Patterns of Treatment for Psychiatric Disorders Among Children and Adolesecents in Mississippi Medicaid

The nature of services for psychiatric disorders in public health systems has been understudied, particularly with regard to frequency, duration, and costs. The current study examines patterns of service reception and costs among Medicaid-covered youth newly diagnosed with anxiety, depression, or behavioral disturbance in a large data set of provider billing claims submitted between 2015–2016. Eligibility criteria included: 1) identification of an initial diagnosis of a single anxiety, unipolar mood, or specific behavioral disorder; 2) continuous Medicaid eligibility over the duration of the time period studied; and 3) under 18 years of age on the date of initial psychiatric diagnosis. The final cohort included 7,627 cases with a mean age of 10.65 (±4.36), of which 58.04% were male, 57.09% were Black, 38.97% were White, and 3.95% were of other ethnicities. Data indicated that 65.94% of the cohort received at least some follow-up services within a median 18 days of diagnosis. Of those, 54.27% received a combination of medical and psychosocial services, 32.01% received medical services only, and 13.72% received psychosocial services only. Overall median costs for direct treatment were $576.69, with wide discrepancies between the lowest (anxiety =$308.41) and highest (behavioral disturbance = $653.59) diagnostic categories. Across all categories the frequency and duration of psychosocial services were much lower than would be expected in comparison to data from a well-known effectiveness trial. Overall, follow-up to psychiatric diagnosis could be characterized as highly variable, underutilized, and emphasizing biomedical treatment. Understanding more about these patterns may facilitate systematic improvements and greater cost efficiency in the future

Hydraulic flow through a channel contraction: multiple steady states

We have investigated shallow water flows through a channel with a contraction by experimental and theoretical means. The horizontal channel consists of a sluice gate and an upstream channel of constant width $b_0$ ending in a linear contraction of minimum width $b_c$. Experimentally, we observe upstream steady and moving bores/shocks, and oblique waves in the contraction, as single and multiple steady states, as well as a steady reservoir with a complex hydraulic jump in the contraction occurring in a small section of the $b_c/b_0$ and Froude number parameter plane. One-dimensional hydraulic theory provides a comprehensive leading-order approximation, in which a turbulent frictional parametrization is used to achieve quantitative agreement. An analytical and numerical analysis is given for two-dimensional supercritical shallow water flows. It shows that the one-dimensional hydraulic analysis for inviscid flows away from hydraulic jumps holds surprisingly well, even though the two-dimensional oblique hydraulic jump patterns can show large variations across the contraction channel

Temperament Factors and Dimensional, Latent Bifactor Models of child psychopathology: Transdiagnostic and Specific Associations in Two Youth Samples

Common emotional and behavioral symptoms co-occur and are associated with core temperament factors. This study investigated links between temperament and dimensional, latent psychopathology factors, including a general common psychopathology factor (p factor) and specific latent internalizing and externalizing liabilities, as captured by a bifactor model, in two independent samples of youth. Specifically, we tested the hypothesis that temperament factors of negative affectivity (NA), positive affectivity (PA), and effortful control (EC) could serve as both transdiagnostic and specific risks in relation to recent bifactor models of child psychopathology. Sample 1 included 571 youth (average age 13.6, SD = 2.37, range 9.3–17.5) with both youth and parent report. Sample 2 included 554 preadolescent children (average age 7.7, SD = 1.35, range = 5–11 years) with parent report. Structural equation modeling showed that the latent bifactor models fit in both samples. Replicated in both samples, the p factor was associated with lower EC and higher NA (transdiagnostic risks). Several specific risks replicated in both samples after controlling for co-occurring symptoms via the p factor: internalizing was associated with higher NA and lower PA, lower EC related to externalizing problems

Personalized Depression Prevention: A Randomized Controlled Trial to Optimize Effects Through Risk-Informed Personalization

Objective: To evaluate whether evidence-based depression prevention programs can be optimized by matching youths to interventions that address their psychosocial vulnerabilities. Method: This randomized controlled trial included 204 adolescents (mean [SD] age ¼ 14.26 [1.65] years; 56.4% female). Youths were categorized as high or low on cognitive and interpersonal risks for depression and randomly assigned to Coping With Stress (CWS), a cognitive-behavioral program, or Interpersonal Psychotherapy–Adolescent Skills Training (IPT-AST), an interpersonal program. Some participants received a match between risk and prevention (eg, high cognitive–low interpersonal risk teen in CWS, low cognitive–high interpersonal risk teen in IPT-AST), others received a mismatch (eg, low cognitive-high interpersonal risk teen in CWS). Outcomes were depression diagnoses and symptoms through 18 months postintervention (21 months total). Results: Matched adolescents showed significantly greater decreases in depressive symptoms than mismatched adolescents from postintervention through 18-month follow-up and across the entire 21-month study period (effect size [d] ¼ 0.44, 95% CI ¼ 0.02, 0.86). There was no significant difference in rates of depressive disorders among matched adolescents compared with mismatched adolescents (12.0% versus 18.3%, t193 ¼ .78, p ¼ .44). Conclusion: This study illustrates one approach to personalizing depression prevention as a form of precision mental health. Findings suggest that risk-informed personalization may enhance effects beyond a one-size-fits-all approach. Clinical trial registration information: Bending Adolescent Depression Trajectories Through Personalized Prevention; https://www.clinicaltrials. gov/; NCT01948167

Variability of extracorporeal cardiopulmonary resuscitation utilization for refractory adult out-of-hospital cardiac arrest: an international survey study.

Objective: A growing interest in extracorporeal cardiopulmonary resuscitation (ECPR) as a rescue strategy for refractory adult out-of-hospital cardiac arrest (OHCA) currently exists. This study aims to determine current standards of care and practice variation for ECPR patients in the USA and Korea. Methods: In December 2015, we surveyed centers from the Korean Hypothermia Network (KORHN) Investigators and the US National Post-Arrest Research Consortium (NPARC) on current targeted temperature management and ECPR practices. This project analyzes the subsection of questions addressing ECPR practices. We summarized survey. Results: Overall, 9 KORHN and 4 NPARC centers reported having ECPR programs and had complete survey data available. Two KORHN centers utilized extracorporeal membrane oxygenation only for postarrest circulatory support in patients with refractory shock and were excluded from further analysis. Centers with available ECPR generally saw a high volume of OHCA patients (10/11 centers care for \u3e75 OHCA a year). Location of, and providers trained for cannulation varied across centers. All centers in both countries (KORHN 7/7, NPARC 4/4) treated comatose ECPR patients with targeted temperature management. All NPARC centers and four of seven KORHN centers reported having a standardized hospital protocol for ECPR. Upper age cutoff for eligibility ranged from 60 to 75 years. No absolute contraindications were unanimous among centers. Conclusion: A wide variability in practice patterns exist between centers performing ECPR for refractory OHCA in the US and Korea. Standardized protocols and shared research databases might inform best practices, improve outcomes, and provide a foundation for prospective studies

The Young and the Dustless: Interpreting Radio Observations of UltraViolet Luminous Galaxies

Ultraviolet Luminous Galaxies (UVLGs) have been identified as intensely star-forming, nearby galaxies. A subset of these, the supercompact UVLGs, are believed to be local analogs of high redshift Lyman Break Galaxies. Here we investigate the radio continuum properties of this important population for the first time. We have observed 42 supercompact UVLGs with the VLA, all of which have extensive coverage in the UV/optical by GALEX and SDSS. Our analysis includes comparison samples of multiwavelength data from the Spitzer First Look Survey and from the SDSS-Galex matched catalogs. In addition we have Spitzer MIPS data for 24 of our galaxies and find that they fall on the radio-FIR correlation of normal star-forming galaxies. We find that our galaxies have lower radio-to-UV ratios and lower Balmer decrements than other local galaxies with similar (high) star formation rates. Optical spectra show they have lower Dn(4000) and HdeltaA indices, higher Hbeta emission-line equivalents widths, and higher [OIII]5007/Hbeta emission-line ratios than normal star forming galaxies. Comparing these results to galaxy spectral evolution models we conclude that supercompact UVLGs are distinguished from normal star forming galaxies firstly by their high specific star formation rates. Moreover, compared to other types of galaxies with similar star formation rates, they have significantly less dust attenuation. In both regards they are similar to Lyman Break Galaxies. This suggests that the process that causes star formation in the supercompact UVLGs differs from other local star forming galaxies, but may be similar to Lyman Break Galaxies.Comment: 37 pages, 13 figures, accepted and scheduled to appear in ApJS December 2007 (GALEX Special Issue

Differential criterion of a bubble collapse in viscous liquids

The present work is devoted to a model of bubble collapse in a Newtonian viscous liquid caused by an initial bubble wall motion. The obtained bubble dynamics described by an analytic solution significantly depends on the liquid and bubble parameters. The theory gives two types of bubble behavior: collapse and viscous damping. This results in a general collapse condition proposed as the sufficient differential criterion. The suggested criterion is discussed and successfully applied to the analysis of the void and gas bubble collapses.Comment: 5 pages, 3 figure

The ACS Nearby Galaxy Survey Treasury IV. The Star Formation History of NGC 2976

We present resolved stellar photometry of NGC 2976 obtained with the Advanced Camera for Surveys (ACS) as part of the ACS Nearby Galaxy Survey Treasury (ANGST) program. The data cover the radial extent of the major axis of the disk out to 6 kpc, or ~6 scale lengths. The outer disk was imaged to a depth of M_F606W ~ 1, and an inner field was imaged to the crowding limit at a depth of M_F606W ~ -1. Through detailed analysis and modeling of these CMDs we have reconstructed the star formation history of the stellar populations currently residing in these portions of the galaxy, finding similar ancient populations at all radii but significantly different young populations at increasing radii. In particular, outside of the well-measured break in the disk surface brightness profile, the age of the youngest population increases with distance from the galaxy center, suggesting that star formation is shutting down from the outside-in. We use our measured star formation history, along with H I surface density measurements, to reconstruct the surface density profile of the disk during previous epochs. Comparisons between the recovered star formation rates and reconstructed gas densities at previous epochs are consistent with star formation following the Schmidt law during the past 0.5 Gyrs, but with a drop in star formation efficiency at low gas densities, as seen in local galaxies at the present day. The current rate and gas density suggest that rapid star formation in NGC 2976 is currently in the process of ceasing from the outside-in due to gas depletion. This process of outer disk gas depletion and inner disk star formation was likely triggered by an interaction with the core of the M81 group >~1 Gyr ago that stripped the gas from the galaxy halo and/or triggered gas inflow from the outer disk toward the galaxy center.Comment: 22 pages, 14 figures, 2 tables, accepted for publication by Ap