PS was also associated with worse survival (HR = 2.80, CI95% = 1.34, 5.86). Among patients with ECOG PS 0-1, the percentage of time awake spent immobile was significantly associated with worse survival, HR = 1.93 (CI95% = 1.10, 3.42), whereas ECOG PS did not predict survival.
Significance of Results
Actigraphy may have potential to predict important clinical outcomes, such as quality of life and survival, and may serve to supplement PS. Further validation study is warranted.
This article revisits the Hobbesian account of the state of nature and the formation of states, attending to Hobbes’s account of the family. Drawing on feminist readings, we find in the Leviathan an account of the family as a natural political community. We contend specifically that a focus on conceptions of family life in the Leviathan, and in works by Hobbes’s early modern peers, points to the role of the family as a site of socialisation in the prelude to early state formation and in the formation of political hierarchies more generally – including, we suggest, the formation of international hierarchies. These accounts have thus far been missing from International Relations theory. Contra conventional IR theoretic readings of the Leviathan, the Hobbesian state of nature contains the seeds of both anarchy and hierarchy, as overlapping social configurations. While anarchy emerges clearly in the famous condition of ‘war of all against all’, hierarchy also exists in Hobbes’s depiction of family life as a naturally occurring proto-state setting. On the basis of this contemporary feminist analysis of a classic text, we consider implications for the emerging ‘new hierarchy studies’ in IR.
Wisdom is a complex trait, and previous research has identified several components of wisdom. This study explored the possible impact of a diagnosis of a terminal illness on the conceptualization and evolution of wisdom while facing the end of life.
Design and Participants:
Semi-structured qualitative interviews were conducted with 21 hospice patients aged 58–97 years who were in the last six months of their life.
Hospice patients were asked to describe the core characteristics of wisdom, as well as how their terminal illness might have impacted their understanding of this concept. The interviews were audiotaped, transcribed, and coded by the research team using a grounded theory analytic approach based on coding consensus, co-occurrence, and comparison.
Broad concepts of wisdom described by the hospice patients align with the extant literature, thereby supporting those general conceptualizations. In addition, hospice patients described how their life perspectives shifted after being diagnosed with a terminal illness. Post-illness wisdom can be characterized as a dynamic balance of actively accepting the situation while simultaneously striving for galvanized growth. This delicate tension motivated the patients to live each day fully, yet consciously plan for their final legacy.
The end of life offers a unique perspective on wisdom by highlighting the modulation between actively accepting the current situation while continuing the desire to grow and change at this critical time. This paradox, when embraced, may lead to even greater wisdom while facing one's own mortality.
We report a significant hardening of the Fermi-LAT gamma-ray spectrum from the core of Cen A at E > 2.4 GeV, suggesting there is a source of high energy particles in the core of Cen A which is in addition to the jet component. We show that the observed gamma-ray spectrum is compatible with either a spike in the dark matter halo profile or a population of millisecond pulsars. This work gives a strong indication of new gamma-ray production mechanisms in active galactic nuclei and could even provide evidence for the clustering of heavy dark matter particles around black holes.
A complete understanding of radioactive waste glass interactions with near-field materials is essential for appropriate nuclear waste repository performance assessment. In many geologic repository designs, Fe is present both in the natural environment and in the containers that will hold the waste glasses. In this paper we discuss investigations of the alteration of International Simple Glass (ISG) in the presence of Fe0 foil and hematite (Fe2O3). Based on solid analysis, ISG alteration is more pronounced in the presence of Fe0 than with hematite. Additionally, typical glass corrosion is observed for distances of 5 mm between Fe materials and ISG, but incorporation of Fe in the alteration layer is only observed for systems exhibiting full contact between Fe0 material and ISG. Solution analysis results indicate that diatomaceous earth minimizes corrosion to a larger extent than fumed silica does when present with iron and ISG.
Significant new opportunities for astrophysics and cosmology have been identified at low radio frequencies. The Murchison Widefield Array is the first telescope in the southern hemisphere designed specifically to explore the low-frequency astronomical sky between 80 and 300 MHz with arcminute angular resolution and high survey efficiency. The telescope will enable new advances along four key science themes, including searching for redshifted 21-cm emission from the EoR in the early Universe; Galactic and extragalactic all-sky southern hemisphere surveys; time-domain astrophysics; and solar, heliospheric, and ionospheric science and space weather. The Murchison Widefield Array is located in Western Australia at the site of the planned Square Kilometre Array (SKA) low-band telescope and is the only low-frequency SKA precursor facility. In this paper, we review the performance properties of the Murchison Widefield Array and describe its primary scientific objectives.
This chapter deals with important considerations with regard to pre-procedure, peri-procedure, and post-procedure patient assessment and pain management strategies. Practitioner training and experience in administering sedation is an important consideration. For most patients, pain assessments and establishment of pain treatment goals can be performed by a non-anesthesiologist. Appropriate assessment of pain increases caregiver awareness of pain status, allows for the delivery of appropriate interventions, provides for feedback, decreases both patient and caregiver frustration, and improves patient satisfaction. The chapter outlines the most common pain assessment tools in current use in general and special populations. In the general population, which includes mature children, adults, and the cognitively intact elderly, the use of self-report scales has been validated as the most reliable indicator of pain. With appropriate vigilance, planning, and continuous communication between team members, many of the barriers involved in planning and executing an effective pain management strategy can be overcome.
This is a copy of the slides presented at the meeting but not formally written up for the volume.
Cell surface carbohydrates play unique roles in a host of biologically relevant events such as cell differentiation, adhesion and development. They also mediate many undesired processes such as pathogenic infection and tumor metastasis. A common feature of all tumor cells is the altered expression and presentation of surface glycans that serve as “non-self” structures that can be recognized by the immune system. For many years, these tumor-associated carbohydrate antigens (TACA’s) have been employed in the development of tumor vaccines with varying degrees of success. In addition, these sugars may mediate tumor cell adhesion during the metastatic cascade. We have previously succeeded in preparing both gold nanoparticles and quantum dot nanocrystals that were coated with specific TACA’s. We have concentrated on the Thomsen Friedenreich (TF) antigen disaccharide (Galβ1-3GalNAcα-O-Ser/Thr) and have shown that gold particles coated with TF antigen can either promote or inhibit metastasis in vivo. Here we describe our progress toward the synthesis of a number of these multivalent nanoscaffolds and report on our characterization efforts and how the size and surface chemistry of the particles relates to their biological activities.
Non-compliance with marine protected area (MPA) regulations is a problem worldwide, and this is being addressed through community programmes. Park service and fisheries department personnel, and fishers living adjacent to three parks were studied to determine their perceptions of MPAs. The hypotheses that positive perceptions towards the management of fisheries exclusion and gear-restricted areas would increase with the wealth, education, age and years of employment of the person, the history of community participation and the age of the MPA were tested. The strongest factor was employment, with fishers having significantly less positive perceptions towards areas closed to fishing than government managers, although all groups agreed area management benefited the nation. Government personnel thought that fishers and their communities benefited from area management, while most fishers did not share this view. Increasing wealth or community participation were not significant factors, but secondary education was associated with more positive perceptions of area management. Fishers adjacent to the oldest MPA held significantly more positive perceptions than fishers living adjacent to the newest MPA, although only a slight majority agreed that they and their communities benefited. The results point to a need for patience in expecting change in resource users' perceptions, adopting an approach in which there is more communication between fishers and managers, so that both are more aware of MPA functions, particularly closed areas and the indirect benefits.
The lichen symbiosis has evolved several times within the fungal kingdom, although the total number of lichenization events leading to extant taxa is still unclear. Two lichenized families, the Icmadophilaceae and Baeomycetaceae have been classified in the Helotiales. Because the Helotiales are predominantly nonlichenized, this suggests that these families represent independent evolutionary episodes of lichenization from the Lecanorales. As a first step towards understanding the evolution of the lichen symbiosis within this order, we tested recent hypotheses concerning the segregation of lichen genera between the two lichen families. Specifically, we used phylogenetic analyses of nucleotide sequence data from nuclear small-subunit and large-subunit ribosomal DNA to test the morphology-based hypotheses that Dibaeis is a distinct genus from Baeomyces and that Dibaeis is a member of the Icmadophilaceae rather than the Baeomycetaceae. Phylogenetic analyses of nuclear SSU rDNA and combined SSU and LSU rDNA data support the hypothesis that Dibaeis is more closely related to IcmadophUa than it is to Baeomyces. Therefore, these data support the resurrection of Dibaeis from its previous synonymy with Baeomyces based on the characters of ascocarp colour and ascus morphology. The recognition of two distinct genera is also consistent with character state distribution of unique lichen acids.
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