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The 11th revision to the WHO International Classification of Diseases (ICD-11) identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions.
We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality.
Fifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = −0.90 (CBT; k = 27, 95% CI −1.11 to −0.68; moderate quality) to g = −1.26 (EMDR; k = 4, 95% CI −2.01 to −0.51; low quality). CBT and EA each had moderate–large or large effects on negative self-concept, but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or moderate–large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared with non-specific interventions (e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome.
The development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.
Bacterial cultures exposed to iron-doped apatite nanoparticles (IDANPs) prior to the introduction of antagonistic viruses experience up to 2.3 times the bacterial destruction observed in control cultures. Maximum antibacterial activity of these bacteria-specific viruses, or phage, occurs after bacterial cultures have been exposed to IDANPs for 1 hr prior to phage introduction, demonstrating that IDANP-assisted phage therapy would not be straight forward, but would instead require controlled time release of IDANPs and phage. These findings motivated the design of an electrospun nanofiber mesh treatment delivery system that allows burst release of IDANPs, followed by slow, consistent release of phage for treatment of topical bacterial infections. IDANPs resemble hydroxyapatite, a biocompatible mineral analogous to the inorganic constituent of mammalian bone, which has been approved by the Food and Drug Administration for many biomedical purposes. The composite nanofiber mesh was designed for IDANP-assisted phage therapy treatment of topical wounds and consists of a superficial, rapid release layer of polyethylene oxide (PEO) fibers doped with IDANPs, followed by inner, coaxial polycaprolactone / polyethylene glycol (PCL/PEG) blended polymer fiber layer for slower phage delivery. Our investigations have established that IDANP-doped PEO fibers are effective vehicles for dissemination of IDANPs for bacterial exposure and resultant increased bacterial death by phage. In this work, slower delivery of the phage behind IDANPs was accomplished using coaxial, electrospun fibers composed of PCL/PEG polymer blend.
OBJECTIVES/SPECIFIC AIMS: Drug development is a common research pursuit for basic and clinical scientists that interfaces diagnostic/therapeutic challenges with funding agencies, pharmaceutical industry, regulatory systems, and education. The University at Buffalo Clinical and Translational Science Institute (CTSI) has implemented a Drug Development Core (DDC) with goals that foster team science and collaboration, optimize laboratory use, and networks investigators. Our goals are to foster collaborations within the region and with other CTSAs. METHODS/STUDY POPULATION: The DDC met with 300 potential investigators from 14 departments and several local companies. There were 35 portal requests from 15 departments and 7 companies; 8 were from training programs. For 28 requests, a reviewer provided consultation, while 7 required discussions and review of data. DDC assisted with 15 grant applications (outcomes pending), 10 industry-related new drug development requests and 1 regulatory review. Curriculum reviews noted overlap and gaps. Cross-institute opportunities for M.D.-Ph.D. research mentoring were identified. RESULTS/ANTICIPATED RESULTS: The DDC met with 300 potential investigators from 14 departments and several local companies. There were 35 portal requests from 15 departments and 7 companies; 8 were from training programs. For 28 requests, a reviewer provided consultation, while 7 required discussions and review of data. DDC assisted with 15 grant applications (outcomes pending), 10 industry-related new drug development requests and 1 regulatory review. Curriculum reviews noted overlap and gaps. Cross-institute opportunities for M.D.-Ph.D. research mentoring were identified. DISCUSSION/SIGNIFICANCE OF IMPACT: The CTSI DDC was well received by investigators. The request process fosters collaboration among researchers with similar interests and identifies core laboratory resources that add innovation to ongoing research, funding applications, education, and interinstitutional planning.
OBJECTIVES/SPECIFIC AIMS: To evaluate the NIH-sponsored Best Practices for Social and Behavioral Research e-learning course. METHODS/STUDY POPULATION: Four universities partnered in a pilot study to evaluate this new course. Outcomes from 294 participants completing the course included efficient progress through the training, perceived relevance of the course to current work, level of engagement with the course material, intent to work differently as a result of the course, and downloading digital resources. RESULTS/ANTICIPATED RESULTS: Participants rated the course as relevant and engaging (6.4 and 5.8 on a 7-point Likert scale) and 96% of respondents said they would recommend the course to colleagues. Qualitative analysis of participant testimonials suggested that most respondents had a readiness to change in the way they worked as a result of the course. Overall, results suggest participants completed the course efficiently, perceived outcomes positively and worked differently after the training. DISCUSSION/SIGNIFICANCE OF IMPACT: These results will inform new guidelines for future participants (e.g., average time to complete, expectations for knowledge checks in the training). Future studies should include larger samples and closer coordination and communication between study sites.
The Best Practices in Social and Behavioral Research Course was developed to provide instruction on good clinical practice for social and behavioral trials. This study evaluated the new course.
Participants across 4 universities took the course (n=294) and were sent surveys following course completion and 2 months later. Outcomes included relevance, how engaging the course was, and working differently because of the course. Open-ended questions were posed to understand how work was impacted.
Participants rated the course as relevant and engaging (6.4 and 5.8/7 points) and reported working differently (4.7/7 points). Participants with less experience in social and behavioral trials were most likely to report working differently 2 months later.
The course was perceived as relevant and engaging. Participants described actions taken to improve rigor in implementing trials. Future studies with a larger sample and additional participating sites are recommended.
This paper examines the potential impact of the European Union’s Environmental Liability Directive (ELD)1 on the nanotechnology (NT) sector. In terms of risk governance the ELD represents a new paradigm, affording the environment an enhanced status both in legal and indeed ontological terms. However, the nature of the NT industry itself is such as to create complexity in the implementation of the ELD. Whilst the field of nano-toxicology is making advances, debate still prevails around issues pertaining to exposure, (eco)-toxicity, metrics, potential impact and legal causation. Levels of uncertainty remain high and hence measuring environmental impact is problematic. The paper addresses the potential environmental liability exposures of NT manufacturers and producers pursuant to the provisions of the ELD and by extension highlights the importance of the insurability of the liability risk all of which bears significance for the sustainability of the industry. It also examines the legal and regulatory challenges of the application of the ELD in the context of the NT industry, highlighting the challenges which this pervasive technology presents for regulatory policy. A cursory discussion of the legal theoretical underpinning of the directive helps to explain the rationale of the directive.
To determine the effect of graft choice (allograft, bone-patellar tendon-bone autograft, or hamstring autograft) on deep tissue infections following anterior cruciate ligament (ACL) reconstructions.
Retrospective cohort study.
SETTING AND POPULATION
Patients from 6 US health plans who underwent ACL reconstruction from January 1, 2000, through December 31, 2008.
We identified ACL reconstructions and potential postoperative infections using claims data. A hierarchical stratified sampling strategy was used to identify patients for medical record review to confirm ACL reconstructions and to determine allograft vs autograft tissue implanted, clinical characteristics, and infection status. We estimated infection rates overall and by graft type. We used logistic regression to assess the association between infections and patients’ demographic characteristics, comorbidities, and choice of graft.
On review of 1,452 medical records, we found 55 deep wound infections. With correction for sampling weights, infection rates varied by graft type: 0.5% (95% CI, 0.3%-0.8%) with allografts, 0.6% (0.1%–1.5%) with bone-patellar tendon-bone autografts, and 2.5% (1.9%–3.1%) with hamstring autograft. After adjusting for potential confounders, we found an increased infection risk with hamstring autografts compared with allografts (odds ratio, 5.9; 95% CI, 2.8–12.8). However, there was no difference in infection risk among bone-patellar tendon-bone autografts vs allografts (odds ratio, 1.2; 95% CI, 0.3–4.8).
The overall risk for deep wound infections following ACL reconstruction is low but it does vary by graft type. Infection risk was highest in hamstring autograft recipients compared with allograft recipients and bone-patellar tendon-bone autograft recipients.
This paper produces new estimates for white and black mortality and fertility at the state level from 1800(20)–2000. It produces new estimates of black and white schooling for this same period. Using a calibrated model of black and white parents, we fit the time series of black and white fertility and schooling. We then produce estimates of the benefits of equal education opportunity for blacks over the period 1820–2000. For the better part of US history, blacks have suffered from less access to schooling for their children than whites. This paper quantifies the magnitude of this discrimination. Our estimates of the welfare cost of this discrimination prior to the Civil War range between 0.5 and 20 times black wealth, and between 0.5 and 10 times black wealth prior to 1960. Further we find that the Civil Rights era was valued by blacks in the South by between 1% to 2% of wealth. Outside of the South, we find significant costs of discrimination prior to 1960, ranging from 6% to 150% of black wealth. For these divisions from 1960–2000, blacks have attained rough parity in schooling access. The welfare magnitudes are similar to the hypothetical gains to blacks if they had white mortality rates. We show that the model’s black and white human capital series are strongly, positively correlated with state output measures, black and white permanent incomes and black and white earnings.
IAU Commission 5, Documentation and Astronomical Data, continued its mission of promoting and supporting sound practices of data management, data dissemination, and data preservation over the past three years. The Commission also prepared its proposal for continuation, with some changes in emphasis, after the IAU's commission restructuring program. Below we report on the activities of the various Working Groups and the one Task Force in Commission 5.
This paper discusses some of the criticisms recently raised by Rafael Dobado-González about our work on real wages in the Americas in the long run. Although addressing a series of issues, Dobado mainly questions our use of the welfare ratio methodology to assess standards of living in colonial Spanish America. In this article we explain how, despite its limitations, this methodology provides a solid, transparent metric to compare economic development across space and time. In particular, welfare ratios present more economically relevant information on living standards than the commodity wages that Dobado prefers (Dobado González and García Montero 2014). We argue that Dobado fails to offer convincing evidence against our findings; hence, we stand by these results, which suggest that the divergence between North and Latin America began early in the colonial period.
We present the characteristics of a high temperature CMOS integrated circuit process based on 4H silicon carbide designed to operate at temperatures beyond 300°C. N-channel and P-channel transistor characteristics at room and elevated temperatures are presented. Both channel types show the expected low values of field effect mobility well known in SiC MOSFETS. However the performance achieved is easily capable of exploitation in CMOS digital logic circuits and certain analogue circuits, over a wide temperature range.
Data is also presented for the performance of digital logic demonstrator circuits, in particular a 4 to 1 analogue multiplexer and a configurable timer operating over a wide temperature range. Devices are packaged in high temperature ceramic dual in line (DIL) packages, which are capable of greater than 300°C operation. A high temperature “micro-oven” system has been designed and built to enable testing and stressing of units assembled in these package types. This system heats a group of devices together to temperatures of up to 300°C while keeping the electrical connections at much lower temperatures. In addition, long term reliability data for some structures such as contact chains to n-type and p-type SiC and simple logic circuits is summarized.
To explore the feasibility of identifying anterior cruciate ligament (ACL) allograft implantations and infections using claims.
Retrospective cohort study.
We identified ACL reconstructions using procedure codes at 6 health plans from 2000 to 2008. We then identified potential infections using claims-based indicators of infection, including diagnoses, procedures, antibiotic dispensings, specialty consultations, emergency department visits, and hospitalizations. Patients’ medical records were reviewed to determine graft type, validate infection status, and calculate sensitivity and positive predictive value (PPV) for indicators of ACL allografts and infections.
A total of 11,778 patients with codes for ACL reconstruction were identified. After chart review, PPV for ACL reconstruction was 96% (95% confidence interval [CI], 94%–97%). Of the confirmed ACL reconstructions, 39% (95% CI, 35%–42%) used allograft tissues. The deep infection rate after ACL reconstruction was 1.0% (95% CI, 0.7%–1.4%). The odds ratio of infection for allografts versus autografts was 0.41 (95% CI, 0.19–0.78). Sensitivity of individual claims-based indicators for deep infection after ACL reconstruction ranged from 0% to 75% and PPV from 0% to 100%. Claims-based infection indicators could be combined to enhance sensitivity or PPV but not both.
While claims data accurately identify ACL reconstructions, they poorly distinguish between allografts and autografts and identify infections with variable accuracy. Claims data could be useful to monitor infection trends after ACL reconstruction, with different algorithms optimized for different surveillance goals.
Cold atom electron and ion sources produce electron bunches and ion beams by photoionization of laser-cooled atoms. They offer high coherence and the potential for high brightness, with applications including ultra-fast electron-diffractive imaging of dynamic processes at the nanoscale. The effective brightness of electron sources has been limited by nonlinear divergence caused by repulsive interactions between the electrons, known as the Coulomb explosion. It has been shown that electron bunches with ellipsoidal shape and uniform density distribution have linear internal Coulomb fields, such that the Coulomb explosion can be reversed using conventional optics. Our source can create bunches shaped in three dimensions and hence in principle achieve the transverse spatial coherence and brightness needed for picosecond-diffractive imaging with nanometer resolution. Here we present results showing how the shaping capability can be used to measure the spatial coherence properties of the cold electron source. We also investigate space-charge effects with ions and generate electron bunches with durations of a few hundred picoseconds. Future development of the cold atom electron and ion source will increase the bunch charge and charge density, demonstrate reversal of Coulomb explosion, and ultimately, ultra-fast coherent electron-diffractive imaging.
To explore multiple methods of calculating diet diversity scores (DDS) to maximize associations with predicted dietary micronutrient adequacy among schoolchildren in rural Kenya.
Up to three 24 h recall interviews were administered for each child for a total of 1544 d of intake from all schoolchildren. Daily amounts of food consumed were assigned to one of eight food groups. Five DDS were developed based on various minimum intake amounts from each food group: (i) 1 g; (ii) 15 g; (iii) a variable minimum based on the content of a target nutrient for each group; (iv) the median intake level for each group; and (v) the 90th percentile intake level for each group. A diet was assigned 1 point towards the daily DDS if the food group intake was above the defined minimum level. Five scores were calculated for each child, and bivariate longitudinal random-effects models were used to assess the correlation between each DDS and the mean probability of adequacy for fourteen nutrients.
Embu District, Kenya.
Schoolchildren (n 529), mean age 7·00 (sd 1·41) years.
Only DDS based on a 15 g minimum and DDS based on nutrient content were significantly associated with mean probability of adequacy after adjusting for energy intake (0·21 and 0·41, respectively).
A DDS using minimum intakes based on nutrients contributed by a food group best predicted nutrient adequacy in this population. These analyses contribute to the continued search for simpler and more valid dietary quality indicators among low-income nations.