Comparing Fixed-amount and Progressive-amount DRO Schedules for Tic Suppression in Youth with Chronic Tic Disorders

Chronic tic disorders (CTDs) involve motor and/or vocal tics that often cause substantial distress and impairment. Differential reinforcement of other behavior (DRO) schedules of reinforcement produce robust, but incomplete, reductions in tic frequency in youth with CTDs; however, a more robust reduction may be needed to affect durable clinical change. Standard, fixed‐amount DRO schedules have not commonly yielded such reductions, so we evaluated a novel, progressive‐amount DRO schedule, based on its ability to facilitate sustained abstinence from functionally similar behaviors. Five youth with CTDs were exposed to periods of baseline, fixed‐amount DRO (DRO‐F), and progressive‐amount DRO (DRO‐P). Both DRO schedules produced decreases in tic rate and increases in intertic interval duration, but no systematic differences were seen between the two schedules on any dimension of tic occurrence. The DRO‐F schedule was generally preferred to the DRO‐P schedule. Possible procedural improvements and other future directions are discussed

EMG Analysis of Latissimus Dorsi, Erector Spinae and Middle Trapezius Muscle Activity during Spinal Rotation: A Pilot Study

Purpose/Hypothesis: Rotation of the spine, a complex movement that has yet to be fully understood, occurs regularly in activities of daily living (ADLs) and sport performance. Rotation (twisting) of the spine is a contributing factor in low back pain pathology and, by reports, has been associated with up to 60% of all back injuries. One of the largest muscles of the back, the latissimus dorsi (LD), is the only muscle to attach to the spine, pelvis, ribs, scapula, and humerus, and has the potential to impact the spine during many different activities. To date, there is limited research on the activity of the LD during spinal rotation or the effects of the muscle in rehabilitation programs for patients with low back pain (LBP). The purpose of this pilot study was to determine the LD muscle activity throughout spinal rotation during open and closed kinetic chain activities. Three hypotheses were established. Malerials/Methods: Muscle activity of the LD was recorded by surface electrodes while the subjects performed rotation to the left and right in standing and in quadruped positions. Spinal rotation motion was initiated in the four test positions (standing rotation right/left, quadruped rotation right/left) by movement of the pelvis. Muscle activity was normalized to the maximal voluntary contraction (MVC) of the muscle. Significance was set at α=.05 level. Results: The ipsilateral LD muscle produced significantly more muscle activity during spinal rotation while in fixed (quadruped) than the contralateral LD muscle (p Discussion/Conclusion: The results of this study found the LD to be more active during the fixed positional movements. In the right fixed position, the left LD had significantly higher EMG activity than the MT and ES. However, this was not found to be true in the left fixed position. The data showed a significant difference between the activation of the right and left LD, which could be examined further in the future. Although the LD are active without the arms fixed, they demonstrate a significantly greater muscle activity when placed in a quadruped position. When in standing without the upper extremities fixed, other muscles have a greater function in rotation of the spine. Clinical Relevance: This pilot study highlights the contributions of the LD muscle with spinal rotation and is the beginning of ongoing research efforts to address LD as part of the rotational movement strategy in individuals both with and without LBP. Many everyday movements require spinal rotation with the UEs fixed. Frequently, rehabilitation for LBP includes positions such as the quadruped position. LD is a muscle that should be considered when looking at spinal rotational movement systems

Antibiotic Resistance

Antibiotic resistance is the ability of bacteria to resist the effects of an antibiotic. It occurs when bacteria change in a way that reduces the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections. Bacteria survive and continue to multiply, causing more harm.https://digitalcommons.cedarville.edu/public_health_posters/1003/thumbnail.jp

Nutrition in Medical Education: Where do we stand and what needs to be explored?

Introduction: Dietary interventions and nutrition care improve patient outcomes and reduce healthcare costs. Despite status as a necessary topic in medical school education, many U.S. medical schools do not adequately prepare future physicians for everyday nutritional challenges in clinical practice. There is immense research behind the necessity of nutrition education but little concerning the methods of implementing this change. The purpose of this work was to review the current innovations of nutrition curriculum in the literature and discuss future directions for our medical school. Method: A systematic search of scientific literature databases was performed to examine existing literature about the current state of nutrition curriculum and identify current methods of improving nutrition curriculum. A database search of the undergraduate GW SMHS curricula helped us map where nutrition is currently taught and look into ways to expand and integrate it. Results: Shortcomings in sufficient nutrition education result from lack of proficient faculty, low funding, and lack of established core curricula with guidelines and protocols. Additionally, international medical schools have recognized their deficiency in nutrition education compared to U.S. standards. U.S. institutions making headway in new nutrition education programs include The University of North Carolina, Chapel Hill, Boston University School of Medicine, Southern Illinois School of Medicine, University of Nevada School of Medicine, Northwestern University Feinberg School of Medicine, University of Colorado School of Medicine, Mercer University School of Medicine, and various institutions introducing “culinary medicine”. Successful nutrition integration should be spread longitudinally across all years with an emphasis on active-learning techniques over rote memorization. Creativity, chief support, an established taskforce, trained faculty, and evaluation methods are essential tools to enhance medical curriculum. Looking at GW SMHS curricula, nutrition is concentrated in the Pre-Clinical years with very little emphasis in the Clinical years, a common trend across most medical schools. Medical students may be more confident incorporating nutrition into patient care if nutrition were spread proportionally across all years to combine basic foundations with clinical application. Conclusion: Expanding nutrition curriculum at The George Washington University School of Medicine could involve utilizing the Nutrition in Medicine project developed by The University of North Carolina, Chapel Hill or bringing in internationally renowned chef José Andrés to expand on his previous culinary courses and incorporate nutrition fundamentals into the medical curriculum. Future directions need to evaluate existing programs, current initiatives, and their effectiveness in order to be able to improve programs across the continuum

Coping with psychological distress during COVID-19: a cautionary note of self-criticalness and personal resilience among healthcare workers

PURPOSE: The COVID-19 pandemic resulted in immense pressure on healthcare workers (HCWs) and healthcare systems worldwide. The current multi-centre evaluation sought to explore the association between coping behaviours and levels of psychological distress among HCWs working during the initial onset of COVID-19. DESIGN/METHODOLOGY/APPROACH: Between April and July 2020 HCWs at three urban hospitals in England were invited to complete an online survey measuring personal and professional characteristics, psychological distress and coping. A principal component analysis (PCA) identified components of coping and structural equation modelling (SEM) was used to test the relationship between components of coping and psychological distress. FINDINGS: A total of 2,254 HCWs participated (77% female, 67% white, 66% in clinical roles). Three components for coping were retained in the PCA analysis: external strategies, internal strategies and self-criticalness/substance use. SEM indicated that internally based coping was associated with lower levels of psychological distress, whereas externally based coping and self-criticalness were associated with greater psychological distress. The final model accounted for 35% of the variance in psychological distress. ORIGINALITY/VALUE: This multi-centre evaluation provides unique insight into the level of psychological distress among HCWs during the initial onset of the COVID-19 pandemic (2020) and associated coping strategies. Addressing self-criticalness and supporting cognitive-based internal coping strategies among HCWs may protect against prolonged exposure to psychological distress. Findings highlight the importance of developing a culture of professional resilience among this vital workforce as a whole rather than placing pressure on an individual's personal resilience

The PRECISE (PREgnancy Care Integrating translational Science, Everywhere) Network’s first protocol: deep phenotyping in three sub-Saharan African countries

Background: The PRECISE (PREgnancy Care Integrating translational Science, Everywhere) Network is a new and broadly-based group of research scientists and health advocates based in the UK, Africa and North America. Methods: This paper describes the protocol that underpins the clinical research activity of the Network, so that the investigators, and broader global health community, can have access to ‘deep phenotyping’ (social determinants of health, demographic and clinical parameters, placental biology and agnostic discovery biology) of women as they advance through pregnancy to the end of the puerperium, whether those pregnancies have normal outcomes or are complicated by one/more of the placental disorders of pregnancy (pregnancy hypertension, fetal growth restriction and stillbirth). Our clinical sites are in The Gambia (Farafenni), Kenya (Kilifi County), and Mozambique (Maputo Province). In each country, 50 non-pregnant women of reproductive age will be recruited each month for 1 year, to provide a final national sample size of 600; these women will provide culturally-, ethnically-, seasonallyand spatially-relevant control data with which to compare women with normal and complicated pregnancies. Between the three countries we will recruit ≈10,000 unselected pregnant women over 2 years. An estimated 1500 women will experience one/more placental complications over the same epoch. Importantly, as we will have accurate gestational age dating using the TraCer device, we will be able to discriminate between fetal growth restriction and preterm birth. Recruitment and follow-up will be primarily facility-based and will include women booking for antenatal care, subsequent visits in the third trimester, at time-of-disease, when relevant, during/ immediately after birth and 6 weeks after birth. Conclusions: To accelerate progress towards the women’s and children’s health-relevant Sustainable Development Goals, we need to understand how a variety of social, chronic disease, biomarker and pregnancy-specific determinants health interact to result in either a resilient or a compromised pregnancy for either mother or fetus/ newborn, or both. This protocol has been designed to create such a depth of understanding. We are seeking funding to maintain the cohort to better understand the implications of pregnancy complications for both maternal and child health

Consistency of metabolic responses and appetite sensations under postabsorptive and postprandial conditions

The present study aimed to investigate the reliability of metabolic and subjective appetite responses under fasted conditions and following consumption of a cereal-based breakfast. Twelve healthy, physically active males completed two postabsorption (PA) and two postprandial (PP) trials in a randomised order. In PP trials a cereal based breakfast providing 1859 kJ of energy was consumed. Expired gas samples were used to estimate energy expenditure and fat oxidation and 100 mm visual analogue scales were used to determine appetite sensations at baseline and every 30 min for 120 min. Reliability was assessed using limits of agreement, coefficient of variation (CV), intraclass coefficient of correlation and 95% confidence limits of typical error. The limits of agreement and typical error were 292.0 and 105.5 kJ for total energy expenditure, 9.3 and 3.4 g for total fat oxidation and 22.9 and 8.3 mm for time-averaged AUC for hunger sensations, respectively over the 120 min period in the PP trial. The reliability of energy expenditure and appetite in the 2 h response to a cereal-based breakfast would suggest that an intervention requires a 211 kJ and 16.6 mm difference in total postprandial energy expenditure and time-averaged hunger AUC to be meaningful, fat oxidation would require a 6.7 g difference which may not be sensitive to most meal manipulations

Climate Change and Utah Ski Resorts: Impacts, Perceptions, and Adaptation Strategies

Climate change is a threat to ski resorts, the ski industry, and mountain communities that rely on ski tourism. Ski resorts may be able to mitigate some of the social and economic impacts caused by climate change with proactive adaptation strategies. Using historical weather data, future climate projections, and interviews with ski resort managers in Utah (United States), this research investigates the effects of climate change on ski resorts across the state. We examine temperature change at all resorts within the state from 1980–2018 and climate projections from 2021–2100 under different climate change scenarios (RCPs 2.6, 4.5, and 8.5). We also report on semistructured interviews with resort managers to provide insights into how resort leadership perceives the impacts of climate change, is implementing adaptation strategies, and is addressing barriers to adaptation. Many resorts in Utah are warming faster than global averages, and minimum temperatures are rising faster than maximum temperatures. By the end of the century, winter (December–March) minimum daily temperatures in Utah could warm an additional 6.0°C under the RCP 8.5 scenario near northern Utah resorts and 6.6°C near southern Utah resorts. Resort managers are concerned about shorter season lengths, shifting ski seasons, less snow cover, and poorer snow quality. Many resorts are already adapting, with the most common adaptations being snowmaking and diversifying outdoor recreation offerings (particularly during the summer and shoulder seasons). Barriers to adaptation reported by managers include financial costs, adequate water availability for snowmaking, and uncertainty about climate change projections. Climate change is already impacting Utah ski resorts, but adaptation practices can reduce the negative impacts to some degree at most resorts

UK dietitians' attitudes and experiences of formula very low- and low-energy diets in clinical practice

Despite evidence that formula very low-energy diets (VLED) and low-energy diets (LED) are both effective and safe as treatments for obesity and type 2 diabetes, these diets remain underutilized in the United Kingdom. The aim of this study was to explore UK dietitians' attitudes and experiences of using formula VLED and LED. A cross-sectional survey was disseminated between September 2019 and April 2020 through websites, social media platforms and dietetic networks using snowball sampling. In total, 241 dietitians responded to the online survey with 152 participants included in the final analysis (female [94.1%], mean age 40.8 years [SD 9.5]; median 12 years [interquartile range 8, 22] within dietetic practice). One hundred and nine (71.7%) participants reported currently using VLED/LED in clinical practice and 43 (28.3%) did not. Those with lower motivation and confidence in implementing VLED/LED in clinical practice were less likely to use them. Cost and adherence were the two highest reported barriers to use. Dietitians perceived VLED/LED were effective, but concerns remained about long-term effectiveness, particularly for some patient groups. Dietitians also reported that further education, funding and service infrastructure, including access to clinic space and administrative support, were required to help embed VLED/LED into routine clinical practice. With clinical services now regularly offering VLED/LED programmes in the United Kingdom, dietitians are ideally placed to provide long-term support. However, understanding, reporting and addressing the potential barriers (funding/infrastructure and education) appear to be key requirements in increasing the delivery of VLED/LED programmes nationally