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We assessed patterns of enteric infections caused by 14 pathogens, in a longitudinal cohort study of sequelae in British Columbia (BC) Canada, 2005–2014. Our population cohort of 5.8 million individuals was followed for an average of 7.5 years/person; during this time, 40 523 individuals experienced 42 308 incident laboratory-confirmed, provincially reported enteric infections (96.4 incident infections per 100 000 person-years). Most individuals (38 882/40 523; 96%) had only one, but 4% had multiple concurrent infections or more than one infection across the study. Among individuals with more than one infection, the pathogens and combinations occurring most frequently per individual matched the pathogens occurring most frequently in the BC population. An additional 298 557 new fee-for-service physician visits and hospitalisations for enteric infections, that did not coincide with a reported enteric infection, also occurred, and some may be potentially unreported enteric infections. Our findings demonstrate that sequelae risk analyses should explore the possible impacts of multiple infections, and that estimating risk for individuals who may have had a potentially unreported enteric infection is warranted.
Our aim was to develop a brief cognitive behavioural therapy (CBT) protocol to augment treatment for social anxiety disorder (SAD). This protocol focused specifically upon fear of positive evaluation (FPE). To our knowledge, this is the first protocol that has been designed to systematically target FPE.
To test the feasibility of a brief (two-session) CBT protocol for FPE and report proof-of-principle data in the form of effect sizes.
Seven patients with a principal diagnosis of SAD were recruited to participate. Following a pre-treatment assessment, patients were randomized to either (a) an immediate CBT condition (n = 3), or (b) a comparable wait-list (WL) period (2 weeks; n = 4). Two WL patients also completed the CBT protocol following the WL period (delayed CBT condition). Patients completed follow-up assessments 1 week after completing the protocol.
A total of five patients completed the brief, FPE-specific CBT protocol (two of the seven patients were wait-listed only and did not complete delayed CBT). All five patients completed the protocol and provided 1-week follow-up data. CBT patients demonstrated large reductions in FPE-related concerns as well as overall social anxiety symptoms, whereas WL patients demonstrated an increase in FPE-related concerns.
Our brief FPE-specific CBT protocol is feasible to use and was associated with large FPE-specific and social anxiety symptom reductions. To our knowledge, this is the first treatment report that has focused on systematic treatment of FPE in patients with SAD. Our protocol warrants further controlled evaluation.
OBJECTIVES/SPECIFIC AIMS: Clostridium difficile infection (CDI) is the most common cause of antibiotic-associated diarrhea and an increasingly common infection in children in both hospital and community settings. Between 20% and 30% of pediatric patients will have a recurrence of symptoms in the days to weeks following an initial infection. Multiple recurrences have been successfully treated with fecal microbiota transplantation (FMT), though the body of evidence in pediatric patients is limited primarily to case reports and case series. The goal of our study was to better understand practices, success, and safety of FMT in children as well as identify risk factors associated with a failed FMT in our pediatric patients. METHODS/STUDY POPULATION: This multicenter retrospective analysis included 373 patients who underwent FMT for CDI between January 1, 2006 and January 1, 2017 from 18 pediatric centers. Demographics, baseline characteristics, FMT practices, C. difficile outcomes, and post-FMT complications were collected through chart abstraction. Successful FMT was defined as no recurrence of CDI within 60 days after FMT. Of the 373 patients in the cohort, 342 had known outcome data at two months post-FMT and were included in the primary analysis evaluating risk factors for recurrence post-FMT. An additional six patients who underwent FMT for refractory CDI were excluded from the primary analysis. Unadjusted analysis was performed using Wilcoxon rank-sum test, Pearson χ2 test, or Fisher exact test where appropriate. Stepwise logistic regression was utilized to determine independent predictors of success. RESULTS/ANTICIPATED RESULTS: The median age of included patients was 10 years (IQR; 3.0, 15.0) and 50% of patients were female. The majority of the cohort was White (89.0%). Comorbidities included 120 patients with inflammatory bowel disease (IBD) and 14 patients who had undergone a solid organ or stem cell transplantation. Of the 336 patients with known outcomes at two months, 272 (81%) had a successful outcome. In the 64 (19%) patients that did have a recurrence, 35 underwent repeat FMT which was successful in 20 of the 35 (57%). The overall success rate of FMT in preventing further episodes of CDI in the cohort with known outcome data was 87%. Unadjusted predictors of a primary FMT response are summarized. Based on stepwise logistic regression modeling, the use of fresh stool, FMT delivery via colonoscopy, the lack of a feeding tube, and a lower number of CDI episodes before undergoing FMT were independently associated with a successful outcome. There were 20 adverse events in the cohort assessed to be related to FMT, 6 of which were felt to be severe. There were no deaths assessed to be related to FMT in the cohort. DISCUSSION/SIGNIFICANCE OF IMPACT: The overall success of FMT in pediatric patients with recurrent or severe CDI is 81% after a single FMT. Children without a feeding tube, who receive an early FMT, FMT with fresh stool, or FMT via colonoscopy are less likely to have a recurrence of CDI in the 2 months following FMT. This is the first large study of FMT for CDI in a pediatric cohort. These findings, if confirmed by additional prospective studies, will support alterations in the practice of FMT in children.
The United States relies on uncompensated family caregivers to provide most of the long-term care required by older adults as they age. But such care comes at a significant financial cost to these caregivers in the form of lower lifetime earnings and diminished (or even no) Social Security retirement benefits, ineligibility for Medicare coverage of their healthcare costs, and minimal retirement savings. To reduce the impact of uncompensated caregiving on the intergenerational transmission of poverty, this paper discusses three possible mechanisms of compensating family caregivers: public payments, deemed wage credits under Social Security, and income tax incentives.
For the last 40 years, American medical patients have utilized “advance medical directives” to communicate their medical treatment desires should a situation arise where they are incapable of expressing their own preferences. These directives encompass a range of complex medical decisions, including end-of-life wishes, allowable and unallowable medical procedures, and who gets to make the medical decisions. Often, the patient’s religious beliefs affect the way he or she makes these decisions. Given this, religious organizations have become increasingly involved in drafting and enforcing these provisions. Difficulties can also arise when the physicians’ religious beliefs affect the advance medical directive or when patient religious beliefs are at a tension with the political tide. This chapter will examine these issues further.
Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder which effects an estimated 3% to 5% of children. Despite estimates that ADHD persists in 30% to 70% of adults having had the disorder in childhood, ADHD in adulthood remains controversial. This report summarizes current thinking in the diagnosis and etiology of adult ADHD. Most theories posit that ADHD is related to anomalies in frontal lobe function and dopaminergic transmission. However, there is debate as to whether ADHD is a unitary disorder with different manifestations, a syndrome, or multiple disorders. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, classifies ADHD into inattention, hyperactivity-impulsivity, and combined subtypes. Although problems with cognition are core ADHD symptoms, self reporting has not been a reliable predictor of neuropsychological test performance. Nevertheless, we suggest that a performance-based diagnosis, including empirically derived, age-sensitive neuropsychological tests, provides the best hope of dissociating ADHD from psychiatric disorders with similar symptoms. We also describe the promise of new neuroimaging technologies, such as functional magnetic resonance imaging, in elucidating the pathophysiology of ADHD and similar psychiatric disorders.
Objective: This study was conducted to describe Axis I sexual diagnoses of 60 males arrested for possession of child pornography obtained via the Internet and/or attempting to meet children via the Internet.
Methods: Data was obtained from a chart review of evaluations conducted on 60 males referred for a psychosexual evaluation following an arrest for possession of child pornography and/or attempting to meet children. All crimes involved use of the Internet. Information obtained from the chart review was entered into SAS. All diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Simple descriptive statistics were computed and cross tabulations were tested for significance using χ2 or Fisher's Exact test.
Results: Of the total sample, 40% had at least one paraphilia. Thirty-one percent had a diagnosis of pedophilia and 18% of a paraphilia not otherwise specified (NOS). Thirty-three percent had a sexual disorder NOS, characterized by hypersexuality. Seventy percent of the total sample had an Axis I disorder that antedated and was judged to be contributory to the behavior leading to their arrest.
Conclusions: This sample of men arrested for committing crimes against children and adolescents via the Internet has a high incidence of lifetime sexual and other psychopathology.
The goal of the division is to address the scientific issues that were developed at the 2009 IAU General Assembly in Rio de Janeiro. These are:
• Astronomical constants
—Gaussian gravitational constant, Astronomical Unit, GMSun, geodesic precession-nutation
• Astronomical software
• Solar System Ephemerides
—Comparison of dynamical reference frames
• Future Optical Reference Frame
• Future Radio Reference Frame
• Predictions of Earth orientation
• Units of measurements for astronomical quantities in relativistic context
• Astronomical units in the relativistic framework
• Time-dependent ecliptic in the GCRS
• Asteroid masses
• Review of space missions
• Detection of gravitational waves
• VLBI on the Moon
• Real time electronic access to UT1-UTC
In pursuit of these goals Division I members have made significant scientific and organizational progress, and are organizing a Joint Discussion on Space-Time Reference Systems for Future Research at the 2012 IAU General Assembly. The details of Division activities and references are provided in the individual Commission and Working Group reports in this volume. A comprehensive list of references related to the work of the Division is available at the IAU Division I website at http://maia.usno.navy.mil/iaudiv1/.
There were four 1.5-hour sessions of Division I business meetings during the XXVIIth IAU General Assembly. The first three were devoted to the reports of Commissions, Working Groups and services associated with the Division, discussion about plans for the next triennium and future structure of the Division. Scientific presentations on the future space astrometric mission Gaia were made at the fourth session.
Henry Brady's career is a testament to the virtues of big social science—big questions, big datasets, big toolkits, big institutions. While much of political science still functions as a cottage industry, he has played a leading role in the second generation of our discipline's post-war industrial revolution. Building on the varied contributions of such earlier stalwarts as Warren Miller, David Truman, Gabriel Almond, and Paul Lazarsfeld, Brady has contributed significantly to the theoretical, empirical, methodological, and institutional development of the field. With intelligence, energy, and good will, he has instigated and nurtured a remarkable variety of projects, partnerships, and programs to advance our understanding of important political phenomena.
We argue that brown dwarfs (BDs) and planemos form by the same mechanisms as low-mass hydrogen-burning stars, but that as one moves to lower and lower masses, an increasing fraction of these objects is formed by fragmentation of the outer parts (R ≳ 100 AU) of protostellar accretion discs around more massive primary protostars, which in turn formed in their own very-low-mass prestellar cores. Numerical simulations of disc fragmentation with realistic thermodynamics show that low-mass objects are readily formed by fragmentation of short-lived massive, extended protostellar accretion discs. Such objects tend subsequently to be liberated into the field at low speed, due to mutual interactions with the primary protostar. Many (~20%) are in low-mass (M1 + M2 < 0.2M⊙) binary systems with semi-major axes a ~ 1 to 2 AU or ~200 AU and mass ratios q ≡ M2/M1 ≳ 0.7. Most of the brown dwarfs have sufficiently large attendant discs to sustain accretion and outflows. Most of the BDs that remain bound to the primary protostar have wide orbits (i.e., there is a BD desert), and these BDs also have a significantly higher probability of being in a BD/BD binary system than do the brown dwarfs that are liberated into the field (just as observed). In this picture, the multiplicity statistics and velocity dispersion of brown dwarfs are largely determined by the eigen evolution of a small-N system, born from a single prestellar core, rather than the larger-scale dynamics of the parent cluster. Consequently, many of the statistical properties of brown dwarfs should not differ very much from one star-formation region to another.