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To understand how exposure to victimization during adolescence and the presence of comorbid psychological conditions influence substance use treatment entry and substance use disorder diagnosis from 14 to 25 years old among serious juvenile offenders, this study included 1,354 serious juvenile offenders who were prospectively followed over 7 years. Growth mixture modeling was used to assess profiles of early victimization during adolescence (14–17 years). Discrete time survival mixture analysis was used to assess time to treatment entry and substance use disorder diagnosis. Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) were used as predictors of survival time. Mixture models revealed three profiles of victimization: sustained poly-victimization, moderate/decreasing victimization, and low victimization. Youth in the sustained poly-victimization class were more likely to enter treatment earlier and have a substance use diagnosis earlier than other classes. PTSD was a significant predictor of treatment entry for youth in the sustained poly-victimization class, and MDD was a significant predictor of substance use disorder diagnosis for youth in the moderate/decreasing victimization class. Therefore, substance use prevention programming targeted at youth experiencing poly-victimization in early adolescence—especially those who have PTSD or MDD—is needed.
OBJECTIVES/SPECIFIC AIMS: This study (1) investigated the presence and severity of autonomic nervous system (ANS) dysfunction in patients with pre-symptomatic Huntington Disease (HD) and (2) determined if pharmacologic manipulation of the ANS could modify the progression of HD. METHODS/STUDY POPULATION: Using a unique data set of children at-risk for HD (the Kids-HD study), markers of autonomic function (resting heart rate [rHR], blood pressure [BP], and core body temperature [CBT]) were compared between pre-symptomatic, gene-expanded children (psGE) and healthy developing children using mixed models analyses controlling for sex, age, and body mass index. Included participants had to be < 18 years old and be at least 10 years from their predicted motor diagnosis of HD. Using the Enroll-HD database, inverse-propensity score weighted, Cox Regression analyses investigated the effects of beta-blockers on the timing of motor diagnosis of presymptomatic, adult patients with HD. RESULTS/ANTICIPATED RESULTS: Compared to healthy controls, the psGE participants had significantly (p<0.05) higher mean rHR, systolic BP percentile, and CBT compared to the healthy controls (elevated by 4.01 bpm 0.19°C, and 5.96 percentile points, respectively, in the psGE group). Participants from Enroll-HD who were using a beta-blocker prior to motor diagnosis (n=65) demonstrated a significantly lower annualized risk of motor diagnosis [HR=0.56, p=0.03], compared to other participants with HD (n=1972). DISCUSSION/SIGNIFICANCE OF IMPACT: Sympathetic nervous system activity is elevated in patients with HD decades prior to their predicted motor diagnosis. Furthermore, modulation of the sympathetic nervous system with beta-blockers significantly lowers the annualized risk of motor diagnosis of HD.
be an elliptic curve over a field
. There is a functor
from the category of finitely presented torsion-free left
-modules to the category of abelian varieties isogenous to a power of
, and a functor
in the opposite direction. We prove necessary and sufficient conditions on
for these functors to be equivalences of categories. We also prove a partial generalization in which
is replaced by a suitable higher-dimensional abelian variety over
Workfare increases requirements on welfare claimants: a major shift in UK social welfare policy post-1980s. Political, academic and cultural debates surround the ethical basis, and practical operations, of workfare schemes. Moreover, the UK government has claimed that workfare provides value for money in an age of austerity, ‘help and support’ for the long-term unemployed, and ‘incentives’ for increased claimant job-seeking. This article presents results gathered from sociological research into the UK's ‘Work Programme’ workfare scheme in order to contextualise these debates and contribute to wider academic and social policy workfare analyses. It finds a complex picture: a largely pointless scheme, resented by many participants, but providing a basic social service for some others.
Obesity is a major risk factor for osteoarthritis (OA) whilst there is some evidence that diabetes also increases risk. Metformin is a common oral treatment for those with diabetes.
The aim is to investigate whether metformin reduces the risk of OA.
This was a cohort study set within the Consultations in Primary Care Archive, with 3217 patients with type 2 diabetes. Patients at 13 general practices with recorded type 2 diabetes in the baseline period (2002–2003) and no prior record of OA were identified. Exposure was a prescription for metformin. Outcome was an OA record during follow up. Cox proportional hazard models with Gamma frailty term were fitted: adjusted for age, gender, deprivation, and comorbidity.
There was no association between prescribed metformin treatment at baseline and OA (adjusted HR: 1.02, 95% CI: 0.91, 1.15). A similar non- significant association was found when allowing exposure status of prescription of metformin to vary over time.
Driving in persons with dementia poses risks that must be counterbalanced with the importance of the care for autonomy and mobility. Physicians often find substantial challenges in the assessment and reporting of driving safety for persons with dementia. This paper describes a driving in dementia decision tool (DD-DT) developed to aid physicians in deciding when to report older drivers with either mild dementia or mild cognitive impairment to local transportation administrators.
A multi-faceted, computerized decision support tool was developed, using a systematic literature and guideline review, expert opinion from an earlier Delphi study, as well as qualitative interviews and focus groups with physicians, caregivers of former drivers with dementia, and transportation administrators. The tool integrates inputs from the physician-user about the patient's clinical and driving history as well as cognitive findings, and it produces a recommendation for reporting to transportation administrators. This recommendation is translated into a customized reporting form for the transportation authority, if applicable, and additional resources are provided for the patient and caregiver.
An innovative approach was needed to develop the DD-DT. The literature and guideline review confirmed the algorithm derived from the earlier Delphi study, and barriers identified in the qualitative research were incorporated into the design of the tool.
The Republic of Senegal Disaster Preparedness and Response Exercise was held from June 2-6, 2014, in Dakar, Senegal. The goal was to assist in familiarizing roles and responsibilities within 3 existing plans and to update the National Disaster Management Strategic Work Plan.
There were 60 participants in the exercise, which was driven by a series of evolving disaster scenarios. During the separate Disaster Management Strategic Work Plan review, participants refined a list of projects, including specific tasks to provide a “road map” for completing each project, project timelines, and estimated resource requirements. Project staff administered a survey to conference participants.
A total of 86% of respondents had improved knowledge of Senegal disaster plans as a result of the exercise. A total of 89% of respondents had a better understanding of their ministry’s role in disaster response, and 92% had a better understanding of the role of the military during a pandemic. Participants also generated ideas for disaster management system improvement in Senegal through a formal “gap analysis.”
Participants were in strong agreement that the exercise helped them to better understand the contents of their disaster response plans, build relationships across ministerial lines, and effectively enhance future disaster response efforts. (Disaster Med Public Health Preparedness. 2017;11:183–189)
Research was conducted from 2011 to 2014 to determine weed population dynamics and frequency of glyphosate-resistant (GR) Palmer amaranth with herbicide programs consisting of glyphosate, dicamba, and residual herbicides in dicamba-tolerant cotton. Five treatments were maintained in the same plots over the duration of the experiment: three sequential POST applications of glyphosate with or without pendimethalin plus diuron PRE; three sequential POST applications of glyphosate plus dicamba with and without the PRE herbicides; and a POST application of glyphosate plus dicamba plus acetochlor followed by one or two POST applications of glyphosate plus dicamba without PRE herbicides. Additional treatments included alternating years with three sequential POST applications of glyphosate only and glyphosate plus dicamba POST with and without PRE herbicides. The greatest population of Palmer amaranth was observed when glyphosate was the only POST herbicide throughout the experiment. Although diuron plus pendimethalin PRE in a program with only glyphosate POST improved control during the first 2 yr, these herbicides were ineffective by the final 2 yr on the basis of weed counts from soil cores. The lowest population of Palmer amaranth was observed when glyphosate plus dicamba were applied regardless of PRE herbicides or inclusion of acetochlor POST. Frequency of GR Palmer amaranth was 8% or less when the experiment was initiated. Frequency of GR Palmer amaranth varied by herbicide program during 2012 but was similar among all herbicide programs in 2013 and 2014. Similar frequency of GR Palmer amaranth across all treatments at the end of the experiment most likely resulted from pollen movement from Palmer amaranth treated with glyphosate only to any surviving female plants regardless of PRE or POST treatment. These data suggest that GR Palmer amaranth can be controlled by dicamba and that dicamba is an effective alternative mode of action to glyphosate in fields where GR Palmer amaranth exists.
Fibromyalgia (FM) is common in older adults suffering from mood disorders. However, clinical diagnosis of FM is challenging, particularly in psychiatric settings. We examined the prevalence of FM and the sensitivity of three simple screeners for FM.
Using cross-sectional data, we evaluated three tests against the American College of Rheumatology (ACR) 1990 Criteria for the Classification of FM: a “Do you often feel like you hurt all over?” question, a pain map score, and the Pope and Hudson (PH) interview for FM. Participants were 185 community-dwelling adults ≥ 60 years old with comorbid depression and chronic low back pain evaluated at a late-life mental health clinic.
Fifty three of 185 participants (29%) met the ACR 1990 FM criteria. Compared to those without FM, the FM group had more “yes” answers to the “hurt all over?” question and higher pain map scores. To reach a sensitivity of at least 0.90, the cut-off score for the pain map was 8. The sensitivity of the pain map, “hurt all over?” question, and PH criteria were 0.92 [95%CI 0.82–0.98], 0.91 [95%CI 0.79–0.97], and 0.94 [95%CI 0.843–0.99] respectively.
Nearly one in three older adults suffering from depression and chronic low back pain met ACR 1990 FM criteria. Three short screening tests showed high sensitivity when compared to the ACR 1990 FM criteria. Implementation of one of the simple screeners for FM in geriatric psychiatry settings may guide the need for further diagnostic evaluation.
Discovery of ultra-compact dwarfs (UCDs) in the past 15 years blurs the once thought clear division between classic globular clusters (GCs) and early-type galaxies. The intermediate nature of UCDs, which are larger and more massive than typical GCs but more compact than typical dwarf galaxies, has triggered hot debate on whether UCDs should be considered galactic in origin or merely the most extreme GCs. Previous studies of various scaling relations, stellar populations and internal dynamics did not give an unambiguous answer to the primary origin of UCDs. In this contribution, we present the first ever detailed study of global dynamics of 97 UCDs (rh ≳ 10 pc) associated with the central cD galaxy of the Virgo cluster, M87. We found that UCDs follow a different radial number density profile and different rotational properties from GCs. The orbital anisotropies of UCDs are tangentially-biased within ~ 40 kpc of M87 and become radially-biased with radius further out. In contrast, the blue GCs, which have similar median colors to our sample of UCDs, become more tangentially-biased at larger radii beyond ~ 40 kpc. Our analysis suggests that most UCDs in M87 are not consistent with being merely the most luminous and extended examples of otherwise normal GCs. The radially-biased orbital structure of UCDs at large radii is in general agreement with the scenario that most UCDs originated from the tidally threshed dwarf galaxies.
Financial regulators are weighing up the effectiveness of different templates for communicating investment risk to retirement savers since welfare depends on comprehension of risk information. We compare nine standard risk presentations using a discrete choice experiment where subjects choose between three retirement accounts. Switching between graphical or textual presentations, or between formats that emphasize benchmarks rather than return ranges or values at risk, affects predicted choices more than large changes in underlying risk. Innumerate individuals are more susceptible to presentation, and those with weak basic financial literacy are insensitive to increasing risk levels, regardless of presentation. Presentation effects are moderated but not eliminated as financial literacy improves.
Vasectomy is an extremely common, cost-effective, and permanent form of contraception dating back to the late 1800s. Presently, in the USA, approximately 500,000 vasectomies are performed annually. An approximated 11% of the USA population uses vasectomy as their means of contraception, making it the most commonly performed urologic procedure in the USA.
In comparison with other methods, vasectomy has been estimated to produce a 5-year saving of nearly $14,000. Contraception saves the USA $19 billion a year in medical costs. The three most cost-effective forms of contraception when comparing all types are the copper-T IUD, vasectomy, and the LNG-20 IUS.
Couples often come to a personal decision on contraception,
and therefore must choose from various options. Urologists
can educate patients regarding vasectomy as a safe, costeffective,
permanent form of contraception.
The initial office visit of a patient seeking a vasectomy
should begin with a complete history/physical and specific
questions regarding the patient’s reasons for seeking a vasectomy.
Questions to the patient should include: if discussion
about vasectomy has occurred with the partner; how many
children they have, and if they know anyone else who has had a
vasectomy. Other pertinent questions should include family
history of bleeding disorders, patient use of antiplatelet or
anticoagulant medications, and any past history of surgery/
trauma to the testis or inguinal canal (i.e., hernia). The exam,
while complete, should focus on palpation of both vasa deferentia.
The feasibility of performing the vasectomy procedure is
based on the patient’s anatomy. Complications to be discussed
include epididymitis, recanalization, chronic orchialgia, and