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Recovery from trauma can be naturally occurring or facilitated through psychotherapy. Few brief measures exist to provide clinicians with dispositional, empirical assessments of patient’s sentiments during psychotherapy.
This manuscript presents the Dispositional Recovery and Dysfunction Inventory (DRDI), a measure created to assist clinicians in evaluating patient’s treatment progress during psychotherapy, as well as evaluate its factor structure, reliability estimates, measurement invariance, and correlates.
The DRDI was created based on feedback from experts with experience treating posttraumatic stress disorder (PTSD) and was structurally validated in two distinct populations. Exploratory factor analysis was conducted in sample 1 consisting of (n=401) university students. Confirmatory factor analysis, measure validity and structure validation were then conducted in sample 2 (n=249) composed of 49% individuals with clinically significant PTSD symptoms.
Exploratory and confirmatory factor analysis revealed that the DRDI was best represented by a two-factor correlated traits model representing sentiments related to dispositional recovery and dysfunctional cognitions. The recovery subscale exhibited relationships with convergent measures including authenticity and psychological hardiness (r values of .30 to .60). The dysfunctional beliefs subscale exhibited relationships with convergent measures: PTSD, depression, suicidality and stress (r values of .55 to 80). Measurement invariance across gender and PTSD status was observed.
Initial findings indicate that the DRDI has the potential to be a useful tool to assess individuals’ beliefs about their propensity to recover from and thrive through adversity.
Students exhibiting behaviours of concern are at increased risk of poor outcomes during their school years. The implementation of school-wide positive behavioural interventions and supports (SWPBIS) has repeatedly been shown to be an effective, evidence-based approach that supports teachers to select and adopt effective practices to meet the social and behavioural needs of all learners. Implementation of SWPBIS within Australian schools is increasing. Although there is considerable evidence supporting the effectiveness and efficacy of SWPBIS as a means to improve the behavioural outcomes of all students, these positive outcomes largely depend on the actions of teachers. To this point, very limited research has been published that explores the experiences of teachers working in Australian schools currently implementing SWPBIS. The current study asked 206 Victorian teachers working in schools implementing SWPBIS two open-ended questions about the factors that they believed were facilitators or barriers to their ability to improve the behavioural outcomes of their students. The most commonly reported facilitators were availability of time, consistency of staff implementation of behaviour support, and adequate training. The most frequently identified barriers were a lack of time and inconsistent implementation. The practical and research implications of these preliminary qualitative findings are discussed.
The study aims to investigate attention deficit hyperactivity disorder (ADHD) symptoms, gastrointestinal (GI) symptoms, comorbid psychopathology and behaviour problems in children and adolescents with autism spectrum disorder (ASD).
Parents of 147 children and adolescents with ASD aged 6–18 years completed the Conners 3 Parent-Short Form, Gastrointestinal Symptom Inventory, Behavior Problems Inventory-Short Form and Autism Spectrum Disorder-Comorbid for Children.
Fifty-six per cent of children and adolescents had a comorbid diagnosis of ADHD, yet over 70% presented with clinically significant ADHD symptoms. Forty per cent of participants received a diagnosis of ADHD before ASD and 25.6% received a diagnosis of ASD first. Relationships were found between ADHD symptoms and comorbid psychopathology, GI symptoms, and behaviour problems.
The outcomes suggest that ADHD is being underestimated as a comorbid disorder of ASD. This may have implications on treatment and interventions for children and adolescents who have a diagnosis of both ASD and ADHD.
Field studies were conducted to evaluate linuron for POST control of Palmer amaranth in sweetpotato to minimize reliance on protoporphyrinogen oxidase (PPO)-inhibiting herbicides. Treatments were arranged in a two by four factorial where the first factor consisted of two rates of linuron (420 and 700 g ai ha−1), and the second factor consisted of linuron applied alone or in combinations of linuron plus a nonionic surfactant (NIS) (0.5% v/v), linuron plus S-metolachlor (800 g ai ha−1), or linuron plus NIS plus S-metolachlor. In addition, S-metolachlor alone and nontreated weedy and weed-free checks were included for comparison. Treatments were applied to ‘Covington’ sweetpotato 8 d after transplanting (DAP). S-metolachlor alone provided poor Palmer amaranth control because emergence had occurred at applications. All treatments that included linuron resulted in at least 98 and 91% Palmer amaranth control 1 and 2 wk after treatment (WAT), respectively. Including NIS with linuron did not increase Palmer amaranth control compared to linuron alone, but increased sweetpotato injury and subsequently decreased total sweetpotato yield by 25%. Including S-metolachlor with linuron resulted in the greatest Palmer amaranth control 4 WAT, but increased crop foliar injury to 36% 1 WAT compared to 17% foliar injury from linuron alone. Marketable and total sweetpotato yield was similar between linuron alone and linuron plus S-metolachlor or S-metolachlor plus NIS treatments, though all treatments resulted in at least 39% less total yield than the weed-free check resulting from herbicide injury and/or Palmer amaranth competition. Because of the excellent POST Palmer amaranth control from linuron 1 WAT, a system including linuron applied 7 DAP followed by S-metolachlor applied 14 DAP could help to extend residual Palmer amaranth control further into the critical period of weed control while minimizing sweetpotato injury.
Catheter ablation is a safe and effective therapy for the treatment of supraventricular tachycardia in children. Current improvements in technology have allowed progressive reduction in radiation exposure associated with the procedure. To assess the impact of three-dimensional mapping, we compared acute procedural results collected from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry to published results from the Prospective Assessment after Pediatric Cardiac Ablation study.
Inclusion and exclusion criteria from the Prospective Assessment after Pediatric Cardiac Ablation study were used as guidelines to select patient data from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry to compare acute procedural outcomes between cohorts. Outcomes assessed include procedural and fluoroscopy exposure times, success rates of procedure, and complications.
In 786 ablation procedures, targeting 498 accessory pathways and 288 atrioventricular nodal reentrant tachycardia substrates, average procedural time (156.5 versus 206.7 minutes, p < 0.01), and fluoroscopy time (1.2 versus 38.3 minutes, p < 0.01) were significantly shorter in the study group. Success rates for the various substrates were similar except for manifest accessory pathways which had a significantly higher success rate in the study group (96.4% versus 93.0%, p < 0.01). Major complication rates were significantly lower in the study group (0.3% versus 1.6%, p < 0.01).
In a large, multicentre study, three-dimensional systems show favourable improvements in clinical outcomes in children undergoing catheter ablation of supraventricular tachycardia compared to the traditional fluoroscopic approach. Further improvements are anticipated as technology advances.
While experiences of later-life homelessness are known to vary, classification of shelter, housing and service models that meet the diverse needs of older people with experiences of homelessness (OPEH) are limited. To address this gap, a scoping review was conducted of shelter/housing options, supports and interventions for OPEH. Fourteen databases were searched for English-language peer-reviewed and/or empirical literature published between 1999 and 2019, resulting in the inclusion of 22 sources. Through a collaborative, iterative process of reading, discussing and coding, data extracted from the studies were organised into six models: (1) long-term care, (2) permanent supportive housing (PSH), including PSH delivered through Housing First, (3) supported housing, (4) transitional housing, (5) emergency shelter settings with health and social supports, and (6) case management and outreach. Programme descriptions and OPEH outcomes are described and contribute to our understanding that multiple shelter/housing options are needed to support diverse OPEH. The categorised models are considered alongside existing ‘ageing in place’ research, which largely focuses on older adults who are housed. Through extending discussions of ageing in the ‘right’ place to diverse OPEH, additional considerations are offered. Future research should explore distinct sub-populations of OPEH and how individual-level supports for ageing in place must attend to mezzo- and macro-level systems and policies.
Field studies were conducted in 2019 and 2020 to compare the effects of shade cloth light interception and Palmer amaranth (Amaranthus palmeri S. Watson) competition on ‘Covington’ sweetpotato [Ipomoea batatas (L.) Lam.]. Treatments consisted of a seven by two factorial arrangement, in which the first factor included shade cloth with an average measured light interception of 41%, 59%, 76%, and 94% and A. palmeri thinned to 0.6 or 3.1 plants m−2 or a nontreated weed-free check; and the second factor included shade cloth or A. palmeri removal timing at 6 or 10 wk after planting (WAP). Amaranthus palmeri light interception peaked around 710 to 840 growing degree days (base 10 C) (6 to 7 WAP) with a maximum light interception of 67% and 84% for the 0.6 and 3.1 plants m−2 densities, respectively. Increasing shade cloth light interception by 1% linearly increased yield loss by 1% for No. 1, jumbo, and total yield. Yield loss increased by 36%, 23%, and 35% as shade cloth removal was delayed from 6 to 10 WAP for No. 1, jumbo, and total yield, respectively. F-tests comparing reduced versus full models of yield loss provided no evidence that the presence of yield loss from A. palmeri light interception caused yield loss different than that explained by the shade cloth at similar light-interception levels. Results indicate that shade cloth structures could be used to simulate Covington sweetpotato yield loss from A. palmeri competition, and light interception could be used as a predictor for expected yield loss from A. palmeri competition.
Many newborns with pulmonary atresia/intact ventricular septum require intervention to establish pulmonary flow and sufficient cardiac output. The resulting haemodynamic changes are not well characterised and may have unintended consequences.
This is a 30-year (1988–2018) retrospective study of patients with pulmonary atresia intact ventricular septum.
Eighty-nine patients were included, and median follow-up was 8 years. Fifty-five per cent had coronary sinusoids and 27% had right ventricular-dependent coronary circulation. Most patients were managed with surgical aortopulmonary or modified Blalock–Taussig shunt (73%), and 12 patients underwent balloon atrial septostomy before surgical intervention. The remaining patients (27%) underwent only transcatheter interventions; 7 required an atrial septostomy and 17 required ductal stentings. All-cause mortality was 10%, most deaths (89%) occurred before 18 months of age. Of these early deaths, 87% required a balloon atrial septostomy and 85% had right ventricular-dependent coronary sinusoids. Eighteen-month mortality was significantly higher for patients who required a balloon atrial septostomy compared to those who did not (36% versus 1.4% p < 0.0001).
Patients with pulmonary atresia/intact ventricular septum who require balloon atrial septostomy in the newborn period have significantly higher 18-month mortality. Quantifying the mortality difference may help guide prognostication and expectation setting. Infants who had septostomy and a surgical shunt in the newborn period fared better than those who only underwent septostomy (even when accompanied by ductal stenting). For infants with right ventricular-dependent circulation, atrial septostomy should only be performed on an urgent or emergent basis and these patients should be considered for early surgical intervention and neonatal transplant.
Cognitive tasks delivered during ecological momentary assessment (EMA) may elucidate the short-term dynamics and contextual influences on cognition and judgements of performance. This paper provides initial validation of a smartphone task of facial emotion recognition in serious mental illness.
A total of 86 participants with psychotic disorders (non-affective and affective psychosis), aged 19–65, were administered in-lab ‘gold standard’ affect recognition, neurocognition, and symptom assessments. They subsequently completed 10 days of the mobile facial emotion recognition task, assessing both accuracy and self-assessed performance, along with concurrent EMA of psychotic symptoms and mood. Validation focused on task adherence and predictors of adherence, gold standard convergent validity, and symptom and diagnostic group variation.
The mean rate of adherence to the task was 79%; no demographic or clinical variables predicted adherence. Convergent validity was observed with in-lab measures of facial emotion recognition, and no practice effects were observed on the mobile facial emotion recognition task. EMA reports of more severe voices, sadness, and paranoia were associated with worse performance, whereas mood more strongly associated with self-assessed performance.
The mobile facial emotion recognition task was tolerated and demonstrated convergent validity with in-lab measures of the same construct. Social cognitive performance, and biased judgements previously shown to predict function, can be evaluated in real-time in naturalistic environments.
To assess researchers’ experiences working with community advisory boards (CABs) and perceptions of how community member stakeholder feedback impacted the research.
Individual interviews were conducted with researchers (n= 34) who had presented their research to a Mayo Clinic CAB (at MN, AZ, or FL) from 2014 to 2017, with an average interview duration of 10–15 min. Researchers were asked “In what ways did the feedback you received from the CAB influence your research?” A validated, structured, 7-item interview was used to assess domains of the potential influence that CABs had on the research: (1) pre-research (e.g., generated ideas), (2) infrastructure (e.g., budget preparation), (3) research design, (4) implementation (e.g., research recruitment), (5) analysis, (6) dissemination, and (7) post-research. A total mean score was calculated with a possible range of 0–7. In addition, open-ended examples and feedback from researchers in response to each domain were summarized for themes using content analysis.
Researchers reported that the CAB influenced research in the following domains: pre-research (24%), infrastructure (24%), study design (41%), implementation (41%), analysis (6%), dissemination (24%), and post-research activities (18%). The mean total score was = 1.8 (SD = 1.7, range: 0–6). Open-ended responses revealed major themes of CAB helpfulness in generating/refining ideas, identifying community partners, culturally tailored and targeted recruitment strategies, intervention design and delivery, and dissemination.
Findings from this preliminary evaluation indicate that despite positive experiences noted in open-ended feedback, the perceived quantitative impact of CAB feedback on the research was moderate. Bidirectional communication between researchers and community member stakeholders has the potential to make clinical and translational research more relevant and appropriate.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
Adolescent diet, physical activity and nutritional status are generally known to be sub-optimal. This is an introduction to a special issue of papers devoted to exploring factors affecting diet and physical activity in adolescents, including food insecure and vulnerable groups.
Eight settings including urban, peri-urban and rural across sites from five different low- and middle-income countries.
Focus groups with adolescents and caregivers carried out by trained researchers.
Our results show that adolescents, even in poor settings, know about healthy diet and lifestyles. They want to have energy, feel happy, look good and live longer, but their desire for autonomy, a need to ‘belong’ in their peer group, plus vulnerability to marketing exploiting their aspirations, leads them to make unhealthy choices. They describe significant gender, culture and context-specific barriers. For example, urban adolescents had easy access to energy dense, unhealthy foods bought outside the home, whereas junk foods were only beginning to permeate rural sites. Among adolescents in Indian sites, pressure to excel in exams meant that academic studies were squeezing out physical activity time.
Interventions to improve adolescents’ diets and physical activity levels must therefore address structural and environmental issues and influences in their homes and schools, since it is clear that their food and activity choices are the product of an interacting complex of factors. In the next phase of work, the Transforming Adolescent Lives through Nutrition consortium will employ groups of adolescents, caregivers and local stakeholders in each site to develop interventions to improve adolescent nutritional status.
To develop a staff training intervention for agitation in people with severe dementia, reaching end-of-life, residing in nursing homes (NHs), test feasibility, acceptability, and whether a trial is warranted.
Feasibility study with pre- and post-intervention data collection, qualitative interviews, and focus groups.
Three NHs in South East England with dementia units, diverse in terms of size, ownership status, and location.
Residents with a dementia diagnosis or scoring ≥2 on the Noticeable Problems Checklist, rated as “severe” on Clinical Dementia Rating Scale, family carers, and staff (healthcare assistants and nurses).
Manualized training, delivered by nonclinical psychology graduates focusing on agitation in severe dementia, underpinned by a palliative care framework.
Main outcomes were feasibility of recruitment, data collection, follow-up, and intervention acceptability. We collected resident, family carer, and staff demographics. Staff provided data on resident’s agitation, pain, quality of life, and service receipt. Staff reported their sense of competence in dementia care. Family carers reported on satisfaction with end-of-life care. In qualitative interviews, we explored staff and family carers’ views on the intervention.
The target three NHs participated: 28 (49%) residents, 53 (74%) staff, and 11 (85%) family carers who were eligible to participate consented. Eight-four percent of staff attended ≥3 sessions, and we achieved 93% follow-up. We were able to complete quantitative interviews. Staff and family carers reported the intervention and delivery were acceptable and helpful.
The intervention was feasible and acceptable indicating a larger trial for effectiveness may be warranted.
In 2012, the US government overhauled school nutrition standards, but few studies have evaluated the effects of these standards at the national level. The current study examines the impact of the updated school nutrition standards on dietary and health outcomes of schoolchildren in a nationally representative data set.
Difference-in-differences. We compared weekday fruit and vegetable intake between students with daily school lunch participation and students without school lunch participation before and after implementation of updated school nutrition standards using a multivariable linear regression model. Secondary outcomes included weekday solid fat and added sugar (SoFAS) intake and overweight and obesity prevalence. We adjusted analyses for demographic and family socio-economic factors.
K-12 students, aged 6–20 years (n 9172), from the National Health and Nutrition Examination Survey, 2005–2016.
Implementation of updated school nutrition standards was not associated with a change in weekday fruit and vegetable intake (β = 0·02 cups, 95 % CI −0·23, 0·26) for students with daily school lunch participation. However, implementation of the policy was associated with a 1·5 percentage point (95 % CI −3·0, −0·1) decline in weekday SoFAS intake and a 6·1 percentage point (95 % CI −12·1, −0·1) decline in overweight and obesity prevalence.
Changes to US school nutrition standards were associated with reductions in the consumption of SoFAS as well as a decrease in overweight and obesity in children who eat school lunch. However, we did not detect a change in weekday intake of fruits and vegetables associated with the policy change.
Field studies were conducted to determine sweetpotato tolerance to and weed control from management systems that included linuron. Treatments included flumioxazin preplant (107 g ai ha−1) followed by (fb) S-metolachlor (800 g ai ha−1), oryzalin (840 g ai ha−1), or linuron (280, 420, 560, 700, and 840 g ai ha−1) alone or mixed with S-metolachlor or oryzalin applied 7 d after transplanting. Weeds did not emerge before the treatment applications. Two of the four field studies were maintained weed-free throughout the season to evaluate sweetpotato tolerance without weed interference. The herbicide program with the greatest sweetpotato yield was flumioxazin fb S-metolachlor. Mixing linuron with S-metolachlor did not improve Palmer amaranth management and decreased marketable yield by up to 28% compared with flumioxazin fb S-metolachlor. Thus, linuron should not be applied POST in sweetpotato if Palmer amaranth has not emerged at the time of application.
Through a strategic learning process, prototypes unveil design directions. We provide a review of prototyping methods for novice designers to study and pedagogical practice for capstone design course faculty to juxtapose. Stanford University's ME310 graduate-level project-based learning course introduces students to various prototyping design techniques, such as Needfinding and Benchmarking, and prototyping methods, such as the Critical Experience Prototype, Critical Function Prototype, Dark Horse Prototype, Part-X is Finished, Funky System Prototype, and Functional System Prototype.
Introduction: This study aims to evaluate the accuracy of the Échelle québécoise de triage préhospitalier en traumatologie (EQTPT) to identify patients who will need urgent and specialized trauma care in the La Capitale-Nationale region, province of Quebec. Methods: A detailed review of prehospital and in-hospital medical charts was conducted for a sample of patients transported following a trauma by ambulance to one of the five CHU de Quebec's emergency departments (ED) between November 2016 and March 2017. Data related to the trauma mechanism, population, injuries sustained, diagnosis, intervention and patient outcomes were extracted. The study primary outcome was the use of at least one urgent and specialized trauma care defined as: admission to the intensive care unit (ICU), urgent surgery within less than 24 hours after arrival (excluding orthopedic surgery for one limb only), intubation in ED, angioembolization within 24 hours after ED arrival, activation of a massive transfusion protocol in the ED. Also, patients who died secondary to their trauma were also considered as requiring urgent care. Results: 902 patients were included. The mean age (SD) was 59 (28.5) years old, 494 (54.8%) were female. The main trauma mechanisms were falls (592 (65.6%)) followed by motor vehicle accident (201 (22%)). 367 (40.7%) patients were transported directly to the tertiary trauma centre from the field. 231 (25.6%) patients had at least one criteria included in the steps 1, 2 or 3 of the EQTPT. Subsequently, most patients (649 (71.9%) were discharged home from the ED while 177 (19.6%) patients were admitted to the hospital. 82 (9.1%) patients required urgent and specialized trauma care. Of these 82 patients, 27 patients (32%) were identified in step 1 of the protocol, 12 patients (14.6%) in step 2, 5 patients (6.1%) in step 3, 13 patients (15.9%) in step 4 and 2 patients (2.4%) in step 5 while 23 (28.0%) patients were not identified by any steps of the EQTPT protocol. Therefore, 44 (53.6%) of the patients requiring urgent and specialized trauma care were identified by the criteria proposed in the steps 1, 2 or 3. Conclusion: In this retrospective cohort study, the EQTPT was insensitive to identify trauma patients who will need prompt and complex trauma management. Studies are required to determine the factors that could help improve its accuracy.
Introduction: Patients hospitalized following a trauma will be frequently treated with opioids during their stay and after discharge. We examined the relationship between acute phase (< 3 months) opioid use after discharge and the risk of opioid poisoning (OP) or opioid use disorder (OUD) in older trauma patients Methods: In a retrospective multicenter cohort study conducted on registry data, we included all patients aged 65 years and older admitted (hospital stay >2 days) for injury in 57 trauma centers in the province of Quebec (Canada) between 2004 and 2014. We searched for OP and OUD from ICD-9 and ICD-10 code diagnosis that resulted in a hospitalization or a medical consultation after their initial injury. Patients that filled an opioid prescription within a 3-month period after sustaining the trauma were compared to those who did not fill an opioid prescription during that period using Cox proportional hazards regressions. Results: A total of 70,314 participants were retained for analysis; median age was 82 years (IQR: 75-87), 68% were women, and 34% of the patients filled an opioid prescription within 3-months of the initial trauma. During a median follow-up of 2.6 years (IQR: 1-5), 192 participants (0.30%; 95%CI: 0.25%-0.35%) were hospitalized for OP and 73 (0.10%; 95%CI: 0.07%-0.13%) were diagnosed with OUD. Having filled an opioid prescription within 3-months of injury was associated with an increased hazard ratio of OP (2.6; 95%CI: 1.9-3.5) and OUD (4.0; 95%CI: 2.3-7.0). However, history of OP (2.7; 95%CI: 1.2-6.1), of substance use disorder (4.3; 95%CI: 2.4-7.9), or of opioid prescription filled (2.7; 95%CI: 2.1-3.5) before trauma were also related to OP or OUD. Conclusion: Opioid poisoning and opioid use disorder are rare events after hospitalization for trauma in older patients. However, opioids should be used cautiously in patients with history of substance use disorder, opioid poisoning or opioid use during the past year.