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Individuals with long-term physical health conditions (LTCs) experience higher rates of depression and anxiety. Conventional self-report measures do not distinguish distress related to LTCs from primary mental health disorders. This difference is important as treatment protocols differ. We developed a transdiagnostic self-report measure of illness-related distress, applicable across LTCs.
Methods
The new Illness-Related Distress (IRD) scale was developed through thematic coding of interviews, systematic literature search, think-aloud interviews with patients and healthcare providers, and expert-consensus meetings. An internet sample (n = 1,398) of UK-based individuals with LTCs completed the IRD scale for psychometric analysis. We randomly split the sample (1:1) to conduct: (1) an exploratory factor analysis (EFA; n = 698) for item reduction, and (2) iterative confirmatory factor analysis (CFA; n = 700) and exploratory structural equation modeling (ESEM). Here, further item reduction took place to generate a final version. Measurement invariance, internal consistency, convergent, test–retest reliability, and clinical cut-points were assessed.
Results
EFA suggested a 2-factor structure for the IRD scale, subsequently confirmed by iteratively comparing unidimensional, lower order, and bifactor CFAs and ESEMs. A lower-order correlated 2-factor CFA model (two 7-item subscales: intrapersonal distress and interpersonal distress) was favored and was structurally invariant for gender. Subscales demonstrated excellent internal consistency, very good test–retest reliability, and good convergent validity. Clinical cut points were identified (intrapersonal = 15, interpersonal = 12).
Conclusion
The IRD scale is the first measure that captures transdiagnostic distress. It may aid assessment within clinical practice and research related to psychological adjustment and distress in LTCs.
Members of the Shewanella genus transfer electrons to metal and actinide electron acceptors such as hexavalent uranium, U(VI), via c-type cytochromes. The intracellular mechanism of electron transfer is well studied but the delivery of electrons to external electron acceptors less well so. MtrC, a decaheme c-type cytochrome located on the cell surface side of the outer membrane of many Shewanella species, and extending to the extracellular medium, transfers electrons to U(VI), both in vivo and in vitro when purified. However, it is unclear how the electron transfer between the terminal heme(s) of the protein and extracellular U(VI) occurs. In particular, the type of interaction between MtrC and U(VI), and the parameters controlling electron transfer remain to be elucidated. Here, we investigated the kinetics of U(VI) reduction by S. baltica MtrC in solution for U(VI) complexed with one of five ligands: carbonate, hydroxyl, citrate, nitrilotriacetic acid (NTA) or ethylenediaminetetraacetic acid (EDTA). We observed two initial reaction rates, one more rapid for U-citrate, U-NTA and U-EDTA, and another slower for U-carbonate and U-hydroxo. By combining Nuclear Magnetic Resonance spectroscopy and M4-edge High Resolution X-ray Absorption Near Edge Structure spectroscopy, we attributed these differences to the type of interaction between the U-ligand complex and MtrC, i.e., probably electrostatic interaction with the ligand of U-EDTA, hydrogen bonding to the ligand of U-citrate and U-NTA, and covalent bonding with U-carbonate and U-hydroxo. We also demonstrate the persistence of U(V) in the U-carbonate system when interacting with MtrC. Overall, we showed that the mechanism of electron transfer depended on the chemistry of the soluble U(VI) complex serving as the substrate.
Data gathered from previous studies has demonstrated the efficacy and safety of lamotrigine in the adult psychiatric population; however, it has not been well studied in children and adolescents with mood disorders (Watanabe & Hongo, 2017).
Objective
The objective of this study is to understand patients’ perspective of Lamotrigine efficacy and safety when prescribed for children and adolescents with mood disorders.
Methods
A proposal was approved by the University of Missouri-Columbia Internal Review Board to conduct this study. To answer a questionnaire, 20 patients were randomly selected who were taking lamotrigine for mood disorder. All 20 patients were seen in person at the University of Missouri Child and Adolescent Psychiatry Out-patient Clinic. A consent form was reviewed and signed by their respective legal guardian. The questionnaire consisted of yes or no, and free-response questions. Each participant was asked a series of questions about their symptoms before and after lamotrigine, whether or not the medication was helpful, and whether or not they experienced any side effects. Additional details were also obtained, including dosage, the length of their prescription, and any concomitant medications. Demographic information, including age, race, gender, and grade, was also obtained.
Results
Among the participants, 65% were females and 35% were male patients who agreed to take the questionnaire. Fifty percent of the patients were between the ages of 16 and 18, 35% were between the ages of 11 and 15 and. 15% were between the ages of 8 and 10. Seventy present were Caucasian, 10% were African American, and 20% identified as belonging to another race. 35% of the patients were prescribed lamotrigine for less than a year, and 65% were prescribed lamotrigine for over a year. 30% of patients take 25-50mg daily, 25% take between 51-100mg daily, 40% take 101-200mg daily, and 5% take more than 200mg daily. Before lamotrigine was prescribed to the 20 patients in this study, collective reported symptoms included: anger, aggression, mood swings, irritability, depression, anxiety, and self-harm. Eighty percent of patients claimed lamotrigine improved their symptoms after taking the medication. Most improvement was claimed by patients with mood swings followed by patients with anger, aggression, and irritable mood. Seventy percent of patients reported no side effects with the medication. 10% of patients reported increased appetite, 5% reported rash, 5% GI issue, and other 10% reported various side effects, including fatigue, myalgia, and restlessness.
Conclusion
According to patients reports, this study provides data that lamotrigine may be effective in pediatric mood disorders and shows minimal adverse effects. Further larger clinical studies are needed to conclude the safety and efficacy of Lamotrigine in the treatment of pediatric mood disorder.
Research study complexity refers to variables that contribute to the difficulty of a clinical trial or study. This includes variables such as intervention type, design, sample, and data management. High complexity often requires more resources, advanced planning, and specialized expertise to execute studies effectively. However, there are limited instruments that scale study complexity across research designs. The purpose of this study was to develop and establish initial psychometric properties of an instrument that scales research study complexity.
Methods:
Technical and grammatical principles were followed to produce clear, concise items using language familiar to researchers. Items underwent face, content, and cognitive validity testing through quantitative surveys and qualitative interviews. Content validity indices were calculated, and iterative scale revision was performed. The instrument underwent pilot testing using 2 exemplar protocols, asking participants (n = 31) to score 25 items (e.g., study arms, data collection procedures).
Results:
The instrument (Research Complexity Index) demonstrated face, content, and cognitive validity. Item mean and standard deviation ranged from 1.0 to 2.75 (Protocol 1) and 1.31 to 2.86 (Protocol 2). Corrected item-total correlations ranged from .030 to .618. Eight elements appear to be under correlated to other elements. Cronbach’s alpha was 0.586 (Protocol 1) and 0.764 (Protocol 2). Inter-rater reliability was fair (kappa = 0.338).
Conclusion:
Initial pilot testing demonstrates face, content, and cognitive validity, moderate internal consistency reliability and fair inter-rater reliability. Further refinement of the instrument may increase reliability thus providing a comprehensive method to assess study complexity and related resource quantification (e.g., staffing requirements).
The escalating threat of antimicrobial resistance (AMR) necessitates impactful, reproducible, and scalable antimicrobial stewardship strategies. This review addresses the critical need to enhance the quality of antimicrobial stewardship intervention research. We propose five considerations for authors planning and evaluating antimicrobial stewardship initiatives. Antimicrobial stewards should consider the following mnemonic ABCDE: (A) plan Ahead using implementation science; (B) Be clear and thoroughly describe the intervention by using the TidIER checklist; (C) Use a Checklist to comprehensively report study components; (D) Select a study Design carefully; and (E) Assess Effectiveness and implementation by selecting meaningful outcomes. Incorporating these recommendations will help strengthen the evidence base of antimicrobial stewardship literature and support optimal implementation of strategies to mitigate AMR.
Newcastle disease (ND) is a notifiable disease affecting chickens and other avian species caused by virulent strains of Avian paramyxovirus type 1 (APMV-1). While outbreaks of ND can have devastating consequences, avirulent strains of APMV-1 generally cause subclinical infections or mild disease. However, viruses can cause different levels of disease in different species and virulence can evolve following cross-species transmission events. This report describes the detection of three cases of avirulent APMV-1 infection in Great Britain (GB). Case 1 emerged from the ‘testing to exclude’ scheme in chickens in Shropshire while cases 2 and 3 were made directly from notifiable avian disease investigations in chicken broilers in Herefordshire and on premises in Wiltshire containing ducks and mixed species, respectively). Class II/genotype I.1.1 APMV-1 from case 1 shared 99.94% identity to the Queensland V4 strain of APMV-1. Class II/genotype II APMV-1 was detected from case 2 while the class II/genotype I.2 virus from case 3 aligned closely with strains isolated from Anseriformes. Exclusion of ND through rapid detection of avirulent APMV-1 is important where clinical signs caused by avirulent or virulent APMV-1s could be ambiguous. Understanding the diversity of APMV-1s circulating in GB is critical to understanding disease threat from these adaptable viruses.
Background: Healthcare facilities have experienced many challenges during the COVID-19 pandemic, including limited personal protective equipment (PPE) supplies. Healthcare personnel (HCP) rely on PPE, vaccines, and other infection control measures to prevent SARS-CoV-2 infections. We describe PPE concerns reported by HCP who had close contact with COVID-19 patients in the workplace and tested positive for SARS-CoV-2. Method: The CDC collaborated with Emerging Infections Program (EIP) sites in 10 states to conduct surveillance for SARS-CoV-2 infections in HCP. EIP staff interviewed HCP with positive SARS-CoV-2 viral tests (ie, cases) to collect data on demographics, healthcare roles, exposures, PPE use, and concerns about their PPE use during COVID-19 patient care in the 14 days before the HCP’s SARS-CoV-2 positive test. PPE concerns were qualitatively coded as being related to supply (eg, low quality, shortages); use (eg, extended use, reuse, lack of fit test); or facility policy (eg, lack of guidance). We calculated and compared the percentages of cases reporting each concern type during the initial phase of the pandemic (April–May 2020), during the first US peak of daily COVID-19 cases (June–August 2020), and during the second US peak (September 2020–January 2021). We compared percentages using mid-P or Fisher exact tests (α = 0.05). Results: Among 1,998 HCP cases occurring during April 2020–January 2021 who had close contact with COVID-19 patients, 613 (30.7%) reported ≥1 PPE concern (Table 1). The percentage of cases reporting supply or use concerns was higher during the first peak period than the second peak period (supply concerns: 12.5% vs 7.5%; use concerns: 25.5% vs 18.2%; p Conclusions: Although lower percentages of HCP cases overall reported PPE concerns after the first US peak, our results highlight the importance of developing capacity to produce and distribute PPE during times of increased demand. The difference we observed among selected groups of cases may indicate that PPE access and use were more challenging for some, such as nonphysicians and nursing home HCP. These findings underscore the need to ensure that PPE is accessible and used correctly by HCP for whom use is recommended.
Castration of male piglets in the United States is conducted without analgesics because no Food and Drug Administration (FDA) approved products are labeled for pain control in swine. The absence of approved products is primarily due to a wide variation in how pain is measured in suckling piglets and the lack of validated pain-specific outcomes individually indistinct from other biological responses, such as general stress or inflammation responses with cortisol. Simply put, to measure pain mitigation, measurement of pain must be specific, quantifiable, and defined. Therefore, given the need for mitigating castration pain, a consortium of researchers, veterinarians, industry, and regulatory agencies was formed to identify potential animal-based outcomes and develop a methodology, based on the known scientific research, to measure pain and the efficacy of mitigation strategies. The outcome-based measures included physiological, neuroendocrine, behavioral, and production parameters. Ultimately, this consortium aims to provide a validated multimodal methodology to demonstrate analgesic drug efficacy for piglet castration.
Measurable outcomes were selected based on published studies suggesting their validity, reliability, and sensitivity for the direct or indirect measurement of pain associated with surgical castration in piglets. Outcomes to be considered are observation of pain behaviors (i.e. ethogram defined behaviors and piglet grimace scale), gait parameters measured with a pressure mat, infrared thermography of skin temperature of the cranium and periphery of the eye, and blood biomarkers. Other measures include body weight and mortality rate.
This standardized measurement of the outcome variable's primary goal is to facilitate consistency and rigor by developing a research methodology utilizing endpoints that are well-defined and reliably measure pain in piglets. The resulting methodology will facilitate and guide the evaluation of the effectiveness of comprehensive analgesic interventions for 3- to 5-day-old piglets following surgical castration.
Healthcare personnel with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection were interviewed to describe activities and practices in and outside the workplace. Among 2,625 healthcare personnel, workplace-related factors that may increase infection risk were more common among nursing-home personnel than hospital personnel, whereas selected factors outside the workplace were more common among hospital personnel.
The novel coronavirus disease 2019 (COVID-19) pandemic upended the world. As emergency departments and hospitals across the nation and world braced themselves for the surge of this new disease, the emergency department (ED) at Children’s National Hospital (CNH) quickly created a process to address surges in patient visits and follow-ups for coronavirus testing. Within 2 wk of the first reported pediatric patient diagnosed with COVID-19 in the Washington, DC, metropolitan area, CNH ED implemented a new comprehensive follow-up process. This article describes the novel process that ensured timely notification of testing results, enabled patients to speak remotely with ED providers, increased patient and staff safety by reducing unnecessary exposures, and suggested a good patient experience. With over 1900 patients discharged pending their COVID-19 results, the program is successful. We anticipate expansion into antibody testing and notification as the pandemic progresses.
Much of the pivotal debate concerning the validity of affirmative action is situated in a legal context of defending or challenging claims that there may be broad societal gains from increased diversity. Race-conscious affirmative action policies originally advanced legal sanctions to promote racial equity in the United States. Today, increasingly detached from its historical context, defense or rejection of affirmative action is otherwise upheld to achieve diversity. A “diversity” rationale for affirmative action calls for increasing tolerance of the “other,” reducing negative stereotypes, and moderating prejudice as goals—all objectives that deviate from the former aim of race-targeted inclusion intended to resolve racial discrimination in employment and college admissions. Diversity policy provides a tapered defense for affirmative action, one detached from principles of justice and equity. The current article suggests that, despite the fact that the ostensible benefits of “racial inclusion as diversity” may be the remaining legal prop for affirmative action in the U.S., there is a need to consider whether diversity intrinsically can engender the benefits that affirmative action policy seeks to provide.
To evaluate the feasibility and acceptability of the Takeaway Masterclass, a three-hour training session delivered to staff of independent takeaway food outlets that promoted healthy cooking practices and menu options.
Design:
A mixed-methods study design. All participating food outlets provided progress feedback at 6 weeks post-intervention. Baseline and 6-week post-intervention observational and self-reported data were collected in half of participating takeaway food outlets.
Setting:
North East England.
Participants:
Independent takeaway food outlet owners and managers.
Results:
Staff from eighteen (10 % of invited) takeaway food outlets attended the training; attendance did not appear to be associated with the level of deprivation of food outlet location. Changes made by staff that required minimal effort or cost to the business were the most likely to be implemented and sustained. Less popular changes included using products that are difficult (or expensive) to source from suppliers, or changes perceived to be unpopular with customers.
Conclusion:
The Takeaway Masterclass appears to be a feasible and acceptable intervention for improving cooking practices and menu options in takeaway food outlets for those who attended the training. Further work is required to increase participation and retention and explore effectiveness, paying particular attention to minimising adverse inequality effects.
OBJECTIVES/SPECIFIC AIMS: Engaging patients and consumers in research is a complex process where innovative strategies are needed to effectively translate scientific discoveries into improvements in the public’s health (Wilkins et. al., 2013; Terry et. al., 2013). The Clinical Translational Science Awards (CTSA)—supported by the National Institute of Health (NIH) under the auspices of the National Center for Advancing Translational Sciences (NCATS)—aim to provide resources and support needed to strengthen our nation’s clinical and translational research (CTR) enterprise. In 2008, Stanford University was awarded a CTSA from the NIH, establishing Spectrum (Stanford Center for Clinical and Translational Research and Education) and its Community Engagement (CE) Program aimed at building long-standing community-academic research partnerships for translational research in the local area surrounding Stanford University. To date, the CE Pilot Program has funded 38 pilot projects from the 2009-2017 calendar year. The purpose of this study was to understand, through a unique pilot program, the barriers, challenges, and facilitators to community-engaged research targeting health disparities as well as community-academic partnerships. METHODS/STUDY POPULATION: Investigators conducted a qualitative study of the community engagement pilot program. Previous pilot awardees were recruited via email and phone to participate in a one-hour focus group to discuss their pilot project experience—describing any barriers, challenges, and facilitators to implementing their pilot project. RESULTS/ANTICIPATED RESULTS: The focus group revealed that community engage research through the pilot program was not only appreciated by faculty, but projects were successful, and partnerships developed were sustained after funding. Specifically, the pilot program has seen success in both traditional and capacity building metrics: the initial investment of $652,250.00 to fund 38 projects has led to over $11 million dollars in additional grant funding. In addition, pilot funding has led to peer-reviewed publications, data resources for theses and dissertations, local and national presentations/news articles, programmatic innovation, and community-level impact. Challenges and barriers were mainly related to timing, grant constraints, and university administrative processes. DISCUSSION/SIGNIFICANCE OF IMPACT: The Community Engagement Pilot Program demonstrates an innovative collaborative approach to support community-academic partnerships. This assessment highlights the value and importance of pilot program to increase community engaged research targeting health disparities. Challenges are mainly administrative in nature: pilot awardees mentioned difficulties working on university quarterly timelines, challenges of subcontracting or sharing money with community partners, onerous NIH prior approval process, and limitations to carryover funding. However, pilot grants administered through the program strengthen the capacity to develop larger scale community-based research initiatives.
The Virtual Personalities Model is a motive-based neural network model that provides both a psychological model and a computational implementation that explicates the dynamics and often large within-person variability in behavior that arises over time. At the same time the same model can produce—across many virtual personalities—between-subject variability in behavior that when factor analyzed yields familiar personality structure (e.g., the Big Five). First, we describe our personality model and its implementation as a neural network model. Second, we focus on detailing the neurobiological underpinnings of this model. Third, we examine the learning mechanisms, and their biological substrates, as ways that the model gets “wired up,” discussing Pavlovian and Instrumental conditioning, Pavlovian to Instrumental transfer, and habits. Finally, we describe the dynamics of how initial differences in propensities (e.g., dopamine functioning), wiring differences due to experience, and other factors could operate together to develop and change personality over time, and how this might be empirically examined. Thus, our goal is to contribute to the rising chorus of voices seeking a more precise neurobiologically based science of the complex dynamics underlying personality.
The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.
Hypervelocity stars (HVSs) are characterized by a total velocity in excess of the Galactic escape speed, and with trajectories consistent with coming from the Galactic Centre. We apply a novel data mining routine, an artificial neural network, to discover HVSs in the TGAS subset of the first data release of the Gaia satellite, using only the astrometry of the stars. We find 80 stars with a predicted probability >90% of being HVSs, and we retrieved radial velocities for 47 of those. We discover 14 objects with a total velocity in the Galactic rest frame >400 km s−1, and 5 of these have a probability >50% of being unbound from the Milky Way. Tracing back orbits in different Galactic potentials, we discover 1 HVS candidate, 5 bound HVS candidates, and 5 runaway star candidates with remarkably high velocities, between 400 and 780 km s−1. We wait for future Gaia releases to confirm the goodness of our sample and to increase the number of HVS candidates.
What is the role of the situation in situational judgment tests (SJTs)? Lievens and Motowidlo (2016) assert that SJTs are somewhat of a misnomer because they do not actually measure how individuals would behave in a given situation per se. According to these researchers, SJTs assess general domain knowledge—whether potential employees recognize the “utility of expressing certain traits” (p. 4). As a result, SJTs map onto personality measures, which are a summary of behavior across time and situations. SJTs provide predictive validity in part because they tap into personality. However, rather than renaming SJTs, it is possible to reintroduce the concept of a situation to provide even greater predictive power. Thus, the goals of this commentary are to (a) clarify what constitutes a situation, (b) describe what SJTs might actually measure, and (c) set forth a path for a taxonomy of workplace situations.
Bloodstream infections due to methicillin-resistant Staphylococcus aureus (MRSA) have been associated with significant risk of in-hospital mortality. The acute physiology and chronic health evaluation (APACHE) II score was developed and validated for use among intensive care unit (ICU) patients, but its utility among non-ICU patients is unknown. The aim of this study was to determine the ability of APACHE II to predict death at multiple time points among ICU and non-ICU patients with MRSA bacteremia.
Design.
Retrospective cohort study.
Participants.
Secondary analysis of data from 200 patients with MRSA bacteremia at 2 hospitals.
Methods.
Logistic regression models were constructed to predict overall in-hospital mortality and mortality at 48 hours, 7 days, 14 days, and 30 days using APACHE II scores separately in ICU and non-ICU patients. The performance of APACHE II scores was compared with age adjustment alone among all patients. Discriminatory ability was assessed using the c-statistic and was compared at each time point using X2 tests. Model calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test.
Results.
APACHE II was a significant predictor of death at all time points in both ICU and non-ICU patients. Discrimination was high in all models, with c-statistics ranging from 0.72 to 0.84, and was similar between ICU and non-ICU patients at all time points. APACHE II scores significantly improved the prediction of overall and 48-hour mortality compared with age adjustment alone.
Conclusions.
The APACHE II score may be a valid tool to control for confounding or for the prediction of death among ICU and non-ICU patients with MRSA bacteremia.