Strategies for Prevention of Varicella Pneumonia: A Cost-Effectiveness Analysis

Objective: The objective of this study was to compare the cost-effectiveness of 3 strategies of serologic enzyme-linked immunosorbent assay (ELISA) testing and post-exposure varicella zoster immune globulin (VZIG) prophylaxis for the prevention of maternal varicella pneumonia during pregnancy in patients with negative or uncertain histories of varicella infection

Effect of permafrost thaw on CO2 and CH4 exchange in a western Alaska peatland chronosequence

Permafrost soils store over half of global soil carbon (C), and northern frozen peatlands store about 10% of global permafrost C. With thaw, inundation of high latitude lowland peatlands typically increases the surface-atmosphere flux of methane (CH4), a potent greenhouse gas. To examine the effects of lowland permafrost thaw over millennial timescales, we measured carbon dioxide (CO2) and CH4 exchange along sites that constitute a ~1000 yr thaw chronosequence of thermokarst collapse bogs and adjacent fen locations at Innoko Flats Wildlife Refuge in western Alaska. Peak CH4 exchange in July (123 ± 71 mg CH4–C m−2 d−1) was observed in features that have been thawed for 30 to 70 (\u3c100) yr, where soils were warmer than at more recently thawed sites (14 to 21 yr; emitting 1.37 ± 0.67 mg CH4–C m−2 d−1 in July) and had shallower water tables than at older sites (200 to 1400 yr; emitting 6.55 ± 2.23 mg CH4–C m−2 d−1 in July). Carbon lost via CH4 efflux during the growing season at these intermediate age sites was 8% of uptake by net ecosystem exchange. Our results provide evidence that CH4 emissions following lowland permafrost thaw are enhanced over decadal time scales, but limited over millennia. Over larger spatial scales, adjacent fen systems may contribute sustained CH4 emission, CO2 uptake, and DOC export. We argue that over timescales of decades to centuries, thaw features in high-latitude lowland peatlands, particularly those developed on poorly drained mineral substrates, are a key locus of elevated CH4 emission to the atmosphere that must be considered for a complete understanding of high latitude CH4 dynamics

Strategies for Prevention of Varicella Pneumonia: A Cost-Effectiveness Analysis

ABSTRACT Objective: The objective of this study was to compare the cost-effectiveness of 3 strategies of serologic enzyme-linked immunosorbent assay (ELISA) testing and post-exposure varicella zoster immune globulin (VZIG) prophylaxis for the prevention of maternal varicella pneumonia during pregnancy in patients with negative or uncertain histories of varicella infection. Methods: A decision tree was constructed to compare the following strategies: 1) routine serologic testing for varicella immunity followed by targeted post-exposure VZIG prophylaxis, 2) post-exposure serologic testing followed by targeted VZIG prophylaxis, and 3) untargeted post-exposure VZIG administration. The probabilities for the model were obtained from the medical literature and supplemented by expert opinion. The costs were obtained by a review of inpatient hospitalizations for varicella pneumonia. All costs were converted to 1995 dollars. Results: Routine serologic testing followed by targeted post-exposure VZIG prophylaxis was the most costly strategy ($37.22/person), with no demonstrable increase in benefit compared with the other 2 strategies. The disutility of this strategy compared with the others was stable across a wide range of values for the probabilities and costs utilized in the sensitivity analysis. We were unable to differentiate between the cost-effectiveness of the other 2 strategies. Conclusions: Routine serologic testing for varicella immunity in patients with negative or uncertain histories of varicella infection should not be performed. The remaining options of screening and prophylaxis appear to be reasonable alternatives for dealing with varicella exposures. (C

Closing the Gap in High-Risk Pregnancy Care Using Machine Learning and Human-AI Collaboration

Health insurers often use algorithms to identify members who would benefit from care and condition management programs, which provide personalized, high-touch clinical support. Timely, accurate, and seamless integration between algorithmic identification and clinical intervention depends on effective collaboration between the system designers and nurse care managers. We focus on a high-risk pregnancy (HRP) program designed to reduce the likelihood of adverse prenatal, perinatal, and postnatal events and describe how we overcome three challenges of HRP programs as articulated by nurse care managers; (1) early detection of pregnancy, (2) accurate identification of impactable high-risk members, and (3) provision of explainable indicators to supplement predictions. We propose a novel algorithm for pregnancy identification that identifies pregnancies 57 days earlier than previous code-based models in a retrospective study. We then build a model to predict impactable pregnancy complications that achieves an AUROC of 0.760. Models for pregnancy identification and complications are then integrated into a proposed user interface. In a set of user studies, we collected quantitative and qualitative feedback from nurses on the utility of the predictions combined with clinical information driving the predictions on triaging members for the HRP program

Isotopic signals in an agricultural watershed suggest denitrification is locally intensive in riparian areas but extensive in upland soils

© The Author(s), 2022. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Sigler, W. A., Ewing, S. A., Wankel, S. D., Jones, C. A., Leuthold, S., Brookshire, E. N. J., & Payn, R. A. Isotopic signals in an agricultural watershed suggest denitrification is locally intensive in riparian areas but extensive in upland soils. Biogeochemistry, 158, (2022): 251–268, https://doi.org/10.1007/s10533-022-00898-9.Nitrogen loss from cultivated soils threatens the economic and environmental sustainability of agriculture. Nitrate (NO3−) derived from nitrification of nitrogen fertilizer and ammonified soil organic nitrogen may be lost from soils via denitrification, producing dinitrogen gas (N2) or the greenhouse gas nitrous oxide (N2O). Nitrate that accumulates in soils is also subject to leaching loss, which can degrade water quality and make NO3− available for downstream denitrification. Here we use patterns in the isotopic composition of NO3− observed from 2012 to 2017 to characterize N loss to denitrification within soils, groundwater, and stream riparian corridors of a non-irrigated agroecosystem in the northern Great Plains (Judith River Watershed, Montana, USA). We find evidence for denitrification across these domains, expressed as a positive linear relationship between δ15N and δ18O values of NO3−, as well as increasing δ15N values with decreasing NO3− concentration. In soils, isotopic evidence of denitrification was present during fallow periods (no crop growing), despite net accumulation of NO3− from the nitrification of ammonified soil organic nitrogen. We combine previous results for soil NO3− mass balance with δ15N mass balance to estimate denitrification rates in soil relative to groundwater and streams. Substantial denitrification from soils during fallow periods may be masked by nitrification of ammonified soil organic nitrogen, representing a hidden loss of soil organic nitrogen and an under-quantified flux of N to the atmosphere. Globally, cultivated land spends ca. 50% of time in a fallow condition; denitrification in fallow soils may be an overlooked but globally significant source of agricultural N2O emissions, which must be reduced along-side other emissions to meet Paris Agreement goals for slowing global temperature increase.National Institute of Food and Agriculture, 2011–51130-31121, S. A. Ewing, 2011, S. A. Ewing, 2016–67026-25067, S. A. Ewing, Montana State University Extension, Montana Fertilizer Advisory Committee, Montana Agricultural Experiment Station, Montana State University Vice President of Research, Montana State University College of Agriculture, Montana Institute on Ecosystems, NSF EPSCoR, OIA-1757351, S. A. Ewing, OIA-1443108, S. A. Ewing, EPS-110134, S. A. Ewing

A Randomized Controlled Trial: Attachment-Based Family and Nondirective Supportive Treatments for Youth Who Are Suicidal

Objective: To evaluate the efficacy of attachment-based family therapy (ABFT) compared with a family-enhanced nondirective supportive therapy (FE-NST) for decreasing adolescents’ suicide ideation and depressive symptoms. Method: A randomized controlled trial of 129 adolescents who are suicidal ages 12- to 18-years-old (49% were African American) were randomized to ABFT (n ¼ 66) or FE-NST (n ¼ 63) for 16 weeks of treatment. Assessments occurred at baseline and 4, 8, 12, and 16 weeks. Trajectory of change and clinical recovery were calculated for suicidal ideation and depressive symptoms. Results: There was no significant between-group difference in the rate of change in self-reported ideation (Suicidal Ideation Questionnaire-Jr; F1,127 ¼ 181, p ¼ .18). Similar results were found for depressive symptoms. However, adolescents receiving ABFT showed a significant decrease in suicide ideation (t127 ¼ 12.61, p \u3c .0001; effect size, d ¼ 2.24). Adolescents receiving FE-NST showed a similar significant decrease (t127 ¼ 10.88, p \u3c .0001; effect size, d ¼ 1.93). Response rates (ie, 50% decrease in suicide ideation symptoms from baseline) at post-treatment were 69.1% for ABFT versus 62.3% for FE-NST. Conclusion: Contrary to expectations, ABFT did not perform better than FE-NST. The 2 treatments produced substantial decreases in suicidal ideation and depressive symptoms that were comparable to or better than those reported in other more intensive, multicomponent treatments. The equivalent outcomes could be attributed to common treatment elements, different active mechanisms, or regression to the mean. Future studies will explore long-term follow up, secondary outcomes, and potential moderators and mediators

When nutritional guidelines and life collide: family fruit and vegetable socialisation practices in low socioeconomic communities

Parents play a critical role in promoting fruit and vegetable consumption, for eating patterns established early in life tend to persist into adulthood. Despite this, the factors that facilitate or inhibit parents’ capacity to socialise fruit and vegetable consumption into their children’s daily diets remain poorly defined. Thirty-eight semi-structured interviews with residents, allied healthcare professionals, community leaders, community programme leaders and a local government leader living or working in two low socioeconomic suburbs were consequently conducted to ascertain factors exogenous and endogenous to the family unit that shaped parental food socialisation practices. Budgetary and time constraints emerged as exogenous factors that constrained fruit and vegetable socialisation. Constraining effects were also found for a range of endogenous factors, including commensal experiences, children’s food fussiness and the feeding styles employed by parents. As such, while many caregivers may wish to socialise fruit and vegetable consumption into their children’s daily diets, their capacity to do so is often inhibited by factors beyond their volitional control. Failure to take heed of these factors could therefore result in the development of social marketing campaigns that are ineffective at best or give rise to unintentionally harmful outcomes at worst

Combining attachment-based family therapy and cognitive behavioral therapy to improve outcomes for adolescents with anxiety

Increases in adolescent anxiety over the past several years suggest a need for trauma-informed, culturally responsive interventions that help teens cope with environmental stressors like those associated with the COVID-19 pandemic. Although abundant evidence supports the efficacy of cognitive behavioral therapy (CBT) in treating adolescent anxiety, not all teens respond positively to CBT. CBT does not typically include strategies that address important family factors that may be impacting the teen’s functioning, such as the attachment relationship. Attachment-based family therapy (ABFT) addresses the attachment relationship and other factors that contribute to the adolescent’s anxiety and related distress. By enhancing positive parenting behaviors, such as acceptance and validation of the adolescent’s distress and promotion of their autonomy, ABFT sessions may repair the attachment relationship and increase the family’s ability and willingness to engage in CBT tasks aimed at reducing anxiety. This theoretical paper describes the ABFT model and proposes that implementing ABFT sessions prior to CBT could result in better clinical outcomes for adolescents with anxiety disorders by improving the context within which the anxiety symptoms and treatment are experienced. Given that ABFT is sensitive and responsive to family and other contextual factors, adolescents from marginalized communities and those from less individualistic cultures may find the model to be more acceptable and appropriate for addressing factors related to their anxiety. Thus, a combined ABFT+CBT model might result in better outcomes for adolescents who have not historically responded well to CBT alone