Biobehavioral Influences of Anxiety, Depression, and Hostility Symptoms on Health-Related Outcomes in Patients with Heart Failure

The incidence of heart failure (HF) has increased each year as more people are living longer with heart disease and other chronic conditions. Recently, there has been much interest in the psychological dimensions of HF and the influence psychological symptoms have on the health outcomes (e.g., self-care, rehospitalization, mortality and quality of life) of patients living with HF. Patients with HF frequently experience symptoms of anxiety, depression, and hostility that may be associated with poor health outcomes. The purpose of this dissertation was to examine how psychological variables influence health outcomes of patients with HF, how psychological variables change over time, and whether different trajectories of psychological variables are associated with health outcomes. The specific aims of this dissertation were to: (1) evaluate the psychometric properties of the Brief Symptom Inventory (BSI) Hostility subscale in patients with HF; (2) determine whether anxiety, depression, and hostility predict self-care behaviors in patients with HF; and (3) describe trajectories of anxiety and depressive symptoms among patients with HF at baseline and 3 and 12 months post-baseline, and explore whether these symptom trajectories predict 1-year cardiac event-free survival and physical health-related quality of life (P-HRQOL). Secondary analyses of longitudinal data from a large, multi-region registry representing the Midwest, Southwest, Southeast, Northwest and Northeast United States (Heart Failure Quality of Life Trialists Collaborative) were conducted. Data from three subsets of participants enrolled in the Collaborative with complete data on the variables of interest comprised the samples for the three studies in this dissertation. In the first study, a psychometric evaluation of the BSI Hostility subscale was conducted using data from 345 patients with HF. The subscale demonstrated adequate internal consistency reliability (Cronbach’s alpha = .77) and construct validity. In the second longitudinal study of 214 patients with HF, baseline anxiety, depression, and hostility did not predict self-care at 12 months; however, higher perceived social support predicted greater self-care. In the third study, baseline, 3-month, and 12-month data from 597 patients with HF were used to examine the association of anxiety and depression trajectories with one-year cardiac event-free survival and P-HRQOL in patients with HF. Distinct trajectories of anxiety and depression predicted mortality, hospital readmission, and P-HRQOL. The findings of these studies filled some gaps in our understanding regarding how anxiety, depression, and hostility influence health outcomes of patients with HF. The findings suggest how a measure of hostility may be improved to assess hostility in patients with HF and the importance of assessing psychological symptoms routinely in order to identify changes in these symptoms. Results showed that psychological variables did not predict self-care, a component of risk reduction in improving health outcomes among patients with HF, but that social support, an important psychosocial variable, was a strong predictor of self-care. Trajectories of psychological variables were significant predictors of health outcomes in patients with HF at 1-year follow-up. Implications include the importance of monitoring psychological symptoms over time. A better understanding of how psychological symptoms change is meaningful, as it affords clinicians the opportunity for timely interventions designed to reduce the risk of adverse events and improve health outcomes. Even though numerous studies exist which examine psychological symptoms and health outcomes in patients with HF, there are very few longitudinal studies investigating trajectories of psychological symptoms in this population. Subsequently, more research is needed to investigate psychological symptom trajectories and identify high risk groups. In addition, the design and testing of interventions aimed at reducing psychological symptoms is critical to improve health outcomes in patients with HF

International Infection Control Training Partnerships: Experiences from the Egypt-University of Louisville Collaboration

Background: Healthcare-associated infection (HAI) is a global challenge that represent opportunities for international collaboration. Both the United States and Egypt prioritize HAI reduction as activities of public health importance. These shared priorities provide a foundation for interactive education and training. Objective: In the fall 2018, The United States Agency for International Development (USAID) sought a US training site where a delegation of physicians and nurses from Egypt could receive experiential training regarding HAI and prevention. The objectives of this review are to: 1) outline the training components used for the US-Egypt collaboration held at the University of Louisville in Kentucky; 2) describe the immersive and experiential approaches used to promote interprofessional education in infection control; and 3) identify some of the successes and challenges of this cultural and practice collaboration. Methods: The course curriculum consisted of a 10-day agenda that provided classroom training, live simulation, role playing, and healthcare facility visits all supporting immersive and experiential learning. Evaluation methods were based upon Kirkpatrick’s Model and included individual self-assessments, daily course evaluations, a summative course evaluation, pre-and post-course testing, and action learning plans. Results: The Egyptian cohort consisted of twenty-six physicians and nurses representing twenty-six different healthcare facilities across the country. Participants rated the course highly but had a strong desire for more interactive experiences at the hospitals. Comparing pre- and post-course knowledge, overall knowledge improved in both the physician and nurse groups. Conclusions: Results from this collaboration demonstrate an ability to provide an organized infection prevention and control training course that reached the University of Louisville team goals and met the stated expectations of the course sponsors. Both the University of Louisville team and the Egyptian delegation indicated that a longer planning horizon would have been beneficial

Closing the gap between science and management of cold-water refuges in rivers and streams

Human activities and climate change threaten coldwater organisms in freshwater eco-systems by causing rivers and streams to warm, increasing the intensity and frequency of warm temperature events, and reducing thermal heterogeneity. Cold-water refuges are discrete patches of relatively cool water that are used by coldwater organisms for thermal relief and short-term survival. Globally, cohesive management approaches are needed that consider interlinked physical, biological, and social factors of cold-water refuges. We review current understanding of cold-water refuges, identify gaps between science and management, and evaluate policies aimed at protecting thermally sensitive species. Existing policies include designating cold-water habitats, restricting fishing during warm periods, and implementing threshold temperature standards or guidelines. However, these policies are rare and uncoordinated across spatial scales and often do not consider input from Indigenous peoples. We propose that cold-water refuges be managed as dis-tinct operational landscape units, which provide a social and ecological context that is relevant at the watershed scale. These operational landscape units provide the founda-tion for an integrated framework that links science and management by (1) mapping and characterizing cold-water refuges to prioritize management and conservation actions, (2) leveraging existing and new policies, (3) improving coordination across jurisdictions, and (4) implementing adaptive management practices across scales. Our findings show that while there are many opportunities for scientific advancement, the current state of the sciences is sufficient to inform policy and management. Our proposed framework pro-vides a path forward for managing and protecting cold-water refuges using existing and new policies to protect coldwater organisms in the face of global change. behavioral thermoregulation, climate change adaptation, lotic ecosystem management, refugia, salmonids, temperature, thermal heterogeneity, thermal refugespublishedVersio

Phenotypic spectrum and transcriptomic profile associated with germline variants in TRAF7

PURPOSE: Somatic variants in tumor necrosis factor receptor-associated factor 7 (TRAF7) cause meningioma, while germline variants have recently been identified in seven patients with developmental delay and cardiac, facial, and digital anomalies. We aimed to define the clinical and mutational spectrum associated with TRAF7 germline variants in a large series of patients, and to determine the molecular effects of the variants through transcriptomic analysis of patient fibroblasts. METHODS: We performed exome, targeted capture, and Sanger sequencing of patients with undiagnosed developmental disorders, in multiple independent diagnostic or research centers. Phenotypic and mutational comparisons were facilitated through data exchange platforms. Whole-transcriptome sequencing was performed on RNA from patient- and control-derived fibroblasts. RESULTS: We identified heterozygous missense variants in TRAF7 as the cause of a developmental delay-malformation syndrome in 45 patients. Major features include a recognizable facial gestalt (characterized in particular by blepharophimosis), short neck, pectus carinatum, digital deviations, and patent ductus arteriosus. Almost all variants occur in the WD40 repeats and most are recurrent. Several differentially expressed genes were identified in patient fibroblasts. CONCLUSION: We provide the first large-scale analysis of the clinical and mutational spectrum associated with the TRAF7 developmental syndrome, and we shed light on its molecular etiology through transcriptome studies

Closing the gap between science and management of cold‐water refuges in rivers and streams

Human activities and climate change threaten coldwater organisms in freshwater ecosystems by causing rivers and streams to warm, increasing the intensity and frequency of warm temperature events, and reducing thermal heterogeneity. Cold-water refuges are discrete patches of relatively cool water that are used by coldwater organisms for thermal relief and short-term survival. Globally, cohesive management approaches are needed that consider interlinked physical, biological, and social factors of cold-water refuges. We review current understanding of cold-water refuges, identify gaps between science and management, and evaluate policies aimed at protecting thermally sensitive species. Existing policies include designating cold-water habitats, restricting fishing during warm periods, and implementing threshold temperature standards or guidelines. However, these policies are rare and uncoordinated across spatial scales and often do not consider input from Indigenous peoples. We propose that cold-water refuges be managed as distinct operational landscape units, which provide a social and ecological context that is relevant at the watershed scale. These operational landscape units provide the foundation for an integrated framework that links science and management by (1) mapping and characterizing cold-water refuges to prioritize management and conservation actions, (2) leveraging existing and new policies, (3) improving coordination across jurisdictions, and (4) implementing adaptive management practices across scales. Our findings show that while there are many opportunities for scientific advancement, the current state of the sciences is sufficient to inform policy and management. Our proposed framework provides a path forward for managing and protecting cold-water refuges using existing and new policies to protect coldwater organisms in the face of global change

Search for Supersymmetry with Gauge-Mediated Breaking in Diphoton Events with Missing Transverse Energy at CDF II

accepted to Phys. Rev. LettWe present the results of a search for supersymmetry with gauge-mediated breaking and \NONE\to\gamma\Gravitino in the $\gamma\gamma$+missing transverse energy final state. In 2.6$\pm$0.2 \invfb of $p{\bar p}$ collisions at $\sqrt{s}$$=$1.96 TeV recorded by the CDF II detector we observe no candidate events, consistent with a standard model background expectation of 1.4$\pm$0.4 events. We set limits on the cross section at the 95% C.L. and place the world's best limit of 149\gevc on the \none mass at $\tau_{\tilde{\chi}_1^0}$$We present the results of a search for supersymmetry with gauge-mediated breaking and χ˜10→γG˜ in the γγ+missing transverse energy final state. In 2.6±0.2  fb-1 of pp̅ collisions at √s=1.96  TeV recorded by the CDF II detector we observe no candidate events, consistent with a standard model background expectation of 1.4±0.4 events. We set limits on the cross section at the 95% C.L. and place the world’s best limit of 149  GeV/c2 on the χ˜10 mass at τχ˜10≪1  ns. We also exclude regions in the χ˜10 mass-lifetime plane for τχ˜10≲2  ns.Peer reviewe

Measurements of branching fraction ratios and CP asymmetries in B+/- ->D_CP K+/- decays in hadron collisions

We reconstruct B+/- -> D K+/- decays in a data sample collected by the CDF II detector at the Tevatron collider corresponding to 1 fb-1 of integrated luminosity. We select decay modes where the D meson decays to either K- pi+ (flavor eigenstate) or K- K+, pi- pi+ (CP-even eigenstates), and measure the direct CP asymmetry A_CP+ = 0.39 +/- 0.17(stat) +/- 0.04(syst), and the double ratio of CP-even to flavor eigenstate branching fractions R_CP+ = 1.30 +/- 0.24(stat) +/- 0.12(syst). These measurements will improve the determination of the CKM angle gamma. They are performed here for the first time using data from hadron collisions.We reconstruct B±→DK± decays in a data sample collected by the CDF II detector at the Tevatron collider corresponding to 1  fb-1 of integrated luminosity. We select decay modes where the D meson decays to either K-π+ (flavor eigenstate) or K-K+, π-π+ (CP-even eigenstates), and measure the direct CP asymmetry ACP+=0.39±0.17(stat)±0.04(syst), and the double ratio of CP-even to flavor eigenstate branching fractions RCP+=1.30±0.24(stat)±0.12(syst). These measurements will improve the determination of the Cabibbo-Kobayashi-Maskawa angle γ. They are performed here for the first time using data from hadron collisions.Peer reviewe

Inclusive Search for Standard Model Higgs Boson Production in the WW Decay Channel using the CDF II Detector

We present a search for standard model (SM) Higgs boson production using ppbar collision data at sqrt(s) = 1.96 TeV, collected with the CDF II detector and corresponding to an integrated luminosity of 4.8 fb-1. We search for Higgs bosons produced in all processes with a significant production rate and decaying to two W bosons. We find no evidence for SM Higgs boson production and place upper limits at the 95% confidence level on the SM production cross section (sigma(H)) for values of the Higgs boson mass (m_H) in the range from 110 to 200 GeV. These limits are the most stringent for m_H > 130 GeV and are 1.29 above the predicted value of sigma(H) for mH = 165 GeV.We present a search for standard model (SM) Higgs boson production using pp̅ collision data at √s=1.96  TeV, collected with the CDF II detector and corresponding to an integrated luminosity of 4.8  fb-1. We search for Higgs bosons produced in all processes with a significant production rate and decaying to two W bosons. We find no evidence for SM Higgs boson production and place upper limits at the 95% confidence level on the SM production cross section (σH) for values of the Higgs boson mass (mH) in the range from 110 to 200 GeV. These limits are the most stringent for mH>130  GeV and are 1.29 above the predicted value of σH for mH=165  GeV.Peer reviewe

Measurement of the Lambda_b Lifetime in Lambda_b -> Lambda_c+ pi- Decays in p-pbar Collisions at sqrt(s) = 1.96 TeV

Submitted to Phys. Rev. LettWe report a measurement of the lifetime of the Lambda_b baryon in decays to the Lambda_C+ pi- final state in a sample corresponding to 1.1 fb^-1 collected in p-pbar collisions at sqrt(s) = 1.96 TeV by the CDF II detector at the Tevatron collider. Using a sample of about 3000 fully reconstructed Lambda_b events we measure tau(Lambda_b) = 1.401 +- 0.046 (stat) +- 0.035 (syst) ps (corresponding to c.tau(Lambda_b) = 420.1 +- 13.7 (stat) +- 10.6 (syst) um, where c is the speed of light). The ratio of this result and the world average B^0 lifetime yields tau(Lambda_b)/tau(B^0) = 0.918 +- 0.038 (stat and syst), in good agreement with recent theoretical predictions.We report a measurement of the lifetime of the Λb0 baryon in decays to the Λc+π- final state in a sample corresponding to 1.1  fb-1 collected in pp̅ collisions at √s=1.96  TeV by the CDF II detector at the Tevatron collider. Using a sample of about 3000 fully reconstructed Λb0 events we measure τ(Λb0)=1.401±0.046(stat)±0.035(syst)  ps (corresponding to cτ(Λb0)=420.1±13.7(stat)±10.6(syst)  μm, where c is the speed of light). The ratio of this result and the world average B0 lifetime yields τ(Λb0)/τ(B0)=0.918±0.038 (stat) and (syst), in good agreement with recent theoretical predictions.Peer reviewe

Measurement of the Top Quark Mass and ppbar -> ttbar Cross Section in the All-Hadronic Mode with the CDFII Detector

Submitted to Phys. Rev. DWe present a measurement of the top quark mass and of the top-antitop pair production cross section using p-pbar data collected with the CDFII detector at the Tevatron Collider at the Fermi National Accelerator Laboratory and corresponding to an integrated luminosity of 2.9 fb-1. We select events with six or more jets satisfying a number of kinematical requirements imposed by means of a neural network algorithm. At least one of these jets must originate from a b quark, as identified by the reconstruction of a secondary vertex inside the jet. The mass measurement is based on a likelihood fit incorporating reconstructed mass distributions representative of signal and background, where the absolute jet energy scale (JES) is measured simultaneously with the top quark mass. The measurement yields a value of 174.8 +- 2.4(stat+JES) ^{+1.2}_{-1.0}(syst) GeV/c^2, where the uncertainty from the absolute jet energy scale is evaluated together with the statistical uncertainty. The procedure measures also the amount of signal from which we derive a cross section, sigma_{ttbar} = 7.2 +- 0.5(stat) +- 1.0 (syst) +- 0.4 (lum) pb, for the measured values of top quark mass and JES.We present a measurement of the top quark mass and of the top-antitop (tt̅ ) pair production cross section using pp̅ data collected with the CDF II detector at the Tevatron Collider at the Fermi National Accelerator Laboratory and corresponding to an integrated luminosity of 2.9  fb-1. We select events with six or more jets satisfying a number of kinematical requirements imposed by means of a neural-network algorithm. At least one of these jets must originate from a b quark, as identified by the reconstruction of a secondary vertex inside the jet. The mass measurement is based on a likelihood fit incorporating reconstructed mass distributions representative of signal and background, where the absolute jet energy scale (JES) is measured simultaneously with the top quark mass. The measurement yields a value of 174.8±2.4(stat+JES)-1.0+1.2(syst)  GeV/c2, where the uncertainty from the absolute jet energy scale is evaluated together with the statistical uncertainty. The procedure also measures the amount of signal from which we derive a cross section, σtt̅ =7.2±0.5(stat)±1.0(syst)±0.4(lum)  pb, for the measured values of top quark mass and JES.Peer reviewe