Search

In the last decade Bayesian analysis of radiocarbon dates has become commonplace for archaeologists grappling with regional chronologies. Here we present Bayesian analysis for radiocarbon dates from Moche cultural contexts from the north coast of Peru with the aim to understand the duration of the phenomenon and to compile all known dates in a single location for future analysis and use. The analysis demonstrates that the long-standing Moche ceramic sequence does not provide a perfect proxy for tracking the timing of all social interactions. However, our results show general agreement with traditional relative Moche chronologies. Finally, our study shows that Moche was a shorter cultural phenomenon than has been previously argued, with the current data indicating that it began between the late 4th and early 6th centuries CE and lasted until the 9th century CE. [ABSTRACT FROM AUTHOR]

To quantify differences in coronary artery stenosis severity in patients with calcified lesions between conventional energy-integrating detector (EID) CT and ultra-high-resolution (UHR) photon-counting-detector (PCD) CT. Patients undergoing clinically indicated coronary CT angiography were prospectively recruited and scanned first on an EID-CT (SOMATOM Force, Siemens Healthineers) and then a PCD-CT (NAEOTOM Alpha, Siemens Healthineers) on the same day. EID-CT was performed with standard mode (192 ​× ​0.6 ​mm detector collimation) following our clinical protocol. PCD-CT scans were performed under UHR mode (120 ​× ​0.2 ​mm detector collimation). For each patient, left main, left anterior descending, right coronary artery, and circumflex were reviewed and the most severe stenosis from dense calcification for each coronary was quantified using commercial software. Additionally, each measured stenosis was assigned a severity category based on percent diameter stenosis, and changes in severity category across EID-CT and PCD-CT were assessed. A total of 23 patients were enrolled, with 34 coronary artery stenoses analyzed. Stenosis was significantly reduced in PCD-CT compared to EID-CT (p ​< ​0.001), resulting in an average of 11% (SD ​= ​11%) reduction in percent diameter stenosis. Among the 34 lesions, 15 changed in stenosis severity category: 3 went from moderate to minimal, 1 from moderate to mild, 9 from mild to minimal, and 2 from minimal to mild with the use of PCD-CT compared to EID-CT. Use of UHR PCD-CT decreased percent diameter stenosis by an average of 11% relative to EID-CT, resulting in 13 of 34 stenoses being downgraded in stenosis severity category, potentially sparing patients from unnecessary intervention. [ABSTRACT FROM AUTHOR]

• Clustering data on symptom and illness severity, three distinct profiles were identified. • Symptom burden among lung transplantation candidates is highly heterogenous. • Heterogeneity in symptom burden may be linked to social determinants of health. There is considerable heterogeneity in symptom burden among lung transplant candidates that may not be explained by objective measures of illness severity. This study aimed to characterize symptom burden, identify distinct profiles based on symptom burden and illness severity, and determine whether observed profiles are defined by differences in social determinates of health (SDOH). This was a prospective study of adult lung transplant candidates. Symptoms were assessed within 3 months of transplant with the Memorial Symptom Assessment Scale (MSAS). MSAS subscale (physical and psychological) scores range 0–4 (higher=more symptom burden). The lung allocation score (LAS) (range 0–100) was our proxy measure of illness severity. The MSAS subscales and LAS were used as continuous indicators in a latent profile analysis to identify distinct symptom-illness severity profiles. Comparative statistics were used to identify SDOH differences among observed profiles. Among 93 candidates, 3 distinct symptom-illness severity profiles were identified: 71% had a mild profile in which mild symptoms (MSAS physical 0.49; MSAS psychological 0.57) paired with mild illness severity (LAS 38.59). Of the 29% mismatched participants, 9% had moderate symptoms (MSAS physical 0.88; MSAS psychological 1.47) but severe illness severity (LAS 88.02) and 20% had severe symptoms (MSAS physical 1.30; MSAS psychological 1.94) but mild illness severity (LAS 42.13). The two mismatch profiles were younger, more racially diverse, and had higher psychosocial risk scores. Symptom burden is heterogenous, does not always reflect objective measures of illness severity, and may be linked to SDOH. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol withdrawal syndrome (AWS) is a serious consequence of alcohol use disorder (AUD). Due to the current COVID-19 pandemic there was a closure of Pennsylvania (PA) liquor stores on March 17, 2020.Methods: This is a retrospective, observational study of AWS patients presenting to a tertiary care hospital. We used descriptive statistics for continuous and categorical variables and compared AWS consults placed to the medical toxicology service for six months preceding liquor store closure to those placed between March 17, 2020 and August 31, 2020. We compared this to consults placed to the medical toxicology service placed from October 1, 2019 through March 16, 2020. Charts were identified based on consults placed to the medical toxicology service, and alcohol withdrawal was determined via chart review by a medical toxicologist. This study did not require IRB approval. We evaluated Emergency Department (ED) length of stay (LOS), weekly and monthly consultation rate, rate of admission and ED recidivism, both pre- and post-liquor store closure.Results: A total of 324 AWS consults were placed during the ten month period. 142 (43.8%) and 182 (56.2%) consults were pre- and post-liquor store closure. The number of consults was not statistically significant comparing these two time frames. There was no significant difference by patient age, gender, or race or by weekly or monthly consultation rate when comparing pre- and post-liquor store periods. The median ED LOS was 7 h (95% Confidence Interval (CI) Larson et al. (2012), Pollard et al. (2020) [5, 11]) and did not significantly differ between pre- and post-liquor store periods (p = 0.78). 92.9% of AWS patients required admission without significant difference between the pre- and post-liquor store closure periods (94.4% vs. 91.8%, p = 0.36). There was a significant increase in the number of AWS patients requiring a return ED visit (Odds Ratio 2.49; 95% CI [1.38, 4.49]) post closure.Conclusion: There were nearly 2.5 times greater odds of ED recidivism among post-liquor store closure AWS patients compared with pre-closure AWS patients. [ABSTRACT FROM AUTHOR]

Osteochondral defects present a unique clinical challenge due to their combination of phenotypically distinct cartilage and bone, which require specific, stratified biochemical cues for tissue regeneration. Furthermore, the articular cartilage exhibits significantly worse regeneration than bone due to its largely acellular and avascular nature, prompting significant demand for regenerative therapies. To address these clinical challenges, we have developed a bilayered, modular hydrogel system that enables the click functionalization of cartilage- and bone-specific biochemical cues to each layer. In this system, the crosslinker poly(glycolic acid)-poly(ethylene glycol)-poly(glycolic acid)-di(but-2-yne-1,4-dithiol) (PdBT) was click conjugated with either a cartilage- or bone-specific peptide sequence of interest, and then mixed with a suspension of thermoresponsive polymer and mesenchymal stem cells (MSCs) to generate tissue-specific, cell-encapsulated hydrogel layers targeting the cartilage or bone. We implanted bilayered hydrogels in rabbit femoral condyle defects and investigated the effects of tissue-specific peptide presentation and cell encapsulation on osteochondral tissue repair. After 12 weeks implantation, hydrogels with a chondrogenic peptide sequence produced higher histological measures of overall defect filling, cartilage surface regularity, glycosaminoglycan (GAG)/cell content of neocartilage and adjacent cartilage, and bone filling and bonding compared to non-chondrogenic hydrogels. Furthermore, MSC encapsulation promoted greater histological measures of overall defect filling, cartilage thickness, GAG/cell content of neocartilage, and bone filling. Our results establish the utility of this click functionalized hydrogel system for in vivo repair of the osteochondral unit. Osteochondral repair requires mimicry of both cartilage- and bone-specific biochemical cues, which are highly distinct. While traditional constructs for osteochondral repair have mimicked gross compositional differences between the cartilage and bone in mineral content, mechanical properties, proteins, or cell types, few constructs have recapitulated the specific biochemical cues responsible for the differential development of cartilage and bone. In this study, click biofunctionalized, bilayered hydrogels produced stratified presentation of developmentally inspired peptide sequences for chondrogenesis and osteogenesis. This work represents, to the authors' knowledge, the first application of bioconjugation chemistry for the simultaneous repair of bone and cartilage tissue. The conjugation of tissue-specific peptide sequences successfully promoted development of both cartilage and bone tissues in vivo. [Display omitted] [ABSTRACT FROM AUTHOR]

Frailty is a clinical state of vulnerability to stressors resulting from cumulative alterations in multiple physiological and molecular systems. Frailty assessment in patients with chronic disease is useful for identifying those who are at increased risk for poor clinical and patient reported outcomes. Due to biobehavioral changes purported to cause both frailty and certain chronic lung diseases, patients with lung disease appear susceptible to frailty and prone to developing it decades earlier than community dwelling healthy populations. Herein, we review the literature and potential pathobiological mechanisms underpinning associations between frailty in lung disease and age, sex, comorbidity and symptom burden, severity of lung disease, inflammatory biomarkers, various clinical parameters, body composition measures, and physical activity levels. We also propose a multipronged program of future research focused on improving the accuracy and precision of frailty measurement in lung disease, identifying blood-based biomarkers and measures of body composition for frailty, determining whether subphenotypes of frailty with distinct pathobiology exist, and developing personalized interventions that target the specific underlying mechanisms causing frailty. [ABSTRACT FROM AUTHOR]

Context: Fatigue is a symptom reported by patients with a variety of chronic conditions. However, it is unclear whether fatigue is similar across conditions. Better understanding its nature could provide important clues regarding the mechanisms underlying fatigue and aid in developing more effective therapeutic interventions to decrease fatigue and improve quality of life.Objectives: To better understand the nature of fatigue, we performed a qualitative metasynthesis exploring patients' experiences of fatigue across five chronic noninfectious conditions: heart failure, multiple sclerosis, rheumatoid arthritis, chronic kidney disease, and chronic obstructive pulmonary disease.Methods: We identified 34 qualitative studies written in the last 10 years describing fatigue in patients with one of the aforementioned conditions using three databases (Embase, PubMed, and CINAHL). Studies with patient quotes describing fatigue were synthesized, integrated, and interpreted.Results: Across conditions, patients consistently described fatigue as persistent overwhelming tiredness, severe lack of energy, and physical weakness that worsened over time. Four common themes emerged: running out of batteries, a bad life, associated symptoms (e.g., sleep disturbance, impaired cognition, and depression), and feeling misunderstood by others, with a fear of not being believed or being perceived negatively.Conclusion: In adults with heart failure, multiple sclerosis, rheumatoid arthritis, chronic kidney disease, and chronic obstructive pulmonary disease, we found that fatigue was characterized by severe energy depletion, which had negative impacts on patients' lives and caused associated symptoms that exacerbated fatigue. Yet, fatigue is commonly misunderstood and inadequately acknowledged. [ABSTRACT FROM AUTHOR]

Background: The opioid epidemic is a crisis leading to over utilization of resources within emergency departments (EDs). We assessed how implementation of an opioid-free headache and migraine treatment algorithm in the ED impacted patient centered outcomes.Methods: This was a retrospective review of patients presenting to EDs across a health network with a primary diagnosis of headache or migraine. Two analyses were completed comparing patients presenting before and after implementation of an opioid-free treatment algorithm and patients treated with or without opioids in the ED. The primary outcome was incidence of an ED revisit within thirty days. Secondary outcomes included ED length of stay, admission rate, and incidence of revisit during the entire study period.Results: In total, 2953 patient encounters were included. Incidence of revisit within thirty days was lower in the post- (84/1339, 6.3%) versus pre-algorithm group (133/1614, 8.2%; odds ratio [OR] 0.75, 95% confidence interval [CI] 0.56-0.99; p = 0.049), as was the incidence of revisit within the entire study period (9.2% vs. 12.1%; OR 0.74, CI 0.58-0.93; p = 0.014). In the secondary analysis, patients treated with opioids had a higher incidence of revisit within thirty days (51/335, 15.2%) compared to those not treated with opioids (166/2618, 6.3%). The opioid group also had a higher incidence of admission rates and median ED length of stay.Conclusions: Opioid use in the ED to treat patients with headaches or migraines may have several negative ramifications including increased risk of revisit, hospital admission, and increased ED length of stay. [ABSTRACT FROM AUTHOR]

It is generally understood that pain experience and opioid abuse have relied on male-dominated models. However, sex and gender play a role in both pain experience and opioid use disorder. Using the previously validated Texas Tech University Health Sciences Center Sex and Gender Specific Health PubMed Advanced Search Tool, the authors used pertinent literature to develop this literature-based commentary on sex and gender differences in pain experience and opioid use disorder. Women report their experience of pain more frequently, have increased rates of diagnoses related to pain, have increased pain sensitivity, and have a variable response to pain and analgesia. This variable response is due to anatomic, physiologic, hormonal, psychological, and social factors that differ by sex and gender. Women have been found to be at greater risk for opioid abuse in all age groups. This may be due to the differences in pain experience, as well as sex and gender differences in prescribing patterns, cultural norms, and the increased likelihood to experience dependency and withdrawal. Approaches to the treatment of opioid use disorder are also subject to sex and gender differences—an area in need of further investigation. [ABSTRACT FROM AUTHOR]

Background & Aims Endoscopic ultrasound–guided transmural drainage and necrosectomy have become the standard treatment for patients with pancreatic walled-off necrosis (WON). Lumen-apposing metal stents (LAMS) have shown success in the management of pancreatic fluid collections. However, there are few data on their specific roles in management of WON. We investigated the efficacy and safety of LAMS in treatment of WON. Methods We performed a retrospective multicenter case series of 124 patients with WON who underwent endoscopic transmural drainage by using LAMS at 17 tertiary care centers from January 2014 through May 2015. Patients underwent endoscopic ultrasound–guided cystogastrostomy or cystoenterostomy with placement of an LAMS into the WON collection. At the discretion of the endoscopist, we performed direct endoscopic necrosectomy, irrigation with hydrogen peroxide, and/or nasocystic drain placement. We performed endoscopic retrograde cholangiopancreatography with pancreatic duct stent placement when indicated. Concomitant therapies included direct endoscopic debridement (n = 78), pancreatic duct stent placement for leak (n = 19), hydrogen peroxide–assisted necrosectomy (n = 38), and nasocystic irrigation (n = 22). We collected data for a median time of 4 months (range, 1–34 months) after the LAMS placement. The primary outcomes were rates of technical success (successful placement of the LAMS), clinical success (resolution of WON, on the basis of image analysis, without need for further intervention via surgery or interventional radiology), and adverse events. Results The median size of the WON was 9.5 cm (range, 4–30 cm). Eight patients had 2 LAMS placed for multiport access, all with technical success (100%). Clinical success was achieved in 107 patients (86.3%) after 3 months of follow-up. Thirteen patients required a percutaneous drain, and 3 required a surgical intervention to manage their WON. The stents remained patent in 94% of patients (117 of 124) and migrated in 5.6% of patients (7 of 124). The median number of endoscopic interventions was 2 (range, 1–9 interventions). Conclusions On the basis of a retrospective analysis of 124 patients, endoscopic therapy of WON by using LAMS is safe and effective. Creation of a large and sustained cystogastrostomy or cystoenterostomy tract is effective in the drainage and treatment of WON. [ABSTRACT FROM AUTHOR]

Background and Aims EMR is increasingly used for resection of sporadic, nonampullary duodenal adenomas (SNDAs), but there are no guidelines for the management of these lesions. The aims of this study were to evaluate the safety and efficacy of EMR exclusively for SNDAs and to determine the factors predictive of outcomes. Methods We performed a retrospective review of patients with SNDAs referred for endoscopic therapy from 2006 to 2013. The outcomes studied were successful endoscopic resection, major adverse events, early and late recurrences, and clinical remission. Results Sixty-eight patients with SNDAs were included and 51 (75%) underwent EMR. The mean adenoma size was 22.0 ± 8.9 mm. Successful resection was achieved in 49 of 51 patients (96.1%), and major adverse events were noted in 8 of 51 patients (15.7%). Early and late recurrences were noted in 25.6% and 5.2% of patients, respectively, and were treated endoscopically. Clinical remission was achieved in 89.7% of patients after a median follow-up of 15 months. Presence of villous histology was associated with increased recurrence ( P = .019), but no association of recurrence was noted with other endoscopic features or resection technique. Large adenoma size ( P = .0057) and need for intraprocedural hemostasis ( P = .006) were associated with increased adverse events, but no association of adverse events was noted with location or resection technique. Conclusions Large duodenal adenomas can be effectively managed with EMR at a referral center with experienced endoscopists. However, EMR has a significant recurrence rate, especially early recurrence, and the risk of adverse events is not negligible. Endoscopic therapy is successful in managing recurrent adenomas. [ABSTRACT FROM AUTHOR]

Background: Recent literature has implicated dairy as having a potential acne-inducing effect.Objectives: The aim of this study was to investigate the link between dairy consumption and acne in teenagers. We tested the hypothesis that teenagers with facial acne consume more dairy than those without acne.Methods: A case-control study was conducted among 225 participants, ages 14 to 19 years, with either moderate acne or no acne. Moderate acne was determined by a dermatologist using the Global Acne Assessment Scale. Participants who met inclusion criteria then completed up to three 24-hour diet recall interviews using the Nutrition Data System for Research software and food and nutrient intake were compared between groups.Results: The amount of low-fat/skim milk consumed by participants with acne with significantly higher (P = .01) than those with no acne. No significant difference was found among total dairy intake, saturated fat or trans-fat, or glycemic load. No significant difference was found for total energy intake or body mass index.Limitations: Limitations include self-report of diet and portion size, and association does not determine causation.Conclusions: Consumption of low-fat/skim milk, but not full-fat milk, was positively associated with acne. [ABSTRACT FROM AUTHOR]

We present the every-direction variogram analysis (EVA) method for quantifying orientation and scale dependence of topographic anisotropy to aid in differentiation of the fluvial and tectonic contributions to surface evolution. Using multi-directional variogram statistics to track the spatial persistence of elevation values across a landscape, we calculate anisotropy as a multiscale, direction-sensitive variance in elevation between two points on a surface. Tectonically derived topographic anisotropy is associated with the three-dimensional kinematic field, which contributes (1) differential surface displacement and (2) crustal weakening along fault structures, both of which amplify processes of surface erosion. Based on our analysis, tectonic displacements dominate the topographic field at the orogenic scale, while a combination of the local displacement and strength fields are well represented at the ridge and valley scale. Drainage network patterns tend to reflect the geometry of underlying active or inactive tectonic structures due to the rapid erosion of faults and differential uplift associated with fault motion. Regions that have uniform environmental conditions and have been largely devoid of tectonic strain, such as passive coastal margins, have predominantly isotropic topography with typically dendritic drainage network patterns. Isolated features, such as stratovolcanoes, are nearly isotropic at their peaks but exhibit a concentric pattern of anisotropy along their flanks. The methods we provide can be used to successfully infer the settings of past or present tectonic regimes, and can be particularly useful in predicting the location and orientation of structural features that would otherwise be impossible to elude interpretation in the field. Though we limit the scope of this paper to elevation, EVA can be used to quantify the anisotropy of any spatially variable property. [ABSTRACT FROM AUTHOR]

Background & Aims Although several classification systems have been proposed for characterization of Barrett’s esophagus (BE) surface patterns based on narrow-band imaging (NBI), none have been widely accepted. The Barrett’s International NBI Group (BING) aimed to develop and validate an NBI classification system for identification of dysplasia and cancer in patients with BE. Methods The BING working group, composed of NBI experts from the United States, Europe, and Japan, met to develop a validated, consensus-driven NBI classification system for identifying dysplasia and cancer in BE. The group reviewed 60 NBI images of nondysplastic BE, high-grade dysplasia, and esophageal adenocarcinoma to characterize mucosal and vascular patterns visible by NBI; these features were used to develop the BING criteria. We then recruited adult patients undergoing surveillance or endoscopic treatment for BE at 4 institutions in the United States and Europe, obtaining high-quality NBI images and performing histologic analysis of biopsies. Experts individually reviewed 50 NBI images to validate the BING criteria, and then evaluated 120 additional NBI images (not previously viewed) to determine whether the criteria accurately predicted the histology results. Results The BING criteria identified patients with dysplasia with 85% overall accuracy, 80% sensitivity, 88% specificity, 81% positive predictive value, and 88% negative predictive value. When dysplasia was identified with a high level of confidence, these values were 92%, 91%, 93%, 89%, and 95%, respectively. The overall strength of inter-observer agreement was substantial (κ = 0.681). Conclusions The BING working group developed a simple, internally validated system to identify dysplasia and EAC in patients with BE based on NBI results. When images are assessed with a high degree of confidence, the system can classify BE with >90% accuracy and a high level of inter-observer agreement. [ABSTRACT FROM AUTHOR]

Understanding the interplay between exploitation and natural mortality is essential to guiding sustainable conservation of wildlife. Exploitation of carnivores by humans has long been thought to result in compensatory reductions of natural mortality among survivors. If rates of human exploitation exceed natural mortality, however, such actions will ‘add’ to overall mortality and could imperil the sustainability of such actions. We applied competing risk analyses to ⩾16 years of data for heavily harvested and semi-protected cougar populations in Utah to test the additive and compensatory mortality hypotheses, while accounting for parameter uncertainty. We additionally tested for presence of the two primary mechanisms by which compensatory mortality can arise: density dependence and individual heterogeneity in mortality risks. Despite an opportunity for compensation in the heavily harvested population, we could not reject the additive mortality hypothesis when uncertainty in parameter estimates was accounted for. In the semi-protected population, however, we detected evidence for partial compensation of increased anthropogenic exploitation via reductions in natural mortality. As may be common in carnivore studies, we found that ignoring uncertainty in estimates of cause-specific mortality systematically led to biased conclusions regarding additive and compensatory mortality hypotheses. Efforts should be made to address and minimize this uncertainty in demographic studies of carnivores in order to avoid flawed management recommendations. To attain the necessary sample sizes for making sound inference, this may require that the spatial extent of management units be extended for territorial species with large home-range requirements. [ABSTRACT FROM AUTHOR]

Background & Aims Endoscopic ultrasound (EUS) often is used to stage rectal cancer and thereby guide treatment. Prior assessments of its accuracy have been limited by small sets of data collected from tumors of varying stages. We aimed to characterize the diagnostic performance of EUS analysis of rectal cancer, paying particular attention to determining whether patients should undergo primary surgical resection. Methods We performed a retrospective observational study using procedural databases and electronic medical records from 4 academic tertiary-care hospitals, collecting data on EUS analyses from 2000 through 2012. Data were analyzed from 86 patients with rectal cancer initially staged as T2N0 by EUS. The negative predictive value (NPV) was calculated by comparing initial stages determined by EUS with those determined by pathology analysis of surgical samples. Logistic regression models were used to assess variation in diagnostic performance with case attributes. Results EUS excluded advanced tumor depth with an NPV of 0.837 (95% confidence interval [CI], 0.742–0.908), nodal metastasis with an NPV of 0.872 (95% CI, 0.783–0.934), and both together with an NPV of 0.767 (95% CI, 0.664–0.852) compared with pathology analysis. Incorrect staging by EUS affected treatment decision making for 20 of 86 patients (23.3%). Patient age at time of the procedure correlated with the NPV for metastasis to lymph node, but no other patient features were associated significantly with diagnostic performance. Conclusions Based on a multicenter retrospective study, EUS staging of rectal cancer as T2N0 excludes advanced tumor depth and nodal metastasis, respectively, with an approximate NPV of 85%, similar to that of other modalities. EUS has an error rate of approximately 23% in identifying disease appropriate for surgical resection, which is lower than previously reported. [ABSTRACT FROM AUTHOR]

Symptoms experienced by lung transplant candidates are heterogenous and may not reflect objective measures of illness severity. Both may contribute to healthcare use. We aimed to identify distinct profiles using integrated data on symptoms and illness severity and examine differences in healthcare use among observed profiles. This was a single-center prospective study of adult lung transplant candidates. Symptoms were assessed within 3 months of transplant with the Memorial Symptom Assessment Scale (MSAS). Two subscales, the MSAS physical and psychological, were calculated by averaging the severity, frequency, and distress scores for 12 physical and 6 psychological symptoms (score range 0-4, higher=more severe). The LAS, a score (0-100) that represents illness severity and survival benefit, was our measure of illness severity and obtained from the health record at time of MSAS completion. Latent class analysis was used to identify distinct symptom-illness severity profiles based on two MSAS subscales and LAS. Differences in pretransplant hospitalization rates and posttransplant length of stay (LOS) among profiles were determined by comparative statistics. Among 93 candidates, three distinct symptom-illness severity profiles were identified: 71% had congruent symptom-illness severity; mild symptoms (MSAS phys 0.49; MSAS psych 0.57) matched mild illness severity (LAS 39.75) and 29% had symptom-illness severity mismatch; 9% had moderate symptoms (MSAS phys 0.88; MSAS psych 1.47) but severe illness severity (LAS 83.59) and 20% had severe symptoms (MSAS phys 1.30; MSAS psych 1.94) but mild illness severity (LAS 42.64). Compared to the congruent profile, mismatch profiles were younger (65 vs 53 and 52 years, p= 0.007), more racially diverse (% white: 88 vs 62 and 63, p=0.002), with higher psychosocial risk scores (7.5 vs 10.5 and 13, p=0.03). Hospitalization at time of transplant was more common among the mismatch profiles compared to the congruent profile (11% vs 50% and 26%, p=0.02). Post-transplant hospital LOS did not significantly differ (p= 0.5). We found incongruence between symptom and illness severity in a subset of patients. Higher rates of pretransplant hospitalization were observed among the mismatch profiles suggesting that both severity of symptoms and illness may be clinically relevant drivers of pretransplant healthcare use. [ABSTRACT FROM AUTHOR]

Abstract: Dialectical Behavior Therapy (DBT) is an evidence-based treatment for borderline personality disorder that has been widely disseminated to many outpatient treatment settings. Many practitioners depend on third-party payers to fund treatment delivery. DBT requires additional clinical services not often included in outpatient therapy, including a weekly skills group led by 2 clinicians, and the requirement for clinicians to attend weekly consultation team and provide intersession contact for coaching. Standard outpatient insurance rates for individual and group sessions do not provide adequate reimbursement for the additional services of DBT. This paper describes how 2 DBT team leaders collaborated to obtain improved reimbursement for their programs. The 2 teams met with insurers, educated them about DBT, and showed outcomes from their programs to achieve large increases in reimbursement rates. The paper includes client outcome data from both programs. [Copyright &y& Elsevier]

Abstract: In actively deforming orogens, the material strength at the Earth''s surface is controlled in part by strain localization determined by the local stress fields which in turn are driven by contributions from local topography and far field plate velocities. Material weakening associated with strain localization imparts partially predictable, and entirely inescapable heterogeneity to the material fabric of an orogen. The characteristic damage structure of individual fault zones that undergo strain weakening, as imaged in dam site excavations, deep drill holes and geological observations, results in geomorphically relevant strength variations normal to the fault of many orders of magnitude. The sensitivity of hillslope and fluvial erosion to the strength parameters coupled with the large and oriented strain-related strength variations, cause the topographic evolution to be dominated by tectonically driven rheological behavior at multiple wavelengths. Using three-dimensional, lithospheric scale modeling of two oblique orogens, Southern Alps, New Zealand and the Eastern Himalayan Syntaxis, we examine the generation of model surface strength fields that occur as a consequence of a simple strain softening upper crustal rheological model. Mapping of topographic anisotropy of the Southern Alps and the Eastern Himalaya Syntaxis indicates azimuthal control on correlation distances that are spatially related to the different strain regimes of the two orogens. By defining landscape evolution in terms of mechanical failure in the conventional motion—stress mechanical framework, the behavior of Earth''s surface can be brought into the same theoretical framework as the behavior of the sub-surface and many of the observational—theoretical inconsistencies arising from application of dominantly potential field theory can be obviated. Heterogeneity and anisotropy of material strength are fundamental aspects of active orogens and description of the strength field in terms of mechanical evolution can significantly extend present Earth surface models. These basic aspects of mechanics are expressed in landscape geomorphometrics of anisotropy and spatial patterns of complexity. [Copyright &y& Elsevier]

Abstract: Standard, outpatient Dialectical Behavior Therapy (DBT) includes the provision of intersession telephone contact between the therapist and the client to reduce suicidal crisis behaviors, enhance skills generalization, and reduce alienation and conflict in the therapeutic relationship. Therapists providing telephone consultation need the help of the team to stay within the goals and targets of DBT, manage therapy-interfering behavior and avoid burnout. The article offers 3 case examples illustrating problematic telephone behaviors of both clients and therapists in DBT and discusses the role of the team in consulting to the therapist when difficulties arise. [Copyright &y& Elsevier]

There has been a substantial increase in the number of mass shooting incidents on college campuses in the United States in recent years. Although empirical research examined the impacts of secondary school shootings on student fear, there have been no comparable studies of the impacts of campus shootings. This study began to fill this void by examining responses to surveys administered to convenience samples of students enrolled at the University of South Carolina prior to and following the mass shooting incidents on the campuses of Virginia Tech and Northern Illinois University. Findings indicated that both shootings were associated with modest increases in various measures of fear. Other findings were that the impacts of the shootings depended on both the type of fear measured (e.g., general fear versus fear of being a victim of specific crimes) and student characteristics such as age, sex, and race. [Copyright &y& Elsevier]

Abstract: Schizophrenia spectrum disorders are rare in childhood and little is known about their psychosocial treatment. Relevant findings from the adult and child literature are reviewed. The case of 10-year-old “Michael” is presented, who participated in a randomized clinical trial of a psychoeducational family treatment for mood disorders. Following treatment, quantitative and qualitative data show that Michael''s mood and social functioning improved, utilization of mental health services improved, the overall family emotional climate became more positive, and his parents felt supported. He no longer met criteria for a mood episode but continued to display psychosis. This family''s response suggests that group psychoeducation may be an effective treatment for families of children with emerging schizophrenia spectrum disorders. [Copyright &y& Elsevier]

Abstract: Population abundance is critically important in conservation, management, and demographic theory. Thus, to better understand how perturbations to the life history affect long-term population size, we examined population momentum for four vertebrate classes with different life history strategies. In a series of demographic experiments we show that population momentum generally has a larger effect on long-term population size for organisms with long generation times than for organisms with short generation times. However, patterns between population momentum and generation time varied across taxonomic groups and according to the life history parameter that was changed. Our findings indicate that momentum may be an especially important aspect of population dynamics for long-lived vertebrates, and deserves greater attention in life history studies. Further, we discuss the importance of population momentum in natural resource management, pest control, and conservation arenas. [Copyright &y& Elsevier]

Abstract: Twelve vocational rehabilitation clients with severe mental illness received a comprehensive adaptation of dialectical behavior therapy (DBT) delivered in a group format. Treatment consisted of 2 hours of standard DBT skills training per week and 90 minutes of diary card review, chain analysis, and behavioral rehearsal. Participants were selected based on previous failure to obtain or maintain employment. The participants had a mean of 3 psychiatric diagnoses each, and all participants met criteria for a personality disorder, with 58.3% having a diagnosis of borderline personality disorder. There were 4 dropouts and 8 treatment completers. The treatment completers improved significantly and maintained their improvements (at 6-month follow-up) in depression, hopelessness, and the experience of anger. In addition, the completers improved significantly from pretreatment to 6 months follow-up on anger expression, control of anger expression, work role satisfaction, and on number of hours worked weekly. [Copyright &y& Elsevier]

Several studies have indicated that telephone coaching can play an important role in psychological intervention (; ; ). Less well understood, however, is the role of telephone coaching with severe, complex, multiproblem clients, such as those diagnosed with borderline personality disorder. Dialectical behavior therapy (DBT), a comprehensive, cognitive-behavioral treatment, provides structure and guidance in this area by describing a target hierarchy relevant to telephone coaching. In order of importance, the targets to be addressed in DBT telephone coaching are: (1) decreasing suicidal/nonsuicidal self-injurious behaviors, (2) increasing generalization of behavioral skills, and (3) decreasing the sense of conflict, alienation, and/or distance from the therapist (). This article introduces a decision-tree model for telephone contacts based upon the DBT target hierarchy for telephone coaching. The decision tree model is designed to: (a) assist therapists in identifying the type of phone call received from clients (e.g., calls related to suicide attempts/nonsuicidal self-injurious behaviors, skills generalization calls, relationship repair calls, or inappropriate calls); (b) outline a priority course of action; and (c) suggest which skills and principles of DBT apply in which circumstances. [Copyright &y& Elsevier]

Copyright of Annals of Tourism Research is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Most environments are variable and disturbances (e.g., hurricanes, fires) can lead to substantial changes in a population''s state (i.e., age, stage, or size distribution). In these situations, the long-term (i.e., asymptotic) measure of population growth rate (λ 1) may inaccurately represent population growth in the short-term. Thus, we calculated the short-term (i.e., transient) population growth rate and its sensitivity to changes in the life-cycle parameters for three bird and three mammal species with widely varying life histories. Further, we performed these calculations for initial population states that spanned the entire range of possibilities. Variation in a population''s initial net reproductive value largely explained the variation in transient growth rates and their sensitivities to changes in life-cycle parameters (all AICc ≥6.67 units better than the null model, all R 2 ≥0.55). Additionally, the transient fertility and adult survival sensitivities tended to increase with the initial net reproductive value of the population, whereas the sub-adult survival sensitivity decreased. Transient population dynamics of long-lived, slow reproducing species were more variable and more different than asymptotic dynamics than they were for short-lived, fast reproducing species. Because λ 1 can be a biased estimate of the actual growth rate in the short-term (e.g., 19% difference), conservation and wildlife biologists should consider transient dynamics when developing management plans that could affect a population''s state, or whenever population state could be unstable. [Copyright &y& Elsevier]

We analyze the ULF magnetic field emissions observed at three different field sites. Large seismic events occurred near each station. Temporal dependence of the polarization ratio (ratio of horizontal to vertical magnetic field components) has been calculated in the frequency range between 1.17 mHz and 0.5 Hz with longer than 2-year data for each event. Two of three seismic events were associated with anomalous change in the polarization ratio. Remarkable similarities were found in the ratio between these two different seismic events: (1) The ratio has a significant increase about 1 month before the earthquake (about two times larger than usual level), (2) the increase is seen in the nighttime period (22–02 LT). The frequency range of increase in the ratio depends on the earthquake (0.01–0.022 Hz for the Izu Island earthquake swarms and 0.05–0.1 Hz for the Guam earthquake). Calculated ratio based on the simple theoretical model has a good agreement with observed values for these two earthquakes. [Copyright &y& Elsevier]

We reviewed published literature to examine the effect of habitat fragmentation on avian nesting success at three spatial scales (i.e., edge, patch, and landscape scales). We identified 86 relevant manuscripts that provided 117 individual tests of hypotheses regarding the effects of habitat fragmentation on nesting success. Most papers and reviews on this topic have been narrow in scope and have not examined multiple spatial scales. However, our results suggest that the scale at which fragmentation is measured (i.e., edge, patch and landscape) and the duration of the study do influence the probability that a study will detect a fragmentation effect. Studies that measured fragmentation at landscape scales and studies conducted over several years were more likely to detect effects of fragmentation on nesting success. A recent review of research on nest predators and habitat fragmentation found a very similar scale-dependent pattern; predator effects were more prevalent when fragmentation occurs at landscape scales than patch or edge scales. Based on these findings, we recommend future research on the topic should be conducted at the landscape scale, over several years, and incorporate accompanying work on nest-predator ecology. Correspondingly, conservation actions that limit fragmentation at landscape scales should have positive impacts on nesting success rates and bird populations. [Copyright &y& Elsevier]

The delivery of substance abuse treatment within correctional settings marks one of the criminal justice system''s primary opportunities to disrupt the drugs-crime nexus. Federally funded residential substance abuse treatment programs were rapidly introduced across the nation, although implementation problems increased their operational variability. This article examines how implementation barriers interrelate with other types of obstacles and multiply to hinder determinations of program effectiveness. Specific barriers were identified from a case study of process and outcome evaluations of the South Carolina Residential Substance Abuse Treatment (RSAT) program. A conceptual framework groups barriers by type into four interrelated domains wherein additive effects and reciprocal consequences that can undermine effective program assessment are illustrated. [Copyright &y& Elsevier]