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To examine the impact of early traumatic brain injury (TBI) on effortful control (EC) over time and the relationship of EC and executive functioning (EF) to long-term functional and social outcomes.
Parents of children (N = 206, ages 3–7) with moderate-to-severe TBI or orthopedic injuries (OIs) rated EC using the Child Behavior Questionnaire at 1 (pre-injury), 6, 12, and 18 months post-injury. Child functioning and social competence were assessed at 7 years post-injury. Mixed models examined the effects of injury, time since injury, and their interaction on EC. General linear models examined the associations of pre-injury EC and EC at 18 months with long-term functional and social outcomes. Models controlled for EF to assess the unique contribution of EC to outcomes.
Children with severe TBI had significantly lower EC than both the OI and moderate TBI groups at each post-injury time point. Both pre-injury and 18-month EC were associated with long-term outcomes. Among those with low EC at baseline, children with moderate and severe TBI had more functional impairment than those with OI; however, no group differences were noted at high levels of EC. EC had main effects on parent-reported social competence that did not vary by injury type.
Findings suggest that EC is sensitive to TBI effects and is a unique predictor of functional outcomes, independent of EF. High EC could serve as a protective factor, and as such measures of EC could be used to identify children for more intensive intervention.
Agri-environmental schemes (AES) are used to enhance pollinator diversity on agricultural farms within the UK. Though the impacts of these schemes on archetypal pollinator species such as the bumblebee (Bombus) and honeybee (Apis) are well-studied, the effects on non-target bee species like solitary bees, in the same environment, are generally lacking. One goal of AES is to alter floral provision and taxonomic composition of plant communities to provide better forage for pollinators, however, this may potentially impact other ecological communities such as fungal diversity associated with plant-bee communities. Fungi are integral in these bee communities as they can impact bee species both beneficially and detrimentally. We test the hypothesis that alteration of the environment through provision of novel plant communities has non-target effects on the fungi associated with solitary bee communities. We analyse fungal diversity and ecological networks formed between fungi and solitary bees present on 15 agricultural farms in the UK using samples from brood cells. The farms were allocated to two categories, low and high management, which differ in the number of agri-environmental measures implemented. Using internal transcribed spacer metabarcoding, we identified 456 fungal taxa that interact with solitary bees. Of these, 202 (approximately 44%) could be assigned to functional groups, the majority being pathotrophic and saprotrophic species. A large proportion was Ascosphaeraceae, a family of bee-specialist fungi. We considered the connectance, nestedness, modularity, nestedness overlap and decreasing fill, linkage density and fungal generality of the farms' bee–fungi ecological networks. We found no difference in the structure of bee–fungi ecological networks between low and high management farms, suggesting floral provision by AES has no significant impact on interactions between these two taxonomic groups. However, bee emergence was lower on the low management farms compared to high management, suggesting some limited non-target effects of AES. This study characterizes the fungal community associated with solitary bees and provides evidence that floral provision through AES does not impact fungal interactions.
Some consider potatoes to be unhealthy vegetables that may contribute to adverse cardiometabolic health outcomes. We evaluated the association between potato consumption (including fried and non-fried types) and three key cardiometabolic outcomes among middle-aged and older adults in the Framingham Offspring Study. We included 2523 subjects ≥30 years of age with available dietary data from 3-d food records. Cox-proportional hazards models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for hypertension, type 2 diabetes or impaired fasting glucose (T2DM/IFG), and elevated triglycerides, adjusting for anthropometric, demographic and lifestyle factors. In the present study, 36 % of potatoes consumed were baked, 28 % fried, 14 % mashed, 9 % boiled and the rest cooked in other ways. Overall, higher total potato intake (≥4 v. <1 cup-equivalents/week) was not associated with risks of T2DM/IFG (HR 0⋅97, 95 % CI 0⋅81, 1⋅15), hypertension (HR 0⋅95; 95 % CI 0⋅80, 1⋅12) or elevated triglycerides (HR 0⋅99, 95 % CI 0⋅86, 1⋅13). Stratified analyses were used to evaluate effect modification by physical activity levels and red meat consumption, and in those analyses, there were no adverse effects of potato intake. However, when combined with higher levels of physical activity, greater consumption of fried potatoes was associated with a 24 % lower risk (95 % CI 0⋅60, 0⋅96) of T2DM/IFG, and in combination with lower red meat consumption, higher fried potato intake was associated with a 26 % lower risk (95 % CI 0⋅56, 0⋅99) of elevated triglycerides. In this prospective cohort, there was no adverse association between fried or non-fried potato consumption and risks of T2DM/IFG, hypertension or elevated triglycerides.
The diagnosis of neurodegenerative and psychiatric disorders (NPDs) in primary care can suffer from inefficiencies resulting in misdiagnoses and delayed diagnosis, limiting effective treatment options. The development of speech and language-based profiling biomarkers could aid in achieving earlier motor diagnosis for PD for instance, or more accurate diagnosis of clinically similar or late presenting NPDs.
RHAPSODY aims to investigate the feasibility of the remote administration of a battery of speech tasks in eliciting continuous narrative speech across a range of NPDs. The project also aims to determine the feasibility of using acoustic and linguistic biomarkers from speech data to support the clinical assessment and disambiguation of common NPDs
All participants (n=250) will take part in a single virtual telemedicine video conference with a researcher in which they are screened and complete a battery of speech tasks, in addition to cohort-specific screening measures. Over the following month, participants will be asked to complete a series of short, self-administered speech assessments via a smartphone application.
The speech tasks will be audio-recorded and analysed on Novoic’s technology platform. Objectives will be analysed using measures including average length of speech elicitation for speech tasks, intra- and inter-subject variance, differences in linguistic patterns, and response rates to speech assessments.
The analyses could help to identify and validate speech-derived clinical biomarkers to support clinicians in detecting and disambiguating between NPDs with heterogeneous presentations. This should further support earlier intervention, improved treatment options and improved quality of life.
In terms of significant financial interest and relationships, it is emphasised that the private organisation Novoic, who aim to develop speech algorithms for diagnostic use, is the study’s sponsor and employees or former employees of this company comprise
Language is one of the most remarkable developmental accomplishments of childhood and a tool for life. Over the course of childhood and adolescence, language and literacy develop in dynamic complementarity, shaped by children’s developmental circumstances. Children’s developmental circumstances include characteristics of the child, their parents, family, communities and schools, and the social and cultural contexts in which they grow up. This chapter uses data collected in Growing up in Australia: The Longitudinal Study of Australian Children (LSAC) that was linked to Australia’s National Assessment of Literacy and Numeracy (NAPLAN) to quantify the effects of multiple risk factors on children’s language and literacy development. Latent class analysis and growth curve modelling are used to identify children’s developmental circumstances (i.e. risk profiles) and quantify the effects of different clusters of risk factors on children’s receptive vocabulary growth and reading achievement from age 4 to 15. The developmental circumstances that gave rise to stark inequalities in language and literacy comprise distinct clustering of sociodemographic, cognitive and non-cognitive risk factors. The results point to the need for cross-cutting social, health and education policies and coordinated multi-agency interventions efforts to address social determinants and break the cycle of developmental disadvantage.
Child protection systems monitoring is key to ensuring children’s wellbeing. In England, monitoring is rooted in onsite inspection, culminating in judgements ranging from ‘outstanding’ to ‘inadequate’. But inspection may carry unintended consequences where child protection systems are weak. One potential consequence is increased child welfare intervention rates. In this longitudinal ecological study of local authorities in England, we used Poisson mixed-effects regression models to assess whether child welfare intervention rates are higher in an inspection year, whether this is driven by inspection judgement, and whether more deprived areas experience different rates for a given inspection judgement. We investigated the impact of inspection on care entry, Child Protection Plan-initiation, and child-in-need status. We found that inspection was associated with a rise in rates across the spectrum of interventions. Worse judgements yielded higher rates. Inspection may also exacerbate existing inequalities. Unlike less deprived areas, more deprived areas judged inadequate did not experience an increase in the less intrusive ‘child-in-need’ interventions. Our findings suggest that a narrow focus on social work practice is unlikely to address weaknesses in the child protection system. Child protection systems monitoring should be guided by a holistic model of systems improvement, encompassing the socioeconomic determinants of quality.
To understand barriers and facilitators to evidence-based prescribing of antibiotics in the outpatient dental setting.
Outpatient dental setting.
Dentists from 40 Veterans’ Health Administration (VA) facilities across the United States.
Dentists were identified based on their prescribing patterns and were recruited to participate in a semistructured interview on perceptions toward prescribing. All interviews were recorded, transcribed, and double-coded for analysis, with high reliability between coders. We identified general trends using the theoretical domains framework and mapped overarching themes onto the behavior change wheel to identify prospective interventions that improve evidence-based prescribing.
In total, 90 dentists participated in our study. The following barriers and facilitators to evidence-based prescribing emerged as impacts on a dentist’s decision making on prescribing an antibiotic: access to resources, social influence of peers and other care providers, clinical judgment, beliefs about consequences, local features of the clinic setting, and beliefs about capabilities.
Findings from this work reveal the need to increase awareness of up-to-date antibiotic prescribing behaviors in dentistry and may inform the best antimicrobial stewardship interventions to support dentists’ ongoing professional development and improve evidence-based prescribing.
Georgia vegetable growers produce more than 27% of the nation’s fresh-market cucumbers. To maximize yields and profit, fields must be weed-free when planting. Limitations with current burndown herbicide options motivated academic, industry, and U.S. Department of Agriculture partners to search for new tools to assist growers. One possibility, glufosinate, controls many common and troublesome weeds, but its influence on cucumber development through residual activity when applied before or at planting is not understood. Thus, four different studies were each conducted two to four times from 2017 to 2020 to determine 1) transplant cucumber response to preplant glufosinate applications as influenced by rate, overhead irrigation, and interval between application and planting; and 2) seeded cucumber response to preemergence (PRE) glufosinate applications as influenced by rate, overhead irrigation, and planting depth. Glufosinate applied at 330, 660, 980, and 1,640 g ai ha−1 the day before transplanting caused 11% to 53% injury on sandy, low organic matter soils. Cucumber vine lengths and plant biomass were reduced up to 28% and 46%, respectively, with the three highest rates. Early-season yield (harvests 1 to 4) noted a 31% to 60% yield loss with glufosinate at 660 to 1,640 g ha−1 with similar trends observed with total yield (11 to 13 harvests). Irrigation (0.75 cm) after application and before transplanting reduced injury to less than 21%, eliminated vine length and biomass suppression except at the highest rate, and eliminated yield loss. Extending the interval between glufosinate application and transplanting from 1 to 4 d was not beneficial, and further extending the interval to 7 d significantly reduced injury half the time. When applied PRE to seeded cucumber and combining the data across locations, glufosinate caused less than 7% injury even at 1,640 g ha−1. Seeded plant vine lengths, biomass, and marketable yield were not influenced by the PRE application, and neither irrigation nor planting depth influenced seeded crop response to glufosinate.
Background: Visual impairment can impact 70% of individuals who have experienced a stroke. Identification and remediation of visual impairments can improve overall function and perceived quality of life. Our project aimed to improve visual assessment and timely intervention for patients with post-stroke visual impairment (PSVI). Methods: We conducted a quality improvement initiative to create a standardized screening and referral process for patients with PSVI to access an orthoptist. Post-stroke visual impairment was identified using the Visual Screen Assessment (VISA) tool. Patients filled out a VFQ-25 questionnaire before and after orthoptic assessment, and differences between scores were evaluated. Results: Eighteen patients completed the VFQ-25 both before and after orthoptic assessment. Of the vision related constructs, there was a significant improvement in reported outcomes for general vision (M=56.9, SD=30.7; M=48.6, SD=16.0), p=0.002, peripheral vision (M=88.3, SD=16; M=75, SD=23.1), p= 0.027, ocular pain (M=97.2, SD=6.9; M=87.5, SD=21.4), p=0.022, near activities (M=82.4, SD=24.1; M=67.8, SD=25.6), p<0.001, social functioning (M=90.2, SD=19; M=78.5, SD=29.3), p=0.019, mental health (M=84.0, SD=25.9; M=70.5, SD=31.2), p=0.017, and role difficulties (M=84.7, SD=26.3; M=67.4, SD=37.9), p=0.005. Conclusions: Orthoptic assessments for those with PSVI significantly improved perceived quality of life in a numerous vision related constructs, suggesting it is a valuable part of a patient’s post-stroke recovery.
Delayed cerebral ischemia (DCI) is a complication of aneurysmal subarachnoid hemorrhage (aSAH) and is associated with significant morbidity and mortality. There is little high-quality evidence available to guide the management of DCI. The Canadian Neurosurgery Research Collaborative (CNRC) is comprised of resident physicians who are positioned to capture national, multi-site data. The objective of this study was to evaluate practice patterns of Canadian physicians regarding the management of aSAH and DCI.
We performed a cross-sectional survey of Canadian neurosurgeons, intensivists, and neurologists who manage aSAH. A 19-question electronic survey (Survey Monkey) was developed and validated by the CNRC following a DCI-related literature review (PubMed, Embase). The survey was distributed to members of the Canadian Neurosurgical Society and to Canadian members of the Neurocritical Care Society. Responses were analyzed using quantitative and qualitative methods.
The response rate was 129/340 (38%). Agreement among respondents was limited to the need for intensive care unit admission, use of clinical and radiographic monitoring, and prophylaxis for the prevention of DCI. Several inconsistencies were identified. Indications for starting hyperdynamic therapy varied. There was discrepancy in the proportion of patients who felt to require IV milrinone, IA vasodilators, or physical angioplasty for treatment of DCI. Most respondents reported their facility does not utilize a standardized definition for DCI.
DCI is an important clinical entity for which no homogeneity and standardization exists in management among Canadian practitioners. The CNRC calls for the development of national standards in the definition, identification, and treatment of DCI.
The present study examined the differential effect of the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism on neuropsychological functioning in children with traumatic brain injury (TBI) relative to orthopedic injury (OI).
Participants were drawn from a prospective, longitudinal study of children who sustained a TBI (n = 69) or OI (n = 72) between 3 and 7 years of age. Children completed a battery of neuropsychological measures targeting attention, memory, and executive functions at four timepoints spanning the immediate post-acute period to 18 months post-injury. Children also completed a comparable age-appropriate battery of measures approximately 7 years post-injury. Parents rated children’s dysexecutive behaviors at all timepoints.
Longitudinal mixed models revealed a significant allele status × injury group interaction with a medium effect size for verbal fluency. Cross-sectional models at 7 years post-injury revealed non-significant but medium effect sizes for the allele status x injury group interaction for fluid reasoning and immediate and delayed verbal memory. Post hoc stratified analyses revealed a consistent pattern of poorer neuropsychological functioning in Met carriers relative to Val/Val homozygotes in the TBI group, with small effect sizes; the opposite trend or no appreciable effect was observed in the OI group.
The results suggest a differential effect of the BDNF Val66Met polymorphism on verbal fluency, and possibly fluid reasoning and immediate and delayed verbal memory, in children with early TBI relative to OI. The Met allele—associated with reduced activity-dependent secretion of BDNF—may confer risk for poorer neuropsychological functioning in children with TBI.
The Centers for Medicare and Medicaid mandated that nursing homes implement antibiotic stewardship programs (ASPs) by November 2017. We conducted surveys of Wisconsin nursing-home stewardship practices before and after this mandate. Our comparison of these surveys shows an overall increase in ASP implementation efforts, but it also highlights areas for further improvement.
Anxiety and depression impact many children and adolescents and cause significant impairments in multiple domains. Child and adolescent psychotherapy have now been researched for approximately 50 years and the extant literature suggests that structured, manualized treatments produce a significant benefit for this specific population. Overall, research indicates that youth-focused behavioral psychotherapies, including cognitive behavioral therapy (CBT), demonstrate robust effects across multi-informants (i.e., child/adolescent, parent, and teacher). Individual CBT for child and adolescent anxiety disorders and depression has a strong evidence base. When adapting and implementing CBT with young clients, there are important considerations regarding treatment planning, including assessment, diagnostic and differential considerations, case conceptualization, implementation of interventions, and consistent reassessment with outcome measures.
The African American population of Buffalo, New York experiences striking race-based health disparities due to adverse social determinants of health. A team of community leaders and university faculty determined that a community dialogue was needed to focus research and advocacy on the root causes of these disparities. In response, we organized the annual Igniting Hope conference series that has become the premier conference on health disparities in the region. The series, now supported by an R13 conference grant from NCATS, has been held four times (2018–2021) and has attracted community members, community leaders, university faculty, and trainees. The agenda includes talks by national leaders and breakout/working groups that led to a new state law that has reduced disproportionate traffic-ticketing and drivers' license suspensions in Black neighborhoods; mitigation of the disproportionate COVID-19 fatalities in Black communities; and the launching of a university-supported institute. We describe the key elements of success for a conference series designed by a community–university partnership to catalyze initiatives that are having an impact on social determinants of health in Buffalo.
Sabellidites cambriensis is a tubular non-mineralized metazoan that appears as compressed ribbon-shaped imprints with transverse wrinkling, thick walls and an even tube diameter of up to 3 mm. The distribution of Sabellidites is investigated in three Ediacaran–Cambrian sections on the Digermulen Peninsula in Arctic Norway, spanning the Manndrapselva Member of the Stáhpogieddi Formation and the lower member of the Breidvika Formation. Here, the Ediacaran–Cambrian boundary is located in the lower part of the upper parasequence (third cycle) of the Manndrapselva Member. Specimens of Sabellidites are rare but consistently present close to the lowest level of Treptichnus pedum and upsection, whereas the taxon is common and abundant in the lower part of the lower member of the Breidvika Formation, with an upper record at c. 55 m above the base. The range is comparable with that of the GSSP section in Newfoundland, Canada, establishing Sabellidites as an index fossil for the lowermost Cambrian. In the Manndrapselva Member, Sabellidites co-occurs with the acritarch Granomarginata, indicative of the lowermost Cambrian Granomarginata Zone, whereas in the Breidvika Formation it co-occurs with Asteridium. Sabellidites is widely distributed in Baltica, through the Rovnian and Lontovan regional stages but confined to the Fortunian global stage. In its lower range, Sabellidites is associated with a Treptichnus pedum trace fossil association and a depauperate leiosphaerid acritarch assemblage, followed by a Granomarginata assemblage. In its upper range, Sabellidites co-occurs with acritarchs of the Asteridium–Comasphaeridium Zone and the tubular foraminiferan Platysolenites. In Baltica, Sabellidites is a useful index fossil.