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An inflammation-induced imbalance in the kynurenine pathway (KP) has been reported in major depressive disorder but the utility of these metabolites as predictive or therapeutic biomarkers of behavioral activation (BA) therapy is unknown.
Serum samples were provided by 56 depressed individuals before BA therapy and 29 of these individuals also provided samples after 10 weeks of therapy to measure cytokines and KP metabolites. The PROMIS Depression Scale (PROMIS-D) and the Sheehan Disability Scale were administered weekly and the Beck depression inventory was administered pre- and post-therapy. Data were analyzed with linear mixed-effect, general linear, and logistic regression models. The primary outcome for the biomarker analyses was the ratio of kynurenic acid to quinolinic acid (KynA/QA).
BA decreased depression and disability scores (p's < 0.001, Cohen's d's > 0.5). KynA/QA significantly increased at post-therapy relative to baseline (p < 0.001, d = 2.2), an effect driven by a decrease in QA post-therapy (p < 0.001, uncorrected, d = 3.39). A trend towards a decrease in the ratio of kynurenine to tryptophan (KYN/TRP) was also observed (p = 0.054, uncorrected, d = 0.78). The change in KynA/QA was nominally associated with the magnitude of change in PROMIS-D scores (p = 0.074, Cohen's f2 = 0.054). Baseline KynA/QA did not predict response to BA therapy.
The current findings together with previous research show that electronconvulsive therapy, escitalopram, and ketamine decrease concentrations of the neurotoxin, QA, raise the possibility that a common therapeutic mechanism underlies diverse forms of anti-depressant treatment but future controlled studies are needed to test this hypothesis.
Ambulatory healthcare-associated infections (HAIs) occur frequently in children and are associated with morbidity. Less is known about ambulatory HAI costs. This study estimated additional costs associated with pediatric ambulatory central-line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSIs) following ambulatory surgery.
Retrospective case-control study.
Four academic medical centers.
Children aged 0–22 years seen between 2010 and 2015 and at risk for HAI as identified by electronic queries.
Chart review adjudicated HAIs. Charges were obtained for patients with HAIs and matched controls 30 days before HAI, on the day of, and 30 days after HAI. Charges were converted to costs and 2015 USD. Mixed-effects linear regression was used to estimate the difference-in-differences of HAI case versus control costs in 2 models: unrecorded charge values considered missing and a sensitivity analysis with unrecorded charge considered $0.
Our search identified 177 patients with ambulatory CLABSIs, 53 with ambulatory CAUTIs, and 26 with SSIs following ambulatory surgery who were matched with 382, 110, and 75 controls, respectively. Additional cost associated with an ambulatory CLABSI was $5,684 (95% confidence interval [CI], $1,005–$10,362) and $6,502 (95% CI, $2,261–$10,744) in the 2 models; cost associated with a CAUTI was $6,660 (95% CI, $1,055, $12,145) and $2,661 (95% CI, −$431 to $5,753); cost associated with an SSI following ambulatory surgery at 1 institution only was $6,370 (95% CI, $4,022–$8,719).
Ambulatory HAI in pediatric patients are associated with significant additional costs. Further work is needed to reduce ambulatory HAIs.
Catheter-associated urinary tract infections (CAUTIs) occur frequently in pediatric inpatients, and they are associated with increased morbidity and cost. Few studies have investigated ambulatory CAUTIs, despite at-risk children utilizing home urinary catheterization. This retrospective cohort and case-control study determined incidence, risk factors, and outcomes of pediatric patients with ambulatory CAUTI.
Broad electronic queries identified potential patients with ambulatory urinary catheters, and direct chart review confirmed catheters and adjudicated whether ambulatory CAUTI occurred. CAUTI definitions included clean intermittent catheterization (CIC). Our matched case-control analysis assessed risk factors.
Five urban, academic medical centers, part of the New York City Clinical Data Research Network.
Potential patients were age <22 years who were seen between October 2010 and September 2015.
In total, 3,598 eligible patients were identified; 359 of these used ambulatory catheterization (representing186,616 ambulatory catheter days). Of these, 63 patients (18%) experienced 95 ambulatory CAUTIs. The overall ambulatory CAUTI incidence was 0.51 infections per 1,000 catheter days (1.35 for indwelling catheters and 0.47 for CIC; incidence rate ratio, 2.88). Patients with nonprivate medical insurance (odds ratio, 2.5; 95% confidence interval, 1.1–6.3) were significantly more likely to have ambulatory CAUTIs in bivariate models but not multivariable models. Also, 45% of ambulatory CAUTI resulted in hospitalization (median duration, 3 days); 5% resulted in intensive care admission; 47% underwent imaging; and 88% were treated with antibiotics.
Pediatric ambulatory CAUTIs occur in 18% of patients with catheters; they are associated with morbidity and healthcare utilization. Ambulatory indwelling catheter CAUTI incidence exceeded national inpatient incidence. Future quality improvement research to reduce these harmful infections is warranted.
The purpose of this study was to document the lived experiences of flow during an optimal music performance. Fifteen undergraduate musicians (Mage = 19, 53% male) participated in in-depth, semi-structured interviews, where they were asked to describe an optimal performance experience. Results from an inductive qualitative analysis revealed three main themes: environmental context, emotional connectedness and interpersonal relationships, which synthesised the optimal performance experience. The results also suggest that flow among musicians appears to be a common emotional state and similar to that conceptualised in sport. The ways a musician experiences flow are important, as these can help music educators gain a better understanding of the conceptualisation of flow within music performance. However, given the nuanced differences in the sociocultural environment of a flow experience typical in a sport or music performance, additional research into the divergences of domains may be warranted.
B-vitamin insufficiency is associated with depression but it is uncertain if treatment with these is effective in prevention or treatment.
Objectives and Aims
1. To determine if daily supplementation with B-vitamins enhances response to antidepressants.
2. Systematic review and meta-analysis of randomised, placebo-controlled trials of B-vitamins for depressive symptoms in adults.
1. The B-VITAGE trial is a 52 week randomised, double-blind, placebo-controlled trial of citalopram together with vitamin B12, B6 and folic acid in older adult participants with major depression.
2. Systematic review of 13 eligible trials of B-vitamin supplementation for the reduction, remission and prevention of clinically significant depressive symptoms.
Remission was achieved by 78.1% and 79.4% of participants treated with placebo (n=76) and vitamins (n=77) by week 12 (p=0.328), and by 75.8% and 85.5% at week 52 (effect of intervention over 52 weeks: odds ratio, OR=2.49; 95% confidence interval, 95%CI=1.12,5.51). The risk of subsequent relapse among those who had achieved remission of symptoms at week 12 was lower in the vitamin group (OR=0.33, 95%CI=0.12,0.94).
Short-term use of vitamins did not improve depressive symptoms in adults with major depression treated with antidepressants (standardised mean difference=-0.12, 95% CI=-0.45,0.22), but more prolonged consumption decreased the risk of relapse (OR=0.33, 95%CI=0.12,0.94) and the onset of clinically significant symptoms in people at risk (risk ratio=0.65, 95%CI=0.43,0.98).
Short-term use of B-vitamins does not appear to benefit depressive symptoms although longer use may enhance and sustain antidepressant response and decrease the risk of relapse or onset of clinically significant depression.
Exposure to glucocorticoid levels higher than appropriate for current developmental stages induces offspring metabolic dysfunction. Overfed/obese (OB) ewes and their fetuses display elevated blood cortisol, while fetal Adrenocorticotropic hormone (ACTH) remains unchanged. We hypothesized that OB pregnancies would show increased placental 11β hydroxysteroid dehydrogenase 2 (11β-HSD2) that converts maternal cortisol to fetal cortisone as it crosses the placenta and increased 11β-HSD system components responsible for peripheral tissue cortisol production, providing a mechanism for ACTH-independent increase in circulating fetal cortisol. Control ewes ate 100% National Research Council recommendations (CON) and OB ewes ate 150% CON diet from 60 days before conception until necropsy at day 135 gestation. At necropsy, maternal jugular and umbilical venous blood, fetal liver, perirenal fat, and cotyledonary tissues were harvested. Maternal plasma cortisol and fetal cortisol and cortisone were measured. Fetal liver, perirenal fat, cotyledonary 11β-HSD1, hexose-6-phosphate dehydrogenase (H6PD), and 11β-HSD2 protein abundance were determined by Western blot. Maternal plasma cortisol, fetal plasma cortisol, and cortisone were higher in OB vs. CON (p < 0.01). 11β-HSD2 protein was greater (p < 0.05) in OB cotyledonary tissue than CON. 11β-HSD1 abundance increased (p < 0.05) in OB vs. CON fetal liver and perirenal fat. Fetal H6PD, an 11β-HSD1 cofactor, also increased (p < 0.05) in OB vs. CON perirenal fat and tended to be elevated in OB liver (p < 0.10). Our data provide evidence for increased 11β-HSD system components responsible for peripheral tissue cortisol production in fetal liver and adipose tissue, thereby providing a mechanism for an ACTH-independent increase in circulating fetal cortisol in OB fetuses.
This chapter situates our analysis of the Indonesian labor movement within theoretical debates in comparative labor politics and Indonesian politics and presents the broad contours of our answers to the three overarching questions that guide the analysis in the book: Why did Indonesia’s labor movement combine contentious street politics with autonomous electoral engagement, why has the Indonesian labor movement been surprisingly effective in winning pro-labor policies, and why have unions have been less successful in the electoral arena than in the policy arena? In answering these questions, the chapter delineates three phases of the development of Indonesia’s labor movement, and emphasizes the role of authoritarian legacies, changing opportunity structures, organizational learning, the geographic concentration of the labor movement, and comparatively weak cooperation across organizational divides in the electoral arena. The chapter also outlines our research sites and methods, provides background information about the economic and political contexts, describes the union landscape, and concludes with a summary of the book’s chapters.
This chapter examines the first decade of worker mobilization in post-Suharto Indonesia. At the national level, the labor movement experienced stunning success in shaping labor law reform during this period. In the absence of strong ties to political parties, unions created mayhem in the streets to capture the attention of politicians and raise the cost of supporting laws that unions opposed. Since both the executive and the legislature had to approve labor legislation, unions could stop the enactment of antilabor laws by peeling away legislative support. This task was facilitated by government instability and weak presidential control over coalition partners and the fact that the Minister of Manpower was from a labor background in some years. At the local level, by contrast, unions had fewer points of entry and less leverage. Although newly created tripartite wage councils gave workers a voice in wage-setting, executives had the final authority to determine minimum wages increases, and they were relatively immune to pressure from workers until direct elections were phased in between mid-2005 and late 2008.
This chapter explores the question of whether the increased electoral engagement of Indonesia’s unions has fostered the development of a working-class constituency. After explaining the specific challenges of developing such a constituency, we utilize evidence from surveys conducted in working-class communities in four union-dense districts in Bekasi and Tangerang to assess workers’ views on political issues and to analyze their voting behavior in the 2009 and 2014 legislative and presidential races. We find evidence that there is a stable if not growing proportion of workers with politicized collective identities. In legislative races, we argue that these politicized collective identities have not resulted in the formation of a working-class constituency but rather an organizational constituency rooted in the membership of one union, FSPMI. In presidential races, however, we find stronger evidence that union engagement in politics has contributed to the formation of a working-class constituency that crosses organizational divides.
This chapter examines the forces that produced Indonesia’s highly mobilized but politically independent labor movement. It describes the authoritarian legacies that shaped the first phase of its evolution when the labor movement had no choice but to use street politics as its primary weapon in the struggle for more worker-friendly labor policy. In a second phase, new opportunities opened by the decentralization process led unions to experiment with electoral engagement. The focus of these efforts was at the local level where union activists backed executive candidates from many different parties, pragmatically trading their political support for pro-labor measures. In a third phase, unions drew on their past organizational learning and experimentation to extend their electoral engagement to the legislative arena. Reluctant to tie themselves directly to a single party, union strategists chose to place union cadres on legislative tickets of many different political parties. Autonomous electoral participation now complemented street politics as central features of labor’s political strategy.
This chapter examines the Indonesian labor movement’s unusual strategy of running union cadres as legislative candidates with a large number of non-programmatic parties. It begins by assessing parties’ motivations for entering into these partnerships with unions, tracking the evolving strategies of the two parties that engaged most systematically with unions. It then turns its attention to SPN and FSPMI, the two union federations that had the strongest organizational commitment to running legislative candidates in the period between 2004 and 2014. In both cases, the initial decision to engage in the legislative arena was necessarily taken by the central leadership. But, in SPN’s case, the poor showing of its candidates in the 2009 elections created internal friction, and the union quickly backed away from its organizational commitment to electoral politics. By contrast, FSPMI deepened its engagement in the 2014 legislative elections, resulting in the election of two union cadres to local legislative office in Bekasi. Unperturbed by the setbacks it experienced during the first Jokowi presidency, it again refined its institutional strategy for 2019.
This chapter focuses on the Indonesian labor movement’s increasingly assertive and offensive posture in the second decade after Suharto’s fall. At the national level, unions learned to lobby more effectively, generate favorable media attention, and leverage judicial institutions to complement street mobilization. They played a central role in the passage of a groundbreaking social security law. They made even greater strides at the local level, where they embarked on an unprecedented round of mobilizations around wages. Having consolidated their networks and their position on the wage councils, they transformed them into institutions that delivered sustained real wage gains. In doing so, they exploited the opportunities presented by direct local and provincial executive elections, leveraging electoral cycles, and harnessing regional patterns of wage-setting to win massive gains. Massive protests in several core industrial areas and stronger coordination among national confederations also allowed unions to nationalize local conflicts. Even after this support vanished, unions in some parts of Indonesia sustained substantial real minimum wage increases through their local organizing efforts.
This chapter provides a detailed account of the backlash against unions in Jokowi’s first term in office and some reflections on the lessons that can be learned from the Indonesian case. These lessons include the importance of geographic and institutional factors in allowing the labor movement to mobilize on a massive scale despite its low density and high levels of fragmentation, the role of the broader regime context in creating a political climate conducive for advancing a labor agenda through street politics, and the conditions under which decentralization can offer new opportunities for unions to pursue prolabor policies at the local level. However, they also include the ways in which the Indonesian labor movement’s diffuse, networked forms of power constitute a distinctive type of unionism, one that can compensate for weakness on classic measures of union strength.