Nature Is The Best Medicine

This project examined the cost of mental health diagnosis on the health care system and how interactions with green space and nature increase mental health wellbeing. A Vermont state government program to increase access to state parks through primary care providers offices is highlighted. Interviews were conducted with a community psychologist discussing interaction with nature and its effects on mental health. The second interview was with a member of the volunteer board for the Governors council on fitness discussing the origins of the state park program.https://scholarworks.uvm.edu/fmclerk/1912/thumbnail.jp

What Makes Negotiators Happy? The Differential Effects of Internal and External Social Comparisons on Negotiator Satisfaction

This paper examines the role of internal and external social comparisons in negotiator satisfaction. Internal comparisons involve another party to the negotiation (e.g., buyer compared to seller), while external comparisons focus on someone outside of the negotiation (e.g., buyer compared to other buyers). Negotiator satisfaction can influence a range of post-negotiation behavior, but relatively little is known about what makes negotiators more or less satisfied. In many contexts negotiators receive little objective feedback and lack benchmarks against which to judge their outcome. Prior work has modeled negotiator satisfaction as a function of utility maximization, expectancy disconfirmation, and internal social comparisons (social utility). In this paper we identify another particularly important driver of negotiator satisfaction, external social comparisons. Across five studies we demonstrate that external social comparisons affect satisfaction and that the effects of external social comparisons are qualitatively different from those of internal social comparisons. In particular, we find that downward external social comparisons increase satisfaction, while downward internal social comparisons decrease satisfaction. These results inform important prescriptions, and we discuss implications of these results for managing negotiator satisfaction

Jet Diffusion versus JetGPT -- Modern Networks for the LHC

We introduce two diffusion models and an autoregressive transformer for LHC physics simulations. Bayesian versions allow us to control the networks and capture training uncertainties. After illustrating their different density estimation methods for simple toy models, we discuss their advantages for Z plus jets event generation. While diffusion networks excel through their precision, the transformer scales best with the phase space dimensionality. Given the different training and evaluation speed, we expect LHC physics to benefit from dedicated use cases for normalizing flows, diffusion models, and autoregressive transformers.Comment: 37 pages, 17 figure

Health Benefits Are Associated With Employment Status For People With Intellectual Disabilities

Recent studies demonstrate that people with developmental disabilities are at increased risk for preventable illnesses. In our study, we examined several variables suspected to be major contributing factors, with emphasis on job security and employment. The development of sheltered workshops was initially an attempt to promote employment opportunities for people with intellectual and developmental disabilities (IDD), though at subminimum wages. We explored whether these workshops allow for adequate community and healthcare engagement that is necessary for overall health and wellbeing. We designed a study that allowed us to statistically compare health-related data among states that eliminated sheltered workshops with those continuing this practice. These results were compared with internally available data (N=79) at Champlain Community Services (CCS), a specialized employment organization in Vermont serving people with IDD. We quantified health outcomes based on Medicaid standards which include annual wellness visits with a PCP, annual dental visits, and ensuring individuals are up to date on vaccinations. Additionally, we quantified other predictors for general wellbeing including current smoking status and body mass index (BMI). The results of our study indicated that people with IDD from states that have eliminated sheltered workshops tend to have better health outcomes with notable exemplary outcomes in consumers involved with CCS. We anticipate the results of this study will assist organizations, such as CCS, by articulating the impact of sheltered workshops on people living with IDD and receiving subminimum wage.https://scholarworks.uvm.edu/comphp_gallery/1309/thumbnail.jp

Sleep apnea predicts distinct alterations in glucose homeostasis and biomarkers in obese adults with normal and impaired glucose metabolism

<p>Abstract</p> <p>Background</p> <p>Notwithstanding previous studies supporting independent associations between obstructive sleep apnea (OSA) and prevalence of diabetes, the underlying pathogenesis of impaired glucose regulation in OSA remains unclear. We explored mechanisms linking OSA with prediabetes/diabetes and associated biomarker profiles. We hypothesized that OSA is associated with distinct alterations in glucose homeostasis and biomarker profiles in subjects with normal (NGM) and impaired glucose metabolism (IGM).</p> <p>Methods</p> <p>Forty-five severely obese adults (36 women) without certain comorbidities/medications underwent anthropometric measurements, polysomnography, and blood tests. We measured fasting serum glucose, insulin, selected cytokines, and calculated homeostasis model assessment estimates of insulin sensitivity (HOMA-IS) and pancreatic beta-cell function (HOMA-B).</p> <p>Results</p> <p>Both increases in apnea-hypopnea index (AHI) and the presence of prediabetes/diabetes were associated with reductions in HOMA-IS in the entire cohort even after adjustment for sex, race, age, and BMI (<it>P </it>= 0.003). In subjects with NGM (n = 30), OSA severity was associated with significantly increased HOMA-B (a trend towards decreased HOMA-IS) independent of sex and adiposity. OSA-related oxyhemoglobin desaturations correlated with TNF-α (r=-0.76; <it>P </it>= 0.001) in women with NGM and with IL-6 (rho=-0.55; <it>P </it>= 0.035) in women with IGM (n = 15) matched individually for age, adiposity, and AHI.</p> <p>Conclusions</p> <p>OSA is independently associated with altered glucose homeostasis and increased basal beta-cell function in severely obese adults with NGM. The findings suggest that moderate to severe OSA imposes an excessive functional demand on pancreatic beta-cells, which may lead to their exhaustion and impaired secretory capacity over time. The two distinct biomarker profiles linking sleep apnea with NGM and IGM via TNF-α and IL-6 have been discerned in our study to suggest that sleep apnea and particularly nocturnal oxyhemoglobin desaturations are associated with chronic metabolic fluxes and specific cytokine stressors that reflect links between sleep apnea and glucose metabolism. The study may help illuminate potential mechanisms for glucose dysregulation in OSA, and resolve some controversy over the associations of OSA with TNF-α and IL-6 in previous studies.</p

Aims and challenges of building national trainee networks in clinical microbiology and infectious disease disciplines

Trainees represent the medical practice of tomorrow. Interactions and collaborations at the early stage in career will strengthen the future of our specialties, clinical microbiology and infectious diseases. Trainee networks at the national level help access the best education and career opportunities. The aim of this collaborative white paper between the Trainee Association of European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and four national trainee networks is to discuss the motivation for building such networks and offer guidance for their creation and sustainability even during a health crisis.Publisher PDFPeer reviewe

Ecosystem Consequences of Plant Genetic Divergence with Colonization of New Habitat

When plants colonize new habitats altered by natural or anthropogenic disturbances, those individuals may encounter biotic and abiotic conditions novel to the species, which can cause plant functional trait divergence. Over time, site-driven adaptation can give rise to population-level genetic variation, with consequences for plant community dynamics and ecosystem processes. We used a series of 3000-yr-old, lava-created forest fragments on the Island of Hawai`i to examine whether disturbance and subsequent colonization can lead to genetically differentiated populations, and where differentiation occurs, if there are ecosystem consequences of trait-driven changes. These fragments are dominated by a single tree species, Metrosideros polymorpha (Myrtaceae) or ʻohiʻa, which have been actively colonizing the surrounding lava flow created in 1858. To test our ideas about differentiation of genetically determined traits, we (1) created rooted cuttings of ʻohiʻa individuals sampled from fragment interiors and open lava sites, raised these individuals in a greenhouse, and then used these cuttings to create a common garden where plant growth was monitored for three years; and (2) assessed genetic variation and made QST/FST comparisons using microsatellite repeat markers. Results from the greenhouse showed quantitative trait divergence in plant height and pubescence across plants sampled from fragment interior and matrix sites. Results from the subsequent common garden study confirmed that the matrix environment can select for individuals with 9.1% less shoot production and 17.3% higher leaf pubescence. We found no difference in molecular genetic variation indicating gene flow among the populations. The strongest QST level was greater than the FST estimate, indicating sympatric genetic divergence in growth traits. Tree height was correlated with ecosystem properties such as soil carbon and nitrogen storage, soil carbon turnover rates, and soil phosphatase activity, indicating that selection for growth traits will influence structure, function, and dynamics of developing ecosystems. These data show that divergence can occur on centennial timescales of early colonization

The value of episodic, intensive blood glucose monitoring in non-insulin treated persons with type 2 diabetes: Design of the Structured Testing Program (STeP) Study, a cluster-randomised, clinical trial [NCT00674986]

<p>Abstract</p> <p>Background</p> <p>The value and utility of self-monitoring of blood glucose (SMBG) in non-insulin treated T2DM has yet to be clearly determined. Findings from studies in this population have been inconsistent, due mainly to design differences and limitations, including the prescribed frequency and timing of SMBG, role of the patient and physician in responding to SMBG results, inclusion criteria that may contribute to untoward floor effects, subject compliance, and cross-arm contamination. We have designed an SMBG intervention study that attempts to address these issues.</p> <p>Methods/design</p> <p>The Structured Testing Program (STeP) study is a 12-month, cluster-randomised, multi-centre clinical trial to evaluate whether poorly controlled (HbA1c ≥ 7.5%), non-insulin treated T2DM patients will benefit from a comprehensive, integrated physician/patient intervention using structured SMBG in US primary care practices. Thirty-four practices will be recruited and randomly assigned to an active control group (ACG) that receives enhanced usual care or to an enhanced usual care group plus structured SMBG (STG). A total of 504 patients will be enrolled; eligible patients at each site will be randomly selected using a defined protocol. Anticipated attrition of 20% will yield a sample size of at least 204 per arm, which will provide a 90% power to detect a difference of at least 0.5% in change from baseline in HbA1c values, assuming a common standard deviation of 1.5%. Differences in timing and degree of treatment intensification, cost effectiveness, and changes in patient self-management behaviours, mood, and quality of life (QOL) over time will also be assessed. Analysis of change in HbA1c and other dependent variables over time will be performed using both intent-to-treat and per protocol analyses. Trial results will be available in 2010.</p> <p>Discussion</p> <p>The intervention and trial design builds upon previous research by emphasizing appropriate and collaborative use of SMBG by both patients and physicians. Utilization of per protocol and intent-to-treat analyses facilitates a comprehensive assessment of the intervention. Use of practice site cluster-randomisation reduces the potential for intervention contamination, and inclusion criteria (HbA1c ≥ 7.5%) reduces the possibility of floor effects. Inclusion of multiple dependent variables allows us to assess the broader impact of the intervention, including changes in patient and physician attitudes and behaviours.</p> <p>Trial Registration</p> <p>Current Controlled Trials NCT00674986.</p