Childhood Anxiety

The following paper closely examines anxiety in school-aged children, especially those predisposed through environmental and biological factors. While there are many typical worries and fears in children, atypical signs that point to an anxiety disorder include severity and high frequency of worry and avoidance behavior. Anxiety disorders affect roughly a third of children ages six through eleven, and early intervention and cognitive strategies are extremely effective in giving children coping skills for their separation, social, or generalized anxiety. Some of the treatment plans examined in this paper include Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT) and Narrative Therapy and Externalization. Professional and at home treatment plans are examined, and current children’s books are critiqued through this therapeutic lens. Some children’s books are helpful in providing comfort or tools to anxious children, while many trivialize the fear or give false hope of “curing” anxiety with quick fixes. This author has written and illustrated a children’s book entitled “My Scary and Me” that combines therapeutic approaches with the author’s unique experiences with anxiety herself. The text and illustrations in the picture book aim to make anxious feelings external, visible, and relatable for anxious children

The Law of 180-Day Exclusivity

When Congress enacted the Hatch-Waxman amendments to the Federal Food, Drug, and Cosmetic Act (FDCA) in 1984, creating a statutory pathway for abbreviated new drug applications (ANDAs), it included an incentive for generic applicants to challenge as invalid, or alternatively design around, patents claiming the innovative drugs on which they based their abbreviated applications.\u27 In brief, the first generic applicant to file an ANDA asserting that such a patent was invalid or not infringed would be awarded 180 days of generic market exclusivity. During this exclusivity period, the Food and Drug Administration (FDA) could not approve a subsequent ANDA that challenged a patent claiming the same drug. This is the fourth in a series of articles explaining the law of 180-day exclusivity. Like the others, it takes a descriptive and doctrinal approach to the law that has emerged from the statute, the agency\u27s implementing materials (which range from regulations to citizen petition responses and decisions to award or deny exclusivity), and court decisions. Its scope is, however, slightly different. Section I of this article provides the necessary background regarding the statutory language as well as a high-level description of the steps FDA has taken to implement the scheme. It defers discussion of the details of FDA\u27s implementing regulations to section II. Section II discusses the discrete interpretive issues, arranged in five categories: which rules apply, earning exclusivity, forfeiture of exclusivity, commencing the exclusivity term, and enjoyment (use) of the exclusivity term. This section presents each issue as a question and then offers a short answer and a more full discussion. In some cases, the issue is sufficiently discrete and the discussion sufficiently brief that the article dispenses with a short answer altogether. Because FDA has announced that it will release guidance on 180-day exclusivity sometime in 2016, section II flags open issues as well as apparent agency policies that could be confirmed in guidance. We conclude in section III with a brief discussion of lingering and renewed criticisms of the scheme, in the courts, academic literature, and Congress. We note a variety of proposals, both in Congress and in the secondary literature, to change the scheme yet again

The Vascular Flora and Community Structure of Little Calumet Headwaters Nature Preserve, Laporte Country, Indiana

Little Calumet Headwaters Nature Preserve is a 108-acre tract of woodland and wetland areas that comprise the headwaters of the Little Calumet River in northwestern Indiana. The preserve, consisting of upland hardwood forests, groundwater seeps, and wetland complex, is an area of high diversity due to its topographical variation. A floristic inventory, plot sampling, and seed bank analysis were used to determine the structure and composition of the plant communities. The flora consists of 298 species (27 exotic) representing 188 genera and 84 families. Dominant vegetation of the forest includes Liriodendron tulipifera, Prunus serotina, Packera aurea and Podophyllum peltatum. Each groundwater seep contains similar plant communities with variant species that depend on water flow and topography. They include species such as Symplocarpus foetidus, Impatiens capensis, and Caltha palustris and lack an extensive woody overstory except for occasional Salix spp. or Cornus spp. The wetland complex contains three distinct areas: an open fen dominated by Leersia oryzoides and Cornus spp.; a marsh dominated by Typha latifolia and Carex lasiocarpa; and a shrub-carr portion dominated by Symplocarpus foetidus, Cornus alternifolia, and Salix nigra. A wetland seed bank study resulted in a total of 46 species representing 33 genera and 22 families. A similarity of 71.7% was determined between the seed bank samples and the above-ground vegetation. The entire preserve has a high floristic quality index (FQI) of 70.1 and average mean coefficient of conservatism of 4.1. The high FQI value is influenced by property size and the number of communities in the preserve

The evolution of cooperative turn-taking in animal conflict

<p>Abstract</p> <p>Background</p> <p>A fundamental assumption in animal socio-ecology is that animals compete over limited resources. This view has been challenged by the finding that individuals might cooperatively partition resources by "taking turns". Turn-taking occurs when two individuals coordinate their agonistic behaviour in a way that leads to an alternating pattern in who obtains a resource without engaging in costly fights. Cooperative turn-taking has been largely ignored in models of animal conflict and socio-ecological models that explain the evolution of social behaviours based only on contest and scramble competition. Currently it is unclear whether turn-taking should be included in socio-ecological models because the evolution of turn-taking is not well understood. In particular, it is unknown whether turn-taking can evolve when fighting costs and assessment of fighting abilities are not fixed but emerge from evolved within-fight behaviour. We address this problem with an evolutionary agent-based model.</p> <p>Results</p> <p>We found that turn-taking evolves for small resource values, alongside a contest strategy that leads to stable dominance relationships. Turn-taking leads to egalitarian societies with unclear dominance relationships and non-linear dominance hierarchies. Evolutionary stability of turn-taking emerged despite strength differences among individuals and the possibility to evolve within-fight behaviour that allows good assessment of fighting abilities. Evolutionary stability emerged from frequency-dependent effects on fitness, which are modulated by feedbacks between the evolution of within-fight behaviour and the evolution of higher-level conflict strategies.</p> <p>Conclusions</p> <p>Our results reveal the impact of feedbacks between the evolution of within-fight behaviour and the evolution of higher-level conflict strategies, such as turn-taking. Similar feedbacks might be important for the evolution of other conflict strategies such as winner-loser effects or coalitions. However, we are not aware of any study that investigated such feedbacks. Furthermore, our model suggests that turn-taking could be used by animals to partition low value resources, but to our knowledge this has never been tested. The existence of turn-taking might have been overlooked because it leads to societies with similar characteristics that have been expected to emerge from scramble competition. Analyses of temporal interaction patterns could be used to test whether turn-taking occurs in animals.</p

Seasonal and successional streamflow response to forest cutting and regrowth in the northwest and eastern United States

This study examined daily streamflow response over up to four decades in northwest conifer forest and eastern deciduous forest sites in the United States. We used novel methods to analyze daily observations of climate and streamflow spanning more than 900 basin years of record at 14 treated/control basin pairs where forest removal and regrowth experiments were underway in the period 1930–2002. In the 1 to 5-year period after forest removal, maximum daily increases ranged from 2 to 3 mm at deciduous forest sites, to 6 to 8 mm at conifer forest sites. Significant spring surpluses persisted for up to 35 years in conifer forest basins, but winter and spring streamflow deficits appeared after 10 to 15 years of forest regrowth in eastern deciduous forest basins. In all 5-yr posttreatment periods, absolute changes in daily streamflow were significantly more likely during moist, warm seasons, or during snowmelt seasons, but relative changes were more likely during warm seasons irrespective of moisture status. Both relative and absolute streamflow changes in the 1 to 5 and 15 to 25-year periods after forest removal were significantly positively related to the age of the forest at the time it was cut. Eastern deciduous forests had been disturbed by logging or hurricane 12 to 56 years prior to forest removal, while Pacific Northwest conifer forests had been not experienced logging or wildfire for 90 to 450 years. Paired basin experiments provide a continuous, and continuously changing, record of vegetation structure, composition, and climate, and their effects on streamflow

Employment Among People With Spinal Cord Injury in 22 Countries Across the World:Results From the International Spinal Cord Injury Community Survey

Objectives: To describe the employment situation of individuals with spinal cord injury (SCI) in 22 countries participating in the International Spinal Cord Injury community survey, to compare observed and predicted employment rates, to estimate gaps in employment rates among people with SCI compared with the general population, and to study differences in employment between men and women. Design: Cross-sectional survey. Setting: Community. Participants: People of employable age (N=9875; 18-64 y) with traumatic or non-traumatic SCI (including cauda equina syndrome) who were at least 18 years of age at the time of the survey, living in the community, and able to respond to one of the available language versions of the questionnaire. Interventions: Not applicable Main Outcome Measures: The observed employment rate was defined as performing paid work for at least 1 hour a week, and predicted employment rate was adjusted for sample composition from mixed logistic regression analysis. Results: A total of 9875 participants were included (165-1174 per country). Considerable differences in sample composition were found. The observed worldwide employment rate was 38%. A wide variation was found across countries, ranging from 10.3% to 61.4%. Some countries showed substantially higher or lower employment rates than predicted based on the composition of their sample. Gaps between the observed employment rates among participants with SCI and the general population ranged from 14.8% to 54.8%. On average, employment rates were slightly higher among men compared with women, but with large variation across countries. Employment gaps, however, were smaller among women for most countries. Conclusions: This first worldwide survey among people with SCI shows an average employment rate of 38%. Differences between observed and predicted employment rates across countries point at country-specific factors that warrant further investigation. Gaps with employment rates in the general population were considerable and call for actions for more inclusive labor market policies in most of the countries investigated. (C) 2020 by the American Congress of Rehabilitation Medicin

Outcomes and risk factors associated with endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents.

OBJECTIVE: To describe outcomes of and risk factors for endophthalmitis after intravitreal anti-vascular endothelial growth factor (VEGF) injection. DESIGN: Single-center, consecutive, case series and retrospective case-control study. PARTICIPANTS: Between January 1, 2009, and May 31, 2010, 16 vitreoretinal surgeons administered a total of 27 736 injections. During this period, 23 cases of presumed infectious endophthalmitis occurred. Each surgeon used his own preferred injection technique. INTERVENTION: Vitreous or aqueous tap, or both, with intravitreal antibiotic injection and subsequent topical antibiotic and steroid drops. MAIN OUTCOME MEASURES: Visual acuity, bladed lid speculum use, conjunctival displacement, hemisphere of injection, bevacizumab versus ranibizumab, and infectious organism. RESULTS: Seven of 23 cases had positive culture results; 3 grew coagulase-negative Staphylococcus. All cases had pain and vitritis on average 3.4 days (range, 1-6 days) after injection, with no difference between culture-positive and culture-negative groups. Eighteen (78%) of 23 cases had a hypopyon. Fifteen of 23 cases returned to baseline vision (±2 lines) within 3 months. Neither lid speculum use (0.10% vs. 0.066% in the no-use group; P = 0.27), conjunctival displacement (0.11% vs. 0.076% in the no-displacement group; P = 0.43), hemisphere of injection (0.11% superior vs. 0.079% inferior; P = 0.56), or bevacizumab versus ranibizumab (0.11% vs. 0.066%; P = 0.21) affected risk. Analysis of only culture-positive results yielded similar results. There was no statistically significant difference between the proportion of culture-negative cases after bevacizumab injection (83%) versus ranibizumab injection (55%; P = 0.13). CONCLUSIONS: Most patients in whom presumed infectious endophthalmitis develop after anti-VEGF injection regained baseline vision after treatment. Bladed lid speculum use, conjunctival displacement, hemisphere of injection, and type of anti-VEGF agent did not affect risk. No difference in culture-negative endophthalmitis rates was detected after bevacizumab versus ranibizumab injection. Neither the presence of pain, vitritis, decreased vision, hypopyon, nor the interval between injection and development of symptoms differentiate culture-positive from culture-negative cases. Because a subgroup of patients had poor outcomes, a low threshold for vitreous tap with intravitreal antibiotic injection may be warranted. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article

Appraisals and coping mediate the relationship between resilience and distress among significant others of persons with spinal cord injury or acquired brain injury: a cross-sectional study

Background: Many significant others of persons with serious conditions like spinal cord injury (SCI) and acquired brain injury (ABI) report high levels of psychological distress. In line with the stress-coping model, the aim of the present study was to investigate the relationship between personal resource resilience and psychological distress, and whether appraisals of threat and loss, and passive coping mediate this relationship. Methods: Significant others (n = 228) of persons with SCI or ABI completed questionnaires shortly after admission to first inpatient rehabilitation after onset of the condition. The questionnaire included measures to assess psychological distress (Hospital Anxiety and Depression Scale), resilience (Connor-Davidson Resilience Scale-10), appraisals (Appraisals of Life Events scale, threat and loss) and passive coping (Utrecht Coping List). The PROCESS tool was used to test the presence of mediation. Confounding and differences between SCI and ABI were investigated. Results: High levels of psychological distress among significant others were found (34-41%). Fifty-five percent of the variance in psychological distress was explained by the relationship between resilience and psychological distress. This relationship was mediated by appraisals of threat and loss, and passive coping. The relationship between resilience and psychological distress was similar in the SCI and ABI groups. Conclusions: The results of our study indicate that appraisals of threat and loss and passive coping are mediating factors in the relationship between resilience and psychological distress. It seems useful to investigate if interventions focussing on psychological factors like resilience, appraisal and coping are effective to prevent or reduce psychological distress among significant others of persons with SCI or ABI