Attention Deficit HyperactivityDisorder (ADHD): Survey Report

In the spring of 2016, the New Hampshire Pediatric Improvement Partnership (NHPIP) conducted an online survey of NH pediatric and family practice clinicians to understand practice patterns, comfort level, and support needs relative to caring for pediatric patients with Attention Deficit Hyperactivity Disorder (ADHD). Of the clinicians surveyed, 138 responded yielding a 13% response rate

Foot care education and self management behaviors in diverse veterans with diabetes

The objective of this study was to examine differences in self-reported diabetes foot care education, self management behaviors, and barriers to good foot care among veterans with diabetes by race and ethnicity. Data was collected using the Veterans Health Administration Footcare Survey, a validated tool that assessed demographic, general health, diabetes and foot self-care information, barriers to foot self-care, receipt of professional foot care, and satisfaction with current care. We mailed surveys to a random sample of patients with diabetes from eight VA medical centers. Study participants were 81% White; 13% African American; 4% Asian, and 2% American Indian and Pacific Islanders. The majority of respondents felt that they did not know enough about foot self-care. There were large gaps between self-reported knowledge and actual foot care practices, even among those who reported “knowing enough” on a given topic. There were significant differences in self-reported foot care behaviors and education by race and ethnicity. These findings document the need for culturally-specific self-management education to address unique cultural preferences and barriers to care

Determination of Background Uranium Concentration in the Snake River Plain Aquifer under the Idaho National Engineering and Environmental Laboratory's Radioactive Waste Management Complex

Uranium occurs naturally in the environment and is also a contaminant that is disposed of at the Radioactive Waste Management Complex (RWMC) at the Idaho National Engineering and Environmental Laboratory. To determine whether uranium concentrations in the Snake River Plain Aquifer, which underlies the laboratory, are elevated as a result of migration of anthropogenic uranium from the Subsurface Disposal Area in the RWMC, uranium background concentrations are necessary. Guideline values are calculated for total uranium, 234U, 235U, and 238U from analytical results from up to five datasets. Three of the datasets include results of samples analyzed using isotope dilution thermal ionization mass spectrometry (ID-TIMS) and two of the datasets include results obtained using alpha spectrometry. All samples included in the statistical testing were collected from aquifer monitoring wells located within 10 miles of the RWMC. Results from ID-TIMS and alpha spectrometry are combined when the data are not statistically different. Guideline values for total uranium were calculated using four of the datasets, while guideline values for 234U were calculated using only the alpha spectrometry results (2 datasets). Data from all five datasets were used to calculate 238U guideline values. No limit is calculated for 235U because the ID-TIMS results are not useful for comparison with routine monitoring data, and the alpha spectrometry results are too close to the detection limit to be deemed accurate or reliable for calculating a 235U guideline value. All guideline values presented represent the upper 95% coverage 95% confidence tolerance limits for background concentration. If a future monitoring result is above this guideline, then the exceedance will be noted in the quarterly monitoring report and assessed with respect to other aquifer information. The guidelines (tolerance limits) for total U, 234U, and 238U are 2.75 pCi/L, 1.92 pCi/L, and 0.90 pCi/L, respectively

Descriptive Characteristics and Risk Factors for Trauma: An Evidence-Based Practice Project

This Evidence-Based Practice (EBP) project examined the following question: What are the perspectives, experiences, and self-reports of adult individuals, groups, or populations who have MCI or report problems with Functional Cognition (and / or their caregivers)

Practice Considerations for Adapting In-Person Groups to Telerehabilitation

The Coronavirus-2019 (COVID-19) pandemic has shifted research and healthcare system priorities, stimulating literature on implementation and evaluation of telerehabilitation for a variety of patient populations. While there is substantial literature on individual telerehabilitation, evidence about group telerehabilitation remains limited despite its increasing use by rehabilitation providers. Therefore, the purpose of this manuscript is to describe our expert team’s consensus on practice considerations for adapting in-person group rehabilitation to group telerehabilitation to provide rapid guidance during a pandemic and create a foundation for sustainability of group telerehabilitation beyond the pandemic’s end. &nbsp

Physiological and behavioral effects of animal-assisted interventions for therapy dogs in pediatric oncology settings

Over the past two decades, animal-assisted interventions (AAIs), defined as the purposeful incorporation of specially trained animals in services to improve human health, have become increasingly popular in clinical settings. However, to date, there have been few rigorously-designed studies aimed at examining the impact of AAIs on therapy animals, despite a notable potential for stress. The current study measured physiological and behavioral stress indicators in therapy dogs who participated in AAI sessions in pediatric oncology settings, while also examining the psychosocial effects for patients and their parents. This manuscript describes the study’s canine stress findings. Methods: A total of 26 therapy dog-handler teams were paired with newly diagnosed children with cancer at five children’s hospitals in the United States. These teams provided regular AAI visits to the child and his/her parent(s) for a period of four months. The teams completed a demographic form, the Canine Behavioral Assessment & Research Questionnaire (C-BARQ), and a self-report survey to document the types of activities that occurred during each session. Canine saliva was also collected at five baseline time points and 20 minutes after the start of study sessions for cortisol analysis, and all study sessions were video recorded to document the dog’s behavior via an ethogram measure. Results: Data showed no significant differences in salivary cortisol levels between baseline (0.51µg/dL) and AAI sessions (0.44µg/dL), p = 0.757. Higher salivary cortisol was significantly associated with a higher number of stress behaviors per session (p = 0.039). There was a significant relationship between stress and affiliative session behaviors (pConclusions:Results show that therapy dogs did not have significantly increased physiological stress responses, nor did they exhibit significantly more stress-related behaviors than affiliative-related behaviors, while participating in AAIs in pediatric oncology settings. The significant relationship between canine cortisol and behavior, thus strengthening the argument for the use of cortisol in canine well-being research. This study discusses the importance of further investigation to confirm these findings, which may lead to enhanced canine involvement in hospital settings

Assessment of brain age in posttraumatic stress disorder: Findings from the ENIGMA PTSD and brain age working groups

Background: Posttraumatic stress disorder (PTSD) is associated with markers of accelerated aging. Estimates of brain age, compared to chronological age, may clarify the effects of PTSD on the brain and may inform treatment approaches targeting the neurobiology of aging in the context of PTSD. Method: Adult subjects (N = 2229; 56.2% male) aged 18–69 years (mean = 35.6, SD = 11.0) from 21 ENIGMA-PGC PTSD sites underwent T1-weighted brain structural magnetic resonance imaging, and PTSD assessment (PTSD+, n = 884). Previously trained voxel-wise (brainageR) and region-of-interest (BARACUS and PHOTON) machine learning pipelines were compared in a subset of control subjects (n = 386). Linear mixed effects models were conducted in the full sample (those with and without PTSD) to examine the effect of PTSD on brain predicted age difference (brain PAD; brain age − chronological age) controlling for chronological age, sex, and scan site. Results: BrainageR most accurately predicted brain age in a subset (n = 386) of controls (brainageR: ICC = 0.71, R = 0.72, MAE = 5.68; PHOTON: ICC = 0.61, R = 0.62, MAE = 6.37; BARACUS: ICC = 0.47, R = 0.64, MAE = 8.80). Using brainageR, a three-way interaction revealed that young males with PTSD exhibited higher brain PAD relative to male controls in young and old age groups; old males with PTSD exhibited lower brain PAD compared to male controls of all ages. Discussion: Differential impact of PTSD on brain PAD in younger versus older males may indicate a critical window when PTSD impacts brain aging, followed by age-related brain changes that are consonant with individuals without PTSD. Future longitudinal research is warranted to understand how PTSD impacts brain aging across the lifespan

Neural primacy of the salience processing system in schizophrenia

For effective information processing, two large-scale distributed neural networks appear to be critical: a multimodal executive system anchored on the dorsolateral prefrontal cortex (DLPFC) and a salience system anchored on the anterior insula. Aberrant interaction among distributed networks is a feature of psychiatric disorders such as schizophrenia. We used whole-brain Granger causal modeling using resting fMRI and observed a significant failure of both the feedforward and reciprocal influence between the insula and the DLPFC in schizophrenia. Further, a significant failure of directed influence from bilateral visual cortices to the insula was also seen in patients. These findings provide compelling evidence for a breakdown of the salience-execution loop in the clinical expression of psychosis. In addition, this offers a parsimonious explanation for the often-observed “frontal inefficiency,” the failure to recruit prefrontal system when salient or novel information becomes available in patients with schizophrenia