Predictors of Readmission in Hospitalized Anorexia Nervosa Patients

Objective: Managed care practices that limit access to and duration of treatment conflict with established standards of care for patients with anorexia nervosa (AN). However, there is little information about how abbreviated lengths of hospitalization relate to the need for rehospitalization, one indicator of unfavorable outcome. This dissertation describes the demographic and clinical features of patients who require multiple psychiatric hospitalizations for treatment of AN and identifies patient characteristics that predict both likelihood of and time to readmission in the current care environment. Method: One-hundred-forty-seven patients with a primary diagnosis of AN and hospitalized on a specialized eating disorders psychiatric unit completed self-report questionnaires measuring eating disorders symptoms, mood, and personality functioning at admission and discharge. Medical record reviews yielded demographic, historical, and inpatient course of treatment information. Medical records were later reviewed to determine which of the 147 patients had been readmitted to the same facility within 3 years of their index admission. Multivariate logistic regression analysis was used to evaluate prediction of readmission status. Cox regression survival techniques were used to evaluate prediction of time to readmission. Parallel analyses were conducted on the full sample (n = 147) and on a subsample of patients (n=107) who were not discharged against medical advice (i.e., received an adequate dose of treatment). Results: Twenty-seven percent of the full sample and 31% of the subsample were readmitted within 3 years of their discharge. Body dissatisfaction and mood disorder diagnosis at discharge best predicted the likelihood of both readmission and time to readmission for the group of patients who received an adequate dose of inpatient treatment. Discussion: The observed predictors differ from those typically associated with readmission in patients with AN. The findings highlight the centrality of psychopathological aspects of AN and comorbid mood disorder, and they suggest a need to refine inpatient treatment interventions to more specifically target the psychological distress associated with body image disturbances and mood disorder. More broadly, the findings suggest the need to further evaluate the extent to which the managed care treatment environment is affecting treatment outcomes

Changes in quality of life and coping among people with multiple sclerosis over a 2 year period

There is a need to investigate the impact of different coping strategies on quality of life (QOL) of people with multiple sclerosis (MS), in order to better inform intervention programs for this population. This study evaluated the relationship between QOL and coping over a 2 year period among people with MS. Participants were 382 people with MS (144 male, 238 females) and 291 people without a neurological or other chronic illness from the general population (101 males, 190 females). People with MS experienced lower QOL than the control group in the domains of global QOL, independence, social and spiritual QOL scales, as well as the problem solving and social/emotional support coping scales. Interestingly, people with MS experienced higher psychological QOL than the general population, and higher detachment and focusing on the positive coping. Over time, people with MS demonstrated increases in their global QOL as well as in their social/emotional support coping. Women demonstrated higher levels than men of global QOL and Social/emotional support coping. The results of these findings have implications for information and intervention programs for people with MS. <br /

The difference of Being in the early modern world: a relational-material approach to life in Scotland in the period of the witch trials

This thesis investigates how ways of being in different ontologies emerge from material and embodied practice. This general concern is explored through the particular case study of Scotland in the period of the witch trials (the 16th and 17th centuries C.E.). The field of early modern Scottish witchcraft studies has been active and dynamic over the past 15 years but its prioritisation of what people said over what they did leaves a clear gap for a situated and relational approach focusing upon materiality. Such an approach requires a move away from the Cartesian dichotomies of modern ontology to recognise past beliefs as real to those who experienced them, coconstitutive of embodiment and of the material worlds people inhabited. In theory, method and practice, this demands a different way of exploring past worlds to avoid flattening strange data. To this end, the study incorporates narratives and ‘disruptions’ – unique engagements with Contemporary Art which facilitate understanding by enabling the temporary suspension of disbelief. The methodology is iterative, tacking between material and written sources in order to better understand the heterogeneous assemblages of early modern (counter-) witchcraft. Previously separate areas of discourse are (re-)constituted into alternative ontic categories of newly-parallel materials. New interpretations of things, places, bodies and personhoods emerge, raising questions about early modern experiences of the world. Three thematic chapters explore different sets of collaborative agencies as they entwine into new things, co-fabricating a very different world. Moving between witch trial accounts, healing wells, infant burial grounds, animals, discipline artefacts and charms, the boundaries of all prove highly permeable. People, cloth and place bleed into one another through contact; trees and water emerge as powerful agents of magical-place-making; and people and animals meet to become single, hybrid-persons spread over two bodies. Life and death consistently emerge as protracted processes with the capacity to overlap and occur simultaneously in problematic ways. The research presented in this thesis establishes a new way of looking at the nature of Being as experienced by early modern Scots. This provides a foundation for further studies, which can draw in other materials not explored here such as communion wares and metal charms. Comparison with other early modern Western societies may also prove fruitful. Furthermore, the methodology may be suitable for application to other interdisciplinary projects incorporating historical and material evidence

Imagining a Gold Open Access future: Attitudes, behaviors, and funding scenarios among authors of academic scholarship.

The viability of gold open access publishing models into the future will depend, in part, on the attitudes of authors toward open access (OA). In a survey of academics at four major research universities in North America, we examine academic authors’ opinions and behaviors toward gold OA. The study allows us to see what academics know and perceive about open access models, their current behavior in regard to publishing in OA, and possible future behavior. In particular, we gauge current attitudes to examine the perceived likelihood of various outcomes in an all-open access publishing scenario. We also survey how much authors at these types of universities would be willing to pay for article processing charges (APCs) from different sources. Although the loudest voices may often be heard, in reality there is a wide range of attitudes and behaviors toward publishing. Understanding the range of perceptions, opinions, and behaviors among academics toward gold OA is important for academic librarians who must examine how OA serves their research communities, to prepare for an OA future, and to understand how OA impacts the library’s role

Effect of Hesperidin with and without a Calcium (Calcilock®) Supplement on Bone Health in Postmenopausal Women

Context: Citrus fruits contain unique flavanones. One of the most abundant of the flavanones, hesperidin, has been shown to prevent bone loss in ovariectomized rats. Objective: The objective of the study was to measure the effect of hesperidin with or without calcium supplementation on bone calcium retention in postmenopausal women. Design: The study was a double-blind, placebo-controlled, randomized-order crossover design of 500 g hesperidin with or without 500 mg calcium supplement in 12 healthy postmenopausal women. Bone calcium retention was determined from urinary excretion of the rare isotope, 41Ca, from bone. Results: Calcium plus hesperidin, but not hesperidin alone, improved bone calcium retention by 5.5% (P < .04). Conclusion: Calcium supplementation (Calcilock), in combination with hesperidin, is effective at preserving bone in postmenopausal women. - See more at: http://press.endocrine.org/doi/10.1210/jc.2015-3767#sthash.ztalWWcv.dpu

An in vivo root hair assay for determining rates of apoptotic-like programmed cell death in plants

In Arabidopsis thaliana we demonstrate that dying root hairs provide an easy and rapid in vivo model for the morphological identification of apoptotic-like programmed cell death (AL-PCD) in plants. The model described here is transferable between species, can be used to investigate rates of AL-PCD in response to various treatments and to identify modulation of AL-PCD rates in mutant/transgenic plant lines facilitating rapid screening of mutant populations in order to identify genes involved in AL-PCD regulation

Adiposity, Cardiometabolic Risk, and Vitamin D Status: The Framingham Heart Study

OBJECTIVE: Because vitamin D deficiency is associated with a variety of chronic diseases, understanding the characteristics that promote vitamin D deficiency in otherwise healthy adults could have important clinical implications. Few studies relating vitamin D deficiency to obesity have included direct measures of adiposity. Furthermore, the degree to which vitamin D is associated with metabolic traits after adjusting for adiposity measures is unclear. RESEARCH DESIGN AND METHODS: We investigated the relations of serum 25-hydroxyvitamin D (25[OH]D) concentrations with indexes of cardiometabolic risk in 3,890 nondiabetic individuals; 1,882 had subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) volumes measured by multidetector computed tomography (CT). RESULTS: In multivariable-adjusted regression models, 25(OH)D was inversely associated with winter season, waist circumference, and serum insulin (P < 0.005 for all). In models further adjusted for CT measures, 25(OH)D was inversely related to SAT (−1.1 ng/ml per SD increment in SAT, P = 0.016) and VAT (−2.3 ng/ml per SD, P < 0.0001). The association of 25(OH)D with insulin resistance measures became nonsignificant after adjustment for VAT. Higher adiposity volumes were correlated with lower 25(OH)D across different categories of BMI, including in lean individuals (BMI <25 kg/m2). The prevalence of vitamin D deficiency (25[OH]D <20 ng/ml) was threefold higher in those with high SAT and high VAT than in those with low SAT and low VAT (P < 0.0001). CONCLUSIONS: Vitamin D status is strongly associated with variation in subcutaneous and especially visceral adiposity. The mechanisms by which adiposity promotes vitamin D deficiency warrant further study.National Institutes of Health's National Heart, Lung, and Blood Institute (N01-HC-25195, R01-DK-80739): American Heart Associatio

Changes over time in sexual and relationship functioning of people with multiple sclerosis

Relationship and sexual satisfaction among people with multiple sclerosis (MS) has received little research attention. This article reports on a longitudinal investigation of the impact of coping style and illness-related variables among people with MS and the general population on sexual and relationship functioning. Both men (n = 120) and women (n= 201) with MS and men (n = 79) and women (n = 160) from the general population participated in the study at two points in time, 6 months apart. People with MS experienced lower levels of sexual activity, sexual satisfaction, and relationship satisfaction and higher levels of sexual dysfunction. Generally speaking, the time 1 levels of the health and coping variables explained little of the variance in the time 2 sexual and relationship variables. However, sexual activity at time 1 contributed significant unique variance to relationship satisfaction at time 2 for MS men, and coping strategies at time I contributed to relationship satisfaction among general population women at time 2. Furthermore, for those respondents who had been diagnosed with MS for less than 7 years, levels of sexual activity at time 2 were predicted by levels of sexual and relationship satisfaction, as well as levels of sexual activity at time 1. These results suggest that strategies used to cope with illness may not play a major role in sexual and relationship satisfaction. However, an examination of these strategies over a longer time frame is needed