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We present a 1000 km transect of phase-sensitive radar measurements of ice thickness, basal reflection strength, basal melting and ice-column deformation across the Ross Ice Shelf (RIS). Measurements were gathered at varying intervals in austral summer between 2015 and 2020, connecting the grounding line with the distant ice shelf front. We identified changing basal reflection strengths revealing a variety of basal conditions influenced by ice flow and by ice–ocean interaction at the ice base. Reflection strength is lower across the central RIS, while strong reflections in the near-front and near-grounding line regions correspond with higher basal melt rates, up to 0.47 ± 0.02 m a−1 in the north. Melting from atmospherically warmed surface water extends 150–170 km south of the RIS front. Melt rates up to 0.29 ± 0.03 m a−1 and 0.15 ± 0.03 m a−1 are observed near the grounding lines of the Whillans and Kamb Ice Stream, respectively. Although troublesome to compare directly, our surface-based observations generally agree with the basal melt pattern provided by satellite-based methods but provide a distinctly smoother pattern. Our work delivers a precise measurement of basal melt rates across the RIS, a rare insight that also provides an early 21st-century baseline.
We recently reported on the radio-frequency attenuation length of cold polar ice at Summit Station, Greenland, based on bi-static radar measurements of radio-frequency bedrock echo strengths taken during the summer of 2021. Those data also allow studies of (a) the relative contributions of coherent (such as discrete internal conducting layers with sub-centimeter transverse scale) vs incoherent (e.g. bulk volumetric) scattering, (b) the magnitude of internal layer reflection coefficients, (c) limits on signal propagation velocity asymmetries (‘birefringence’) and (d) limits on signal dispersion in-ice over a bandwidth of ~100 MHz. We find that (1) attenuation lengths approach 1 km in our band, (2) after averaging 10 000 echo triggers, reflected signals observable over the thermal floor (to depths of ~1500 m) are consistent with being entirely coherent, (3) internal layer reflectivities are ≈–60$\to$–70 dB, (4) birefringent effects for vertically propagating signals are smaller by an order of magnitude relative to South Pole and (5) within our experimental limits, glacial ice is non-dispersive over the frequency band relevant for neutrino detection experiments.
Anxiety disorders are the most frequently diagnosed psychiatric conditions in children and adolescents. Cognitive behavioural therapy (CBT) is a well-established and effective treatment for anxiety and related disorders across the lifespan. Expectations of psychotherapy have been demonstrated to affect outcomes, yet there is sparse existing literature on adolescent patient and parent perspectives of CBT prior to engagement with treatment.
Aims:
This study aimed to qualitatively explore the expectations and perceptions of CBT for anxiety and related disorders among adolescent patients and parents.
Method:
Fourteen adolescent patients and 16 parents participated in semi-structured individual interviews or focus groups consisting of 2–3 participants. Interview transcripts were analysed using inductive analysis.
Results:
Three themes were identified: worries about CBT, expectations and knowledge of the CBT process, and the role of parents and families. Overall, we found that adolescents and parents had generally positive views of CBT. The outset of CBT saw adolescents and parents express concern about stigma as well as the ambiguity of CBT. Parents continued to express a lack of understanding of what CBT entailed during their child’s treatment course.
Conclusion:
These results suggest that both adolescents and parents would benefit from early discussion and reinforcement of expectations for CBT treatment. Further research efforts are warranted and should be directed towards determining appropriate expectations for parental involvement in a child’s CBT course and effective communication of treatment expectations to both adolescents and parents.
Recent global events demonstrate that analytical frameworks to aid professionals in healthcare ethics must consider the pervasive role of social structures in the emergence of bioethical issues. To address this, the authors propose a new sociologically informed approach to healthcare ethics that they term “social bioethics.” Their approach is animated by the interpretive social sciences to highlight how social structures operate vis-à-vis the everyday practices and moral reasoning of individuals, a phenomenon known as social discourse. As an exemplar, the authors use social bioethics to reframe common ethical issues in psychiatric services and discuss potential implications. Lastly, the authors discuss how social bioethics illuminates the ways healthcare ethics consultants in both policy and clinical decision-making participate in and shape broader social, political, and economic systems, which then cyclically informs the design and delivery of healthcare.
This study examined associations between multiple dietary supplement (DS) categories and medical conditions diagnosed by health professionals.
Design:
Cross-sectional.
Setting:
Volunteers completed an online questionnaire on DS use and demographic/lifestyle factors. Medical diagnoses were obtained from a comprehensive military electronic medical surveillance system and grouped into twenty-four clinically diagnosed medical conditions (CDMC).
Participants:
A stratified random sample of US service members (SM) from all military services (n 26 680).
Results:
After adjustment for demographic/lifestyle factors (logistic regression), higher risk was found for 92 % (22/24) of CDMC among individual vitamins/minerals users, 58 % (14/24) of CDMC among herbal users, 50 % (12/24) of CDMC among any DS users and 46 % (11/24) of CDMC among multivitamins/multiminerals (MVM) users. Among protein/amino acid (AA) users, risk was lower in 25 % (6/24) of CDMC. For combination products, risk was higher in 13 % (3/24) of CDMC and lower in 8 % (2/24). The greater the number of CDMC, the higher the prevalence of DS use in most DS categories except proteins/AA where prevalence decreased.
Conclusions:
Users in many DS categories had a greater number of CDMC, but protein/AA users had fewer CDMC; results for combination products were mixed. These data indicate those with certain CDMC were also users in some DS categories, especially individual vitamins/minerals, herbals and MVM. Data are consistent with the perception that use of DS enhances health, especially in those with CDMC. Protein/AA and combination product users were more likely to be younger, more physically active men, factors that likely reduced CDMC.
Although exposure therapy (ET) is an effective treatment for anxiety disorders and obsessive-compulsive disorder, many clinicians report not utilizing it. The present study targeted common utilization barriers by evaluating an intensive ET training experience in a relatively inexperienced sample of pre-professionals. Thirty-two individuals at the undergraduate or college graduate level without formal clinical experience participated as camp counsellors in a 5day exposure-based therapeutic summer camp for youth with anxiety disorders and/or obsessive-compulsive disorder. Participants were trained in ET through a progressive cascading model and answered questionnaires before and after camp. Repeated measure MANOVA revealed significantly increased feelings of self-efficacy conducting exposures, and significantly decreased feelings of disgust sensitivity and contamination-related disgust from pre-camp to post-camp. A subset of individuals providing data 1 month after the camp maintained a significant gain in ET self-efficacy. Regression analyses revealed that contamination-related disgust, but not disgust sensitivity, significantly predicted post-camp ET self-efficacy. These findings suggest that individuals early into their post-secondary education can learn ET, and the progressive cascading model holds promise in its utility across experience levels and warrants further investigation. Disgust may also play a role in feelings of competency conducting ET. Implications on dissemination and implementation efforts are also discussed.
Key learning aims
(1) How can training of CBT techniques such as exposure occur prior to graduate education?
(2) Can self-efficacy in conducting exposures meaningfully increase in an experiential training of pre-professionals?
(3) How does an individual’s tolerance of disgust impact feelings of competence conducting exposures?
ABSTRACT IMPACT: Despite its importance in systemic diseases such as diabetes, the eye is notably difficult to examine for non-specialists; this study introduces a fully automated approach for eye disease screening, coupling a deep learning algorithm with a robotically-aligned optical coherence tomography system to improve eye care in non-ophthalmology settings. OBJECTIVES/GOALS: This study aims to develop and test a deep learning (DL) method to classify images acquired from a robotically-aligned optical coherence tomography (OCT) system as normal vs. abnormal. The long-term goal of our study is to integrate artificial intelligence and robotic eye imaging to fully automate eye disease screening in diverse clinical settings. METHODS/STUDY POPULATION: Between August and October 2020, patients seen at the Duke Eye Center and healthy volunteers (age ≥18) were imaged with a custom, robotically-aligned OCT (RAOCT) system following routine eye exam. Using transfer learning, we adapted a preexisting convolutional neural network to train a DL algorithm to classify OCT images as normal vs. abnormal. The model was trained and validated on two publicly available OCT datasets and two of our own RAOCT volumes. For external testing, the top-performing model based on validation was applied to a representative averaged B-scan from each of the remaining RAOCT volumes. The model’s performance was evaluated against a reference standard of clinical diagnoses by retina specialists. Saliency maps were created to visualize the areas contributing most to the model predictions. RESULTS/ANTICIPATED RESULTS: The training and validation datasets included 87,697 OCT images, of which 59,743 were abnormal. The top-performing DL model had a training accuracy of 96% and a validation accuracy of 99%. For external testing, 43 eyes of 27 subjects were imaged with the robotically-aligned OCT system. Compared to clinical diagnoses, the model correctly labeled 18 out of 22 normal averaged B-scans and 18 out of 21 abnormal averaged B-scans. Overall, in the testing set, the model had an AUC for the detection of pathology of 0.92, an accuracy of 84%, a sensitivity of 86%, and a specificity of 82%. For the correctly predicted scans, saliency maps identified the areas contributing most to the DL algorithm’s predictions, which matched the regions of greatest clinical importance. DISCUSSION/SIGNIFICANCE OF FINDINGS: This is the first study to develop and apply a DL model to images acquired from a self-aligning OCT system, demonstrating the potential of integrating DL and robotic eye imaging to automate eye disease screening. We are working to translate this technology for use in emergency departments and primary care, where it will have the greatest impact.
This two-part article examines the global public health (GPH) information system deficits emerging in the coronavirus disease 2019 (COVID-19) pandemic. It surveys past, missed opportunities for public health (PH) information system and operational improvements, examines current megatrend changes to information management, and describes a new multi-disciplinary model for population-based management (PBM) supported by a GPH Database applicable to pandemics and GPH crises.
This study examined the relationship between patient performance on multiple memory measures and regional brain volumes using an FDA-cleared quantitative volumetric analysis program – Neuroreader™.
Method:
Ninety-two patients diagnosed with mild cognitive impairment (MCI) by a clinical neuropsychologist completed cognitive evaluations and underwent MR Neuroreader™ within 1 year of testing. Select brain regions were correlated with three widely used memory tests. Regression analyses were conducted to determine if using more than one memory measures would better predict hippocampal z-scores and to explore the added value of recognition memory to prediction models.
Results:
Memory performances were most strongly correlated with hippocampal volumes than other brain regions. After controlling for encoding/Immediate Recall standard scores, statistically significant correlations emerged between Delayed Recall and hippocampal volumes (rs ranging from .348 to .490). Regression analysis revealed that evaluating memory performance across multiple memory measures is a better predictor of hippocampal volume than individual memory performances. Recognition memory did not add further predictive utility to regression analyses.
Conclusions:
This study provides support for use of MR Neuroreader™ hippocampal volumes as a clinically informative biomarker associated with memory performance, which is a critical diagnostic feature of MCI phenotype.
Water exposures in healthcare settings and during healthcare delivery can place patients at risk for infection with water-related organisms and can potentially lead to outbreaks. We aimed to describe Centers for Disease Control and Prevention (CDC) consultations involving water-related organisms leading to healthcare-associated infections (HAIs).
Design:
Retrospective observational study.
Methods:
We reviewed internal CDC records from January 1, 2014, through December 31, 2017, using water-related terms and organisms, excluding Legionella, to identify consultations that involved potential or confirmed transmission of water-related organisms in healthcare. We determined plausible exposure pathways and routes of transmission when possible.
Results:
Of 620 consultations during the study period, we identified 134 consultations (21.6%), with 1,380 patients, that involved the investigation of potential water-related HAIs or infection control lapses with the potential for water-related HAIs. Nontuberculous mycobacteria were involved in the greatest number of investigations (n = 40, 29.9%). Most frequently, investigations involved medical products (n = 48, 35.8%), and most of these products were medical devices (n = 40, 83.3%). We identified a variety of plausible water-exposure pathways, including medication preparation near water splash zones and water contamination at the manufacturing sites of medications and medical devices.
Conclusions:
Water-related investigations represent a substantial proportion of CDC HAI consultations and likely represent only a fraction of all water-related HAI investigations and outbreaks occurring in US healthcare facilities. Water-related HAI investigations should consider all potential pathways of water exposure. Finally, healthcare facilities should develop and implement water management programs to limit the growth and spread of water-related organisms.
Hyperbolic polariton modes are highly appealing for a broad range of applications in nanophotonics, including surfaced enhanced sensing, sub-diffractional imaging, and reconfigurable metasurfaces. Here we show that attenuated total reflectance (ATR) micro-spectroscopy using standard spectroscopic tools can launch hyperbolic polaritons in a Kretschmann–Raether configuration. We measure multiple hyperbolic and dielectric modes within the naturally hyperbolic material hexagonal boron nitride as a function of different isotopic enrichments and flake thickness. This overcomes the technical challenges of measurement approaches based on nanostructuring, or scattering scanning near-field optical microscopy. Ultimately, our ATR approach allows us to compare the optical properties of small-scale materials prepared by different techniques systematically.
Traditional ambulatory rhythm monitoring in children can have limitations, including cumbersome leads and limited monitoring duration. The ZioTM patch ambulatory monitor is a small, adhesive, single-channel rhythm monitor that can be worn up to 2 weeks. In this study, we present a retrospective cross-sectional analysis of the ZioTM monitor’s impact in clinical practice. Patients aged 0–18 years were included in the study. A total of 373 studies were reviewed in 332 patients. In all, 28.4% had structural heart disease, and 16.9% had a prior surgical, catheterisation, or electrophysiology procedure. The most common indication for monitoring was tachypalpitations (41%); 93.5% of these patients had their symptoms captured during the study window. The median duration of monitoring was 5 days. Overall, 5.1% of ZioTM monitoring identified arrhythmias requiring new intervention or increased medical management; 4.0% identified arrhythmias requiring increased clinical surveillance. The remainder had either normal-variant rhythm or minor rhythm findings requiring no change in management. For patients with tachypalpitations and no structural heart disease, 13.2% had pathological arrhythmias, but 72.9% had normal-variant rhythm during symptoms, allowing discharge from cardiology care. Notably, for patients with findings requiring intervention or increased surveillance, 56% had findings first identified beyond 24 hours, and only 62% were patient-triggered findings. Seven studies (1.9%) were associated with complications or patient intolerance. The ZioTM is a well-tolerated device that may improve what traditional Holter and event monitoring would detect in paediatric cardiology patients. This study shows a positive clinical impact on the management of patients within a paediatric cardiology practice.
Molecular assays are often implemented by weed scientists for detection ofherbicide-resistant individuals; however, the utility of these assays can belimited if multiple mechanisms of evolved resistance exist. Waterhempresistant to protoporphyrinogen oxidase (PPO)– inhibiting herbicides isconferred by a target-site mutation in PPX2L (a gene codingfor PPO), resulting in the loss of a glycine at position 210 (ΔG210). ThisΔG210 mutation of PPX2L is the only known mechanismresponsible for PPO-inhibitor resistance (PPO-R) in waterhemp from fivestates (Illinois, Indiana, Iowa, Kansas, and Missouri); however, a limitednumber of populations have been tested, especially in Illinois. To verifythe ubiquity of the ΔG210 in PPO-R waterhemp populations in Illinois, apreviously published allele-specific PCR (asPCR) was used for the detectionof the ΔG210 mutation to associate this mutation with phenotypic resistancein 94 Illinois waterhemp populations. The ΔG210 mutation was detected in allpopulations displaying phenotypic resistance to lactofen (220 g ai ha−1), indicating the deletion is likely the only mechanism ofresistance. With evidence that the ΔG210 mutation dominates PPO-R waterhempbiotypes, molecular detection techniques have considerable utility.Unfortunately, the previously published asPCR is time consuming, verysensitive to PCR conditions, and requires additional steps to eliminate thepossibility of false negatives. To overcome these limitations, a streamlinedmolecular method using the TaqMan® technique was developed, utilizingallele-specific, fluorescent probes for high-throughput, robustdiscrimination of each allele (resistant and susceptible) at the 210th aminoacid position of PPX2L.
A new instrument for high-resolution optical logging has been built and tested in Antarctica. Its purpose is to obtain records of volcanic products and other scattering features, such as bubbles and impurities, preserved in polar ice sheets, and it achieves this by using long wavelength near-infrared light that is absorbed by the ice before many scattering events occur. Longer wavelengths ensure that the return signal is composed primarily of a single or few backscattering event(s) that limit its spatial spread. The compact optical logger features no components on its body that draw power, which minimizes its size and weight. A prototype of the logger was built and tested at Siple Dome A borehole, and the results were correlated with prior optical logging profiles and records of volcanic products from collected ice core samples.
Non-destructive investigation, chemically fingerprinting, and authentication of ceramic cultural artifacts is a challenging analytical problem. Electron paramagnetic resonance (EPR) spectroscopy is capable of distinguishing between clays based on the paramagnetic metals present, and firing temperature (TF) based on the complexes of these metals formed at different TF values. Unfortunately, the 9 GHz frequency of conventional X-band EPR restricts sample size to a few mm and limits its applicability to small fragments. Low frequency EPR (LFEPR) is based on an EPR spectrometer operating at a few hundred MHz. LFEPR can utilize larger samples on the order of a few cm, but has a lower sensitivity due to the smaller Boltzmann ratio. Additionally, LFEPR may not be capable of detecting a spectral transition if the LFEPR operating frequency is less then the zero-field splitting of the paramagnetic metal complex. We utilized an LFEPR operating at 300 MHz which scans the applied magnetic field between the local Earth’s magnetic field and 26 mT to determine the feasibility of detecting EPR signals from clays, pigments, and glazes. Various clay samples were studied at 100 < TF < 1200 °C. Spectral differences were seen as a function of both clay type and TF. Differences in the LFEPR spectra of Han, Egyptian, and Ultramarine blue support the ability to distinguish among pigments. Paramagnetic impurities in glass may allow distinction between glaze spectra. We have also explored the utility of LFESR by the use of a radio frequency surface coil rather than an enclosed resonator. Although the active volume of the surface coil is ∼1 cm3, objects as large as 20 cm in diameter might be easily characterized with our spectrometer.
Nanoscale metal–insulator–metal (MIM) diodes consisting of a nanoscale-thickness insulator layer sandwiched between two dissimilar metal layers offer the potential for very high frequency alternating current to direct current signal rectification. Active nanoscale tuning of electronic tunneling through the insulator layer to form point contact diodes has previously been limited to barriers composed of soft organic films due to the force limitations of conductive-atomic force microscopy. In this paper, MIM diodes with oxide-based insulators are formed in situ with sub-nanometer depth precision and characterized using a nanoindenter equipped with electrical testing capabilities. Simultaneous measurement of both electrical and nano-mechanical information is accomplished in an MIM stack of the form Nb/Nb2O5/boron-doped diamond nanoindenter tip. Using this technique, we show that the diode behavior can be electromechanically tuned over a range of more than 1 V at equivalent currents via small changes in indentation depth and the results can be modeled using a Fowler–Nordheim approximation.