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It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.
Aims
To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
Method
Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
Results
IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).
Conclusions
Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.
Assess the efficacy of staged interventions aimed to reduce inappropriate Clostridioides difficile testing and hospital-onset C. difficile infection (HO-CDI) rates.
Design:
Interrupted time series.
Setting:
Community-based.
Methods/Interventions:
National Healthcare Safety Network (NHSN) C. difficile metrics from January 2019 to November 2022 were analyzed after three interventions at a community-based healthcare system. Interventions included: (1) an electronic medical record (EMR) based hard stop requiring confirming ≥3 loose or liquid stools over 24 h, (2) an infectious diseases (ID) review and approval of testing >3 days of hospital admission, and (3) an infection control practitioner (ICP) reviews combined with switching to a reverse two-tiered clinical testing algorithm.
Results:
After all interventions, the number of C. difficile tests per 1,000 patient-days (PD) and HO-CDI cases per 10,000 PD decreased from 20.53 to 6.92 and 9.80 to 0.20, respectively. The EMR hard stop resulted in a (28%) reduction in the CDI testing rate (adjusted incidence rate ratio ((aIRR): 0.72; 95% confidence interval [CI], 0.53 to 0.96)) and ID review resulted in a (42%) reduction in the CDI testing rate (aIRR: 0.58; 95% CI, 0.42–0.79). Changing to the reverse testing algorithm reduced reported HO-CDI rate by (95%) (cIRR: 0.05; 95% CI; 0.01–0.40).
Conclusions:
Staged interventions aimed at improving diagnostic stewardship were effective in overall reducing CDI testing in a community healthcare system.
The present study explored how individual differences and development of gray matter architecture in inferior frontal gyri (IFG), anterior cingulate (ACC), and inferior parietal lobe (IPL) relate to development of response inhibition as measured by both the Stop Signal Task (SST) and the Go/No-Go (GNG) task in a longitudinal sample of healthy adolescents and young adults. Reliability of behavioral and neural measures was also explored.
Participants and Methods:
A total of 145 individuals contributed data from the second through fifth timepoints of an accelerated longitudinal study focused on adolescent brain and behavioral development at the University of Minnesota. At baseline, participants were 9 to 23 years of age and were typically-developing. Assessment waves were spaced approximately 2 years apart. Behavioral measures of response inhibition collected at each assessment included GNG Commission Errors (CE) and the SST Stop Signal Reaction Time (SSRT). Structural T1 MRI scans were collected on a Siemens 3 T Tim Trio and processed with the longitudinal Freesurfer 6.0 pipeline to yield cortical thickness (CT) and surface area values. Regions of interest based on the Desikan-Killiany-Tourville atlas included IFG regions (pars opercularis (PO) and pars triangularis (PT)), ACC and IPL. The cuneus and global brain measures were evaluated as control regions. Retest stability of all measures was calculated using the psych package in R. Mixed linear effects modeling using the lme4 R package identified whether age-based trajectories for SSRTs and GNG CEs best fit linear, quadratic, or inverse curve. Then, disaggregated between- and within-subjects effects of regional cortical architecture measures were added to longitudinal behavioral models to identify individual differences and developmental effects, respectively.
Results:
Both response inhibition metrics demonstrated fair reliability and were best fit by an inverse age trajectory. Neural measures demonstrated excellent retest stability (all ICCs > 0.834). Age-based analyses of regional CT identified heterogeneous patterns of development, including linear trajectories for ACC and inverse age trajectories for bilateral PT. Individuals with thinner left PO showed worse performance on both response inhibition tasks. SSRTs were related to individual differences in right PO thickness and surface area. A developmental pattern was observed for right PT cortical thickness, where thinning over time was related to better GNG performance. Lower surface area of the right PT was related to worse GNG performance. No individual differences or developmental patterns were observed for the ACC, IPL, cuneus, or global metrics.
Conclusions:
This study examined the adolescent development of response inhibition and its association with cortical architecture in the IFG, ACC and IPL. Separate response inhibition tasks demonstrated similar developmental patterns with steepest improvements in early adolescence and relationships with left PO thickness, but each measure had unique relationships with other IFG regions. This study indicates that a region of the IFG, the par opercularis, relates to both individual difference and developmental change in response inhibition. These patterns suggest brain-behavior association that could be further explored in functional imaging studies and that may index, in vulnerable individuals, risk for psychopathology.
We argue that the dual-system approach and, particularly, the default-interventionist framework favored by De Neys unnecessarily constrains process models, limiting their range of application. In turn, the accommodations De Neys makes for these constraints raise questions of parsimony and falsifiability. We conclude that the extent to which processes possess features of system 1 versus system 2 must be tested empirically.
OBJECTIVES/SPECIFIC AIMS: People with metabolically abnormal obesity (MAO), defined as those with insulin resistance and high intrahepatic triglyceride, are at high risk for developing type 2 diabetes and cardiovascular disease. Weight loss through reduced energy intake and increased physical activity has profound impacts on improving cardiometabolic function. However, the specific additional effects of exercise training with diet-induced weight loss on metabolic function are equivocal. METHODS/STUDY POPULATION: A comparative trial is ongoing in MAO adults undergoing 8-10% weight loss induced by a very-low fat plant-based (PB) diet with structured exercise training (n=8) compared to the same weight loss induced by the PB diet alone (n=3). RESULTS/ANTICIPATED RESULTS: Preliminary results indicate that, PB diet with or without exercise training results in significant weight loss concomitant with enhanced insulin sensitivity, reduced intrahepatic triglyceride, reduced 24-hour postprandial glucose response, reduced fat mass, and reduced diastolic blood pressure. Those undergoing PB diet with exercise training had greater improvements in muscular strength and cardiorespiratory fitness than those undergoing PB diet alone. Differences between intervention groups for other cardiometabolic measures are not yet known. DISCUSSION/SIGNIFICANCE OF IMPACT: Each of the interventions resulted in improved cardiometabolic measures; however the extent of the differences between the interventions is not yet clear. It is hypothesized that compared with weight loss induced by a PB diet, the same weight loss induced by a PB diet and structured exercise training will i) cause greater improvement in skeletal muscle insulin sensitivity, ii) will attenuate the usual decline in muscle mass while increasing strength, and iii) result in greater increases in left ventricular diastolic function. The long-term objective of this proposal is to provide a foundation for future studies evaluating mechanisms for the effects of exercise in cardiometabolic disease prevention and therapy.
The purpose of the present study was to examine the temperament and behavior problems of 32 toddlers born preterm and very low birth weight and 25 toddlers born full-term without medical problems. Mothers completed the Early Childhood Behavior Questionnaire and the Child Behavior Checklist-1.5–5 for assessing toddler`s temperament and behavior problems, respectively. The results showed that, regarding temperament, toddlers born preterm exhibited higher scores on the temperament dimensions Motor Activation, Perceptual Sensitivity, and High Intensity Pleasure, and lower scores on the temperament dimension Cuddliness than toddlers born full-term. In regard to behavior problems, toddlers born preterm showed higher attention problems scores than the comparison group. These findings indicated that children born preterm presented developmental vulnerabilities in temperament dimensions related to behavior problems at toddlerhood. Early intervention programs for preventing psychological problems in at-risk children, especially those born preterm, could focus on children’s temperament dispositions.
Exercise causes a dramatic increase in energy requirements because of the metabolic needs of working muscles. Exercise-dependent factors regulate fuel use. Absolute exercise intensity determines the exercise-induced increase in energy demands, whereas exercise intensity relative to an individual's maximal aerobic capacity (VO2max) determines the proportional contribution of different fuel sources (i.e. plasma glucose, plasma fatty acids, muscle glycogen and intramuscular triacylglycerols). Endurance training increases aerobic capacity in muscle and the oxidation of fat during exercise. In addition, exercise-independent factors, such as diet composition, sex, age, and body composition also influence substrate use during exercise. The present review discusses the regulation of substrate use during exercise in human subjects, with a focus on the role of exercise-independent factors.
Malnutrition is associated with an increased incidence of perioperative morbidity and mortality. To evaluate the effect of malnutrition on the metabolic and inflammatory response to surgery in patients with oesophageal cancer, we studied the effects of oesophagectomy in six patients with major (13·9 (se 1·3) %) weight loss and five patients with minor (0·7 (se 0·6) %) weight loss in the 6 months before to surgery. Rates of appearance (Ra) of glucose, glycerol, leucine and urea were determined by stable isotopically labelled tracer infusion before and after surgery. C-reactive protein was measured as an inflammation marker. BMI was lower in the patients with major weight loss than those with minor weight loss (20·3 (se 0·7) and 24·9 (se 1·5) kg/m2, P = 0·02). With the exception of greater glucose Ra in the major weight loss than minor weight loss subjects (11·1 (se 0·3) v. 9·5 (se 0·3) μmol/kg per min, P = 0·01), there were no differences in substrate kinetics before surgery between groups. Surgery increased glucose Ra, leucine Ra and urea Ra by 41, 24 and 58 %, respectively, in the total group. Changes in substrate kinetics in response to surgery were not different between patients with major and minor weight loss. Surgery increased C-reactive protein concentrations to a comparable extent in both groups. In conclusion, major upper gastrointestinal tract surgery in patients with oesophageal cancer elicits a catabolic response, characterized by increased inflammation, glucose production and protein breakdown. However, this catabolic response does not seem to be influenced by pre-operative nutritional status.
A theoretical model of microwave absorption in linear dielectric (non-ferroelectric) ionic crystals that takes into account the presence of point defects was synthesized and verified using NaCl single crystals. In the next stage of this research, we will introduce a controlled density of dislocations into the single crystal NaCl samples and study the effect on the microwave absorption mechanisms (ionic conduction, dielectric relaxation and multi-phonon processes) both theoretically and experimentally. Qualitative outlines of this modified theory are presented. The loss factor ε’ has been measured in the dislocation-free case by a cavity resonator insertion technique and the experimental results are in good agreement with the theoretical model. We describe the sample preparation technique that will be used to produce a controlled dislocation density in single crystal samples that will also be studied in our cavity resonator insertion system.
NASA's microwave observing program for SETI is presented. This strategy is composed of a high sensitivity, narrow frequency coverage, Target Search and a low sensitivity, broad frequency coverage, Sky Survey. The complementary nature of this dual mode search strategy is discussed. An overview is given of ongoing work in the development of the search strategy for the Sky Survey.
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