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OBJECTIVES/GOALS: Using the NIH’s expanded definition of underrepresented populations in the biomedical, clinical, behavioral and social science research enterprise, we examined the impediments for conducting translational research experienced by those from underrepresented groups. [https://acts.slayte.com/calls/detail/740a13de-316c-11ee-90f4-0e0ce905385c/draft/389221c1-434e-11ee-90f4-0e0ce905385c#_ftn1] #_ftn1 METHODS/STUDY POPULATION: One hundred and ninety-nine people completed a survey distributed to 750 persons who had interacted with our Center’s service cores as users, awardees, mentors, committee members, seminar attendees, and/or participated Center sponsored programming (response rate = 26.5%). The survey addressed barriers to conducting clinical and translational research at the respondent’s institution, awareness of and interest in using specific Advance RI-CTR services, and satisfaction with their institution’s efforts to support clinical and translational research. RESULTS/ANTICIPATED RESULTS: Women reported access to collaboration across institutions as a barrier to clinical and translational research that existed to a great extent (28%) significantly more than men (10%). More than half (53%) of the other underrepresented researchers surveyed identified insufficient grant administration supportas a barrier that occurs to a great extent, compared with 35% of researchers who were not from an underrepresented group. Other barriers reported more frequently among underrepresented researchers included lack of pilot project funding, inadequate space for conducting research, lower access to collaborators across institutions, and difficulty obtaining advice on regulatory issues and commercial development. DISCUSSION/SIGNIFICANCE: Efforts to address the barriers identified by underrepresented groups will include, but not be limited to, improving collaborations across institutions, support for grant administration, and a discussion of plans for the Center to augment and advocate at the partner institutions on behalf of these underrepresented individuals.
The nature of the pathway from conduct disorder (CD) in adolescence to antisocial behavior in adulthood has been debated and the role of certain mediators remains unclear. One perspective is that CD forms part of a general psychopathology dimension, playing a central role in the developmental trajectory. Impairment in reflective functioning (RF), i.e., the capacity to understand one's own and others' mental states, may relate to CD, psychopathology, and aggression. Here, we characterized the structure of psychopathology in adult male-offenders and its role, along with RF, in mediating the relationship between CD in their adolescence and current aggression.
Methods
A secondary analysis of pre-treatment data from 313 probation-supervised offenders was conducted, and measures of CD symptoms, general and specific psychopathology factors, RF, and aggression were evaluated through clinical interviews and questionnaires.
Results
Confirmatory factor analyses indicated that a bifactor model best fitted the sample's psychopathology structure, including a general psychopathology factor (p factor) and five specific factors: internalizing, disinhibition, detachment, antagonism, and psychoticism. The structure of RF was fitted to the data using a one-factor model. According to our mediation model, CD significantly predicted the p factor, which was positively linked to RF impairments, resulting in increased aggression.
Conclusions
These findings highlight the critical role of a transdiagnostic approach provided by RF and general psychopathology in explaining the link between CD and aggression. Furthermore, they underscore the potential utility of treatments focusing on RF, such as mentalization-based treatment, in mitigating aggression in offenders with diverse psychopathologies.
The cleavage of two single-crystal chlorites (a clinochlore and a penninite) has been studied using angle-resolved X-ray photoelectron spectroscopy (XPS). Both minerals cleaved in regions not typical of the bulk; the composition of the clinochlore was found to be especially non-uniform. The brucitic interlayer divided evenly between the pair of new surfaces exposed for two cleaves in the clinochlore, but was partitioned unequally in two cleaves in the penninite. The differences in apparent composition between the complementary pairs of surfaces are interpreted to show a marked preference of octahedral Al for the brucitic layer, in agreement with X-ray bulk structure refinements. For both chlorites, the layer charge was reduced in regions of easy cleavage, which also had a higher proportion of Si and less tetrahedral Al than the bulk chlorite. The percentages of tetrahedral aluminium deduced from the XPS surface analyses agreed satisfactorily with the percentages independently determined by consideration of the magnitude of anisotropy in the X-ray photoelectron diffraction (XPD) patterns. The XPD patterns from the clinochlore for rotation about axes parallel and antiparallel to the crystallographic a-axis were identical, showing that tetrahedral ordering was absent.
Background: Statistically significant decreases in methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections (HAIs) occurred in Veterans Health Administration (VA) facilities from 2007 to 2019 using active surveillance for facility admissions and contact precautions for patients colonized (CPC) or infected (CPI) with MRSA, but the value of these interventions is controversial. Objective: To determine the impact of active surveillance, CPC, and CPI on prevention MRSA HAIs, we conducted a prospective cohort study between July 2020 and June 2022 in all 123 acute-care VA medical facilities. In April 2020, all facilities were given the option to suspend any combination of active surveillance, CPC, or CPI to free up laboratory resources for COVID-19 testing and conserve personal protective equipment. We measured MRSA HAIs (cases per 1,000 patient days) in intensive care units (ICUs) and non-ICUs by the infection control policy. Results: During the analysis period, there were 917,591 admissions, 5,225,174 patient days, and 568 MRSA HAIs. Only 20% of facilities continued all 3 MRSA infection control measures in July 2020, but this rate increased to 57% by June 2022. The MRSA HAI rate for all infection sites in non-ICUs was 0.07 (95% CI, 0.05–0.08) for facilities practicing active surveillance plus CPC plus CPI compared to 0.12 (95% CI, 0.08–0.19; P = .01) for those not practicing any of these strategies, and in ICUs the MRSA HAI rates were 0.20 (95% CI, 0.15–0.26) and 0.65 (95% CI, 0.41–0.98; P < .001) for the respective policies. Similar differences were seen when the analyses were restricted to MRSA bloodstream HAIs. Accounting for monthly COVID-19 admissions to facilities over the analysis period using a negative binomial regression model did not change the relationships between facility policy and MRSA HAI rates in the ICUs or non-ICUs. There was no statistically significant difference in monthly facility urinary catheter-associated infection rates, a nonequivalent dependent variable, in the categories during the analysis period in either ICUs or non-ICUs. Conclusions: In Veterans Affairs medical centers, there were fewer MRSA HAIs when facilities practiced active surveillance and contact precautions for colonized or infected patients during the COVID-19 pandemic. The effect was greater in ICUs than non-ICUs.
The authors discuss methods of sustaining the global trade in frankincense through CITES, with a particular focus on the ways in which governance mechanisms can be used.
People with psychosis in Malawi have very limited access to timely assessment and evidence-based care, leading to a long duration of untreated psychosis and persistent disability. Most people with psychosis in the country consult traditional or religious healers. Stigmatising attitudes are common and services have limited capacity, particularly in rural areas. This paper, focusing on pathways to care for psychosis in Malawi, is based on the Wellcome Trust Psychosis Flagship Report on the Landscape of Mental Health Services for Psychosis in Malawi. Its purpose is to inform Psychosis Recovery Orientation in Malawi by Improving Services and Engagement (PROMISE), a longitudinal study that aims to build on existing services to develop sustainable psychosis detection systems and management pathways to promote recovery.
People with schizophrenia die almost 20 years earlier than the general population, most commonly from avertable cardiometabolic disease. Existing pharmacological weight-loss agents including metformin have limited efficacy. Recently available glucagon-like peptide (GLP-1) receptor agonists such as semaglutide have shown promise for weight loss but have yet to be trialled in this population.
Aims
To examine the efficacy of semaglutide to ameliorate antipsychotic-induced obesity in people with schizophrenia who have been treated with clozapine for more than 18 weeks.
Method
This is a 36-week, double-blinded, randomised placebo-controlled trial. We will recruit 80 clozapine-treated patients with schizophrenia or schizoaffective disorder, aged 18–64 years, with a baseline body mass index ≥26 kg/m2, who will be randomised to subcutaneous semaglutide of 2.0 mg once a week or placebo for 36 weeks. The primary endpoint will be percentage change in body weight from baseline.
Results
This trial will assess the efficacy and side-effects of the GLP-1 receptor agonist semaglutide on body weight and provide evidence on the possible clinical utility of semaglutide in patients with inadequate response to metformin. The study is registered with the Australian New Zealand Clinical Trials Registry (www.anzctr.org.au) with clinical trial registration number ACTRN12621001539820.
Conclusion
This research could benefit individuals with schizophrenia who experience significant health issues, leading to premature mortality, owing to antipsychotic-induced weight gain. Study findings will be disseminated through peer-reviewed publications and conference presentations.
The next generation of high-power lasers enables repetition of experiments at orders of magnitude higher frequency than what was possible using the prior generation. Facilities requiring human intervention between laser repetitions need to adapt in order to keep pace with the new laser technology. A distributed networked control system can enable laboratory-wide automation and feedback control loops. These higher-repetition-rate experiments will create enormous quantities of data. A consistent approach to managing data can increase data accessibility, reduce repetitive data-software development and mitigate poorly organized metadata. An opportunity arises to share knowledge of improvements to control and data infrastructure currently being undertaken. We compare platforms and approaches to state-of-the-art control systems and data management at high-power laser facilities, and we illustrate these topics with case studies from our community.
Edited by
Bruce Campbell, Clim-Eat, Global Center on Adaptation, University of Copenhagen,Philip Thornton, Clim-Eat, International Livestock Research Institute,Ana Maria Loboguerrero, CGIAR Research Program on Climate Change, Agriculture and Food Security and Bioversity International,Dhanush Dinesh, Clim-Eat,Andreea Nowak, Bioversity International
Climate services (CS) and agricultural advisory services (AAS) have the potential to play synergistic roles in helping farmers manage climate-related risk, providing they are integrated. For information and communication technology (ICT)-enabled, climate-informed AAS to contribute towards transformation, the focus must shift from scaling access to scaling impact. With expanding rural ICT capacity and mobile phone penetration, digital innovation brings significant opportunities to improve access to services. Achieving impact requires the following actions: building farmers’ capacity and voice; employing a diverse delivery strategy for CS that exploits digital innovation; bundling CS, agri-advisories, and other services; investing in institutional capacity; and embedding services in a sustainable and enabling environment in terms of policy, governance, and resourcing. Recent experiences in several countries demonstrate how well targeted investments can alleviate constraints and enhance the impact of climate-informed AAS.
As part of a quality improvement project beginning in October 2011, our centre introduced changes to reduce radiation exposure during paediatric cardiac catheterisations. This led to significant initial decreases in radiation to patients. Starting in April 2016, we sought to determine whether these initial reductions were sustained.
Methods:
After a 30-day trial period, we implemented (1) weight-based reductions in preset frame rates for fluoroscopy and angiography, (2) increased use of collimators and safety shields, (3) utilisation of stored fluoroscopy and virtual magnification, and (4) hiring of a devoted radiation technician. We collected patient weight (kg), total fluoroscopy time (min), and procedure radiation dosage (cGy-cm2) for cardiac catheterisations between October, 2011 and September, 2019.
Results:
A total of 1889 procedures were evaluated (196 pre-intervention, 303 in the post-intervention time period, and 1400 in the long-term group). Fluoroscopy times (18.3 ± 13.6 pre; 19.8 ± 14.1 post; 17.11 ± 15.06 long-term, p = 0.782) were not significantly different between the three groups. Patient mean radiation dose per kilogram decreased significantly after the initial quality improvement intervention (39.7% reduction, p = 0.039) and was sustained over the long term (p = 0.043). Provider radiation exposure was also significantly decreased from the onset of this project through the long-term period (overall decrease of 73%, p < 0.01) despite several changes in the interventional cardiologists who made up the team over this time period.
Conclusion:
Introduction of technical and clinical practice changes can result in a significant reduction in radiation exposure for patients and providers in a paediatric cardiac catheterisation laboratory. These reductions can be maintained over the long term.
The current scientifically informed view of suicide is that, while complex, suicide is a health-related outcome. Driven by a convergence of health factors along with other psychosocial and environmental factors, suicide risk is multifactorial. Like most health outcomes, a set of genetic, environmental, and psychological/behavioral factors are relevant. It is critically important that health professionals develop a current understanding of suicide as older views have permeated and clouded societal understanding leading to assumptions and judgment that have silenced generations of people suffering suicidal struggles or loss of a loved one to suicide.
For which patients does this guidance apply? These principles should be applied in clinical decision making for a broader group of patients than just those with expressed suicidal ideation. Suicide risk includes any patients with elevated risk, many of whom do not present with a chief complaint of suicidal ideation. Their risk may be identified by a recent suicide attempt, or by a family history of suicide along with current psychosocial stressors, or the patient facing a life transition or loss along with deterioration in clinical status. (See Suicide Risk Assessment in Chapter 6). At the broadest level, current clinical standards (including those of The Joint Commission which is based in the USA but accredits health systems in the USA and internationally) consider all patients being treated in behavioral healthcare settings (psychiatric inpatient and outpatient care, psychological therapy, substances use disorder treatment, etc.) as having potentially elevated suicide risk.
The science of suicide risk and prevention is growing, making one thing very clear. While suicide risk involves a complex set of risk factors, the end common pathway is a life-threatening health crisis. As is the case with all health-related causes of death, a robust public health strategy can reduce mortality. This chapter provides a framework for understanding the public health approach to preventing suicide. Examples of effective public health suicide prevention strategies at national and regional levels are provided.