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Threat sensitivity, an individual difference construct reflecting variation in responsiveness to threats of various types, predicts physiological reactivity to aversive stimuli and shares heritable variance with anxiety disorders in adults. However, no research has been conducted yet with youth to examine the heritability of threat sensitivity or evaluate the role of genetic versus environmental influences in its relations with mental health problems. The current study addressed this gap by evaluating the psychometric properties of a measure of this construct, the 20-item Trait Fear scale (TF-20), and examining its phenotypic and genotypic correlations with different forms of psychopathology in a sample of 346 twin pairs (121 monozygotic), aged 9–14 years. Analyses revealed high internal consistency and test-retest reliability for the TF-20. Evidence was also found for its convergent and discriminant validity in terms of phenotypic and genotypic correlations with measures of fear-related psychopathology. By contrast, the TF-20’s associations with depressive conditions were largely attributable to environmental influences. Extending prior work with adults, current study findings provide support for threat sensitivity as a genetically-influenced liability for phobic fear disorders in youth.
Older adults with treatment-resistant depression (TRD) benefit more from treatment augmentation than switching. It is useful to identify moderators that influence these treatment strategies for personalised medicine.
Aims
Our objective was to test whether age, executive dysfunction, comorbid medical burden, comorbid anxiety or the number of previous adequate antidepressant trials could moderate the superiority of augmentation over switching. A significant moderator would influence the differential effect of augmentation versus switching on treatment outcomes.
Method
We performed a preplanned moderation analysis of data from the Optimizing Outcomes of Treatment-Resistant Depression in Older Adults (OPTIMUM) randomised controlled trial (N = 742). Participants were 60 years old or older with TRD. Participants were either (a) randomised to antidepressant augmentation with aripiprazole (2.5–15 mg), bupropion (150–450 mg) or lithium (target serum drug level 0.6 mmol/L) or (b) switched to bupropion (150–450 mg) or nortriptyline (target serum drug level 80–120 ng/mL). Treatment duration was 10 weeks. The two main outcomes of this analysis were (a) symptom improvement, defined as change in Montgomery–Asberg Depression Rating Scale (MADRS) scores from baseline to week 10 and (b) remission, defined as MADRS score of 10 or less at week 10.
Results
Of the 742 participants, 480 were randomised to augmentation and 262 to switching. The number of adequate previous antidepressant trials was a significant moderator of depression symptom improvement (b = −1.6, t = −2.1, P = 0.033, 95% CI [−3.0, −0.1], where b is the coefficient of the relationship (i.e. effect size), and t is the t-statistic for that coefficient associated with the P-value). The effect was similar across all augmentation strategies. No other putative moderators were significant.
Conclusions
Augmenting was superior to switching antidepressants only in older patients with fewer than three previous antidepressant trials. This suggests that other intervention strategies should be considered following three or more trials.
In this work we focus on expected flow in porous formations with highly conductive isolated fractures, which are of non-negligible length compared with the scales of interest. Accordingly, the definition of a representative elementary volume (REV) for flow and transport predictions may not be possible. Recently, a non-local kernel-based theory for flow in such formations has been proposed. There, fracture properties like their expected pressure are represented as field quantities. Unlike existing models, where fractures are assumed to be small compared with the scale of interest, a non-local kernel function is used to quantify the expected flow transfer between a point in the fracture domain and a potentially distant point in the matrix continuum. The transfer coefficient implied by the kernel is a function of the fracture characteristics that are in turn captured statistically. So far the model has successfully been applied for statistically homogeneous cases. In the present work we demonstrate the applicability for heterogeneous cases with spatially varying fracture statistics. Moreover, a scaling law is presented that relates the transfer coefficient to the fracture characteristics. Test cases involving discontinuously and continuously varying fracture statistics are presented, and the validity of the scaling law is demonstrated.
Brian Leftow’s observation that the logical problem of evil is largely resolved, mainly due to the success of free-will defenses, is not universally accepted.1 Graham Oppy, for instance, acknowledges the current shortcomings in formulating a logical argument from evil but contends that deeming such efforts futile is premature.2 Likewise, James Sterba’s recent work shows continued attempts to develop this argument.3 These views prompt a critical question: Is constructing a successful logical argument from evil futile, or will persistence yield success as it has in other philosophical inquiries?
This article introduces the ‘Layers of Reality Response’ to the logical problem of evil, aiming to conclusively resolve the debate for classical theists, independent of free-will defenses. This response establishes two points:
1. Common linking principles in logical arguments from evil are not evidently true and fail to apply across different layers of reality.
2. There is no non-question-begging linking principle for proponents of the logical argument from evil, making a successful formulation inherently unachievable.
If correct, this renders the logical argument from evil not just a philosophical failure but an argument that cannot, in principle, be successfully reformulated – it is not only dead but ‘unresurrectable’.
We prove a conjecture of Pappas and Rapoport for all Shimura varieties of abelian type with parahoric level structure when $p>2$ by showing that the Kisin–Pappas–Zhou integral models of Shimura varieties of abelian type are canonical. In particular, this shows that these models are independent of the choices made during their construction, and that they satisfy functoriality with respect to morphisms of Shimura data.
One difficulty in studying “astronomers” and “mathematicians” as distinct classes in ancient China is that the important ones were neither specialists nor professionals, but polymaths, with little to distinguish them from any other intellectual. Another difficulty, confounding any modern taxonomy, is the tight relationship between astronomy, mathematics, Classical exegesis, and ritual. This article uses the thousands of lost and extant works cataloged under discrete emic categories in the Hanshu, Suishu, and Jiu Tangshu bibliographic treatises to weigh the place of the sciences and their practitioners vis-à-vis other contemporary forms of knowledge and, using polymathy as a vector, to map the connectivity and clusters between fields. It presents numerous findings about relative anonymity, fame, productivity, and the fields in which “scientists” were most implicated, but its principal interest is in proposing a method to sidestep modern observer’s categories.
To quantify the impact of patient- and unit-level risk adjustment on infant hospital-onset bacteremia (HOB) standardized infection ratio (SIR) ranking.
Design:
A retrospective, multicenter cohort study.
Setting and participants:
Infants admitted to 284 neonatal intensive care units (NICUs) in the United States between 2016 and 2021.
Methods:
Expected HOB rates and SIRs were calculated using four adjustment strategies: birthweight (model 1), birthweight and postnatal age (model 2), birthweight and NICU complexity (model 3), and birthweight, postnatal age, and NICU complexity (model 4). Sites were ranked according to the unadjusted HOB rate, and these rankings were compared to rankings based on the four adjusted SIR models.
Results:
Compared to unadjusted HOB rate ranking (smallest to largest), the number and proportion of NICUs that left the fourth quartile (worst-performing) following adjustments were as follows: adjusted for birthweight (16, 22.5%), birthweight and postnatal age (19, 26.8%), birthweight and NICU complexity (22, 31.0%), birthweight, postnatal age and NICU complexity (23, 32.4%). Comparing NICUs that moved into the better-performing quartiles after birthweight adjustment to those that remained in the better-performing quartiles regardless of adjustment, the median percentage of low birthweight infants was 17.1% (Interquartile Range (IQR): 15.8, 19.2) vs 8.7% (IQR: 4.8, 12.6); and the median percentage of infants who died was 2.2% (IQR: 1.8, 3.1) vs 0.5% (IQR: 0.01, 12.0), respectively.
Conclusion:
Adjusting for patient and unit-level complexity moved one-third of NICUs in the worst-performing quartile into a better-performing quartile. Risk adjustment may allow for a more accurate comparison across units with varying levels of patient acuity and complexity.
Urgent care centers (UCCs) have reported high rates of antibiotic prescribing for acute respiratory tract infections. Prior UCC studies have generally been limited to single networks. Broadly generalizable stewardship efforts targeting common diagnoses are needed. This study examines the effectiveness of an antibiotic stewardship intervention in reducing inappropriate prescribing for bronchitis and viral upper respiratory tract infections (URTIs) in UCCs.
Design:
A quality improvement study comparing inappropriate antibiotic prescribing rates in UCCs after the introduction of an antibiotic stewardship intervention.
Setting:
Forty-nine UCCs in 27 different networks from 18 states, including 1 telemedicine site.
Participants:
Urgent care clinicians from a national collaborative of UCCs, all members of the Urgent Care Association.
Methods:
The intervention included signing a commitment statement and selecting from 5 different intervention options during 3 plan-do-study-act cycles. The primary outcome was the percentage of urgent care encounters for viral URTIs or bronchitis with inappropriate prescribing, stratified by clinician engagement and diagnosis. A 3-month baseline and 9-month intervention period were compared using a regression model using a generalized estimating equation.
Results:
Among 15,385 encounters, the intervention was associated with decreases in inappropriate antibiotic prescribing for bronchitis (48% relative decrease, aOR = 0.52; 95% CI, 0.33–0.83) and viral URTIs (33%, aOR = 0.67; 95% CI, 0.55–0.82) among actively engaged clinicians compared to baseline. The intervention did not result in significant changes for clinicians not actively engaged.
Conclusions:
This intervention was associated with reductions in inappropriate prescribing among actively engaged clinicians. Implementing stewardship interventions in UCCs may reduce inappropriate antibiotic prescriptions for common diagnoses; however, active clinician engagement may be necessary.
In this work we consider the problem of optimizing a stellarator subject to hard constraints on the design variables and physics properties of the equilibrium. We survey current numerical methods for handling these constraints, and summarize a number of methods from the wider optimization community that have not been used extensively for stellarator optimization thus far. We demonstrate the utility of new methods of constrained optimization by optimizing a quasi-axisymmetric stellarator for favourable physics properties while preventing strong shaping of the plasma boundary, which can be difficult to create with external current sources.
We show how a complete mathematical model of a physical process can be learned directly from data via a hybrid approach combining three simple and general ingredients: physical assumptions of smoothness, locality and symmetry, a weak formulation of differential equations and sparse regression. To illustrate this, we extract a complete system of governing equations of fluid dynamics – the Navier–Stokes equation, the continuity equation and the boundary conditions – as well as the pressure-Poisson and energy equations, from numerical data describing a highly turbulent channel flow in three dimensions. Whether they represent known or unknown physics, relations discovered using this approach take the familiar form of partial differential equations, which are easily interpretable and readily provide information about the relative importance of different physical effects. The proposed approach offers insight into the quality of the data, serving as a useful diagnostic tool. It is also remarkably robust, yielding accurate results for very high noise levels, and should thus be well suited for analysis of experimental data.
Cellulose of tree rings is often assumed to be predominantly formed by direct assimilation of CO2 by photosynthesis and consequently can be used to reconstruct past atmospheric 14C concentrations at annual resolution. Yet little is known about the extent and the age of stored carbon from previous years used in addition to the direct assimilation in tree rings. Here, we studied 14C in earlywood and latewood cellulose of four different species (oak, pine, larch and spruce), which are commonly used for radiocarbon calibration and dating. These trees were still growing during the radiocarbon bomb peak period (1958–1972). We compared cellulose 14C measured in tree-ring subdivisions with the atmospheric 14C corresponding to the time of ring formation. We observed that cellulose 14C carried up to about 50% of the atmospheric 14C signal from the previous 1–2 years only in the earlywood of oak, whereas in conifers it was up to 20% in the earlywood and in the case of spruce also in the latewood. The bias in using the full ring of trees growing in a temperate oceanic climate to estimate atmospheric 14C concentration might be minimal considering that earlywood has a low mass contribution and that the variability in atmospheric 14C over a few years is usually less than 3‰.
The specific and multifaceted service needs of young people have driven the development of youth-specific integrated primary mental healthcare models, such as the internationally pioneering headspace services in Australia. Although these services were designed for early intervention, they often need to cater for young people with severe conditions and complex needs, creating challenges in service planning and resource allocation. There is, however, a lack of understanding and consensus on the definition of complexity in such clinical settings.
Methods
This retrospective study involved analysis of headspace’s clinical minimum data set from young people accessing services in Australia between 1 July 2018 and 30 June 2019. Based on consultations with experts, complexity factors were mapped from a range of demographic information, symptom severity, diagnoses, illness stage, primary presenting issues and service engagement patterns. Consensus clustering was used to identify complexity subgroups based on identified factors. Multinomial logistic regression was then used to evaluate whether these complexity subgroups were associated with other risk factors.
Results
A total of 81,622 episodes of care from 76,021 young people across 113 services were analysed. Around 20% of young people clustered into a ‘high complexity’ group, presenting with a variety of complexity factors, including severe disorders, a trauma history and psychosocial impairments. Two moderate complexity groups were identified representing ‘distress complexity’ and ‘psychosocial complexity’ (about 20% each). Compared with the ‘distress complexity’ group, young people in the ‘psychosocial complexity’ group presented with a higher proportion of education, employment and housing issues in addition to psychological distress, and had lower levels of service engagement. The distribution of complexity profiles also varied across different headspace services.
Conclusions
The proposed data-driven complexity model offers valuable insights for clinical planning and resource allocation. The identified groups highlight the importance of adopting a holistic and multidisciplinary approach to address the diverse factors contributing to clinical complexity. The large number of young people presenting with moderate-to-high complexity to headspace early intervention services emphasises the need for systemic change in youth mental healthcare to ensure the availability of appropriate and timely support for all young people.
How was trust created and reinforced between the inhabitants of medieval and early modern cities? And how did the social foundations of trusting relationships change over time? Current research highlights the role of kinship, neighbourhood, and associations, particularly guilds, in creating ‘relationships of trust’ and social capital in the face of high levels of migration, mortality, and economic volatility, but tells us little about their relative importance or how they developed. We uncover a profound shift in the contribution of family and guilds to trust networks among the middling and elite of one of Europe's major cities, London, over three centuries, from the 1330s to the 1680s. We examine almost 15,000 networks of sureties created to secure orphans’ inheritances to measure the presence of trusting relationships connected by guild membership, family, and place. We uncover a profound increase in the role of kinship – a re-embedding of trust within the family – and a decline of the importance of shared guild membership in connecting Londoners who secured orphans’ inheritances together. These developments indicate a profound transformation in the social fabric of urban society.
OBJECTIVES/GOALS: Residents of environmental justice (EJ) communities experience significantly higher rates of negative health outcomes associated with poor air quality. Low-cost air sensors may supplement regulatory monitoring to better measure air pollution at local scales, but widespread application of this technology remains limited due to many challenges. METHODS/STUDY POPULATION: To address these obstacles, we designed a training program to equip community and academic research partners with the skills and knowledge to successfully apply low-cost sensors in community-engaged environmental health research. The R esearch Innovations using Sensor Technology in Environmental Justice Communities (RISE Communities) program was established through an NIEHS R25 award in 2022 and has three specific aims: 1) Foster community-academic partnerships through research education, training, and team development activities, 2) Provide technical training in the application of low-cost sensors for indoor, outdoor, and personal air monitoring in EJ communities, and 3) Establish a community of practice to address air quality in communities nationwide. RESULTS/ANTICIPATED RESULTS: We hosted our first cohort in August 2023, training five community-academic research teams in team collaboration, community-engaged research, and technical skills for collecting and analyzing data from PurpleAir sensors. Each team received 12 sensors to take to their home EJ communities to begin their projects. Community of practice development continues through interactive webinars and development of a web-based repository of training videos and discussion board posts. Evaluation data show high participant learning and satisfaction, with mean confidence scores improving on 6/8 metrics. Evaluation data also suggest several areas for improvement such as more time spent in teams for planning and additional opportunities for interaction within the cohort and with program instructors for problem-solving. DISCUSSION/SIGNIFICANCE: Effective training for team-based community-engaged research requires careful planning for team development and study implementation. Longitudinal training and support for the technical aspects of utilizing air sensors is also critical to team success. The RISE Communities program is actively recruiting for future training cohorts.
To evaluate temporal trends in the prevalence of gram-negative bacteria (GNB) with difficult-to-treat resistance (DTR) in the southeastern United States. Secondary objective was to examine the use of novel β-lactams for GNB with DTR by both antimicrobial use (AU) and a novel metric of adjusted AU by microbiological burden (am-AU).
Design:
Retrospective, multicenter, cohort.
Setting:
Ten hospitals in the southeastern United States.
Methods:
GNB with DTR including Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter spp. from 2015 to 2020 were tracked at each institution. Cumulative AU of novel β-lactams including ceftolozane/tazobactam, ceftazidime/avibactam, meropenem/vaborbactam, imipenem/cilastatin/relebactam, and cefiderocol in days of therapy (DOT) per 1,000 patient-days was calculated. Linear regression was utilized to examine temporal trends in the prevalence of GNB with DTR and cumulative AU of novel β-lactams.
Results:
The overall prevalence of GNB with DTR was 0.85% (1,223/143,638) with numerical increase from 0.77% to 1.00% between 2015 and 2020 (P = .06). There was a statistically significant increase in DTR Enterobacterales (0.11% to 0.28%, P = .023) and DTR Acinetobacter spp. (4.2% to 18.8%, P = .002). Cumulative AU of novel β-lactams was 1.91 ± 1.95 DOT per 1,000 patient-days. When comparing cumulative mean AU and am-AU, there was an increase from 1.91 to 2.36 DOT/1,000 patient-days, with more than half of the hospitals shifting in ranking after adjustment for microbiological burden.
Conclusions:
The overall prevalence of GNB with DTR and the use of novel β-lactams remain low. However, the uptrend in the use of novel β-lactams after adjusting for microbiological burden suggests a higher utilization relative to the prevalence of GNB with DTR.
Most countries in Africa deployed digital solutions to monitor progress in rolling out COVID-19 vaccines. A rapid assessment of existing data systems for COVID-19 vaccines in the African region was conducted between May and July 2022, in 23 countries. Data were collected through interviews with key informants, identified among senior staff within Ministries of Health, using a semi-structured electronic questionnaire. At vaccination sites, individual data were collected in paper-based registers in five countries (21.7%), in an electronic registry in two countries (8.7%), and in the remaining 16 countries (69.6%) using a combination of paper-based and electronic registries. Of the 18 countries using client-based digital registries, 11 (61%) deployed the District Health Information System 2 Tracker, and seven (39%), a locally developed platform. The mean percentage of individual data transcribed in the electronic registries was 61% ± 36% standard deviation. Unreliable Internet coverage (100% of countries), non-payment of data clerks’ incentives (89%), and lack of electronic devices (89%) were the main reasons for the suboptimal functioning of digital systems quoted by key informants. It is critical for investments made and experience acquired in deploying electronic platforms for COVID-19 vaccines to be leveraged to strengthen routine immunization data management.
Clay minerals in chilled or brecciated margins (altered glass) and massive inner crystalline parts (mesostasis) of three basalt-hawaiite bodies from Mururoa Atoll (French Polynesia) have been studied in order to compare their chemical and mineralogical compositions. Polyphase assemblages comprise di- and trioctahedral phases, both of which consist of non-expandable layers (chlorite, celadonite) and two types of expandable layers (saponite and Fe-rich smectite or ‘nontronite-like’ material). The presence of the Fe-rich clays is supported by the presence of the X-ray diffraction 060 peak at 1.51–1.52 Å and of the infrared absorption bands at 875 and 822 cm−1 (Fe3+-Al-OH and Fe3+-Fe3+-OH groups, respectively). The chemical composition of the Fe-rich smectites does not fit with the theoretical nontronite field. The layer charge averages 1 per Si4O10 making these Fe-rich smectites close to ‘celadonite-type’ clays. This could explain the presence of mixed-layer celadonite-smectite. Plotted in an M+/4Si vs. Fe/sum octahedral cations diagram, the chemical compositions of clay minerals in the mesostasis form a continuous field limited by the celadonite-high-charge nontronite-like smectite and chlorite end-members. The clay assemblages are different from those formed in hydrothermal systems or low-grade metamorphic conditions which are characterized by the sequence: saponite → randomly ordered chlorite-smectite mixed-layered minerals (MLMs) → corrensite → chlorite. The systematic presence of Fe-rich clays either in the altered chilled margins or in the massive inner parts of the basalt-hawaiite bodies (high-charge nontronite-like smectite and mixed-layer nontronite-celadonite) makes the Mururoa sea-mount a potential terrestrial analogue for Mars surface exploration.
The clay minerals formed in chilled margins and massive crystallized inner parts of three basalt-hawaiite bodies of Mururoa Atoll (French Polynesia) exhibit contrasting textures. Glass alteration textures are observed around fractures crosscutting the quenched margins: Fe-rich clays grow inward into the glass (retreating surface) while Mg-rich clays grow outward (open space). The textures of clay deposits filling the diktytaxitic voids (mesostasis) in the massive inner parts of the three volcanic bodies are different: unoriented clay matrix with embedded euhedral apatite and pyroxene microcrysts (submarine flow); pallisadic clays coating the void walls and the crystal surfaces of apatite and K-feldspar microcrysts (subaerial flow); and clay muffs covering all the apatite needles, with the central part of the void remaining empty (dike). The unoriented texture could result from the alteration of a glass precursor concomitant with the olivine phenocrysts (clay pseudomorphs). However, such an alteration implies important chemical transfers which are not observed. The pallisadic and muff textures form through heterogeneous nucleation on the solid surfaces and crystal growth from a saline solution. No glass precursor existed. As the center of the diktytaxitic voids in the dike is empty, the residual liquid was probably boiling. The amounts of light rare earth elements (LREE), Sr, and the most incompatible elements are greater in clays from diktytaxitic voids relative to the amounts formed in the altered glass of the chilled margins. Thus, diktytaxitic clays formed from a residual liquid which gave either an evolved glass or a saline solution after cooling (fractionation process). The δ18O variation vs. loss on ignition (LOI) indicates that sea water was involved either in rock alteration or magma contamination. This is confirmed by the 87Rb/86Sr ratio of bulk rocks and clay fractions from the quenched and massive inner parts of the three volcanic bodies which do not fit with the 11.5 Ma isochron indicating that the Rb-Sr system was not closed at any stage during the magmatic history.
Recent studies have begun to explore the role of psychological resilience in pediatric mTBI recovery, with findings associating higher levels of resilience with shorter recovery and lower levels of resilience mediated by pre-injury anxiety and depression associated with persistent symptoms. The purpose of this study is to extend the current literature by further exploring the relationship between resilience, post-injury emotional changes, and length of recovery from pediatric mTBI. Based upon previous literature, we predicted that resilience would explain a unique portion of the variance in length of recovery above and beyond acute post-injury emotional symptoms in adolescents recovering from mTBI compared with orthopedic injured (OI) controls.
Participants and Methods:
The current study pulled data from a larger project utilizing a prospective cohort design in two cohorts of high school student-athletes aged 14-18 (N = 32). Participants with mTBI (n = 17) or OI (n = 15) sustained during sport were recruited within 10 days of injury from a quaternary care setting. Participants completed a neuropsychological screening evaluation within one week of enrollment, including self-report rating scales of resilience (Connor-Davidson Resilience Scale-10; CD-RISC) and self- and parent-reported post-concussion symptoms (Post-Concussion Symptom Inventory, Second Edition; PCSI-2). Hierarchical regression analysis was performed with days from injury to recovery as the dependent variable. Predictors were entered in three steps: (1) group (mTBI/OI) and sex, (2) PCSI self- and parent-reported post-injury change in emotional symptoms, and (3) CD-RISC raw score. Bonferroni correction was utilized to control for multiple comparisons.
Results:
Group and sex did not provide significant prediction when entered into the first block of the model (p= .61). Introducing PCSI emotional ratings in the second block showed statistically significant improvement, F (2,26) = 5.12, p< .01), accounting for 31% of the variance in recovery length. Addition of the CD-RISC in the third block was not statistically significant (p=.59). Post hoc testing indicated parent ratings on the PCSI were significantly associated with recovery length t(32) = 3.16, p < .01, while self-reported ratings were not (p=.54).
Conclusions:
Findings indicated that psychological resilience did not explain a unique portion of the variance in length of recovery above and beyond acute parent report of postinjury emotional symptoms in adolescents recovering from mTBI compared with orthopedic injured (OI) controls. Interestingly, sex, group (mTBI vs. OI), and self-reported acute postinjury emotional symptoms were not significant predictors of recovery length in this sample. Results highlight the significant role of acute changes in emotional symptoms in adolescents recovering from mTBI and OI in predicting length of recovery, as well as the importance of obtaining separate caregiver report. A more robust understanding of factors contributing to recovery from injury can help inform and improve preventive measures and treatment plants for those at risk or impacted; however, psychological resilience may not uniquely contribute to predicting length of recovery in acutely injured adolescents, limiting value added to the clinical exam. Future studies should explore the relationship between type of injury and recovery time in larger samples.