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Anxiety is a common comorbid feature of late-life depression (LLD) and is associated with poorer global cognitive functioning independent of depression severity. However, little is known about whether comorbid anxiety is associated with a domain-specific pattern of cognitive dysfunction. We therefore examined group differences (LLD with and without comorbid anxiety) in cognitive functioning performance across multiple domains.
Method:
Older adults with major depressive disorder (N = 228, ages 65–91) were evaluated for anxiety and depression severity, and cognitive functioning (learning, memory, language, processing speed, executive functioning, working memory, and visuospatial functioning). Ordinary least squares regression adjusting for age, sex, education, and concurrent depression severity examined anxiety group differences in performance on tests of cognitive functioning.
Results:
Significant group differences emerged for confrontation naming and visuospatial functioning, as well as for verbal fluency, working memory, and inhibition with lower performance for LLD with comorbid anxiety compared to LLD only, controlling for depression severity.
Conclusions:
Performance patterns identified among older adults with LLD and comorbid anxiety resemble neuropsychological profiles typically seen in neurodegenerative diseases of aging. These findings have potential implications for etiological considerations in the interpretation of neuropsychological profiles.
Late-life depression (LLD) is common and frequently co-occurs with neurodegenerative diseases of aging. Little is known about how heterogeneity within LLD relates to factors typically associated with neurodegeneration. Varying levels of anxiety are one source of heterogeneity in LLD. We examined associations between anxiety symptom severity and factors associated with neurodegeneration, including regional brain volumes, amyloid beta (Aβ) deposition, white matter disease, cognitive dysfunction, and functional ability in LLD.
Participants and Measurements:
Older adults with major depression (N = 121, Ages 65–91) were evaluated for anxiety severity and the following: brain volume (orbitofrontal cortex [OFC], insula), cortical Aβ standardized uptake value ratio (SUVR), white matter hyperintensity (WMH) volume, global cognition, and functional ability. Separate linear regression analyses adjusting for age, sex, and concurrent depression severity were conducted to examine associations between anxiety and each of these factors. A global regression analysis was then conducted to examine the relative associations of these variables with anxiety severity.
Results:
Greater anxiety severity was associated with lower OFC volume (β = −68.25, t = −2.18, p = .031) and greater cognitive dysfunction (β = 0.23, t = 2.46, p = .016). Anxiety severity was not associated with insula volume, Aβ SUVR, WMH, or functional ability. When examining the relative associations of cognitive functioning and OFC volume with anxiety in a global model, cognitive dysfunction (β = 0.24, t = 2.62, p = .010), but not OFC volume, remained significantly associated with anxiety.
Conclusions:
Among multiple factors typically associated with neurodegeneration, cognitive dysfunction stands out as a key factor associated with anxiety severity in LLD which has implications for cognitive and psychiatric interventions.
We explain the concept of dilemmas and how they underpin the logic of interpretive comparison. Existing work in interpretive theory refers mainly to ‘Big-D’ dilemmas that focus on ideational conflicts between traditions such as the clash between neoliberalism and state ownership. We add the notion of ‘small-d’ dilemmas that focus on the everyday, the routine and the mundane, choices, ‘court’ politics and realpolitik. We suggest that empirical, comparative, interpretive social science research revolves around the process of identifying the dilemmas that actors experience and the ways they respond to them, and puzzling about whether they vary according to the traditions in which they are situated. We suggest rules of thumb for identifying dilemmas.
We outline briefly the difference between naturalism and humanism before providing a summary of our key concepts of decentring, situated agency and plausible conjectures. In effect, we set the theoretical scene for the rest of the book and the underpinnings for comparative analysis based on dilemmas. We challenge the naturalist mantra of ‘different tools, shared standards’ and provide an alternative account of what constitutes valuable and rigorous interpretive research. We set out a new set of criteria by which interpretive comparative work should be assessed and towards which interpretive comparative researchers ought to strive. We focus on accuracy, openness and aesthetics. We show that not anything goes in comparative interpretive research.
The chapter introduces the idea of creative intuition and interpretation before summarising the book's contents. At the heart of this book is the idea of comparative intuition. People in general, and social scientists in particular, are engaged in ‘constant comparison’. Comparison is what enables us to make sense of events as they unfold across time and space. Interpretive research offers a distinctive approach to the comparative intuition because it consciously offers interpretations of interpretations. This chapter has five substantive sections. First, we outline our basic argument for a consciously and explicitly comparative interpretive approach. Second, we provide a brief summary of the interpretive approach. Third, we seek to justify the rigour and sensitivity of a comparative interpretive orientation. Fourth, we foreshadow in greater depth the structure of the book and detail of its component chapters. Finally, we provide guidance for readers on how to use the book, and in particular on how to combine its insights with those stemming from canonical texts in the field.
We explain, and illustrate with examples drawn from our own work, how interpretive researchers analyse comparative data. We argue that a comparative project compounds the uncertainty, confusion and paralysis that can set in when confronted with a 'mountain' of qualitative data. We argue it is not possible to 'somehow capture' this full complexity. We outline and defend the need for a consciously impressionistic orientation to data analysis. Rather than searching for a ‘Eureka!’ moment that confirms or refutes a narrow theory (in naturalist mode) or makes sense of the whole picture (in idiographic mode), a comparative focus on dilemmas enables the use of a kaleidoscope of different analytical lenses and tools to explore complex specificness in context. We outline rules of thumb for helping along the way.
In the Retrospective, we turn our methods back on our own book and ask, ‘what are the dilemmas of using the approach we advocate?’ It is an exercise in professional reflexivity as we reflect on the personal dilemmas that we navigated in writing this book. We ask, ‘what are the dilemmas of using our comparative approach?' Also, we impress upon the reader the merits of our approach by summarising the key terms of both the interpretive approach and our comparative interpretive approach. It is a short cut for those who like to skim books before reading them.
We outline the place of fieldwork in comparative interpretive research. Detailed qualitative fieldwork is central to most interpretive research, but practical guidance on how to navigate the field remains rooted to the idiographic tradition. The presumption is one of sustained immersion in a discrete setting. Interpretive comparison, however, necessarily requires partial immersion across multiple sites in shorter, more interrupted bursts. We call this yo-yoing. Crucially, the researcher must be alert to the surprises and moments of epiphany that can challenge initial assumptions and open new possibilities. We seek here to develop and illustrate key ‘rules of thumb’ that will enable researchers to manage the challenges and maximise the opportunities.
We look at the craft of writing. Although we discuss the challenges of writing that confront all social scientists, we focus on the dilemmas of writing up comparative interpretive research – dilemmas which we confront because we speak to a broader range of audiences. In doing so, we highlight the importance of seeing writing as integral to the research process, not something that starts once the research is done. We identify the rules of thumb for writing both linear and evocative narratives and discuss the dilemmas encountered in both approaches.
We look at how to design a comparative interpretive project and tackle the perennial case selection question. The problem here is one of justifying unorthodox comparison: a lot has been written on comparative case selection from a naturalist perspective, but this language is often an uncomfortable fit for interpretive projects. We argue that case selection is not something that is designed into a project from inception. For interpretive research, it changes as we go. We therefore suggest different strategies of case selection for different phases of a comparative interpretive project. We identify rules of thumb to guide design choices as the project or programme evolves.
Is it possible to compare French presidential politics with village leadership in rural India? Most social scientists are united in thinking such unlikely juxtapositions are not feasible. Boswell, Corbett and Rhodes argue that they are possible. This book explains why and how. It is a call to arms for interpretivists to embrace creatively comparative work. As well as explaining, defending and illustrating the comparative interpretive approach, this book is also an engaging, hands-on guide to doing comparative interpretive research, with chapters covering design, fieldwork, analysis and writing. The advice in each revolves around 'rules of thumb', grounded in experience, and illustrated through stories and examples from the authors' research in different contexts around the world. Naturalist and humanist traditions have thus far dominated the field but this book presents a real alternative to these two orthodoxies which expands the horizons of comparative analysis in social science research.
We evaluated whether a diagnostic stewardship initiative consisting of ASP preauthorization paired with education could reduce false-positive hospital-onset (HO) Clostridioides difficile infection (CDI).
Design:
Single center, quasi-experimental study.
Setting:
Tertiary academic medical center in Chicago, Illinois.
Patients:
Adult inpatients were included in the intervention if they were admitted between October 1, 2016, and April 30, 2018, and were eligible for C. difficile preauthorization review. Patients admitted to the stem cell transplant (SCT) unit were not included in the intervention and were therefore considered a contemporaneous noninterventional control group.
Intervention:
The intervention consisted of requiring prescriber attestation that diarrhea has met CDI clinical criteria, ASP preauthorization, and verbal clinician feedback. Data were compared 33 months before and 19 months after implementation. Facility-wide HO-CDI incidence rates (IR) per 10,000 patient days (PD) and standardized infection ratios (SIR) were extracted from hospital infection prevention reports.
Results:
During the entire 52 month period, the mean facility-wide HO-CDI-IR was 7.8 per 10,000 PD and the SIR was 0.9 overall. The mean ± SD HO-CDI-IR (8.5 ± 2.0 vs 6.5 ± 2.3; P < .001) and SIR (0.97 ± 0.23 vs 0.78 ± 0.26; P = .015) decreased from baseline during the intervention. Segmented regression models identified significant decreases in HO-CDI-IR (Pstep = .06; Ptrend = .008) and SIR (Pstep = .1; Ptrend = .017) trends concurrent with decreases in oral vancomycin (Pstep < .001; Ptrend < .001). HO-CDI-IR within a noninterventional control unit did not change (Pstep = .125; Ptrend = .115).
Conclusions:
A multidisciplinary, multifaceted intervention leveraging clinician education and feedback reduced the HO-CDI-IR and the SIR in select populations. Institutions may consider interventions like ours to reduce false-positive C. difficile NAAT tests.
The commissioning and operation of apparatus for neutron diffraction at simultaneous high temperatures and pressures is reported. The basic design is based on the Paris-Edinburgh cell using opposed anvils, with internal heating. Temperature is measured using neutron radiography. The apparatus has been shown in both on-line and off-line tests to operate to a pressure of 7 GPa and temperature of 1700°C. The apparatus has been used in a neutron diffraction study of the crystal structure of deuterated brucite, and results for 520°C and 5.15 GPa are presented. The diffraction data that can be obtained from the apparatus are of comparable quality to previous high-pressure studies at ambient temperatures, and are clearly good enough for Rietveld refinement analysis to give structural data of reasonable quality.
This paper analyzes in detail the role of environmental and economic shocks in the migration of the 1930s. The 1940 US Census of Population asked every inhabitant where they lived five years earlier, a unique source for understanding migration flows and networks. Earlier research documented migrant origins and destinations, but we will show how short-term and annual weather conditions at sending locations in the 1930s explain those flows, and how they operated through agricultural success. Beyond demographic data, we use data about temperature and precipitation, plus data about agricultural production from the agricultural census. The widely known migration literature for the 1930s describes an era of relatively low migration, with much of the migration that did occur radiating outward from the Dust Bowl region and the cotton South. Our work about the complete United States will provide a fuller examination of migration in this socially and economically important era.