The Mountain West Clinical and Translational Infrastructure Network Community Engagement and Outreach (CEO) Core has fostered academic-community engagement since 2018. States historically receiving lower levels of NIH funding are characterized by significantly higher proportions of rural and remote populations, as well as uniquely elevated percentages of Native American/Alaska Native and Native Hawaiian/Pacific Islander populations compared to most other states. This case study highlights the Core’s efforts in advancing community-engaged research. Key initiatives included forming a CEO Core Steering Committee to recruit interdisciplinary investigators, establishing regional community advisory boards to identify research priorities, and creating a Resource Library and Training Portal for stakeholders. The Core also collaborated with other Cores to provide training, mentorship, and funding for community-engaged research. Despite these achievements, geographical and cultural diversity presented engagement challenges. Regular meetings between investigators and stakeholders ensured bidirectional communication and aligned goals. The Core transformed transactional engagement into meaningful collaboration, emphasizing the need for interdisciplinary teams who understand community needs. Future goals include training academic teams, clinical providers, and community members, empowering early-stage investigators to share findings with partners, leveraging health records for research, and developing strategies to protect investigators’ time.

Eating disorders (EDs) are one of the most severe and complex mental health problems facing researchers and clinicians today. The effective prevention and treatment of these conditions is therefore of paramount importance. However, at present our treatments fall short: generally demonstrating only poor to moderate efficacy, and often completely ineffective for severe or chronic cases. A possible reason for this is that the current theories underlying these treatments are flawed. In this paper, we review and evaluate several prominent theoretical explanations associated with current frontline and promising treatments for ED. In doing so, we identify fundamental problems within the construction of current ED explanations and their implications for treatment. In response to these findings, we propose several strategies for the construction of future ED explanations which we believe have the power to ameliorate these problems and potentially help to develop more efficacious treatment downstream.

Symptom network models (SNWMs) play an important role in identifying but not explaining patterns of symptoms. We discuss underlying assumptions of SNWMs and argue that they represent phenomenal models, best suited to detecting patterns among symptoms. SNWMs need to be supplemented with mechanistic models that provide constitutive and etiological explanations of each symptom (network nodes) once relevant patterns have been identified.

In the field of psychopathology there is still a lack of consensus on how mental disorders, such as depression, should be classified and explained. Many of our current classifications suffer from disorder heterogeneity and are conceptually vague. While some researchers have argued that mental disorders are better explained from a biological perspective, others have made the case for pluralistic and integrative explanations. Using depression as an extended example, we explore the challenges in classifying and explaining psychopathology. We begin by evaluating the current approaches to classification, including frameworks for what we consider a mental disorder. This is followed by a detailed summary of current explanatory perspectives in psychiatry. The relationship between classification and explanation presents unique theoretical challenges in understanding mental disorders. We suggest that by adjusting our focus from understanding syndromes to clinical phenomena we can advance our understanding of mental disorders.

OBJECTIVES/SPECIFIC AIMS: The objective of the study was 2-fold; to identify potentially deleterious alleles in a child with Treacher Collins syndrome, and; to demonstrate the value of the iobio analysis platform for intuitively and rapidly analyzing genomic data. METHODS/STUDY POPULATION: We used the iobio suite of web-based applications to analyze quality metrics for the sequencing data and called variants for the proband and his parents. We then visually interrogated variants in genes potentially associated with the syndrome in real-time, using the intuitive gene.iobio application. We sought high impact variants that demonstrated a predicted impact on the protein function, and were simultaneously at low allele frequency in the general human population. Variants were also compared against the ClinVar database of known mutations to identify variants that have already been associated with this, or related syndromes in the literature or clinical studies. Finally, the gene.iobio tool allows users to interrogate the primary sequencing data to ensure that no variants had been missed by the primary variant calling pipeline. This analysis pipeline was performed using intuitive web-based apps in real time, and consequently represents a system that is available to users that traditionally are excluded from these analyses. RESULTS/ANTICIPATED RESULTS: The iobio suite was used to rapidly assess data quality and interrogate genetic variants for a child with Treacher Collins syndrome. A compound heterozygote consisting of 2 missense alleles in the TCOF1 gene was identified as a compelling pathogenic allele, necessitating further functional investigation. The study helped validate the use of the intuitive iobio tools in such analyses, strengthening the case for greater involvement of medical professionals in data analysis. DISCUSSION/SIGNIFICANCE OF IMPACT: The performed analyses demonstrated that the whole genome sequencing data for the family being studied was of a very high quality, although 1 gene demonstrated a local region of almost zero coverage. This ensured that study conclusions can be presented with confidence. A variant associated with Treacher Collins syndrome 1 in ClinVar was uncovered in the TCOF1 gene, however, given it’s benign rating, this variant was not considered further. The most interesting candidate was a compound heterozygote, consisting of 2 missense mutations, also in the TCOF1 gene. These mutations occurred with allele frequencies of 22% and 8% in the general population, and additional molecular and functional studies are currently being pursued.

Clinical reasoning is one of the central components of psychological assessment. The identification of a client's psychological difficulties and the subsequent depiction of their onset, development, and interrelationships enables clinicians to plan treatment in a systematic and effective manner. In an article (Ward, Vertue, & Haig, 1999), we outlined the abductive theory of method (ATOM) and argued that it offered a useful framework for highlighting and integrating the major phases of psychological assessment. These phases involve detecting clinical phenomena, postulating psychological mechanisms, developing a case formulation, and evaluating a case formulation. In this article we present a revised version of the adaptation of ATOM and elaborate on the related clinical dimensions of assessment.

In the context of the UK Supreme Court decision in Sienkiewicz v Greif (2011) this article discusses the question whether so-called “naked statistical evidence” can satisfy the civil standard of proof in English law, the “balance of probabilities”. It argues that what is required to satisfy the standard is a judicial belief that causation is more likely than not, rather than a categorical belief that causation occurred. Whether such a belief is justified depends on the weight of the evidence as well as the degree of probability it purports to establish, but there is no reason of principle why epidemiological evidence alone should not satisfy this standard.

This commentary updates the paper ‘Excluding evidence (or staying proceedings) to vindicate rights in Irish and English law’ by analysing the recent decision of the Supreme Court of Ireland in DPP v JC. It argues that although the court has relaxed the exclusionary rule in one major respect, it has strengthened it in others, and that Ireland's approach to unconstitutionally or illegally obtained evidence remains very different from that of England and Wales.

The constitutional duty of the Irish state ‘to defend and vindicate the personal rights of the citizen’ is the basis of a strict rule excluding unconstitutionally obtained evidence. Although English courts recognise a similar duty to ‘vindicate human rights and the rule of law’, their powers to exclude evidence or stay proceedings for abuse of process are extremely flexible and discretionary. In both jurisdictions, there has been particular controversy over the application of these powers to covert recordings that breach legal professional privilege. This paper argues that the duty to vindicate rights and the rule of law underpins both the exclusion of unlawfully obtained evidence and the punishment of offenders. It requires a balancing exercise, not between defendants' rights and an incommensurable public interest but, rather, between two aspects of the same constitutional duty of the courts.

Relapse prevention is a multimodal, cognitive-behavioural approach to treating, among other types of clients, child molesters. Rather than positing a cure as the outcome of treatment, it emphasises self-management and personal responsibility for avoiding or coping with situations that threaten self-control. The motivation to use these self-control strategies is likely to vary according to beliefs about the causes of their offending behaviour, particularly as a function of the degree to which they are seen as controllable. Fifteen child molesters, classified as preferential or situational type, and familial or nonfamilial, from the Kia Marama unit at Rolleston Prison reported on their causal beliefs concerning their offence-related behaviour at four points in their description of their most typical or recent relapse. This assessment was carried out at four points in the 35-week relapse-prevention based treatment program.

All participants made clinically positive changes in their causal ascriptions over treatment. Preferential participants judged the cause of their offending to be less controllable, and more stable at the time of offence, and more global than situational offenders. Compared with non-familial participants, incestuous participants evaluated the cause of their offending to be less stable at the time of their offence and less global across all the assessment points. The results are discussed in terms of the utility of attributional assessment as an interim measure of progress, particularly with respect to motivation to avoid reoffending.

Sexual offences against women and children constitute a serious and distressingly prevalent social problem. The psychological and emotional costs to victims and their families, the high reoffending rates of some types of offenders, and the financial costs of incarceration all highlight the urgent need for effective research and treatment of this problem behaviour. In the past two decades, a number of innovations have led to improved treatment of these difficult men. In addition, theories and models have been developed with the aim of furthering our understanding of sex offenders. In this paper we identify a number of issues within the broad areas of assessment and treatment that we believe to be problematic, and make some suggestions about ways of resolving these problems in the future.

The clinical literature has long acknowledged the paradoxical findings that deliberate attempts to suppress particular thoughts actually increase their occurrence. The unwanted, intrusive thoughts that are a major feature of obsessive disorders, depression, sleep disorders, and a range of other disturbances are of particular clinical concern. The exploration of psychological factors associated with cognitive control is, therefore, clinically relevant. The present paper considers the role of mental control and thought suppression in bulimia nervosa in explaining the occurrence of unwanted thoughts and feelings, specifically in relation to weight, shape, and food. Our fundamental argument is that suppression of thoughts of food, weight, and body shape can lead to the increased frequency of these thoughts. The increase in unwanted thoughts is likely to result in a loss of control over eating, and lead to the escalation and perpetuation of bulimia. Dietary restriction is likely to be associated with successful suppression, and binge-eating with failed suppression. Indeed, the initial success of suppression paradoxically causes its inevitable failure. We conclude that the suppression of thoughts of food and weight or shape in bulimia nervosa is maladaptive and counterproductive. In addition, the therapeutic implications of thought suppression are considered.

Driving while disqualified represents a serious and recurrent social problem, with approximately 40% of convicted individuals reoffending. The high relapse (or recidivism) rates in this group are thought to be associated with compulsivity or addictive processes. In this paper we describe a cognitive-behavioural treatment program (relapse prevention) for offenders convicted of driving while disqualified. This program represents a significant innovation in the rehabilitation of persistent driving offenders, as in the past most intervention programs have focused on driver education and/or alcohol treatment. A major assumption of the relapse-prevention approach is that for many men their driving offences represent a maladaptive response to stressful events such as interpersonal conflict. Therefore, the primary treatment approach revolves around teaching individuals more effective ways to solve their interpersonal problems and to regulate negative affective states.

The assessment of sexual aggression presents many difficulties for clinicians. The tendency of offenders to minimise or deny their offending, and their frequent distrust of mental health professionals, require high levels of skill to circumvent. In addition, the multifactorial nature of rape means that assessment needs to cover a broad range of content areas and utilise a number of different methods. In this paper we suggest that a comprehensive assessment should inquire into the developmental history of rapists, social competency, attitudes and beliefs about women and sexual crimes, sexual knowledge, sexual preferences and disorders, empathy, offence variables, psychiatric history, and substance abuse. The clinical interview remains the primary method of information acquisition, and needs to be tailored to match the particular interpersonal style of rapists. The use of psychometric and physiological measures are also valuable sources of clinical data.

A comprehensive cognitive-behavioural treatment program for incarcerated child molesters is described. This program operates within Kia Marama, a medium-security unit for sex offenders in the New Zealand prison system. It lasts 32 weeks and includes a four-week assessment process both before and after the 24 weeks of intensive treatment. Treatment covers a variety of issues including distorted cognitions, sexual issues, victim empathy, social skills, problem solving, life skills, stress management, and relapse-prevention training. In addition, when offenders are released they are supervised by professionals trained in relapse-prevention procedures. As this program began in late 1989, it is too early to properly estimate its success, but similar programs in North America have produced promising outcome data, and what tentative evidence we have to date suggests that the program is valuable.