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Behavioral determinants with the largest effects are often those related to the environments in which behaviors occur. This suggests the merits of a shift in focus of changing behavior at scale away from interventions based on deliberation and decision-making and toward interventions that involve changing cues – physical, digital, social, and economic – in environments. This chapter focuses on changing cues in small-scale physical environments – sometimes known as choice architecture or nudge interventions. Despite attracting much interest, these interventions have been little explored from a theoretical perspective. Exploring the mechanisms by which some of these interventions exert their effects provides a starting point. Examining evidence of three interventions – increasing availability of healthier food options, reducing glass size, and putting warning labels on food and alcohol products – suggests no single theory explains their effects. The mechanisms by which these interventions affect behavior change also necessitate different levels of explanation and demand a theoretical framework that applies at different levels. Recognizing the distinction between model-free and model-based learning and behavior may be central to this. Advancing knowledge on changing behavior by changing environments requires robustly designed field studies to estimate effect sizes, complemented by laboratory studies testing mechanisms to optimize interventions and develop theoretical understanding.
The species of Gagnepainia K.Schum. and Hemiorchis Kurz are revised throughout their ranges. These genera are shown with evidence from morphological and molecular studies to be distinct, although closely related to each other. Two species of Gagnepainia and three of Hemiorchis are recognised. A key to the genera of Globbeae and keys to the species of Gagnepainia and Hemiorchis are given, all names are typified and descriptions are provided. Conservation assessments of all taxa are proposed.
Several studies show that despite poor oral health substance users fail to access dental care. This was confirmed locally by audit in 2005; 63% (n = 82) were not registered with a dentist and 72% had dental problems, of whom 83% were not receiving treatment.
To examine issues affecting substance users use of dental services.
To identify factors influencing whether substance users visit the dentist, in particular whether having a ‘regular’ dentist is important. Secondly, to compare this with perceptions of dental care staff.
A cross sectional survey was conducted across Norfolk & Waveney Mental Health Trust's Alcohol and Drugs Service and Norwich dental practices. 87 substance users participated, half of Norwich dentists (n = 67) and 66 reception staff from Norwich dental practices.
Participants reported high levels of dental problems, most commonly toothache (71%). Those having a dentist they normally saw were more likely to have visited the dentist in the previous year (X2 = 14.06, p < 0.01). The most common reasons for not receiving treatment were difficulty finding a dentist, difficulty keeping appointments and few available appointments. Dental staff acknowledged similar dental problems, but were more likely to think lack of motivation caused non-attendance. Drug use, substitute prescribing or duration in treatment did not influence frequency of dental visits. Dentists hi-lighted remuneration issues for providing services to substance users.
Having a ‘regular’ dentist could improve use of dental services. Examining capacity and revisiting payments for this group under the new dental contract could improve treatment rates.
Bipolar, migraine and epilepsy disorders are often co-morbid conditions. This link may help explain their pathogenesis, diagnosis and treatment. The more understood mechanisms by which epilepsy and migraine arise may offer new insight into bipolar disorder neurobiology. Here, we examine the prevalence of these disorders in a UK community mental health team. We then report on a wide-ranging literature review highlighting shared features of the conditions and suggest how they may develop along a similar pathway.
• Examine co-morbidity prevalence in Bedford East Community Mental Health Team outpatients.
• Identify overlapping aspects of neurobiology.
• Explain how these may relate to each other.
• Add to existing co-morbidity data.
• Offer insight into bipolar neurobiology.
Manual search of an outpatient database covering January 2010 to February 2011 (n = 615), identifying cases of bipolar disorder, migraine and epilepsy.
Bipolar + epilepsy 0.16%; 0.82% of bipolar patients.
Bipolar + migraine 1.1%; 5.7% of bipolar patients.
Contrasting with previous studies, co-morbidity was much lower - likely to reflect under-reporting of secondary diagnoses. Most literature supports a connection between the disorders. Common features exist regarding disease course, pharmacological treatment, altered cellular and loss of network stability.
We discuss the relationship between genes and environment, and hence impact on Metabolic factors, Ion Channels and neurotropic factors, which affect network changes, Hyper-excitability,Cellular vulnerability and Loss of ‘stabilising’ circuits. We suggest an accumulating pathological change towards disease and we note accompanying Inflammatory/Immune responses.
Several autonomous phase-sensitive radio-echo sounders (ApRES) were deployed at Greenland glaciers to investigate ice deformation. Different attenuation settings were tested and it was observed that, in the presence of clipping of the deramped ApRES signal, each setting produced a different result. Specifically, higher levels of clipping associated with lower attenuation produced an apparent linear increase of diurnal vertical cumulative displacement with depth, and obscured the visibility of the basal reflector in the return amplitude. An example with a synthetic deramped signal confirmed that these types of artifacts result from the introduction of harmonics from square-wave-like features introduced by clipping. Apparent linear increase of vertical displacement with depth occurs when the vertical position of a near-surface internal reflector changes in time. Artifacts in the return amplitude may obscure returns from internal reflectors and the basal reflector, making it difficult to detect thickness evolution of the ice and to correctly estimate vertical velocities. Variations in surface melt during ApRES deployments can substantially modulate the received signal strength on short timescales, and we therefore recommend using higher attenuator settings for deployments in such locations.
A striking new species of Begonia, B. joshii, is described from Amazonas Region, Peru. The new species is unusual among the South American members of the genus both in its combination of tuberous habit with peltate leaves and in living in a seasonally dry tropical forest environment. A phylogeny of this and closely related species is presented, and its sectional affiliation and IUCN conservation status are discussed. A key to the peltate Peruvian species of Begonia is provided.
Lateral memristors consisting of planar Ag electrodes (with sub-micrometer separation) supported on thin films of amorphous zinc-tin-oxide have been characterized. After an initial filament-forming process, each device exhibited volatile, resistive switching. In the low resistance state, the transport mechanism and conductance depended on prior activity and on the imposed current limit, mimicking biologic synaptic plasticity. Microscopic observations performed on each device revealed nanoscale filaments between the electrodes. These filaments were subject to Rayleigh instability and exhibited relaxation times determined by their effective radii. The relaxation times and on:off resistance ratios suggest suitability for threshold switching selector devices.
The aim of this study was to evaluate the cost-effectiveness of exposure in vivo (EXP, a cognitive-behavioral treatment targeting pain-related fear) in Complex Regional Pain Syndrome Type I (CRPS-I), as compared to pain-contingent physical therapy (PPT).
Data from a randomized controlled trial were used to compare the cost-effectiveness of EXP versus PPT from a societal perspective. Intervention costs, other healthcare costs, costs to patient and family, and productivity losses were included. The main outcomes were changes in the SF-36 physical component scale and quality-adjusted life-years. Changes were followed until 6 months after treatment. Uncertainty was estimated using nonparametric bootstrap analysis, cost-effectiveness acceptability curves and cost-effectiveness planes. Sensitivity analyses were performed to check robustness of findings.
Forty-six patients were randomized and thirty-eight completed the study. Over 6 months, EXP resulted in greater improvement in physical health-related quality of life and quality-adjusted life-years than PPT. Despite higher initial treatment costs, EXP showed a tendency to reduce all costs compared with PPT; healthcare costs were significantly reduced. Furthermore, the cost-effectiveness planes were in favor of EXP. Sensitivity analyses, for different program costs and complete cases only, confirmed robustness of these findings.
EXP, a cognitive-behavioral treatment, seems more cost-effective than PPT in CRPS patients with pain-related fear. The initial higher costs for EXP are offset by a long-term reduction of costs for healthcare use, and a tendency to lower work absenteeism and reduced societal costs. Due to low sample sizes, replication of findings is required to confirm results.
The final rule for the protection of human subjects requires that informed consent be “in language understandable to the subject” and mandates that “the informed consent must be organized in such a way that facilitates comprehension.” This study assessed the readability of Institutional Review Board-approved informed consent forms at our institution, implemented an intervention to improve the readability of consent forms, and measured the first year impact of the intervention.
Readability assessment was conducted on a sample of 217 Institutional Review Board-approved informed consents from 2013 to 2015. A plain language informed consent template was developed and implemented and readability was assessed again after 1 year.
The mean readability of the baseline sample was 10th grade. The mean readability of the post-intervention sample (n=82) was seventh grade.
Providing investigators with a plain language informed consent template and training can promote improved readability of informed consents for research.
Identifying youth who may engage in future substance use could facilitate early identification of substance use disorder vulnerability. We aimed to identify biomarkers that predicted future substance use in psychiatrically un-well youth.
LASSO regression for variable selection was used to predict substance use 24.3 months after neuroimaging assessment in 73 behaviorally and emotionally dysregulated youth aged 13.9 (s.d. = 2.0) years, 30 female, from three clinical sites in the Longitudinal Assessment of Manic Symptoms (LAMS) study. Predictor variables included neural activity during a reward task, cortical thickness, and clinical and demographic variables.
Future substance use was associated with higher left middle prefrontal cortex activity, lower left ventral anterior insula activity, thicker caudal anterior cingulate cortex, higher depression and lower mania scores, not using antipsychotic medication, more parental stress, older age. This combination of variables explained 60.4% of the variance in future substance use, and accurately classified 83.6%.
These variables explained a large proportion of the variance, were useful classifiers of future substance use, and showed the value of combining multiple domains to provide a comprehensive understanding of substance use development. This may be a step toward identifying neural measures that can identify future substance use disorder risk, and act as targets for therapeutic interventions.
To determine the impact of total household decolonization with intranasal mupirocin and chlorhexidine gluconate body wash on recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection among subjects with MRSA skin and soft-tissue infection.
Three-arm nonmasked randomized controlled trial.
Five academic medical centers in Southeastern Pennsylvania.
Adults and children presenting to ambulatory care settings with community-onset MRSA skin and soft-tissue infection (ie, index cases) and their household members.
Enrolled households were randomized to 1 of 3 intervention groups: (1) education on routine hygiene measures, (2) education plus decolonization without reminders (intranasal mupirocin ointment twice daily for 7 days and chlorhexidine gluconate on the first and last day), or (3) education plus decolonization with reminders, where subjects received daily telephone call or text message reminders.
MAIN OUTCOME MEASURES
Owing to small numbers of recurrent infections, this analysis focused on time to clearance of colonization in the index case.
Of 223 households, 73 were randomized to education-only, 76 to decolonization without reminders, 74 to decolonization with reminders. There was no significant difference in time to clearance of colonization between the education-only and decolonization groups (log-rank P=.768). In secondary analyses, compliance with decolonization was associated with decreased time to clearance (P=.018).
Total household decolonization did not result in decreased time to clearance of MRSA colonization among adults and children with MRSA skin and soft-tissue infection. However, subjects who were compliant with the protocol had more rapid clearance
We applied three statistical classification techniques—linear discriminant analysis (LDA), logistic regression, and random forests—to three astronomical datasets associated with searches for interstellar masers. We compared the performance of these methods in identifying whether specific mid-infrared or millimetre continuum sources are likely to have associated interstellar masers. We also discuss the interpretability of the results of each classification technique. Non-parametric methods have the potential to make accurate predictions when there are complex relationships between critical parameters. We found that for the small datasets the parametric methods logistic regression and LDA performed best, for the largest dataset the non-parametric method of random forests performed with comparable accuracy to parametric techniques, rather than any significant improvement. This suggests that at least for the specific examples investigated here accuracy of the predictions obtained is not being limited by the use of parametric models. We also found that for LDA, transformation of the data to match a normal distribution led to a significant improvement in accuracy. The different classification techniques had significant overlap in their predictions; further astronomical observations will enable the accuracy of these predictions to be tested.
To identify risk factors for recurrent methicillin-resistant Staphylococcus aureus (MRSA) colonization.
Prospective cohort study conducted from January 1, 2010, through December 31, 2012.
Five adult and pediatric academic medical centers.
Subjects (ie, index cases) who presented with acute community-onset MRSA skin and soft-tissue infection.
Index cases and all household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as 2 consecutive sampling periods with negative surveillance cultures. Recurrent colonization was defined as any positive MRSA surveillance culture after clearance. Index cases with recurrent MRSA colonization were compared with those without recurrence on the basis of antibiotic exposure, household demographic characteristics, and presence of MRSA colonization in household members.
The study cohort comprised 195 index cases; recurrent MRSA colonization occurred in 85 (43.6%). Median time to recurrence was 53 days (interquartile range, 36–84 days). Treatment with clindamycin was associated with lower risk of recurrence (odds ratio, 0.52; 95% CI, 0.29–0.93). Higher percentage of household members younger than 18 was associated with increased risk of recurrence (odds ratio, 1.01; 95% CI, 1.00–1.02). The association between MRSA colonization in household members and recurrent colonization in index cases did not reach statistical significance in primary analyses.
A large proportion of patients initially presenting with MRSA skin and soft-tissue infection will have recurrent colonization after clearance. The reduced rate of recurrent colonization associated with clindamycin may indicate a unique role for this antibiotic in the treatment of such infection.
Infect. Control Hosp. Epidemiol. 2015;36(7):786–793
The search for an association between disease incidence and possible risk factors using surveillance data needs to account for possible spatial and temporal correlations in underlying risk. This can be especially difficult if there are missing values for some important covariates. We present a case study to show how this problem can be overcome in a Bayesian analysis framework by adding to the usual spatio-temporal model a component for modelling the missing data.
The Family Evaluation of Hospice Care (FEHC) survey is widely employed by hospices, and several studies have examined this information to help inform and enhance end-of-life services. However, these studies have largely focused on examining relatively straightforward associations between variables and have not tested larger models that could reveal more complex effects. The present study aimed to examine the direct and mediating (i.e., via information/education, patient care, and family support) effects of demographic factors, length of stay, timing of referral, patient symptom severity, location of services, and relationship to caregiver on two outcome variables: overall satisfaction and caregiver confidence.
Surveys were collected from 3226 participants who had lost a loved one who received hospice services. Structural equation modeling was employed to examine the direct and mediating effects of the independent variables on the two outcomes of interest.
Participants reporting on racial minority patients, patients with more symptoms, and those referred too late or too early were the most likely to express some discontentment with hospice services. The information/education these individuals received was the only mediating factor significantly associated with caregiver confidence. More positive perceptions of patient care and information/education were both significantly related to greater overall satisfaction.
Significance of Results:
These findings help to (1) pinpoint those most at risk for being less satisfied with hospice, (2) identify which aspects of care may be most strongly related to overall outcomes, and (3) provide a model for examining complex associations among FEHC variables that may be employed by other researchers.