Filling the Gaps in Mental Health Care; Considerations and Approach to CBT in Clinical Practice

Caring for patients with psychiatric illnesses is an inevitable part of being a health care provider in the United States. The increasing prevalence of mental illness and shortage of mental health clinicians places considerable burden on the US health care system. Few treatment modalities have been as consistently effective as Cognitive Behavioral Therapy (CBT) in treating a wide range of psychiatric disorders. The purpose of this article is to educate both current and future health care providers on the practice of and indications for CBT, identify barriers to its implementation, and to improve awareness of opportunities for CBT training and treatment for patients

CONTROLLING WILDLIFE AND LIVESTOCK DISEASE WITH ENDOGENOUS ON-FARM BIOSECURITY

The spread of infectious disease among and between wild and domesticated animals has become a major problem worldwide. We analyze the socially optimal management of wildlife and livestock, including choices involving environmental habitat variables and on-farm biosecurity controls, when wildlife and livestock can spread an infectious disease to each other. The model is applied to the problem of bovine tuberculosis among Michigan white-tailed deer. The optimum is a cycle in which the disease remains endemic in the wildlife, but in which the cattle herd is depleted when the prevalence rate in deer grows too large.Research Methods/ Statistical Methods,

Predictors of Missed Hepatitis C Intake Appointments and Failure to Establish Hepatitis C Care Among Patients Living With HIV.

BackgroundWe estimated and characterized the proportion of patients living with HIV (PLWH) who missed hepatitis C (HCV) intake appointments and subsequently failed to establish HCV care.MethodsLogistic regression analyses were used to identify factors associated with missed HCV intake appointments and failure to establish HCV care among PLWH referred for HCV treatment between January 2014 and December 2017. In addition to demographics, variables included HIV treatment characteristics, type of insurance, liver health status, active alcohol or illicit drug use, unstable housing, and history of a mental health disorder (MHD).ResultsDuring the study period, 349 new HCV clinic appointments were scheduled for 202 unduplicated patients. Approximately half were nonwhite, and 80% had an undetectable HIV viral load. Drug use (31.7%), heavy alcohol use (32.8%), and MHD (37.8%) were prevalent. Over the 4-year period, 21.9% of PLWH referred for HCV treatment missed their HCV intake appointment. The proportion increased each year, from 17.2% in 2014 to 25.4% in 2017 (P = .021). Sixty-six of the 202 newly referred HCV patients (32.7%) missed their first HCV appointment, and 28 of these (42.4%) failed to establish HCV care. Having a history of MHD, CD4 <200, ongoing drug use, and being nonwhite were independent predictors of missing an intake HCV appointment. The strongest predictor of failure to establish HCV care was having a detectable HIV viral load.ConclusionsThe proportion of PLWH with missed HCV appointments increased over time. HCV elimination among PLWH may require integrated treatment of MHD and substance use

Methods for tracking material properties within an unstructured, adaptive mesh computational modelling framework, with application to simulating the development of seismic anisotropy at spreading centres and transform faults

The ability to accurately and efficiently track material properties in a Lagrangian sense during geodynamical flows, as well as evaluate how they evolve through both space and time, is of vital importance to our understanding of the structure, dynamics and evolution of Earth's mantle and lithosphere. An approach for achieving this, widely advocated by the geodynamics community, is the so-called particle-in cell technique. With this scheme, material properties are tracked by a large number of particles that are advected with the flow field. These properties can represent a wide range of parameters (e.g. material composition or strain) and the information they carry can be accessed during a simulation to feed back into the flow equations (e.g. composition controlling material density), as well as generate diagnostic fields for analysis (e.g. the generation of lattice-preferred orientation). In Chapter 2, we develop a particle-in-cell scheme within an adaptive, unstructured, anisotropic mesh computational modelling framework called Fluidity. Regions of geodynamic interest often vary throughout a simulation, and the combination of the particle-in-cell scheme with a state of the art adaptive mesh algorithm enables both the mesh resolution and particle density to capture areas of interest with high resolution (or density), while reducing resolution (or density) in areas of little geodynamic interest. This ensures that a high level of accuracy is maintained throughout the computational domain, while also greatly improving numerical efficiency. The implementation of this scheme saw several inherent challenges which had to be overcome, including the treatment of particles during mesh adaptivity, the transfer of particle between processors, and the interpolation of values between particles and nodes of the mesh. In Chapter 3, validation of the implemented particle-in-cell scheme is undertaken for a series of well-known thermo-chemical convection benchmark tests. For each benchmark, particles track material composition as they are advected throughout the computational domain, with material composition feeding back onto the density field and influencing the buoyancy of materials. Results from the particle scheme are compared with results from a field-based control volume, flux-limited conservative difference scheme known as HyperC. Both schemes perform favourably across the series of benchmark tests, with HyperC displaying superior mass conservation and the particle scheme exhibiting superior shape preservation, resulting in a smoother material interface and the visualization of finer scale features. The particle-in-cell scheme is favoured, as it is more flexible in its application to tracking generalized material properties, enabling it to be applied to a wide range of geodynamical problems, such as the tracking of material texture. In Chapter 4, we develop the software package PyDRex, which is capable of converting tracked deformation parameters into predictions of material lattice-preferred orientation and seismic anisotropy. The generation of lattice-preferred orientation and subsequent observations of seismic anisotropy within Earth's mantle yields some of the most direct constrains available on both past and present-day deformation. By simulating these processes with geodynamics models, it is possible to generate synthetic seismic anisotropy predictions, which can be compared with observations in an attempt to constrain the prevalent flow regime in the upper mantle. In Chapter 5, we utilize the PyDRex software package with Fluidity and develop three sets of oceanic plate boundary models, being 2-D and 3-D mid-ocean ridge models, and 3-D mid-ocean ridge models with a transform fault offset. We compare anisotropy predictions from these models with seismic observations of anisotropy, allowing inferences to be made on the prevalent flow regime and distribution of material anisotropy surrounding oceanic plate boundaries

Deoxyribonucleotide Metabolism, Mutagenesis, and Cancer

Cancer was recognized as a genetic disease at least four decades ago, with the realization that the spontaneous mutation rate must increase early in tumorigenesis, to account for the many mutations in tumor cells as compared with their progenitor normal cells. The genetic basis for cancer was established also from the finding that viral oncogenes have cellular counterparts, expression of which could transform cells. Deoxyribonucleotide pool abnormalities have long been recognized as determinants of DNA replication fidelity, and hence, may contribute to mutagenic processes involved in carcinogenesis. In addition, many anticancer agents act as antagonists of deoxyribonucleotide metabolism. To what extent may aspects of deoxyribonucleotide metabolism contribute to our understanding of both carcinogenesis and the effective use of anticancer agents?Keywords: DNA mismatch repair, Biochemistry, Base excision repair, DNA replication, DNA metabolism, Genomic instabilit