Efficacy of Cognitive and Metacognitive Interventions on Executive Functioning Post Traumatic Brain Injury to Enhance Occupational Performance

Cognitive rehabilitation (CR) is proposed as an effective intervention for individuals post Traumatic Brain Injury (TBI), by addressing cognitive function through remediating skills and practicing new compensatory skills. While there is considerable research, including systematic reviews that explore cognitive interventions post TBI, more research is needed in which occupational performance is the primary outcome of cognitive intervention. This current systematic review aims to synthesize the current body of evidence available on how using CR techniques to address executive functioning impact occupational performance in individuals who sustained a mild or moderate TBI

Data constraints on glacial Atlantic Water mass geometry and properties

© The Author(s), 2018. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Paleoceanography and Paleoclimatology 33 (2018): 1013-1034, doi:10.1029/2018PA003408.The chemical composition of benthic foraminifera from marine sediment cores provides information on how glacial subsurface water properties differed from modern, but separating the influence of changes in the origin and end‐member properties of subsurface water from changes in flows and mixing is challenging. Spatial gaps in coverage of glacial data add to the uncertainty. Here we present new data from cores collected from the Demerara Rise in the western tropical North Atlantic, including cores from the modern tropical phosphate maximum at Antarctic Intermediate Water (AAIW) depths. The results suggest lower phosphate concentration and higher carbonate saturation state within the phosphate maximum than modern despite similar carbon isotope values, consistent with less accumulation of respired nutrients and carbon, and reduced air‐sea gas exchange in source waters to the region. An inversion of new and published glacial data confirms these inferences and further suggests that lower preformed nutrients in AAIW, and partial replacement of this still relatively high‐nutrient AAIW with nutrient‐depleted, carbonate‐rich waters sourced from the region of the modern‐day northern subtropics, also contributed to the observed changes. The results suggest that glacial preformed and remineralized phosphate were lower throughout the upper Atlantic, but deep phosphate concentration was higher. The inversion, which relies on the fidelity of the paleoceanographic data, suggests that the partial replacement of North Atlantic sourced deep water by Southern Ocean Water was largely responsible for the apparent deep North Atlantic phosphate increase, rather than greater remineralization.National Science Foundation (NSF) Grant Numbers: OCE‐0750880, OCE‐1335191, OCE‐1558341, OCE‐1536380; Woods Hole Oceanographic Institution (WHOI) Grant Numbers: 27007592, 2700080

Prevalence of sexual harassment among Norwegian female elite athletes in relation to sport type

Although it is often assumed that the prevalence of sexual harassment is different in different sports, this assumption has not been empirically tested. This study considers whether the experience of sexual harassment varies by sport. The female elite athletes (N = 553) in the study participated in 56 different sport disciplines. These were grouped as follows :1) team or individual sports; 2) extent to which clothing required for competition is revealing ; 3) gender structure (male-or female dominated membership statistics); and 4) gender culture (masculine, gender-neutral, or feminine). The data show that sexual harassment occurs in every sport group. Female elite athletes who participated in ‘masculine’ sports appear to experience more harassment than women in the other groups. We conclude that, when it comes to female athletes’ experiences of sexual harassment, sport type matters far less than sport participation per se

Medication intensification in diabetes in rural primary care: a cluster-randomised effectiveness trial

OBJECTIVE: To determine the effectiveness of a provider-based intervention to improve medication intensification among patients with diabetes. DESIGN: Effectiveness cluster-randomised trial. Baseline and follow-up cross-sections of diabetes physicians\u27 patients. SETTING: Eleven U.S. Southeastern states, 2006-2008. PARTICIPANTS: 205 Rural primary care physicians, 95 completed the study. INTERVENTION: Multicomponent interactive intervention including web-based continuing medical education (CME), performance feedback and quality improvement tools. PRIMARY OUTCOME MEASURES: Medication intensification, a dose increase of an existing medication or the addition of a new class of medication for glucose, blood pressure and lipids control on any of the three most recent office visits. RESULTS: Of 364 physicians attempting to register, 102 were randomised to the intervention and 103 to the control arms; 95 physicians (intervention, n=48; control, n=47) provided data on their 1182 of their patients at baseline (intervention, n=715; control, n=467) and 945 patients at follow-up (intervention, n=479; control, n=466). For A1c control, medication intensification increased in both groups (intervention, pre 26.4% vs post 32.6%, p=0.022; control, pre 24.8% vs post 31.1%, p=0.033) (intervention, adjusted OR (AOR) 1.37; 95% CI 1.06 to 1.76; control, AOR 1.41 (95% CI 1.06 to 1.89)); however, we observed no incremental benefit solely due to the intervention (group-by-time interaction, p=0.948). Among patients with the worst glucose control (A1c \u3e9%), intensification increased in both groups (intervention, pre 34.8% vs post 62.5%, p=0.002; control, pre 35.7% vs post 61.4%, p=0.008). CONCLUSIONS: A wide-reach, low-intensity, web-based interactive multicomponent intervention had no significant incremental effect on medication intensification for control of glucose, blood pressure or lipids for patients with diabetes of physicians practising in the rural Southeastern USA. TRIAL REGISTRATION: NCT00403091

Policy Coherence in US Tobacco Control: Beyond FDA Regulation

Joshua Yang and Thomas Novotny explore whether the US government can develop and implement a coherent policy agenda to reduce tobacco-related morbidity and mortality

Prospects for progress on health inequalities in England in the post-primary care trust era : professional views on challenges, risks and opportunities

Background - Addressing health inequalities remains a prominent policy objective of the current UK government, but current NHS reforms involve a significant shift in roles and responsibilities. Clinicians are now placed at the heart of healthcare commissioning through which significant inequalities in access, uptake and impact of healthcare services must be addressed. Questions arise as to whether these new arrangements will help or hinder progress on health inequalities. This paper explores the perspectives of experienced healthcare professionals working within the commissioning arena; many of whom are likely to remain key actors in this unfolding scenario. Methods - Semi-structured interviews were conducted with 42 professionals involved with health and social care commissioning at national and local levels. These included representatives from the Department of Health, Primary Care Trusts, Strategic Health Authorities, Local Authorities, and third sector organisations. Results - In general, respondents lamented the lack of progress on health inequalities during the PCT commissioning era, where strong policy had not resulted in measurable improvements. However, there was concern that GP-led commissioning will fare little better, particularly in a time of reduced spending. Specific concerns centred on: reduced commitment to a health inequalities agenda; inadequate skills and loss of expertise; and weakened partnership working and engagement. There were more mixed opinions as to whether GP commissioners would be better able than their predecessors to challenge large provider trusts and shift spend towards prevention and early intervention, and whether GPs’ clinical experience would support commissioning action on inequalities. Though largely pessimistic, respondents highlighted some opportunities, including the potential for greater accountability of healthcare commissioners to the public and more influential needs assessments via emergent Health & Wellbeing Boards. Conclusions - There is doubt about the ability of GP commissioners to take clearer action on health inequalities than PCTs have historically achieved. Key actors expect the contribution from commissioning to address health inequalities to become even more piecemeal in the new arrangements, as it will be dependent upon the interest and agency of particular individuals within the new commissioning groups to engage and influence a wider range of stakeholders.</p

Transiting Exoplanet Studies and Community Targets for JWST's Early Release Science Program

The James Webb Space Telescope will revolutionize transiting exoplanet atmospheric science due to its capability for continuous, long-duration observations and its larger collecting area, spectral coverage, and spectral resolution compared to existing space-based facilities. However, it is unclear precisely how well JWST will perform and which of its myriad instruments and observing modes will be best suited for transiting exoplanet studies. In this article, we describe a prefatory JWST Early Release Science (ERS) program that focuses on testing specific observing modes to quickly give the community the data and experience it needs to plan more efficient and successful future transiting exoplanet characterization programs. We propose a multi-pronged approach wherein one aspect of the program focuses on observing transits of a single target with all of the recommended observing modes to identify and understand potential systematics, compare transmission spectra at overlapping and neighboring wavelength regions, confirm throughputs, and determine overall performances. In our search for transiting exoplanets that are well suited to achieving these goals, we identify 12 objects (dubbed "community targets") that meet our defined criteria. Currently, the most favorable target is WASP-62b because of its large predicted signal size, relatively bright host star, and location in JWST's continuous viewing zone. Since most of the community targets do not have well-characterized atmospheres, we recommend initiating preparatory observing programs to determine the presence of obscuring clouds/hazes within their atmospheres. Measurable spectroscopic features are needed to establish the optimal resolution and wavelength regions for exoplanet characterization. Other initiatives from our proposed ERS program include testing the instrument brightness limits and performing phase-curve observations.(Abridged)Comment: This is a white paper that originated from an open discussion at the Enabling Transiting Exoplanet Science with JWST workshop held November 16 - 18, 2015 at STScI (http://www.stsci.edu/jwst/science/exoplanets). Accepted for publication in PAS