We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Because pediatric anxiety disorders precede the onset of many other problems, successful prediction of response to the first-line treatment, cognitive-behavioral therapy (CBT), could have a major impact. This study evaluates whether structural and resting-state functional magnetic resonance imaging can predict post-CBT anxiety symptoms.
Methods
Two datasets were studied: (A) one consisted of n = 54 subjects with an anxiety diagnosis, who received 12 weeks of CBT, and (B) one consisted of n = 15 subjects treated for 8 weeks. Connectome predictive modeling (CPM) was used to predict treatment response, as assessed with the PARS. The main analysis included network edges positively correlated with treatment outcome and age, sex, and baseline anxiety severity as predictors. Results from alternative models and analyses are also presented. Model assessments utilized 1000 bootstraps, resulting in a 95% CI for R2, r, and mean absolute error (MAE).
Results
The main model showed a MAE of approximately 3.5 (95% CI: [3.1–3.8]) points, an R2 of 0.08 [−0.14–0.26], and an r of 0.38 [0.24–0.511]. When testing this model in the left-out sample (B), the results were similar, with an MAE of 3.4 [2.8–4.7], R2−0.65 [−2.29–0.16], and r of 0.4 [0.24–0.54]. The anatomical metrics showed a similar pattern, where models rendered overall low R2.
Conclusions
The analysis showed that models based on earlier promising results failed to predict clinical outcomes. Despite the small sample size, this study does not support the extensive use of CPM to predict outcomes in pediatric anxiety.
Over the last couple of decades, there has been a growing awareness of the value of community-engaged research (CEnR). Simultaneously, many academic institutions have established centralized support for CEnR. For example, dozens of academic medical centers in the United States receive National Institutes of Health (NIH)-funded Clinical and Translational Science Awards (CTSAs) and have embedded community engagement programs (CE) whose primary expertise and mission is to advance CEnR at their institutions.
Methods:
As part of a larger interview study aiming to learn more about how institutional CE programs and HRPPs work together, we analyzed interviews with CE program leaders at academic medical centers that receive funding from the NIH CTSA program to identify barriers and strategies to conducting CEnR at their institutions, primarily focusing on the relationships with Institutional Review Boards (IRBs).
Results:
We identified three categories in the interviews: barriers and strategies vis-à-vis IRBs to address 1) CE/IRB relationships; 2) Understanding issues; and 3) Structural and resource issues.
Conclusions:
CTSA CE program leaders have experience implementing solutions to common barriers to IRB review faced by CEnR researchers. The barriers they face in these three categories and the strategies they use to overcome them can provide helpful insights to others who hope to facilitate CEnR research at their institutions.
Background: External comparisons of antimicrobial use (AU) may be more informative if adjusted for encounter characteristics. Optimal methods to define input variables for encounter-level risk-adjustment models of AU are not established. Methods: This retrospective analysis of electronic health record data included 50 US hospitals in 2020-2021. We used NHSN definitions for all antibacterials days of therapy (DOT), including adult and pediatric encounters with at least 1 day present in inpatient locations. We assessed 4 methods to define input variables: 1) diagnosis-related group (DRG) categories by Yu et al., 2) adjudicated Elixhauser comorbidity categories by Goodman et al., 3) all Clinical Classification Software Refined (CCSR) diagnosis and procedure categories, and 4) adjudicated CCSR categories where codes not appropriate for AU risk-adjustment were excluded by expert consensus, requiring review of 867 codes over 4 months to attain consensus. Data were split randomly, stratified by bed size as follows: 1) training dataset including two-thirds of encounters among two-thirds of hospitals; 2) internal testing set including one-third of encounters within training hospitals, and 3) external testing set including the remaining one-third of hospitals. We used a gradient-boosted machine (GBM) tree-based model and two-staged approach to first identify encounters with zero DOT, then estimate DOT among those with >0.5 probability of receiving antibiotics. Accuracy was assessed using mean absolute error (MAE) in testing datasets. Correlation plots compared model estimates and observed DOT among testing datasets. The top 20 most influential variables were defined using modeled variable importance. Results: Our datasets included 629,445 training, 314,971 internal testing, and 419,109 external testing encounters. Demographic data included 41% male, 59% non-Hispanic White, 25% non-Hispanic Black, 9% Hispanic, and 5% pediatric encounters. DRG was missing in 29% of encounters. MAE was lower in pediatrics as compared to adults, and lowest for models incorporating CCSR inputs (Figure 1). Performance in internal and external testing was similar, though Goodman/Elixhauser variable strategies were less accurate in external testing and underestimated long DOT outliers (Figure 2). Agnostic and adjudicated CCSR model estimates were highly correlated; their influential variables lists were similar (Figure 3). Conclusion: Larger numbers of CCSR diagnosis and procedure inputs improved risk-adjustment model accuracy compared with prior strategies. Variable importance and accuracy were similar for agnostic and adjudicated approaches. However, maintaining adjudications by experts would require significant time and potentially introduce personal bias. If findings are confirmed, the need for expert adjudication of input variables should be reconsidered.
Disclosure: Elizabeth Dodds Ashley: Advisor- HealthTrackRx. David J Weber: Consultant on vaccines: Pfizer; DSMB chair: GSK; Consultant on disinfection: BD, GAMA, PDI, Germitec
This chapter examines the boundary-breaking spatial and social dynamism of animalian entities embodied within LB I–LB II polychrome murals of Crete and Thera. In these innovative paintings, animalian entities engaged with both painted and lived contexts, taking on novel manners of involvement in Aegean sociocultural spaces; some established new aspects of creaturely identity and relation. We begin with three animalian entities considered – boar’s tusk helmets, ox-hide shields and ikria – examining how their presence in murals further challenged long-standing parameters of two-dimensional representation. Here discussion broadens to consider how renderings of various animals in Minoan frescoes charged and unsettled the fabric of powerful built spaces. Innovations in color, scale and the creation of spatial depth approached the ways animalian bodies were experienced in the round. Simultaneously, details of the frescoes kept the painted creatures, and the spaces they occupied, tautly embroiled in the structured order of the wall. We close by considering how polychrome frescoes could foster radical newness in animals’ identities, focusing on renderings of blue simians. This blueness, regardless of whether originally intended to approximate biological hues, engendered distinct status for simians in the Aegean, with fascinating connections to renderings of young peoples.
This chapter examines how movable renderings of animals contributed to sociopolitical experience in Minoan Crete, with close attention to zoomorphic vessels. Beginning in the Prepalatial period, we examine a group of clay body-form vessels that could stand independently. While typically labelled “anthropomorphic,” the vessels’ identities are more complex: their forms do not neatly suggest a particular species, and their affordances as objects are integral to what they are and how they are experienced. Through analysis of their unique corporeal characters and depositional circumstances, I argue that these figures could have been experienced as distinct productive agents, who participated in cultivating community space between Prepalatial tombs and settlements. Next, looking forward, we consider how animalian vessels continued to contribute to Cretan social venues, while subtle changes to how they embodied animals could imply profound shifts in their presence and performance. From the late Protopalatial, we see rhyta rendered as bodiless animal heads, most bovine. Unlike the Prepalatial vessels, these appeared dramatically dependent on living people to become productive, placing emphasis on human action. I contextualize these rhyta with a problematization of palatial-era politico-environmental developments and changes in social performance and “cattle culture.”
Through close analyses of a wide range of Minoan animalian things, we have explored the specificity of their involvements in the experiences of people, and how those engagements contributed to the unique character of sociocultural life in the Aegean, on various levels. Here we draw out key points from across the foregoing analyses. Special attention has come to the objects’ inter-corporeal relationships with living humans and the connections that would have been realized through the objects’ particular qualities—connections with other animals, things, and spaces. Such relations were afforded through different dynamics, including bodily juxtaposition, cultivation of formal assonance, the sharing of specific features (e.g., a forward gaze), and embodiment with the same substances, as well as through similarities in size, composition (e.g., in friezes), and contextualization. Moreover, by working beyond an implicit focus on the design of the objects, to instead emphasize people’s actual experiences with them, we have opened the space for appreciating how both intended and unintended associations involving these complex things were in play together. We should view these not as alternative lenses on the objects, but as forces working concurrently, and upon one another, in the creative realizations that the animalian objects were.
Chapter 4 fundamentally rethinks the identity of “composite” or “hybrid” creatures as they were embodied and experienced in Crete and the southern Cyclades from the late third to mid-second millennium BCE. I argue that, when pondered closely and in their contexts, many of the creatures to which we apply this label in fact would have been experienced not as counterintuitive compounds of body parts stemming from other species, but, instead, as whole beings that were perceived as being similar to a range of other creatures. These lines of similitude could concern matters of form as well as other aspects of the creatures’ natures (e.g., color, efficacies). With this, the traditional category of the “composite” being is set aside as a larger swath of interconnected creatures comes into view. These remarkable creatures share amongst them the quality of having apparent connections both beyond the Aegean, with thingly embodiments of beasts from overseas, and more locally, with other Aegean fabricated and biological animals. An iconic creature of the Aegean Bronze Age, the griffin, provides a jumping off point for different parts of this discussion, as we reconsider the creativity realized in such beasts.
The sociocultural spaces of the “Minoan” Aegean were teeming with animal bodies. Many of these animals were alive, but many were not—and never had been; the latter are our focus here. Realized across a range of media, such as zoomorphic vessels, frescoes, and seal stones, animals’ bodies took on a rich diversity of material and spatial qualities that could afford distinctive interactive experiences that the notion of “representations” fails to capture. By recognizing both biological and fabricated entities as real embodiments of animals, which could coexist and interact in Aegean spaces, the nature of our discussion changes. We see that the dynamics of representation were caught up in a much wider field of relationships involving these crafted bodies, which characterized their engagements with people. Doing so moves us beyond questions of signification and intentional design, and toward a fuller recognition of people’s actual experiences of animalian bodies. Looking closely at a variety of venues, ranging from palatial courts to a modest house bench, our focus thus can turn to how the world of animalian things was a crucial part of social life in Aegean spaces, and how direct interactions with these other animal bodies were central, yet often overlooked and minimized, components of human relations with nonhuman beasts.
entities stand as crystallizations of a distinctly Aegean manner of animalian compositeness that is highly intuitive in its integration. These entities – the boar’s tusk helmet, ox-hide shield and ikrion (ship cabin) – embody this dynamic in an arrant fashion, since, while each is prominently animalian and bodily, they do not themselves take the shapes of animal physiques. Instead, they brought novel, conventional object-forms to animalian presences in the Aegean. By not standing as animals themselves, they starkly draw out the potent relational dynamics that could be realized between creatures, and between creatures and things. Discussion ultimately concerns the added complexity introduced to the statuses of these entities when rendered in movable representational media like glyptic and painted ceramics; particular attention comes to their frequent rendering in series. While seriation is often read as simplifying something’s status to the merely ornamental, I argue, instead, that articulation of shields, helmets and ikria in series imbued them with a peculiar, complex dynamism.
Chapter 3 explores the relationship of material and immaterial embodiments of animals in the Bronze Age Aegean, through the lion. Since populations of living lions were not present on Crete, representational embodiments were the basis of people’s physical encounters with the species; hence the peculiarities of these “object-bodies” powerfully contributed to the characterization of the beast. The vast majority of Cretan lion representations occurred in glyptic. Seals (as worn objects) and impressions (as material signifiers of identity) consistently placed the leonine in direct relation to the human, through bodily and sociocultural juxtapositions. Cretans also would have encountered lions in immaterial manifestations, through oral culture. Early Aegean poetic traditions formulated a paralleling of human and lion through similes that was remarkably similar to the paralleling juxtaposition generated between a lion-seal and person. In MBA III–LBA II, after centuries of development in Crete, the lion’s association with glyptic extended to the early Mycenaean mainland. This moment saw intense intra-Aegean exchange, with material, practical and linguistic dimensions. The epic tradition was taking form, including lion similes. Through its various embodiments, the lion was caught up in this interaction, as its Aegean juxtaposition with humans fluidly continued and developed.
Since the earliest era of archaeological discovery on Crete, vivid renderings of animals have been celebrated as defining elements of Minoan culture. Animals were crafted in a rich range of substances and media in the broad Minoan world, from tiny seal-stones to life-size frescoes. In this study, Emily Anderson fundamentally rethinks the status of these zoomorphic objects. Setting aside their traditional classification as 'representations' or signs, she recognizes them as distinctively real embodiments of animals in the world. These fabricated animals-engaged with in quiet tombs, bustling harbors, and monumental palatial halls-contributed in unique ways to Bronze Age Aegean sociocultural life and affected the status of animals within people's lived experience. Some gave new substance and contour to familiar biological species, while many exotic and fantastical beasts gained physical reality only in these fabricated embodiments. As real presences, the creatures that the Minoans crafted artfully toyed with expectation and realized new dimensions within and between animalian identities.
A review of hospital-onset COVID-19 cases revealed 8 definite, 106 probable, and 46 possible cases. Correlations between hospital-onset cases and both HCW and inpatient cases were noted in 2021. Rises in community measures were associated with rises in hospital-onset cases. Measures of community COVID-19 activity might predict hospital-onset cases.