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This study characterized outpatient parenteral antimicrobial therapy (OPAT) orders and associated antimicrobial stewardship program (ASP) pharmacist recommendations made in a freestanding children’s hospital. Recommendations occurred in over 50% of orders, indicating an opportunity for the review of OPAT by ASP pharmacists.
The United States Government (USG) public-private partnership “Accelerating COVID-19 Treatment Interventions and Vaccines” (ACTIV) was launched to identify safe, effective therapeutics to treat patients with Coronavirus Disease 2019 (COVID-19) and prevent hospitalization, progression of disease, and death. Eleven original master protocols were developed by ACTIV, and thirty-seven therapeutic agents entered evaluation for treatment benefit. Challenges encountered during trial implementation led to innovations enabling initiation and enrollment of over 26,000 participants in the trials. While only two ACTIV trials continue to enroll, the recommendations here reflect information from all the trials as of May 2023. We review clinical trial implementation challenges and corresponding lessons learned to inform future therapeutic clinical trials implemented in response to a public health emergency and the conduct of complex clinical trials during “peacetime,” as well.
In this work, we present a quantitative comparison of the cell division dynamics between populations of intact and regenerating root tips in the plant model system Arabidopsis thaliana. To achieve the required temporal resolution and to sustain it for the duration of the regeneration process, we adopted a live imaging system based on light-sheet fluorescence microscopy, previously developed in the laboratory. We offer a straightforward quantitative analysis of the temporal and spatial patterns of cell division events showing a statistically significant difference in the frequency of mitotic events and spatial separation of mitotic event clusters between intact and regenerating roots.
Adverse factors in the psychosocial work environment are associated with the onset of depression among those without a personal history of depression. However, the evidence is sparse regarding whether adverse work factors can also play a role in depression recurrence. This study aimed to prospectively examine whether factors in the psychosocial work environment are associated with first-time and recurrent treatment for depression.
Methods
The study included 24,226 participants from the Danish Well-being in Hospital Employees study. We measured ten individual psychosocial work factors and three theoretical constructs (effort–reward imbalance, job strain and workplace social capital). We ascertained treatment for depression through registrations of hospital contacts for depression (International Statistical Classification of Diseases and Related Health Problems version 10 [ICD-10]: F32 and F33) and redeemed prescriptions of antidepressant medication (Anatomical Therapeutic Chemical [ATC]: N06A) in Danish national registries. We estimated the associations between work factors and treatment for depression for up to 2 years after baseline among those without (first-time treatment) and with (recurrent treatment) a personal history of treatment for depression before baseline. We excluded participants registered with treatment within 6 months before baseline. In supplementary analyses, we extended this washout period to up to 2 years. We applied logistic regression analyses with adjustment for confounding.
Results
Among 21,156 (87%) participants without a history of treatment for depression, 350 (1.7%) had first-time treatment during follow-up. Among the 3070 (13%) participants with treatment history, 353 (11%) had recurrent treatment during follow-up. Those with a history of depression generally reported a more adverse work environment than those without such a history. Baseline exposure to bullying (odds ratio [OR] = 1.72, 95% confidence interval [95% CI]: 1.30–2.32), and to some extent also low influence on work schedule (OR = 1.27, 95% CI: 0.97–1.66) and job strain (OR = 1.24, 95% CI: 0.97–1.57), was associated with first-time treatment for depression during follow-up. Baseline exposure to bullying (OR = 1.40, 95% CI: 1.04–1.88), lack of collaboration (OR = 1.31, 95% CI: 1.03–1.67) and low job control (OR = 1.27, 95% CI: 1.00–1.62) were associated with recurrent treatment for depression during follow-up. However, most work factors were not associated with treatment for depression. Using a 2-year washout period resulted in similar or stronger associations.
Conclusions
Depression constitutes a substantial morbidity burden in the working-age population. Specific adverse working conditions were associated with first-time and recurrent treatment for depression and improving these may contribute to reducing the onset and recurrence of depression.
Motivation is an important factor in therapy and potentially even more so in an online setting. Earlier research shows that more autonomously motivated patients have better outcomes and completion rates than more controlled motivated patients´. However, little is known about how motivation type influences treatment effect in an online setting and in patients with binge eating disorder specifically.
Objectives
This study set out to investigate how motivation type as per the Self-Determination Theory would affect treatment adherence and effect in a sample of 148 patients, undergoing an Internet-based Cognitive Behavioral Therapy (iCBT) for BED.
Methods
The study was mixed-methods. A sample of 148 patients gave two written qualitative statements regarding their motivation for seeking treatment and reasons for choosing online therapy
The statements were transformed into quantitative units via the condensation method. The themes were categorized according to the model by Ryan and Deci based on level of autonomy and perceived locus of causality.
This was compared with completion rate and outcomes on eating disorder symptomatology. Completion was designated into three groups. Low adherers - less than six sessions (n=54), high adherers – between 7 and 10 sessions (n =56) and full adherers - 10 session plus follow up (n=37).
The effect of the treatment was measured via the Eating Disorder Examination Questionnaire (EDEQ) and Binge Eating Disorder Questionnaire (BEDQ).
Results
Table 1
shows the distribution of patients’ motivational types regarding therapy aims
Controlled
→
Autonomous
Motivational type:
Introjection
Introjection
Identification
Integration
Patient motivation:
Shame
Weight loss
Psychologicalstress
Insight
In all
In all
25
25
50
48
148
Table 2
shows the distribution of patients´motivational types regarding online treatment
Controlled
→
Autonomous
Motivational type:
Introjection
Introjection
Identification
Integration
Patient motivation:
External
Avoidance
Convenience
Reflection
In All
In all
31
21
81
15
148
Table 3
shows the results from morivational types in each setting on BEDQ and EDEQ scores. No significant correlation was found.
Therapy Aims
BEDQ
0.92
EDEQ
0.51
Why Online Therapy
BEDQ
0.99
EDEQ
0.23
Conclusions
Perceived locus of causality and level of autonomy, did not affect level of adherence or outcome of treatment in either setting. This unexpected result may suggest that internet-based therapy is less dependent on motivation types, when comparing with face-to-face treatment.
Tail-biting in pigs (Sus scrofa) reduces welfare and production. Tail-docking reduces (but does not eliminate) tail-biting damage. The reason tail-docking reduces tail damage is unknown. It may reduce pigs’ attraction to tails (H1), or increase tails’ sensitivity to investigation (H2). To investigate these hypotheses, behavioural differences between 472 individually marked grower pigs with intact tails (nine groups of 25-34 pigs) or docked tails (nine groups of 22-24 pigs) were observed from 5-8 weeks of age on a commercial farm in Denmark. Pens had part-slatted floors, dry feeding and two handfuls of straw per day, and enrichment objects were provided. Behavioural sampling recorded actor and recipient for tail-directed (tail interest, tail in mouth, tail reaction) and investigatory behaviours (belly-nosing, ear-chewing, interaction with enrichment). Scan sampling recorded pig posture/activity and tail posture. Intact-tail pigs performed more overall investigatory behaviours but tail type did not affect the amount of tail-directed behaviours. Larger pigs performed more investigatory and tail-directed behaviours than smaller pigs and females performed slightly more tail investigation. Tail-directed behaviours were not consistent over time at the individual or group level. However, ear-chewing was consistent at the group level. One group with intact tails was affected by a tail-biting outbreak in the final week of the study (evidenced by tail-damage scores) and showed an increase over time in tail posture (tail down) and tail-directed behaviour but not activity. Overall, there were few behavioural differences between docked and undocked pigs: no evidence of reduced tail investigation (H1) or an increased reaction to tail investigation (H2) in docked pigs, and yet docked pigs had less tail damage. We propose that docking might be effective because longer tails are more easily damaged as pigs are able to bite them with their cheek teeth.
Substance use, aggression/violence, delinquency, and risky sexual behaviors emerge and peak during adolescence, as teens enter new social and digital ecologies. This chapter reviews the literature on the co-occurrence and mutual influences between adolescent digital media use and engagement in online and offline health risk behaviors, with attentions to the mechanisms underlying these associations. Research suggests the quantity of time adolescents spend online is less important than the quality of how they spend that time, and that many well-documented peer influence processes (first studied in face-to-face peer interactions) are also emerging in online spaces. Shared vulnerabilities, peer selection, peer socialization, and identity development are important mechanisms helping us understand why adolescents engage in online and offline risk taking (and thus potential targets of interventions to reduce risk processes). This chapter highlights directions for future research, emphasizing longitudinal and experimental designs to improve causal inference and testing directionality of effects.
This is the first full-scale discussion of English phonology since Chomsky and Halle's seminal The Sound Pattern of English (SPE). The book enphasizes the analysis using ordered rules and builds on SPE by incorporating lexical and metrical and prosodic analysis and the insights afforded by Lexical Phonology. It provides clear explanations and logical development throughout, introducing rules individually and then illustrating their interactions. These features make this influential theory accessible to students from a variety of backgrounds in linguistics and phonology. Rule-ordering diagrams summarize the crucial ordering of approximately 85 rules. Many of the interactions result in phonological opacity, where either the effect of a rule is not evident in the output or its conditions of application are not present in the output, due to the operation of later rules. This demonstrates the superiority of a rule-based account over output oriented approaches such as Optimality Theory or pre-Generative structuralist phonology.
The use of prosodic categories gives a clearer understanding of the intonation of utterancesthan the syntactic structure that was assumed in SPE. The prosodic hierarchy includes eight categories from the highest (the phonological utterance)through the intermediate cateories (intonation phrase, phonological phrase, clitic group, phonological word, foot, syllable) to the lowest (the mora). Each unit consists exclusively of units of the next lower category, though certain derived structures are possible with nesting, as when a syllable is adjoined to a foot. In that case the original foot is a constituent of the derived larger foot and a sister to the adjoined syllable. Exemplification of segmental rules that apply in terms of each prosodic category from English and other languages. The three highest units can sometimes be restructured, either broken into smaller units or combined into a larger unit. Summary of the postlexical rules.
Basic principles of generative phonology, as codified in SPE, and later developments within this framework, including metrical phonology, lexical phonology, autosegmental phonology, and underspecification theory. The role of cyclicity. The rise of Optimality Theory and the difficulties encountered in this framework in accounting for opaque relationships.
Principles of lexical phonology, properties of lexical strata, survey of English morphology, zero derivation, cyclicity and the strict-cycle condition. Summary of the cyclic rules of stratum 1.
The parametric approach to stress includes parameters (1) quantity sensitivity, (2) maximally binary or unbounded feet, (3) left or right branching and left or right strong, (4) direction of stress-tree construction, and (5) the word tree as left or right branching, Exemplification of this approach in Maranungku, Latvian, Warao, Eastern Cheemis, and Latin. Application to English as quantity sensitive with maximally binary feet that are left branching and left strong constructed from right to left with a right-branching word tree. It is necessary to allow some segments and syllables to be extrametrical prior to the application of the rules. Destressing rules are also required, with a convention of stray syllable adjunction. Most stress rules apply cyclically on stratum 1 of the phonology, with some noncyclic on stratum 2. Exceptions are to be accounted for by marking some items exceptions to certain rules; there is no need to assume stress in underlying representations.
The detailed phonology of the word level, defined as the last lexical stratum. This is stratum 2 in English, which, like stratum 1 is word bounded, is structure preserving, and has access to word-internal structure assigned at the same stratum, but unlike stratum 1 is not cyclic and is not subject to the Strict Cycle Condition, allowing rules like Vowel Shift and Velar Softening to apply freely in nonderived contexts. Vowek Shift is a chain shift that affects stressed tense vowels by shifting high vowels to low and raising low vowels to mid and mid vowels to high, without creating any mergers. Some additional rules are required to ensure the final vowel qualities. Some tensing rules apply on stratum 1 or this stratum before Vowel Shift, another applies after Vowel Shift. Vowel reduction produces two or three vowels (depending on dialect), not just schwa as in SPE. Rules for consonants include Velar Softening, Palatalization, Spirantization, with interesting and complex ordering relations. Summary of the stratum 2 rules and their ordering.