The Impact of an Epilepsy Self-Management Program on Healthcare Utilization and Related Costs

During a summer 2015 internship at Dartmouth-Hitchcock Medical Center, I was part of a team studying the cost effectiveness of Home Based Self-Management and Cognitive Training Changes Lives (HOBSCOTCH), a self-management program for memory impairment in epilepsy patients designed by the Dartmouth-Hitchcock Epilepsy Center. Our method was to evaluate the number of healthcare encounters of the patients six months before and after the program, which took place from January 2013 to June 2014. Decreases in the number of encounters was equated with decreases in healthcare costs to both the patient and the healthcare system. The intervention group showed a decrease in both total and neurology encounters post-program, although the decrease was not statistically significant. The high frequency group, however, showed a statistically significant decrease in the total number of encounters. Data on encounters was also related to earlier data on quality of life and depression scores of the participants. Pre-program, high depression and/or low quality of life scores related directly to high numbers of neurology encounters for all patients. Post-program this association was not true for all patients with high depression and/or low quality of life scores. It is hypothesized that these changes are the result of participants learning to self-manage memory impairment, and this ability improved their quality of life and general health

Homotopical resolutions associated to deformable adjunctions

Given an adjunction connecting reasonable categories with weak equivalences, we define a new derived bar and cobar construction associated to the adjunction. This yields homotopical models of the completion and cocompletion associated to the monad and comonad of the adjunction. We discuss applications of these resolutions to spectral sequences for derived completions and Goodwillie calculus in general model categories.Comment: 22 pages; v2 is the final journal version, with expository improvements suggested by the refere

Levels in the toposes of simplicial sets and cubical sets

The essential subtoposes of a fixed topos form a complete lattice, which gives rise to the notion of a level in a topos. In the familiar example of simplicial sets, levels coincide with dimensions and give rise to the usual notions of n-skeletal and n-coskeletal simplicial sets. In addition to the obvious ordering, the levels provide a stricter means of comparing the complexity of objects, which is determined by the answer to the following question posed by Bill Lawvere: when does n-skeletal imply k-coskeletal? This paper answers this question for several toposes of interest to homotopy theory and higher category theory: simplicial sets, cubical sets, and reflexive globular sets. For the latter, n-skeletal implies (n+1)-coskeletal but for the other two examples the situation is considerably more complicated: n-skeletal implies (2n-1)-coskeletal for simplicial sets and 2n-coskeletal for cubical sets, but nothing stronger. In a discussion of further applications, we prove that n-skeletal cyclic sets are necessarily (2n+1)-coskeletal.Comment: This paper subsumes earlier work of the first, third, and fourth authors. 19 page

Correlations Between Nicotine Usage, Mental Wellbeing, and Other Psychoactive Substances Among College Students

Nicotine use may be associated with risk of illicit drug use and lower mental wellbeing. However, this relationship among college students is unknown. The purpose of the study is to assess the relationship between nicotine use, illicit ADHD medication use, and the use of other specific psychoactive substances and mental health of college students. An anonymous survey was distributed online to several higher education institutions. About 700 participants self-reported on the use of ADHD medications, cannabis, nicotine, other psychoactive drugs, and mental distress. Data was analyzed using Pearson’s Correlation Coefficient in SPSS. Very frequent nicotine use was positively correlated with mental distress. Very frequent use was linked to Cannabis and LSD use in addition to unprescribed use of painkillers. Non frequent use was positively associated with use of psilocybin, ADHD medication, LSD, and sedatives. Nicotine users may be inclined to use psychoactive substances, which requires further research.https://orb.binghamton.edu/research_days_posters_2023/1139/thumbnail.jp

Face masks have emotion-dependent dissociable effects on accuracy and confidence in identifying facial expressions of emotion

The coronavirus pandemic has resulted in increased use of face masks worldwide. Here, we examined the effect of wearing a face mask on the ability to recognise facial expressions of emotion. In a within-subjects design, 100 UK-based undergraduate students were shown facial expressions of anger, disgust, fear, happiness, sadness, and neutral expression; these were either posed with or without a face mask, or with a face mask artificially imposed onto them. Participants identified the emotion portrayed in the photographs from a fixed choice array of answers and rated their confidence in their selection. While overall accuracy was higher without than with masks, the effect varied across emotions, with a clear advantage without masks in disgust, happiness, and sadness; no effect for neutral, and lower accuracy without masks for anger and fear. In contrast, confidence was generally higher without masks, with the effect clear for all emotions other than anger. These results confirm that emotion recognition is affected by face mask wearing, but reveal that the effect depends on the emotion being displayed—with this emotion-dependence not reflected in subjects’ confidence. The disparity between the effects of mask wearing on different emotions and the failure of this to be reflected in confidence ratings suggests that mask wearing not only effects emotion recognition, but may also create biases in the perception of facial expressions of emotion of which perceivers are unaware. In addition, the similarity of results between the Imposed Mask and Posed Mask conditions suggests that prior research using artificially imposed masks has not been deleteriously affected by the use of this manipulation

Primary school staff perspectives of school closures due to COVID-19, experiences of schools reopening and recommendations for the future: A qualitative survey in Wales

School closures due to the COVID-19 global pandemic are likely to have a range of negative consequences spanning the domains of child development, education and health, in addition to the widening of inequalities and inequities. Research is required to improve understanding of the impact of school closures on the education, health and wellbeing of pupils and school staff, the challenges posed during face-to-face reopening and importantly to identify how the impacts of these challenges can be addressed going forward to inform emerging policy and practice. This qualitative study aimed to reflect on the perspectives and experiences of primary school staff (pupils aged 3–11) in Wales regarding school closures and the initial face-to-face reopening of schools and to identify recommendations for the future. A total of 208 school staff completed a national online survey through the HAPPEN primary school network, consisting of questions about school closures (March to June 2020), the phased face-to-face reopening of schools (June to July 2020) and a return to face-to-face education. Thematic analysis of survey responses highlighted that primary school staff perceive that gaps in learning, health and wellbeing have increased and inequalities have widened during school closures. Findings from this study identified five recommendations; (i) prioritise the health and wellbeing of pupils and staff; (ii) focus on enabling parental engagement and support; (iii) improve digital competence amongst pupils, teachers and parents; (iv) consider opportunities for smaller class sizes and additional staffing; and (v) improve the mechanism of communication between schools and families, and between government and schools

Antidepressant mechanisms of ketamine: a review of actions with relevance to treatment-resistance and neuroprogression

Concurrent with recent insights into the neuroprogressive nature of depression, ketamine shows promise in interfering with several neuroprogressive factors, and has been suggested to reverse neuropathological patterns seen in depression. These insights come at a time of great need for novel approaches, as prevalence is rising and current treatment options remain inadequate for a large number of people. The rapidly growing literature on ketamine’s antidepressant potential has yielded multiple proposed mechanisms of action, many of which have implications for recently elucidated aspects of depressive pathology. This review aims to provide the reader with an understanding of neuroprogressive aspects of depressive pathology and how ketamine is suggested to act on it. Literature was identified through PubMed and Google Scholar, and the reference lists of retrieved articles. When reviewing the evidence of depressive pathology, a picture emerges of four elements interacting with each other to facilitate progressive worsening, namely stress, inflammation, neurotoxicity and neurodegeneration. Ketamine acts on all of these levels of pathology, with rapid and potent reductions of depressive symptoms. Converging evidence suggests that ketamine works to increase stress resilience and reverse stress-induced dysfunction, modulate systemic inflammation and neuroinflammation, attenuate neurotoxic processes and glial dysfunction, and facilitate synaptogenesis rather than neurodegeneration. Still, much remains to be revealed about ketamine’s antidepressant mechanisms of action, and research is lacking on the durability of effect. The findings discussed herein calls for more longitudinal approaches when determining efficacy and its relation to neuroprogressive factors, and could provide relevant considerations for clinical implementation.publishedVersio

Curriculum-based outdoor learning for children aged 9-11: A qualitative analysis of pupils’ and teachers’ views

The relationship between child health, wellbeing and education demonstrates that healthier and happier children achieve higher educational attainment. An engaging curriculum that facilitates children in achieving their academic potential has strong implications for educational outcomes, future employment prospects, and health and wellbeing during adulthood. Outdoor learning is a pedagogical approach used to enrich learning, enhance school engagement and improve pupil health and wellbeing. However, its non-traditional means of achieving curricular aims are not yet recognised beyond the early years by education inspectorates. This requires evidence into its acceptability from those at the forefront of delivery. This study aimed to explore headteachers’, teachers’ and pupils’ views and experiences of an outdoor learning programme within the key stage two curriculum (ages 9–11) in South Wales, United Kingdom. We examine the process of implementation to offer case study evidence through 1:1 interviews with headteachers (n = 3) and teachers (n = 10) and focus groups with pupils aged 9–11 (n = 10) from three primary schools. Interviews and focus groups were conducted at baseline and six months into implementation. Schools introduced regular outdoor learning within the curriculum. This study found a variety of perceived benefits for pupils and schools. Pupils and teachers noticed improvements in pupils’ engagement with learning, concentration and behaviour, as well as positive impacts on health and wellbeing and teachers’ job satisfaction. Curriculum demands including testing and evidencing work were barriers to implementation, in addition to safety concerns, resources and teacher confidence. Participants supported outdoor learning as a curriculum-based programme for older primary school pupils. However, embedding outdoor learning within the curriculum requires education inspectorates to place higher value on this approach in achieving curricular aims, alongside greater acknowledgment of the wider benefits to children which current measurements do not capture

Toll-like Receptor 3 L412F Polymorphism Promotes a Persistent Clinical Phenotype in Pulmonary Sarcoidosis

Background: Sarcoidosis is a multisystemic disorder of unknown etiology, characterised by the presence of non-caseating granulomas in target organs. In ninety percent of cases, there is thoracic involvement. Fifty to seventy percent of pulmonary sarcoidosis patients will experience acute, self-limiting disease. For the subgroup of patients who develop persistent disease, no targeted therapy is currently available. Aim: To investigate the potential of the single nucleotide polymorphism (SNP), Toll-like receptor 3 Leu412Phe (TLR3 L412F; rs3775291), as a causative factor in the development of, and in disease persistence in pulmonary sarcoidosis. To investigate the functionality of TLR3 L412F in vitro in primary human lung fibroblasts from pulmonary sarcoidosis patients. Methods: Cohorts of Irish sarcoidosis patients (n=228), healthy Irish controls (n = 263) and a secondary cohort of American sarcoidosis patients (n=123) were genotyped for TLR3 L412F. Additionally, the effect of TLR3 L412F in primary lung fibroblasts from pulmonary sarcoidosis patients was quantitated following TLR3 activation in the context of cytokine and type I interferon production, TLR3 expression, and apoptotic- and fibroproliferative-responses. Results: We report a significant association between TLR3 L412F and persistent clinical disease in two cohorts of Irish and American Caucasians with pulmonary sarcoidosis. Furthermore, activation of TLR3 in primary lung fibroblasts from 412F-homozygous pulmonary sarcoidosis patients resulted in reduced IFN-â and TLR3 expression, reduced apoptosis- and dysregulated fibroproliferative-responses compared with TLR3 wild-type patients. Conclusions: This study identifies defective TLR3 function as a previously unidentified factor in persistent clinical disease in pulmonary sarcoidosis and reveals TLR3 L412F as a candidate biomarker