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Objectives: Concussions cause diverse symptoms that are often measured through a single symptom severity score. Researchers have postulated distinct dimensions of concussion symptoms, raising the possibility that total scores may not accurately represent their multidimensional nature. This study examined to what degree concussion symptoms, assessed by the Sport Concussion Assessment Tool 3 (SCAT3), reflect a unidimensional versus multidimensional construct to inform how the SCAT3 should be scored and advance efforts to identify distinct phenotypes of concussion. Methods: Data were aggregated across two prospective studies of sport-related concussion, yielding 219 high school and college athletes in the acute (<48 hr) post-injury period. Item-level ratings on the SCAT3 checklist were analyzed through exploratory and confirmatory factor analyses. We specified higher-order and bifactor models and compared their fit, interpretability, and external correlates. Results: The best-fitting model was a five-factor bifactor model that included a general factor on which all items loaded and four specific factors reflecting emotional symptoms, torpor, sensory sensitivities, and headache symptoms. The bifactor model demonstrated better discriminant validity than the counterpart higher-order model, in which the factors were highly correlated (r=.55–.91). Conclusions: The SCAT3 contains items that appear unidimensional, suggesting that it is appropriate to quantify concussion symptoms with total scores. However, evidence of multidimensionality was revealed using bifactor modeling. Additional work is needed to clarify the nature of factors identified by this model, explicate their clinical and research utility, and determine to what degree the model applies to other stages of injury recovery and patient subgroups. (JINS, 2018, 24, 793–804)
OBJECTIVES/SPECIFIC AIMS: (1) Identify current barriers to coordinated care between behavior consultation and PCIT services. (2) Identify current facilitators to coordinated care between behavior consultation and PCIT services. (3) Utilize this knowledge to create and pilot a coordinated care model that will enhance PCIT and behavior consultation service outcomes. METHODS/STUDY POPULATION: Objectives 1 and 2: Two focus groups consisting of 8–10 behavior consultants will be conducted to gather initial information on barriers and facilitators to coordinated care. Participants will be recruited from the state-funded behavior consultation team, to represent consultation occurring in rural and urban settings. All focus groups will be recorded and transcribed to capture questions and comments. Focus groups will be provided with an initial 10-minute overview of PCIT, including theory, prescribed strategies, and mode of intervention. A grand tour question will then be asked to elicit consultant perceptions of PCIT (e.g., “What are your thoughts on the compatibility between PCIT and behavior consultation services”), followed by probe questions deigned to elicit more detailed information about any perceived differences based on philosophical approach; differences in what is recommended in childcare settings Versus at home, etc.; and perceived barriers to coordinated care between school and outpatient services (e.g., “What factors make coordinating care with outpatient providers challenging?). Participants will be asked about their willingness to participate in a second focus group to review materials created to enhance coordinated care, based on their feedback. Objective 3. Based on feedback from the focus groups and quantitative data regarding factors associated with PCIT outcomes, we will develop an enhanced childcare component(s) for eventual implementation. To confirm our approach, we will invite the members of both focus groups back for a second session, in which we provide them with the created materials and elicit their feedback. We will start with a grand tour question (e.g., “How do you think parents and teachers would react to these materials?”) and then follow-up with probe questions related to feasibility (e.g., “How do you anticipate using these tools?”), appropriateness (e.g., “How adequately do you feel these materials address concerns with coordinated care?”), and acceptability (e.g., “How likely are you to begin using these tools within your consultation?”). Both focus groups will be recorded and transcribed to capture questions and comments. RESULTS/ANTICIPATED RESULTS: (1) Barriers and facilitators to coordinated care will include individual (e.g., acceptability of PCIT framework) and system-level factors (e.g., ease of communication between providers). (2) There will be significant overlap in coordination between the first phase of PCIT (which focuses on positive parenting strategies) and what is prescribed by behavior consultants. (3) There will be less compatibility between the second phase of PCIT (which focuses on disciplinary strategies) and what is prescribed by behavior consultants. (4) A coordinated are model will be rated as more feasible, appropriate, and acceptable to behavior consultants than PCIT services as currently prescribed. DISCUSSION/SIGNIFICANCE OF IMPACT: Childhood disruptive behaviors are among the most frequent reasons for referral to outpatient child/adolescent mental health clinics (Sukhodolsky et al., 2016). Disruptive and aggressive behaviors are problematic, not only for victims of children who are aggressive but also for aggressive children as they age. Although effective treatments exist, families are often provided with conflicting strategies for behavior management by outpatient clinicians and behavior consultants in the daycare setting, thus providing children inconsistent feedback which will delay their attainment of new skills. These data will provide the initial foundation for the development of a coordinated care model that promotes treatment efficacy by improving the compatibility between clinic-based PCIT and daycare-based behavior consultation services.
To investigate the potential dietary impact of the opening of new retailers of healthy foods.
Systematic review of the peer-reviewed research literature.
References published before November 2015 were retrieved from MEDLINE, EMBASE and Web of Science databases using keyword searches.
The outcome of the review was change in fruit and vegetable consumption among adults.
Of 3514 references retrieved, ninety-two articles were reviewed in full text, and twenty-three articles representing fifteen studies were included. Studies used post-test only (n 4), repeated cross-sectional (n 4) and repeated measures designs (n 7) to evaluate the dietary impact of supermarket (n 7), farmers’ market (n 4), produce stand (n 2) or mobile market (n 2) openings. Evidence of increased fruit and vegetable consumption was most consistent among adults who began shopping at the new retailer. Three of four repeated measures studies found modest, albeit not always statistically significant, increases in fruit and vegetable consumption (range 0·23–0·54 servings/d) at 6–12 months after baseline. Dietary change among residents of the broader community where the new retailer opened was less consistent.
The methodological quality of studies, including research designs, sampling methods, follow-up intervals and outcome measures, ranged widely. Future research should align methodologically with previous work to facilitate meta-analytic synthesis of results. Opening a new retailer may result in modest short-term increases in fruit and vegetable consumption among adults who choose to shop there, but the potential longer-term dietary impact on customers and its impact on the broader community remain unclear.
Fifty years of pulsars also mean fifty years of using them as tools to probe other phenomena and physics. One prominent example is the usage of pulsars to test theories of gravity. Probing the quasi-stationary strong-field regime, pulsars allow high precision tests that will maintain their importance even in the era of gravitation wave observations with ground-based detectors. This contribution summarise the methods and status of the field and provides a brief outlook into the future.
The challenges of detecting and localising Fast Radio Bursts in real time can be met with the use of Phased Array Feeds. One such system, capable of creating up to 36 simultaneous beams, is currently being commissioned at the Effelsberg radio telescope in Germany following testing at the 64 m Parkes radio telescope. The PAFINDER (Phased Array Feed FRB Finder) pipeline will be used with this receiver to enable real–time single–pulse detection and localisation.
To evaluate the effects of levomilnacipran extended-release (ER) on suicidal ideation and behavior in adults with major depressive disorder (MDD).
Post hoc analyses were conducted in patients from 4 randomized, double-blind, placebo-controlled trials and a long-term, open-label extension study of levomilnacipran ER (40-120 mg/d) in adults with MDD. Analyses included incidence of suicide-related treatment-emergent adverse events (TEAEs); incidence of Columbia–Suicide Severity Rating Scale (C-SSRS) suicidal ideation (score=1–5) and behavior (score=6-10); percent of patients who shifted from no C-SSRS suicidal ideation/behavior at baseline to suicidal ideation during treatment (worsened from score=0 to score=1–5), or vice-versa (improved from score=1-5 to score=0).
Suicide-related TEAEs occurred in<1% of patients in the levomilnacipran ER studies. The incidence of C-SSRS suicidal ideation was 22.2%, 23.9%, and 21.7% for placebo, short-term levomilnacipran ER, and long-term levomilnacipran ER, respectively; C-SSRS suicidal behavior was<1% in all of these groups. In the short-term studies, the percentage of patients with C-SSRS shifts were as follows: worsening from score=0 to score=1–5 (placebo, 8.6%; levomilnacipran ER, 11.0%); improvement from score=1–5 to score=0 (placebo, 24.0%; levomilnacipran ER, 27.7%).
In adult MDD patients, the incidence of suicidal ideation and behavior was similar between placebo and short-term levomilnacipran ER as indicated by TEAE reports and C-SSRS scores. Worsening in C-SSRS scores was also similar between placebo and levomilnacipran ER. There was no indication of increased suicidality during longer courses of continued therapy. Together, these findings suggest that this medication is not associated with increased risks of suicidal ideation or behavior.
Infection prevention in electrophysiology (EP) laboratories is poorly characterized; thus, we conducted a cross-sectional survey using the SHEA Research Network. We found limited uptake of basic interventions, such as surveillance and appropriate peri-procedural antimicrobial use. Further study is needed to identify ways to improve infection prevention in this setting.
The largest number of known young neutron stars axe observed as spin-powered pulsars. While the majority of those are detected at radio frequencies, an increasing number can be studied in other parts of the electromagnetic spectrum as well. The Crab pulsar is the prototype of a young pulsar which can be observed from radio to gamma-ray frequencies, providing a red thread of discussion during a tour through the pulsar properties observed across the electromagnetic spectrum. The basic observational features of pulsar emission are presented, preparing the ground for more detailed reviews given in these proceedings. Here, particular attention will be paid to those emission features which may provide a link between the radio and high-energy emission processes.
Over a two year period the polarization properties of the largest sample of millisecond pulsars yet observed have been regularly monitored with the Effelsberg 100-m radiotelescope at λ21cm. A comparison of the observed emission properties with those of the population of long period pulsars is presented here. Most of the sources exhibit wide, often multiple-component profiles, with complex polarization features, not easily interpretable in the context of the well established phenomenological models used to describe the properties of long period pulsars. While both groups share common emission features suggesting similar emission processes, the implied field structures as revealed from polarization information appear substantially different from a dipolar structure. Generally, short period pulsars exhibit a relatively large percentage of circularly polarized emission while at λ21cm they tend to be less polarized than long period pulsars.
Average pulse profiles are generally separable into several components whereas individual components can be described by a Gaussian shape. One generally distinguishes between core and conal components, although it is yet unclear whether core and conal components originate from the same (Lyne & Manchester 1988) or a different emission mechanism (Rankin 1983). Investigating this problem, we studied the behaviour of individual components observed in about 200 profiles of 18 pulsars measured at three different frequencies, i.e. at 1.4 GHz, 4.75 GHz and 10.55 GHz. We unambiguously determined the number, location, width, flux density and spectral index of individual components using a special technique (Kramer et al. 1994). The applied method ensures that only intrinsic features of the pulse profiles are fitted by comparing off-pulse noise statistics and post-fit residuals as a goodness-of-fit estimator. As a first result, we note that all high S/N pulsar profiles can be accurately described by using only a small number (usually ≤ 5) of gaussian components, although we also find an example of a seven component pulse shape (B0740–28). Fitted components determined for different observations of the same pulsar were averaged, producing a grand mean profile which is completely noise-free and thus suitable for a reliable flux density measurement of individual components, for an accurate determination of the pulse width to calculate opening angles, ρ, of the emission cone, or for use as a template for obtaining pulse arrival times.
We have extended the database of flux density measurements of 280 pulsars made by Lorimer et al. (1995) to frequencies higher than 1.4 GHz and lower than 300 MHz. Our analysis shows that the spectral behaviour of the majority of pulsars can be well described by a simple power law (S ~ υα where = −1.8) though some pulsar spectra are described by a ”broken power law” with a break at high frequencies υb ~ 1.8 GHz.
We report flux density measurements, polarimetric and timing observations of pulsars made at the highest radio frequencies to date, covering the widest frequency range from 1.4 GHz to 86 GHz. We find that the magnetic field maintains its dipolar structure throughout the active part of the magnetosphere, a region located close to the stellar surface and confined to a small slab of a few stellar radii. The change in width and shape of pulse profiles saturates at mm-wavelengths while the depolarization accelerates, leading to almost completely depolarized emission. Two pulsars seem to exhibit a turn-up in their flux density spectrum at mm-wavelengths.
Pulse shapes of pulsars have been observed at many frequencies with the Effelsberg 100-m radiotelescope since 1972. The rationale behind these surveys was to use the great sensitivity of the 100-m telescope of the Max-Planck-Institut für Radioastronomie in particular at high radio frequencies for a complete study of pulse profiles.
The recent advent of HEMT amplifiers has improved the observational sensitivity enormously. Using these new systems it was possible to obtain integrated profiles of 183 pulsars at 1.4 GHz, 46 pulsars at 4.75 GHz and 24 pulsars at 10.6 GHz (see Seiradakis et al. 1995). Furthermore eight pulsars have been studied at 9 mm wavelengths (Kramer et al. 1996).
The aims of this study were to develop and validate a prediction equation of fat-free mass (FFM) based on bioelectrical impedance analysis (BIA) and anthropometry using air-displacement plethysmography (ADP) as a reference in Asian neonates and to test the applicability of the prediction equations in an independent Western cohort. A total of 173 neonates at birth and 140 at two weeks of age were included. Multiple linear regression analysis was performed to develop the prediction equations in a two-third randomly selected subset and validated on the remaining one-third subset at each time point and in an independent Queensland cohort. FFM measured by ADP was the dependent variable, and anthropometric measures, sex and impedance quotient (L2/R50) were independent variables in the model. Accuracy of prediction equations was assessed using intra-class correlation and Bland–Altman analyses. L2/R50 was the significant predictor of FFM at week two but not at birth. Compared with the model using weight, sex and length, including L2/R50 slightly improved the prediction with a bias of 0·01 kg with 2 sd limits of agreement (LOA) (0·18, −0·20). Prediction explained 88·9 % of variation but not beyond that of anthropometry. Applying these equations to the Queensland cohort provided similar performance at the appropriate age. However, when the Queensland equations were applied to our cohort, the bias increased slightly but with similar LOA. BIA appears to have limited use in predicting FFM in the first few weeks of life compared with simple anthropometry in Asian populations. There is a need for population- and age-appropriate FFM prediction equations.
Dementia cases are increasing worldwide; thus, investigators seek to identify interventions that might prevent or ameliorate cognitive decline in later life. Extensive research confirms the benefits of physical exercise for brain health, yet only a fraction of older adults exercise regularly. Interactive mental and physical exercise, as in aerobic exergaming, not only motivates, but has also been found to yield cognitive benefit above and beyond traditional exercise. This pilot study sought to investigate whether greater cognitive challenge while exergaming would yield differential outcomes in executive function and generalize to everyday functioning. Sixty-four community based older adults (mean age=82) were randomly assigned to pedal a stationary bike, while interactively engaging on-screen with: (1) a low cognitive demand task (bike tour), or (2) a high cognitive demand task (video game). Executive function (indices from Trails, Stroop and Digit Span) was assessed before and after a single-bout and 3-month exercise intervention. Significant group × time interactions were found after a single-bout (Color Trails) and after 3 months of exergaming (Stroop; among 20 adherents). Those in the high cognitive demand group performed better than those in the low cognitive dose condition. Everyday function improved across both exercise conditions. Pilot data indicate that for older adults, cognitive benefit while exergaming increased concomitantly with higher doses of interactive mental challenge. (JINS, 2015, 21, 768–779)