Women with co-occurring disorders and histories of abuse: moderators of treatment effect on services use and costs

Objective: Women with co-occurring mental health and substance abuse disorders and histories of abuse are heterogeneous in symptom severity and use of support services, which may affect their treatment response. This dissertation estimated differential effects of an integrated counseling intervention (IC) across sub-groups of women in this population on their outcome services use and costs. Data Sources/Study Setting: Data from a national study conducted from 1998-2003. 2,729 eligible women were recruited into IC or usual care study groups at nine study sites. Study Design: Interviews were conducted with participants at baseline, three, six, nine and 12 months regarding their service use. Data Collection/Extraction Methods: Cluster analyses identified sub-groups of participants according to symptom profiles at baseline and separately according to service use profiles at baseline. Regression analyses estimated the effect of IC, by sub-group, on participants' outcome use of outpatient counseling, residential substance abuse treatment, medical and overall costs. Latent class analyses were also conducted as a comparative approach to modeling sub-group effects of IC. Principal Findings: Among women with moderate-to-severe PTSD at baseline, the IC group had fewer counseling visits and a lower probability of having any medical costs at follow-up than the usual care group. Among women who used counseling intensively at baseline, the IC group had fewer days of residential treatment at 12 months than the usual care group. Among women with high drug addiction and PTSD at baseline and women with high alcohol severity, those in IC had lower medical costs than women in usual care. Latent class models produced generally consistent effects for residential treatment and medical costs. Conclusions: IC was relatively inefficient for women whose predominant symptom at baseline was moderate-to-severe PTSD. Efforts should be made to improve treatment and outcomes for these women. IC worked well for women who at baseline used counseling intensively, had high drug addiction and PTSD, or had high alcohol severity. Practitioners can identify these women among their patients and direct them toward IC if they are not already engaged. Optimizing the effect of IC for women in this population can improve patient outcomes and conserve public resources

Service Utilization Patterns as Predictors of Response to Trauma-Informed Integrated Treatment for Women With Co-occurring Disorders

The current study examined whether clinical responses to an integrated treatment intervention among women with co-occurring disorders and histories of abuse varied according to their service use patterns at baseline

Multi-scale assembly of hydrogels formed by highly branched arabinoxylans from Plantago ovata seed mucilage studied by USANS/SANS and rheology

© 2018 Elsevier Ltd The structures of two hydrogels formed by purified brush-like polysaccharides from Plantago ovata seed mucilage have been characterised from the nanometre to micrometre scale by using a combination of SANS and USANS techniques. These two hydrogels have distinctly different melting and rheological properties, but the structure of their gel networks bears striking similarity as revealed by USANS/SANS experiments. Surprisingly, we find that the dramatic changes in the rheological properties induced by temperature or change in the solvent quality are accompanied by a small alteration of the network structure as inferred from scattering curves recorded above melting or in a chaotropic solvent (0.7 M KOD). These results suggest that, in contrast to most gel-forming polysaccharides for which gelation depends on a structural transition, the rheological properties of Plantago ovata mucilage gels are dependent on variations in intermolecular hydrogen bonding. By enzymatically cleaving off terminal arabinose residues from the side chains, we have demonstrated that composition of side-chains has a strong effect on intermolecular interactions, which, in turn, has a profound effect on rheological and structural properties of these unique polysaccharides

Ketamine and Attentional Bias Toward Emotional Faces: Dynamic Causal Modeling of Magnetoencephalographic Connectivity in Treatment-Resistant Depression

The glutamatergic modulator ketamine rapidly reduces depressive symptoms in individuals with treatment-resistant major depressive disorder (TRD) and bipolar disorder. While its underlying mechanism of antidepressant action is not fully understood, modulating glutamatergically-mediated connectivity appears to be a critical component moderating antidepressant response. This double-blind, crossover, placebo-controlled study analyzed data from 19 drug-free individuals with TRD and 15 healthy volunteers who received a single intravenous infusion of ketamine hydrochloride (0.5 mg/kg) as well as an intravenous infusion of saline placebo. Magnetoencephalographic recordings were collected prior to the first infusion and 6–9 h after both drug and placebo infusions. During scanning, participants completed an attentional dot probe task that included emotional faces. Antidepressant response was measured across time points using the Montgomery-Asberg Depression Rating Scale (MADRS). Dynamic causal modeling (DCM) was used to measure changes in parameter estimates of connectivity via a biophysical model that included realistic local neuronal architecture and receptor channel signaling, modeling connectivity between the early visual cortex, fusiform cortex, amygdala, and inferior frontal gyrus. Clinically, ketamine administration significantly reduced depressive symptoms in TRD participants. Within the model, ketamine administration led to faster gamma aminobutyric acid (GABA) and N-methyl-D-aspartate (NMDA) transmission in the early visual cortex, faster NMDA transmission in the fusiform cortex, and slower NMDA transmission in the amygdala. Ketamine administration also led to direct and indirect changes in local inhibition in the early visual cortex and inferior frontal gyrus and to indirect increases in cortical excitability within the amygdala. Finally, reductions in depressive symptoms in TRD participants post-ketamine were associated with faster α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) transmission and increases in gain control of spiny stellate cells in the early visual cortex. These findings provide additional support for the GABA and NMDA inhibition and disinhibition hypotheses of depression and support the role of AMPA throughput in ketamine's antidepressant effects.Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT00088699?term=NCT00088699&draw=2&rank=1, identifier NCT00088699

Differential Service Utilization Associated With Trauma-informed Integrated Treatment for Women With Co-occurring Disorders

Women with co-occurring mental health and substance use disorders and trauma histories vary greatly in symptom severity and use of support services. This study estimated differential effects of an integrated treatment intervention (IT) across sub-groups of women in this population on services utilization outcomes. Data from a national study were used to cluster participants by symptoms and service utilization, and then estimate the effect of IT versus usual care on 12-month service utilization for each sub-group. The intervention effect varied significantly across groups, in particular indicating relative increases in residential treatment utilization associated with IT among women with predominating trauma and substance abuse symptoms. Understanding how IT influences service utilization for different groups of women in this population with complex needs is an important step toward achieving an optimal balance between need for treatment and service utilization, which can ultimately improve outcomes and conserve resources

Atmospheric Escape From Three Terrestrial Planets in the L 98-59 System

A critically important process affecting the climate evolution and potential habitability of an exoplanet is atmospheric escape, in which high-energy radiation from a star drives the escape of hydrogen atoms and other light elements from a planet's atmosphere. L 98-59 is a benchmark system for studying such atmospheric processes, with three transiting terrestrial-size planets receiving Venus-like instellations (4-25 S$_\oplus$) from their M3 host star. We use the VPLanet model to simulate the evolution of the L 98-59 system and the atmospheric escape of its inner three small planets, given different assumed initial water quantities. We find that, regardless of their initial water content, all three planets accumulate significant quantities of oxygen due to efficient water photolysis and hydrogen loss. All three planets also receive enough XUV flux to drive rapid water loss, which considerably affects their developing climates and atmospheres. Even in scenarios of low initial water content, our results suggest that the James Webb Space Telescope (JWST) will be sensitive to observations of retained oxygen on the L 98-59 planets in its future scheduled observations, with planets b and c being the most likely targets to possess an extended atmosphere. Our results constrain the atmospheric evolution of these small rocky planets, and they provide context for current and future observations of the L 98-59 system to generalize our understanding of multi-terrestrial planet systems.Comment: 17 pages, 7 figures, accepted for publication in the Astrophysical Journa

Who participates in web-assisted tobacco interventions? The quit-primo and national dental practice-based research network hi-quit studies

INTRODUCTION: Smoking is the most preventable cause of death. Although effective, Web-assisted tobacco interventions are underutilized and recruitment is challenging. Understanding who participates in Web-assisted tobacco interventions may help in improving recruitment. OBJECTIVES: To understand characteristics of smokers participating in a Web-assisted tobacco intervention (Decide2Quit.org). METHODS: In addition to the typical Google advertisements, we expanded Decide2Quit.org recruitment to include referrals from medical and dental providers. We assessed how the expanded recruitment of smokers changed the users\u27 characteristics, including comparison with a population-based sample of smokers from the national Behavioral Risk Factors Surveillance Survey (BRFSS). Using a negative binomial regression, we compared demographic and smoking characteristics by recruitment source, in particular readiness to quit and association with subsequent Decide2Quit.org use. RESULTS: The Decide2Quit.org cohort included 605 smokers; the 2010 BRFSS dataset included 69,992. Compared to BRFSS smokers, a higher proportion of Decide2Quit.org smokers were female (65.2% vs 45.7%, P=.001), over age 35 (80.8% vs 67.0%, P=.001), and had some college or were college graduates (65.7% vs 45.9%, P=.001). Demographic and smoking characteristics varied by recruitment; for example, a lower proportion of medical- (22.1%) and dental-referred (18.9%) smokers had set a quit date or had already quit than Google smokers (40.1%, P CONCLUSIONS: Recruitment from clinical practices complimented Google recruitment attracting smokers less motivated to quit and less experienced with Web-assisted tobacco interventions. TRIAL REGISTRATION: Clinicaltrials.gov NCT00797628; http://clinicaltrials.gov/ct2/show/NCT00797628 (Archived by WebCite at http://www.webcitation.org/6F3tqz0b3)

Cluster-randomized trial of a web-assisted tobacco quality improvement intervention of subsequent patient tobacco product use: A national dental PBRN study

ABSTRACT: BACKGROUND: Brief clinician delivered advice helps in tobacco cessation efforts. This study assessed the impact of our intervention on instances of advice given to dental patients during visits on tobacco use quit rates 6 months after the intervention. METHODS: The intervention was cluster randomized trial at the dental practice level. Intervention dental practices were provided a longitudinal technology-assisted intervention, oralcancerprevention.org that included a series of interactive educational cases and motivational email cues to remind dental provides to complete guideline-concordant brief behavioral counseling at the point of care. In all dental practices, exit cards were given to the first 100 consecutive patients, in which tobacco users provided contact information for a six month follow-up telephone survey. RESULTS: A total of 564 tobacco using dental patients completed a six month follow-up survey. Among intervention patients, 55% reported receiving advice to quit tobacco, and 39% of control practice patients reported receiving advice to quit tobacco (p \u3c 0.01). Six-month tobacco use quit rates were not significantly between the Intervention (9%) and Control (13%) groups, (p = 0.088). CONCLUSION: Although we increased rates of cessation advice delivered in dental practices, this study shows no evidence that brief advice by dentist\u27s increases long-term abstinence in smokers.Trial registration: ClinicalTrials.gov NCT00627185