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Posttraumatic stress disorder (PTSD) is the most highly co-occurring psychiatric disorder among veterans with cannabis use disorder (CUD). Despite some evidence that cannabis use prospectively exacerbates the course of PTSD, which in turn increases the risk for CUD, the causal nature of the relationship between cannabis and psychiatric comorbidity is debated. The longitudinal relationship between PTSD diagnosis and traumatic intrusion symptoms with cannabis use and CUD was examined using cross-lagged panel model (CLPM) analysis.
Prospective data from a longitudinal observational study of 361 veterans deployed post-9/11/2001 included PTSD and CUD diagnoses, cannabis use, and PTSD-related traumatic intrusion symptoms from the Inventory of Depression and Anxiety Symptoms.
A random intercept CLPM analysis that leveraged three waves (baseline, 6 months and 12 months) of cannabis use and PTSD-related intrusion symptoms to account for between-person differences found that baseline cannabis use was significantly positively associated with 6-month intrusion symptoms; the converse association was significant but reduced in magnitude (baseline use to 6-month intrusions: β = 0.46, 95% CI 0.155–0.765; baseline intrusions to 6-month use: β = 0.22, 95% CI −0.003 to 0.444). Results from the two-wave CLPM reveal a significant effect from baseline PTSD to 12-month CUD (β = 0.15, 95% CI 0.028–0.272) but not from baseline CUD to 12-month PTSD (β = 0.12, 95% CI −0.022 to 0.262).
Strong prospective associations capturing within-person changes suggest that cannabis use is linked with greater severity of trauma-related intrusion symptoms over time. A strong person-level directional association between PTSD and CUD was evident. Findings have significant clinical implications for the long-term effects of cannabis use among individuals with PTSD.
In response to advancing clinical practice guidelines regarding concussion management, service members, like athletes, complete a baseline assessment prior to participating in high-risk activities. While several studies have established test stability in athletes, no investigation to date has examined the stability of baseline assessment scores in military cadets. The objective of this study was to assess the test–retest reliability of a baseline concussion test battery in cadets at U.S. Service Academies.
All cadets participating in the Concussion Assessment, Research, and Education (CARE) Consortium investigation completed a standard baseline battery that included memory, balance, symptom, and neurocognitive assessments. Annual baseline testing was completed during the first 3 years of the study. A two-way mixed-model analysis of variance (intraclass correlation coefficent (ICC)3,1) and Kappa statistics were used to assess the stability of the metrics at 1-year and 2-year time intervals.
ICC values for the 1-year test interval ranged from 0.28 to 0.67 and from 0.15 to 0.57 for the 2-year interval. Kappa values ranged from 0.16 to 0.21 for the 1-year interval and from 0.29 to 0.31 for the 2-year test interval. Across all measures, the observed effects were small, ranging from 0.01 to 0.44.
This investigation noted less than optimal reliability for the most common concussion baseline assessments. While none of the assessments met or exceeded the accepted clinical threshold, the effect sizes were relatively small suggesting an overlap in performance from year-to-year. As such, baseline assessments beyond the initial evaluation in cadets are not essential but could aid concussion diagnosis.
OBJECTIVES/SPECIFIC AIMS: The Clinical Research Operations Program is a free educational program designed to educate clinical research personnel on the conduct of clinical research (CR). The participant completes 16 required core sessions (24 h), 4 elective sessions (4 h), and passes the final exam to receive a certification in CR operations at Stanford. Sessions focus on the 9 domains of CR (established by the Joint Task Force for Clinical Trial Competency), such as Ethical & Participant Safety Considerations, Clinical Study Operations, & Data Management/Informatics. METHODS/STUDY POPULATION: Sessions are taught by volunteer lecturers. Participants may also attend the sessions without pursuing the certification. The program objective is to provide easy-access education in CR in order to increase regulatory compliance, staff retention, and improve CR at Stanford. The program targets CR coordinators, however, staff, postdocs, fellows, and faculty also participate. RESULTS/ANTICIPATED RESULTS: Since the program’s launch in January 2017, 119 individuals have enrolled in the certification program. The most represented group is the Department of Medicine. Sessions consistently reach their maximum with a waiting list. Each core session requires that the participant complete an evaluation (Likert scale, 1–5) of the registration process (4.5/5), the class environment (4.6/5), the presented content (4.5/5), and the instructor (4.6/5). Data from these evaluations are positive to date and is used to continually refine the program. DISCUSSION/SIGNIFICANCE OF IMPACT: N/A.
To establish an initial conceptualisation of how psychiatrists understand and use formulation within adult psychiatry practice. Twelve psychiatrists took part in semi-structured interviews. Transcripts were analysed using a constructivist grounded theory methodology.
Formulation was conceptualised as an addition to diagnosis, triggered by risk, complexity and a need for an enhanced understanding. Participants valued collaborative formulation with psychologists. Multiple contextual factors were perceived to either facilitate or inhibit the process. Barriers to formulation led to a disjointed way of working.
Findings contribute to an understanding of formulation within psychiatry training and practice.
Star formation in the Galactic disc is primarily controlled by gravity, turbulence, and magnetic fields. It is not clear that this also applies to star formation near the Galactic Centre. Here we determine the turbulence and star formation in the CMZ cloud G0.253+0.016. Using maps of 3 mm dust emission and HNCO intensity-weighted velocity obtained with ALMA, we measure the volume-density variance σρ /ρ 0=1.3±0.5 and turbulent Mach number
= 11±3. Combining these with turbulence simulations to constrain the plasma β = 0.34±0.35, we reconstruct the turbulence driving parameter b=0.22±0.12 in G0.253+0.016. This low value of b indicates solenoidal (divergence-free) driving of the turbulence in G0.253+0.016. By contrast, typical clouds in the Milky Way disc and spiral arms have a significant compressive (curl-free) driving component (b > 0.4). We speculate that shear causes the solenoidal driving in G0.253+0.016 and show that this may reduce the star formation rate by a factor of 7 compared to nearby clouds.
Some epidemiological evidence suggests that diets high in omega 3 fatty acids (n-3 FAs) may be beneficial for skeletal health. The aim of this systematic review was to determine if randomized controlled trials (RCTs) support a positive effect of n-3 FAs on osteoporosis. A systematic search was performed in PubMed and EMBASE databases. We included RCTs with skeletal outcomes conducted in adults or children (> = 1 year old) using n-3 FA fortified foods, diets or supplements alone or in combination with other vitamins/minerals, versus placebo. Primary outcomes were incident fracture at any site and bone mineral density (BMD) in g/cm2. Secondary outcomes included bone formation or resorption markers and bone turnover regulators. A total of 10 RCTs met inclusion criteria. Effect sizes with 95 % confidence intervals were estimated to compare studies across various treatments and outcome measures. No pooled analysis was completed due to heterogeneity of studies and small sample sizes. No RCTs included fracture as an outcome. Four studies reported significant favorable effects of n-3 FA on BMD or bone turnover markers. Of these, three delivered n-3 FA in combination with high calcium foods or supplements. Five studies reported no differences in outcomes between n-3 FA intervention and control groups; one study included insufficient data for effect size estimation. Strong conclusions regarding n-3 FAs and bone disease are limited due to the small number and modest sample sizes of RCTs, however, it appears that any potential benefit of n-3 FA on skeletal health may be enhanced by concurrent administration of calcium.
A single large colony (20 cm) of Rhombopora blakei n. sp. from the Hook Head Formation of Ireland (Tournaisian Stage, Mississippian) permits an analysis of within-colony variation associated with environmental change at a calendar scale (days to decades). Morphometric data for three external characters—apertures spacing along a branch and diagonal to a branch as well as lateral zooecial spacing—were collected as growth series (16–30 generations) from 13 segments within the colony. ANOVA, post-hoc means testing and graphical analysis of standardized data revealed nearest neighbor effects at the zooecial level and non-random distribution of variances across the colony. Parametric tests for sequential nonrandomness revealed cyclic variation through growth transects at three levels (23.3, 9.4 and 5.3 generations). Comparisons to growth rates of modern bryozoans suggests that the longer-term cycles are annual and that the shortest cycles may be related to lunar tidal cycles. The exceptional size and preservation of this single specimen, which is a new species of rhabdomesine Bryozoa, reinforces the importance of collecting individual morphological measurements from randomly selected and widely spaced parts of a colony for taxonomic, evolutionary and ecological applications.
Obesity and sarcopenia are health problems associated with ageing. The present study modelled the longitudinal changes in body composition of healthy men, aged from 20 to 96 years, and evaluated the fidelity of BMI to identify age-dependent changes in fat mass and fat-free mass. The data from 7265 men with multiple body composition determinations (total observations 38 328) were used to model the age-related changes in body mass, fat mass, fat-free mass, BMI and percentage of body fat. Changes in fat mass and fat-free mass were used to evaluate the fidelity of BMI and to detect body composition changes with ageing. Linear mixed regression models showed that all trajectories of body composition with healthy ageing were quadratic. Fat mass, BMI and percentage of body fat increased from age 20 years and levelled off at approximately 80 years. Fat-free mass increased slightly from age 20 to 47 years and then declined at a non-linear rate with ageing. Levels of aerobic exercise had a positive influence on fat mass and a slight negative effect on fat-free mass. BMI and percentage of body fat were sensitive in detecting the increase in fat mass that occurred with healthy ageing, but failed to identify the loss of fat-free mass that started at age 47 years.
An ultrafast laser irradiation method for the removal of corrosion from Daguerreotypes without detrimentally affecting image quality has been developed. Corrosion products such as silver oxide and silver sulfide may be removed by chemical cleaning but these reactions are hard to control and are often damaging to the underlying silver, ruining the image. The Ti:Sapphire 150 fs laser pulses used in this study are focused to a beam diameter of 60 μm and are normally incident to the Daguerreotype. It was found that the corrosion layer has a lower material removal threshold than silver allowing for removal of corrosion with minimal removal of vital information contained in the silver substrate.