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The authors assessed the association of physical function, social variables, functional status, and psychiatric co-morbidity with cognitive function among older HIV-infected adults.
From 2012–2014, a cross-sectional study was conducted among HIV-infected patients ages 50 or older who underwent comprehensive clinical geriatric assessment.
Two San Francisco HIV clinics.
359 HIV-infected patients age 50 years or older
Unadjusted and adjusted Poisson regression measured prevalence ratios and 95% confidence intervals for demographic, functional and psychiatric variables and their association with cognitive impairment using a Montreal Cognitive Assessment (MoCA) score < 26 as reflective of cognitive impairment.
Thirty-four percent of participants had a MoCA score of < 26. In unadjusted analyses, the following variables were significantly associated with an abnormal MoCA score: born female, not identifying as homosexual, non-white race, high school or less educational attainment, annual income < $10,000, tobacco use, slower gait speed, reported problems with balance, and poor social support. In subsequent adjusted analysis, the following variables were significantly associated with an abnormal MoCA score: not identifying as homosexual, non-white race, longer 4-meter walk time, and poor social support. Psychiatric symptoms of depressive, anxiety, and post-traumatic stress disorders did not correlate with abnormal MoCA scores.
Cognitive impairment remains common in older HIV-infected patients. Counter to expectations, co-morbid psychiatric symptoms were not associated with cognitive impairment, suggesting that cognitive impairment in this sample may be due to neurocognitive disorders, not due to other psychiatric illness. The other conditions associated with cognitive impairment in this sample may warrant separate clinical and social interventions to optimize patient outcomes.
OBJECTIVES/SPECIFIC AIMS: National concerns about IRB-related research delays have led to re-assessment of IRB review processes at institutional levels. We sought to address whether a dedicated IRB Liaison Service at the Irving Institute’s central location could provide additional useful staff support to the investigator community for interactions with the IRB at various levels of protocol submission. METHODS/STUDY POPULATION: We evaluated the results of a user satisfaction survey and performed a focused in-depth analysis of Liaison Service impact. An online tracking and satisfaction survey was implemented for researchers to complete following each consultation. The goal was to gauge the uses, user types and usefulness of the Service, and to follow-up with researchers who might have additional questions. Data was gathered about users of the Service and their affiliations, and the topics and questions that were discussed. A terse summary was drafted to categorize each consultation that was conducted during office hour sessions. Additionally, surveys were emailed to researchers to gauge their experience with the Service and their overall satisfaction. Users completed the survey either in person at the end of the consultation, or by email request sent immediately following each in-person consultation. The impact of the IRB Liaison Service on IRB protocol approval times was analyzed for a random sub-sample of protocols for which consultations were provided. Consultations for studies with an associated IRB protocol number (i.e., at least initially submitted) from May 2015-June 2017 had been assigned a number in an Excel file. Using a randomization formula, a subset of 90 protocols was identified for further analysis. Protocols that did not result in an IRB submission and duplicate entries were removed. The final dataset consisted of 67 protocols. Those protocols were assessed by type of review process (expedited versus full board review), by status (new submission, first return, second return, etc.), and by which of the seven IRB committees completed the review. Consultations for each protocol included in this subset were reviewed using the notes about that consultation. IRB records in Columbia’s online research oversight system, Rascal, were also reviewed to assess the timing of and issues raised in subsequent IRB review. Factors examined included whether the protocol was approved at next submission and if not, whether questions raised in subsequent IRB returns were related to the topics discussed in the consultation. RESULTS/ANTICIPATED RESULTS: Since its inception in January 2015 through June 2017 (2.5 years), a total of 501 in-person consultations have been performed, usually 25-30 per month. Users were primarily study coordinators and investigators. Most requests concerned new protocol development, policy questions or assistance in addressing IRB comments from submitted protocols. Survey response rate was 43%. Results of 215 competed satisfaction surveys were 100% positive. Of 67 unique protocols analyzed for outcomes of the consultation, 73% were subsequently approved within 14 days. DISCUSSION/SIGNIFICANCE OF IMPACT: Overall, we have found the Liaison Service to be a popular addition to research support, and plan to continue the service. We will continue to evaluate its user satisfaction and usefulness. Additional focus will be placed on whether the Service can improve approval times for human subjects research for protocols using the Liaison Service.
The prevalence of mental disorders among Black, Latino, and Asian adults is lower than among Whites. Factors that explain these differences are largely unknown. We examined whether racial/ethnic differences in exposure to traumatic events (TEs) or vulnerability to trauma-related psychopathology explained the lower rates of psychopathology among racial/ethnic minorities.
We estimated the prevalence of TE exposure and associations with onset of DSM-IV depression, anxiety and substance disorders and with lifetime post-traumatic stress disorder (PTSD) in the Collaborative Psychiatric Epidemiology Surveys, a national sample (N = 13 775) with substantial proportions of Black (35.9%), Latino (18.9%), and Asian Americans (14.9%).
TE exposure varied across racial/ethnic groups. Asians were most likely to experience organized violence – particularly being a refugee – but had the lowest exposure to all other TEs. Blacks had the greatest exposure to participation in organized violence, sexual violence, and other TEs, Latinos had the highest exposure to physical violence, and Whites were most likely to experience accidents/injuries. Racial/ethnic minorities had lower odds ratios of depression, anxiety, and substance disorder onset relative to Whites. Neither variation in TE exposure nor vulnerability to psychopathology following TEs across racial/ethnic groups explained these differences. Vulnerability to PTSD did vary across groups, however, such that Asians were less likely and Blacks more likely to develop PTSD following TEs than Whites.
Lower prevalence of mental disorders among racial/ethnic minorities does not appear to reflect reduced vulnerability to TEs, with the exception of PTSD among Asians. This highlights the importance of investigating other potential mechanisms underlying racial/ethnic differences in psychopathology.
In the emergency department, portable point-of-care testing (POCT) coagulation devices may facilitate stroke patient care by providing rapid International Normalized Ratio (INR) measurement. The objective of this study was to evaluate the reliability, validity, and impact on clinical decision-making of a POCT device for INR testing in the setting of acute ischemic stroke (AIS).
A total of 150 patients (50 healthy volunteers, 51 anticoagulated patients, 49 AIS patients) were assessed in a tertiary care facility. The INR’s were measured using the Roche Coaguchek S and the standard laboratory technique.
The interclass correlation coefficient and 95% confidence interval between overall POCT device and standard laboratory value INRs was high (0.932 (0.69 - 0.78). In the AIS group alone, the correlation coefficient and 95% CI was also high 0.937 (0.59 - 0.74) and diagnostic accuracy of the POCT device was 94%.
When used by a trained health professional in the emergency department to assess INR in acute ischemic stroke patients, the CoaguChek S is reliable and provides rapid results. However, as concordance with laboratory INR values decreases with higher INR values, it is recommended that with CoaguChek S INRs in the > 1.5 range, a standard laboratory measurement be used to confirm the results.
Although significant associations of childhood adversities with adult mental disorders are widely documented, most studies focus on single childhood adversities predicting single disorders.
To examine joint associations of 12 childhood adversities with first onset of 20 DSM–IV disorders in World Mental Health (WMH) Surveys in 21 countries.
Nationally or regionally representative surveys of 51 945 adults assessed childhood adversities and lifetime DSM–IV disorders with the WHO Composite International Diagnostic Interview (CIDI).
Childhood adversities were highly prevalent and interrelated. Childhood adversities associated with maladaptive family functioning (e.g. parental mental illness, child abuse, neglect) were the strongest predictors of disorders. Co-occurring childhood adversities associated with maladaptive family functioning had significant subadditive predictive associations and little specificity across disorders. Childhood adversities account for 29.8% of all disorders across countries.
Childhood adversities have strong associations with all classes of disorders at all life-course stages in all groups of WMH countries. Long-term associations imply the existence of as-yet undetermined mediators.
The garment industry is a good example of the relative autonomy of academic fields. Two histories of the industry are being written simultaneously but separately. One is a history of women; the other, a history of immigrants. Two types of workers have indeed come to the sweatshops, and each have had distinct reasons for doing so. The nineteenth century saw the shift from tailormade to ready-made garments, from the (hand-held) needle to the sewing machine, from tailors and dressmakers to garment workers, and from more to less skill in the making of clothing. The ready-to-wear revolution was also accompanied by a global shift in the sewing labor force, from men to women and from natives to immigrants. The story is a complicated one, yet one which has most often been told in parallel fashion.
Candida G. Brush, Associate Professor of Strategy and Policy, Director of the Council for Women's Entrepreneurship and Leadership, and Research Director for the Entrepreneurial Management Institute, Boston University,
Nancy M. Carter, Chair in Entrepreneurship, University of St. Thomas,
Elizabeth Gatewood, Chair of Entrepreneurship and Director of the Johnson Center for Entrepreneurship and Innovation, Indiana University,
Patricia G. Greene, Chair in Entrepreneurial Leadership, University of Missouri; Executive Director, Entrepreneurial Growth Resource Center,
Myra M. Hart, Professor of Management Practice, Harvard Business School, Harvard University
Diana was a heroic woman, a huntress. Women seeking capital are hunters rather than gatherers. They are hunting for capital in a traditionally male dominated arena.
Women's participation in entrepreneurship is vital to the growth of the U.S. economy. It is not surprising, then, that breaking down gender barriers and facilitating the start-up and development of women-owned businesses has been at the forefront of public policy for several decades. Legislative changes such as the Civil Rights Act of 1964, the Equal Credit Opportunity Act of 1975, and the Affirmative Action Act of 1978 were pioneering efforts to address some of the challenges that women faced in starting and growing their own businesses. Baseline data on women's participation as business owners in the wake of these efforts were first made available in The Bottom Line (President's Interagency Task Force 1979). Ten years later passage of the Women's Business Ownership Act provided set-asides for women business owners, created the National Women's Business Council, called for additional data collection, and established new federal capacities to guarantee loans to women-owned businesses.
More recently, women's entrepreneurship policy has been manifested in a wide range of federal, state, and local programs. Relevant federal initiatives include the Small Business Administration (SBA)'s preferential procurement program (known as section 8(a)), which provides government contracts and other assistance to small businesses owned by socially and economically disadvantaged persons; the Women-owned Business Procurement Program, which teaches women how to market to the federal government; the Women's Demonstration Program, which provides women with long-term training and counseling for all aspects of owning and managing a business; and the Women's Network for Entrepreneurial Training, which arranges for experienced women owners to serve as mentors to others.