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To identify latent trajectories of IQ over time after pediatric traumatic brain injury (TBI) and examine the predictive value of risk factors within and across recovery trajectories.
206 children ages 3–7 years at injury were included: 87 TBI (23 severe, 21 moderate, 43 complicated mild) and 119 orthopedic injury (OI). We administered intelligence tests shortly after injury (1½ months), 12 months, and 6.8 years postinjury. Latent class growth modeling was used to identify latent subgroups. Separate models examined verbal and nonverbal IQ recovery trajectories following TBI versus OI. Variables included: age at injury, sex, race, socioeconomic status, injury severity, quality of the home environment, family functioning, and parenting style.
Both the TBI and OI analyses yielded different growth models for nonverbal (k = 3) and verbal IQ (k = 3). Although all models resulted in 3 latent classes (below average, average, and aboveaverage performance); trajectory shapes, contributors to class membership, and performance within each class varied by injury group and IQ domain. TBI severity was associated with class membership for nonverbal IQ, with less severe injuries associated with higher IQ scores; however, TBI severity did not influence verbal IQ class membership. Parenting style had a more prominent effect on verbal and nonverbal IQ within the TBI than OI trajectories.
Findings suggest TBI severity is related to recovery trajectories for nonverbal but not verbal IQ and parenting style has stronger effects on recovery in TBI than OI. Results highlight the importance of parental factors on long-term recovery after TBI.
To assess the relationship between program attendance in a produce prescription program and changes in cardiovascular risk factors.
The Georgia Food for Health (GF4H) program provided 6 monthly nutrition education sessions, 6 weekly cooking classes, and weekly produce vouchers. Participants became program graduates attending at least 4 of the 6 of both the weekly cooking classes and monthly education sessions. We used a longitudinal, single-arm approach to estimate the association between the number of monthly program visits attended and changes in health indicators.
GF4H was implemented in partnership with a large safety-net health system in Atlanta, GA.
331 participants living with or at-risk of chronic disease and food insecurity were recruited from primary care clinics. Over three years, 282 participants graduated from the program.
After adjusting for program site, year, participant sex, age, race & ethnicity, SNAP participation, and household size, we estimated that each additional program visit attended beyond 4 visits was associated with a 0.06 kg/m2 reduction in BMI (95% CI: -0.12, -0.01; p=0.02), a 0.37 inch reduction in waist circumference (95% CI: -0.48, -0.27; p<0.001), a 1.01 mmHg reduction in systolic blood pressure (95% CI: -1.45, -0.57; p<0.001), and a 0.43 mmHg reduction in diastolic blood pressure (95% CI: -0.69, -0.17; p=0.001).
Each additional cooking and nutrition education visit attended beyond the graduation threshold was associated with modest but significant improvements in cardiovascular disease risk factors, suggesting that increased engagement in educational components of a produce prescription program improves health outcomes.
This presentation describes an initiative to provide psychosocial support to children in Ukraine during the ongoing war using a children’s storybook, coloring book, and activity book. The resources promote emotion identification, self-expression, coping skills, and social support–variables with empirical support in promoting children’s mental health in response to trauma.
The book: “An Unusual Situation” is a bibliotherapy intervention for children struggling with difficult situations. By identifying with the characters, children learn about their own struggles, they learn that other children share similar concerns, and learn important coping skills.
The book was translated into Ukrainian and Russian; supplementary materials including a coloring book, activity book and a guidebook were developed. Following a three-hour training, Ukrainian mental health professionals worked with children on the materials in their respective wartime settings.
Results of the following research questions will be presented:
1) How do mental health professionals working with children in Ukraine utilize the associated book resources measured by a survey and completed by the professionals engaged in the project.
2) What do children who use these resources report about their experiences coping with the ongoing war, measured by:
a) Collecting children’s responses in the activity book.
b) Surveying the mental health professionals about their observations of the children during the intervention process.
3) Does the intervention reduce children’s distress, interpersonal functioning, or problematic behaviors, measured by pre-post scores on the Youth Outcome Questionnaire 2.0.
This pilot study will provide information to guide the implementation of a broad psychosocial support intervention for children living in the setting of the ongoing war in Ukraine. Conclusions to be presented include:
1) Tailoring the intervention to the current needs of Ukrainian children
2) Designing a wide-scale implementation plan tailored to Ukrainian mental health professionals’ recommendations
Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with homelessness and substance misuse.
This study aims to evaluate whether the Engager intervention improves mental health outcomes following release.
The design is a parallel randomised superiority trial that was conducted in the North West and South West of England (ISRCTN11707331). Men serving a prison sentence of 2 years or less were individually allocated 1:1 to either the intervention (Engager plus usual care) or usual care alone. Engager included psychological and practical support in prison, on release and for 3–5 months in the community. The primary outcome was the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), 6 months after release. Primary analysis compared groups based on intention-to-treat (ITT).
In total, 280 men were randomised out of the 396 who were potentially eligible and agreed to participate; 105 did not meet the mental health inclusion criteria. There was no mean difference in the ITT complete case analysis between groups (92 in each arm) for change in the CORE-OM score (1.1, 95% CI –1.1 to 3.2, P = 0.325) or secondary analyses. There were no consistent clinically significant between-group differences for secondary outcomes. Full delivery was not achieved, with 77% (108/140) receiving community-based contact.
Engager is the first trial of a collaborative care intervention adapted for prison leavers. The intervention was not shown to be effective using standard outcome measures. Further testing of different support strategies for prison with mental health problems is needed.
This article argues that descriptive representation, or demographic similarities between legislators and the public, can provide effective substantive representation of citizens’ concerns. We examine representation through the lens of opinion congruence or alignment in the policy preferences of legislators and citizens sharing various identities. Congruence may result from shared material interests or from self-selection into an identity group on the basis of policy views, but it can also be a product of networks and organizations that socialize masses and elites into a common worldview. Though political parties were historically the most important agents of political socialization, we argue that religious organizations constitute a more powerful socializing force in many new democracies. Examining the case of Brazil, we draw on three legislative surveys and fifteen mass surveys to analyze congruence across seven issue areas. Legislators and voters from underrepresented groups—women, Afro-Brazilians, evangelical Christians, and those of lower social class—are generally closer in their opinions than those sharing a party or electoral district. Evangelicals are often the most congruent.
Analyzing original surveys of congregations and clergy, we argue that this finding results from the socializing role of churches.
We examined whether preadmission history of depression is associated with less delirium/coma-free (DCF) days, worse 1-year depression severity and cognitive impairment.
Design and measurements:
A health proxy reported history of depression. Separate models examined the effect of preadmission history of depression on: (a) intensive care unit (ICU) course, measured as DCF days; (b) depression symptom severity at 3 and 12 months, measured by the Beck Depression Inventory-II (BDI-II); and (c) cognitive performance at 3 and 12 months, measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) global score.
Setting and participants:
Patients admitted to the medical/surgical ICU services were eligible.
Of 821 subjects eligible at enrollment, 261 (33%) had preadmission history of depression. After adjusting for covariates, preadmission history of depression was not associated with less DCF days (OR 0.78, 95% CI, 0.59–1.03 p = 0.077). A prior history of depression was associated with higher BDI-II scores at 3 and 12 months (3 months OR 2.15, 95% CI, 1.42–3.24 p = <0.001; 12 months OR 1.89, 95% CI, 1.24–2.87 p = 0.003). We did not observe an association between preadmission history of depression and cognitive performance at either 3 or 12 months (3 months beta coefficient −0.04, 95% CI, −2.70–2.62 p = 0.97; 12 months 1.5, 95% CI, −1.26–4.26 p = 0.28).
Patients with a depression history prior to ICU stay exhibit a greater severity of depressive symptoms in the year after hospitalization.
The updated common rule, for human subjects research, requires that consents “begin with a ‘concise and focused’ presentation of the key information that will most likely help someone make a decision about whether to participate in a study” (Menikoff, Kaneshiro, Pritchard. The New England Journal of Medicine. 2017; 376(7): 613–615.). We utilized a community-engaged technology development approach to inform feature options within the REDCap software platform centered around collection and storage of electronic consent (eConsent) to address issues of transparency, clinical trial efficiency, and regulatory compliance for informed consent (Harris, et al. Journal of Biomedical Informatics 2009; 42(2): 377–381.). eConsent may also improve recruitment and retention in clinical research studies by addressing: (1) barriers for accessing rural populations by facilitating remote consent and (2) cultural and literacy barriers by including optional explanatory material (e.g., defining terms by hovering over them with the cursor) or the choice of displaying different videos/images based on participant’s race, ethnicity, or educational level (Phillippi, et al. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2018; 47(4): 529–534.).
We developed and pilot tested our eConsent framework to provide a personalized consent experience whereby users are guided through a consent document that utilizes avatars, contextual glossary information supplements, and videos, to facilitate communication of information.
The eConsent framework includes a portfolio of eight features, reviewed by community stakeholders, and tested at two academic medical centers.
Early adoption and utilization of this eConsent framework have demonstrated acceptability. Next steps will emphasize testing efficacy of features to improve participant engagement with the consent process.
A physical oceanographic, geophysical and marine geological survey of Edward VIII Gulf, Kemp Coast, collected data from conductivity–temperature–depth casts, multi-beam bathymetric swath mapping and 3.5 kHz sub-bottom surveying. Modified circumpolar deep water (mCDW) is observed in Edward VIII Gulf, as well as notable bathymetric features including mega-scale glacial lineations and a 1750 m-deep trough. Sedimentological, geochemical, rock-magnetic and micropalaeontological analysis of two kasten cores document regional palaeoclimate and palaeo-oceanographic conditions over the past 8000 years, with a warm period occurring from c. 8 to 4 ka and a shift to cooler conditions beginning at c. 4 ka and persisting until at least 0.9 ka. Sediment packages > 40 m thick within deep troughs in Edward VIII Gulf present potential targets for higher-resolution Holocene and deglacial climate studies. Despite the presence of mCDW on the shelf, inland bed topography consisting of highland terrain suggests the likelihood of relative stability of this sector of the East Antarctic Ice Sheet.
This article describes a collaborative project that aimed to develop a patient-centred curriculum in radiotherapy. In the wake of the Francis report in 2013 and a call for compassion to be a central tenet of health programmes, the project was a timely opportunity to enhance the radiotherapy curriculum.
Collaboration between university staff and patients and carers using the service improvement model Plan-Do-Study-Act was the method employed for the curriculum project. Two key discussion forums helped shape the curriculum plan, with module and course evaluation continuing to inform developments.
The key outcome of the project is that it has shaped the 'care' theme evident in the current undergraduate programme. Co-production methods resulted in the development of a range of shared classroom activities that focus on experiences, care values and communication strategies. The new curriculum has evaluated positively and the impact of learning is demonstrated both in the classroom and clinical setting. The project team have also influenced recruitment processes and patient and carer involvement in programme approval is embedded.
Working together, with patients and carers is an ideal method to enhance the curriculum and reflect the requirements in practice of current health and social care professions. Further developments in student assessment are planned.
Head and neck cancer patients receiving radiotherapy can experience a number of toxicities, including weight loss and malnutrition, which can impact upon the quality of treatment. The purpose of this retrospective cohort study is to evaluate weight loss and identify predictive factors for this patient group.
Materials and methods
A total of 40 patients treated with radiotherapy since 2012 at the study centre were selected for analysis. Data were collected from patient records. The association between potential risk factors and weight loss was investigated.
Mean weight loss was 5 kg (6%). In all, 24 patients lost >5% starting body weight. Age, T-stage, N-stage, chemotherapy and starting body weight were individually associated with significant differences in weight loss. On multiple linear regression analysis age and nodal status were predictive.
Younger patients and those with nodal disease were most at risk of weight loss. Other studies have identified the same risk factors along with several other variables. The relative significance of each along with a number of other potential factors is yet to be fully understood. Further research is required to help identify patients most at risk of weight loss; and assess interventions aimed at preventing weight loss and malnutrition.
Dual-energy X-ray absorptiometry (DXA) and isotope dilution technique have been used as reference methods to validate the estimates of body composition by simple field techniques; however, very few studies have compared these two methods. We compared the estimates of body composition by DXA and isotope dilution (18O) technique in apparently healthy Indian men and women (aged 19–70 years, n 152, 48 % men) with a wide range of BMI (14–40 kg/m2). Isotopic enrichment was assessed by isotope ratio mass spectroscopy. The agreement between the estimates of body composition measured by the two techniques was assessed by the Bland–Altman method. The mean age and BMI were 37 (sd 15) years and 23·3 (sd 5·1) kg/m2, respectively, for men and 37 (sd 14) years and 24·1 (sd 5·8) kg/m2, respectively, for women. The estimates of fat-free mass were higher by about 7 (95 % CI 6, 9) %, those of fat mass were lower by about 21 (95 % CI − 18, − 23) %, and those of body fat percentage (BF%) were lower by about 7·4 (95 % CI − 8·2, − 6·6) % as obtained by DXA compared with the isotope dilution technique. The Bland–Altman analysis showed wide limits of agreement that indicated poor agreement between the methods. The bias in the estimates of BF% was higher at the lower values of BF%. Thus, the two commonly used reference methods showed substantial differences in the estimates of body composition with wide limits of agreement. As the estimates of body composition are method-dependent, the two methods cannot be used interchangeably.
The Florida State Twin Registry began in 2002 through a pilot study of personality disorders and executive cognitive functioning in adult twins. Since 2006, the registry has grown substantially as part of the Learning Disability Research Center at Florida State University that recently began its second funding cycle through the National Institute of Child Health and Development. An update on the Florida State Twin Registry sample, focus, and measures is provided, as well as future directions.
Yearly, there are over six million cataract surgeries worldwide that involve intraocular lenses (IOLs) . However, preventing post-operative biofouling of these lenses remains a challenge. One major complication is post-operative bacterial infection . Surface modification of IOLs may provide a solution. This study proposes the use of the anti-adhesive protein lubricin (LUB), a glycoprotein found in the synovial fluid, as a means to make polymer surfaces less prone to bacterial adhesion and proliferation, thus reducing the opportunity for post-operative infection . This study used extended bacteria growth trials in the presence of lubricin, vitronectin, and mucin to investigate how lubricin and protein sub-regions of lubricin reduce bacterial functions. This study showed for the first time that polymer surface coatings of lubricin and vitronectin significantly reduce Staphylococcus aureus growth over the course of 15 hours, while mucin was only able to delay the start of the Staphylococcus aureus exponential growth phase and retard proliferation. In solution, both lubricin and mucin significantly reduce bacterial proliferation. Thus, the results of this study demonstrated that lubricin and its sub-regions mucin and vitronectin should be studied for a wide range of antibacterial applications.
The present study investigated whether fatty acid compositions of testes are affected by the obese condition and dietary n-3 long-chain fatty acid (LCFA) intake. Male lean and obese Zucker rats were fed a 15 % (w/w, total diet) fat diet containing either 0 or 5·0 % (w/w, total fatty acids) n-3 LCFA for 8 weeks. Reproductive organ weights, sperm morphology and fatty acid composition of phosphatidylcholine (PC), and phosphatidylethanolamine (PE) of testes were analysed. The obese rats had significantly (P < 0·0001) smaller epididymides and seminal vesicles, larger prostates and abundant underdeveloped testes compared with lean rats. Diet treatment did not affect the sex organ weights. The effect of genotype on fatty acid composition was minor in PC and PE except for DHA (22 : 6n-3). The n-3 LCFA diet significantly (P < 0·0001) elevated 22 : 6n-3 and reduced arachidonic acid (20 : 4n-6) and DPA (22 : 5n-6) in testicular PC and PE of lean and obese rats compared with the control diet. The acylation of dietary n-3 LCFA into 22 : 6n-3 was 2-fold higher in obese rat testes than in lean rats fed the same diet. Underdeveloped testes had 70 % less 22 : 5n-6 in PC and PE than normal-size testes. Results indicate that testicular fatty acid composition is sensitive to dietary fat modulations and especially obese rats responded more to dietary n-3 LCFA than their lean counterparts. The selective reduction in 22 : 5n-6 in underdeveloped testes indicates that 22 : 5n-6 is important in male reproduction in rats and requires further study to define the role of elongation and desaturation in testicular development.
Lubricin is an amphiphilic glycoprotein that is found in the synovial fluid . This protein holds promise as an anti-biofouling agent. This study investigated lubricin’s ability to prevent bacterial attachment and proliferation on intraocular lenses. The findings from this study indicated that lubricin is able to reduce the attachment of Staphylococcus aureus to poly (methyl methacrylate) intraocular lens. Lubricin coatings were confirmed on the surfaces after a 2 hour soak by changes in surface energy. Also, lubricin reduced bacterial proliferation.