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The ubiquity of social media platforms allows individuals to easily share and curate their personal lives with friends, family, and the world. The selective nature of sharing one’s personal life may reinforce the memories and details of the shared experiences while simultaneously inducing the forgetting of related, unshared memories/experiences. This is a well-established psychological phenomenon known as retrieval-induced forgetting (RIF, Anderson et al.). To examine this phenomenon in the context of social media, two experiments were conducted using an adapted version of the RIF paradigm in which participants either shared experimenter-contrived (Study 1) or personal photographs (Study 2) on social media platforms. Study 1 revealed that participants had more accurate recall of the details surrounding the shared photographs as well as enhanced recognition of the shared photographs. Study 2 revealed that participants had more consistent recall of event details captured in the shared photographs than details captured or uncaptured in the unshared photographs. These results suggest that selectively sharing photographs on social media may specifically enhance the recollection of event details associated with the shared photographs. The novel and ecologically embedded methods provide fodder for future research to better understand the important role of social media in shaping how individuals remember their personal experiences.
Good maternal nutrition is vital for positive pregnancy outcomes. However, midwives report a lack of confidence and skills regarding advising pregnant women about diet and weight during antenatal care(1). Research has shown that the delivery of nutrition education sessions for midwives can improve their knowledge and skills(2), but there is no evidence that this leads to a change in practice. The aim of this study was to evaluate a series of nutrition education sessions for student midwives, delivered by a dietitian, to determine if it is likely to lead to a change in practice.
Final year student midwives (n = 33) were recruited during a final taught nutrition session at their university. They were asked to provide free-text feedback on anonymous post-it notes regarding their thoughts and feelings as to whether the taught nutrition sessions were likely to result in a change in their midwifery practice. The comments were collated and analysed thematically.
Three main themes were identified: 1) Nutrition as a priority 2) Personalised Nutrition 3) Sources of information and signposting.
Most students commented that they now viewed maternal nutrition as ‘important’ and intended to prioritise discussions about nutrition in their future practice. They realised that messages needed to be personalised “It has made me aware to tailor advice to different women.” They also appreciated that signposting women to reliable sources of information or other health professionals helped to support ‘evidence-based practice,” and was an important part of their role: “The additional resources and signposts were really helpful.”
The results from this convenience sample of student midwives indicates promising findings that the taught nutrition sessions are likely to result in a positive change in practice. UK antenatal guidelines state that midwives should discuss nutrition, diet, and vitamin supplementation at booking-in appointments(3), but earlier research suggests that this rarely happens(1). Nutrition education which is delivered by a dietitian and focuses on case studies and care pathways, appears to have empowered student midwives to consider incorporating some of this applied knowledge and advice into their practice.
UK antenatal guidelines state that midwives should discuss nutrition, diet, and vitamin supplementation at booking-in appointments(1). Our earlier research suggests that this rarely happens(2). Participant and Public Involvement (PPI), enhances research by making it more meaningful and reliable. This study incorporated PPI to elicit the experiences of postnatal women regarding the nutrition and weight management advice they received during antenatal care and their opinions regarding the design of a future resource for midwives.
Eight postnatal women were recruited from a Children’s Centre in Liverpool. They were asked questions by one researcher, about: a) any nutrition advice given by midwives during their antenatal care and b) their opinions regarding the development of a nutrition resource for midwives in future. Notes of the conversations were made by a second researcher; these were then transcribed and analysed thematically. Participants were given a shopping voucher to thank them for their input.
Regarding the development of a resource, three themes were identified: 1) Factual information, 2) The Midwives approach, 3) Include us. They identified that they wanted more in-depth facts from midwives, particularly regarding key nutrients and food that should be included in a healthy diet “Good nutrition grows babies”. However, they felt that midwives needed to improve their approach to discussing diet and weight, to include more empathy and sensitivity, as women often felt judged or anxious by comments that were made “It’s not what they say – it’s the way they say it”. Finally, they agreed that their voices should be included in the development of a resource, with midwives and service users coming together to share their views “Get them [midwives] involved in something like this”.
All women agreed that a nutrition resource for midwives was needed as they were dissatisfied with the advice they received. They wanted less focus on food safety/food to avoid and increased emphasis on food and essential nutrients to include. Involving the expertise of dietitians/nutritionists in the resource would help to address knowledge gaps and inconsistencies. Midwives would benefit from training regarding sensitive weight management advice too, as weight was rarely discussed or was approached in a distressing way. This has been documented elsewhere with the recommendation that training regarding sensitive weight management advice should be included in the midwifery curriculum and mandatory training(3). Support and expertise from a health psychologist would help to develop this aspect of the resource. Including the experiences and opinions of service users alongside midwives will be vital to the success of developing a suitable resource for midwives, so ongoing PPI activities need to be considered.
Background: Reducing oral corticosteroids (OCS) use can alleviate the risk of many adverse events related to long-term OCS use. Here, we evaluate real-world utilization of OCS among patients with generalized myasthenia gravis (gMG) over the first 6 months following efgartigimod initiation. Methods: Patients with gMG using OCS who initiated efgartigimod treatment were identified retrospectively from an open US medical and pharmacy claims database (IQVIA Longitudinal Access and Adjudication Data [LAAD], April 2016-April 2023). Average daily dose (ADD) of OCS was analyzed during the 3-month period preceding efgartigimod initiation, and at 3 and 6 months post-efgartigimod initiation. Results: Of 231 patients assessed, 17 (7.4%), 109 (47.1%), and 105 (45.5%) had baseline OCS ADD of 0–5 mg, 5–20 mg, or >20 mg, respectively. At 3 and 6 months post-efgartigimod, 82 (35%) and 99 (43%) patients, respectively, reduced ADD by ≥5 mg. Proportion of patients with ADD of 0–5 mg increased >3-fold (7% baseline vs. 26% 6 months post-efgartigimod) and proportion of patients with ADD of >20 mg decreased by 35% (45% baseline vs. 29% 6 months post-efgartigimod) following efgartigimod initiation. Conclusions: Approximately 43% of patients were able to decrease steroid use or achieved steroid-free status within 6 months of efgartigimod treatment initiation.
Saponite, hectorite, and laponite have been pillared with cationic Al clusters, and special attention has been given to the solution chemistry or Al. Pillared saponite is obtained after exchange with refluxed Al solutions; while for hectorite, Al solutions treated with ammonium acetate give a pillared product with 1.8–1.9 nm spacing and thermal stability up to 873 K. In both types of solutions, the Keggin ion Al cluster is a minority species or totally absent. The typical 1.8–1.9 nm spacing is only obtained after washing. The quality of the pillared material can be judged from its thermal stability, its surface area, and the width of the d001 line before and after pillaring. The width should not exceed 0.3 nm before calcination and 0.5 nm after calcination. The latter criterion reflects the importance of the crystallinity of the parent clay for successful pillaring. Pillaring in concentrated conditions occurs by a combination of ion exchange and precipitation of Al and gives materials that exhibit poor thermal stability.
We compared dissociative seizure specific cognitive behavior therapy (DS-CBT) plus standardized medical care (SMC) to SMC alone in a randomized controlled trial. DS-CBT resulted in better outcomes on several secondary trial outcome measures at the 12-month follow-up point. The purpose of this paper is to evaluate putative treatment mechanisms.
Methods
We carried out a secondary mediation analysis of the CODES trial. 368 participants were recruited from the National Health Service in secondary / tertiary care in England, Scotland, and Wales. Sixteen mediation hypotheses corresponding to combinations of important trial outcomes and putative mediators were assessed. Twelve-month trial outcomes considered were final-month seizure frequency, Work and Social Adjustment Scale (WSAS), and the SF-12v2, a quality-of-life measure providing physical (PCS) and mental component summary (MCS) scores. Mediators chosen for analysis at six months (broadly corresponding to completion of DS-CBT) included: (a) beliefs about emotions, (b) a measure of avoidance behavior, (c) anxiety and (d) depression.
Results
All putative mediator variables except beliefs about emotions were found to be improved by DS-CBT. We found evidence for DS-CBT effect mediation for the outcome variables dissociative seizures (DS), WSAS and SF-12v2 MCS scores by improvements in target variables avoidance behavior, anxiety, and depression. The only variable to mediate the DS-CBT effect on the SF-12v2 PCS score was avoidance behavior.
Conclusions
Our findings largely confirmed the logic model underlying the development of CBT for patients with DS. Interventions could be additionally developed to specifically address beliefs about emotions to assess whether it improves outcomes.
N-Methyl-D-Aspartate Receptor (NMDAR) hypofunction is hypothesised to underlie psychosis but this has not been tested early in illness.
Objectives
Our aim was to determine if NMDAR availability was lower in patients with first episode psychosis compared to healthy controls.
Methods
To address this, we studied 40 volunteers (21 patients with first episode psychosis and 19 matched healthy controls) using PET imaging with an NMDAR selective ligand, [18F]GE179, that binds to the ketamine binding site to index its distribution volume ratio (DVR) and volume of distribution (VT). Striatal glutamatergic indices (glutamate and Glx) were measured simultaneously using magnetic resonance spectroscopy imaging (1H-MRS).
Results
Hippocampal DVR, but not VT, was significantly lower in patients relative to controls (p=0.02, Cohen’s d=0.81; p=0.15, Cohen’s d=0.49), and negatively associated with total (rho=-0.47, p= 0.04), depressive (rho=-0.67, p=0.002), and general symptom severity (rho=-0.74, p<0.001). Exploratory analyses found no significant differences in other brain regions (anterior cingulate cortex, thalamus, striatum and temporal cortex). We found an inverse relationship between hippocampal NMDAR availability and striatal glutamate levels in people with first-episode psychosis (rho = -0.74, p <0.001) but not in healthy controls (rho = -0.22, p = 0.44).
Conclusions
These findings are consistent with the NMDAR hypofunction hypothesis and identify the hippocampus as a key locus for relative NMDAR hypofunction, although further studies should test specificity and causality.
Area-level residential instability (ARI), an index of social fragmentation, has been shown to explain the association between urbanicity and psychosis. Urban upbringing has been shown to be associated with decreased gray matter volumes (GMV)s of brain regions corresponding to the right caudal middle frontal gyrus (CMFG) and rostral anterior cingulate cortex (rACC).
Objectives
We hypothesize that greater ARI will be associated with reduced right posterior CMFG and rACC GMVs.
Methods
Data were collected at baseline as part of the North American Prodrome Longitudinal Study. Counties where participants resided during childhood were geographically coded using the US Censuses to area-level factors. ARI was defined as the percentage of residents living in a different house five years ago. Generalized linear mixed models tested associations between ARI and GMVs.
Results
This study included 29 HC and 64 CHR-P individuals who were aged 12 to 24 years, had remained in their baseline residential area, and had magnetic resonance imaging scans. ARI was associated with reduced right CMFG (adjusted β = -0.258; 95% CI = -0.502 – -0.015) and right rACC volumes (adjusted β = -0.318; 95% CI = -0.612 – -0.023). The interaction terms (ARI X diagnostic group) in the prediction of both brain regions were not significant, indicating that the relationships between ARI and regional brain volumes held for both CHR-P and HCs.
Conclusions
Like urban upbringing, ARI may be an important social environmental characteristic that adversely impacts brain regions related to schizophrenia.
Early adolescents (ages 10–14) living in low- and middle-income countries have heightened vulnerability to psychosocial risks, but available evidence from these settings is limited. This study used data from the Global Early Adolescent Study to characterize prototypical patterns of emotional and behavioral problems among 10,437 early adolescents (51% female) living in the Democratic Republic of Congo (DRC), Malawi, Indonesia, and China, and explore the extent to which these patterns varied by country and sex. LCA was used to identify and classify patterns of emotional and behavioral problems separately by country. Within each country, measurement invariance by sex was evaluated. LCA supported a four-class solution in DRC, Malawi, and Indonesia, and a three-class solution in China. Across countries, early adolescents fell into the following subgroups: Well-Adjusted (40–62%), Emotional Problems (14–29%), Behavioral Problems (15–22%; not present in China), and Maladjusted (4–15%). Despite the consistency of these patterns, there were notable contextual differences. Further, tests of measurement invariance indicated that the prevalence and nature of these classes differed by sex. Findings can be used to support the tailoring of interventions targeting psychosocial adjustment, and suggest that such programs may have utility across diverse cross-national settings.
We present a numerical study of the dynamics of an elastic fibre in a shear flow at low Reynolds number, and seek to understand several aspects of the fibre's motion using the equations for slender-body theory coupled to the elastica. The numerical simulations are performed in the bead-spring framework including hydrodynamic interactions in two theoretical schemes: the generalized Rotne–Prager–Yamakawa model and a multipole expansion corrected for lubrication forces. In general, the two schemes yield similar results, including for the dominant scaling features of the shape that we identify. In particular, we focus on the evolution of an initially straight fibre oriented in the flow direction and show that the time scales of fibre bending, curling and rotation, which depend on its length and stiffness, determine the overall motion and evolution of the shapes. We document several characteristic time scales and curvatures representative of the shape that vary as power laws of the bending stiffness and fibre length. The numerical results are further supported by an interpretation using an elastica model.
Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
Methods.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
Results.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
Conclusions.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
Acute change in mental status (ACMS), defined by the Confusion Assessment Method, is used to identify infections in nursing home residents. A medical record review revealed that none of 15,276 residents had an ACMS documented. Using the revised McGeer criteria with a possible ACMS definition, we identified 296 residents and 21 additional infections. The use of a possible ACMS definition should be considered for retrospective nursing home infection surveillance.
Basic Self disturbances (BSD), including changes of the 'pre-reflexive' sense of self and the loss first-person perspective, are characteristic of the schizophrenic spectrum disorders and highly prevalent in subjects at 'ultra high risk' for psychosis (UHR). The current literature indicates that cortical midline structures (CMS) may be implicated in the neurobiological substrates of the 'basic self' in healthy controls.
Objectives
Neuroanatomical investigation of BSD in a UHR sample
Aims
To test the hypotheses :(i) UHR subjects have higher 'Examination of Anomalous Self Experience, EASE' scores as compared to controls, (ii) UHR subjects have neuroanatomical alterations as compared to controls in CMS, (iii) within UHR subjects, EASE scores are directly related to structural CMS alterations.
Methods
32 HR subjects (27 antipsychotics-naïve) and 17 healthy controls (HC) were assessed with the 57-items semi-structured EASE interview. Voxel-Based Morphometry (VBM) was conducted in the same subjects, with a-priori Region of Interests (ROIs) defined in the CMS (anterior/posterior cingulate and medial-prefrontal cortex).
Results
Despite high variability in the HR group, the overall EASE score was higher (t-test >0.01, Cohen's d =2.91) in HR (mean=30.15, SD=16.46) as compared to HC group (mean=1.79, SD=2.83). UHR subjects had gray matter reduction in CMS as compared to HC (p>0.05 FWE-corrected). Across the whole sample, lower gray matter volume in the anterior cingulate was correlated with higher EASE scores (p>0.05).
Conclusions
This study provides preliminary evidence that gray matter reductions in the CMS are correlated with BSD in UHR people.
Evidence suggests that early trauma may have a negative effect on cognitive functioning in individuals with psychosis, yet the relationship between childhood trauma and cognition among those at clinical high risk (CHR) for psychosis remains unexplored. Our sample consisted of 626 CHR children and 279 healthy controls who were recruited as part of the North American Prodrome Longitudinal Study 2. Childhood trauma up to the age of 16 (psychological, physical, and sexual abuse, emotional neglect, and bullying) was assessed by using the Childhood Trauma and Abuse Scale. Multiple domains of cognition were measured at baseline and at the time of psychosis conversion, using standardized assessments. In the CHR group, there was a trend for better performance in individuals who reported a history of multiple types of childhood trauma compared with those with no/one type of trauma (Cohen d = 0.16). A history of multiple trauma types was not associated with greater cognitive change in CHR converters over time. Our findings tentatively suggest there may be different mechanisms that lead to CHR states. Individuals who are at clinical high risk who have experienced multiple types of childhood trauma may have more typically developing premorbid cognitive functioning than those who reported minimal trauma do. Further research is needed to unravel the complexity of factors underlying the development of at-risk states.
Externalizing disorders are known to be partly heritable, but the biological pathways linking genetic risk to the manifestation of these costly behaviors remain under investigation. This study sought to identify neural phenotypes associated with genomic vulnerability for externalizing disorders.
Methods
One-hundred fifty-five White, non-Hispanic veterans were genotyped using a genome-wide array and underwent resting-state functional magnetic resonance imaging. Genetic susceptibility was assessed using an independently developed polygenic score (PS) for externalizing, and functional neural networks were identified using graph theory based network analysis. Tasks of inhibitory control and psychiatric diagnosis (alcohol/substance use disorders) were used to measure externalizing phenotypes.
Results
A polygenic externalizing disorder score (PS) predicted connectivity in a brain circuit (10 nodes, nine links) centered on left amygdala that included several cortical [bilateral inferior frontal gyrus (IFG) pars triangularis, left rostral anterior cingulate cortex (rACC)] and subcortical (bilateral amygdala, hippocampus, and striatum) regions. Directional analyses revealed that bilateral amygdala influenced left prefrontal cortex (IFG) in participants scoring higher on the externalizing PS, whereas the opposite direction of influence was observed for those scoring lower on the PS. Polygenic variation was also associated with higher Participation Coefficient for bilateral amygdala and left rACC, suggesting that genes related to externalizing modulated the extent to which these nodes functioned as communication hubs.
Conclusions
Findings suggest that externalizing polygenic risk is associated with disrupted connectivity in a neural network implicated in emotion regulation, impulse control, and reinforcement learning. Results provide evidence that this network represents a genetically associated neurobiological vulnerability for externalizing disorders.
Five vermiculite samples collected from Béni Bousera, Morocco and four from Palabora, South Africa were investigated by X-ray diffraction, chemical analysis, 57Fe Mössbauer spectroscopy, and 27Al magic angle spinning nuclear magnetic resonance. The X-ray diffraction studies indicate that all vermiculites have very similar crystallographic parameters. The chemical analyses and the NMR spectra indicate that the Béni Bousera vermiculites contain Al3+ cations in both octahedral and tetrahedral sheets and the Palabora vermiculites contain Al3+ in the tetrahedral sheet. The Mössbauer spectra indicate that the Béni Bousera vermiculites contain more Fe2+ cations than the Palabora vermiculites and do not contain tetrahedral Fe3+ cations. The different cation compositions and distribution in the two sets of vermiculites may result from different parent minerals, i.e. chlorite in the case of Béni Bousera and phlogopite in the case of Palabora, and different genetic processes, i.e. weathering in Béni Bousera and hydrothermal alteration in Palabora.
Trioctahedral micas in the Karlovy Vary pluton range in composition from Fe-biotites in the granites of the Older Intrusive Complex (OIC) through siderophyllite and lithian siderophyllite to zinnwaldite in the granites of the Younger Intrusive Complex (YIC). Li + AlVI + Si would appear to substitute for Fe2+ + AlIV in biotite with a formula similar to that given in Henderson et al. (1989), but Li + Si appears to substitute for Fe2+ + AlIV in the Li-micas. In mica vs. host rock plots, Rb and F show positive linear covariation except for the Li-mica granites, but femic constituents and tFeO/(tFeO + MgO) have separate trends for OIC and YIC granites and micas. Further differences between OIC and YIC granite micas are seen in their Ti and Mg contents and in plots like V vs. SiO2, AlIVvs. Fe/(Fe+Mg) and Li vs. total iron as Fe2+ and in the results of discriminant analysis. These reveal a geochemical hiatus between OIC and YIC granite micas that coincides with a major temporal hiatus.
Biotite compositions in the YIC granites are similar to those in the granites of the Cornubian batholith and reveal a similar magmatic evolution and genesis in which later biotites evolve to lithian siderophyllites with some enrichment in trace alkalis and F. It is suggested that the biotite granites in the YIC were derived from the products of partial fusion of the OIC granites. A less well-marked geochemical hiatus exists between YIC biotites and zinnwaldites. In some plots (e.g. Si vs. Li, Li vs. tFe) apparent continuity between biotite and the Li-micas suggests continuous evolution, but in others (e.g. Rb vs. TiO2, Rb(biotite) vs. Rb(rock)), Li-mica data points stand apart from the biotites suggesting, like the whole rock data, a separate evolution. Comparison with the more abundant data for Li-micas of the Cornubian batholith suggests derivation of the Li-mica granites by partial fusion of the OIC/YIC granite residues.
To test the hypothesis that long-term care facility (LTCF) residents with Clostridium difficile infection (CDI) or asymptomatic carriage of toxigenic strains are an important source of transmission in the LTCF and in the hospital during acute-care admissions.
Design
A 6-month cohort study with identification of transmission events was conducted based on tracking of patient movement combined with restriction endonuclease analysis (REA) and whole-genome sequencing (WGS).
Setting
Veterans Affairs hospital and affiliated LTCF.
Participants
The study included 29 LTCF residents identified as asymptomatic carriers of toxigenic C. difficile based on every other week perirectal screening and 37 healthcare facility-associated CDI cases (ie, diagnosis >3 days after admission or within 4 weeks of discharge to the community), including 26 hospital-associated and 11 LTCF-associated cases.
Results
Of the 37 CDI cases, 7 (18·9%) were linked to LTCF residents with LTCF-associated CDI or asymptomatic carriage, including 3 of 26 hospital-associated CDI cases (11·5%) and 4 of 11 LTCF-associated cases (36·4%). Of the 7 transmissions linked to LTCF residents, 5 (71·4%) were linked to asymptomatic carriers versus 2 (28·6%) to CDI cases, and all involved transmission of epidemic BI/NAP1/027 strains. No incident hospital-associated CDI cases were linked to other hospital-associated CDI cases.
Conclusions
Our findings suggest that LTCF residents with asymptomatic carriage of C. difficile or CDI contribute to transmission both in the LTCF and in the affiliated hospital during acute-care admissions. Greater emphasis on infection control measures and antimicrobial stewardship in LTCFs is needed, and these efforts should focus on LTCF residents during hospital admissions.
Research on the cities of the Classical Greek world has traditionally focused on mapping the organisation of urban space and studying major civic or religious buildings. More recently, newer techniques such as field survey and geophysical survey have facilitated exploration of the extent and character of larger areas within urban settlements, raising questions about economic processes. At the same time, detailed analysis of residential buildings has also supported a change of emphasis towards understanding some of the functional and social aspects of the built environment as well as purely formal ones. This article argues for the advantages of analysing Greek cities using a multidisciplinary, multi-scalar framework which encompasses all of these various approaches and adds to them other analytical techniques (particularly micro-archaeology). We suggest that this strategy can lead towards a more holistic view of a city, not only as a physical place, but also as a dynamic community, revealing its origins, development and patterns of social and economic activity. Our argument is made with reference to the research design, methodology and results of the first three seasons of fieldwork at the city of Olynthos, carried out by the Olynthos Project.