Predicting Outcome at Posttreatment for Adolescent Obsessive-Compulsive Disorder in a Residential Treatment Setting

Exposure and response prevention (ERP) paired with psychopharmacological interventions are considered first line treatments for pediatric obsessive compulsive disorder (OCD). Recent literature has emphasized the importance of investigating effectiveness and treatment outcomes for difficult-to-treat cases of pediatric OCD who do not respond to outpatient treatment. Effectiveness studies have found that adolescent patients treated in residential settings have demonstrated gains comparable to those patients included in published outpatient outcomes studies (Bjorgvinsson et al., 2008; Leonard et al., 2014). Current research efforts are needed to 1) better predict gains in real-world clinical settings and 2) identify risk factors for difficult-to-treat patients who have previously failed effective treatment strategies. The purpose of this study was to investigate predictors of residential treatment outcome in 196 adolescent (13-17 years old) patients receiving intensive combined treatment for a primary diagnosis of OCD. Clinical factors within five relevant domains were investigated to determine whether predictors above and beyond baseline symptom severity are able to predict OCD treatment response in this population. Patients were assessed at admission and discharge with standardized self-report measures of OCD symptom severity, depression, anxiety sensitivity, and anxiety-related symptoms. Admission data were used for the prediction of OCD severity at discharge as measured by the Children\u27s Yale-Brown Obsessive-Compulsive Scale - Self Report (CY-BOCS-SR; Piacentini, Langley, & Roblek, 2007). Results indicated the variables of having received partial hospitalization/day treatment prior to admission to residential and higher severity at admission significantly predicted greater OCD severity at discharge. The relation between treatment history and outcome deserve additional exploration to uncover factors related to previous treatment experience and subsequent treatment outcomes. Differences among subtests on the CY-BOCS-SR in predicting treatment outcome provided evidence for the need for additional investigations of the link between severity of compulsory behaviors at admission and response to treatment. The challenge remains to systematically identify program components that match unique patient needs to increase prescriptive efficacy with this difficult-to-treat population.The challenge remains to systematically identify program components that match unique patient needs to increase prescriptive efficacy with this difficulty-to-treat population

Transport infrastructure evaluation using cost-benefit analysis: improvements to valuing the asset through residual value—a case study

Residual value (RV) is an important component of Cost Benefit Analysis (CBA), often valued at 20% to 50% of total construction costs. It is often overlooked which can artificially depress the project?s returns. The treatment of RV is inadequate and needs further research. Residual value represents the value of the infrastructure at the end of its project lifetime and the value that the asset generates from then on. We analyze three methods for calculating RV: straight-line depreciation, annuity/perpetuity and component. The straight-line depreciation method is the most commonly used; it is simple and quick to produce and it typically uses a percent of the total construction cost rather than real value. The perpetuity/annuity method ignores the actual value of the asset. It reflects the difference of costs and benefits between economic and useful life (annuity method) or assumes an infinite economic life (perpetuity method). The component method is the most detailed and difficult to calculate method. It gives the actual value of the physical asset at the end of project appraisal by infrastructure component. We assume three scenarios for the future for the component method. We use the case study of the Portuguese High Speed Rail project to calculate and compare each method. As expected, the perpetuity has the highest RV and net present value (NPV), followed by the annuity method and then the component method. The straight-line method produces the lowest values (other than one scenario for the component method). Sensitivity analysis is performed ceteris paribus for the demand, construction cost and discount rate factors. We conclude that RV is important in situations when the benefit-cost ratio is close to 1 and the method selected can have a large impact on the size (and sign) of the NPV

Stimulus Threat and Exposure Context Modulate the Effect of Mere Exposure on Approach Behaviors

Mere-exposure (ME) research has found that initially neutral objects made familiar are preferred relative to novel objects. Recent work extends these preference judgments into the behavioral domain by illustrating that mere exposure prompts approachoriented behavior toward familiar stimuli. However, no investigations have examined the effect of mere exposure on approach-oriented behavior toward threatening stimuli. The current work examines this issue and also explores how exposure context interacts with stimulus threat to influence behavioral tendencies. In two experiments participants were presented with both mere-exposed and novel stimuli and approach speed was assessed. In the first experiment, when stimulus threat was presented in a homogeneous format (i.e., participants viewed exclusively neutral or threatening stimuli), ME potentiated approach behaviors for both neutral and threatening stimuli. However, in the second experiment, in which stimulus threat was presented in a heterogeneous fashion (i.e., participants viewed both neutral and threatening stimuli), mere exposure facilitated approach only for initially neutral stimuli. These results suggest that ME effects on approach behaviors are highly context sensitive and depend on both stimulus valence and exposure context. Further implications of these findings for the ME literature are discussed

Unique transcriptomic landscapes identified in idiopathic spontaneous and infection related preterm births compared to normal term births.

Preterm birth (PTB) is leading contributor to infant death in the United States and globally, yet the underlying mechanistic causes are not well understood. Histopathological studies of preterm birth suggest advanced villous maturity may have a role in idiopathic spontaneous preterm birth (isPTB). To better understand pathological and molecular basis of isPTB, we compared placental villous transcriptomes from carefully phenotyped cohorts of PTB due to infection or isPTB between 28-36 weeks gestation and healthy term placentas. Transcriptomic analyses revealed a unique expression signature for isPTB distinct from the age-matched controls that were delivered prematurely due to infection. This signature included the upregulation of three IGF binding proteins (IGFBP1, IGFBP2, and IGFBP6), supporting a role for aberrant IGF signaling in isPTB. However, within the isPTB expression signature, we detected secondary signature of inflammatory markers including TNC, C3, CFH, and C1R, which have been associated with placental maturity. In contrast, the expression signature of the gestational age-matched infected samples included upregulation of proliferative genes along with cell cycling and mitosis pathways. Together, these data suggest an isPTB molecular signature of placental hypermaturity, likely contributing to the premature activation of inflammatory pathways associated with birth and providing a molecular basis for idiopathic spontaneous birth

Gelation by histidine-derived ureas

A series of l-histidine-derived monoureas are described which exhibit versatile organogelation peroperties when the substituent directly attached to the urea is an aliphatic group. Arylureas exhibit a tendency to bind chloride anion

Can consumers learn to ask three questions to improve shared decision making? A feasibility study of the ASK (AskShareKnow) Patient–Clinician Communication Model® intervention in a primary health-care setting

Funded by Informed Medical Decisions Foundation. Grant Number: #0175-1 National Health and Medical Research Council Public Health Training Fellowship. Grant Number: 568962Peer reviewedPublisher PD

Viromic Analysis of Wastewater Input to a River Catchment Reveals a Diverse Assemblage of RNA Viruses

Enteric viruses cause gastrointestinal illness and are commonly transmitted through the fecal-oral route. When wastewater is released into river systems, these viruses can contaminate the environment. Our results show that we can use viromics to find the range of potentially pathogenic viruses that are present in the environment and identify prevalent genotypes. The ultimate goal is to trace the fate of these pathogenic viruses from origin to the point where they are a threat to human health, informing reference-based detection methods and water quality management.Detection of viruses in the environment is heavily dependent on PCR-based approaches that require reference sequences for primer design. While this strategy can accurately detect known viruses, it will not find novel genotypes or emerging and invasive viral species. In this study, we investigated the use of viromics, i.e., high-throughput sequencing of the biosphere’s viral fraction, to detect human-/animal-pathogenic RNA viruses in the Conwy river catchment area in Wales, United Kingdom. Using a combination of filtering and nuclease treatment, we extracted the viral fraction from wastewater and estuarine river water and sediment, followed by high-throughput RNA sequencing (RNA-Seq) analysis on the Illumina HiSeq platform, for the discovery of RNA virus genomes. We found a higher richness of RNA viruses in wastewater samples than in river water and sediment, and we assembled a complete norovirus genotype GI.2 genome from wastewater effluent, which was not contemporaneously detected by conventional reverse transcription-quantitative PCR (qRT-PCR). The simultaneous presence of diverse rotavirus signatures in wastewater indicated the potential for zoonotic infections in the area and suggested runoff from pig farms as a possible origin of these viruses. Our results show that viromics can be an important tool in the discovery of pathogenic viruses in the environment and can be used to inform and optimize reference-based detection methods provided appropriate and rigorous controls are included

“We’re, like, the Most Unhealthy People in the Country”: Employing an Equity Lens to Reduce Barriers to Healthy Food Access in Rural Appalachia

Introduction Obesity disproportionately affects rural communities, and Appalachia has some of the highest obesity rates in the nation. Successful policy, systems, and environmental (PSE) interventions to reduce obesity must reflect the circumstances of the population. We used a health equity lens to identify barriers and facilitators for healthy food access in Martin County, Kentucky, to design interventions responsive to social, cultural, and historical contexts. Methods We conducted 5 focus groups in Martin County, Kentucky, in fall 2019 to obtain perspectives on the local food system and gauge acceptability of PSE interventions. We used grounded theory to identify perceived barriers and facilitators for healthy eating. Results Thirty-four adults (27 women; median age, 46 years) participated in 5 groups. One prominent theme was declining interest in farming; many participants believed this decline was generational. One participant noted, “Most of my adult male relatives worked in the coal mines, and they worked 6 days a week. . . . My grandpa had the garden, but then my dad’s generation is the one quit gardening.” Another shared, “You would probably have to have someone to teach [gardening].” Instead of enhancing farmers markets, participants suggested building community capacity for home gardens to increase vegetable consumption. Conclusion Our findings demonstrate the importance of obtaining community input on the development of PSE interventions to mitigate inequities in obesity. Although farmers market interventions were deemed not feasible, other solutions to enhance access to produce were identified. Developers of community-responsive PSE interventions to improve healthy eating in rural, food-insecure locations should consider using an equity-oriented prevention framework to ensure acceptable interventions