The simulation heuristic, paranoia, and social anxiety in a non-clinical sample

Background and objectives: Quality of reasoning within non-clinical paranoia and mental simulation of future paranoia themed events was investigated by use of a simulation task to determine whether paranoid individuals would be restricted or more adept at reasoning about paranoia relevant material in comparison to a social anxiety group and a group with low paranoia and social anxiety. Method: Participants (N = 63) were divided into the three groups based on paranoia and social anxiety scores. They were presented with the beginning and end of an imaginary situation and were asked to describe, step-by-step, what they imagined would happen between those two points. They were also administered a beads task to evaluate the jumping to conclusion decision making bias. Results: The prediction of more adept reasoning was not supported for paranoia. However, the social anxiety comparison group on average better simulated a scenario with congruent (socially anxious) thematic content compared to ones with non-congruent content. Further, in an exploratory analysis, jumping to conclusions bias was found to be positively related to goodness of simulation for paranoia themed scenarios within the paranoia group. Limitations: Study groups were relatively small and so power was an issue. Conclusion: The results are discussed in the context of the sometimes paradoxical findings in the area of cognitive biases and paranoia

Gastric Tube Placement in Children 1-215 Months Old

poster abstractFeeding by a nasogastric/orogastric (NG/OG) tube is preferred when the gastrointestinal system is functional and the need for assisted feeding is expected to be short-term. Preliminary studies in children show that between 21% and 44% of these tubes are placed incorrectly. When tubes are out of place, children can be seriously harmed, causing increased morbidity and occasionally death. The aims of this study were to determine the best method to predict the insertion distance for placing NG/OG tubes and to determine the best clinical methods of testing the location of NG/OG tubes once they were inserted. A randomized clinical trial was conducted. The three insertion-distance prediction methods tested were nose-ear-xiphoid (NEX); nose-ear-mid-umbilicus (NEMU); and age-related, height-based (ARHB). An abdominal radiograph was obtained immediately following tube insertion to determine the internal location of the tube tip and orifice(s). Based on data from 95 children age 1-220 months (M = 51.8, SD = 54.9, median = 33.4), both the ARHB and NEMU methods were superior to NEX in placing the tube in the stomach (p = .0064). ARHB and NEMU were not significantly different from each other. NEX was frequently too short (41.93% of tube insertions) leaving the tube tip and/or orifices in the esophagus. The three clinical methods of testing tube location were CO2 monitoring and measuring pH and bilirubin in tube aspirate. Measuring pH of tube aspirate was the superior clinical method of determining tube location. Aspirate was available for testing in 84 children (88.42%). Based on a pH cutoff of 5 (recommended by Metheny in fasting adults), the sensitivity was 26.67 (low), specificity was 80.60 (high), positive predictive value was 23.53 (low), and negative predictive value was 83.08 (high). Measuring the NEX distance is the method most commonly used by nurses in practice; therefore, based on the results of this study and studies of other researchers, a practice change to either ARHB or NEMU should improve the safety of enteral feeding in children. Because of the low sensitivity in predicting misplaced tubes using pH, the superior clinical method, obtaining an abdominal x-ray to ensure placement in the stomach at the time of tube insertion is recommended

The Resonance in the B-P-a Reaction

The yield of alpha particles of range greater than 2 cms. from boron bombarded by protons has been studied as a function of bombarding energy in the range from 100 to 200 ekv, using a thin target, either methyl borate or boron trifluoride at pressures of 1 mm. of Hg. The yield vs. energy curve shows an approximately exponential rise on which is superposed a sharp (half breadth ~ 6 ekv) intense line at 150 ± ekv. There is some indication of a weaker and much broader line at 190 ekv. Number range curves are not yet available, but the appearance of pulses on the oscillograph screen leads us to suppose that the high yield (line) at 150 ekv is due to emission of a homogeneous long-range group

Development of evidence-based Australian medication-related indicators of potentially preventable hospitalisations: a modified RAND appropriateness method

Objective: Indicators of potentially preventable hospitalisations have been adopted internationally as a measure of health system performance; however, few assess appropriate processes of care around medication use, that if followed may prevent hospitalisation. The aim of this study was to develop and validate evidence-based medication-related indicators of potentially preventable hospitalisations. Setting: Australian primary healthcare. Participants: Medical specialists, general practitioners and pharmacists. A modified RAND appropriateness method was used for the development of medication-related indicators of potentially preventable hospitalisations, which included a literature review, assessment of the strength of the supporting evidence base, an initial face and content validity by an expert panel, followed by an independent assessment of indicators by an expert clinical panel across various disciplines, using an online survey. Primary Outcome Measure: Analysis of ratings was performed on the four key elements of preventability; the medication-related problem must be recognisable, the adverse outcomes foreseeable and the causes and outcomes identifiable and controllable. Results: A total of 48 potential indicators across all major disease groupings were developed based on level III evidence or greater, that were independently assessed by 78 expert clinicians (22.1% response rate). The expert panel considered 29 of these (60.4%) sufficiently valid. Of these, 21 (72.4%) were based on level I evidence. Conclusions: This study provides a set of face and content validated indicators of medication-related potentially preventable hospitalisations, linking suboptimal processes of care and medication use with subsequent hospitalisation. Further analysis is required to establish operational validity in a population-based sample, using an administrative health database. Implementation of these indicators within routine monitoring of healthcare systems will highlight those conditions where hospitalisations could potentially be avoided through improved medication management.Gillian E Caughey, Lisa M Kalisch Ellett, Te Ying Won

Association between Ophthalmic Timolol and Hospitalisation for Bradycardia

Introduction. Ophthalmic timolol, a topical nonselective beta-blocker, has the potential to be absorbed systemically which may cause adverse cardiovascular effects. This study was conducted to determine whether initiation of ophthalmic timolol was associated with an increased risk of hospitalisation for bradycardia. Materials and Methods. A self-controlled case-series study was undertaken in patients who were hospitalised for bradycardia and were exposed to timolol. Person-time after timolol initiation was partitioned into risk periods: 1–30 days, 31–180 days, and >180 days. A 30-day risk period prior to initiating timolol was also included. All remaining time was considered unexposed. Results. There were 6,373 patients with at least one hospitalisation for bradycardia during the study period; 267 were exposed to timolol. Risk of bradycardia was significantly increased in the 31–180 days after timolol initiation (incidence rate ratio (IRR) = 1.93; 95% confidence interval (CI) 1.00–1.87). No increased risk was observed in the first 30 days or beyond 180 days of continuous exposure (IRR = 1.40; 95% CI 0.87–2.26 and IRR = 1.21; 95% CI 0.64–2.31, resp.). Conclusion. Bradycardia is a potential adverse event following timolol initiation. Practitioners should consider patient history before choosing a glaucoma regime and closely monitor patients after treatment initiation with topical nonselective beta-blocker eye drops

A randomised trial comparing a brief online delivery of mindfulness-plus-values versus values only for symptoms of depression:Does baseline severity matter?

Background: Acceptance/mindfulness-based interventions often focus on (a) developing dispositional mindfulness and (b) pursuing personally meaningful and valued activities. Acceptance/mindfulness-based interventions can reduce depression, but little is known about the combined effects of components or the influence of baseline variables on outcomes. This study tested whether practicing a brief (10-min) mindfulness meditation over a 2-week period followed by a single values session (mindfulness+values) was more effective than values alone (values only) in reducing symptoms of depression. The study was delivered online and modules were fully self-help (i.e., no therapist contact).Methods: 206 participants (Mage=23.4 years, SD=6.53) with elevated depression scores (DASS-depression ≥ 10) were randomised to: mindfulness+values condition or a 2-week wait period followed by the values session (i.e., values only condition). Symptoms of depression were assessed at baseline, after the 2-week mindfulness practice/wait period, and 1-week following the values session.Results: Reductions in depression and recovery rates were significantly greater following mindfulness+values than values only. Baseline severity affected outcomes: mindfulness+values was significantly more beneficial than values only for individuals with high baseline levels of depression. Outcomes did not differ for those with low levels of depression. Rates of deterioration were higher than expected for values only participants.Limitations: Conclusions are preliminary and tentative due to no follow-up period and a small sample. Drop-out was high (50%) and findings cannot be assumed to generalise to treatment seeking or more diverse samples.Conclusions: Tentatively, results suggest mindfulness+values can significantly reduce depression, especially for individuals with higher baseline depression

Comparing Bedside Methods of Determining Placement of Gastric Tubes in Children

Purpose The purpose of this study was to compare the accuracy and predictive validity of pH, bilirubin, and CO2 in identifying gastric tube placement errors in children. Design and Methods After the tube was inserted into 276 children, the CO2 monitor reading was obtained. Fluid was then aspirated to test pH and bilirubin. Results Lack of ability to obtain tube aspirate was the best predictor of NG/OG placement errors with a sensitivity of 34.9% and a positive predictive value of 66.7%. Measuring pH, bilirubin, and CO2 of tube aspirate was less helpful. Practice Implications Health care providers should suspect NG/OG tube misplacement when no fluid is aspirated

Pseudorapidity Distribution of Charged Particles in PbarP Collisions at root(s)= 630GeV

Using a silicon vertex detector, we measure the charged particle pseudorapidity distribution over the range 1.5 to 5.5 using data collected from PbarP collisions at root s = 630 GeV. With a data sample of 3 million events, we deduce a result with an overall normalization uncertainty of 5%, and typical bin to bin errors of a few percent. We compare our result to the measurement of UA5, and the distribution generated by the Lund Monte Carlo with default settings. This is only the second measurement at this level of precision, and only the second measurement for pseudorapidity greater than 3.Comment: 9 pages, 5 figures, LaTeX format. For ps file see http://hep1.physics.wayne.edu/harr/harr.html Submitted to Physics Letters

Modeling Water Flux at the Base of the Rooting Zone for Soils with Varying Glacial Parent Materials

Poster presented at American Geophysical Union meeting in 2013.Soils of varying glacial parent materials in the Great Lakes Region (USA) are characterized by thin unsaturated zones and widespread use of agricultural pesticides and nutrients that affect shallow groundwater. To better our understanding of the fate and transport of contaminants, improved models of water fluxes through the vadose zones of various hydrogeologic settings are warranted. Furthermore, calibrated unsaturated zone models can be coupled with watershed models, providing a means for predicting the impact of varying climate scenarios on agriculture in the region. To address these issues, a network of monitoring sites was developed in Indiana that provides continuous measurements of precipitation, potential evapotranspiration (PET), soil volumetric water content (VWC), and soil matric potential to parameterize and calibrate models. Flux at the base of the root zone is simulated using two models of varying complexity: 1) the HYDRUS model, which numerically solves the Richards equation, and 2) the soil-water-balance (SWB) model, which assumes vertical flow under a unit gradient with infiltration and evapotranspiration treated as separate, sequential processes. Soil hydraulic parameters are determined based on laboratory data, a pedo-transfer function (ROSETTA), field measurements (Guelph permeameter), and parameter optimization. Groundwater elevation data are available at three of six sites to establish the base of the unsaturated zone model domain. Initial modeling focused on the groundwater recharge season (Nov–Feb) when PET is limited and much of the annual vertical flux occurs. HYDRUS results indicate that base of root zone fluxes at a site underlain by glacial ice-contact parent materials are 48% of recharge season precipitation (VWC RMSE=8.2%), while SWB results indicate that fluxes are 43% (VWC RMSE=3.7%). Due in part to variations in surface boundary conditions, more variable fluxes were obtained for a site underlain by alluvium with the SWB model (68% of recharge season precipitation, VWC RMSE=7.0%) predicting much greater drainage than HYDRUS (38% of recharge season precipitation, VWC RMSE=6.6%). Results also show that when calculating drainage flux over the recharge period, HYDRUS is highly sensitive to model initialization using observed water content from in-situ instrumentation. Simulated recharge season drainage flux is as much as 3.5 times higher when a one-month spin-up period was performed in the HYDRUS model for the same site. SWB results are less sensitive to water content initialization, but drainage flux is 1.6 times higher at one site using the same spin-up analysis. The long-term goals of this effort are to leverage the robust calibration data set to establish optimal approaches for determining hydraulic parameters such that water fluxes in the lower vadose zone can be modeled for a wider range of geomorphic settings where calibration data are unavailable