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Jaswal & Akhtar provide several quotes ostensibly from people with autism but obtained via the discredited techniques of Facilitated Communication and the Rapid Prompting Method, and they do not acknowledge the use of these techniques. As a result, their argument is substantially less convincing than they assert, and the article lacks transparency.
Therapist validation in treatment is theorized to be related to positive outcomes (Linehan, 1993), including keeping patients in therapy longer.
We sought to evaluate the role of therapist validation from both therapists’ and clients’ perspectives as a predictor of drop-out from psychotherapy in three cognitive behavioural training clinics.
Clients in psychotherapy (n = 50; 80% female; 82% Caucasian) and their trainee therapists (n = 22; 68% female; 86% Caucasian) rated validation by the therapist at each of four early sessions of therapy.
After accounting for symptom severity, clients who reported greater therapist validation were less likely to drop out of treatment. Therapist ratings of their own validating behaviours were unrelated to client drop-out. Therapist experience moderated the relation between client-rated validation and drop-out, such that validation was unrelated to drop-out for more experienced therapists.
Assessing and attending to client perceptions of validation by the therapist early in treatment, with brief self-report inventories, can alert therapists to clients at greater risk of drop-out.
Pre-operative imaging is often used to predict the extent of a cholesteatoma and anatomical variation to plan for surgery. This study aimed to measure the predictive accuracy of computed tomography findings.
A retrospective cohort study was conducted of all patients in a district general hospital undergoing mastoid surgery within a consecutive 12-month period, in whom computed tomography had been performed prior to operative intervention. The study measured the key findings of pre-operative computed tomography imaging and compared them to the intra-operative findings.
A total of 106 patients were included. The sensitivity and specificity for predicting cholesteatoma were 79 per cent and 81 per cent respectively. The positive predictive value was 90 per cent and the negative predictive value was 65 per cent. In predicting complications of cholesteatomas, the sensitivity was 70 per cent, whereas the specificity was 91 per cent. The positive predictive value was 88 per cent and the negative predictive value was 76 per cent.
Pre-operative computed tomography conducted prior to mastoid surgery has high positive predictive values for both predicting cholesteatomas and complications (90 per cent and 88 per cent respectively).
Salmonella enterica serovar Wangata (S. Wangata) is an important cause of endemic salmonellosis in Australia, with human infections occurring from undefined sources. This investigation sought to examine possible environmental and zoonotic sources for human infections with S. Wangata in north-eastern New South Wales (NSW), Australia. The investigation adopted a One Health approach and was comprised of three complimentary components: a case–control study examining human risk factors; environmental and animal sampling; and genomic analysis of human, animal and environmental isolates. Forty-eight human S. Wangata cases were interviewed during a 6-month period from November 2016 to April 2017, together with 55 Salmonella Typhimurium (S. Typhimurium) controls and 130 neighbourhood controls. Indirect contact with bats/flying foxes (S. Typhimurium controls (adjusted odds ratio (aOR) 2.63, 95% confidence interval (CI) 1.06–6.48)) (neighbourhood controls (aOR 8.33, 95% CI 2.58–26.83)), wild frogs (aOR 3.65, 95% CI 1.32–10.07) and wild birds (aOR 6.93, 95% CI 2.29–21.00) were statistically associated with illness in multivariable analyses. S. Wangata was detected in dog faeces, wildlife scats and a compost specimen collected from the outdoor environments of cases’ residences. In addition, S. Wangata was detected in the faeces of wild birds and sea turtles in the investigation area. Genomic analysis revealed that S. Wangata isolates were relatively clonal. Our findings suggest that S. Wangata is present in the environment and may have a reservoir in wildlife populations in north-eastern NSW. Further investigation is required to better understand the occurrence of Salmonella in wildlife groups and to identify possible transmission pathways for human infections.
The degree of crystallinity and unit cell parameters have been determined using WAXS on a number of compression molded high-density polyethylene (HDPE) plaques processed at widely varying conditions of crystallization and annealing times and temperatures. Changes in unit cell parameters with variations in processing conditions can be explained in terms of increases in lamellar thickness of polyethylene crystals with increasing thermal treatments. Concomitant increases in the degree of crystallinity of these samples can also be explained in terms of lamellar thickening and other changes in polyethylene morphology. Crystallinity determinations using XRD data are also compared with values determined by differential scanning calorimetry (DSC) and solid-state 13C nuclear magnetic resonance (NMR). Comparisons of crystallinity values obtained by these three different techniques can reveal details of the morphology of HDPE including the presence of an interfacial zone in addition to the crystalline and amorphous components of the system.
Helical dislocations and vacancy aggregates have been reported in lithiumdoped germanium and in diffused silicon. In the present study, defects related to an excess vacancy concentration are examined in as-grown silicon. X-ray topography, etch techniques, and Hall effect are used in determining the conditions of formation of these imperfections. Two distinct types of defects are observed: (1) helical dislocations and (2) dislocation loops. The helical dislocations are identified in the X-ray topographs and correlated to their etch figures. The diameters of the helices in various crystals range from less than 10 to 100 μ. The largest concentration of helices are observed in the initial growth, but prismatic loops or helical segments are also present in the low dislocation density regions of some crystals. The dislocation loop image consists of a pair of opposed arcs. The lengths of images vary from 30 to 400 μ, and the axis of the loop is usually parallel to <110> linage contrast changes with changes in sample orientation, but conclusive Burgers vector determinations are incomplete.
The formation of these defects is shown to be directly related to the heat treatment during crystal growth. The total acquisition of vacancies during growth is quite high and is attributed to the “orbital” growth process. In the “orbital” method, the seed check rotates 8-9 rpm about the center of the crucible as the growing crystal rotates 50-60 rpm. A linear relationship exists at room temperature between the vacancy concentration and the antimony impurity concentration. Impurity concentrations were determined independently by chemical and mass spectrograph techniques. A defect complex involving V− and Sb+ in thermal equilibrium is employed to explain this effect.
OBJECTIVES/SPECIFIC AIMS: To understand the mechanisms of how a non-antimicrobial can reshape a commensal microbe community to cure a ubiquitous human disease. METHODS/STUDY POPULATION: Whole genome sequencing of bacterial isolates, metabolomic investigations of previously collected skin microbe isolates from patients, and structural investigations of a protein from these skin microbes. RESULTS/ANTICIPATED RESULTS: Metabolic pathways associated with adaptation to a changing skin microenvironment, novel antimicrobial characterization, and a structural understanding of a novel nutrient acquisition protein. DISCUSSION/SIGNIFICANCE OF IMPACT: Multiple angles of this investigation are poised to improve current non-antimicrobial dermatologic treatments and they have the potential to impact microbe-related diseases in other human microenvironments.
To identify potential participants for clinical trials, electronic health records (EHRs) are searched at potential sites. As an alternative, we investigated using medical devices used for real-time diagnostic decisions for trial enrollment.
To project cohorts for a trial in acute coronary syndromes (ACS), we used electrocardiograph-based algorithms that identify ACS or ST elevation myocardial infarction (STEMI) that prompt clinicians to offer patients trial enrollment. We searched six hospitals’ electrocardiograph systems for electrocardiograms (ECGs) meeting the planned trial’s enrollment criterion: ECGs with STEMI or > 75% probability of ACS by the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI). We revised the ACI-TIPI regression to require only data directly from the electrocardiograph, the e-ACI-TIPI using the same data used for the original ACI-TIPI (development set n = 3,453; test set n = 2,315). We also tested both on data from emergency department electrocardiographs from across the US (n = 8,556). We then used ACI-TIPI and e-ACI-TIPI to identify potential cohorts for the ACS trial and compared performance to cohorts from EHR data at the hospitals.
Receiver-operating characteristic (ROC) curve areas on the test set were excellent, 0.89 for ACI-TIPI and 0.84 for the e-ACI-TIPI, as was calibration. On the national electrocardiographic database, ROC areas were 0.78 and 0.69, respectively, and with very good calibration. When tested for detection of patients with > 75% ACS probability, both electrocardiograph-based methods identified eligible patients well, and better than did EHRs.
Using data from medical devices such as electrocardiographs may provide accurate projections of available cohorts for clinical trials.
Breakthrough Listen is a 10-yr initiative to search for signatures of technologies created by extraterrestrial civilisations at radio and optical wavelengths. Here, we detail the digital data recording system deployed for Breakthrough Listen observations at the 64-m aperture CSIRO Parkes Telescope in New South Wales, Australia. The recording system currently implements two modes: a dual-polarisation, 1.125-GHz bandwidth mode for single-beam observations, and a 26-input, 308-MHz bandwidth mode for the 21-cm multibeam receiver. The system is also designed to support a 3-GHz single-beam mode for the forthcoming Parkes ultra-wideband feed. In this paper, we present details of the system architecture, provide an overview of hardware and software, and present initial performance results.
The rate of cardiovascular implantable electronic device (CIED) infection is increasing coincident with an increase in the number of device procedures. Preprocedural antimicrobial prophylaxis reduces CIED infections; however, there is no evidence that prolonged postprocedural antimicrobials additionally reduce risk. Thus, we sought to quantify the harms associated with this approach.
To measure the association between Clostridium difficile infection (CDI), acute kidney injury (AKI) and receipt of prolonged postprocedural antimicrobials.
CIED procedures entered into the VA Clinical Assessment Reporting and Tracking Electrophysiology (CART-EP) database during fiscal years 2008–2016 were included. The primary outcome was 90-day incidence of CDI and the secondary outcome was the 7-day incidence of AKI. The primary exposure measure was duration of postprocedural antimicrobial therapy. Associations were measured using Cox-proportional hazards and binomial regression.
Prolonged postprocedural antimicrobial therapy was identified following 3,331 of 6,497 CIED procedures (51.3%), and the median duration of prophylaxis was 5 days. Prolonged postprocedural antimicrobial use was associated with increased risk of CDI (hazard ratio [HR], 2.90; 95% confidence interval [CI], 1.54–5.46). Of the 27 patients who developed CDI, 11 subsequently died. Postprocedural antimicrobial use with ≥2 antimicrobials was associated with an increased risk of AKI (OR, 4.16; 95% CI, 2.50–6.90). The impact was particularly significant when one of the dual agents prescribed was vancomycin (adjusted OR, 8.41; 95% CI, 5.53–12.79).
Prolonged antimicrobial prophylaxis following CIED procedures increases preventable harm; this practice should be discouraged in procedural settings such as the cardiac electrophysiology laboratory.
Potentially modifiable risk factors for developing dementia have been identified. However, risk factors for increased mortality in patients with diagnosed dementia are not well understood. Identifying factors that influence prognosis would help clinicians plan care and address unmet needs.
To investigate diagnosed depression and sociodemographic factors as predictors of mortality in patients with dementia in UK secondary clinical care services.
We conducted a cohort study of patients with a dementia diagnosis in an electronic health records database in a UK National Health Service mental health trust.
In 3374 patients with 10 856 person-years of follow-up, comorbid depression was not associated with mortality (adjusted hazard ratio 0.94; 95% CI 0.71–1.24). Single patients had higher mortality than those who were married (adjusted hazard ratio 1.25; 95% CI 1.03–1.50). Patients of Asian ethnicity had lower mortality rates than White British patients (adjusted hazard ratio 0.50; 95% CI 0.34–0.73).
Clinically diagnosed depression does not increase mortality in patients with dementia. Patients who are single are a potential high-mortality risk group. Lower mortality rates in Asian patients with dementia that have been reported in the USA also apply in the UK.
Raw materials used in feed manufacture are contaminated with high (>104 cfu/g) levels of enterobacteriaceae indicating the potential for contamination with pathogenic bacteria such as salmonella (Wood et al. 2001). There is urgent need to reduce the contamination of animal feed with zoonoses such as salmonella and campylobacter. During manufacture of feedingstuffs, heat and moisture are used to process and sterilise feed but this can also provide conditions for microbial growth. High temperature treatment used to sterilise feed will not protect feedingstuffs from recontamination, if residual microbial contamination remains in the feed mill. It is essential to understand the influence of feed processing and the feed mill environment on the microbial contamination of feed.
Bacteria belonging to the family Enterobacteriaceae enter the animal feed chain as normal contaminants of raw materials used in the manufacture of animal feeds. The family Enterobacteriaceae encompasses 30 established genera, including Salmonella spp, Escherichia spp, Shigella spp and Yersinia spp. Many of the genera exhibit pathogenicity towards man, animals, insects and plants and many of the pathogenic forms produce toxins. A number of the genera in this family occur regularly in association with animals; they are found as indigenous members of the gut microflora where they may either produce no harmful effects, or are capable of causing disease in both endothermic and ectothermic animals. There is a recognised association between the risk of isolation of salmonella and degree of Enterobacteriaceae contamination (Veldman et al. 1995). This has led to the consideration of recording Enterobacteriaceae contamination levels in feed stuffs as an indicator of feed hygiene and potential limits to the degree of contamination being set by the major retailers. This paper sets out data gathered from the routine analysis of feed raw materials examined for Enterobacteriaceae contamination.
Objectives: The aim of this study was to identify whether the three main primary progressive aphasia (PPA) variants would show differential profiles on measures of visuospatial cognition. We hypothesized that the logopenic variant would have the most difficulty across tasks requiring visuospatial and visual memory abilities. Methods: PPA patients (n=156), diagnosed using current criteria, and controls were tested on a battery of tests tapping different aspects of visuospatial cognition. We compared the groups on an overall visuospatial factor; construction, immediate recall, delayed recall, and executive functioning composites; and on individual tests. Cross-sectional and longitudinal comparisons were made, adjusted for disease severity, age, and education. Results: The logopenic variant had significantly lower scores on the visuospatial factor and the most impaired scores on all composites. The nonfluent variant had significant difficulty on all visuospatial composites except the delayed recall, which differentiated them from the logopenic variant. In contrast, the semantic variants performed poorly only on delayed recall of visual information. The logopenic and nonfluent variants showed decline in figure copying performance over time, whereas in the semantic variant, this skill was remarkably preserved. Conclusions: This extensive examination of performance on visuospatial tasks in the PPA variants solidifies some previous findings, for example, delayed recall of visual stimuli adds value in differential diagnosis between logopenic variant PPA and nonfluent variant PPA variants, and illuminates the possibility of common mechanisms that underlie both linguistic and non-linguistic deficits in the variants. Furthermore, this is the first study that has investigated visuospatial functioning over time in the PPA variants. (JINS, 2018, 24, 259–268)
Knowledge of the spatial distribution of bed lubrication regimes, i.e. frozen vs wet conditions, is crucial for understanding ice-sheet flow. Radar sounding can probe differing reflectivities between wet and frozen beds, but is limited by uncertainty in attenuation within the ice of bed echoes. Here we present two methods to estimate attenuation: (1) wide-angle radar sounding, in which source and receiver locations are varied so as to vary propagation path length, and thus echo amplitude; and (2) profiling, inwhich similar variations are obtained by sounding through varying ice thicknesses (assuming constant bed reflectivity). Siple Dome, West Antarctica, provides unusually favorable circumstances for application of these methods: the bed beneath Siple Dome is flat and uniform in its radar reflectivity, while ice thickness varies by several hundred meters. Wide-angle data 4 km from the summit yield an estimate for characteristic attenuation length of 124 m (35 dB km–1 loss), whereas profiling yields an estimate of 168 m.The difference between estimates is modest compared to the range of attenuation lengths reported in the literature. It may nonetheless prove informative by bounding effects of two ice properties to which the methods respond differently: (1) wide-angle sounding sampled relatively warm (lossy) ice beneath the summit, whereas the profiling method sampled relatively cold ice beneath the flanks as well; and (2) strain-induced crystal orientation fabrics and resulting dielectric anisotropy in the ice would vary from summit to flank, and may influence wide-angle sounding more strongly than profiling.
OBJECTIVES/SPECIFIC AIMS: In the United States, it is estimated that approximately half of all pregnancies are unintended. This study examines the prevalence of unintended pregnancy in a cohort of cancer survivors and identifies factors associated with unintended pregnancy after cancer. METHODS/STUDY POPULATION: The FUCHSIA Women’s Study is a population-based study of female cancer survivors at a reproductive age of 22–45 years. Cancer survivors diagnosed between the ages of 20 and 35 years and at least 2 years postdiagnosis were recruited in collaboration with the Georgia Cancer Registry. Participants were interviewed about their reproductive histories. The prediagnosis analysis included all women who completed the interview; the postdiagnosis analysis excluded those who had a hysterectomy, bilateral oophorectomy, or tubal ligation by cancer diagnosis. RESULTS/ANTICIPATED RESULTS: Of the 1282 survivors interviewed, 57.5% reported at least 1 pregnancy before cancer diagnosis; of which, 44.5% were unintended. Of the 1088 survivors included in the postdiagnosis analysis, 36.9% reported a post-cancer pregnancy. Among those who had a pregnancy after cancer diagnosis, 38.6% reported at least 1 pregnancy was unintended. Of the 80 breast cancer survivors who had a pregnancy after diagnosis, 52.5% of them were unintended. Predictors of unintended pregnancy in cancer survivors included being younger than 30 years at diagnosis [odds ratio (OR) 2.1; 95% confidence interval (CI) 1.4, 2.9], identifying as Black (OR 1.6, 95% CI 1.1, 2.3, comparison: White), and having resumption of menses after cancer treatment (OR 8.1, 95% CI 2.0, 33.0). Compared with being <4 years from cancer diagnosis, those who were farther from diagnosis at the time of the interview also had increased odds of unintended pregnancy (4–7 years: OR 1.5, 95% CI 0.9, 2.7; 8–10 years: OR 1.3, 95% CI 0.7, 2.4; >10 years: OR 2.7, 95% CI 1.6, 4.7). DISCUSSION/SIGNIFICANCE OF IMPACT: Despite being at higher risk of infertility, cancer survivors may still be at considerable risk of unintended pregnancy. Women with certain types of cancer that are more likely to be hormone responsive, such as some types of breast cancer, may be hesitant to use hormonal birth control and thus be at higher risk of unintended pregnancy. Counseling for cancer survivors should include a discussion of the risk of unintended pregnancy and contraceptive options.
Little is known about the joint mental health effects of air pollution and tobacco smoking in low- and middle-income countries.
To investigate the effects of exposure to ambient fine particulate matter pollution (PM2.5) and smoking and their combined (interactive) effects on depression.
Multilevel logistic regression analysis of baseline data of a prospective cohort study (n=41785). The 3-year average concentrations of PM2.5 were estimated using US National Aeronautics and Space Administration satellite data, and depression was diagnosed using a standardised questionnaire. Three-level logistic regression models were applied to examine the associations with depression.
The odds ratio (OR) for depression was 1.09 (95% CI 1.01–1.17) per 10 μg/m3 increase in ambient PM2.5, and the association remained after adjusting for potential confounding factors (adjusted OR = 1.10, 95% CI 1.02–1.19). Tobacco smoking (smoking status, frequency, duration and amount) was also significantly associated with depression. There appeared to be a synergistic interaction between ambient PM2.5 and smoking on depression in the additive model, but the interaction was not statistically significant in the multiplicative model.
Our study suggests that exposure to ambient PM2.5 may increase the risk of depression, and smoking may enhance this effect.
Most of our understanding of BPF's is based on observations of the neutral and ionized gas in bright, high luminosity sources. Data on low luminosity (L ≲ 30 L⊙) objects has now become more available (e.g. Frerking and Langer, Astrophys. J. 256, 523, 1982) permitting a test of models at this end of the luminosity range. We have performed a series of multi-wavelength observations, emphasizing low luminosity objects.