Depression and Cardiac Disease: Epidemiology, Mechanisms, and Diagnosis

In patients with cardiovascular disease (CVD), depression is common, persistent, and associated with worse health-related quality of life, recurrent cardiac events, and mortality. Both physiological and behavioral factors—including endothelial dysfunction, platelet abnormalities, inflammation, autonomic nervous system dysfunction, and reduced engagement in health-promoting activities—may link depression with adverse cardiac outcomes. Because of the potential impact of depression on quality of life and cardiac outcomes, the American Heart Association has recommended routine depression screening of all cardiac patients with the 2- and 9-item Patient Health Questionnaires. However, despite the availability of these easy-to-use screening tools and effective treatments, depression is underrecognized and undertreated in patients with CVD. In this paper, we review the literature on epidemiology, phenomenology, comorbid conditions, and risk factors for depression in cardiac disease. We outline the associations between depression and cardiac outcomes, as well as the mechanisms that may mediate these links. Finally, we discuss the evidence for and against routine depression screening in patients with CVD and make specific recommendations for when and how to assess for depression in this high-risk population

Determinants and Long‐Term Effects of Attendance Levels in a Marital Enrichment Program for African American Couples

Although most efficacious marital enrichment programs are multisession, few studies have explored whether outcomes differ according to session attendance, particularly among minority groups with lower than average participation in prevention programs. This study therefore investigates attendance levels and long‐term improvements in couple functioning among 164 couples participating in the Promoting Strong African American Families program. Structural equation models indicated session attendance predicted 2‐year changes for men\u27s reports of communication, commitment, and spousal support (marginally) but not for women\u27s. Individual and couple characteristics that predicted attendance levels were also identified. Results highlight distinct gender differences in the effects of sustained attendance as well as characteristics that provide early identifiers for African American couples at increased risk of low program attendance

Prevention effects on trajectories of African American adolescents\u27 exposure to interparental conflict and depressive symptoms.

The present study investigates the trajectory of children\u27s exposure to interparental conflict during adolescence, its effects on adolescents\u27 psychological adjustment, as well as the ability of a family-centered prevention program to alter this trajectory. A total of 331 African American couples with an adolescent or preadolescent child participated in a randomized control trial of the Promoting Strong African American Families program, a newly developed program targeting couple and cocaregiving processes. Using a multi-informant, latent growth curve approach, child exposure to interparental conflict during adolescence was found to be stable over a period of 2 years among families in the control group, but significantly declined among families in the treatment condition. Rates of change were significantly different between intervention and control groups based on parents\u27 report of youth exposure to interparental conflict, but not for child\u27s report. Structural equation models found trajectory parameters of interparental conflict predicted changes in adolescent depressive symptoms, with increasing rates of changes in conflict associated with increases in adolescent internalizing symptoms over the 2-year duration of the study. Finally, a significant indirect effect was identified linking treatment, changes in parents\u27 reports of child exposure to interparental conflict, and adolescent depressive symptoms. The implications for research and intervention are discussed

Permeability evolution during progressive development of deformation bands in porous sandstones

[1] Triaxial deformation experiments were carried out on large (0.1 m) diameter cores of a porous sandstone in order to investigate the evolution of bulk sample permeability as a function of axial strain and effective confining pressure. The log permeability of each sample evolved via three stages: (1) a linear decrease prior to sample failure associated with poroelastic compaction, (2) a transient increase associated with dynamic stress drop, and (3) a systematic quasi-static decrease associated with progressive formation of new deformation bands with increasing inelastic axial strain. A quantitative model for permeability evolution with increasing inelastic axial strain is used to analyze the permeability data in the postfailure stage. The model explicitly accounts for the observed fault zone geometry, allowing the permeability of individual deformation bands to be estimated from measured bulk parameters. In a test of the model for Clashach sandstone, the parameters vary systematically with confining pressure and define a simple constitutive rule for bulk permeability of the sample as a function of inelastic axial strain and effective confining pressure. The parameters may thus be useful in predicting fault permeability and sealing potential as a function of burial depth and faul

Frequently Identified Gaps in Antibiotic Stewardship Programs in Critical Access Hospitals

Background: Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) is a CDC funded project. ICAP team works in collaboration with NE Department of Health and Human Services (NEDHHS) to assess and improve infection prevention and control programs (IPCP) in various health care settings including resource limited settings like critical access hospitals (CAH). Little is known about the existing gaps in antimicrobial stewardship programs (ASP) of CAH. Hence, we decided to study the current level of ASP activities and factors associated with these activities in CAH. Methods: NE ICAP conducted on-site surveys in 36 CAH from October 2015 to February 2017. ASP activities related to the 7 CDC recommended core elements (CE) including leadership support (LS), accountability, drug expertise (DE), action, tracking, reporting, and education were assessed using a CDC Infection Control Assessment Tool for acute care hospitals. Descriptive analyses evaluated CAH characteristics and frequency of CE implementation. Fisher’s exact, Mann–Whitney, and Kruskal–Wallis tests were used for statistical analyses examining the association of various factors with level of ASP activities. Results: The 36 surveyed CAH had a median of 20 (range 10–25) beds and employed a median of 0.4 (range 0.1–1.6) infection preventionist (IP) full-time equivalent (FTE)/25-bed. Frequency of CE implementation varied among CAH with action and LS as the most (69%) and least (28%) frequently implemented elements, respectively. Close to half (47%) of surveyed CAH had implemented ≥4 CE but only 14% of facilities had all 7 CE. Median bed size and IP FTE/25-bed were similar among CAH with 0–2, 3-5, or ≥6 CE in place. CAH with LS or accountability for ASP implemented higher median numbers of the remaining CE compared with CAH without LS or accountability (5 vs. 2, P \u3c 0.01 and 4 vs. 2, P \u3c 0.01, respectively). Facilities with The presence of LS, accountability and drug expertise were more likely to have all 4 remaining CE implemented than others (56% vs. 8%, P \u3c 0.01). Conclusion: LS, accountability, and DE are important factors for the implementation of the remaining 4 CE in CAH. Although LS was the least frequently implemented CE, when present was associated with implementation of most of the other CE. Acquiring LS will facilitate implementation of additional ASP efforts in CAH.https://digitalcommons.unmc.edu/asap_pres/1000/thumbnail.jp

Compendium of Single Event Effects Test Results for Commercial Off-The-Shelf and Standard Electronics for Low Earth Orbit and Deep Space Applications

We present the results of Single Event Effects (SEE) testing with high energy protons and with low and high energy heavy ions for electrical components considered for Low Earth Orbit (LEO) and for deep space applications

Central and Peripheral α-Synuclein in Parkinson Disease Detected by Seed Amplification Assay

Objectives Detection of α‐synuclein aggregates by seed amplification is a promising Parkinson disease biomarker assay. Understanding intraindividual relationships of α‐synuclein measures could inform optimal biomarker development. The objectives were to test accuracy of α‐synuclein seed amplification assay in central (cerebrospinal fluid) and peripheral (submandibular gland) sources, compare to total α‐synuclein measures, and investigate within‐subject relationships. Methods The Systemic Synuclein Sampling Study aimed to characterize α‐synuclein in multiple tissues and biofluids within Parkinson disease subjects (n = 59) and compared to healthy controls (n = 21). Motor and non‐motor measures and dopamine transporter scans were obtained. Four measures of α‐synuclein were compared: seed amplification assay in cerebrospinal fluid and formalin‐fixed paraffin‐embedded submandibular gland, total α‐synuclein quantified in biofluids using enzyme‐linked immunoassay, and aggregated α‐synuclein in submandibular gland detected by immunohistochemistry. Accuracy of seed amplification assay for Parkinson disease diagnosis was examined and within‐subject α‐synuclein measures were compared. Results Sensitivity and specificity of α‐synuclein seed amplification assay for Parkinson disease diagnosis was 92.6% and 90.5% in cerebrospinal fluid, and 73.2% and 78.6% in submandibular gland, respectively. 25/38 (65.8%) Parkinson disease participants were positive for both cerebrospinal fluid and submandibular gland seed amplification assay. Comparing accuracy for Parkinson disease diagnosis of different α‐synuclein measures, cerebrospinal fluid seed amplification assay was the highest (Youden Index = 83.1%). 98.3% of all Parkinson disease cases had ≥1 measure of α‐synuclein positive. Interpretation α‐synuclein seed amplification assay (cerebrospinal fluid\u3esubmandibular gland) had higher sensitivity and specificity compared to total α‐synuclein measures, and within‐subject relationships of central and peripheral α‐synuclein measures emerged

An Anthropocene Without Archaeology—Should We Care?

For more than a decade, a movement has been gathering steam among geoscientists to designate an Anthropocene Epoch and formally recognize that we have entered a new geological age in which Earth’s systems are dominated by humans. Chemists, climatologists, and other scientists have entered the discussion, and there is a growing consensus that we are living in the Anthropocene. Nobel Prize-winning atmospheric chemist Paul Crutzen (2002a, 2002b; Crutzen and Stoermer 2000) coined the term, but the idea that humans are a driver of our planet’s climate and ecosystems has much deeper roots. Italian geologist Antonio Stoppani wrote of the “anthropozoic era” in 1873 (Crutzen 2002a), and many others have proposed similar ideas, including journalist Andrew Revkin’s (1992) reference to the “Anthrocene” and Vitousek and colleagues (1997) article about human domination of earth’s ecosystems. It was not until Crutzen (2002a, 2002b) proposed that the Anthropocene began with increased atmospheric carbon levels caused by the Industrial Revolution in the late eighteenth century (including the invention of the steam engine in A.D. 1784), however, that the concept began to gain serious traction among scientists and inspire debate

Evaluation of Right-of-Way Fence Tags to Reduce Animal-Vehicle Collisions

Animal-vehicle collisions (AVC) pose a serious and growing threat to motorists traveling on ADOT roads. Solutions exist to effectively mitigate AVC, such as wildlife crossing structures (overpasses and underpasses), however these solutions can be costly and untimely. Fence tags, a small reflective tag that is attached to the right-of-way fence and deter animals from crossing the fence, provide a potential cost-effective solution to reduce AVC. The research team evaluated the effectiveness of fence tags designed by Swift Creek, LLC, in reducing AVC. Fence tags were installed along both sides of five 2-mile segments of roadway and maintained for three years by replacing missing or damaged fence tags on a quarterly basis. The research team queried ADOT Crash Data to determine changes in AVC prior to the study (July 1, 2015 \u2013 June 30, 2018) and following fence tag installation (July 1, 2018 \u2013 June 30, 2021). Collisions in the areas where fence tags were installed were reduced by an average of 25.4 percent across all sites. This reduction was significant; however, the control sites were also reduced by a similar average of 25.8 percent across all study sites. These findings indicate that (1) the effectiveness of fence tags at reducing AVC were not noticeably different than the control, or (2) external factors that were not considered in the study, such as the effect of nearby road construction, may have influenced the effectiveness of the fence tags. To better understand the results of this study and improve available data for future projects and management decisions, the research team recommends: (1) further examining fence tags as a viable mitigation technique by looking at other aspects that could be taken into account in the study, such as other external factors affecting their use; measuring the effective tag size; implementing a longer observation period before, during, and after the intervention, etc. and (2) implementing data collection forms that capture animal type/species

Developing Standards for Cultural Competency Training for Health Care Providers to Care for Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual Persons: Consensus Recommendations from a National Panel

Purpose: Lesbian, gay, bisexual, transgender, queer, intersex, and/or asexual and other sexual and gender diverse persons (LGBTQIA + or SGD persons) experience barriers to equitable health care. The purpose of this article is to describe a collaborative process that resulted in core cultural competency recommendations addressing training for those who provide health care and/or social services to LGBTQIA + patients. Methods: In 2018 and 2019, Whitman-Walker Health, a Federally Qualified Community Health Center in Washing- ton, DC, and the National LGBT Cancer Network purposively selected leaders of community clinics and community-based organizations, cultural competency trainers, and clinicians and researchers with expertise in SGD health with diverse lived experiences to develop consensus-based cultural competency recommendations. Recommendations were developed through a synthesis of peer-reviewed studies, publicly accessible curricula, and evaluations of SGD cultural competency trainings; two in-person convenings; and iterative feedback from diverse stakeholders. Results: Five anchoring recommendations emerged: (1) know your audience; (2) develop and fine-tune the curriculum; (3) employ both adult and transformational learning theories; (4) choose multiple effective trainers; and (5) evaluate impact of training. These recommendations promote an ongoing process of individual and organizational improvement and a stance of humility rather than competence to be mastered. Conclusion: By setting core cultural competency standards for all persons involved in health care and social services, these recommendations complement existing clinical competency recommendations to advance SGD health equity