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The attitudes toward genomics and precision medicine (AGPM) measure examines attitudes toward activities such as genetic testing, gene editing, and biobanking. This is a useful tool for research on the ethical, legal, and social implications of genomics, a major program within the National Institutes of Health. We updated the AGPM to explore controversies over mRNA vaccines. This brief report examines the factor structure of the updated AGPM using a sample of 4939 adults in the USA. The updated AGPM’s seven factors include health benefits, knowledge benefits, and concerns about the sacredness of life, privacy, gene editing, mRNA vaccines, and social justice.
Sleep value is the relative worth individuals assign to sleep. We previously found that individual differences in several sleep value subfactors relate to demographic, health and sleep variables. Given the pivotal role values play in health behavior and the positive association between sleep value and sleep disturbance, individual differences in sleep value may influence vulnerability/resilience to sleep and circadian disturbance. This survey study (N = 455) aimed to establish the latent factor structure of sleep value and identify whether sleep value profiles relate to demographic and sleep characteristics. Factor analysis on the Sleep Valuation Item Bank 2.0 identified five factors (wanting, prioritizing, devaluing, appreciating and preferring). Latent profile analyses revealed five distinct sleep value profiles (unconcerned, appreciative, devalue, ambivalent priority and concerned). Depression, sleep disturbance and sleep-related impairment were highest among those who highly value sleep (concerned profile) and lowest among those who neither value nor devalue sleep (unconcerned profile). Findings suggest sleep value is a complex aspect of sleep health rather than a “more is better” construct and highlight that individual differences in sleep value profiles may be associated with vulnerability/resilience to sleep disturbance.
Antibiotic overuse is common across walk-in clinics, but it is unclear which stewardship metrics are most effective for audit and feedback. In this study, we assessed the validity of a metric that captures antibiotic prescribing for respiratory tract diagnoses (RTDs).
Design:
We performed a mixed-methods study to evaluate an RTD metric, which quantified the frequency at which a provider prescribed antibiotics for RTD visits after excluding visits with complicating factors.
Setting:
Seven walk-in clinics across an integrated healthcare system.
Participants:
We included clinic visits during 2018–2022. We also conducted 17 semi-structured interviews with 10 unique providers to assess metric acceptability.
Results:
There were 331,496 visits; 120,937 (36.5%) met RTD criteria and 44,382 (36.7%) of these received an antibiotic. Factors associated with an increased odds of antibiotic use for RTDs included patient age ≥ 65 (OR = 1.40; 95% CI 1.30–1.51), age 0–17 (1.55, 95% CI 1.50–1.60), and ≥1 comorbidity (OR = 1.22; 95% CI = 1.15–1.29). After stratifying providers by their antibiotic-prescribing frequency for RTDs, patient case-mix was similar across tertiles. However, the highest tertile of prescribers more frequently coded suppurative otitis media and more frequently prescribed antibiotics for antibiotic-nonresponsive conditions (eg, viral infections). There was no correlation between antibiotic prescribing for RTDs and the frequency of return visits (r = 0.01, P = 0.96). Interviews with providers demonstrated the acceptability of the metric as an assessment tool.
Conclusion:
A provider-level metric that quantifies the frequency of antibiotic prescribing for all RTDs has both construct and face validity. Future studies should assess whether this type of metric is an effective feedback tool.
The physical and chemical interactions between organic amines and mineral surfaces are of considerable importance in many industrial applications. For example, the preparation of organophilic minerals often involves the adsorption of organic amines, or the ion exchange of the minerals with quaternary ammonium salts (Jordon, 1951; Miller and Faust, 1972). Chemical interactions occurring in these systems have been studied because of their relevance to an understanding of the chemical nature of the clay surface. A number of these studies have reported on the decomposition of adsorbed amines and alkylammonium-mineral complexes at elevated temperatures, usually in excess of 100°C (Chaussidon and Calvet, 1965; Weiss and Roloff, 1963; Durand, Pellet and Fripiat, 1972; Chou and McAtee, 1969). It is now well established that under these conditions the mineral may have potential strong-acidity, and these reactions have been explained in terms of acid-induced decomposition or rearrangement of the adsorbed amines or their derivatives. However, there have been few studies of the reactions of organo-mineral complexes at temperatures below 100°C, under conditions where retention of adsorbed water could be expected to moderate the mineral surface acidity.
The presence, percentage, origins, and rate of formation of clay minerals have been important components in studies involving the geochemical and structural composition of waste-rock piles. The objective of the present study was to investigate the use of tritium as an indicator of the origin of clay minerals within such piles. Tritium values in pore water, interlayer water, and structural hydroxyl sites of clay minerals were examined to evaluate the origins of clay minerals within waste-rock piles located near Questa, New Mexico. Five clay minerals were identified: kaolinite, chlorite, illite, smectite, and mixedlayer illite-smectite, along with the hydrous sulfate minerals gypsum and jarosite. Analysis of waters derived from clay minerals was achieved by thermal reaction of dry-sieved bulk material obtained from the Questa site. In all Questa samples, the low-temperature water derived from pore-water and interlayer sites, as well as the intermediate-temperature water derived from interlayer cation sites occupied by hydronium and structural hydroxyl ions, show tritium values at or near modern levels for precipitation. Pore water and interlayer water ranged from 5.31 to 12.19 tritium units (TU) and interlayer hydronium and structurally derived water ranged from 3.92 to 7.93 TU. Tritium levels for local precipitation ranged from ~4 to 8 TU. One tritium unit (TU) represents one molecule of 3H1HO in 1018 molecules of 1H1HO. The elevated levels of tritium in structural sites can be accounted for by thermal incorporation of significant amounts of hydronium ions in interlayer cation sites for illite and mixed-layer clays, both common at the Questa site. In low-pH environments, such as those found within Questa waste-rock piles (typically pH ~3), the hydronium ion is an abundant species in the rock-pile pore-water system.
Ludwig Lachmann is a central but underappreciated figure within the Austrian school of economics. Although his understanding of institutions, his appreciation of the heterogeneity of capital, his emphasis on subjectivity, and his focus on the dynamism and uncertainty of the real world have become dominant positions amongst Austrian economists, he is still viewed as something of an outsider. As such, the contributions of Lachmann's economics are arguably misunderstood. This Element attempts to tease out and discuss the critical contributions of Lachmann's economics. Arguably, one way in which to understand Lachmann's economics is by seeing it as unified in considering, in various ways, a single conceptual 'problem' – the apparent tension between the dynamic nature of social reality and the intelligible nature of the social world. Approaching Lachmann with this theme in mind allows us to put things together more coherently than other exegetical strategies.
We assessed factors associated with increased risk to loss of follow-up with infectious diseases staff in OPAT patients. Discharge to subacute healthcare facilities is strongly associated with loss to follow-up. We did not identify sociodemographic disparities. Poor communication between OPAT providers and subacute healthcare facilities remains a serious issue.
There have been no systematic experiments conducted in Nevada's water-limited environment that examined the simultaneous benefits of soil health and feed value derived from cool-season cover cropping systems. The objective of this study was to determine the influence of different annual cool-season cover crop systems on above and belowground biomass production, plant tissue carbon and nitrogen, forage nutritive value (crude protein, acid, and neutral detergent fiber), relative feed value (RFV), and short-term soil health indicators under irrigation in a semi-arid environment. Treatments (cover crop systems) were a fallow (no cover crop), five monocultures of rye (Secale cereale L.), winter lentil (Lens culinaris Medik.), arrowleaf clover (Trifolium vesiculosum Savi), white sweetclover (Melilotus alba), forage kale (Brassica oleracea L.), and two three-species mixtures in 50-25-25 seeding ratios (CCM 1: rye, winter lentil, arrowleaf clover; CCM 2: rye, white sweetclover, forage kale). Cover crop systems were arranged in an RCBD with three replications. Plots were fall seeded in Reno, NV early October of each year (2020 and 2021) and terminated at the end of July of 2021 and 2022, respectively. Averaged across years, aboveground biomass production was lowest for the monoculture of winter lentil (4104 kg DM ha−1; SE = 1551) compared to all other cover crop systems (average = 7593 kg DM ha−1; SE = 1551). Biomass carbon produced was lowest for winter lentil (1717 kg ha−1; SE = 675) relative to all other cover crop systems (average = 3227 kg ha−1; SE = 675). The CCM 1 system had a greater C/N ratio (36.3) than CCM 2 and the monocultures of winter lentil, arrowleaf clover, and white sweetclover (average = 24.9). Belowground biomass did not differ among cover crop systems (average = 3161 kg DM ha−1; SE = 962). Crude protein concentration was similar among cover crop systems but the RFV was greatest for forage kale (RFV = 165; SE = 4.0) among all cover crop systems. Soil total N and organic carbon concentration did not differ among cover crop systems but soil K concentration was greatest under fallow (428 mg kg−1 soil; SE = 26) relative to all other systems (average = 345.6 mg kg−1 soil; SE = 26). Soil microbial community biomass was not altered by cover crop system or its interaction with year. While the short-term impact of the cover crop systems on soil health indicators was minimal relative to the fallow system, the overall results suggested that there is potential to integrate cover crops in Nevada's semi-arid environment under irrigation.
The Mini International Neuropsychiatric Interview 7.0.2 (MINI-7) is a widely used tool and known to have sound psychometric properties; but very little is known about its use in low and middle-income countries (LMICs). This study aimed to examine the psychometric properties of the MINI-7 psychosis items in a sample of 8609 participants across four countries in Sub-Saharan Africa.
Methods
We examined the latent factor structure and the item difficulty of the MINI-7 psychosis items in the full sample and across four countries.
Results
Multiple group confirmatory factor analyses (CFAs) revealed an adequate fitting unidimensional model for the full sample; however, single group CFAs at the country level revealed that the underlying latent structure of psychosis was not invariant. Specifically, although the unidimensional structure was an adequate model fit for Ethiopia, Kenya, and South Africa, it was a poor fit for Uganda. Instead, a 2-factor latent structure of the MINI-7 psychosis items provided the optimal fit for Uganda. Examination of item difficulties revealed that MINI-7 item K7, measuring visual hallucinations, had the lowest difficulty across the four countries. In contrast, the items with the highest difficulty were different across the four countries, suggesting that MINI-7 items that are the most predictive of being high on the latent factor of psychosis are different for each country.
Conclusions
The present study is the first to provide evidence that the factor structure and item functioning of the MINI-7 psychosis vary across different settings and populations in Africa.
The aim of this study was to assess the extent to which three non-invasive measures of welfare in laying hens (egg-shell quality, corticosteroid levels as measured from the birds' faeces, and behavioural preferences) were correlated over a period of five days in two groups of birds. One group had access to an enriched test area (bark chips on the floor and a tray of sprouted wheat); the other group had access to a comparably sized barren area (bare wire mesh floor). The measure of preference used was the amount of time hens spent in the test area as measured each day. It was predicted that birds with access to the less preferred environment would show higher levels of faecal corticosteroids and egg-shell anomalies. However, although the birds showed a preference for the enriched environment from Day 1, the other two measures did not follow the same pattern. Faecal corticosteroid metabolites showed an initial increase in both groups, which declined significantly by Day 4, with the ‘enriched’ birds in fact showing a trend for higher levels than the ‘barren’ birds. Shell thickness also showed a change over the five days, but with a different time course: declining to a minimal level on Day 3 and then rising again by Day 5. No measure of shell quality was significantly different between the two environments, but there was a trend for changes in shell thickness to be more pronounced in eggs from enriched birds. The results indicate the caution that needs to be exercised in using shell quality or corticosteroid measurements in isolation from assessments of what the animals themselves prefer.
Several evidence-informed consent practices (ECPs) have been shown to improve informed consent in clinical trials but are not routinely used. These include optimizing consent formatting, using plain language, using validated instruments to assess understanding, and involving legally authorized representatives when appropriate. We hypothesized that participants receiving an implementation science toolkit and a social media push would have increased adoption of ECPs and other outcomes.
Methods:
We conducted a 1-year trial with clinical research professionals in the USA (n = 1284) who have trials open to older adults or focus on Alzheimer’s disease. We randomized participants to receive information on ECPs via receiving a toolkit with a social media push (intervention) or receiving an online learning module (active control). Participants completed a baseline survey and a follow-up survey after 1 year. A subset of participants was interviewed (n = 43).
Results:
Participants who engaged more with the toolkit were more likely to have tried to implement an ECP during the trial than participants less engaged with the toolkit or the active control group. However, there were no significant differences in the adoption of ECPs, intention to adopt, or positive attitudes. Participants reported the toolkit and social media push were satisfactory, and participating increased their awareness of ECPs. However, they reported lacking the time needed to engage with the toolkit more fully.
Conclusions:
Using an implementation science approach to increase the use of ECPs was only modestly successful. Data suggest that having institutional review boards recommend or require ECPs may be an effective way to increase their use.
To characterize factors associated with increased risk of outpatient parenteral antimicrobial therapy (OPAT) complication.
Design:
Retrospective cohort study.
Setting:
Four hospitals within NYU Langone Health (NYULH).
Patients:
All patients aged ≥18 years with OPAT episodes who were admitted to an acute-care facility at NYULH between January 1, 2017, and December 31, 2020, who had an infectious diseases consultation during admission.
Results:
Overall, 8.45% of OPAT patients suffered a vascular complication and 6.04% suffered an antimicrobial complication. Among these patients, 19.95% had a 30-day readmission and 3.35% had OPAT-related readmission. Also, 1.58% of patients developed a catheter-related bloodstream infection (CRBSI). After adjusting for key confounders, we found that patients discharged to a subacute rehabilitation center (SARC) were more likely to develop a CRBSI (odds ratio [OR], 4.75; P = .005) and to be readmitted for OPAT complications (OR, 2.89; P = .002). Loss to follow-up with the infectious diseases service was associated with increased risks of CRBSI (OR, 3.78; P = .007) and 30-day readmission (OR, 2.59; P < .001).
Conclusions:
Discharge to an SARC is strongly associated with increased risks of readmission for OPAT-related complications and CRBSI. Loss to follow-up with the infectious diseases service is strongly associated with increased risk of readmission and CRBSI. CRBSI prevention during SARC admission is a critically needed public health intervention. Further work must be done for patients undergoing OPAT to improve their follow-up retention with the infectious diseases service.
Diablo II is a noteworthy game for a variety of reasons: it was a tremendous commercial success, one of the bestselling titles of its era, and along with contemporaneous MMORPGs, its online mode was among the first game environments to generate gray markets for in-game goods and the associated commercialization of “gold farming” (although in Diablo II's case, this is quite a misnomer). When it comes to political economy, however, it deserves a place of particular distinction because its virtual economy evolved in a distinct (and far more interesting) fashion than many of those in MMOs—a process related only indirectly to its associated gray-market item sales denominated in “real-world” currency. As became quickly evident to individuals joining the online player base, Diablo II's nominal in-game monetary unit did not function effectively as a medium of exchange for player transactions. With this default option proving nonviable, and no obvious alternative available, players looked to barter one item for another rather than acting as buyers and sellers of goods valued in monetary terms. From this initial situation in which, in the absence of a monetary unit, players fell back on barter transactions, the course of the game's history shows a gradual transition toward the use of an increasingly sophisticated system of commodity money. Diablo II's monetary standard is one remembered with sufficient fondness that the economy in one of its present descendants (Path of Exile) was designed to replicate it.
Diablo II is a case study of great interest for monetary theory, first of all because it provides a set of observable circumstances in which monetary exchange emerged from a barter economy. We can therefore use it to assess competing claims regarding what preconditions, if any, are required for the emergence of monetary exchange, and of the degree of correspondence between the properties expected of an emergent monetary commodity and their mapping into the game's environment. This allows us to evaluate the accuracy of theories regarding the mechanisms at work in the process of monetary emergence. More general questions can be asked as well regarding the institutional environment in which exchange in Diablo II took place and the relationship between these institutional features and the successes—and shortcomings—of the game's economic interactions.
Poor maternal mental health during the perinatal period leads to serious complications, especially in humanitarian settings where both mothers and children have often been exposed to multiple stressful events. In those contexts, culturally relevant mental health and psychosocial interventions are required to support mother-infant dyads and ultimately to alleviate potential negative outcomes on child’s health and development.
Objectives
This study aims at assessing the use of postnatal services by mothers and infants under 2 and its impact on maternal mental health.
Methods
A process evaluation of Baby Friendly Spaces (BFS) program was conducted in Nguynyel refugee camp (Ethiopia) and a prospective quantitative assessment was administered to lactating women at baseline and endline (2 months later) to measure maternal functional impairment (WHODAS 2.0), general psychological distress (Kessler scale-K6); depression symptoms (Patient Health Questionnaire-PHQ9) and post-traumatic stress symptoms (PTSD Checklist-PCL-6).
Results
201 lactating women and their babies were enrolled between October 2018 and March 2019. Statistically significant reductions were observed in all mental health outcomes at follow-up. Total mean scores decrease by 19% (p<0.001) for general psychological distress and posttraumatic stress, by 23% (p<0.001) for the depression and by 15% (p<0.001) for the functional impairment. Examination of the compliance to the services revealed that mothers who dropped out early had statistically significantly lower depression scores (p=0.01), and functional impairment scores (p<0.001) than mothers who stayed in the program.
Conclusions
The integration of maternal mental health interventions within perinatal services is challenging but essential for identifying and treating maternal common mental disorders.
Participants and research professionals often overestimate how well participants understand and appreciate consent information for clinical trials, and experts often vary in their determinations of participant’s capacity to consent to research. Past research has developed and validated instruments designed to assess participant understanding and appreciation, but the frequency with which they are utilized is unknown.
Methods:
We administered a survey to clinical researchers working with older adults or those at risk of cognitive impairment (N = 1284), supplemented by qualitative interviews (N = 60).
Results:
We found that using a validated assessment of consent is relatively uncommon, being used by only 44% of researchers who had an opportunity. Factors that predicted adoption of validated assessments included not seeing the study sponsor as a barrier, positive attitudes toward assessments, and being confident that they had the resources needed to implement an assessment. The perceived barriers to adopting validated assessments of consent included lack of awareness, lack of knowledge, being unsure of how to administer such an assessment, and the burden associated with implementing this practice.
Conclusions:
Increasing the use of validated assessments of consent will require educating researchers on the practice and emphasizing very practical assessments, and may require Institutional Review Boards (IRBs) or study sponsors to champion the use of assessments.
The Shyok Suture in western Himalaya preserves a record of the opening and closure of the Mesotethys Ocean between the Shyok ophiolite and Karakoram terrane prior to the India–Eurasia collision. The formation age of the Shyok ophiolite was unknown, which impeded correlation with similar rocks along the Shyok Suture in Pakistan and corresponding sutures in Tibet. We report the first zircon U–Pb ages of a newly documented suite, here named the Changmar Complex. The Changmar Complex gabbronorite and plagiogranite yielded SHRIMP U–Pb zircon Late Jurassic ages of 159.4 ± 0.9 Ma and 151.9 ± 1.5 Ma. Their highly positive initial εHf values (+14.9 to +16.9) indicate a juvenile mantle origin, without continental crust influence on the magma source. The Shyok ophiolite represents either: (1) a separate island arc that preceded formation of the Cretaceous–Eocene Ladakh Arc; or (2) the oldest magmatism and early stage of the Ladakh Arc. Intrusive and extrusive mafic rocks from the Shyok Suture analysed in this study have typical supra-subduction zone enrichment characteristics in their geochemistry and are classified as part of the volcanic-arc ophiolite. The U–Pb age and Hf isotopic signatures for the Shyok ophiolite are similar to the Late Jurassic Matum Das tonalite within the Kohistan Arc; we therefore suggest that they are part of the same intra-oceanic island-arc system that formed in the Mesotethys Ocean prior to Late Jurassic time.
Number and procedures of involuntary hospital admissions vary in Europe according to the different socio-cultural contexts. The European Commission has funded the EUNOMIA study in 12 European countries in order to develop European recommendations for good clinical practice in involuntary hospital admissions. The recommendations have been developed with the direct and active involvement of national leaders and key professionals, who worked out national recommendations, subsequently summarized into a European document, through the use of specific categories. The need for standardizing the involuntary hospital admission has been highlighted by all centers. In the final recommendations, it has been stressed the need to: providing information to patients about the reasons for hospitalization and its presumable duration; protecting patients’ rights during hospitalization; encouraging the involvement of family members; improving the communication between community and hospital teams; organizing meetings, seminars and focus-groups with users; developing training courses for involved professionals on the management of aggressive behaviors, clinical aspects of major mental disorders, the legal and administrative aspects of involuntary hospital admissions, on communication skills. The results showed the huge variation of involuntary hospital admissions in Europe and the importance of developing guidelines on this procedure.
The long-term associations between posttraumatic stress disorder (PTSD) and suicidal ideation (SI) among ex-prisoners of war (ex-POWs) has recently been exemplified. Several studies have revealed the toll of war captivity on secondary traumatization’ (ST) of ex-POWs’ wives. However, a question remains regarding the possible SI among ex-POWs’ wives.
Objectives
Understanding of SI phenomena among wives of severely traumatized ex-POWs in a longitudinal dyadic designed study.
Aims
Assessment of SI among ex-POWs’ wives and the longitudinal associations with their husbands’ PTSD. We also aim to assess the moderating role of the couple's dyadic adjustment in these associations.
Method
A sample of 233 Israeli couples (142 ex-POWs couples and a comparison group of 91 veteran couples) completed self-report measures at two time points: T1 30 (2003-4) and T2 37 (2010) years after the ‘Yom Kipur’ 1973 war.
Results
Surprisingly, no significant differences were found between ex-POWs wives and veterans’ wives, with and without husbands’ PTSD, in SI at T1 and T2. Only among ex-POW couples, an increase in the husband's level of PTSD and SI was related to a more moderate increase in their wives’ SI between T1 and T2. Interestingly, the more a wife reported positive dyadic adjustment, the more moderate the increase in her SI between T1 to T2, regardless of the study group.
Conclusions
Suicidal ideation among ex-POWs’ wives is closely related to their husbands’ PTSD and is moderated by their perception of marital adjustment.
Disclosure of interest
The authors have not supplied their declaration of competing interest.