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The First Episode Rapid Early Intervention for Eating Disorders (FREED) service model is associated with significant reductions in wait times and improved clinical outcomes for emerging adults with recent-onset eating disorders. An understanding of how FREED is implemented is a necessary precondition to enable an attribution of these findings to key components of the model, namely the wait-time targets and care package.
This study evaluated fidelity to the FREED service model during the multicentre FREED-Up study.
Participants were 259 emerging adults (aged 16–25 years) with an eating disorder of <3 years duration, offered treatment through the FREED care pathway. Patient journey records documented patient care from screening to end of treatment. Adherence to wait-time targets (engagement call within 48 h, assessment within 2 weeks, treatment within 4 weeks) and care package, and differences in adherence across diagnosis and treatment group were examined.
There were significant increases (16–40%) in adherence to the wait-time targets following the introduction of FREED, irrespective of diagnosis. Receiving FREED under optimal conditions also increased adherence to the targets. Care package use differed by component and diagnosis. The most used care package activities were psychoeducation and dietary change. Attention to transitions was less well used.
This study provides an indication of adherence levels to key components of the FREED model. These adherence rates can tentatively be considered as clinically meaningful thresholds. Results highlight aspects of the model and its implementation that warrant future examination.
Child and adolescent mental health is understood to be highly embedded in the family system, particularly the parent-child relationship. Indeed, models of risk pathways to psychopathology emphasize interactions and transactions between the family environment and individual differences at the child level, including gene-environment interplay. Therapist knowledge regarding the role of the family in these pathways is central to the clinical competencies involved in the evidence-based treatment of children and adolescents. This chapter provides an overview of current theory regarding family contributions to the major forms psychopathology seen among children and adolescents. Attention is given to key family and parenting variables as they are conceptualized in the current literature, the mechanisms by which these variables contribute to the emergence and maintenance of psychopathology and the origins and determinants of parenting.
The training of mental health practitioners has seen a growing focus on core competencies in recent years in response to the need for guidance in the implementation of evidence-based treatment of mental disorders. This chapter outlines the aims and advantages of a competency-based approach and describes existing models of competencies in the treatment of adults, children and adolescents. For the most part, existing models have focused on cognitive behavioural therapy (CBT) to the exclusion of other evidence-based approaches and on individual therapy at the expense of treatment in which family members are actively involved. We present a novel model of the therapist competencies needed for the effective delivery of evidence-based family interventions for common child and adolescent mental health disorders. The proposed framework provides a potential foundation for curricula planning and assessment in practitioner training and stands to inform evidence-based practice guidelines and future research into professional development.
ABSTRACT IMPACT: The Independent Investigator Incubator program provides 1:1 mentoring from ‘super-mentors’ to enhance junior faculty careers in research. OBJECTIVES/GOALS: In 2014, the Indiana University School of Medicine (IUSM) in collaboration with the Indiana CTSI established the Independent Investigator Incubator (I3) Program. The I3 Program is designed to provide 1:1 mentoring for new research faculty during the crucial early years of their careers. Our goal is to provide an overview of the I3 design and 5-year data. METHODS/STUDY POPULATION: The I3 Program employs a resource-sharing, centralized design that provides concentrated 1:1 mentorship from a senior faculty ‘super mentor’ as well as other resources, such as grant writing support. Unlike many mentorship programs, I3 mentors closely interact with the mentees within the School and are compensated for their efforts (5% full-time equivalency per mentee, max of 15%). The number of ‘super mentors’ has grown from 6 to 15 faculty over 5 years, and mentors typically serve 4 to 5 mentees. Mentee applications are accepted on a rolling enrollment basis. The I3 mentees represent a diverse group based on sex, ethnicity, terminal degree, academic track, and discipline. Mentors and mentees have annual reviews through the program. RESULTS/ANTICIPATED RESULTS: In five years, 110 mentees have enrolled in the I3 program. Upon entering, 53% had no external funding, 28% had internal funding, 12% had K-awards, 7% had R03/R21 awards. Over the first five years, 75% have received extramural funding. The median funding was $340,000 with nearly a third of mentees securing grants > 1 million in direct costs. For mentees who joined the program in its first three years (n=59), the average time to a notable extramural grant (defined as a NIH or foundation grant >$300K direct costs) was 2.2 years (median - 2.6 years). Nearly all mentees were satisfied with their mentor pairing based on the mentor’s ‘availability’ and ‘valuable feedback,’ and all mentees wanted the mentoring relationship to continue DISCUSSION/SIGNIFICANCE OF FINDINGS: Since 2014, the I3 Program has had a positive impact on the careers of junior faculty at IUSM as determined by faculty satisfaction and funding metrics. Future focus areas will include developing criteria/models for graduating from the program to balance fiscal sustainability with mentee needs during their transition to mid-career.
The rapid spread of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) throughout key regions of the United States in early 2020 placed a premium on timely, national surveillance of hospital patient censuses. To meet that need, the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN), the nation’s largest hospital surveillance system, launched a module for collecting hospital coronavirus disease 2019 (COVID-19) data. We present time-series estimates of the critical hospital capacity indicators from April 1 to July 14, 2020.
From March 27 to July 14, 2020, the NHSN collected daily data on hospital bed occupancy, number of hospitalized patients with COVID-19, and the availability and/or use of mechanical ventilators. Time series were constructed using multiple imputation and survey weighting to allow near–real-time daily national and state estimates to be computed.
During the pandemic’s April peak in the United States, among an estimated 431,000 total inpatients, 84,000 (19%) had COVID-19. Although the number of inpatients with COVID-19 decreased from April to July, the proportion of occupied inpatient beds increased steadily. COVID-19 hospitalizations increased from mid-June in the South and Southwest regions after stay-at-home restrictions were eased. The proportion of inpatients with COVID-19 on ventilators decreased from April to July.
The NHSN hospital capacity estimates served as important, near–real-time indicators of the pandemic’s magnitude, spread, and impact, providing quantitative guidance for the public health response. Use of the estimates detected the rise of hospitalizations in specific geographic regions in June after they declined from a peak in April. Patient outcomes appeared to improve from early April to mid-July.
The most effective treatments for child and adolescent psychopathology are often family-based, emphasising the active involvement of family members beyond the referred individual. This book details the clinical skills, knowledge, and attitudes that form the core competencies for the delivery of evidence-based family interventions for a range of mental health problems. Offering practical case studies to illustrate treatment principles, and discussing barriers to treatment and problem-solving in relation to common difficulties. Covers topics such as anxiety, attention-deficit hyperactivity disorder, sleep, and eating disorders. Therapist competencies are thoroughly examined, from the role they play in severe/complex cases and in achieving successful outcomes to commonly misunderstood aspects of family-based interventions and how they can be enhanced. Clinical approaches to working with diverse families, and those of children affected by parental psychopathology, child maltreatment and family violence are also explored. Essential reading for psychologists, psychiatrists, paediatricians, mental health nurses, counsellors and social workers.
People living in precarious housing or homelessness have higher than expected rates of psychotic disorders, persistent psychotic symptoms, and premature mortality. Psychotic symptoms can be modeled as a complex dynamic system, allowing assessment of roles for risk factors in symptom development, persistence, and contribution to premature mortality.
The severity of delusions, conceptual disorganization, hallucinations, suspiciousness, and unusual thought content was rated monthly over 5 years in a community sample of precariously housed/homeless adults (n = 375) in Vancouver, Canada. Multilevel vector auto-regression analysis was used to construct temporal, contemporaneous, and between-person symptom networks. Network measures were compared between participants with (n = 219) or without (n = 156) history of psychotic disorder using bootstrap and permutation analyses. Relationships between network connectivity and risk factors including homelessness, trauma, and substance dependence were estimated by multiple linear regression. The contribution of network measures to premature mortality was estimated by Cox proportional hazard models.
Delusions and unusual thought content were central symptoms in the multilevel network. Each psychotic symptom was positively reinforcing over time, an effect most pronounced in participants with a history of psychotic disorder. Global connectivity was similar between those with and without such a history. Greater connectivity between symptoms was associated with methamphetamine dependence and past trauma exposure. Auto-regressive connectivity was associated with premature mortality in participants under age 55.
Past and current experiences contribute to the severity and dynamic relationships between psychotic symptoms. Interrupting the self-perpetuating severity of psychotic symptoms in a vulnerable group of people could contribute to reducing premature mortality.
Representation of under-represented minority (URM) faculty in the health sciences disciplines is persistently low relative to both national and student population demographics. Although some progress has been made through nationally funded pipeline development programs, demographic disparities in the various health sciences disciplines remain. As such the development of innovative interventions to help URM faculty and students overcome barriers to advancement remains a national priority. To date, the majority of pipeline development programs have focused on academic readiness, mentorship, and professional development. However, insights from the social sciences literature related to “extra-academic” (e.g., racism) barriers to URM persistence in higher education suggest the limitations of efforts exclusively focused on cognitively mediated endpoints. The purpose of this article is to synthesize findings from the social sciences literature that can inform the enhancement of URM pipeline development programs. Specifically, we highlight research related to the social, emotional, and contextual correlates of URM success in higher education including reducing social isolation, increasing engagement with research, bolstering persistence, enhancing mentoring models, and creating institutional change. Supporting URM’s success in the health sciences has implications for the development of a workforce with the capacity to understand and intervene on the drivers of health inequalities.
Information on performance of sequential treatments of quizalofop-P-ethyl with florpyrauxifen-benzyl on rice is lacking. Field studies were conducted in 2017 and 2018 in Stoneville, MS, to evaluate sequential timings of quizalofop-P-ethyl with florpyrauxifen-benzyl included in preflood treatments of rice. Quizalofop-P-ethyl treatments were no quizalofop-P-ethyl; sequential applications of quizalofop-P-ethyl at 120 g ha−1 followed by (fb) 120 g ai ha−1 applied to rice in the 2- to 3-leaf (EPOST) fb the 4-leaf to 1-tiller (LPOST) growth stages or LPOST fb 10 d after flooding (PTFLD); quizalofop-P-ethyl at 100 g ha−1 fb 139 g ha−1 EPOST fb LPOST or LPOST fb PTFLD; quizalofop-P-ethyl at 139 g ha−1 fb 100 g ha−1 EPOST fb LPOST and LPOST fb PTFLD; and quizalofop-P-ethyl at 85 g ha−1 fb 77 g ha−1 fb 77 g ha−1 EPOST fb LPOST fb PTFLD. Quizalofop-P-ethyl was applied alone and in mixture with florpyrauxifen-benzyl at 29 g ai ha−1 LPOST. Visible rice injury 14 d after PTFLD (DA-PTFLD) was no more than 3%. Visible control of volunteer rice (‘CL151’ and ‘Rex’) 7 DA-PTFLD was similar and at least 95% for each quizalofop-P-ethyl treatment. Barnyardgrass control with quizalofop-P-ethyl at 120 fb 120 g ha−1 LPOST fb PTFLD was greater (88%) in mixture with florpyrauxifen-benzyl. The addition of florpyrauxifen-benzyl to quizalofop-P-ethyl increased rough rice yield when quizalofop-P-ethyl was applied at 100 g ha−1 fb 139 g ha−1 EPOST fb LPOST. Sequential applications of quizalofop-P-ethyl at 120 g ha−1 fb 120 g ha−1 EPOST fb LPOST, 100 g ha−1 fb 139 g ha−1 EPOST fb LPOST, or 139 g ha−1 fb 100 g ha−1 EPOST fb LPOST controlled grass weed species. The addition of florpyrauxifen-benzyl was not beneficial for grass weed control. However, because quizalofop-P-ethyl does not control broadleaf weeds, florpyrauxifen-benzyl could provide broad-spectrum weed control in acetyl coenzyme A carboxylase–resistant rice.
To investigate the association between energy drink (ED) use and sleep-related disturbances in a population-based sample of young adults from the Raine Study.
Analysis of cross-sectional data obtained from self-administered questionnaires to assess ED use and sleep disturbance (Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire (FOSQ-10) and the Pittsburgh Sleep Symptoms Questionnaire–Insomnia (PSSQ-I)). Regression modelling was used to estimate the effect of ED use on sleep disturbances. All models adjusted for various potential confounders.
Males and females, aged 22 years, from Raine Study Gen2–22 year follow-up.
Of the 1115 participants, 66 % were never/rare users (i.e. <once/month) of ED, 17·0 % were occasional users (i.e. >once/month to <once/week) and 17 % were frequent users (≥once/week). Compared with females, a greater proportion of males used ED occasionally (19 % v. 15 %) or frequently (24 % v. 11 %). Among females, frequent ED users experienced significantly higher symptoms of daytime sleepiness (FOSQ-10: β = 0·93, 95 % CI 0·32, 1·54, P = 0·003) and were five times more likely to experience insomnia (PSSQ-I: OR = 5·10, 95 % CI 1·81, 14·35, P = 0·002) compared with never/rare users. No significant associations were observed in males for any sleep outcomes.
We found a positive association between ED use and sleep disturbances in young adult females. Given the importance of sleep for overall health, and ever-increasing ED use, intervention strategies are needed to curb ED use in young adults, particularly females. Further research is needed to determine causation and elucidate reasons for gender-specific findings.
This 17-year prospective study applied a social-developmental lens to the challenge of distinguishing predictors of adolescent-era substance use from predictors of longer term adult substance use problems. A diverse community sample of 168 individuals was repeatedly assessed from age 13 to age 30 using test, self-, parent-, and peer-report methods. As hypothesized, substance use within adolescence was linked to a range of likely transient social and developmental factors that are particularly salient during the adolescent era, including popularity with peers, peer substance use, parent–adolescent conflict, and broader patterns of deviant behavior. Substance abuse problems at ages 27–30 were best predicted, even after accounting for levels of substance use in adolescence, by adolescent-era markers of underlying deficits, including lack of social skills and poor self-concept. The factors that best predicted levels of adolescent-era substance use were not generally predictive of adult substance abuse problems in multivariate models (either with or without accounting for baseline levels of use). Results are interpreted as suggesting that recognizing the developmental nature of adolescent-era substance use may be crucial to distinguishing factors that predict socially driven and/or relatively transient use during adolescence from factors that predict long-term problems with substance abuse that extend well into adulthood.