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Background: Delay discounting (DD), the decrease in reward valuation as a function of delay to receipt, is a key process undergirding alcohol use. Narrative interventions, including episodic future thinking (EFT), have decreased delay discounting and demand for alcohol. Rate dependence, the relationship between a baseline rate and change in that rate after an intervention, has been evidenced as a marker of ef- ficacious substance use treatment, but whether narrative interventions have rate dependent effects needs to be better understood. We investigated the effects of narrative interventions on delay discounting and hypothetical demand for alcohol in this longitudinal, online study. Methods: Individuals (n = 696) reporting high-or low risk alcohol use were recruited for a longitudinal 3 week survey via Amazon Mechanical Turk. Delay discounting and alcohol demand breakpoint were assessed at baseline. Individuals returned at weeks 2 and 3 and were randomized into the EFT or scarcity narrative interventions and again completed the delay discounting tasks and alcohol breakpoint task. Oldham's correlation was used to explore the rate-dependent effects of narrative interventions. Study attrition as a function of delay discounting was assessed. Results: Episodic future thinking significantly decreased, while scarcity significantly increased delay discounting relative to baseline. No effects of EFT or scarcity on the alcohol demand breakpoint were observed. Significant rate-dependent effects were observed for both narrative intervention types. Higher delay discounting rates were associated with a greater likelihood of attrition from the study. Conclusion: The evidence of a rate-dependent effect of EFT on delay discounting rates offers a more nuanced, mechanistic understanding of this novel therapeutic intervention and can allow more precise treatment targeting by demonstrating who is likely to receive the most benefit from it. NIAAA [R01 AA027381]; Fralin Biomedical Research Institute at VTC Published version This work was supported by NIAAA R01 AA027381 and the Fralin Biomedical Research Institute at VTC. The funders had no role other than financial support.

Subjective cognitive decline (SCD) and depressive symptoms (DS) frequently co-occur prior to dementia. However, the temporal sequence of their emergence and their combined prognostic value for cognitive decline and dementia is unclear.Temporal relationships of SCD, DS and memory decline were examined by latent difference score modeling in a high-aged, population-based cohort (N = 3217) and validated using Cox-regression of dementia-conversion. In 334 cognitively unimpaired SCD-patients from memory-clinics, we examined the association of DS with cognitive decline and with cerebrospinal fluid (CSF) Alzheimer's disease (AD) biomarkers.In the population-based cohort, SCD preceded DS. High DS were associated with increased risk of dementia conversion in individuals with SCD. In SCD-patients from memory-clinics, high DS were associated with greater cognitive decline. CSF Aß42 predicted increasing DS.SCD typically precedes DS in the evolution to dementia. SCD-patients from memory-clinics with DS may constitute a high-risk group for cognitive decline.Subjective cognitive decline (SCD) precedes depressive symptoms (DS) as memory declines. Emerging or persistent DS after SCD reports predict dementia. In SCD patients, more amyloid pathology relates to increasing DS. SCD patients with DS are at high risk for symptomatic progression.

ObjectiveAround 25% of cancer patients experiences depressive symptoms. However, the majority does not receive formal psychological care because patients often prefer managing symptoms alone or with informal social support. Previous research has shown that adaptive coping and social support can indeed be effective in managing relatively mild depressive symptoms. However, higher depressive symptom levels rarely improve without psychological treatment. This longitudinal study examined how and to what extent coping and social support are related to reductions in depressive symptoms in cancer patients with moderate to severe depressive symptoms.MethodsRespondents were diagnosed with cancer in the past five years, experienced high depressive symptom levels (PHQ-9 ≥ 10) and were not receiving psychological care at baseline. We collected data with self-report questionnaires (including PHQ-9, brief COPE and Social Support List) at two assessments, taken three months apart.ResultsAlthough depressive symptoms decreased significantly between baseline and follow-up, the average level at follow-up was still moderate to severe. Patients using less avoidant coping, specifically less substance use, were more likely to report a reduction of depressive symptoms. We found no significant beneficial effects of approach coping and social support (coping) on the course of depressive symptoms.ConclusionsA significant group of cancer patients with high levels of depressive symptoms do not seem able to effectively manage depressive symptoms by themselves, especially those more likely to avoid dealing with their symptoms. Cancer patients can be educated about avoidant coping and its possible detrimental effects, as well as being informed about possibilities of psychosocial services.

Individual participant data meta-analysis is a frequently used method to combine and contrast data from multiple independent studies. Bayesian hierarchical models are increasingly used to appropriately take into account potential heterogeneity between studies. In this paper, we propose a Bayesian hierarchical model for individual participant data generated from the Cigarette Purchase Task (CPT). Data from the CPT details how demand for cigarettes varies as a function of price, which is usually described as an exponential demand curve. As opposed to the conventional random-effects meta-analysis methods, Bayesian hierarchical models are able to estimate both the study-specific and population-level parameters simultaneously without relying on the normality assumptions. We applied the proposed model to a meta-analysis with baseline CPT data from six studies and compared the results from the proposed model and a two-step conventional random-effects meta-analysis approach. We conducted extensive simulation studies to investigate the performance of the proposed approach and discussed the benefits of using the Bayesian hierarchical model for individual participant data meta-analysis of demand curves.

Background: Previous studies have shown that men with HIV and germ cell cancer (HIV-GCC) have inferior overall survival (OS) in comparison with their HIV-negative counterparts. However, little information is available on treatments and outcomes of HIV-GCC in the era of combination antiretroviral therapy (cART). Methods: This study examined men living with HIV who were 18 years old or older and had a diagnosis of histologically proven germ cell cancer (GCC). The primary outcomes were OS and progression-free survival (PFS). Results: Data for 89 men with a total of 92 HIV-GCCs (2 synchronous GCCs and 1 metachronous bilateral GCC) were analyzed; among them were 64 seminomas (70%) and 28 nonseminomas (30%). The median age was 36 years, the median CD4 T-cell count at GCC diagnosis was 420 cells/µL, and 77% of the patients on cART had an HIV RNA load < 500 copies/mL. Stage I disease was found in 44 of 79 gonadal GCCs (56%). Among 45 cases with primary disseminated GCC, 78%, 18%, and 4% were assigned to the good-, intermediate-, and poor-prognosis groups, respectively, of the International Germ Cell Cancer Collaborative Group. Relapses occurred in 14 patients. Overall, 12 of 89 patients (13%) died. The causes of death were refractory GCC (n = 5), an AIDS-defining illness (n = 3), and other causes (n = 4). After a median follow-up of 6.5 years, the 5- and 10-year PFS rates were 81% and 73%, respectively, and the 5- and 10-year OS rates were 91% and 85%, respectively. Conclusions: The 5- and 10-year PFS and OS rates of men with HIV-GCC were similar to those reported for men with HIV-negative GCC. Patients with HIV-GCC should be managed identically to HIV-negative patients. Lay Summary: Men living with HIV are at increased risk for germ cell cancer (GCC). Previous studies have shown that the survival of men with HIV-associated germ cell cancer (HIV-GCC) is poorer than the survival of their HIV-negative counterparts. This study examined the characteristics, treatments, and outcomes of 89 men with HIV-GCC in the era of effective combination antiretroviral therapies. The long-term outcomes of men with HIV-GCC were similar to those reported for men with HIV-negative GCC. Patients with HIV-GCC should be managed identically to HIV-negative patients.

With the wider availability of full-color 3D printers, color-accurate 3D-print preparation has received increased attention. A key challenge lies in the inherent translucency of commonly used print materials that blurs out details of the color texture. Previous work tries to compensate for these scattering effects through strategic assignment of colored primary materials to printer voxels. To date, the highest-quality approach uses iterative optimization that relies on computationally expensive Monte Carlo light transport simulation to predict the surface appearance from subsurface scattering within a given print material distribution; that optimization, however, takes in the order of days on a single machine. In our work, we dramatically speed up the process by replacing the light transport simulation with a data-driven approach. Leveraging a deep neural network to predict the scattering within a highly heterogeneous medium, our method performs around two orders of magnitude faster than Monte Carlo rendering while yielding optimization results of similar quality level. The network is based on an established method from atmospheric cloud rendering, adapted to our domain and extended by a physically motivated weight sharing scheme that substantially reduces the network size. We analyze its performance in an end-to-end print preparation pipeline and compare quality and runtime to alternative approaches, and demonstrate its generalization to unseen geometry and material values. This for the first time enables full heterogenous material optimization for 3D-print preparation within time frames in the order of the actual printing time.

BACKGROUND: Substance use recovery is a dynamic process. Relapse, often part of the recovery process, is a persistent problem for individuals seeking freedom from their harmful substance use and has become a focus of research on the improvement of recovery outcomes. Delay discounting is associated with substance use disorder severity, both its negative outcomes and the propensity to relapse. However, the association between delay discounting and perceived risk of relapse as measured by the Alcohol Warning of Relapse (AWARE) Questionnaire has not previously been examined in a population of those in long-term recovery from substance misuse. METHODS: In this study, using data collected from the International Quit and Recovery Registry, we investigated the association between delay discounting, self-reported time in recovery, and perceived risk of relapse. Data from 193 individuals self-reporting to be in recovery from harmful substance use were included in the study. RESULTS: Delay discounting rates were significantly negatively associated with length of recovery (p =.036), and positively with perceived risk of relapse (p =.027) even after controlling for age, gender, education, marital status, ethnicity, race, primary substance, and length in the registry. Moreover, a mediation analysis using Hayes’ methods revealed that the association between the length of recovery and perceived relapse risk was partially mediated by delay discounting, accounting for 21.2% of the effect. CONCLUSIONS: Our finding supports previous characterizations of delay discounting as a candidate behavioral marker of substance misuse and may help identify individuals at higher perceived risk of relapse in an extended recovery population.

OBJECTIVES There is a lack of studies identifying the correlates of institutionalization specifically among the oldest old. Therefore, our aim was to fill this gap in knowledge. METHODS Cross-sectional data (Follow up wave 9; n = 633 observations in the analytical sample) were used from the multicenter prospective cohort study "Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)" Correlates of institutionalization among the oldest old-Evidence from a multicenter cohort study. The sample consists of primary care patients aged 86 years and over (mean 90.5 years, SD: 2.9 years). Sociodemographic and health-related independent variables were included in our regression model. Institutionalization was defined as living in a nursing home or an old-age home (not including assisted living facilities). RESULTS Out of the 633 participants, 502 individuals (79.3%) did not live in an institutionalized setting, whereas 73 individuals (20.7%) lived in an institutionalized setting. Multiple logistic regressions showed that the likelihood of institutionalization increased with being divorced/widowed/single (compared to being married; OR: 5.35 [95% CI: 1.75-16.36]), the presence of social isolation (OR: 2.07 [1.20-3.59]), more depressive symptoms (OR: 1.11 [1.01-1.23]), increased cognitive impairment (OR: 1.67 [1.31-2.15]) and higher levels of frailty (OR: 1.48 [1.07-2.06]). CONCLUSION The study findings identified various sociodemographic and health-related factors associated with institutionalization among the oldest old. Longitudinal studies are required to gain further insights into these associations.

Alien invasive aquatic macrophytes tend to displace native species and transform diverse macrophyte communities into monospecific stands. It is often thought that superior competitiveness allows alien invaders to achieve this. Cabomba caroliniana is a submersed macrophyte that is highly invasive worldwide and frequently monopolises habitats. However, field observations in Queensland, Australia, found that the native floating attached Nymphoides indica can co-exist with C. caroliniana, highlighting N. indica as a potential candidate for habitat restoration. To identify factors and processes that regulate the coexistence of these species, we conducted a field survey and two experiments in artificial mesocosms. We found that N. indica leaf areal coverage of the water surface significantly reduced C. caroliniana standing crop biomass in the field. C. caroliniana growth was also linked to water depth; N. indica was not able to grow beyond 2 m depth. There was a small reduction in N. indica root and shoot biomass when co-cultured with C. caroliniana in our experiment. Therefore, there was reciprocal competitive inhibition between the two species. However, the effect of N. indica on C. caroliniana was much larger. There was evidence that a reduction of C. caroliniana biomass below a threshold of c. 300 g dry mass/m is critical for protecting native submersed macrophyte diversity and abundance. Once C. caroliniana biomass exceeds this threshold, it dominates plant communities and forms high biomass monocultures. The experimental work identified shading as the most important factor that reduces C. caroliniana biomass, corroborating the relationship between leaf areal cover and C. caroliniana biomass found in the field. Based on these findings, N. indica could be useful for restoring the shallow lake littoral habitat, because it suppresses biomass of the invasive species to a level that allows other macrophytes to coexist and additionally increases habitat heterogeneity. Similarly, N. indica could be suitable to restore areas where C. caroliniana was previously removed to reduce the likelihood of future habitat monopolisation by C. caroliniana and realise long-term ecological benefits from invasive macrophyte management.

Anogenital and oropharyngeal infections with human papilloma viruses (HPV) are common. Clinically manifest disease may significantly impact quality of life; the treatment of HPV-associated lesions is associated with a high rate of recurrence and invasive neoplasms, such as cervical, anal, vulvar, penile, and oropharyngeal cancers, which are characterized by significant morbidity and mortality. Vaccination against HPV is an effective and safe measure for the primary prevention of HPV-associated lesions, but immunization rates are still low in Germany. The present publication is an abridged version of the German evidence and consensus-based guideline "Vaccination recommendations for the prevention of HPV-associated lesions", which is available on the website of the German Association of the Scientific Medical Societies (AWMF). On the basis of a systematic review with meta-analyses, a representative panel developed and agreed upon recommendations for the vaccination of different populations against HPV. In addition, consensus-based recommendations were developed for specific issues relevant to everyday practice. Based on current evidence and a representative expert consensus, these recommendations are intended to provide guidance in a field in which there is often uncertainty and in which both patients and health care providers are sometimes confronted with controversial and emotionally charged points of view.