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President Donald Trump faced substantial scandal coverage early in his presidency. Can these stories about presidential controversies change the opinions of Trump’s fellow Republicans, or are the efforts of the news media to inform partisans about prominent issues futile? Past research on partisan reactions to major political scandals were confounded by problems with self-reported media use and single-shot experimental treatments. We address these concerns using a unique, repeated-exposure experimental design that either randomly supplied participants with news about the Trump-Russia scandal, or removed most of those stories from view, over the course of one week in June 2017. This design mimics sustained media attention to a political scandal and disentangles the effects of media coverage from selection in the context of a high-choice media environment. We find that Republicans randomly assigned to see more Trump-Russia headlines reacted more negatively than Democrats or Independents, rating Trump’s performance lower and expressing more negative emotions about him. Republicans’ perceptions of media bias were not affected by Trump-Russia stories, and effects were not contingent upon clicking the articles. Intense media focus on a story can alter partisans’ evaluations of politicians by shifting the balance of headlines.
OBJECTIVES/SPECIFIC AIMS: The objective of this study was to prospectively assess caregiver-perceived barriers to accessing post-acute care for their injured child and determine if caregivers report ongoing, unmet health needs for their children after trauma. METHODS/STUDY POPULATION: This was a prospective cohort study that followed 50 participants for 6 months and administered surveys to parents of children who are admitted to a pediatric level 1 trauma center for injury. Surveys were given bi-weekly regarding care children received after hospital discharge. At 3 months, parents were surveyed over the phone on whether they were able to access all needed health services and if there were any perceived barriers to obtaining or providing at-home care. At 6 months, parents were given the Child & Family Follow-up Survey to assess ongoing physical, mental, social, and scholastic needs. Free responses and transcribed interviews were analyzed using thematic content analysis and frequencies are reported for discrete data. RESULTS/ANTICIPATED RESULTS: Out of 50 families recruited, 47 completed follow-up assessments. At 3 months, common themes regarding challenges after hospital discharge included difficulty scheduling specialist care; uncertainty in managing their child’s pain; transitioning home without enough knowledge to meet their child’s medical needs; lack of communication between multiple providers; distress at having providers release children to full activities before caregivers were comfortable. At 6 months, approximately 24% of parents reported children had ongoing cognitive limitations, 29% reported emotional problems, 19% reported physical limitations, 33.3% reported difficulty in school, and 15% reported play/social difficulties. DISCUSSION/SIGNIFICANCE OF IMPACT: Evidence suggests families face significant barriers in accessing follow-up care, despite nearly universal health insurance coverage for children. Further, a large percentage of parents report ongoing health needs, despite the majority of the cohort having only mild or moderate severity injuries. Making follow-up care more patient-centered for families of traumatically injured children may improve compliance with medical regiments and reduce the likelihood of future disability. Examples of this may be coordinating care among multiple specialty providers, so that patients with multiple injuries can schedule multiple follow-up appointments on the same day. Additionally, more caregiver education on administering pain medication, caring for wounds, and safe practices for returning to full activities would be beneficial for families.
Background: Most people with common mental health problems do not seek evidence-based psychological interventions. Aims: The aim of this study was to investigate whether monitoring symptoms of depression and anxiety using an app increased treatment-seeking. Method: Three hundred and six people with significant levels of anxiety and depression, none of whom were currently receiving treatment, were randomly allocated to receive either (a) information about local psychological services only, (b) information plus regular symptom monitoring (every 6 days), or (c) information plus open symptom monitoring (monitoring when they felt like it). An app was used to provide information and monitor mood. Results: The proportion of participants who reported receiving treatment after starting the study was 7.2% (10/138) in the information only group, 8.1% (9/111) in the information plus regular monitoring group and 15.8% (9/57) in the information plus open monitoring group. There was a trend for participants who were able to monitor whenever they wished to be more likely to report receiving treatment than people who were only given information about their local treatment services. The impact of the intervention was greatest among participants who intended to seek treatment before taking part. Limitations were that only a small minority of those who downloaded the app completed the study and that the study relied on self-reported measures of treatment-seeking. Conclusions: Symptom monitoring can increase actual treatment-seeking in those with an intention to seek treatment.
The Pueblo population of Chaco Canyon during the Bonito Phase (AD 800–1130) employed agricultural strategies and water-management systems to enhance food cultivation in this unpredictable environment. Scepticism concerning the timing and effectiveness of this system, however, remains common. Using optically stimulated luminescence dating of sediments and LiDAR imaging, the authors located Bonito Phase canal features at the far west end of the canyon. Additional ED-XRF and strontium isotope (87Sr/86Sr) analyses confirm the diversion of waters from multiple sources during Chaco’s occupation. The extent of this water-management system raises new questions about social organisation and the role of ritual in facilitating responses to environmental unpredictability.
OBJECTIVES/SPECIFIC AIMS: The objective of this study is to determine predictors and motives for sustained opioid use, prescription misuse, and nonmedical opioid use in the adolescent trauma population. METHODS/STUDY POPULATION: This is a prospective cohort study that will follow patients for 1 year and administer surveys to patients on prescription opioid usage; substance use; utilization of pain management and mental health services; mental and physical health conditions; and behavioral and social risk factors. Patient eligibility criteria include: (1) patient is 12–18 years of age; (2) admitted for trauma; (3) english speaking; (4) resides within Indianapolis, IN metropolitan area; and (5) consent can be obtained from a parent or guardian. Patients with severe brain injuries or other injuries that prevent survey participation will be excluded. The patient sample will comprise of 50 traumatically injured adolescents admitted for trauma who will be followed for 12 months after discharge. RESULTS/ANTICIPATED RESULTS: We expect that the results of this study will identify multiple risk factors for sustained opioid use that can be used to create targeted interventions to reduce opioid misuse in the adolescent trauma population. Clinical predictors such as opioid type, dosage, and duration that can be modified to reduce the risk of long-term opioid use will be identified. We expect to elucidate clinical, behavioral, and social risk factors that increase the likelihood adolescents will misuse their medication and initiate nonmedical opioid use. DISCUSSION/SIGNIFICANCE OF IMPACT: Trauma is a surgical specialty that often has limited collaboration with behavioral health providers. Collaborative care models for trauma patients to adequately address the psychological impact of a traumatic injury have become more common in recent years. These models have primarily been concerned with the prevention of post-traumatic stress disorder. We would like to apply the findings of our research to better understand what motivates adolescents to misuse pain medications as well as how clinical, individual, behavioral, and social factors affect medication usage. This may help identify patients at greater risk of developing a SUD by asking questions not commonly addressed in the hospital setting. For example, similar to how trauma centers have mandated brief interventions on alcohol use be performed for center verification, screening patients’ on their social environment may identify patients at greater risk for SUD than assumed. The long-term goal would be to prevent opioid use disorders in injured adolescents by providing better post-acute care support, possibly by developing and implementing a collaborative care model that addresses opioid use. Additionally, we believe our findings could be applied in the acute care setting as well to help inform opioid prescribing and pain management methods in the acute phase of an injury. Genetic testing to determine which opioid to prescribe pediatric surgical patients is starting to be done at some pediatric hospitals. Certain genes determine which specific opioid is most effective in controlling a patient’s pain and, further, using the optimal opioid medication can also reduce overdose. Our findings may help refine prescribing patterns that could increase or decrease the likelihood of developing SUD in patients with certain genetic, clinical, behavioral, and social characteristics.
Protected areas are central to global efforts to prevent species extinctions, with many countries investing heavily in their establishment. Yet the designation of protected areas alone can only abate certain threats to biodiversity. Targeted management within protected areas is often required to achieve fully effective conservation within their boundaries. It remains unclear what combination of protected area designation and management is needed to remove the suite of processes that imperil species. Here, using Australia as a case study, we use a dataset on the pressures facing threatened species to determine the role of protected areas and management in conserving imperilled species. We found that protected areas that are not resourced for threat management could remove one or more threats to 1,185 (76%) species and all threats to very few (n = 51, 3%) species. In contrast, a protected area network that is adequately resourced to manage threatening processes within their boundary could remove one or more threats to almost all species (n = 1,551; c. 100%) and all threats to almost half (n = 740, 48%). However, 815 (52%) species face one or more threats that require coordinated conservation actions that protected areas alone could not remove. This research shows that investing in the continued expansion of Australia's protected area network without providing adequate funding for threat management within and beyond the existing protected area network will benefit few threatened species. These findings highlight that as the international community expands the global protected area network in accordance with the 2020 Strategic Plan for Biodiversity, a greater emphasis on the effectiveness of threat management is needed.
The Taipan galaxy survey (hereafter simply ‘Taipan’) is a multi-object spectroscopic survey starting in 2017 that will cover 2π steradians over the southern sky (δ ≲ 10°, |b| ≳ 10°), and obtain optical spectra for about two million galaxies out to z < 0.4. Taipan will use the newly refurbished 1.2-m UK Schmidt Telescope at Siding Spring Observatory with the new TAIPAN instrument, which includes an innovative ‘Starbugs’ positioning system capable of rapidly and simultaneously deploying up to 150 spectroscopic fibres (and up to 300 with a proposed upgrade) over the 6° diameter focal plane, and a purpose-built spectrograph operating in the range from 370 to 870 nm with resolving power R ≳ 2000. The main scientific goals of Taipan are (i) to measure the distance scale of the Universe (primarily governed by the local expansion rate, H0) to 1% precision, and the growth rate of structure to 5%; (ii) to make the most extensive map yet constructed of the total mass distribution and motions in the local Universe, using peculiar velocities based on improved Fundamental Plane distances, which will enable sensitive tests of gravitational physics; and (iii) to deliver a legacy sample of low-redshift galaxies as a unique laboratory for studying galaxy evolution as a function of dark matter halo and stellar mass and environment. The final survey, which will be completed within 5 yrs, will consist of a complete magnitude-limited sample (i ⩽ 17) of about 1.2 × 106 galaxies supplemented by an extension to higher redshifts and fainter magnitudes (i ⩽ 18.1) of a luminous red galaxy sample of about 0.8 × 106 galaxies. Observations and data processing will be carried out remotely and in a fully automated way, using a purpose-built automated ‘virtual observer’ software and an automated data reduction pipeline. The Taipan survey is deliberately designed to maximise its legacy value by complementing and enhancing current and planned surveys of the southern sky at wavelengths from the optical to the radio; it will become the primary redshift and optical spectroscopic reference catalogue for the local extragalactic Universe in the southern sky for the coming decade.
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)
Mental Health Systems and Policy: Introduction to Part III
Dennis P. Watson, Assistant Professor, Department of Health Policy and Management, Interim Director, Center for Health Policy,
Erin L. Adams, Doctoral Candidate, Department of Psychology, School of Science, Graduate Research Assistant, Center for Health Policy, School of Public Health, Indiana University - Purdue University Indianapolis,
Joanna R. Jackson, Graduate Research Assistant, Center for Health Policy, Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health
This chapter provides an overview of the history of mental health policy in the United States divided into three periods: (1) the development and establishment of the state asylum as the primary mode of mental health treatment; (2) deinstitutionalization and the move to community-based care; and (3) recovery as the guiding vision of mental health care. Federal involvement is a relatively new development in mental health policy, a fact that has lead to significant fragmentation in the mental health care system. While a number of policies since the 1950s have sought to increase social inclusion and the ability for people with mental illness to control their own lives, lack of support for these policies has resulted in relatively slow actual change. However, recent national reforms have potential to make lasting and substantial change. Watson and colleagues describe these reforms and how they may lead to implementation of recovery-oriented principles by improving mental health care access and service quality. They close with a discussion of potential areas for sociological mental health research related to contemporary health policy. What are the gaps in current mental health policy? How can mental health policy promote recovery for people living with mental health problems?
Historically, there has been a lack of strong federal involvement in US mental health policy making. The result has been a highly fragmented mental health system with significant differences at the state and local levels of government. In this chapter, we provide an overview of the history of US mental health policy from the seventeenth century to the present, with a particular focus on polices affecting people living with serious and persistent mental illness (SPMI). We have divided the chapter into three broad periods of reform. The first period, the late 1700s through the 1940s, was a time marked by increasing social control over the lives of people with mental illness as states started to assume more responsibility for their care. This period culminated with the state psychiatric hospital (also known as the asylum) as the primary locus of mental health treatment. The 1950s–1980s was a time of advocacy leading to the movement of patients from state mental hospitals and into the community. This period was also marked by increased recognition of the rights of people living with mental illness, albeit with relatively few polices or resources to support them.
When children have marked problems with motor coordination, they often have problems with attention and impulse control. Here, we map the neuroanatomic substrate of motor coordination in childhood and ask whether this substrate differs in the presence of concurrent symptoms of attention-deficit/hyperactivity disorder (ADHD).
Participants were 226 children. All completed Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)-based assessment of ADHD symptoms and standardized tests of motor coordination skills assessing aiming/catching, manual dexterity and balance. Symptoms of developmental coordination disorder (DCD) were determined using parental questionnaires. Using 3 Tesla magnetic resonance data, four latent neuroanatomic variables (for the cerebral cortex, cerebellum, basal ganglia and thalamus) were extracted and mapped onto each motor coordination skill using partial least squares pathway modeling.
The motor coordination skill of aiming/catching was significantly linked to latent variables for both the cerebral cortex (t = 4.31, p < 0.0001) and the cerebellum (t = 2.31, p = 0.02). This effect was driven by the premotor/motor cortical regions and the superior cerebellar lobules. These links were not moderated by the severity of symptoms of inattention, hyperactivity and impulsivity. In categorical analyses, the DCD group showed atypical reduction in the volumes of these regions. However, the group with DCD alone did not differ significantly from those with DCD and co-morbid ADHD.
The superior cerebellar lobules and the premotor/motor cortex emerged as pivotal neural substrates of motor coordination in children. The dimensions of these motor coordination regions did not differ significantly between those who had DCD, with or without co-morbid ADHD.
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It discusses the evidence base pertaining to the management of metastatic neck disease in the setting of an unknown primary and provides recommendations on the work up and management for this group of patients receiving cancer care.
•All patients presenting with confirmed cervical lymph node metastatic squamous cell carcinoma and no apparent primary site should undergo:
Spectral line profiles in pulsating stars are affected by the interplay of a number of velocity fields. In addition to the basic velocities associated with the pulsation mode, the complications of stellar rotation, atmospheric velocity gradients, stellar winds and varying scales of turbulence may also be present. Initial modelling for line profiles in variables assumed a constant ‘intrinsic profile’ which was integrated over the limb-darkened stellar disk. This approach has been used even in recent work for nonradial pulsations (Stamford and Watson 1977; Kubiak 1978) because of computational ease. Employing an LTE analysis to predict centre-to-limb profile variations, which are then integrated over the disk, represents an improvement on this. This has been done, for example, by Parsons (1972) for radial pulsations in cepheids and by Smith (1978) for nonradial oscillations in B stars. Mihalas (1979) has recently made an even more detailed examination of profiles in expanding atmospheres which involved consideration of velocity gradients, departures from LTE and rotation.
The β Cephei variables are a group of short period pulsating variables of early spectral type for which no satisfactory physical driving mechanism has yet been discovered. Further it is not clear what form of pulsation these stars are undergoing. The existence of a beat phenomenon and a phase of spectral line broadening is well established in some of these stars. This extends to observed spectral line doubling in three stars, BW Vul, σ Sco and 12 Lac. Because of the difficulty in explaining these phenomena with purely radial oscillations, Ledoux (1951) first suggested the possibility of non-radial oscillations. Other stars in the group, γ Peg, δ Cet, #x03BE;’ CMa and β Cep have approximately sinusoidal velocity and light curves with little indication of spectral line broadening. For these there is probably no a priori observational need to look beyond purely radial oscillations. It is of course conceivable that different modes of oscillation are present in different members of the β Cephei group. However, if line profiles are calculated for various proposed oscillation modes and compared with the observations, it may be possible to eliminate some suggestions and hence limit the search for an instability mechanism.
Both radial and non-radial motions have been suggested at various stages to explain the observational peculiarities of the β Cephei variables. The non-radial possibility has been investigated most recently by Smith (1977) and Stamford and Watson (1977). We here examine the radial shock proposal by generating a series of isothermal radial shock models in suitable early B star atmospheres. Odgers (1955) has long advocated such a model in connection with the large amplitude variable BW Vul. The observations of Goldberg, Walker and Odgers (1976) clearly show a radial velocity ‘stillstand’ effect and line splitting in this star. We discuss our models in the context of these two phenomena.
The proposal that the complex spectral line changes seen in the large amplitude β Cephei variable BW Vul resulted from a shock effect, driven by an underlying radial pulsation, was first made by Odgers (1955). Stamford and Watson (1978) examined some suitable atmospheric models for this star, which were driven by a hard subphotospheric piston under an isothermal assumption. These models displayed strong shock development and had some encouraging similarities with the BW Vul phenomenon. However, particularly because of the use of a hard piston, they were not very physically realistic. Here we discuss the results of a more sophisticated approach to this modelling problem. This modelling problem is of specific current importance because Odell’s (1981) recent observations of a variable polarization in BW Vul have renewed the debate over possible nonradial pulsations in this star. Since nonlinear effects are clearly substantial in BW Vul, it is evident that the implications of these on the observed spectral line changes should be carefully examined on a radial pulsation hypothesis, before turning to the complexities of nonlinear nonradial profile modelling.
Among the most important stimuli for developing the FLAIR multi-object spectroscopy system on the 1.2-m UK Schmidt Telescope was its potential for carrying out large-scale redshift surveys of galaxies of intermediate magnitude (B <~ 17). During FLAIR’s lengthy development period, these objects provided the yardstick by which the system’s performance was measured, and a number of limited-area redshift surveys were carried out. We are now following these with a 1-in-3 survey over the 60 fields of the ROE/Durham Galaxy Catalogue to produce a redshift map of some 4000 galaxies out to a distance of ~ 300h−1 Mpc (where the parameter h is the Hubble constant expressed as a fraction of 100 kms−1 Mpc−1). In this paper we summarise the results from our redshift surveys to highlight the capabilities of FLAIR. We present a status report on the current large-scale survey, and show that the recently-introduced FLAIR II system will speed its progress considerably.