32 results
Factors associated with SARS-CoV-2 and community-onset invasive Staphylococcus aureus coinfection, 2020
- Kelly Jackson, Sydney Resler, Joelle Nadle, Susan Petit, Susan Ray, Lee Harrison, Ruth Lynfield, Kathryn Como-Sabetti, Carmen Bernu, Ghinwa Dumyati, Marissa Tracy, William Schaffner, Holly Biggs, Isaac See
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, pp. s84-s85
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Background: Previous analyses describing the relationship between SARS-CoV-2 infection and Staphylococcus aureus have focused on hospital-onset S. aureus infections occurring during COVID-19 hospitalizations. Because most invasive S. aureus (iSA) infections are community-onset (CO), we characterized CO iSA cases with a recent positive SARS-CoV-2 test (coinfection). Methods: We analyzed CDC Emerging Infections Program active, population- and laboratory-based iSA surveillance data among adults during March 1–December 31, 2020, from 11 counties in 7 states. The iSA cases (S. aureus isolation from a normally sterile site in a surveillance area resident) were considered CO if culture was obtained <3 days after hospital admission. Coinfection was defined as first positive SARS-CoV-2 test ≤14 days before the initial iSA culture. We explored factors independently associated with SARS-CoV-2 coinfection versus no prior positive SARS-CoV-2 test among CO iSA cases through a multivariable logistic regression model (using demographic, healthcare exposure, and underlying condition variables with P<0.25 in univariate analysis) and examined differences in outcomes through descriptive analysis. Results: Overall, 3,908 CO iSA cases were reported, including 138 SARS-CoV-2 coinfections (3.5%); 58.0% of coinfections had iSA culture and the first positive SARS-CoV-2 test on the same day (Fig. 1). In univariate analysis, neither methicillin resistance (44.2% with coinfection vs 36.5% without; P = .06) nor race and ethnicity differed significantly between iSA cases with and without SARS-CoV-2 coinfection (P = .93 for any association between race and ethnicity and coinfection), although iSA cases with coinfection were older (median age, 72 vs 60 years , P<0.01) and more often female (46.7% vs 36.3%, P=0.01). In multivariable analysis, significant associations with SARS-CoV-2 coinfection included older age, female sex, previous location in a long-term care facility (LTCF) or hospital, presence of a central venous catheter (CVC), and diabetes (Figure 2). Two-thirds of co-infection cases had ≥1 of the following characteristics: age > 73 years, LTCF residence 3 days before iSA culture, and/or CVC present any time during the 2 days before iSA culture. More often, iSA cases with SARS-CoV-2 coinfection were admitted to the intensive care unit ≤2 days after iSA culture (37.7% vs 23.3%, P<0.01) and died (33.3% vs 11.3%, P<0.01). Conclusions: CO iSA patients with SARS-CoV-2 coinfection represent a small proportion of CO iSA cases and mostly involve a limited number of factors related to likelihood of acquiring SARS-CoV-2 and iSA. Although CO iSA patients with SARS-CoV-2 coinfection had more severe outcomes, additional research is needed to understand how much of this difference is related to differences in patient characteristics.
Disclosures: None
Social motivation in infancy is associated with familial recurrence of ASD
- Natasha Marrus, Kelly N. Botteron, Zoë Hawks, John R. Pruett, Jr., Jed T. Elison, Joshua J. Jackson, Lori Markson, Adam T. Eggebrecht, Catherine A. Burrows, Lonnie Zwaigenbaum, Stephen R. Dager, Annette M. Estes, Heather Cody Hazlett, Robert T. Schultz, Joseph Piven, John N. Constantino
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- Journal:
- Development and Psychopathology / Volume 36 / Issue 1 / February 2024
- Published online by Cambridge University Press:
- 03 October 2022, pp. 101-111
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Pre-diagnostic deficits in social motivation are hypothesized to contribute to autism spectrum disorder (ASD), a heritable neurodevelopmental condition. We evaluated psychometric properties of a social motivation index (SMI) using parent-report item-level data from 597 participants in a prospective cohort of infant siblings at high and low familial risk for ASD. We tested whether lower SMI scores at 6, 12, and 24 months were associated with a 24-month ASD diagnosis and whether social motivation’s course differed relative to familial ASD liability. The SMI displayed good internal consistency and temporal stability. Children diagnosed with ASD displayed lower mean SMI T-scores at all ages and a decrease in mean T-scores across age. Lower group-level 6-month scores corresponded with higher familial ASD liability. Among high-risk infants, strong decline in SMI T-scores was associated with 10-fold odds of diagnosis. Infant social motivation is quantifiable by parental report, differentiates children with versus without later ASD by age 6 months, and tracks with familial ASD liability, consistent with a diagnostic and susceptibility marker of ASD. Early decrements and decline in social motivation indicate increased likelihood of ASD, highlighting social motivation’s importance to risk assessment and clarification of the ontogeny of ASD.
Increases in methicillin-sensitive Staphylococcus aureus bloodstream infection incidence, 2016–2019
- Kelly Jackson, Joelle Nadle, Susan Ray, Ruth Lynfield, Ghinwa Dumyati, Marissa Tracy, William Schaffner, David Ham, Isaac See
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 2 / Issue S1 / July 2022
- Published online by Cambridge University Press:
- 16 May 2022, pp. s63-s64
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Background: Incidence of methicillin-sensitive Staphylococcus aureus (MSSA) bloodstream infections (BSIs) in the United States during 2012–2017 has been reported to have been stable for hospital-onset BSIs and to have increased 3.9% per year for community-onset BSIs. We sought to determine whether these trends continued in more recent years and whether there were further differences within subgroups of community-onset BSIs. Methods: We analyzed CDC Emerging Infections Program active, population- and laboratory-based surveillance data during 2016–2019 for MSSA BSIs from 8 counties in 5 states. BSI cases were defined as isolation of MSSA from blood in a surveillance area resident. Cases were considered hospital onset (HO) if culture was obtained >3 days after hospital admission and healthcare-associated community-onset (HACO) if culture was obtained on or after day 3 of hospitalization and was associated with dialysis, hospitalization, surgery, or long-term care facility residence within 1 year prior or if a central venous catheter was present ≤2 days prior. Cases were otherwise considered community-associated (CA). Annual rates per 100,000 census population were calculated for each epidemiologic classification; rates of HACO cases among chronic dialysis patients per 100,000 dialysis patients were calculated using US Renal Data System data. Annual increases were modeled using negative binomial or Poisson regression and accounting for changes in the overall population age group, and sex. Descriptive analyses were performed. Results: Overall, 8,344 MSSA BSI cases were reported. From 2016–2019 total MSSA BSI rates increased from 23.9 per 100,000 to 28.5 per 100,000 (6.6% per year; P < .01). MSSA BSI rates also increased significantly among all epidemiologic classes. HO cases increased from 2.5 per 100,000 to 3.2 per 100,000 (7.9% per year; P = .01). HACO cases increased from 12.7 per 100,000 to 14.7 per 100,000 (7.0% per year; P = .01). CA cases increased from 8.4 per 100,000 to 10.4 per 100,000 (6.7% per year; P < .01) (Fig. 1). Significant increases in MSSA BSI rates were also observed for nondialysis HACO cases (9.3 per 100,000 to 11.1 per 100,000; 7.8% per year; P < .01) but not dialysis HACO cases (1,823.2 per 100,000 to 1,857.4 per 100,000; 1.4% per year; P = .59). Healthcare risk factors for HACO cases were hospitalization in the previous year (82%), surgery (31%), dialysis (27%), and long-term care facility residence (19%). Conclusions: MSSA BSI rates increased from 2016–2019 overall, among all epidemiologic classes, and among nondialysis HACO cases. Efforts to prevent MSSA BSIs among individuals with healthcare risk factors, particularly those related to hospitalization, might have an impact on MSSA BSI rates.
Funding: None
Disclosures: None
Association of severe mental illness with stroke outcomes and process-of-care quality indicators: nationwide cohort study
- Kelly Fleetwood, Sarah H. Wild, Daniel J. Smith, Stewart W. Mercer, Kirsty Licence, Cathie L. M. Sudlow, Caroline A. Jackson
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- Journal:
- The British Journal of Psychiatry / Volume 221 / Issue 1 / July 2022
- Published online by Cambridge University Press:
- 19 August 2021, pp. 394-401
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- July 2022
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Background
Severe mental illness (SMI) is associated with increased stroke risk, but little is known about how SMI relates to stroke prognosis and receipt of acute care.
AimsTo determine the association between SMI and stroke outcomes and receipt of process-of-care quality indicators (such as timely admission to stroke unit).
MethodWe conducted a cohort study using routinely collected linked data-sets, including adults with a first hospital admission for stroke in Scotland during 1991–2014, with process-of-care quality indicator data available from 2010. We identified pre-existing schizophrenia, bipolar disorder and major depression from hospital records. We used logistic regression to evaluate 30-day, 1-year and 5-year mortality and receipt of process-of-care quality indicators by pre-existing SMI, adjusting for sociodemographic and clinical factors. We used Cox regression to evaluate further stroke and vascular events (stroke and myocardial infarction).
ResultsAmong 228 699 patients who had had a stroke, 1186 (0.5%), 859 (0.4%), 7308 (3.2%) had schizophrenia, bipolar disorder and major depression, respectively. Overall, median follow-up was 2.6 years. Compared with adults without a record of mental illness, 30-day mortality was higher for schizophrenia (adjusted odds ratio (aOR) = 1.33, 95% CI 1.16–1.52), bipolar disorder (aOR = 1.37, 95% CI 1.18–1.60) and major depression (aOR = 1.11, 95% CI 1.05–1.18). Each disorder was also associated with marked increased risk of 1-year and 5-year mortality and further stroke and vascular events. There were no clear differences in receipt of process-of-care quality indicators.
ConclusionsPre-existing SMI was associated with higher risks of mortality and further vascular events. Urgent action is needed to better understand and address the reasons for these disparities.
Chapter 12 - Abolition
- from Part III - Activism
- Edited by Michaël Roy
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- Book:
- Frederick Douglass in Context
- Published online:
- 16 June 2021
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- 08 July 2021, pp 149-161
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Summary
Throughout the antebellum period, the beliefs in force and direct action splintered the abolitionist movement. Black leadership believed moral suasion failed to protect black people and produce liberation. For some time, Douglass’s endorsement of Garrison’s ideology was out of step with black leaders that wanted the ability to defend their humanity. This essay illustrates how Douglass’s thinking evolved regarding the utility of moral suasion and the direction of the movement overall. Through the force of events, Douglass’s stance in the abolitionist movement shifted from nonresistance to political violence. In time, he conceded and then advocated for emancipation by violent means. Douglass’s stance and celebrity shaped the movement. He helped usher the movement from a group of religious outsiders to a political force who welcomed a war of abolition.
17 - Mary Ellen Pleasant, Nineteenth-Century Massachusetts and California (US)
- from Part III - Envisaging Emancipation during Second Slavery
- Edited by Erica L. Ball, Occidental College, Los Angeles, Tatiana Seijas, Rutgers University, New Jersey, Terri L. Snyder, California State University, Fullerton
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- As If She Were Free
- Published online:
- 24 September 2020
- Print publication:
- 08 October 2020, pp 312-330
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Summary
Mary Ellen Pleasant was a free black woman entrepreneur in California and a pioneer of black philanthropy. During her ninety years of life, she worked on the Underground Railroad and helped to usher in California’s Gold Rush. She is perhaps most famous for using her enormous financial resources to assist John Brown in his raid on Harpers Ferry. Her continued efforts of racial equality in the West led her to be known as “The Mother of Human Rights in California.” When Pleasant and two African American women were kicked off a street car in San Francisco, she filed suits. Her case, Pleasant v. North Beach & Mission Railroad Company, went to the California Supreme Court. After two years of litigation, the city outlawed segregation in San Francisco’s public transportation. This paper places her efforts squarely in the center of America’s greatest turning points. Time and time again we see how black women, and in particular, Mary Ellen Pleasant, cannot be separated from the endorsement of American entrepreneurship, abolitionism, and human rights.
Molecular Typing of Invasive Staphylococcus aureus from the Emerging Infections Program (EIP) Using Whole-Genome Sequencing
- Davina Campbell, Gillian McAllister, Kelly Jackson, Isaac See, Alison Halpin, Joseph Lutgring, Erin Epson, Susan Petit, Susan Ray, William Schaffner, Ghinwa Dumyati, Thomas Ewing, Michelle Adamczyk, Amy Gargis
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s71-s72
- Print publication:
- October 2020
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Background: The CDC has performed surveillance for invasive Staphylococcus aureus (iSA) infections through the Emerging Infections Program (EIP) since 2004. SCCmec and spa typing for clonal complex (CC) assignment and genomic markers have been used to characterize isolates. In 2019, whole-genome sequencing (WGS) of isolates began, allowing for high-resolution assessment of genomic diversity. Here, we evaluate the reliability of SCCmec typing, spa typing, and CC assignment using WGS data compared to traditional methods to ensure that backwards compatibility is maintained. Methods:S. aureus isolates were obtained from a convenience sample of iSA cases reported through the EIP surveillance system. Overall, 78 iSA isolates with diverse spa repeat patterns, CCs, SCCmec types, and antimicrobial susceptibility profiles were sequenced (MiSeq, Illumina). Real-time PCR and Sanger sequencing were used as the SCCmec and spa typing reference methods, respectively. spa-MLST mapping (Ridom SpaServer) served as the reference method for CC assignment. WGS assembly and multilocus sequence typing (MLST) were performed using the CDC QuAISAR-H pipeline. WGS-based MLST CCs were assigned using eBURST and SCCmec types using SCCmecFinder. spa types were assigned from WGS assemblies using BioNumerics. For isolate subtyping, previously published and validated canonical single-nucleotide polymorphisms (canSNPs) as well as the presence of the Panton-Valentine leukocidin (PVL) toxin and arginine catabolic mobile element (ACME) virulence factor were assessed for all genome assemblies. Results: All isolates were assigned WGS-based spa types, which were 100% concordant (78 of 78) with Sanger-based spa typing. SCCmecFinder assigned 91% of isolates (71 of 78) SCCmec types, which were 100% concordant with reference method results. Also, 7 isolates had multiple cassettes predicted or an incomplete SCCmec region assembly. Using WGS data, 96% (75 of 78) of isolates were assigned CCs; 3 isolates had unknown sequence types that were single-locus variants of established sequence types. Overall, 70 isolates had CCs assigned by the reference method; 100% (70 of 70) concordance was observed with WGS-based CCs. Analysis of canSNPs placed 42% (33 of 78) of isolates into CC8, with 17 (52%) of these isolates classified as USA300. PVL and ACME were not accurate markers for inferring the USA300 subtype as 24% (4 of 17) of isolates did not contain these markers. Conclusions:S. aureus CCs, SCCmec, and spa types can be reliably determined using WGS. Incorporation of canSNP analysis represents a more efficient method for CC8 assignment than the use of genomic markers alone. WGS allows for the replacement of multiple typing methods for increased laboratory efficiency, while maintaining backward compatibility with historical typing nomenclature.
Funding: None
Disclosures: None
Characteristics Associated With Invasive Staphylococcus aureus Infection Rates in Nursing Homes, Emerging Infections Program
- Runa Gokhale, Kelly Jackson, Kelly Hatfield, Susan Petit, Susan Ray, Joelle Nadle, Christina B. Felsen, William Schaffner, Isaac See, Prabasaj Paul
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s60-s61
- Print publication:
- October 2020
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Background: Most invasive methicillin-resistant Staphylococcus aureus (iMRSA) infections have onset in the community but are associated with healthcare exposures. More than 25% of cases with healthcare exposure occur in nursing homes (NHs) where facility-specific iMRSA rates vary widely. We assessed associations between nursing home characteristics and iMRSA incidence rates to help target prevention efforts in NHs. Methods: We used active, laboratory- and population-based surveillance data collected through the Emerging Infections Program during 2011–2015 from 25 counties in 7 states. NH-onset cases were defined as isolation of MRSA from a normally sterile site in a surveillance area resident who was in a NH within 3 days before the index culture. We calculated MRSA incidence (cases per NH resident day) using Centers for Medicare & Medicaid Services (CMS) skilled nursing facility cost reports and described variation in iMRSA incidence by NH. We used Poisson regression with backward selection, assessing variables for collinearity, to estimate adjusted rate ratios (aRRs) for NH characteristics (obtained from the CMS minimum dataset) associated with iMRSA rates. Results: Of 590 surveillance area NHs included in analysis, 89 (15%) had no NH-onset iMRSA infections. Rates ranged from 0 to 23.4 infections per 100,000 resident days. Increased rate of NH-onset iMRSA infection occurred with increased percentage of residents in short stay ≤30 days (aRR, 1.09), exhibiting wounds or infection (surgical wound [aRR, 1.08]; vascular ulcer/foot infection [aRR, 1.09]; multidrug-resistant organism infection [aRR, 1.13]; receipt of antibiotics [aRR, 1.06]), using medical devices or invasive support (ostomy [aRR, 1.07]; dialysis [aRR, 1.07]; ventilator support [aRR, 1.17]), carrying neurologic diagnoses (cerebral palsy [aRR, 1.14]; brain injury [aRR, 1.1]), and demonstrating debility (requiring considerable assistance with bed mobility [aRR, 1.05]) (Table). iMRSA rates decreased with increased percentage of residents receiving influenza vaccination (aRR, 0.96) and with the presence of any patients in isolation for any active infection (aRR, 0.83). Conclusions: iMRSA incidence varies greatly across nursing homes, with many NH patient and facility characteristics associated with NH-onset iMRSA rate differences. Some associations (short stay, wounds and infection, medical device use and invasive support) suggest that targeted interventions utilizing known strategies to decrease transmission may help to reduce infection rates, while others (neurologic diagnoses, influenza vaccination, presence of patients in isolation) require further exploration to determine their role. These findings can help identify NHs in other areas more likely to have higher rates of NH-onset iMRSA who could benefit from interventions to reduce infection rates.
Funding: None
Disclosures: None
Antimicrobial Nonsusceptibility Among Invasive MRSA USA300 Strains by Healthcare Exposure, Three Sites, 2005–2016
- Kelly Jackson, Runa Gokhale, Davina Campbell, Amy Gargis, Susan Ray, Ruth Lynfield, William Schaffner, Joseph Lutgring, Isaac See
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s120-s121
- Print publication:
- October 2020
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Background: Incidence of community-associated (CA) and healthcare-associated, community-onset (HACO) USA300 methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections has remained unchanged in recent years. Traditionally considered a CA strain, USA300 is increasingly associated with healthcare settings. We examined whether antimicrobial nonsusceptibility among USA300 strains could distinguish epidemiologic class (community vs hospital), and whether divergences in susceptibility were occurring over time. Methods: We used data on invasive MRSA infections from active, population, and laboratory-based surveillance during 2005–2016 from 11 counties in 3 states. Invasive cases were defined as MRSA isolation from a normally sterile site in a surveillance area resident. Cases were considered hospital-onset (HO) if the culture was obtained >3 days after hospitalization and HACO if ≥1 of the following risk factors was present: hospitalization, surgery, dialysis, or residence in a long-term care facility in the past year; or central vascular catheter ≤2 days before culture. Otherwise, cases were considered CA. Sites submitted a convenience sample of clinical MRSA isolates for molecular typing and antimicrobial susceptibility testing. Molecular typing was performed by pulsed-field gel electrophoresis until 2008, when typing was inferred using a validated algorithm based on molecular characteristics. Reference broth microdilution was performed for 8 antimicrobials and interpreted based on CLSI interpretive criteria. We compared USA300 nonsusceptibility for HO and CA isolates. For antimicrobials with >5% nonsusceptibility and for which HO isolates had greater nonsusceptibility than CA isolates, we compared nonsusceptibility for HACO and CA and analyzed annual trends in nonsusceptibility within each epidemiologic class (ie, CA, HACO, and HO) using linear regression. Results: Of 17,947 MRSA cases during 2005–2016, isolates were available for 6,685 (37%), and 2,120 were USA300 (34% CA, 52% HACO, 14% HO). HO isolates had more nonsusceptibility than CA isolates to gentamicin (2.2% vs 0.6%; P = .03), levofloxacin (47.8% vs 39.7%; P = .02), rifampin (3.7 vs 1.1%; P = .01), and trimethoprim-sulfamethoxazole (3.4% vs 0.6%; P = .04). HACO isolates also had more nonsusceptibility than CA isolates to levofloxacin (50.9% vs 39.7%; P < .01). Levofloxacin nonsusceptibility increased during 2005–2016 for HACO and CA isolates (P < .01), but not among HO isolates (P = .36) (Fig. 1). Conclusions: Overall, nonsusceptibility across drugs cannot distinguish USA300 isolates causing HO versus CA disease. Although HO isolates had higher levofloxacin nonsusceptibility than CA and HACO isolates early on, USA300 MRSA HACO isolates now have levofloxacin nonsusceptibility most similar to that of HO isolates. Further study could help to explore whether increases in fluoroquinolone nonsusceptibility among CA and HACO cases may be contributing to the persistence of USA300 strains.
Disclosures: None
Funding: None
Post-operative discharge education for parent caregivers of children with congenital heart disease: a needs assessment
- Candace N. Mannarino, Kelly Michelson, Lindsay Jackson, Erin Paquette, Mary E. McBride
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- Journal:
- Cardiology in the Young / Volume 30 / Issue 12 / December 2020
- Published online by Cambridge University Press:
- 22 September 2020, pp. 1788-1796
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Objective:
Children with congenital heart disease (CHD) have complex unique post-operative care needs. Limited data assess parents’ hospital discharge preparedness and education quality following cardiac surgery. The goals were to identify knowledge gaps in discharge preparedness after congenital heart surgery and to assess the acceptability of an educational mobile application to improve discharge preparedness.
Methods:Telephonic interviews with parents of children with two-ventricle physiology who underwent cardiac surgery 5–7 days post-discharge and in-person interviews with clinicians were conducted. We collected parent and clinician demographics, parent health literacy information and patient clinical data. We analysed interview transcripts using summative content analysis.
Results:We interviewed 26 parents and 6 clinicians. Twenty-two of the 26 (85%) parents felt ready for discharge; 4 of the 6 (67%) clinicians did not feel most parents were ready for discharge. Fifteen of the 26 parents (58%) reported receiving the majority of discharge teaching on the day of discharge. Eight parents did not feel like all of their questions were answered. Most parents (14/26, 54%) preferred visual educational learning aids and could accurately describe important aspects of care. Most parents (23/26, 88%) and all 6 clinicians felt a mobile application for post-operative care education would be helpful.
Conclusions:Most parents received education on the day of discharge and could describe the information they received prior to discharge, although there were some preparedness gaps identified after discharge. Clinicians and parents varied in their perceptions of the readiness for discharge. Most responses suggest that a mobile application for discharge education may be helpful for transition to home.
Test–Retest Reliability of Concussion Baseline Assessments in United States Service Academy Cadets: A Report from the National Collegiate Athletic Association (NCAA)–Department of Defense (DoD) CARE Consortium
- Megan N. Houston, Kathryn L. Van Pelt, Christopher D’Lauro, Rachel M. Brodeur, Darren E. Campbell, Gerald T. McGinty, Jonathan C. Jackson, Tim F. Kelly, Karen Y. Peck, Steven J. Svoboda, Thomas W. McAllister, Michael A. McCrea, Steven P. Broglio, Kenneth L. Cameron
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- Journal:
- Journal of the International Neuropsychological Society / Volume 27 / Issue 1 / January 2021
- Published online by Cambridge University Press:
- 16 June 2020, pp. 23-34
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Objective:
In response to advancing clinical practice guidelines regarding concussion management, service members, like athletes, complete a baseline assessment prior to participating in high-risk activities. While several studies have established test stability in athletes, no investigation to date has examined the stability of baseline assessment scores in military cadets. The objective of this study was to assess the test–retest reliability of a baseline concussion test battery in cadets at U.S. Service Academies.
Methods:All cadets participating in the Concussion Assessment, Research, and Education (CARE) Consortium investigation completed a standard baseline battery that included memory, balance, symptom, and neurocognitive assessments. Annual baseline testing was completed during the first 3 years of the study. A two-way mixed-model analysis of variance (intraclass correlation coefficent (ICC)3,1) and Kappa statistics were used to assess the stability of the metrics at 1-year and 2-year time intervals.
Results:ICC values for the 1-year test interval ranged from 0.28 to 0.67 and from 0.15 to 0.57 for the 2-year interval. Kappa values ranged from 0.16 to 0.21 for the 1-year interval and from 0.29 to 0.31 for the 2-year test interval. Across all measures, the observed effects were small, ranging from 0.01 to 0.44.
Conclusions:This investigation noted less than optimal reliability for the most common concussion baseline assessments. While none of the assessments met or exceeded the accepted clinical threshold, the effect sizes were relatively small suggesting an overlap in performance from year-to-year. As such, baseline assessments beyond the initial evaluation in cadets are not essential but could aid concussion diagnosis.
Incidence of ischaemic heart disease and stroke among people with psychiatric disorders: retrospective cohort study
- Caroline A. Jackson, Joannes Kerssens, Kelly Fleetwood, Daniel J. Smith, Stewart W. Mercer, Sarah H. Wild
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- Journal:
- The British Journal of Psychiatry / Volume 217 / Issue 2 / August 2020
- Published online by Cambridge University Press:
- 22 November 2019, pp. 442-449
- Print publication:
- August 2020
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Background
Psychiatric disorders are associated with increased risk of ischaemic heart disease (IHD) and stroke, but it is not known whether the associations or the role of sociodemographic factors have changed over time.
AimsTo investigate the association between psychiatric disorders and IHD and stroke, by time period and sociodemographic factors.
MethodWe used Scottish population-based records from 1991 to 2015 to create retrospective cohorts with a hospital record for psychiatric disorders of interest (schizophrenia, bipolar disorder or depression) or no record of hospital admission for mental illness. We estimated incidence and relative risks of IHD and stroke in people with versus without psychiatric disorders by calendar year, age, gender and area-based deprivation level.
ResultsIn all cohorts, incidence of IHD (645 393 events) and stroke (276 073 events) decreased over time, but relative risks decreased for depression only. In 2015, at the mean age at event onset, relative risks were 2- to 2.5-fold higher in people with versus without a psychiatric disorder. Age at incidence of outcome differed by cohort, gender and socioeconomic status. Relative but not absolute risks were generally higher in women than men. Increasing deprivation conveys a greater absolute risk of IHD for people with bipolar disorder or depression.
ConclusionsDespite declines in absolute rates of IHD and stroke, relative risks remain high in those with versus without psychiatric disorders. Cardiovascular disease monitoring and prevention approaches may need to be tailored by psychiatric disorder and cardiovascular outcome, and be targeted, for example, by age and deprivation level.
2 - Social Computing Systems and Ethical Considerations
- Edited by Khurshid Ahmad, Trinity College Dublin
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- Book:
- Social Computing and the Law
- Published online:
- 28 September 2018
- Print publication:
- 11 October 2018, pp 14-24
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Individual placement and support for vocational recovery in first-episode psychosis: randomised controlled trial
- Eóin Killackey, Kelly Allott, Henry J. Jackson, Rosanna Scutella, Yi-Ping Tseng, Jeff Borland, Tina-Marie Proffitt, Sally Hunt, Frances Kay-Lambkin, Gina Chinnery, Gennady Baksheev, Mario Alvarez-Jimenez, Patrick D. McGorry, Susan M. Cotton
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- Journal:
- The British Journal of Psychiatry / Volume 214 / Issue 2 / February 2019
- Published online by Cambridge University Press:
- 25 September 2018, pp. 76-82
- Print publication:
- February 2019
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Background
High unemployment is a hallmark of psychotic illness. Individual placement and support (IPS) may be effective at assisting the vocational recoveries of young people with first-episode psychosis (FEP).
AimsTo examine the effectiveness of IPS at assisting young people with FEP to gain employment (Australian and Clinical Trials Registry ACTRN12608000094370).
MethodYoung people with FEP (n = 146) who were interested in vocational recovery were randomised using computer-generated random permuted blocks on a 1:1 ratio to: (a) 6 months of IPS in addition to treatment as usual (TAU) or (b) TAU alone. Assessments were conducted at baseline, 6 months (end of intervention), 12 months and 18 months post-baseline by research assistants who were masked to the treatment allocations.
ResultsAt the end of the intervention the IPS group had a significantly higher rate of having been employed (71.2%) than the TAU group (48.0%), odds ratio 3.40 (95% CI 1.17–9.91, z = 2.25, P = 0.025). However, this difference was not seen at 12- and 18-month follow-up points. There was no difference at any time point on educational outcomes.
ConclusionsThis is the largest trial to our knowledge on the effectiveness of IPS in FEP. The IPS group achieved a very high employment rate during the 6 months of the intervention. However, the advantage of IPS was not maintained in the long term. This seems to be related more to an unusually high rate of employment being achieved in the control group rather than a gross reduction in employment among the IPS group.
Declaration of interestNone.
Challenges to Safe Injection Practices in Ambulatory Care
- Laura Anderson, Benjamin Weissburg, Kelli Rogers, Jackson Musuuza, Nasia Safdar, Daniel Shirley
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 38 / Issue 5 / May 2017
- Published online by Cambridge University Press:
- 27 February 2017, pp. 614-616
- Print publication:
- May 2017
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Most recent infection outbreaks caused by unsafe injection practices in the United States have occurred in ambulatory settings. We utilized direct observation and a survey to assess injection practices at 31 clinics. Improper vial use was observed at 13 clinics (41.9%). Pharmacy support and healthcare worker education may improve injection practices.
Infect Control Hosp Epidemiol 2017;38:614–616
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- Book:
- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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Contributors
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- By Howard Belzberg, Elizabeth R. Benjamin, Charles Best, Mark W. Bowyer, Demetrios Demetriades, Heidi L. Frankel, Rondi Gelbard, Daniel J. Grabo, Peter Hammer, Kenji Inaba, Emilie Joos, Mark Kaplan, Edward Kwon, Lydia Lam, Jackson Lee, Kazuhide Matsushima, Nicholas Nash, Daniel Oh, Eric Pagenkopf, Vincent L. Rowe, Lisa L. Schlitzkus, Jennifer Smith, Matthew D. Tadlock, Peep Talving, Pedro G. Teixeira, Stephen Varga, George Velmahos, Kelly Vogt, Gabriel Zada, Scott Zakaluzny
- Edited by Demetrios Demetriades, Kenji Inaba, George Velmahos
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- Book:
- Atlas of Surgical Techniques in Trauma
- Published online:
- 05 April 2015
- Print publication:
- 05 March 2015, pp ix-x
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- By Magdalena Anitescu, Charles E. Argoff, Arash Asher, Nyla Azam, Nomen Azeem, Sachin K. Bansal, Jose E. Barreto, Rodrigo A Benavides, Niteesh Bharara, Justin B. Boge, Robert B. Bolash, Thomas K. Bond, Christopher Centeno, Zachariah W. Chambers, Jonathan Chang, Grace Chen, Hamilton Chen, Jeffry Chen, Jianguo Cheng, Natalia Covarrubias, Claire J. Creutzfeldt, Gulshan Doulatram, Amirpasha Ehsan, Ike Eriator, Jeff Ericksen, Mark Etscheidt, Frank J. E. Falco, Jack Fu, Timothy Furnish, Annemarie E. Gallagher, Kingsuk Ganguly, Eugene Garvin, Cliff Gevirtz, Scott E. Glaser, Brandon J. Goff, Harry J. Gould, Christine Greco, Jay S. Grider, Maged Guirguis, Qiao Guo, Justin Hata, John Hau, Garett J. Helber, Eric R. Helm, Lori Hill Marshall, Dean Hommer, Jeffrey Hopcian, Eric S. Hsu, Jakun Ing, Tracy P. Jackson, Gaurav Jain, Chrystina Jeter, Alan David Kaye, James Kelly, Soorena Khojasteh, Ankur Khosla, Daniel Krashin, Monika A. Krzyzek, Prasad Lakshminarasimhiah, Steven Michael Lampert, Garrett LaSalle, Quan D. Le, Ankit Maheshwari, Edward R. Mariano, Joaquin Maury, John P. McCallin, John Michels, Natalia Murinova, Narendren Narayanasamy, Rebekah L. Nilson, Elliot Palmer, Vikram B. Patel, Devin Peck, Donald B. Penzien, Danielle Perret Karimi, Tilak Raj, Michael R. Rasmussen, Mohit Rastogi, Rahul Rastogi, Nashaat N. Rizk, Rinoo V. Shah, Paul A. Sloan, Julian Sosner, A. Raj Swain, Minyi Tan, Natacha Telusca, Santhosh A. Thomas, Andrea Trescot, Michael Truong, Jason Tucker, Richard D. Urman, Brandon A. Van Noord, Nihir Waghela, Irene Wu, Jiang Wu, Jijun Xu, Jinghui Xie, William Yancey
- Edited by Alan David Kaye, Louisiana State University, Rinoo V. Shah
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- Case Studies in Pain Management
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- 05 October 2014
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- 16 October 2014, pp xi-xv
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- By Arthur S. Abramson, Norhaida Aman, Virginie Attina, Sapna Bhat, B. Bhuvaneshwari, Denis Burnham, Brian Byrne, Hsin-Chin Chen, Shyamala K. Chengappa, Chris Davis, Jackson T. Gandour, Winston D. Goh, Thom Huebner, Lixian Jin, Jing Zhou, R. Malatesha Joshi, Benjawan Kasisopa, Jeesun Kim, Christine Kitamura, Ananthanarayan Krishnan, Lay Wah Lee, Elena Lieven, Sudaporn Luksaneeyanawin, Ramesh Mishra, Sonali Nag, Vishnu K. K. Nair, Loraine K. Obler, Tomasina Oh, Richard K. Olson, Prakash Padakannaya, Aparna Pandey, Avanthi Niranjan Paplikar, Shalmalee Pitale, Chaitra Rao, Theeraporn Ratitamkul, Nan Xu Rattanasone, Sunil Kumar Ravi, Rogayah A. Razak, Ronan Reilly, Susan Rickard Liow, Khazriyati Salehuddin, Stefan Samuelsson, Vaijayanthi M. Sarma, Yasuhiro Shirai, Shruti Sircar, John Song, Sabine Stoll, Lidia Suárez, Jennie Tran, Jie-Li Tsai, Kimiko Tsukada, Jyotsna Vaid, Heather Winskel, Janet Wright, Kelly Yeo
- Edited by Heather Winskel, Southern Cross University, Australia, Prakash Padakannaya, University of Mysore, India
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- South and Southeast Asian Psycholinguistics
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- 05 December 2013
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- 28 November 2013, pp xvii-xx
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Therapy Contamination as a Measure of Therapist Treatment Adherence in a Trial of Cognitive Behaviour Therapy versus Befriending for Psychosis
- Sarah Bendall, Kelly Allott, Martina Jovev, Marie-Josee Marois, Eoin J. Killackey, John F. Gleeson, Mario Alvarez-Jimenez, Patrick D. McGorry, Henry J. Jackson
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- Journal:
- Behavioural and Cognitive Psychotherapy / Volume 43 / Issue 3 / May 2015
- Published online by Cambridge University Press:
- 29 October 2013, pp. 314-327
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- May 2015
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Background: High quality randomized controlled trials (RCT) of psychotherapeutic interventions should ensure that the therapy being tested is what is actually delivered. However, contamination of one therapy into the other, a critical component of treatment adherence, is seldom measured in psychotherapy trials of psychosis. Aims: The aim of the study was to determine whether a purpose-designed measure, the ACE Treatment Integrity Measure (ATIM) could detect therapy contaminations within a controlled trial of cognitive behavioural therapy (CBT) versus Befriending for first-episode psychosis and to compare the ATIM to a more traditional adherence measure, the Cognitive Therapy Scale (CTS). Method: Therapy sessions were audio-recorded and at least one therapy session from 53 of the 62 participants in the RCT was rated by an independent rater using the CTS and ATIM. Results: Ninety-nine therapy sessions were rated. All Befriending sessions and all but three CBT sessions were correctly identified. The ATIM showed that 29 of the 99 (29%) sessions were contaminated by techniques from the other therapy. Within the CBT sessions, 19 of the 51 sessions (37%) were contaminated by one or more Befriending techniques. Of the Befriending sessions, 10 of 48 (21%) were contaminated by ACE techniques. The mean CTS score was higher in the CBT than the Befriending group. Conclusions: The ATIM was able to detect contaminations and revealed more meaningful, fine-grained analysis of what therapy techniques were being delivered and what contaminations occurred. The study highlights the benefit of employing purpose-designed measures that include contamination when assessing treatment adherence.