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Objectives/Goals: Research suggests that veterans identifying as Black, Hispanic/Latinx and multiracial may be at higher risk for developing posttraumatic stress disorder (PTSD). The aim of the current study was to compare PTSD treatment outcomes across racial/ethnic veteran groups. Methods/Study Population: Data from 862 veterans who participated in a 2-week cognitive processing therapy (CPT)-based intensive PTSD treatment program were evaluated. Veterans were on average 45.2 years old and 53.8% identified as male. Overall, 64.4% identified as White, Non-Hispanic/ Latino; 17.9% identified as Black, Indigenous, and People of Color (BIPOC), Non-Hispanic/Latino; and 17.7% identified as Hispanic/Latino. PTSD (PCL-5) and depression (PHQ-9) were collected at intake, completion, and at 3-month follow up. A Bayes factor approach was used to examine whether PTSD, and depression outcomes would be noninferior for BIPOC and Hispanic/Latino groups compared to White, Non-Hispanic veterans over time. Results/Anticipated Results: PTSD severity decreased for the White, BIPOC, and Hispanic/Latino groups from baseline to 3-month follow-up. The likelihood that BIPOC and Hispanic/Latino groups would have comparable PTSD outcomes was 1.81e+06 to 208.56 times greater than the likelihood that these groups would have worse outcomes than the White, Non-Hispanic veterans. Depression severity values on the PHQ-9 decreased for the White, BIPOC, and Hispanic/Latino groups from baseline to 3-month follow-up. The likelihood that BIPOC and Hispanic/Latino groups would have comparable depression outcomes at treatment completion approached infinity. At 3-month follow-up, likelihood was 1.42e+11 and 3.09e+05, respectively. Discussion/Significance of Impact: Results indicated that White, BIPOC, and Hispanic/ Latino groups experienced similarly large PTSD and depression symptom reductions. This study adds to the growing body of literature examining differences in clinical outcomes across racial/ ethnic groups for PTSD.
Vaccines have revolutionised the field of medicine, eradicating and controlling many diseases. Recent pandemic vaccine successes have highlighted the accelerated pace of vaccine development and deployment. Leveraging this momentum, attention has shifted to cancer vaccines and personalised cancer vaccines, aimed at targeting individual tumour-specific abnormalities. The UK, now regarded for its vaccine capabilities, is an ideal nation for pioneering cancer vaccine trials. This article convened experts to share insights and approaches to navigate the challenges of cancer vaccine development with personalised or precision cancer vaccines, as well as fixed vaccines. Emphasising partnership and proactive strategies, this article outlines the ambition to harness national and local system capabilities in the UK; to work in collaboration with potential pharmaceutic partners; and to seize the opportunity to deliver the pace for rapid advances in cancer vaccine technology.
In this conceptual replication of Sparks and Dale ([2023]. The prediction from MLAT to L2 achievement is largely due to MLAT asessment of underlying L1 abilities. Studies in Second Language Acquisition, 1–25) utilizing a dataset previously reported by Sparks et al. ([2009]. Long-term relationships among early L1 skills, L2 aptitude, L2 affect, and later L2 proficiency. Applied Psycholinguistics, 30, 725–755.), L1 achievement scores over 1st–5th grades and L2 aptitude scores from the Modern Language Aptitude Test (MLAT) in 9th grade were examined as predictors of L2 achievement for U.S. secondary students completing L2 courses in 9th and 10th grades. The study’s focus was on the uniqueness and efficiency of MLAT with respect to measuring L1 achievement in predicting L2 achievement. All L1 measures and MLAT predicted L2 literacy and language, and L1 measures predicted MLAT scores. Word decoding was the strongest overall L1 predictor, though there was variation across the L2 measures. The unique contribution of MLAT was modest, as the majority of total prediction (77–86%) was due to L1 measures. The efficiency of MLAT in capturing predictive variance from L1 abilities was moderately high (median ∼73%) but variable across the L1 and L2 measures. Findings are generally consistent with those of Sparks and Dale (2023) showing that prediction from MLAT to L2 is largely due to MLAT’s assessment of L1 abilities, even though a substantial amount of L2 prediction-relevant L1 variance is missed by MLAT.
Despite the widespread use and effectiveness of the Modern Language Aptitude Test (MLAT) composite score in predicting individual differences in L2 achievement and proficiency, there has been little examination of MLAT subtests, although they have potential for illuminating components of L2 aptitude and the mechanism of prediction. Here we use regression commonality analysis to decompose the predictive variance from the MLAT into unique components for each subtest alone and for each possible combination of subtests (duos, trios, etc.) that may have shared variance. The results, from a longitudinal study of 307 U.S. secondary students during 2 years of Spanish learning, provide strong evidence for the role of literacy-related skills in all subtests and in predicting all L2 outcomes. These and other results support a view of L1 literacy and language skills leading to metalinguistic development, which in turn leads to stronger L2 aptitude and achievement.
Widespread use of the Modern Language Aptitude Test (MLAT) in L2 studies of individual differences implicitly assumes that L2 aptitude is a distinct cognitive facet. There is considerable evidence for prediction from L1 abilities to L2 learning. In this longitudinal study, L1-MLAT-L2 relations were examined in 307 US secondary students based on six L1 and six L2 measures of language and literacy, and the MLAT. Mediation and regression analyses revealed that each L1 measure individually predicted all L2 scores and MLAT; the L1 measures collectively substantially predicted MLAT scores; MLAT is a significant but moderate mediator of prediction from L1 to L2 scores; and prediction from MLAT to L2 scores is significantly and substantially due to variance in L1 abilities captured by MLAT. Overall, prediction from MLAT is due primarily to its functioning as a measure of L1 abilities, although substantial L1 variance which predicts L2 scores is not captured by the MLAT.
Considerable heterogeneity exists in treatment response to first-line posttraumatic stress disorder (PTSD) treatments, such as Cognitive Processing Therapy (CPT). Relatively little is known about the timing of when during a course of care the treatment response becomes apparent. Novel machine learning methods, especially continuously updating prediction models, have the potential to address these gaps in our understanding of response and optimize PTSD treatment.
Methods
Using data from a 3-week (n = 362) CPT-based intensive PTSD treatment program (ITP), we explored three methods for generating continuously updating prediction models to predict endpoint PTSD severity. These included Mixed Effects Bayesian Additive Regression Trees (MixedBART), Mixed Effects Random Forest (MERF) machine learning models, and Linear Mixed Effects models (LMM). Models used baseline and self-reported PTSD symptom severity data collected every other day during treatment. We then validated our findings by examining model performances in a separate, equally established, 2-week CPT-based ITP (n = 108).
Results
Results across approaches were very similar and indicated modest prediction accuracy at baseline (R2 ~ 0.18), with increasing accuracy of predictions of final PTSD severity across program timepoints (e.g. mid-program R2 ~ 0.62). Similar findings were obtained when the models were applied to the 2-week ITP. Neither the MERF nor the MixedBART machine learning approach outperformed LMM prediction, though benefits of each may differ based on the application.
Conclusions
Utilizing continuously updating models in PTSD treatments may be beneficial for clinicians in determining whether an individual is responding, and when this determination can be made.
This Element has two main purposes. Firstly, it discusses purposes, advantages, and disadvantages as well as the challenges of different formats of language assessment, concluding with a focus on educator-administered language assessment in early childhood and education programs. It addresses the selection of assessment domains, the trade-off between brevity and precision, the challenge of assessing bilinguals, and accommodating the requirements of funders (e.g., government agencies) and users (e.g., educators and schools). It draws on lessons learned from developing two instruments for a national Danish-language and preliteracy assessment program. Secondly, it introduces those two educator-administered instruments-Language Assessment 3-6 (LA 3-6) and Language Assessment 2-year-olds (LA 2)-with respect to content, norming, gender and socioeconomic influences as well as psychometric qualities. The intention is that this experience can help enable the extension of the educator-based approach to other languages and contexts, while simultaneously acknowledging that linguistic and cultural adaptations are crucial.
The Twins Early Development Study (TEDS) is a longitudinal twin study that recruited over 16,000 twin-pairs born between 1994 and 1996 in England and Wales through national birth records. More than 10,000 of these families are still engaged in the study. TEDS was and still is a representative sample of the population in England and Wales. Rich cognitive and emotional/behavioral data have been collected from the twins from infancy to emerging adulthood, with data collection at first contact and at ages 2, 3, 4, 7, 8, 9, 10, 12, 14, 16, 18 and 21, enabling longitudinal genetically sensitive analyses. Data have been collected from the twins themselves, from their parents and teachers, and from the UK National Pupil Database. Genotyped DNA data are available for 10,346 individuals (who are unrelated except for 3320 dizygotic co-twins). TEDS data have contributed to over 400 scientific papers involving more than 140 researchers in 50 research institutions. TEDS offers an outstanding resource for investigating cognitive and behavioral development across childhood and early adulthood and actively fosters scientific collaborations.
The Children of the Twins Early Development Study (CoTEDS) is a new prospective children-of-twins study in the UK, designed to investigate intergenerational associations across child developmental stages. CoTEDS will enable research on genetic and environmental factors that underpin parent–child associations, with a focus on mental health and cognitive-related traits. Through CoTEDS, we will have a new lens to examine the roles that parents play in influencing child development, as well as the genetic and environmental factors that shape parenting behavior and experiences. Recruitment is ongoing from the sample of approximately 20,000 contactable adult twins who have been enrolled in the Twins Early Development Study (TEDS) since infancy. TEDS twins are invited to register all offspring to CoTEDS at birth, with 554 children registered as of May 2019. By recruiting the second generation of TEDS participants, CoTEDS will include information on adult twins and their offspring from infancy. Parent questionnaire-based data collection is now underway for 1- and 2-year-old CoTEDS infants, with further waves of data collection planned. Current data collection includes the following primary constructs: child mental health, temperament, language and cognitive development; parent mental health and social relationships; parenting behaviors and feelings; and other socioecological factors. Measurement tools have been selected with reference to existing genetically informative cohort studies to ensure overlap in phenotypes measured at corresponding stages of development. This built-in study overlap is intended to enable replication and triangulation of future analyses across samples and research designs. Here, we summarize study protocols and measurement procedures and describe future plans.
Immigrant children in Denmark differ greatly in educational outcomes. This study examined whether systematic differences in majority language (L2) and preliteracy skills are apparent already at ages 2–6 in immigrant children in Denmark across regional immigration background. Danish language and preliteracy skills in 1,211 immigrant children in four regional groups (based on maternal origin) and 11,259 native Danish nonimmigrant children, all enrolled in Danish childcare centers, were assessed using an age- and gender-normed language assessment instrument. Hierarchical linear models showed that all four immigrant groups scored significantly lower than the native Danish group; the negative coefficients diminished but remained significant when socioeconomic background and having a native Danish father were controlled for. In addition, even with these controls, significant differences existed between some of the immigrant groups, suggesting that factors relating to regional immigrant background were important sources of differences in L2 development. A greater immigrant disadvantage for language than preliteracy skills was found; two immigrant groups did not differ significantly from the nonimmigrant Danish group for preliteracy skills. The results suggest that measures to reduce inequalities in long-term educational achievement between immigrant groups should be taken already before school with a particular focus on L2 language skills.
Vocabulary input frequency influences age of acquisition, and is also an essential control for investigating the influence of other factors. We propose a new method of frequency estimation, self-report. 918 Danish-speaking parents of 12–36-month-old children estimated their frequency of use of 725 words. Self-report was substantially correlated with both language sample based frequencies (0.67) and frequencies of a large written corpus of Danish (0.58). Correlations within vocabulary categories between frequency and age of acquisition, restricted to words occurring in the language samples, were comparable for the two estimates. Overall, self-report based frequency estimates appear to have a promising degree of validity, which reflects their greatest strength, independence of the situation.
New approaches are needed to safely reduce emergency admissions to hospital by targeting interventions effectively in primary care. A predictive risk stratification tool (PRISM) identifies each registered patient's risk of an emergency admission in the following year, allowing practitioners to identify and manage those at higher risk. We evaluated the introduction of PRISM in primary care in one area of the United Kingdom, assessing its impact on emergency admissions and other service use.
METHODS:
We conducted a randomized stepped wedge trial with cluster-defined control and intervention phases, and participant-level anonymized linked outcomes. PRISM was implemented in eleven primary care practice clusters (total thirty-two practices) over a year from March 2013. We analyzed routine linked data outcomes for 18 months.
RESULTS:
We included outcomes for 230,099 registered patients, assigned to ranked risk groups.
Overall, the rate of emergency admissions was higher in the intervention phase than in the control phase: adjusted difference in number of emergency admissions per participant per year at risk, delta = .011 (95 percent Confidence Interval, CI .010, .013). Patients in the intervention phase spent more days in hospital per year: adjusted delta = .029 (95 percent CI .026, .031). Both effects were consistent across risk groups.
Primary care activity increased in the intervention phase overall delta = .011 (95 percent CI .007, .014), except for the two highest risk groups which showed a decrease in the number of days with recorded activity.
CONCLUSIONS:
Introduction of a predictive risk model in primary care was associated with increased emergency episodes across the general practice population and at each risk level, in contrast to the intended purpose of the model. Future evaluation work could assess the impact of targeting of different services to patients across different levels of risk, rather than the current policy focus on those at highest risk.
Emergency admissions to hospital are a major financial burden on health services. In one area of the United Kingdom (UK), we evaluated a predictive risk stratification tool (PRISM) designed to support primary care practitioners to identify and manage patients at high risk of admission. We assessed the costs of implementing PRISM and its impact on health services costs. At the same time as the study, but independent of it, an incentive payment (‘QOF’) was introduced to encourage primary care practitioners to identify high risk patients and manage their care.
METHODS:
We conducted a randomized stepped wedge trial in thirty-two practices, with cluster-defined control and intervention phases, and participant-level anonymized linked outcomes. We analysed routine linked data on patient outcomes for 18 months (February 2013 – September 2014). We assigned standard unit costs in pound sterling to the resources utilized by each patient. Cost differences between the two study phases were used in conjunction with differences in the primary outcome (emergency admissions) to undertake a cost-effectiveness analysis.
RESULTS:
We included outcomes for 230,099 registered patients. We estimated a PRISM implementation cost of GBP0.12 per patient per year.
Costs of emergency department attendances, outpatient visits, emergency and elective admissions to hospital, and general practice activity were higher per patient per year in the intervention phase than control phase (adjusted δ = GBP76, 95 percent Confidence Interval, CI GBP46, GBP106), an effect that was consistent and generally increased with risk level.
CONCLUSIONS:
Despite low reported use of PRISM, it was associated with increased healthcare expenditure. This effect was unexpected and in the opposite direction to that intended. We cannot disentangle the effects of introducing the PRISM tool from those of imposing the QOF targets; however, since across the UK predictive risk stratification tools for emergency admissions have been introduced alongside incentives to focus on patients at risk, we believe that our findings are generalizable.
A predictive risk stratification tool (PRISM) to estimate a patient's risk of an emergency hospital admission in the following year was trialled in general practice in an area of the United Kingdom. PRISM's introduction coincided with a new incentive payment (‘QOF’) in the regional contract for family doctors to identify and manage the care of people at high risk of emergency hospital admission.
METHODS:
Alongside the trial, we carried out a complementary qualitative study of processes of change associated with PRISM's implementation. We aimed to describe how PRISM was understood, communicated, adopted, and used by practitioners, managers, local commissioners and policy makers. We gathered data through focus groups, interviews and questionnaires at three time points (baseline, mid-trial and end-trial). We analyzed data thematically, informed by Normalisation Process Theory (1).
RESULTS:
All groups showed high awareness of PRISM, but raised concerns about whether it could identify patients not yet known, and about whether there were sufficient community-based services to respond to care needs identified. All practices reported using PRISM to fulfil their QOF targets, but after the QOF reporting period ended, only two practices continued to use it. Family doctors said PRISM changed their awareness of patients and focused them on targeting the highest-risk patients, though they were uncertain about the potential for positive impact on this group.
CONCLUSIONS:
Though external factors supported its uptake in the short term, with a focus on the highest risk patients, PRISM did not become a sustained part of normal practice for primary care practitioners.
Experiments to determine effects of chlorimuron, clomazone, and imazaquin applied the year before planting corn, cotton, and sorghum were conducted at three locations in Georgia. Corn injury was <20% in 1987 and 1988 and yield was not affected. In 1988, imazaquin applied at a high rate or sequentially the previous year to late-planted soybeans injured corn more than applications to the early-planted soybeans. Cotton was the most sensitive crop to herbicides applied the previous year. However, seed cotton yield was not decreased due to herbicides applied the previous year. Sorghum growth and yield 8 weeks after planting was not affected by soybean herbicide application the previous year. Sicklepod, corn, and wheat bioassays did not detect any of the herbicides in soil samples obtained the season after treatment. Bioassays accurately predicted potential injury in corn and sorghum but not cotton.
Experiments were conducted on a Cedarbluff silt loam and a Cecil sandy loam to determine dissipation of imazaquin and imazethapyr as influenced by burning small-grain straw and tillage prior to soybean planting. Corn bioassay detection limits for imazaquin and imazethapyr in the Cedarbluff silt loam were 2.5 to 30 and 5 to 40 ppbw, respectively. Bioassay detection limits for imazaquin and imazethapyr in the Cecil sandy loam were 2.5 to 20 and 10 to 40 ppbw, respectively. Imazaquin and imazethapyr activity was not detectable in soil by 110 to 152 d after treatment. Imazethapyr dissipation was not affected by burning or tillage in the Cedarbluff silt loam and dissipated more slowly in 1989 than imazaquin. Imazaquin dissipation in the Cedarbluff silt loam in 1988 was slower in burned plots than in nonburned plots but was not affected by burning in 1989. No differences were observed between imazaquin and imazethapyr dissipation in the Cecil sandy loam and neither burning or tillage influenced their rate of dissipation in either year. No-till-planted cotton was injured at both locations by imazaquin and imazethapyr that had been applied the previous year.
Aminocyclopyrachlor, a newly discovered synthetic auxin herbicide, and its methyl ester, appear to control a number of perennial broadleaf weeds. The potential volatility of this new herbicide and its methyl ester were determined under laboratory conditions and were also compared to dicamba and aminopyralid with the use of enclosed chamber and open-air plant bioassays. Bioassays consisting of visual estimates of epinastic responses and kidney bean and soybean leaf-width measurements were developed to measure vapor release from glass and plastic. Vapor release of aminocyclopyrachlor from glass surfaces was undetectable under laboratory conditions, and no phytotoxic responses were observed when plants were exposed to vapors emanating from various surfaces. Results were similar to those of aminopyralid, indicating the risk of plant injury from vapor movement of aminocyclopyrachlor and aminopyralid was very low. When combined with 1% methylated seed oil, vapor release of aminocyclopyrachlor-methyl ester reached 86% 192 h after application to glass surfaces. Phytotoxic responses of plants exposed to vapors emanating from various surfaces treated with aminocyclopyrachlor-methyl ester were similar to responses to dicamba under enclosed incubation conditions, but were less in outdoor, open-air environments. Studies are needed to understand better the risk of injury to nontarget plants due to vapor movement of aminocyclopyrachlor-methyl ester under field applications.
Laboratory studies were conducted to compare the soil adsorption of aminopyralid and clopyralid with the use of batch-slurry and centrifugation assays. The calculated soil binding constants for both herbicides varied between the two techniques, but the centrifugation assay had a lower coefficient of variation compared to the batch-slurry assay. These results indicate that a centrifugation assay is a more accurate procedure for measuring the interaction of aminopyralid and clopyralid with soils. Aminopyralid adsorbed more tightly than clopyralid to six of the eight soils tested. Adsorption Kd values ranged from 0.083 to 0.364 for clopyralid and 0.106 to 0.697 for aminopyralid. Pearson correlation analysis indicated that binding of both herbicides was highly correlated to soil organic matter and texture but not to soil pH. On average, soil thin-layer chromatography indicated that aminopyralid was less mobile (Rf = 0.82) than clopyralid (Rf = 0.91), although both were mobile. These results suggest that aminopyralid will have a lower leaching potential than clopyralid. Lower potential aminopyralid soil leaching, coupled with low use rates, suggests it may be the herbicide of choice in areas where potential for leaching could be a concern.
Laboratory studies were conducted using 14C-aminocyclopyrachlor (DPX-MAT28) and its 14C-methyl ester formulation (DPX-KJM44) to (1) determine the adjuvants' effects on absorption, (2) compare the absorption and translocation of aminocyclopyrachlor free acid with the methyl ester, and (3) determine the rate at which aminocyclopyrachlor-methyl ester is metabolized to the free acid in Canada thistle. Canada thistle plants were grown from root cuttings and treated in the rosette growth stage. The effect of different adjuvants on absorption was determined by treating individual leaves with formulated herbicide plus 14C-herbicide alone or with methylated seed oil (MSO), crop oil concentrate, or nonionic surfactant with and without urea ammonium nitrate and ammonium sulfate. Plants were harvested 96 h after treatment (HAT). For absorption and translocation experiments, plants were oversprayed with aminocyclopyrachlor or its methyl ester at a rate of 0.14 kg ae ha−1 in combination with 1% MSO. Formulated herbicide plus 14C-herbicide was then applied to a protected leaf, and plants were harvested 24 to 192 HAT. Plants were harvested and radioactivity was determined in the treated leaf and in aboveground and belowground tissues. Metabolism of aminocyclopyrachlor-methyl ester to the free acid was determined 2, 6, and 24 HAT. All aboveground biomass was analyzed by high-performance liquid chromatography to establish the ratio of methyl ester to free acid. MSO applied with either herbicide formulation resulted in the highest absorption compared with no surfactant. Significantly greater aminocyclopyrachlor-methyl ester was absorbed, compared with the free acid, which was reflected in the greater aboveground translocation for the methyl ester. Both formulations had similar amounts of translocation to the roots, with 8.6% (SE ± 3.3) for the methyl ester compared with 6.2% (SE ± 2.5) for the free acid. Approximately 80% of the methyl ester was converted to the free acid at 6 HAT. Based on this conversion rate, aminocyclopyrachlor translocated as the free acid in Canada thistle.