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Objectives/Goals: Our pilot study tests the hypothesis that a hospital-based oral health education and referral program will increase patient knowledge of the importance of oral health, engagement with dental health services, and create a reproducible model to improve access and utilization of routine oral health care services and treatments. Methods/Study Population: Participants recruited for this study will include a pool of eligible patients at an urban university affiliated teaching hospital, 18 years or older, who upon initial screening, reported having not seen a dentist within the past 12 months. Enrolled participants also reported having some form of dental insurance coverage. Our project plans to recruit fifty hospitalized patients from ten inpatient units. Once consented and enrolled, participants will receive a brief education on oral health and be assisted in scheduling a dental appointment with one of the providers from our dental referral network. The dental referral network will consist of local dental providers who agree to treat our study participants. Tracking of ongoing participant dental care engagement will be tracked over a six-month period. Results/Anticipated Results: We anticipate no issue recruiting the 50 planned hospitalized patients. One, the eligible hospitalized patient pool is large, two, data from previous study indicates that a large percentage (~57%) of hospitalized patients at our facility are not receiving adequate dental services and supports. We anticipated that the number of participants who attend their post-discharge dental appointments will be less than 70%. This number reflects averaged rate of missed dental appointments among other populations and considers that our population may have more barriers to appointment attendance. Due to the high prevalence of unmet dental needs among our study population, we anticipate that providers will report patients were seen for many standard dental procedures (cleanings, extractions, fillings, etc.) Discussion/Significance of Impact: The results of this study demonstrate the feasibility of 1) developing and maintaining a dental provider network and 2) utilizing hospital-based teams to promote inpatient engaging with regular oral hygiene and dental appointments. These results show how inpatients visits provide a valuable opportunity to engage adults with unmet dental needs.
Objectives/Goals: This poster describes the scientific rationale, needs assessment, programmatic elements, and impact of a community of practice (CoP) focusing on advancing equity in the science and practice of mentorship. Methods/Study Population: In 2023, the University of Wisconsin Institute for Clinical and Translational Research received NIH R13 funding to host a conference, the Science of Effective Mentorship (Asquith, McDaniels, et.al., 2023). Approximately 150 researchers and program leaders from Clinical and Translational Science Awards (CTSA) Hubs and beyond attended. Data were collected before, during, and after the conference, providing the authors with an initial idea of community needs. As a result, a mentorship CoP was formed. In the subsequent 18 months, a steering and advisory committee established a program of virtual, topic-focused virtual events every 3 months as well as a community website, with increasing attendance and utilization. A survey was disseminated after the completion of one year, and a focus group was held during the last virtual gathering. Results/Anticipated Results: The demand for infrastructure to support a national community of practice will be demonstrated. The demographic and positional diversity (e.g. role within a CTSA Hub) will highlight the opportunities of convening this diverse community. Organizational challenges and opportunities will be highlighted. Assessment data will reveal the broad range of needs and interests of participants. Aggregate demographic, professional, and participation data about community of practice members will be shared, as well as the governance and programmatic elements of this community of practice. Evaluation results from the first year of activity will be displayed. Needs for sustainability will be discussed. Discussion/Significance of Impact: CoPs are not new in the CTR space. Membership in a CoP may reduce isolation individuals feel as they negotiate the important work of equity in the biomedical workforce. Members of this community of practice share the expertise and commitment to promoting equity in the biomedical workforce through supporting robust culture of mentorship.
To improve early intervention and personalise treatment for individuals early on the psychosis continuum, a greater understanding of symptom dynamics is required. We address this by identifying and evaluating the movement between empirically derived attenuated psychotic symptomatic substates—clusters of symptoms that occur within individuals over time.
Methods
Data came from a 90-day daily diary study evaluating attenuated psychotic and affective symptoms. The sample included 96 individuals aged 18–35 on the psychosis continuum, divided into four subgroups of increasing severity based on their psychometric risk of psychosis, with the fourth meeting ultra-high risk (UHR) criteria. A multilevel hidden Markov modelling (HMM) approach was used to characterise and determine the probability of switching between symptomatic substates. Individual substate trajectories and time spent in each substate were subsequently assessed.
Results
Four substates of increasing psychopathological severity were identified: (1) low-grade affective symptoms with negligible psychotic symptoms; (2) low levels of nonbizarre ideas with moderate affective symptoms; (3) low levels of nonbizarre ideas and unusual thought content, with moderate affective symptoms; and (4) moderate levels of nonbizarre ideas, unusual thought content, and affective symptoms. Perceptual disturbances predominantly occurred within the third and fourth substates. UHR individuals had a reduced probability of switching out of the two most severe substates.
Conclusions
Findings suggest that individuals reporting unusual thought content, rather than nonbizarre ideas in isolation, may exhibit symptom dynamics with greater psychopathological severity. Individuals at a higher risk of psychosis exhibited persistently severe symptom dynamics, indicating a potential reduction in psychological flexibility.
Although cognitive remediation (CR) improves cognition and functioning, the key features that promote or inhibit its effectiveness, especially between cognitive domains, remain unknown. Discovering these key features will help to develop CR for more impact.
Aim
To identify interrelations between cognition, symptoms, and functioning, using a novel network analysis approach and how CR affects these recovery outcomes.
Methods
A secondary analysis of randomized controlled trial data (N = 165) of CR in early psychosis. Regularized partial correlation networks were estimated, including symptoms, cognition, and functioning, for pre-, post-treatment, and change over time. Pre- and post-CR networks were compared on global strength, structure, edge invariance, and centrality invariance.
Results
Cognition, negative, and positive symptoms were separable constructs, with symptoms showing independent relationships with cognition. Negative symptoms were central to the CR networks and most strongly associated with change in functioning. Verbal and visual learning improvement showed independent relationships to improved social functioning and negative symptoms. Only visual learning improvement was positively associated with personal goal achievement. Pre- and post-CR networks did not differ in structure (M = 0.20, p = 0.45) but differed in global strength, reflecting greater overall connectivity in the post-CR network (S = 0.91, p = 0.03).
Conclusions
Negative symptoms influenced network changes following therapy, and their reduction was linked to improvement in verbal and visual learning following CR. Independent relationships between visual and verbal learning and functioning suggest that they may be key intervention targets to enhance social and occupational functioning.
Large datasets, combined with modeling techniques, provide a quantitative way to estimate when known archaeological sites will be impacted by climatological changes. With over 4,000 archaeological sites recorded on the coast of Georgia, USA, the state provides an ideal opportunity to compare methods. Here, we compare the popular passive “bathtub” modeling with the dynamic Sea Level Affecting Marshes Model (SLAMM) combined with the Marshes Equilibrium Model (MEM). The goal of this effort is to evaluate prior modeling and test the benefits of more detailed ecological modeling in assessing site loss. Our findings indicate that although rough counts of archaeological sites destroyed by sea-level rise (SLR) are similar in all approaches, using the latter two methods provides critical information needed in prioritizing site studies and documentation before irrevocable damages occur. Our results indicate that within the next 80 years, approximately 40% of Georgia's coastal sites will undergo a loss of archaeological context due to wetlands shifting from dry ecological zones to transitional marshlands or submerged estuaries and swamps.
Substance use disorder (SUD) is a public health crisis in the United States associated with significant economic costs including healthcare, criminal justice, productivity, and mortality and morbidity costs. In this paper, we present a tool for a customizable economic analysis that can be utilized by different recovery program owners and operators within the SUD continuum of care that considers these program’s operating and capital costs, location, size, and success rate. The goal of this tool is to provide owners and operators with an accessible tool that can estimate their individual program’s economic costs, benefits, and return on investment. In applications of the tool, we find that there are significant benefits associated with SUD recovery-oriented services, even with more conservative modeling of recovery benefits. Specifically, we find that a representative recovery housing program in Florida yields a net benefit of $143 million over 20 years with an associated return on investment of $22.19 per dollar invested. Further, we find that the net benefits of different recovery-oriented modalities including a recovery house, a recovery campus, and a residential inpatient program are positive, with returns on investment varying from nearly $22 per dollar invested to $1 per dollar.
Early intervention in psychosis (EIP) services improve outcomes for young people, but approximately 30% disengage.
Aims
To test whether a new motivational engagement intervention would prolong engagement and whether it was cost-effective.
Method
We conducted a multicentre, single-blind, parallel-group, cluster randomised controlled trial involving 20 EIP teams at five UK National Health Service (NHS) sites. Teams were randomised using permuted blocks stratified by NHS trust. Participants were all young people (aged 14–35 years) presenting with a first episode of psychosis between May 2019 and July 2020 (N = 1027). We compared the novel Early Youth Engagement (EYE-2) intervention plus standardised EIP (sEIP) with sEIP alone. The primary outcome was time to disengagement over 12–26 months. Economic outcomes were mental health costs, societal costs and socio-occupational outcomes over 12 months. Assessors were masked to treatment allocation for primary disengagement and cost-effectiveness outcomes. Analysis followed intention-to-treat principles. The trial was registered at ISRCTN51629746.
Results
Disengagement was low at 15.9% overall in standardised stand-alone services. The adjusted hazard ratio for EYE-2 + sEIP (n = 652) versus sEIP alone (n = 375) was 1.07 (95% CI 0.76–1.49; P = 0.713). The health economic evaluation indicated lower mental healthcare costs linked to reductions in unplanned mental healthcare with no compromise of clinical outcomes, as well as some evidence for lower societal costs and more days in education, training, employment and stable accommodation in the EYE-2 group.
Conclusions
We found no evidence that EYE-2 increased time to disengagement, but there was some evidence for its cost-effectiveness. This is the largest study to date reporting positive engagement, health and cost outcomes in a total EIP population sample. Limitations included high loss to follow-up for secondary outcomes and low completion of societal and socio-occupational data. COVID-19 affected fidelity and implementation. Future engagement research should target engagement to those in greatest need, including in-patients and those with socio-occupational goals.
Motor neuron disease (MND) is a progressive, fatal, neurodegenerative condition that affects motor neurons in the brain and spinal cord, resulting in loss of the ability to move, speak, swallow and breathe. Acceptance and commitment therapy (ACT) is an acceptance-based behavioural therapy that may be particularly beneficial for people living with MND (plwMND). This qualitative study aimed to explore plwMND’s experiences of receiving adapted ACT, tailored to their specific needs, and therapists’ experiences of delivering it.
Method:
Semi-structured qualitative interviews were conducted with plwMND who had received up to eight 1:1 sessions of adapted ACT and therapists who had delivered it within an uncontrolled feasibility study. Interviews explored experiences of ACT and how it could be optimised for plwMND. Interviews were audio recorded, transcribed and analysed using framework analysis.
Results:
Participants were 14 plwMND and 11 therapists. Data were coded into four over-arching themes: (i) an appropriate tool to navigate the disease course; (ii) the value of therapy outweighing the challenges; (iii) relevance to the individual; and (iv) involving others. These themes highlighted that ACT was perceived to be acceptable by plwMND and therapists, and many participants reported or anticipated beneficial outcomes in the future, despite some therapeutic challenges. They also highlighted how individual factors can influence experiences of ACT, and the potential benefit of involving others in therapy.
Conclusions:
Qualitative data supported the acceptability of ACT for plwMND. Future research and clinical practice should address expectations and personal relevance of ACT to optimise its delivery to plwMND.
Key learning aims
(1) To understand the views of people living with motor neuron disease (plwMND) and therapists on acceptance and commitment therapy (ACT) for people living with this condition.
(2) To understand the facilitators of and barriers to ACT for plwMND.
(3) To learn whether ACT that has been tailored to meet the specific needs of plwMND needs to be further adapted to potentially increase its acceptability to this population.
Although the link between alcohol involvement and behavioral phenotypes (e.g. impulsivity, negative affect, executive function [EF]) is well-established, the directionality of these associations, specificity to stages of alcohol involvement, and extent of shared genetic liability remain unclear. We estimate longitudinal associations between transitions among alcohol milestones, behavioral phenotypes, and indices of genetic risk.
Methods
Data came from the Collaborative Study on the Genetics of Alcoholism (n = 3681; ages 11–36). Alcohol transitions (first: drink, intoxication, alcohol use disorder [AUD] symptom, AUD diagnosis), internalizing, and externalizing phenotypes came from the Semi-Structured Assessment for the Genetics of Alcoholism. EF was measured with the Tower of London and Visual Span Tasks. Polygenic scores (PGS) were computed for alcohol-related and behavioral phenotypes. Cox models estimated associations among PGS, behavior, and alcohol milestones.
Results
Externalizing phenotypes (e.g. conduct disorder symptoms) were associated with future initiation and drinking problems (hazard ratio (HR)⩾1.16). Internalizing (e.g. social anxiety) was associated with hazards for progression from first drink to severe AUD (HR⩾1.55). Initiation and AUD were associated with increased hazards for later depressive symptoms and suicidal ideation (HR⩾1.38), and initiation was associated with increased hazards for future conduct symptoms (HR = 1.60). EF was not associated with alcohol transitions. Drinks per week PGS was linked with increased hazards for alcohol transitions (HR⩾1.06). Problematic alcohol use PGS increased hazards for suicidal ideation (HR = 1.20).
Conclusions
Behavioral markers of addiction vulnerability precede and follow alcohol transitions, highlighting dynamic, bidirectional relationships between behavior and emerging addiction.
In situ elemental imaging of planetary surface regolith at a spatial resolution of 100s to 1000s of microns can provide evidence of the provenance of rocks or sediments and their habitability, and can identify post-depositional diagenetic alteration affecting preservation. We use high-resolution elemental maps and XRF spectra from MapX, a flight prototype in situ X-ray imaging instrument, to demonstrate this technology in rock types relevant to astrobiology. Examples are given for various petrologies and depositional/diagenetic environments, including ultramafic/mafic rocks, serpentinites, hydrothermal carbonates, evaporites, stromatolitic cherts and diagenetic concretions.
Helium or neopentane can be used as surrogate gas fill for deuterium (D2) or deuterium-tritium (DT) in laser-plasma interaction studies. Surrogates are convenient to avoid flammability hazards or the integration of cryogenics in an experiment. To test the degree of equivalency between deuterium and helium, experiments were conducted in the Pecos target chamber at Sandia National Laboratories. Observables such as laser propagation and signatures of laser-plasma instabilities (LPI) were recorded for multiple laser and target configurations. It was found that some observables can differ significantly despite the apparent similarity of the gases with respect to molecular charge and weight. While a qualitative behaviour of the interaction may very well be studied by finding a suitable compromise of laser absorption, electron density, and LPI cross sections, a quantitative investigation of expected values for deuterium fills at high laser intensities is not likely to succeed with surrogate gases.
We identify a set of essential recent advances in climate change research with high policy relevance, across natural and social sciences: (1) looming inevitability and implications of overshooting the 1.5°C warming limit, (2) urgent need for a rapid and managed fossil fuel phase-out, (3) challenges for scaling carbon dioxide removal, (4) uncertainties regarding the future contribution of natural carbon sinks, (5) intertwinedness of the crises of biodiversity loss and climate change, (6) compound events, (7) mountain glacier loss, (8) human immobility in the face of climate risks, (9) adaptation justice, and (10) just transitions in food systems.
Technical summary
The Intergovernmental Panel on Climate Change Assessment Reports provides the scientific foundation for international climate negotiations and constitutes an unmatched resource for researchers. However, the assessment cycles take multiple years. As a contribution to cross- and interdisciplinary understanding of climate change across diverse research communities, we have streamlined an annual process to identify and synthesize significant research advances. We collected input from experts on various fields using an online questionnaire and prioritized a set of 10 key research insights with high policy relevance. This year, we focus on: (1) the looming overshoot of the 1.5°C warming limit, (2) the urgency of fossil fuel phase-out, (3) challenges to scale-up carbon dioxide removal, (4) uncertainties regarding future natural carbon sinks, (5) the need for joint governance of biodiversity loss and climate change, (6) advances in understanding compound events, (7) accelerated mountain glacier loss, (8) human immobility amidst climate risks, (9) adaptation justice, and (10) just transitions in food systems. We present a succinct account of these insights, reflect on their policy implications, and offer an integrated set of policy-relevant messages. This science synthesis and science communication effort is also the basis for a policy report contributing to elevate climate science every year in time for the United Nations Climate Change Conference.
Social media summary
We highlight recent and policy-relevant advances in climate change research – with input from more than 200 experts.
This work investigates the effect of surface roughness on cylinder flows in the postcritical regime and reexamines whether the roughness Reynolds number ($Re_{k_s}$) primarily governs the aerodynamic behaviour. It has been motivated by limitations of many previous investigations, containing occasionally contradictory findings. In particular, many past studies were conducted with relatively high blockage ratios and low cylinder aspect ratios. Both of these factors appear to have non-negligible effects on flow behaviour, and particularly fluctuating quantities such as the standard deviation of the lift coefficient. This study employs a 5 % blockage ratio and a span-to-diameter ratio of 10. Cylinders of different relative surface roughness ratios ($k_s/D$), ranging from $1.1\times 10^{-3}$ to $3\times 10^{-3}$, were investigated at Reynolds numbers up to $6.8 \times 10^5$ and $Re_{k_s}$ up to 2200. It is found that the base pressure coefficient, drag coefficient, Strouhal number, spanwise correlation length of lift and the standard deviation of the lift coefficient are well described by $Re_{k_s}$ in postcritical flows. However, roughness does have an effect on the minimum surface pressure coefficient (near separation) that does not collapse with $Re_{k_s}$. The universal Strouhal number proposed by Bearman (Annu. Rev. Fluid Mech., vol. 16, 1984, pp. 195–222) appears to be nearly constant over the range of $Re_{k_s}$ studied, spanning the subcritical through postcritical regimes. Frequencies in the separating shear layers are found to be an order of magnitude lower than the power law predictions for separating shear layers of smooth cylinders.
I am pleased to submit a viewpoint titled “Body mass index on perinatal depression: A critical viewpoint” in response to an article by Ventriglio et al. titled, “The impact of body mass index on the pregnancy outcomes and risk of perinatal depression: Findings from a multicenter Italian study” for consideration for publication in your journal.
This article aims to explore the ethical issues arising from attempts to diversify genomic data and include individuals from underserved groups in studies exploring the relationship between genomics and health. We employed a qualitative synthesis design, combining data from three sources: 1) a rapid review of empirical articles published between 2000 and 2022 with a primary or secondary focus on diversifying genomic data, or the inclusion of underserved groups and ethical issues arising from this, 2) an expert workshop and 3) a narrative review. Using these three sources we found that ethical issues are interconnected across structural factors and research practices. Structural issues include failing to engage with the politics of knowledge production, existing inequities, and their effects on how harms and benefits of genomics are distributed. Issues related to research practices include a lack of reflexivity, exploitative dynamics and the failure to prioritise meaningful co-production. Ethical issues arise from both the structure and the practice of research, which can inhibit researcher and participant opportunities to diversify data in an ethical way. Diverse data are not ethical in and of themselves, and without being attentive to the social, historical and political contexts that shape the lives of potential participants, endeavours to diversify genomic data run the risk of worsening existing inequities. Efforts to construct more representative genomic datasets need to develop ethical approaches that are situated within wider attempts to make the enterprise of genomics more equitable.
An engaging, comprehensive, richly illustrated textbook about the atmospheric general circulation, written by leading researchers in the field. The book elucidates the pervasive role of atmospheric dynamics in the Earth System, interprets the structure and evolution of atmospheric motions across a range of space and time scales in terms of fundamental theoretical principles, and includes relevant historical background and tutorials on research methodology. The book includes over 300 exercises and is accompanied by extensive online resources, including solutions manuals, an animations library, and an introduction to online visualization and analysis tools. This textbook is suitable as a textbook for advanced undergraduate and graduate level courses in atmospheric sciences and geosciences curricula and as a reference textbook for researchers.
Healthcare innovations often represent important improvements in population welfare, but at what cost, and to whom? Health technology assessment (HTA) is a multidisciplinary process to inform resource allocation. HTA is conventionally anchored on health maximization as the only relevant output of health services. If we accept the proposition that health technologies can generate value outside the healthcare system, resource allocation decisions could be suboptimal from a societal perspective. Incorporating “broader value” in HTA as derived from social values and patient experience could provide a richer evaluative space for informing resource allocation decisions. This article considers how HTA is practiced and what its current context implies for adopting “broader value” to evaluating health technologies. Methodological challenges are highlighted, as is a future research agenda. Ireland serves as an example of a healthcare system that both has an explicit role for HTA and is evolving under a current program of reform to offer universal, single-tier access to public services. There are various ways in which HTA processes could move beyond health, including considering the processes of care delivery and/or expanding the evaluative space to some broader concept of well-being. Methods to facilitate the latter exist, but their adaptation to HTA is still emerging. We recommend a multi-stakeholder working group to develop and advance an international agenda for HTA that captures welfare/benefit beyond health.
The term atmospheric general circulation, as used in this book, connotes a statistical representation of the three‐dimensional, time varying flow in the global atmosphere, including the cycling of zonal momentum, energy, water vapor, and other trace constituents.