Diagnostic Accuracy and Acceptability of the Primary Care Posttraumatic Stress Disorder Screen for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) among US Veterans

Importance: Posttraumatic stress disorder (PTSD) is a serious mental health disorder that can be effectively treated with empirically based practices. PTSD screening is essential for identifying undetected cases and providing patients with appropriate care. Objective: To determine whether the Primary Care PTSD screen for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PC-PTSD-5) is a diagnostically accurate and acceptable measure for use in Veterans Affairs (VA) primary care clinics. Design, Setting, and Participants: This cross-sectional, diagnostic accuracy study enrolled participants from May 19, 2017, to September 26, 2018. Participants were recruited from primary care clinics across 2 VA Medical Centers. Session 1 was conducted in person, and session 2 was completed within 30 days via telephone. A consecutive sample of 1594 veterans, aged 18 years or older, who were scheduled for a primary care visit was recruited. Data analysis was performed from March 2019 to August 2020. Exposures: In session 1, participants completed a battery of questionnaires. In session 2, a research assistant administered the PC-PTSD-5 to participants, and then a clinician assessor blind to PC-PTSD-5 results conducted a structured diagnostic interview for PTSD. Main Outcomes and Measures: The range of PC-PTSD-5 cut points overall and across gender was assessed, and diagnostic performance was evaluated by calculating weighted κ values. Results: In total, 495 of 1594 veterans (31%) participated, and 396 completed all measures and were included in the analyses. Participants were demographically similar to the VA primary care population (mean [SD] age, 61.4 [15.5] years; age range, 21-93 years) and were predominantly male (333 participants [84.1%]) and White (296 of 394 participants [75.1%]). The PC-PTSD-5 had high levels of diagnostic accuracy for the overall sample (area under the receiver operating characteristic curve [AUC], 0.927; 95% CI, 0.896-0.959), men (AUC, 0.932; 95% CI, 0.894-0.969), and women (AUC, 0.899, 95% CI, 0.824-0.974). A cut point of 4 ideally balanced false negatives and false positives for the overall sample and for men. However, for women, this cut point resulted in high numbers of false negatives (6 veterans [33.3%]). A cut point of 3 fit better for women, despite increasing the number of false positives. Participants rated the PC-PTSD-5 as highly acceptable. Conclusions and Relevance: The PC-PTSD-5 is an accurate and acceptable screening tool for use in VA primary care settings. Because performance parameters will change according to sample, clinicians should consider sample characteristics and screening purposes when selecting a cut point

The soil and plant biogeochemistry sampling design for The National Ecological Observatory Network

Human impacts on biogeochemical cycles are evident around the world, from changes to forest structure and function due to atmospheric deposition, to eutrophication of surface waters from agricultural effluent, and increasing concentrations of carbon dioxide (CO2) in the atmosphere. The National Ecological Observatory Network (NEON) will contribute to understanding human effects on biogeochemical cycles from local to continental scales. The broad NEON biogeochemistry measurement design focuses on measuring atmospheric deposition of reactive mineral compounds and CO2 fluxes, ecosystem carbon (C) and nutrient stocks, and surface water chemistry across 20 eco‐climatic domains within the United States for 30 yr. Herein, we present the rationale and plan for the ground‐based measurements of C and nutrients in soils and plants based on overarching or “high‐level” requirements agreed upon by the National Science Foundation and NEON. The resulting design incorporates early recommendations by expert review teams, as well as recent input from the larger natural sciences community that went into the formation and interpretation of the requirements, respectively. NEON\u27s efforts will focus on a suite of data streams that will enable end‐users to study and predict changes to biogeochemical cycling and transfers within and across air, land, and water systems at regional to continental scales. At each NEON site, there will be an initial, one‐time effort to survey soil properties to 1 m (including soil texture, bulk density, pH, baseline chemistry) and vegetation community structure and diversity. A sampling program will follow, focused on capturing long‐term trends in soil C, nitrogen (N), and sulfur stocks, isotopic composition (of C and N), soil N transformation rates, phosphorus pools, and plant tissue chemistry and isotopic composition (of C and N). To this end, NEON will conduct extensive measurements of soils and plants within stratified random plots distributed across each site. The resulting data will be a new resource for members of the scientific community interested in addressing questions about long‐term changes in continental‐scale biogeochemical cycles, and is predicted to inspire further process‐based research

“New” cyanobacterial blooms are not new: two centuries of lake production are related to ice cover and land use

Recent cyanobacterial blooms in otherwise unproductive lakes may be warning signs of impending eutrophication in lakes important for recreation and drinking water, but little is known of their historical precedence or mechanisms of regulation. Here, we examined long-term sedimentary records of both general and taxon-specific trophic proxies from seven lakes of varying productivity in the northeastern United States to investigate their relationship to historical in-lake, watershed, and climatic drivers of trophic status. Analysis of fossil pigments (carotenoids and chlorophylls) revealed variable patterns of past primary production across lakes over two centuries despite broadly similar changes in regional climate and land use. Sediment abundance of the cyanobacterium Gloeotrichia, a large, toxic, nitrogen-fixing taxon common in recent blooms in this region, revealed that this was not a new taxon in the phytoplankton communities but rather had been present for centuries. Histories of Gloeotrichia abundance differed strikingly across lakes and were not consistently associated with most other sediment proxies of trophic status. Changes in ice cover most often coincided with changes in fossil pigments, and changes in watershed land use were often related to changes in Gloeotrichia abundance, although no single climatic or land-use factor was associated with proxy changes across all seven lakes. The degree to which changes in lake sediment records co-occurred with changes in the timing of ice-out or agricultural land use was negatively correlated with the ratio of watershed area to lake area. Thus, both climate and land management appeared to play key roles in regulation of primary production in these lakes, although the manner in which these factors influenced lakes was mediated by catchment morphometry. Improved understanding of the past interactions between climate change, land use, landscape setting, and water quality underscores the complexity of mechanisms regulating lake and cyanobacterial production and highlights the necessity of considering these interactions—rather than searching for a singular mechanism—when evaluating the causes of ongoing changes in low-nutrient lakes

A Global lake ecological observatory network (GLEON) for synthesising high-frequency sensor data for validation of deterministic ecological models

A Global Lake Ecological Observatory Network (GLEON; www.gleon.org) has formed to provide a coordinated response to the need for scientific understanding of lake processes, utilising technological advances available from autonomous sensors. The organisation embraces a grassroots approach to engage researchers from varying disciplines, sites spanning geographic and ecological gradients, and novel sensor and cyberinfrastructure to synthesise high-frequency lake data at scales ranging from local to global. The high-frequency data provide a platform to rigorously validate processbased ecological models because model simulation time steps are better aligned with sensor measurements than with lower-frequency, manual samples. Two case studies from Trout Bog, Wisconsin, USA, and Lake Rotoehu, North Island, New Zealand, are presented to demonstrate that in the past, ecological model outputs (e.g., temperature, chlorophyll) have been relatively poorly validated based on a limited number of directly comparable measurements, both in time and space. The case studies demonstrate some of the difficulties of mapping sensor measurements directly to model state variable outputs as well as the opportunities to use deviations between sensor measurements and model simulations to better inform process understanding. Well-validated ecological models provide a mechanism to extrapolate high-frequency sensor data in space and time, thereby potentially creating a fully 3-dimensional simulation of key variables of interest

The Role of Disgust in Posttraumatic Stress: A Critical Review of the Empirical Literature

The current review provides a detailed analysis of the burgeoning literature examining the role of disgust in understanding posttraumatic stress symptomatology. Research in this area generally converges to suggest (1) posttraumatic stress is associated with the experience of elevated disgust, (2) individual differences in disgust vulnerabilities may relate to increased posttraumatic stress symptom levels, (3) retrospective report of peritraumatic disgust is related to posttraumatic stress symptom levels, and (4) posttraumatic stress symptom levels appear to be associated with increased disgust, including in response to traumatic event cues. Importantly, much of this research suggests observed relations between disgust and posttraumatic stress are at least somewhat unique from relations between fear/anxiety and posttraumatic stress. Future research is now needed to identify mechanisms involved in these relations in order to inform the prevention and treatment of disgust-related posttraumatic stress disorder

Field Epidemiology and Laboratory Training Programs in sub-Saharan Africa from 2004 to 2010: need, the process, and prospects

As of 2010 sub-Saharan Africa had approximately 865 million inhabitants living with numerous public health challenges. Several public health initiatives [e.g., the United States (US) President’s Emergency Plan for AIDS Relief and the US President’s Malaria Initiative] have been very successful at reducing mortality from priority diseases. A competently trained public health workforce that can operate multi-disease surveillance and response systems is necessary to build upon and sustain these successes and to address other public health problems. Sub-Saharan Africa appears to have weathered the recent global economic downturn remarkably well and its increasing middle class may soon demand stronger public health systems to protect communities. The Epidemic Intelligence Service (EIS) program of the US Centers for Disease Control and Prevention (CDC) has been the backbone of public health surveillance and response in the US during its 60 years of existence. EIS has been adapted internationally to create the Field Epidemiology Training Program (FETP) in several countries. In the 1990s CDC and the Rockefeller Foundation collaborated with the Uganda and Zimbabwe ministries of health and local universities to create 2-year Public Health Schools Without Walls (PHSWOWs) which were based on the FETP model. In 2004 the FETP model was further adapted to create the Field Epidemiology and Laboratory Training Program (FELTP) in Kenya to conduct joint competencybased training for field epidemiologists and public health laboratory scientists providing a master’s degree to participants upon completion. The FELTP model has been implemented in several additional countries in sub-Saharan Africa. By the end of 2010 these 10 FELTPs and two PHSWOWs covered 613 million of the 865 million people in sub-Saharan Africa and had enrolled 743 public health professionals. We describe the process that we used to develop 10 FELTPs covering 15 countries in sub-Saharan Africa from 2004 to 2010 as a strategy to develop a locally trained public health workforce that can operate multi-disease surveillance and response systems.Key words: Field epidemiology, laboratory management, multi-disease surveillance and response systems, public health workforce capacity buildin