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Delayed reward discounting (DRD), the tendency to prefer smaller rewards available immediately relative to larger rewards available after a delay, is associated with numerous health outcomes across the lifespan. Emerging literature points to the central role of early environments, specifically factors reflecting harshness (including lack of resources) and unpredictability (exposure to instability and stressful events) in the development of DRD. Yet, existing research uses disparate indicators of environmental risk and often draws on small samples resulting in conflicting findings, making comparisons across studies challenging. The current systematic review examined environmental factors that may place youth at greatest risk for heightened DRD and subsequent negative health outcomes. Search results identified 28 articles reflecting 20 unique samples. Additionally, meta-analyses were conducted to examine overall effects for the two most commonly examined environmental predictors (family income and family history of substance use disorder). Results suggest small-to-medium associations of environmental risk with DRD, with smaller associations observed for more distal predictors of harshness (e.g., family income) and larger associations among more proximal indicators of environmental instability (e.g., harsh parenting and parental pathology). Findings highlight the role of environmental factors on DRD development and may inform future interventions.
When a water wave group encounters a floating body, it forces the body into motion; this motion radiates waves that modify the wave group. This study considers a floating body in the form of a two-dimensional (2-D) rectangular block constrained to heaving motion. The focus is on how the 2-D block modifies infragravity (IG) waves, a type of nonlinear low-frequency wave in the wave group. The IG waves transmitted beyond the block comprise two types: (i) bound IG waves generated by nonlinear interactions of first-order carrier waves, and (ii) free IG waves released due to discontinuities in flow potential created by the block. A systematic parameter sweep reveals that, when heaving motion is allowed, the transmitted IG waves differ significantly from those of stationary blocks. In some cases, heaving motion enables attenuation of the total transmitted IG waves, while stationary blocks cannot achieve similar effects. Only small-sized blocks are considered; they are ‘small’ compared with the IG wavelengths. The findings are relevant to dual-purpose wave energy converters designed for energy generation and coastal protection, floating breakwaters and other small-sized floating structures such as ships and some icebergs: the heaving motion of these objects may modify IG waves, thereby influencing harbour resonance, near-shore currents, beach erosion, wave forcing on ice shelves and coastal inundation.
This study considers the global instability of unidirectional flows through single, and double, bifurcation models using linear stability and direct numerical simulation (DNS). The motivation is respiratory flows, so we consider flow in both directions, through two geometries. We identify conditions (quantified by the Reynolds number, ${Re}=U^*D/\nu$, where $U^*$ is the peak centreline velocity, $D$ is the primary pipe diameter and $\nu$ is the kinematic viscosity) where temporal fluctuations occur using DNS. We calculate the linear stability of the steady flows, identifying the critical Reynolds number and leading unstable modes. For flows from single to double pipe, the critical Reynolds number is dependent on the number of bifurcations in the domain, but the mode structures are similar, with growth observed in regions dominated by longitudinal vortices formed by the centrifugal imbalance of flows passing through curved bifurcations. Flows in the opposite direction, from double to single pipe, also depend on the number of bifurcations in the domain. The flow through the double-bifurcation case undergoes two spatial symmetry-breaking bifurcations, altering the mode structure and critical Reynolds number. In all cases, the critical Reynolds number closely matches with temporal fluctuations observed from DNS, suggesting transition is the result of a linear instability, similar to other curved geometries like toroidal and helical pipes. We compare the frequencies of the modes with the frequencies observed from DNS, finding a close match during both initial and saturated flows. These results are important for understanding respiratory flows where turbulent mixing and streaming contribute to gas transport.
Electronic Health Record (EHR) data are critical for advancing translational research and AI technologies. The ENACT network offers access to structured EHR data across 57 CTSA hubs. However, substantial information is contained in clinical narratives, requiring natural language processing (NLP) for research. The ENACT NLP Working Group was formed to make NLP-derived clinical information accessible and queryable across the network.
Methods:
We established the ENACT NLP Working Group with 13 sites selected based on criteria including clinical notes access, IT infrastructure, NLP expertise, and institutional support. We divided sites into five focus groups targeting clinical tasks within disease contexts. Each focus group consisted of two development sites and two validation sites. We extended the ENACT ontology to standardize NLP-derived data and conducted multisite evaluations using the Open Health Natural Language Processing (OHNLP) Toolkit.
Results:
The working group achieved 100% site retention and deployed NLP infrastructure across all sites. We developed and validated NLP algorithms for rare disease phenotyping, social determinants of health, opioid use disorder, sleep phenotyping, and delirium phenotyping. Performance varied across sites (F1 scores 0.53–0.96), highlighting data heterogeneity impacts. We extended the ENACT common data model and ontology to incorporate NLP-derived data while maintaining Shared Health Research Informatics NEtwork (SHRINE) compatibility.
Conclusion:
This demonstrates feasibility of deploying NLP infrastructure across large, federated networks. The focus group approach proved more practical than general-purpose approaches. Key lessons include the challenge of data heterogeneity and importance of collaborative governance. This work also provides a foundation that other networks can build on to implement NLP capabilities for translational research.
To describe the use of non-beta-lactam agents (NBL) to treat ampicillin-susceptible Enterococcus bacteremia (ASEB), and to identify factors associated with their use.
Methods:
A single-center retrospective study at a rural tertiary referral center was conducted to identify ASEB episodes between January 1, 2016, and 31 December, 2021. Patient, microbiological, infection, clinical management characteristics, and outcomes were compared between those who received NBL versus BL agents for definitive therapy. Multivariable logistic regression analysis was used to determine factors associated with NBL use.
Results:
158 episodes of ASEB in 153 patients were included. 43 episodes (27%) were treated with NBL for definitive therapy. Factors associated with NBL therapy were younger age, history of penicillin allergy, history of cancer, end-stage renal disease (ESRD), polymicrobial bacteremia, lack of metastatic foci, and lack of endocarditis. Combination therapy was used in 23% of those treated with BL therapy versus zero patients receiving NBL therapy. All-cause 30-day and 90-day mortality and 30-day relapse rate were not statistically different. In the regression model, NBL therapy was more likely in those with: younger age (AOR 0.95, p < .01), any penicillin allergy (AOR 5.87, p < .01), history of cancer (AOR 5.25, p < .01), ESRD (AOR 12.48, p < .001), and polymicrobial bacteremia (AOR 4.20, p < .01).
Conclusion:
NBL was used as definitive treatment in 27% of ASEB with good clinical outcomes. This real-life experience suggests NBL can be successfully used to treat ASEB based on clinical discretion.
Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.
Methods
T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).
Results
PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).
Conclusions
PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.
To evaluate the impact of a mobile-app-based central line-associated bloodstream infection (CLABSI) prevention program in oncology clinic patients with peripherally inserted central catheters (PICCs).
Design:
Pre-post prospective cohort study with baseline (July 2015–December 2016), phase-in (January 2017–April 2017), and intervention (May 2017–November 2018). Generalized linear mixed models compared intervention with baseline frequency of localized inflammation/infection and dressing peeling. Cox proportional hazards models compared days-to-removal of lines with localized inflammation/infection. Chi-square test compared bacteremia rates before and after intervention.
Setting:
Oncology clinic at a large medical center.
Patients:
Oncology clinic adult patients with PICCs.
Intervention:
CLABSI prevention program consisting of an actionable scoring system for identifying insertion site infection/inflammation coupled with a mobile-app enabling photo-assessments and automated physician alerting for remote response.
Results:
We completed 5,343 assessments of 569 PICCs in 401 patients (baseline: 2,924 assessments, 300 PICCs, 216 patients; intervention: 2,419 assessments, 269 PICCs, 185 patients). The intervention was associated with a 92% lower likelihood of having a dressing with peeling (OR 0.08, 95%CI 0.04-0.17, P < 0.001), 53% lower local inflammation/infection (OR 0.47, 95%CI 0.27-0.84, P < 0.011), and 24% (non-significant) lower CLABSI rates (P = .63). Physician mobile-app alerting and response enabled 80% lower risk of lines remaining in place after inflammation/infection was identified (HR 0.20, 95%CI:0.14-0.30, P < 0.001) and 85% faster removal of infected lines from mean (SD) 11.1 (9.7) to 1.7 (2.4) days.
Conclusions:
A mobile-app-based CLABSI prevention program decreased frequency of inflamed/infected central line insertion sites and increased speed of removal when inflammation/infection was found.
Understanding healthcare personnel’s (HCP) contact patterns are important to mitigate healthcare-associated infectious disease transmission. Little is known about how HCP contact patterns change over time or during outbreaks such as the COVID-19 pandemic.
Methods:
This study in a large United States healthcare system examined the social contact patterns of HCP via standardized social contact diaries. HCP were enrolled from October 2020 to June 2022. Participants completed monthly surveys of social contacts during a representative working day. In June 2022, participants completed a 2-day individual-level contact diary. Regression models estimated the association between contact rates and job type. We generated age-stratified contact matrices.
Results:
Three-hundred and sixty HCP enrolled, 157 completed one or more monthly contact diaries and 88 completed the intensive 2-day diary. In the monthly contact diaries, the median daily contacts were 15 (interquartile range (IQR) 8–20), this increased slightly during the study (slope-estimate 0.004, p-value 0.016). For individual-level contact diaries, 88 HCP reported 2,550 contacts over 2 days. HCP were 2.8 times more likely to contact other HCP (n = 1,592 contacts) than patients (n = 570 contacts). Rehabilitation/transport staff, diagnostic imaging technologists, doctors, nurses, mid-level, and laboratory personnel had higher contacts compared with the lowest contact group (Nursing aids). Contact matrices concentrated in working-age populations.
Conclusions:
HCP contacts concentrate in their work environment, primarily with other HCP. Their contacts remained stable over time even during large changes to societal contact patterns during the COVID-19 pandemic. This stability is critical for designing outbreak and pandemic responses.
Obruchevodid petalodonts are rare small chondrichthyans known from nearly complete to partial skeletons from the Upper Mississippian (Serpukhovian) Bear Gulch Limestone of central Montana and isolated teeth from the Upper Mississippian Bangor Limestone of northern Alabama. New records of obruchevodid petalodonts are presented here from the Middle Mississippian (Viséan) Joppa Member of the Ste. Genevieve Formation at Mammoth Cave National Park, Kentucky. Obruchevodids are here represented by multiple teeth of a new taxon, Clavusodens mcginnisi n. gen. n. sp., and a single tooth referred to ?Netsepoye sp. Clavusodens mcginnisi n. gen. n. sp. is characterized by teeth with pointed mesiodistal and lingual margins and more robust chisel-like cusps on the anterolateral and distolateral teeth. The suggestion that obruchevodid petalodonts evolved to inhabit complex reef-like environments and other nearshore habitats with a feeding ecology analogous to extant triggerfish is explored and discussed.
Increasing resources are devoted to osteoarthritis surgical care in Australia annually, with significant expenditure attributed to hip and knee arthroplasties. Safe, efficient, and sustainable models of care are required. This study aimed to determine the impact on healthcare costs of implementing an enhanced short-stay model of care (ESS-MOC) for arthroplasty at a national level.
Methods
Budget impact analysis was conducted for hospitals providing arthroplasty surgery over the years 2023 to 2030. Population-based sample projections obtained from clinical registry and administrative datasets of individuals receiving hip or knee arthroplasty for osteoarthritis were applied. The ESS-MOC assigned 30 percent of eligible patients to a shortened acute-ward-stay pathway and outpatient rehabilitation. The remaining 70 percent received a current practice pathway. The primary outcome was total healthcare cost savings post-implementation of the ESS-MOC, with return on investment (ROI) ratio and hospital bed-days utilized also estimated. Costs are presented in Australian dollars (AUD) and United States dollars (USD), at 2023 prices.
Results
Estimated hospital cost savings for the years 2023 to 2030 from implementing the ESS-MOC were AUD641 million (USD427 million) (95% CI: AUD99 million [USD66 million] to AUD1,250 million) [USD834 million]). This corresponds to a ROI ratio of 8.88 (1.3 to 17.9) dollars returned for each dollar invested in implementing the care model. For the period 2023 to 2030, an estimated 337,000 (261,000 to 412,000) acute surgical ward bed-days, and 721,000 (471,000 to 1,028,000) rehabilitation bed-days could be saved. Total implementation costs for the ESS-MOC were estimated at AUD72 million (USD46 million) over eight years.
Conclusions
Implementation of an ESS-MOC for eligible arthroplasty patients in Australia would generate significant cost and healthcare resource savings. This budget impact analysis demonstrates a best practice approach to comprehensively assessing value, at a national level, of implementing sustainable models of care in high-burden healthcare contexts. Findings are relevant to other settings where hospital stay following joint arthroplasty remains excessively long.
Words with complex semantic types such as book are characterised by a multiplicity of interpretations that are not mutually exclusive (e.g., as a physical object and/or informational content). Their status with respect to lexical ambiguity is notoriously unclear, and it is debatable whether complex types are a particular form of polysemy (closely related to metonymy) or whether they belong to monosemy. In this study, we investigate the nature of complex types by conducting two experiments on ambiguous nouns in French. The first experiment collects speakers’ judgements about the sameness of meaning between different uses of complex-type, metonymic and monosemous words. The second experiment uses a priming paradigm and a sensicality task to investigate the online processing of complex-type words, as opposed to metonymic and monosemous words. Overall results indicate that, on a continuum of lexical ambiguity, complex types are closer to monosemy than to metonymy. The different interpretations of complex-type words are highly connected and fall under the same meaning, arguably in relation to a unique reference. These results suggest that complex types are associated with single underspecified entries in the mental lexicon. Moreover, they highlight the need for a model of lexical representations of ambiguous words that can account for the difference between complex types and metonymy.
This article presents a short summary of the conclusions we report in a longer manuscript (available in our Supplementary Material) subjecting Lagodny et al.’s new measure of state policy mood to the same set of face validity and construct validity tests we applied earlier to Enns and Koch’s measure. We encourage readers to read this longer manuscript, which contains not only the conclusions herein, but also the evidence justifying these conclusions, before accepting or rejecting any claims we make. Our results show that the characteristics of Enns and Koch’s measure that led us to be doubtful that it is valid are also present in Lagodny et al.’s new measure – leaving us just as doubtful that Lagodny et al.’s measure is valid. Moreover, the low correlation between Lagodny et al.’s measure and Enns and Koch’s measure, combined with evidence from replications of seven published studies that the two measures frequently yield quite different inferences about the impact of policy mood on public policy, indicate that Lagodny et al.’s claim that both their measure and Enns and Koch’s measure are valid is wrong; either neither measure is valid, or one is valid and the other is not. Moreover, extending the replications to include not only Lagodny et al.’s and Enns and Koch’s measures, but also Berry et al.’s measure and Caughey and Warshaw’s measure of mass economic liberalism, shows that each of the four measures yields a substantive conclusion about the effect of policy mood that is dramatically different than each of the other three measures. This suggests that the goal of developing a measure of state policy mood that would be widely accepted as valid remains elusive.
Background: Oncology patients are at high risk for bloodstream infection (BSI) due to immunosuppression and frequent use of central venous catheters. Surveillance in this population is largely relegated to inpatient settings and limited data are available describing community burden. We evaluated rates of BSI, clinic or emergency department (ED) visits, and hospitalizations in a large cohort of oncology outpatients with peripherally inserted central catheters (PICCs). Methods: In this prospective, observational study, we followed a convenience sample of adults (age>18) with PICCs at a large academic outpatient oncology clinic for 35 months between July 2015 and November 2018. We assessed demographics, malignancy type, PICC insertion and removal dates, history of prior PICC, and line duration. Outcomes included BSI events (defined as >1 positive blood cultures or >2 positive blood cultures if coagulase-negative Staphylococcus), ED visits (without hospitalization), and unplanned hospitalizations (excluding scheduled chemotherapy hospitalizations). We used χ2 analyses to compare the frequency of categorical outcomes, and we used unpaired t tests to assess differences in means of continuous variable in hematologic versus solid-tumor malignancy patients. We used generalized linear mixed-effects models to assess differences in BSI (clustered by patient) separately for gram-positive and gram-negative BSI outcomes. Results: Among 478 patients with 658 unique PICC lines and 64,190 line days, 271 patients (413 lines) had hematologic malignancy and 207 patients (232 lines) had solid-tumor malignancy. Cohort characteristics and outcomes stratified by malignancy type are shown in Table 1. Compared to those with hematologic malignancy, solid-tumor patients were older, had 47% fewer clinic visits, and had 32% lower frequency of prior PICC lines. Overall, there were 75 BSI events (12%; 1.2 per 1,000 catheter days). We detected no significant difference in BSI rates when comparing solid-tumor versus hematologic malignancies (P = 0.20); BSIs with gram-positive pathogen were 69% higher in patients with solid tumors. Gram-negative BSIs were 41% higher in patients with hematologic malignancy. Solid-tumor malignancy was associated with 4.5-fold higher odds of developing BSI with gram-positive pathogen (OR, 4.48; 95% CI, 1.60–12.60; P = .005) compared to those with hematologic malignancy, after adjusting for age, sex, history of prior PICC, and line duration. Differences in gram-negative BSI were not significant on multivariate analysis. Conclusions: The burden of all-cause BSIs in cancer clinic adults with PICC lines was 12% or 1.2 per 1,000 catheter days, as high as nationally reported inpatient BSI rates. Higher risk of gram-positive BSIs in solid-tumor patients suggests the need for targeted infection prevention activities in this population, such as improvements in central-line monitoring, outpatient care, and maintenance of lines and/or dressings, as well as chlorhexidine bathing to reduce skin bioburden.
Paleoethnobotanical perspectives are essential for understanding past lifeways yet continue to be underrepresented in Paleoindian research. We present new archaeobotanical and radiocarbon data from combustion features within stratified cultural components at Connley Caves, Oregon, that reaffirm the inclusion of plants in the diet of Paleoindian groups. Botanical remains from three features in Connley Cave 5 show that people foraged for diverse dryland taxa and a narrow range of wetland plants during the summer and fall months. These data add new taxa to the known Pleistocene food economy and support the idea that groups equipped with Western Stemmed Tradition toolkits had broad, flexible diets. When viewed continentally, this work contributes to a growing body of research indicating that regionally adapted subsistence strategies were in place by at least the Younger Dryas and that some foragers in the Far West may have incorporated a wider range of plants including small seeds, leafy greens, fruits, cacti, and geophytes into their diet earlier than did Paleoindian groups elsewhere in North America. The increasing appearance of diverse and seemingly low-ranked resources in the emerging Paleoindian plant-food economy suggests the need to explore a variety of nutritional variables to explain certain aspects of early foraging behavior.
Enns and Koch question the validity of the Berry, Ringquist, Fording, and Hanson measure of state policy mood and defend the validity of the Enns and Koch measure on two grounds. First, they claim policy mood has become more conservative in the South over time; we present empirical evidence to the contrary: policy mood became more liberal in the South between 1980 and 2010. Second, Enns and Koch argue that an indicator’s lack of face validity in cross-sectional comparisons is irrelevant when judging the measure’s suitability in the most common form of pooled cross-sectional time-series analysis. We show their argument is logically flawed, except under highly improbable circumstances. We also demonstrate, by replicating several published studies, that statistical results about the effect of state policy mood can vary dramatically depending on which of the two mood measures is used, making clear that a researcher’s measurement choice can be highly consequential.