Development of an integrated cognitive behavioral therapy for anxiety and opioid use disorder: Study protocol and methods

Opioid use disorder is a highly disabling psychiatric disorder, and is associated with both significant functional disruption and risk for negative health outcomes such as infectious disease and fatal overdose. Even among those who receive evidence-based pharmacotherapy for opioid use disorder, many drop out of treatment or relapse, highlighting the importance of novel treatment strategies for this population. Over 60% of those with opioid use disorder also meet diagnostic criteria for an anxiety disorder; however, efficacious treatments for this common co-occurrence have not be established. This manuscript describes the rationale and methods for a behavioral treatment development study designed to develop and test an integrated cognitive-behavioral therapy for those with co-occurring opioid use disorder and anxiety disorders. The aims of the study are (1) to develop and pilot test a new manualized cognitive behavioral therapy for co-occurring opioid use disorder and anxiety disorders, (2) to test the efficacy of this treatment relative to an active comparison treatment that targets opioid use disorder alone, and (3) to investigate the role of stress reactivity in both prognosis and recovery from opioid use disorder and anxiety disorders. Our overarching aim is to investigate whether this new treatment improves both anxiety and opioid use disorder outcomes relative to standard treatment. Identifying optimal treatment strategies for this population are needed to improve outcomes among those with this highly disabling and life-threatening disorder.This study was funded by NIDA grant DA035297. The funding source had no involvement in the study design, analysis and interpretation of data, writing of the report, or the decision to submit the article for publication. (DA035297 - NIDA)Accepted manuscrip

Bacterial survival following shock compression in the GigaPascal range

The possibility that life can exist within previously unconsidered habitats is causing us to expand our understanding of potential planetary biospheres. Significant populations of living organisms have been identified at depths extending up to several km below the Earth's surface; whereas laboratory experiments have shown that microbial species can survive following exposure to GigaPascal (GPa) pressures. Understanding the degree to which simple organisms such as microbes survive such extreme pressurization under static compression conditions is being actively investigated. The survival of bacteria under dynamic shock compression is also of interest. Such studies are being partly driven to test the hypothesis of potential transport of biological organisms between planetary systems. Shock compression is also of interest for the potential modification and sterilization of foodstuffs and agricultural products. Here we report the survival of Shewanella oneidensis bacteria exposed to dynamic (shock) compression. The samples examined included: (a) a "wild type" (WT) strain and (b) a "pressure adapted" (PA) population obtained by culturing survivors from static compression experiments to 750 MPa. Following exposure to peak shock pressures of 1.5 and 2.5 GPa the proportion of survivors was established as the number of colony forming units (CFU) present after recovery to ambient conditions. The data were compared with previous results in which the same bacterial samples were exposed to static pressurization to the same pressures, for 15 minutes each. The results indicate that shock compression leads to survival of a significantly greater proportion of both WT and PA organisms. The significantly shorter duration of the pressure pulse during the shock experiments (2-3 μs) likely contributes to the increased survival of the microbial species. One reason for this can involve the crossover from deformable to rigid solid-like mechanical relaxational behavior that occurs for bacterial cell walls on the order of seconds in the time dependent strain rate

Tolerance of Artemia to static and shock pressure loading

Hydrostatic and hydrodynamic pressure loading has been applied to unicellular organisms for a number of years due to interest from food technology and extremophile communities. There is also an emerging interest in the response of multicellular organisms to high pressure conditions. Artemia salina is one such organism. Previous experiments have shown a marked difference in the hatching rate of these organisms after exposure to different magnitudes of pressure, with hydrostatic tests showing hatching rates at pressures up to several GPa, compared to dynamic loading that resulted in comparatively low survival rates at lower pressure magnitudes. In order to begin to investigate the origin of this difference, the work presented here has focussed on the response of Artemia salina to (quasi) one-dimensional shock loading. Such experiments were carried out using the plate-impact technique in order to create a planar shock front. Artemia cysts were investigated in this manner along with freshly hatched larvae (nauplii). The nauplii and cysts were observed post-shock using optical microscopy to detect motility or hatching, respectively. Hatching rates of 18% were recorded at pressures reaching 1.5 GPa, as determined with the aid of numerical models. Subjecting Artemia to quasi-one-dimensional shock loading offers a way to more thoroughly explore the shock pressure ranges these organisms can survive

Linguistic DNA: Investigating Conceptual Change in Early Modern English Discourse

This article describes the background and premises of the AHRC-funded project, ‘The Linguistic DNA of Modern Western Thought’. We offer an empirical, encyclopaedic approach to historical semantics regarding ‘conceptual history’, i.e. the history of concepts that shape thought, culture and society in a particular period. We relate the project to traditional work in conceptual and semantic history and define our object of study as the discursive concept, a category of meaning encoded linguistically as a cluster of expressions that co-occur in discourse. We describe our principal data source, EEBO-TCP, and introduce our key research interests, namely, the contexts of conceptual change, the semantic structure of lexical fields and the nature of lexicalisation pressure. We outline our computational processes, which build upon the theoretical definition of discursive concepts, to discover the linguistically encoded forms underpinning the discursive concepts we seek to identify in EEBO-TCP. Finally, we share preliminary results via a worked example, exploring the discursive contexts in which paradigmatic terms of key cultural concepts emerge. We consider the extent to which particular genres, discourses and users in the early modern period make paradigms, and examine the extent to which these contexts determine the characteristics of key concepts

Economic inequalities in the effectiveness of a primary care intervention for depression and suicidal ideation.

BACKGROUND: Economic disadvantage is associated with depression and suicide. We sought to determine whether economic disadvantage reduces the effectiveness of depression treatments received in primary care. METHODS: We conducted differential-effects analyses of the Prevention of Suicide in Primary Care Elderly: Collaborative Trial, a primary-care-based randomized, controlled trial for late-life depression and suicidal ideation conducted between 1999 and 2001, which included 514 patients with major depression or clinically significant minor depression. RESULTS: The intervention effect, defined as change in depressive symptoms from baseline, was stronger among persons reporting financial strain at baseline (differential effect size = -4.5 Hamilton Depression Rating Scale points across the study period [95% confidence interval = -8.6 to -0.3]). We found similar evidence for effect modification by neighborhood poverty, although the intervention effect weakened after the initial 4 months of the trial for participants residing in poor neighborhoods. There was no evidence of substantial differences in the effectiveness of the intervention on suicidal ideation and depression remission by economic disadvantage. CONCLUSIONS: Economic conditions moderated the effectiveness of primary-care-based treatment for late-life depression. Financially strained individuals benefited more from the intervention; we speculate this was because of the enhanced treatment management protocol, which led to a greater improvement in the care received by these persons. People living in poor neighborhoods experienced only temporary benefit from the intervention. Thus, multiple aspects of economic disadvantage affect depression treatment outcomes; additional work is needed to understand the underlying mechanisms

Outcomes Associated With Oral Anticoagulants Plus Antiplatelets in Patients With Newly Diagnosed Atrial Fibrillation.

Importance: Patients with nonvalvular atrial fibrillation at risk of stroke should receive oral anticoagulants (OAC). However, approximately 1 in 8 patients in the Global Anticoagulant Registry in the Field (GARFIELD-AF) registry are treated with antiplatelet (AP) drugs in addition to OAC, with or without documented vascular disease or other indications for AP therapy. Objective: To investigate baseline characteristics and outcomes of patients who were prescribed OAC plus AP therapy vs OAC alone. Design, Setting, and Participants: Prospective cohort study of the GARFIELD-AF registry, an international, multicenter, observational study of adults aged 18 years and older with recently diagnosed nonvalvular atrial fibrillation and at least 1 risk factor for stroke enrolled between March 2010 and August 2016. Data were extracted for analysis in October 2017 and analyzed from April 2018 to June 2019. Exposure: Participants received either OAC plus AP or OAC alone. Main Outcomes and Measures: Clinical outcomes were measured over 3 and 12 months. Outcomes were adjusted for 40 covariates, including baseline conditions and medications. Results: A total of 24 436 patients (13 438 [55.0%] male; median [interquartile range] age, 71 [64-78] years) were analyzed. Among eligible patients, those receiving OAC plus AP therapy had a greater prevalence of cardiovascular indications for AP, including acute coronary syndromes (22.0% vs 4.3%), coronary artery disease (39.1% vs 9.8%), and carotid occlusive disease (4.8% vs 2.0%). Over 1 year, patients treated with OAC plus AP had significantly higher incidence rates of stroke (adjusted hazard ratio [aHR], 1.49; 95% CI, 1.01-2.20) and any bleeding event (aHR, 1.41; 95% CI, 1.17-1.70) than those treated with OAC alone. These patients did not show evidence of reduced all-cause mortality (aHR, 1.22; 95% CI, 0.98-1.51). Risk of acute coronary syndrome was not reduced in patients taking OAC plus AP compared with OAC alone (aHR, 1.16; 95% CI, 0.70-1.94). Patients treated with OAC plus AP also had higher rates of all clinical outcomes than those treated with OAC alone over the short term (3 months). Conclusions and Relevance: This study challenges the practice of coprescribing OAC plus AP unless there is a clear indication for adding AP to OAC therapy in newly diagnosed atrial fibrillation

Performance of stroke risk scores in older people with atrial fibrillation not taking warfarin: comparative cohort study from BAFTA trial

Objective To compare the predictive power of the main existing and recently proposed schemes for stratification of risk of stroke in older patients with atrial fibrillation

An international longitudinal registry of patients with atrial fibrillation at risk of stroke (GARFIELD) : the UK protocol

Background Atrial fibrillation (AF) is an independent risk factor for stroke and a significant predictor of mortality. Evidence-based guidelines for stroke prevention in AF recommend antithrombotic therapy corresponding to the risk of stroke. In practice, many patients with AF do not receive the appropriate antithrombotic therapy and are left either unprotected or inadequately protected against stroke. The purpose of the Global Anticoagulant Registry in the FIELD (GARFIELD) is to determine the real-life management and outcomes of patients newly diagnosed with non-valvular AF. Methods/design GARFIELD is an observational, international registry of newly diagnosed AF patients with at least one additional investigator-defined risk factor for stroke. The aim is to enrol 55,000 patients at more than 1000 centres in 50 countries worldwide. Enrolment will take place in five independent, sequential, prospective cohorts; the first cohort includes a retrospective validation cohort. Each cohort will be followed up for 2 years. The UK stands to be a significant contributor to GARFIELD, aiming to enrol 4,582 patients, and reflecting the care environment in which patients with AF are managed. The UK protocol will also focus on better understanding the validity of the two main stroke risk scores (CHADS2 and CHA2DS2VASC) and the HAS-BLED bleeding risk score, in the context of a diverse patient population. Discussion The GARFIELD registry will describe how therapeutic strategies, patient care, and clinical outcomes evolve over time. This study will provide UK-specific comprehensive data that will allow a range of evaluations both at a national level and in relation to global data and contribute to a better understanding of AF management in the UK

Brewing of filter coffee

We report progress on mathematical modelling of coffee grounds in a drip filter coffee machine. The report focuses on the evolution of the shape of the bed of coffee grounds during extraction with some work also carried out on the chemistry of extraction. This work was sponsored by Philips who are interested in understanding an observed correlation between the final shape of the coffee grounds and the quality of the coffee. We used experimental data gathered by Philips and ourselves to identify regimes in the coffee brewing process and relevant regions of parameter space. Our work makes it clear that a number of separate processes define the shape of the coffee bed depending on the values of the parameters involved e.g. the size of the grains and the speed of fluid flow during extraction. We began work on constructing mathematical models of the redistribution of the coffee grounds specialised to each region and on a model of extraction. A variety of analytic and numerical tools were used. Furthermore our research has progressed far enough to allow us to begin to exploit connections between this problem and other areas of science, in particular the areas of sedimentology and geomorphology, where the processes we have observed in coffee brewing have been studied

Interpretation and the Constraints on International Courts

This paper argues that methodologies of interpretation do not do what they promise – they do not constrain interpretation by providing neutral steps that one can follow in finding out a meaning of a text – but nevertheless do their constraining work by being part of what can be described as the legal practice