Changes to sleep patterns and insomnia symptoms following cognitive behavioural therapy for anxiety disorders in adolescents

Background: It is unclear whether treatment for an anxiety disorder improves sleep. This study examined baseline sleep characteristics of adolescents with an anxiety disorder, comparing weekdays and weekends, and whether there were significant improvements in sleep following cognitive behaviour therapy (CBT). Aims: To improve our understanding of sleep problems in adolescents with an anxiety disorder and examine whether CBT for the treatment of the anxiety disorder improves sleep. Method: Data was gathered from 179 participants with an anxiety disorder (11–17 years old) who had previously engaged with the out-patient child and adolescent mental health service. Baseline self-report measures of anxiety and depression symptoms, sleep patterns and experiences of insomnia were examined. Of this group, 135 participants had baseline data. A subset (n=73) had outcome data, which was used to examine changes in sleep following CBT. Results: At baseline, adolescents reported significantly less total sleep and more night-time waking on weekdays than weekends. Following treatment for their anxiety disorder, adolescents’ weekday sleep patterns significantly improved for sleep onset latency and total sleep time, whereas weekend sleep patterns only showed improvements for sleep onset latency. No significant improvements were reported for symptoms of insomnia. Conclusions: The study relied upon subjective measurement of sleep and there was no control group; however, the findings provide promising results that CBT for adolescent anxiety disorders can improve some sleep problems. Further research is needed to understand discrepancies between subjective and objective sleep, and to explore avenues for the delivery of support for sleep problems

Book Reviews

Reviews of the following books: The Penobscot Dance of Resistence: Tradition in the History of a People by Pauleena MacDougall; Maine’s Visible Black History: The First Chronicle of its People by H. H. Price and Gerald E.Talbot; Borderland Smuggling: Patriots, Loyalists, and Illicit Trade in the Northeast, 1783-1820 by Joshua M. Smith

Alignment of patient and primary care practice member perspectives of chronic illness care: a cross-sectional analysis

Polly H. Noel and Luci K. Leykum are with the South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA -- Polly H. Noel, Ray F. Palmer, Raquel L. Romero, Luci K. Leykum, Holly J. Lanham, and Krista W. Bowers are with the Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA -- Michael L. Parchman is with the MacColl Center for Healthcare Innovation, Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave 1600, Seattle, WA 98101, USA -- Holly J. Leykum is with the The McCombs School of Business, The University of Texas at Austin, 2110 Speedway, Stop B6000, Austin, TX 78712, USA -- John E. Zeber is with the Central Texas Veterans Health Care System, 1901 S. 1st St, Temple, TX 76504, USA and Scott and White Healthcare Center for Applied Health Research, 2401 S. 31st St, Temple, TX 76508, USABackground: Little is known as to whether primary care teams’ perceptions of how well they have implemented the Chronic Care Model (CCM) corresponds with their patients’ own experience of chronic illness care. We examined the extent to which practice members’ perceptions of how well they organized to deliver care consistent with the CCM were associated with their patients’ perceptions of the chronic illness care they have received. Methods: Analysis of baseline measures from a cluster randomized controlled trial testing a practice facilitation intervention to implement the CCM in small, community-based primary care practices. All practice “members” (i.e., physician providers, non-physician providers, and staff) completed the Assessment of Chronic Illness Care (ACIC) survey and adult patients with 1 or more chronic illnesses completed the Patient Assessment of Chronic Illness Care (PACIC) questionnaire. Results: Two sets of hierarchical linear regression models accounting for nesting of practice members (N = 283) and patients (N = 1,769) within 39 practices assessed the association between practice member perspectives of CCM implementation (ACIC scores) and patients’ perspectives of CCM (PACIC). ACIC summary score was not significantly associated with PACIC summary score or most of PACIC subscale scores, but four of the ACIC subscales were consistently associated with PACIC summary score and the majority of PACIC subscale scores after controlling for patient characteristics. The magnitude of the coefficients, however, indicates that the level of association is weak. Conclusions: The ACIC and PACIC scales appear to provide complementary and relatively unique assessments of how well clinical services are aligned with the CCM. Our findings underscore the importance of assessing both patient and practice member perspectives when evaluating quality of chronic illness care.Information, Risk, and Operations Management (IROM)[email protected]

Light and Submerged Macrophyte Communities in Chesapeake Bay: A Scientific Summary

The initial focus of submerged aquatic vegetation (SAV) research in the U.S. Environmental Protection Agency (EPA), Chesapeake Bay Program (CBP) was evaluation of the structural and functional ecology of these communities. In the upper Bay, Myriophyllum spicatum and Potamogeton perfoliatus are the dominant species; the dominant species in the lower Bay are Zostera marina and Ruppia maritima. Studies centered on various aspects of productivity (both primary and secondary), trophic structure, and resource utilization by both ecologically and economically important species. Much of the initial research was descriptively oriented because of a general lack of information on Chesapeake Bay submerged plant communities. These investigations created the data base necessary for the development of ecologically realistic simulation models of the ecosystem. Following these initial studies, the research programs in both Maryland and Virginia evolved toward more· detailed analyses of specific factors ~hat potentially limit or control plant growth and productivity. Previous results indicated certain environmental parameters and biological processes that possibly limited and controlled SAV distribution and abundance. Specifically, these included light, nutrients, herbicides and fouling (epibiotic growth). Laboratory and field studies were devoted in the later phases of the CBP-SAV program toward investigating these interactions. This work is among the first studies in North America to investigate light quality as a major environmental factor affecting the survival of sea grasses.https://scholarworks.wm.edu/vimsbooks/1098/thumbnail.jp

The Challenges of Multimorbidity from the Patient Perspective

BACKGROUND Although multiple co-occurring chronic illnesses within the same individual are increasingly common, few studies have examined the challenges of multimorbidity from the patient perspective. OBJECTIVE The aim of this study is to examine the self-management learning needs and willingness to see non-physician providers of patients with multimorbidity compared to patients with single chronic illnesses. DESIGN. This research is designed as a cross-sectional survey. PARTICIPANTS Based upon ICD-9 codes, patients from a single VHA healthcare system were stratified into multimorbidity clusters or groups with a single chronic illness from the corresponding cluster. Nonproportional sampling was used to randomly select 720 patients. MEASUREMENTS Demographic characteristics, functional status, number of contacts with healthcare providers, components of primary care, self-management learning needs, and willingness to see nonphysician providers. RESULTS Four hundred twenty-two patients returned surveys. A higher percentage of multimorbidity patients compared to single morbidity patients were "definitely" willing to learn all 22 self-management skills, of these only 2 were not significant. Compared to patients with single morbidity, a significantly higher percentage of patients with multimorbidity also reported that they were "definitely" willing to see 6 of 11 non-physician healthcare providers. CONCLUSIONS Self-management learning needs of multimorbidity patients are extensive, and their preferences are consistent with team-based primary care. Alternative methods of providing support and chronic illness care may be needed to meet the needs of these complex patients.US Department of Veterans Affairs (01-110, 02-197); Agency for Healthcare Research and Quality (K08 HS013008-02

Obituary: Thomas Henry Kunz (1938–2020)

Dr. Thomas Henry Kunz, an internationally recognized expert on the ecology and behavior of bats and Professor at Boston University, passed away on April 13, 2020 in Dedham, Massachusetts, at the age of 81 as the result of complications from COVID-19. “Tom,” to his many friends and colleagues, was born on June 11, 1938 in Independence, Missouri, to William H. and Edna F. (Dornfeld) Kunz. He married Margaret Louise Brown on December 27, 1962 in Faucett, Missouri, Margaret’s hometown. Two children were born to Margaret and Tom—Pamela Kunz (Jeffrey Kwan) and David Kunz (Nicole, née D’Angelo), and five grandchildren. As a faculty member at Boston University, Tom progressed through the academic ranks becoming an Associate Professor in 1977 and Professor in 1984 in the Department of Biology. Although Kunz made major scientific contributions through his research and administrative leadership, his greatest impact on the future of chiropterology and of science in America may well be through the students whom he trained. He published prolifically--a total of 347 items--including books, book chapters, journal articles, book reviews, project reports, and popular articles. Includes lists of students trained, grants received, and a complete bibliography of published works, as well as a detailed description of his research program

Enantioselective N-heterocyclic carbene catalyzed formal [3+2] cycloaddition using α-aroyloxyaldehydes and oxaziridines

We thank the EPSRC Centre for Doctoral Training in Critical Resource Catalysis (CRITICAT, grant code EP/L016419/1) (R.W.F.K.) for funding. The European Research Council under the European Union’s Seventh Framework Programme (FP7/2007–2013) ERC Grant Agreement No. 279850 is also acknowledged. A.D.S. thanks the Royal Society for a Wolfson Research Merit Award.An enantioselective N-heterocyclic carbene catalysed formal [3+2] cycloaddition has been developed for the synthesis of oxazolindin-4-one products. The reaction of oxaziridines and α-aroyloxyaldehydes under N-heterocyclic carbene catalysis provides the formal cycloaddition products with excellent control of the diastereo- and enantioselectivity (12 examples, up to >95:5 dr, >99:1 er). A matched-mismatched effect between the enantiomer of the catalyst and oxaziridine was identified, and preliminary mechanistic studies have allowed the proposal of a model to explain these observations.Publisher PDFPeer reviewe

A thermodynamic adsorption/entrapment model for selenium(IV) coprecipitation with calcite

Selenium is an environmentally relevant trace element, while the radioisotope 79Se is of particular concern in the context of nuclear waste disposal safety. Oxidized selenium species are relatively soluble and show only weak adsorption at common mineral surfaces. However, a possible sorption mechanism for selenium in the geosphere is the structural incorporation of selenium(IV) (selenite, SeO3 2) into calcite (CaCO3). In this study we investigate the interactions between selenite and calcite by a series of experimental and computational methods with the aim to quantify selenite incorporation into calcite at standard conditions. We further seek to describe the thermodynamics of selenite-doped calcite, and selenite coprecipitation with calcite. The structure of the incorporated species is investigated using Se K-edge EXAFS (isotropic and polarization dependent) and results are compared to density functional theory (DFT) calculations. These investigations confirm structural incorporation of selenite into calcite by the substitution of carbonate for selenite, leading to the formation of a Ca(SeO3)X(CO3)(1-X)solid solution.Coprecipitation experiments at low supersaturation indicate a linear increase of the selenite to carbonate ratio in the solid with the increase of the selenite to carbonate ratio in the contact solution. This relationship can be described under the assumption of an ideal mixing between calcite and a virtual CaSeO3 endmember, whose standard Gibbs free energy (G0(CaSeO3_exp) = 953 ± 6 kJ/mol, log10(KSP(CaSeO3_exp)) = 6.7 ± 1.0) is defined by linear extrapolation of the excess free energy from the dilute Henry’s law domain to X(CaSeO3) = 1. In contrast to this experimental result, DFT and force field calculations predict the virtual bulk CaSeO3 endmember to be significantly less stable and more soluble: G0(CaSeO3 bulk) = 912 ± 10 kJ/mol and log10(KSP(CaSeO3_bulk)) = 0.5 ± 1.7. To explain this discrepancy we introduce a thermodynamic adsorption/entrapment concept. This concept is based on the idea that the experimental value of 953 ± 6 kJ/mol reflects the Gibbs free energy of CaSeO3 within the surface layer, while the value obtained from atomistic calculations reflects bulk thermodynamic properties. In coprecipitation experiments performed at steady-state conditions the difference between these values is compensated by the supersaturation. Thus, if the Gibbs free energies of the bulk CaCO3 and CaSeO3 endmembers are substituted with the Gibbs free energies of the surface endmembers, the coprecipitation experiment can still be treated within the formalism of equilibrium thermodynamics. This concept leads to a number of important consequences, which can be tested both experimentally and theoretically.We show that selenite adsorption at the calcite surface and selenite coprecipitation with calcite under supersaturated conditions can be described with the same partition coefficient. This implies that the coprecipitation can be viewed as a sequence of adsorption and entrapment events. On the other hand, our aragonite recrystallization experiments show that at near equilibrium conditions the calcite growth is inhibited in the presence of selenite. Consistent with these observations, our DFT calculations show that the substitution of carbonate for selenite is energetically more favorable at the surface than inside the bulk. The whole set of the experimental and atomistic simulation results leads to the conclusion that the calcite–CaSeO3 solid solution can only grow continuously if the aqueous solution is supersaturated with respect to the bulk solid solution. Under these conditions selenite coprecipitates with calcite at a partition coefficient of D = 0.02 ± 0.01. If the solution is undersaturated with respect to the bulk solid solution, only surface ion-exchange occurs. Elevated selenite concentrations in bulk calcite therefore reflect non-equilibrium conditions