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It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.
Aims
To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
Method
Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
Results
IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).
Conclusions
Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.
Objectives/Goals: The Clinical and Translational Research (CTR) pathway aims to increase the number of health science professionals participating in CTR in their careers throughout the WWAMI Region (Washington, Wyoming, Alaska, Montana, and Idaho). Methods/Study Population: The first cohort of thirty-one students started in January 2024 and were organized into three groups that met weekly. One in-person group of students in Anchorage, AK; one in-person group in Seattle, WA; and a group of students from across the WWAMI region convened virtually. Students completed a year-long series of elective courses addressing fundamental concepts of designing, conducting, and presenting the results of a research project. Over the summer between year 1 and year 2 of medical school, students dedicated 8 weeks to full-time research activities under the supervision of their research project mentor. In Fall 2024, students prepared and presented research posters at regional poster sessions and abstracts and oral presentations for submission to the Western Medical Research Conference in January 2025. Results/Anticipated Results: The ultimate goal of the CTR pathway is to increase the number of medical providers across the WWAMI region with significant awareness, interest, and experience in research. Many students hesitate to engage in research due to a perceived lack of necessary skills. The CTR pathway addresses this gap by equipping students with the research competencies needed to participate confidently in scientific inquiry. Feedback from the inaugural cohort has been overwhelmingly positive, with many students highlighting how the CTR pathway enhanced their confidence and knowledge, empowering them to execute their proposed research projects successfully. Our second cohort of students joined the CTR pathway in January 2025. Discussion/Significance of Impact: The CTR pathway positions early medical students to engage in research more deeply during their medical training and prepares them to seek additional training opportunities toward a career in research. The majority of students in the first cohort were located at regional sites and many have interest in practicing in rural or underserved areas.
During the nineteenth century in Ireland, agents of the colonial state like the police, along with the administrators that they served, forged an association between political motivations and Irish agrarian violence. They did so not only through the policing of Irish violence, but through the methods used by the colonial state to categorize, process, record, and archive it. Central to this endeavor was the category of “outrage.” Using this category, the Irish Constabulary created a record that impressed an association between Irish violence or criminality and political resistance. Because the British colonial state had control over the production of the archive, it also dictated the metanarratives present in this “archive of outrages” that gave form and function to the colonial state's fears that Irish violence represented a budding insurrection or a desire to fracture the Union. By perpetuating this logic in document and archival form, Dublin Castle (the seat of the British government's administration of Ireland) helped create the very demon that it sought to exorcise—that of Irish nationalist action and sentiment.
OBJECTIVES/GOALS: The CTSA consortium’s Informatics Enterprise Committee has developed a maturity assessment model for Clinical Trial Management Ecosystems (CTME). This poster will show the improvements achieved using this model at the University of Iowa as well as guidance on how to apply it at other CTSA hubs. METHODS/STUDY POPULATION: The CTME maturity model consists of 11 categories including, study management; regulatory; financial; and reporting. Each category has 3 subcategories: standardization; complexity; and monitoring, while each subcategory is comprised of 1 to 5 maturity statements: initial; developing; aspiring; capable; and efficient. The maturity assessment team at Iowa—comprised of key personnel from clinical research and compliance, accounting, and administration—have used the CTME maturity model to assess Iowa’s research performance across the 11 categories. The initial maturity ratings for each category revealed any gaps in research operations, which led to developing strategies to address the gaps. RESULTS/ANTICIPATED RESULTS: The assessment team initiated a CTME maturity planning project—holding regular meetings to review Iowa’s CTME research maturity and plan changes to improve our CTME maturity ratings. This analysis is done at the statement level to minimize the scope of actions needed and keep resource loads for improvements low. Proposed improvements are assigned to a team member who serves as an “accountability leader.” Such leaders develop action plans aimed at increasing maturity at least one level. The leaders are responsible for acquiring the resources to carry out the plan. Each action plan identifies qualifiers reviewed by the team to confirm that the maturity level has been met. DISCUSSION/SIGNIFICANCE: The CTME maturity model has been shown to be effective in identifying gaps in organizational operations at the University of Iowa, where it has led to incremental steps to improve clinical research operations. The utilization of the model at other CTSA hubs will be discussed at this session.
The aim of this study was to identify key policy objectives by investigating the perception of important stakeholders and affected professionals concerning relevance and feasibility of a successful primary care (PC) reform.
Background:
Since 2013, the Austrian PC system has been undergoing a reform process to establish multiprofessional primary care units. The reforms have various defined objectives and lack clear priorities.
Methods:
After the definition and consensus-based selection of 12 policy objectives, a cross-sectional online survey on their relevance and feasibility was distributed via email and social media to PC and public health networks. The survey was conducted in the period from January to February 2020. Results were analyzed descriptively, and further, Pearson Chi-Square Test or Fisher’s Exact Test was performed for group comparison regarding respondents’ characteristics. Open-ended responses were analyzed using qualitative content analysis.
Findings:
In total, 169 questionnaires were completed. A total of 46.3% of the responders had more than 20 years of professional experience (female: 60.5%). A mandatory internship in general practice, vocational training for general practice, and a modern remuneration system were the three top-rated policy objectives regarding relevance. A mandatory internship in general practice, specialization in general practice, and coding of services and diagnosis were assessed as the most feasible objectives. The group comparisons regarding working field, years of professional experience, age, and sex did not show any meaningful results in the evaluation of relevance and feasibility.
Discussion:
In the view of the study participants, easily obtainable objectives include adapting the duration and setting of internships for medical students, as well as mandatory vocational training for GP trainees. Further efforts are necessary to achieve complex objectives such as the adoption of a modern remuneration scheme and a comprehensive quality assurance program. Building capacity and creating team-oriented environments are also important aspects of a successful PC reform.
The clinical research units (CRUs) are one of the main spaces where both translational research and science take place. However, there is a lack of information about both best practices for CRU operations and, ultimately, benchmarks to evaluate CRU performance. The Research Unit Network (RUN) was created with the purpose to enable direct communication and collaboration among CRUs. An online survey was administered to further illustrate the functionality and impact of RUN. Thirty-one individual survey responses (39.2%) were included in the final analysis. The members value RUN monthly meetings (87.1%) as the most useful aspect of this network and CRU budgeting (67.7%) and staffing (61.3%) were the most relevant topics discussed. This is followed by EPIC – Research (58.1%), delegation of authority logs, unit signatures, and policies (51.6%), COVID-19 pandemic response (41.9%), the implementation of clinical trial management system (29.0%), and protocol deviations (19.4%). The intermediate goal of RUN is to identify best practices CRUs are establishing, implementing, and sharing these experiences with the goal to adopt them in different CRUs. The network’s long-term goal is to establish standard benchmarks that can be used for evaluating the performance of CRUs across the nation.
Freedom from thirst has been long considered of paramount importance for animal welfare, however a feasible and sensitive animal-based indicator to assess thirst, on-farm or at-slaughter, is not available. In this study, voluntary water consumption over time was investigated and validated as a non-invasive behavioural parameter for assessing thirst in broiler chickens. Thirty-two groups of four broilers were used in this study and the effect of three factors on water consumption from a test drinker was investigated: duration of water deprivation (0, 6, 12, or 24 h); familiarity with the test drinker, and age (35 or 37 days). Water consumption was measured after 30, 60, 90 and 120 min following the deprivation period. Water consumption increased with the length of the deprivation period and was greater in birds that had been habituated to the test drinker. The effect of familiarity was smaller for 24-h deprived groups compared to 6- and 12-h deprived groups. When birds were habituated to the drinker, they started to drink sooner than when the drinker was new. These findings illustrate the potential of simple, animal-based measures, such as water consumption over time to assess thirst in chickens and this behavioural test may form the basis of an on-farm test that could be included in integrated animal welfare assessment schemes.
Increasing lameness problems associated with intensified dairy cattle production has lead to the development of several techniques to automatically detect these problems. Comparisons of these new measuring techniques of cow locomotion with the conventional subjective observer scoring are scarce. In order to better understand human observers’ gait scoring, cows walking on a pressure-sensitive mat were evaluated for kinematic gait variables and a visual assessment of gait was also made via video recording. Forty of these videos were used for subjective gait scoring on a 3-point scale, and the observers were also asked to report any observed abnormalities (lameness indicators) that had influenced their scoring. Relationships between reported lameness indicators and subjective gait scores, between subjective gait scores and measured kinematic variables of cow locomotion and between reported lameness indicators and measured kinematic variables of cow locomotion were investigated. In general, observers based their gait score on reported indicators such as ‘tenderness’, ‘arched back’, ‘irregular gait’ and ‘increased abduction’. All of these four reported lameness indicators were correlated with measured kinematic ‘variables of asymmetry’, ‘stance time’ or both, suggesting that human observers are capable of detecting changes within these lameness indicators as measured by the pressure-sensitive mat. ‘Increased abduction’ appeared harder to detect and was reported more frequently by observers already experienced with gait scoring. Also, the measured kinematic variables of ‘stance time’ and ‘measures of asymmetry between left and right limbs’ as measured by the pressure-sensitive mat, show potential in predicting the gait score given. These reported lameness indicators and measured kinematic variables —mutually correlated and both related to the gait scores — were considered promising for subjective gait scoring in general.
Many animal welfare traits vary on a continuous scale but are commonly scored using an ordinal scale with few categories. The rationale behind this practice is rarely stated but appears largely based on the debatable conviction that it increases data reliability. Using 54 observers of varying levels of expertise, inter-observer reliability (IOR) and user-satisfaction were compared between a 3-point ordinal scale (OS) and a continuous modified visual analogue scale with multiple anchors (VAS) for scoring lameness in dairy cattle from video. IOR was significantly better for the VAS than for the OS. IOR increased with self-reported level of expertise for the VAS, whereas for the OS it was highest for observers with a moderate level of expertise. The mean continuous scores and the mean categorical scores were highly correlated. Three times as many observers stated a preference for the VAS (n = 27) compared to the OS (n = 9) in investigating differences in lameness between herds. Contrary to common perception, these results illustrate that it is possible for a continuous cattle lameness score to be more reliable and to have greater user acceptability than a simple categorical scale. As continuous scales are also potentially more sensitive, and produce data more amenable to algebraic processing and more powerful parametric analyses, the scepticism against their application for assessing animal welfare traits should be reconsidered.
OBJECTIVES/GOALS: CTRUs support clinical research. RUN is a Learning Research System that is created to enhance CTSA and non-CTSA research units capacity through implementing, assessing, and disseminating discoveries in methods, approaches, education, and training in clinical and translational science. METHODS/STUDY POPULATION: The RUN association began in July 2018 with eight universities. The association has grown to 44 hospitals, research, and academic institutions (including 36 CTSA institutions). A RUN Discussion Forum has been approved by the National Center for Advancing Science (NCATS) and utilized by RUN. The Discussion Forums are created with the goal of advancing CTSA Program objectives in high priority areas of clinical and translational science. RUN actively engages members through in depth scheduled monthly meeting discussions with various relevant topics regarding the development and evaluation of clinical trials metrics, benchmarks, and scholarly publication and presentation activities. RESULTS/ANTICIPATED RESULTS: Topics covered in RUN monthly meetings include research units general budget guidelines, staff recruitment and retainment strategies, EPIC use in scheduling CRU research visits, and PPE for investigational drugs in context of USP800 requirements. RUN members vary in geographic location, type of clinical research (outpatient vs inpatient), resources, and research subject volume. They are engaged in online discussion and learning opportunities to improve translational science practices. A recent article titled “Impact of COVID-19 on Clinical Research Units (CRUs)” in JCTS is an example of best practices learned by RUN members and shared with the broader research community. DISCUSSION/SIGNIFICANCE: RUN as a Learning Research System enhances clinical and translational research unit capacity and efficiency, encouraging collaboration to contribute with improving public health. This network is aligned with the CTSAs mission of developing innovative solutions to improve translational science.
The corona virus disease-2019 (COVID-19) pandemic began in Wuhan, China, and quickly spread around the world. The pandemic overlapped with two consecutive influenza seasons (2019/2020 and 2020/2021). This provided the opportunity to study community circulation of influenza viruses and severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) in outpatients with acute respiratory infections during these two seasons within the Bavarian Influenza Sentinel (BIS) in Bavaria, Germany. From September to March, oropharyngeal swabs collected at BIS were analysed for influenza viruses and SARS-CoV-2 by real-time polymerase chain reaction. In BIS 2019/2020, 1376 swabs were tested for influenza viruses. The average positive rate was 37.6%, with a maximum of over 60% (in January). The predominant influenza viruses were Influenza A(H1N1)pdm09 (n = 202), Influenza A(H3N2) (n = 144) and Influenza B Victoria lineage (n = 129). In all, 610 of these BIS swabs contained sufficient material to retrospectively test for SARS-CoV-2. SARS-CoV-2 RNA was not detectable in any of these swabs. In BIS 2020/2021, 470 swabs were tested for influenza viruses and 457 for SARS-CoV-2. Only three swabs (0.6%) were positive for Influenza, while SARS-CoV-2 was found in 30 swabs (6.6%). We showed that no circulation of SARS-CoV-2 was detectable in BIS during the 2019/2020 influenza season, while virtually no influenza viruses were found in BIS 2020/2021 during the COVID-19 pandemic.
Few studies have explored the challenges that the COVID-19 pandemic has presented for Clinical Research Units (CRUs), the solutions that have been implemented, and the changes that have been made in the operational guidelines for these entities. This study sought to identify and document common practices implemented by CRUs around the United States of America (USA) when addressing the unique challenges posed by the COVID-19 pandemic. This descriptive study utilized a non-experimental mixed-methods approach and gathered data from representatives of 43 CRUs across the USA. An online survey was followed by in-depth interviews. The findings show that challenges faced from the COVID-19 pandemic, changes made to daily operations, and lessons learned are very similar across CRUs. Although most CRUs never stopped performing essential clinical research, many adapted to the pandemic by engaging in virtual visits, and many played key roles in administering and supporting both COVID-19 therapeutic and vaccine trials. Follow-up interviews showed that processes for formal approval and reopening were similar across CRUs. In addition to highlighting the significance of the role played by CRUs during the COVID-19 pandemic, this study addresses the relevance of CRUs and lays the groundwork for future conversations on the importance of these units.
We investigate theoretically, on the basis of the steady Stokes equations for a viscous incompressible fluid, the flow induced by a stokeslet located on the centre axis of two coaxially positioned rigid disks. The stokeslet is directed along the centre axis. No-slip boundary conditions are assumed to hold at the surfaces of the disks. We perform the calculation of the associated Green's function in large parts analytically, reducing the spatial evaluation of the flow field to one-dimensional integrations amenable to numerical treatment. To this end, we formulate the solution of the hydrodynamic problem for the viscous flow surrounding the two disks as a mixed boundary-value problem, which we then reduce to a system of four dual integral equations. We show the existence of viscous toroidal eddies arising in the fluid domain bounded by the two disks, manifested in the plane containing the centre axis through adjacent counter-rotating eddies. Additionally, we probe the effect of the confining disks on the slow dynamics of a point-like particle by evaluating the hydrodynamic mobility function associated with axial motion. Thereupon, we assess the appropriateness of the commonly employed superposition approximation and discuss its validity and applicability as a function of the geometrical properties of the system. Additionally, we complement our semi-analytical approach by finite-element computer simulations, which reveals a good agreement. Our results may find applications in guiding the design of microparticle-based sensing devices and electrokinetic transport in small-scale capacitors.
The notion that comparison is not the search for similarities but the systematization of differences leads to the question of which shared set of concepts and assumptions might be employed to explore this notion. Comparative analysis should at once reduce the complexity of data in the service of comparison and yet still reference the uniqueness and specificity of local values and ideas. Three types of comparison potentially fulfill these criteria. Claude Lévi-Strauss traces the transformations of oppositions and codes across cultural boundaries without claiming to compare societies as such. Louis Dumont contrasts systems of values that represent societies-as-wholes by analyzing their structuring into hierarchical levels. Niklas Luhmann’s theory of autopoietic systems enables the comparison of relationships between social systems and their environments, without assuming societies as units of comparison – examples being the making of ethnic identities and boundaries. A synthesis of the three approaches provides avenues of comparison in a globalized world, as is exemplified by the author’s own work in upland Southeast Asia.
To identify alterations in neural networks for visual motion perception and pursuit tracking and their interrelationship in schizophrenia, and secondarily to evaluate their comparability to findings in psychotic bipolar disorder.
Methods
Untreated first-episode patients with schizophrenia (N=24) and psychotic bipolar disorder (N=13), and 20 matched healthy participants performed a passive visual motion processing task and a pursuit eye tracking task, which patients have been shown to perform as well as healthy subjects, during functional neuroimaging. Available subjects were retested after four weeks, during which both patient groups received second generation antipsychotics.
Results
During the motion processing task, neither patient group showed reduced activation in V5, but activations in its projection fields in posterior parietal cortex were reduced in both groups. Pursuit related neural activation in both patients groups was not reduced in sensorimotor systems, but was enhanced in anterior intraparietal sulcus and insula. In schizophrenia, activation was also enhanced in dorsolateral prefrontal cortex and dorsomedial thalamus. Greater V5 activation during passive motion processing predicted greater activation in posterior parietal cortex during pursuit in healthy individuals but not in patients. The only significant change at follow-up was decreased anterior cingulate activation during pursuit in schizophrenia.
Conclusions
Reduced transfer of visual motion information to parietal association cortex may compromise information about target speed and tracking error needed for sensorimotor transformations during pursuit tracking in psychotic disorders. Enhanced activation of a prefrontal-thalamo-parietal network during pursuit tracking in schizophrenia may represent compensation for this deficit.
Why are conditional degrees of belief in an observation E, given a statistical hypothesis H, aligned with the objective probabilities expressed by H? After showing that standard replies (ratio analysis of conditional probability, chance-credence coordination) are not satisfactory, I develop a suppositional analysis of conditional degree of belief, transferring Ramsey’s classical proposal to statistical inference. The analysis saves the alignment, explains the role of chance-credence coordination, and rebuts the charge of arbitrary assessment of evidence in Bayesian inference. Finally, I explore the implications of this analysis for Bayesian reasoning with idealized models in science.