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This study aimed to refine the content of a new patient-reported outcome (PRO) measure via cognitive interviewing techniques to assess the unique presentation of depressive symptoms in older adults with cancer (OACs).
Methods
OACs (≥ 70years) with a history of a depressive disorder were administered a draft measure of the Older Adults with Cancer – Depression (OAC-D) Scale, then participated in a semi-structured cognitive interview to provide feedback on the appropriateness, comprehensibility, and overall acceptability of measure. Interviews were audio-recorded and transcribed, and qualitative methods guided revision of scale content and structure.
Results
OACs (N = 10) with a range of cancer diagnoses completed cognitive interviews. Participants felt that the draft measure took a reasonable amount of time to answer and was easily understandable. They favored having item prompts and response anchors repeated with each item for ease of completion, and they helped identify phrasing and wording of key terms consistent with the authors’ intended constructs. From this feedback, a revised version of the OAC-D was created.
Significance of results
The OAC-D Scale is the first PRO developed specifically for use with OACs. The use of expert and patient input and rigorous cognitive interviewing methods provides a conceptually accurate means of assessing the unique symptom experience of OACs with depression.
Evaluate Department of Defense (DoD) antimicrobial stewardship programs (ASPs) by assessing the relationship between key clinical outcome metrics (antibiotic use, incidence of resistant pathogens, and incidence of Clostridioides difficile infections) and CDC Core Element (CE) adherence.
Design:
Retrospective, cross-sectional study of DoD hospitals in 2018 and 2021
Methods:
National Healthcare Safety Network Standardized Antimicrobial Administration Ratios (SAARs) were used to measure antibiotic use and microbiology results to evaluate four types of pathogen incidence. A novel CE scoring approach used scores to quantitatively assess relationships with CE adherence and outcome metrics using correlation and regression models. Assessments were repeated with 2021 data for Priority CE adherence and to conduct adjusted regressions for CEs and Priority CEs controlling for categorical bed size.
Results:
Compared to 2022 national data, DoD hospitals in 2021 had a similar proportion of facilities with a SAAR statistically significantly > 1.0. Leadership, Action, and Tracking CEs followed a more normal score distribution, while Reporting and Education were somewhat left-skewed. Unadjusted models often showed a positive relationship with higher CE scores associated with worse outcomes for the SAAR and pathogen incidence. Adjusted models indicated that procedural CEs, particularly Priority Reporting, were associated with better ASP-related outcomes.
Conclusions:
CEs should be more quantitatively assessed. Results provide initial evidence to prioritize procedural CE implementation within the DoD; however, additional investigation for structural CEs is needed. Patient outcome data should be collected as an important indicator of ASP performance.
Characterization and assessment of Department of Defense’s (DoD’s) Antibiotic Stewardship Programs (ASPs) to determine adherence to Centers for Disease Control and Prevention (CDC) Core Elements and compare to national adherence
Design:
Retrospective, observational with supplemental survey
Methods:
Facility characteristics and CDC Core Elements (CE) adherence data for 2017–2021 were retrieved from the National Healthcare Safety Network’s (NHSN) annual hospital survey with DoD data from the Defense Health Agency and national data from the Antibiotic Resistance and Patient Safety Portal. An online supplemental survey was administered to DoD hospitals. Descriptive statistics and bivariate analyses were completed for facility characteristics and supplemental survey questions to determine correlations between variables. A framework analysis compared DoD ASPs to CEs and Priority Elements.
Results:
Supplemental surveys were completed for 85.1% of DoD’s hospitals. DoD’s hospitals were smaller on average than national hospitals. ASP leaders were assigned more often than volunteer and typically served in the role for less than four years. Staffing mix differed, with more equivalent proportions of civilian/contractor to military at larger hospitals in the U.S. Most DoD ASPs consisted of ≤ 25% pharmacists. ASP leaders were largely available on a daily basis; pharmacist leaders spent more time on ASP activities than physicians. CE adherence was high, but in 2021 DoD lagged national adherence in the structural CEs of Leadership, Accountability, and Pharmacy Expertise.
Conclusions:
DoD hospitals lagged in national adherence to the structural CEs, presenting opportunities for ASP improvement. Refinement of CE adherence measurements, coupled with impact on health outcomes, could aid in better-identifying areas for improvement.
To examine the effectiveness of short-term progressive muscle relaxation therapy in reducing symptoms of depression, anxiety, and aggression/agitation, in patients on an inpatient psychiatric unit. Additionally, to determine the impact of clinical and sociodemographic factors on its effectiveness.
Methods
Psychiatric inpatients at a private, community-based psychiatric hospital were invited to participate in a progressive muscle relaxation activity and filled out pre- and post-activity surveys querying symptoms of depression, anxiety, and aggression/agitation, using a created Likert scale.
Results
The 57 participants in this study showed an average decrease in every symptom domain, including -0.93 in agitation/aggressive symptoms (p<0.001), -2.14 in depressive symptoms (p<0.001), and -1.81 in anxiety symptoms (p<0.001). While diagnosis did not appear to be significantly related to change in score, patients with different primary diagnoses had changes in different symptom domains, with patients with Bipolar Disorder having statistically significant changes in aggression (-1.57, p=0.012) and depression (-2.36, p<0.001), but not in anxiety. Patients with Depression had significant changes in depression (-2.08, p<0.001) and anxiety (-1.96, p<0.001) but not in aggression/agitation, while patients with a Schizophrenia spectrum illness had changes in depression alone (-2.33, p=0.008). Sociodemographic variables had no significant impact.
Conclusions
The findings in this study indicate that a short-term progressive muscle relaxation intervention can lead to statistically and clinically significant changes across various symptom domains and in patients with a variety of psychiatric diagnoses, and support the implementation of this non-invasive and budget-friendly exercise.
Adolescence is a critical period for preventing substance use and mental health concerns, often targeted through separate school-based programs. However, co-occurrence is common and is related to worse outcomes. This study explores prevention effects of leading school-based prevention programs on co-occurring alcohol use and psychological distress.
Methods
Data from two Australian cluster randomized trials involving 8576 students in 97 schools were harmonized for analysis. Students received either health education (control) or one of five prevention programs (e.g. Climate Schools, PreVenture) with assessments at baseline and 6, 12, 24, and 30 or 36 months (from ages ~13–16). Multilevel multinomial regressions were used to predict the relative risk ratios (RRs) of students reporting co-occurring early alcohol use and psychological distress, alcohol use only, distress only, or neither (reference) across programs.
Results
The combined Climate Schools: Alcohol and Cannabis and Climate Schools: Mental Health courses (CSC) as well as the PreVenture program reduced the risk of adolescents reporting co-occurring alcohol use and psychological distress (36 months RRCSC = 0.37; RRPreVenture = 0.22). Other evaluated programs (excluding Climate Schools: Mental Health) only appeared effective for reducing the risk of alcohol use that occurred without distress.
Conclusions
Evidence-based programs exist that reduce the risk of early alcohol use with and without co-occurring psychological distress, though preventing psychological distress alone requires further exploration. Prevention programs appear to have different effects depending on whether alcohol use and distress present on their own or together, thus suggesting the need for tailored prevention strategies.
There is strong evidence for a general psychopathology dimension which captures covariance among all forms of psychopathology, yet its nature and underlying association with personality remain unclear. This study examined the co-development of general psychopathology and four high-risk personality traits: anxiety sensitivity, negative thinking, sensation seeking, and impulsivity. Data from two large Australian school-based randomised controlled trials of substance use prevention programs were analysed (N = 2,083, mean age at baseline = 13.49 years). Adolescents completed self-report measures of psychopathology symptoms and personality at baseline, one-, two-, and three-years post-baseline. Latent curve models with structured residuals, were used to examine the co-development of general psychopathology (extracted from a higher-order model) and personality traits from 13 to 16 years of age, controlling for age, sex, and cohort. Higher than usual levels of anxiety sensitivity and impulsivity were associated with higher than usual levels of general psychopathology at subsequent time points, and higher than usual levels of general psychopathology were associated with higher than usual levels of negative thinking at later time points. Sensation seeking was unrelated to general psychopathology. These findings enhance our understanding of the meaning and validity of general psychopathology, highlighting potential personality-based prevention and intervention targets.
This chapter describes Psychosis Identification and Early Referral (PIER), a clinical and public health system for identifying, treating, and rehabilitating young people at risk for major psychosis and psychotic disorders. A specialized clinical team educates key sectors of the community in identifying very early signs and symptoms of a likely psychosis in youth ages 10–25. The team then rigorously assesses those referred and found at risk and provides family-aided assertive community treatment. This model was originally developed for schizophrenia in young adults, and it has been adapted for the much younger and less seriously symptomatic and disabled at-risk population. The model includes flexible, in-vivo clinical treatment, family psychoeducation, cognitive-behavioral therapy, occupational therapy, supported education and supported employment, and psychiatric and nursing care. PIER has been tested across six population-representative sites in the United States; within testing periods, very few participating youths have experienced psychosis and about 90 percent are in school or working. It has been replicated widely enough that it is available to over 15 percent of the US population.
This introduction to robotics offers a distinct and unified perspective of the mechanics, planning and control of robots. Ideal for self-learning, or for courses, as it assumes only freshman-level physics, ordinary differential equations, linear algebra and a little bit of computing background. Modern Robotics presents the state-of-the-art, screw-theoretic techniques capturing the most salient physical features of a robot in an intuitive geometrical way. With numerous exercises at the end of each chapter, accompanying software written to reinforce the concepts in the book and video lectures aimed at changing the classroom experience, this is the go-to textbook for learning about this fascinating subject.
Bacterial superinfection and antibiotic prescribing in the setting of the current mpox outbreak are not well described in the literature. This retrospective observational study revealed low prevalence (11%) of outpatient antibiotic prescribing for bacterial superinfection of mpox lesions; at least 3 prescriptions (23%) were unnecessary.
The present study examined high-risk personality traits and associations with psychopathology across multiple levels of a hierarchical-dimensional model of psychopathology in a large adolescent, general population sample. Confirmatory factor analyses were run using data from two randomized controlled trials of Australian adolescents (N = 8,654, mean age = 13.01 years, 52% female). A higher-order model – comprised of general psychopathology, fear, distress, alcohol use/harms, and conduct/inattention dimensions – was selected based on model fit, reliability, and replicability. Indirect-effects models were estimated to examine the unique associations between high-risk personality traits (anxiety sensitivity, negative thinking, impulsivity, and sensation seeking) and general and specific dimensions and symptoms of psychopathology. All personality traits were positively associated with general psychopathology. After accounting for general psychopathology, anxiety sensitivity was positively associated with fear; negative thinking was positively associated with distress; impulsivity was positively associated with conduct/inattention; and sensation seeking was positively associated with alcohol use/harms and conduct/inattention, and negatively associated with fear. Several significant associations between personality traits and individual symptoms remained after accounting for general and specific psychopathology. These findings contribute to our understanding of the underlying structure of psychopathology among adolescents and have implications for the development of personality-based prevention and early intervention programs.
The objective of this study was to assess the effect of providing mats in the farrowing pen on behaviour and lesions in sows (n = 38) and piglets. Nineteen of the sows and their litters housed in farrowing crates with metal slatted floors were provided with mats, the remaining 19 acting as controls. Sow skin was inspected pre-farrowing and at weaning: the skin and feet of piglets were examined when they were 6 days old. Skin lesions were scored (on a scale of 0 to 6) according to severity. Total lesion scores per sow and median total lesion scores per litter were calculated. Sow behaviour was recorded by direct observation at feeding. Usage of a heat pad for lying in the presence or absence of mats was assessed over a 2hr observation period. Median skin lesion scores of sows did not differ between treatments. Litters from the control treatment had lower skin lesion scores (median [range] 8 [2-12] vs 10 [5-21]; P < 0.05). Median lesion scores of the front legs tended to be higher for piglets on mats (median [range] 8 [1.5-13] vs 4 [1.5-8]; ns). Sows on metal flooring went from kneeling to lowering their hindquarters faster (median [range] 15 [2—45] s) than sows on mats (23 [11—54] s) (P < 0.05). Furthermore, they slipped more on their front (median [range] 2.7 [0-8.7] vs 0 [0-1.3] slips min1; P < 0.001) and hind (median [range] 5.3 [0.3-31.7] vs 1.9 [0-33.3] slips min1; P < 0.05) feet while standing, than sows on mats. More piglets lay on the heat pad when it was covered by a mat (mean ± SEM 45.97 ± 4.49 %) than when no mat was provided (29.29 ± 4.47 %)(P < 0.05). Mats improve sow comfort and reduce slipping. They encourage piglets to lie on the heat pad but cause damage to the skin of the front legs. Providing pigs with mats in the farrowing house could greatly improve welfare on slatted floors, but further research is needed to identify materials that are less abrasive.
The redshifted cosmological 21-cm signal emitted by neutral hydrogen during the first billion years of the universe is much fainter relative to other galactic and extragalactic radio emissions, posing a great challenge towards detection of the signal. Therefore, precise instrumental calibration is a vital prerequisite for the success of radio interferometers such as the Murchison Widefield Array (MWA), which aim for a 21-cm detection. Over the previous years, novel calibration techniques targeting the power spectrum paradigm of EoR science have been actively researched and where possible implemented. Some of these improvements, for the MWA, include the accuracy of sky models used in calibration and the treatment of ionospheric effects, both of which introduce unwanted contamination to the EoR window. Despite sophisticated non-traditional calibration algorithms being continuously developed over the years to incorporate these methods, the large datasets needed for EoR measurements require high computational costs, leading to trade-offs that impede making use of these new tools to maximum benefit. Using recently acquired computation resources for the MWA, we test the full capabilities of the state-of-the-art calibration techniques available for the MWA EoR project, with a focus on both direction-dependent and direction-independent calibration. Specifically, we investigate improvements that can be made in the vital calibration stages of sky modelling, ionospheric correction, and compact source foreground subtraction as applied in the hybrid foreground mitigation approach (one that combines both foreground subtraction and avoidance). Additionally, we investigate a method of ionospheric correction using interpolated ionospheric phase screens and assess its performance in the power spectrum space. Overall, we identify a refined RTS calibration configuration that leads to an at least 2 factor reduction of the EoR window power contamination at the
$0.1 \; \textrm{hMpc}^{-1}$
scale. The improvement marks a step further towards detecting the 21-cm signal using the MWA and the forthcoming SKA low telescope.
Reaction time variability (RTV) has been estimated using Gaussian, ex-Gaussian, and diffusion model (DM) indices. Rarely have studies examined interrelationships among these performance indices in childhood, and the use of reaction time (RT) computational models has been slow to take hold in the developmental psychopathology literature. Here, we extend prior work in adults by examining the interrelationships among different model parameters in the ABCD sample and demonstrate how computational models of RT can clarify mechanisms of time-on-task effects and sex differences in RTs.
Method:
This study utilized trial-level data from the stop signal task from 8916 children (9–10 years old) to examine Gaussian, ex-Gaussian, and DM indicators of RTV. In addition to describing RTV patterns, we examined interrelations among these indicators, temporal patterns, and sex differences.
Results:
There was no one-to-one correspondence between DM and ex-Gaussian parameters. Nonetheless, drift rate was most strongly associated with standard deviation of RT and tau, while nondecisional processes were most strongly associated with RT, mu, and sigma. Performance worsened across time with changes driven primarily by decreasing drift rate. Boys were faster and less variable than girls, likely attributable to girls’ wide boundary separation.
Conclusions:
Intercorrelations among model parameters are similar in children as has been observed in adults. Computational approaches play a crucial role in understanding performance changes over time and can also clarify mechanisms of group differences. For example, standard RT models may incorrectly suggest slowed processing speed in girls that is actually attributable to other factors.
In this chapter, we examine how creativity, intelligence, and wisdom are related in theoretical frameworks and empirical studies. First, definitions of the three constructs are discussed. Although all of them are complex and multifaceted, the relationship between creativity and intelligence has been extensively studied based on their working definitions and models. However, wisdom research remains sparse, and there is a gap between people’s common beliefs and explicit theories of how wisdom is related to intelligence and creativity. Regardless, some common elements of wisdom have been distilled. These include self-awareness, knowledge, and strategies to cope with uncertainty, which can lead to contributions to social goodness. Second, several empirical studies are reviewed. They show some relationships among the three constructs, but the results have been inconsistent. Third, the WICS model, as a cognitive framework, is used to understand the relationships among the three constructs. The model integrated intelligence, creativity, and wisdom, and has also been tested in some fields. Finally, we argue that wisdom, as a distinguishable component of ability, can help determine whether our intelligence and creativity will be harnessed toward benevolence or malevolence.
The use of ‘cut-and-carry’ (the mechanical harvesting and feeding of fresh grass) has increased in some temperate regions in recent years and evidence suggests that sward management practices in this system differ to conventional grazing. In order to investigate this further, a 2 × 3 × 2 factorial experiment was used to examine the effect of low (1489 kg dry matter (DM)/ha; LHM) and high (2142 kg DM/ha; HHM) pre-cutting herbage mass; three ryegrass cultivars, diploid perennial ryegrass (Lolium perenne; DIP), tetraploid perennial ryegrass (TET) and a hybrid ryegrass (Lolium multiflorum × L. perenne; HY); and the inclusion of red clover (Trifolium pratense) on sward herbage production, nutritive value and ryegrass morphology. Plots were harvested according to herbage mass from March to November in 2018 and 2019. Annual DM production was 1489 kg DM/ha higher in HHM than in LHM swards. Pre-cutting herbage mass had no effect on organic matter digestibility (OMD) in early season for DIP and TET swards or in late season for all cultivars. There was an interaction between ryegrass cultivar and clover inclusion in annual yield whereby red clover increased DM production in all cultivars however, its effect was largest in HY swards. Red clover inclusion increased DM production but reduced OMD in early and mid-seasons. Overall, TET swards were lowest in neutral detergent fibre and highest in OMD compared to HY and DIP. Pre-cutting herbage mass, ryegrass cultivar and red clover inclusion require careful consideration when establishing and managing pastures in cut-and-carry systems.
To overcome grass supply shortages on the main grazing block, some pasture-based dairy farmers are using zero-grazing (also known as ‘cut and carry’), whereby cows are periodically housed and fed fresh grass harvested from external land blocks. To determine the effect of zero-grazing on cow performance, two early-lactation experiments were conducted with autumn and spring-calving dairy cows. Cows were assigned to one of two treatments in a randomized complete block design. The two treatments were zero-grazing (ZG) and grazing (G). The ZG group were housed and fed zero-grazed grass, while the G group grazed outdoors at pasture. Both treatments were fed perennial ryegrass (Lolium perenne L.) from the same paddock. In experiment 1, 24 Holstein Friesian cows (n = 12) were studied over a 35-day experimental period in autumn and offered fresh grass, grass silage, ground maize and concentrates. In experiment 2, 30 Holstein Friesian cows (n = 15) were studied over a 42-day experimental period and offered fresh grass and concentrates. Average dry matter intake and milk yield was similar for ZG and G in both experiments. Likewise, ZG did not have an effect on milk composition, body condition or locomotion. Zero-grazing had no effect on total nitrogen excretion or nitrogen utilization efficiency in either experiment, or on rumen pH and ammonia concentration in experiment 1. While zero-grazing may enable farmers to supply fresh grass to early-lactation cows in spring and autumn, results from this study suggest that there are no additional benefits to cow performance in comparison to well-managed grazed grass.
Caregivers of patients with cancer are at significant risk for existential distress. Such distress negatively impacts caregivers’ quality of life and capacity to serve in their role as healthcare proxies, and ultimately, contributes to poor bereavement outcomes. Our team developed Meaning-Centered Psychotherapy for Cancer Caregivers (MCP-C), the first targeted psychosocial intervention that directly addresses existential distress in caregivers.
Method
Nine caregivers of patients with glioblastoma multiforme (GBM) enrolled in a pilot randomized controlled trial evaluating the feasibility, acceptability, and effects of MCP-C, and completed in-depth interviews about their experience in the therapy. One focus group with three MCP-C interventionists was also completed.
Results
Four key themes emerged from interviews: (1) MCP-C validated caregivers’ experience of caregiving; (2) MCP-C helped participants reframe their “caregiving identity” as a facet of their larger self-identity, by placing caregiving in the context of their life's journey; (3) MCP-C enabled caregivers to find ways to assert their agency through caregiving; and (4) the structure and sequence of sessions made MCP-C accessible and feasible. Feedback from interventionists highlighted several potential manual changes and overall ways in which MCP-C can help facilitate caregivers’ openness to discussing death and engaging in advanced care planning discussions with the patient.
Significance of results
The overarching goal of MCP-C is to allow caregivers to concurrently experience meaning and suffering; the intervention does not seek to deny the reality of challenges endured by caregivers, but instead to foster a connection to meaning and purpose alongside their suffering. Through in-depth interviews with caregivers and a focus group with MCP interventionists, we have refined and improved our MCP-C manual so that it can most effectively assist caregivers in experiencing meaning and purpose, despite inevitable suffering.
One source of the idea that Taiwan independence would be politically desirable is belief in the concept of “Taiwan subjectivity,” which indicates that Taiwan is not an appendage of China but instead an autonomous actor charting its own course – or trying to do so in the face of huge difficulties. The ruling (since 2016) Democratic Progressive Party (DPP) pledges fealty to the goal of ultimately realizing subjectivity but cannot aggressively pursue the agenda because of opposition from the People's Republic of China (PRC), the United States, and some in Taiwan itself. What might that agenda be? Using a Structural Topic Model, we excavate the subjectivity discourse as it developed from 2008 to 2020 in the mainstream DPP-supporting newspaper, the Liberty Times. We find fourteen topics associated with the concept, the most prevalent of which in recent years warn of threats to subjectivity's realization in the political and sociocultural spheres.
Little information is available on the phenotypic performance of perennial ryegrass varieties when exposed to grazing conditions on commercial grassland farms. Grass varieties are classically evaluated in mechanically defoliated plot systems which, although designed to mimic grazing conditions, do not fully capture the range of stresses or interactions that a sward is subjected to under commercial settings or over any period longer than 4 years. The evolution of technology in the form of PastureBase Ireland has led to agronomic data of individual paddocks being made available for analysis over multiple years. Data used in the current study consisted of dry matter (DM) production and ground score data across a 7-year period from ten perennial ryegrass varieties grown as monocultures in 559 paddocks on 98 commercial farms. The results demonstrated how perennial ryegrass variety is associated with a range of agronomic performance traits on commercial farms; including total and seasonal DM production, grazing DM production and number of grazing events. Varieties with the highest total DM production also had the highest spring and mid-season DM production; autumn DM production was associated with the interaction between variety and year. The highest producing variety in the study, AberGain, produced 1342 kg DM/ha/year more than the mean of all other varieties. Variety differences manifested themselves as swards aged, with some varieties increasing in total DM production while others reduced in total DM production. The current work provides a basis for the consideration of on-farm variety assessment in the composition of future variety evaluation protocols.
One of the principal systematic constraints on the Epoch of Reionisation (EoR) experiment is the accuracy of the foreground calibration model. Recent results have shown that highly accurate models of extended foreground sources, and including models for sources in both the primary beam and its sidelobes, are necessary for reducing foreground power. To improve the accuracy of the source models for the EoR fields observed by the Murchison Widefield Array (MWA), we conducted the MWA Long Baseline Epoch of Reionisation Survey (LoBES). This survey consists of multi-frequency observations of the main MWA EoR fields and their eight neighbouring fields using the MWA Phase II extended array. We present the results of the first half of this survey centred on the MWA EoR0 observing field (centred at RA (J2000)
$0^\mathrm{h}$
, Dec (J2000)
$-27^{\circ}$
). This half of the survey covers an area of 3 069 degrees
$^2$
, with an average rms of 2.1 mJy beam–1. The resulting catalogue contains a total of 80 824 sources, with 16 separate spectral measurements between 100 and 230 MHz, and spectral modelling for 78
$\%$
of these sources. Over this region we estimate that the catalogue is 90
$\%$
complete at 32 mJy, and 70
$\%$
complete at 10.5 mJy. The overall normalised source counts are found to be in good agreement with previous low-frequency surveys at similar sensitivities. Testing the performance of the new source models we measure lower residual rms values for peeled sources, particularly for extended sources, in a set of MWA Phase I data. The 2-dimensional power spectrum of these data residuals also show improvement on small angular scales—consistent with the better angular resolution of the LoBES catalogue. It is clear that the LoBES sky models improve upon the current sky model used by the Australian MWA EoR group for the EoR0 field.