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Development of smartphone apps for mental health care has outpaced research on their effectiveness. This pilot study tested Moving ForwardThirty-three veterans seeking mental health care in U.S. Department of Veterans Affairs primary care clinics were randomly assigned to receive six sessions of PST accompanied by either the Moving Forward app (N=17) or a workbook (N=16). Participants completed measures of anxiety, depression, stress, problem-solving style, satisfaction, and between-session practice at baseline and 6- and 12-week follow-ups. Qualitative interviews were used to elicit feedback.Participants in both groups reported high satisfaction and reductions in depression, anxiety, and stress. Veterans who used the app reported skills practice, and qualitative data indicated that patients perceived the app as valuable, with the potential to reduce barriers to care.This study provides preliminary evidence to support the ability of the Moving Forward app to augment brief psychotherapy in primary care clinics.

Recent evidence implicates intensive panic control treatment (IPCT) - a full panic control treatment protocol compressed into a single weekend - as a viable alternative for Veterans with panic disorder who are unable or unwilling to commit to standard weekly cognitive behavioral therapy (CBT). However, no studies to date have examined pretreatment predictors of response to IPCT. Knowledge of such predictors may be important for understanding which Veterans are best suited for IPCT relative to standard CBT.Participants were military Veterans with a primary diagnosis of panic disorder (N = 26) who participated in three open trials of IPCT. Pretreatment predictors were tested within linear regression models used to predict panic disorder severity at 2-week and 6-month follow-up assessments. Pretreatment predictors included: Panic disorder severity, agoraphobic avoidance, PTSD symptoms, anxiety sensitivity, and age.Pretreatment symptoms of PTSD predicted reduced treatment response at 2-week but not 6-month follow-up, whereas pretreatment anxiety sensitivity predicted reduced response at 6-month but not 2-week follow-up.Current findings are tempered by the exploratory nature of the analyses and a small sample.Our study offers tentative evidence that success in IPCT may be linked to a distinct pretreatment profile relative to that of standard weekly therapy. These preliminary findings should be confirmed in larger studies that directly compare pretreatment predictors of intensive versus standard weekly CBT for panic disorder.

This article asks how the category of “mixed race” can help us think through the recent spate of violence against Asian Americans, culminating in the Atlanta mass shootings of March 2021. It further reflects on a tension within mixed-race studies: whereas mixed-race theory, in its embrace of anti-essentialism and hybridity, bespeaks a certain hope and optimism, mixed race as a lens through which to view history brings us inescapably to violence. Tracing how the concept of mixed race threads through a history of violence in this country, the article demonstrates how misogyny and racial hatred toward Asians have long been intertwined. Recent anti-Asian hate crimes surface the continuities in the targeting of Asians as a source of pollution and contagion, and in representations of Asian women as a source of sexual “temptation” that must be restricted, prohibited, or eliminated. Finally, it is argued that the turn away from the post-racialism of the Obama era and the rise of a new white nationalism call our attention to a fundamental flaw in the very premise of mixed-race theory: that is, the category of “mixed race” simultaneously unlocks the liberatory potential of nonbinary identities and reifies the problematic category of race itself.

Hip and knee replacement surgery is common, yet more than 10% of patients who undergo total hip replacement (THR) and total knee replacement (TKR) report postsurgery dissatisfaction. Recommendations for improving patient experience after total joint replacement surgery include increasing support to patients, including having a patient navigator available to patients before and after surgery. This article reports on THR and TKR patients' experiences of using an orthopaedic patient navigator. We employed qualitative description to understand THR and TKR patients' experiences of interacting with an orthopaedic patient navigator in a community teaching hospital. Telephone interviews were conducted with 15 purposefully selected total joint replacement patients (TKR: n = 11; THR: n = 4) who had at least one contact with the navigator. Interview transcripts were analyzed using thematic analysis. Patients described receiving physical support services, emotional support services, informational support services, and care coordination services from the patient navigator. All interactions with the patient navigator were positive. Knowing the patient navigator was available for any future concerns also provided indirect benefits of reassurance, comfort, and security. Patients described these direct and indirect benefits as potentially having long-lasting and resilient positive effects. An orthopaedic patient navigator can have a positive impact on patients' THR and TKR experience and fill gaps in support identified in earlier studies. Addressing patients' complex and varied care needs is well suited to a clinical nurse specialist in the role. Investing in an orthopaedic patient navigator provides reassurance to patients that their needs are a priority and will be addressed in a timely manner.

Background Echocardiographic quantification of mitral regurgitation (MR) remains challenging, requiring dedicated image acquisition, and is limited by potential error from geometric assumptions of annular dimensions. Volume is a product of area and flow and assuming proportional mitral/aortic areas, an increased mitral-inflow volume compared to LV/RV-outflow semi-quantitatively represents greater MR regurgitant volume. Therefore, we investigated the feasibility and diagnostic performance of the mitral-aortic velocity-time integral (VTI) ratio in isolated MR. We also investigated the use of the mitral-pulmonary VTI ratio as an alternative in clinical situations where the LV outflow tract (LVOT) VTI could not be used. Methods We reviewed 166 consecutive patients (54 (33% severe MR by multi-parameter integrated expert opinion)). Pulsed-Doppler VTI at the mitral leaflet tips and the left ventricular outflow and continuous-wave Doppler of the right ventricular outflow tract were measured individually and independently by blinded readers (expert and trainee status) to derive the ratio. Receiver operator characteristic area under the curve (AUC) comparison was calculated and compared with effective regurgitant orifice area (EROA >40 mm), regurgitant volume (RVol >6 0mL), vena contracta (VC >0.7 cm), E-velocity >1.2 cm, systolic flow reversal (SFR), left atrial and ventricular dilatation. Results Increasing ratio was associated with severe MR (AUC 0.94) with optimal threshold defined at 1.3. This provided significant discrimination for severe MR (AUC 0.81) compared to EROA (0.68), VC (0.52), LV dilatation (0.69), LA dilatation (0.70), SFR (0.73), E-velocity (0.68) all p Conclusions The mitral-aortic or mitral-pulmonary VTI ratio is a simple, geometric-free parameter feasibly reproducible from routine echocardiographic datasets and is an excellent discriminative tool for severe MR. Readers should consider integration of this parameter in routine reporting. Funding Acknowledgement Type of funding sources: None.

BACKGROUND Rapid infusion of warmed blood products is the cornerstone of trauma resuscitation and treatment of surgical and obstetric massive hemorrhage. Integral to optimizing this delivery is selection of an intravenous (IV) catheter and use of a rapid infusion device (RID). We investigated which IV catheter and RID system enabled the greatest infusion rate of blood products and the governing catheter characteristics. STUDY DESIGN AND METHODS The maximum flow rates of nine IV catheters were measured while infusing a mixture of packed red blood cells and fresh frozen plasma at a 1:1 ratio using a RID with and without a patient line extension. To account for IV catheters that achieved the RID's maximum 1000 ml/min, the conductance of each infusion circuit configuration was calculated. RESULTS IV catheters of 7-Fr caliber or higher reached the maximum pressurized flow rate. The 9-Fr multi-lumen access catheter (MAC) achieved the greatest conductance, over sevenfold greater than the 18 g peripheral catheter (4.6 vs. 0.6 ml/min/mmHg, p

In 1905, Boston immigration officials detained four Chinese students of the King family, inciting protest from Euro-American elites and sparking an international controversy that gave momentum to the American Boycott movement in Shanghai. A prominent family, the Kings successfully rallied business leaders to take their cause to President Theodore Roosevelt and effectively used the press to articulate Chinese grievances. Bringing to a head the tension between race-based and class-based interpretations of exclusion that troubled the legislation from its inception, the case prompted key reforms in the administration of Chinese exclusion and helped promote a pivot away from the movement for a wholesale “Chinese ban.” An examination of this incident and its role in struggles over immigration law illuminates the conflicted position of Chinese elites—disempowered by race yet empowered by class status—under exclusion. It also provides insights into the agency of Chinese elites in mobilizing resources to combat immigration abuses.

Introduction Chronic pain and posttraumatic stress disorder (PTSD) are prevalent comorbid conditions, particularly in Veterans; however, there are few integrated treatments for chronic pain and PTSD. Instead, interventions are typically implemented separately and may involve addictive opioids. Although there are highly effective, non-pharmacological treatments for PTSD, they are plagued by high dropout, which may be exacerbated by comorbid pain, as these PTSD treatments typically require increased activity. Importantly, a noninvasive pain treatment, tDCS (transcranial direct current stimulation) shows indications of effectiveness and may be integrated with psychological treatments, even when delivered via telehealth. This study examines the feasibility and initial efficacy of integrating home telehealth tDCS with prolonged exposure (PE), an evidence-based PTSD treatment. Materials and Methods Thirty-nine Veterans were contacted, 31 consented to evaluation, 21 were enrolled, and 16 completed treatment and provided pre- and post-treatment data at one of two Veterans Affairs Medical Centers. Transcranial direct current stimulation sessions corresponded with PE exposure assignments, as there is theoretical reason to believe that tDCS may potentiate extinction learning featured in PE. Results Patients evinced significant improvement in both pain interference and PTSD symptoms and a trend toward improvement in depression symptoms. However, a significant change in pain intensity was not observed, likely because of the small sample size. Discussion The findings provide initial support for the feasibility of an entirely home-based, integrated treatment for comorbid PTSD and pain.

1. Melatonin is an indole hormone that, among its myriad biological functions, regulates circadian and seasonal rhythms in animals. The

Early detection of bacterial transmission and outbreaks in hospitals is important because nosocomial infections can result in health complications and longer hospitalization. Current practice to detect outbreaks uses genotyping methods amplified fragment length polymorphism (AFLP) and whole genome sequencing (WGS), which are not suitable methods for real-time transmission screening of both susceptible and resistant bacteria. The aim was to assess the typing technique Fourier transform infrared (FTIR) spectroscopy as real-time screening method to discriminate large amounts of susceptible and resistant bacteria at strain level when there is no evident outbreak in comparison with the WGS reference. Isolates of past hospital outbreak strains of Acinetobacter baumannii/calcoaceticus complex (n = 25), Escherichia coli (n = 31), Enterococcus faecium (n = 22), Staphylococcus aureus (n = 37) and Pseudomonas aeruginosa (n = 30) were used for validation of FTIR. Subsequently, Enterococcus faecalis (n = 106) and Enterococcus faecium (n = 104) isolates from weekly routine screening samples when no potential outbreak was present were analysed. FTIR showed reproducibility and congruence of cluster composition with WGS for A. baumannii/calcoaceticus complex and E. faecium outbreak isolates. The FTIR results of E. faecalis and E. faecium isolates from routine samples showed reproducibility, but the congruence of cluster composition with WGS was low. For A. baumannii/calcoaceticus complex and E. faecium outbreak isolates, FTIR appears to be a discriminatory typing tool. However, our study shows the discriminatory power is too low to screen real-time for transmission of E. faecium and E. faecalis at patient wards based on isolates acquired in routine surveillance cultures when there is no clear suspicion of an ongoing outbreak.

Anxiety disorders are highly prevalent and can cause serious functional impairment. Cognitive-behavioral treatments are effective but they are not always readily available. One factor contributing to this problem is the large number of disorder-specific treatments that require a high level of clinician training and resources, despite the similarity in the mechanisms underlying the various anxiety disorders and their treatments. Group-based, transdiagnostic cognitive-behavioral therapy (TCBT) has been shown to reduce the burden on clinicians while maintaining strong positive treatment outcomes. Furthermore, long courses of treatment may limit some individuals' ability to participate because of issues related to transportation, work, or childcare. Research has supported the efficacy of brief, intensive treatment for anxiety. The goal of the study presented here was to combine these 2 innovative treatment modalities by examining the feasibility and acceptability of TCBT provided in an intensive weekend format. The results of this pilot study indicated that this format was acceptable to a sample of Veterans (N=13) based on their feedback. This pilot study also demonstrated that the format was feasible, as all Veterans who initiated treatment completed the entire program (N=8). Preliminary outcome data suggested that TCBT delivered in an intensive weekend format may have positive effects for individuals with anxiety, including reduction in symptoms of anxiety and depression as well as improved overall functioning. Clinical implications and directions for future research are discussed.

Evidence-based treatments for posttraumatic stress disorder (PTSD) are available for veterans, but many do not benefit due to low treatment engagement. This may be partially due to avoidance behaviors characteristic of individuals with PTSD. Acceptance and Commitment Therapy (ACT) is a transdiagnostic treatment approach that aims to reduce avoidance. The authors propose the use of adjunctive ACT techniques to enhance engagement with treatment for PTSD. ACT techniques such as cognitive defusion and values clarification have been shown to promote engagement with other cognitive-behavioral treatments, but no studies to date have examined these techniques as adjuncts to treatment for PTSD. Because of its focus on reducing avoidance, ACT is uniquely suited for promoting treatment engagement with the “gold standard” treatments for PTSD. The authors review the existing research on ACT as an adjunctive intervention, discuss specific concepts and techniques from ACT that are relevant to PTSD, and provide recommendations for future research.

Transcatheter arterial chemoembolization (TACE) is the most commonly used method for non-surgical treatment of liver cancer, and it is usually used as an adjuvant therapy in patients who have not developed intrahepatic metastases after surgical resection. Postoperative adjuvant TACE therapy may provide a prognostic benefit in liver cancer patients with high recurrence risk. This article reviews the research progress of adjuvant TACE therapy for liver cancer after radical resection.经导管肝动脉化疗栓塞术（TACE）是肝细胞癌非手术治疗的最常用方法，并常被辅助性应用于外科切除术后尚未发生肝内转移的患者。对于具有高复发风险的患者，术后辅助性的TACE治疗可为其预后带来收益。现就术后辅助性TACE治疗的研究进展进行综述。.

Hip and knee replacement surgery is common, yet more than 10% of patients who undergo total hip replacement (THR) and total knee replacement (TKR) report postsurgery dissatisfaction. Recommendations for improving patient experience after total joint replacement surgery include increasing support to patients, including having a patient navigator available to patients before and after surgery. This article reports on THR and TKR patients' experiences of using an orthopaedic patient navigator. We employed qualitative description to understand THR and TKR patients' experiences of interacting with an orthopaedic patient navigator in a community teaching hospital. Telephone interviews were conducted with 15 purposefully selected total joint replacement patients (TKR: n = 11; THR: n = 4) who had at least one contact with the navigator. Interview transcripts were analyzed using thematic analysis. Patients described receiving physical support services, emotional support services, informational support services, and care coordination services from the patient navigator. All interactions with the patient navigator were positive. Knowing the patient navigator was available for any future concerns also provided indirect benefits of reassurance, comfort, and security. Patients described these direct and indirect benefits as potentially having long-lasting and resilient positive effects. An orthopaedic patient navigator can have a positive impact on patients' THR and TKR experience and fill gaps in support identified in earlier studies. Addressing patients' complex and varied care needs is well suited to a clinical nurse specialist in the role. Investing in an orthopaedic patient navigator provides reassurance to patients that their needs are a priority and will be addressed in a timely manner.

The DArk Matter Particle Explorer (DAMPE) is a satellite-borne experiment, in operation since 2015, aimed at studying high-energy gamma rays and cosmic nuclei fluxes. Of the various sub-detectors in the DAMPE payload, the Silicon-Tungsten tracKer-converter (STK) plays a significant role in the charge measurement of incoming ions. Depending on the angle of inclination of the impinging particle and its position of impact on these strips, the collected charge can spread between the strips which results in some fractional signal loss. The $\eta$ variable is used to identify this spread of charge across the strips and correct for the associated charge loss. This brings us closer to accurate determination of particle charge which is crucial for ensuring a good discrimination between particles. The $\eta$-correction is, therefore, expected to play an important role in the determination of heavy ions by the DAMPE detector. It has helped reduce the proton background for the helium identification in STK by a factor of 1.5 for MIP tracks. It has been sucessfully applied to carbon nuclei and its application to heavier nuclei is currently being studied.

Since its launch, in December 2015, the satellite-based DAMPE (DArk Matter Particle Explorer) particle detector is taking data smoothly. The Silicon-Tungsten tracKer-converter (STK) of DAMPE consists of six tracking planes (6x, 6y) of single-sided silicon micro-strip detectors mounted on seven support trays. The STK is able to measure the charge and precisely reconstruct the track of traversing charged particles. Tungsten plates (1 mm thick) are integrated in the second, third and fourth tray from the top to serve as $\gamma \rightarrow e^+e^−$ converters. Commissioned rapidly after the launch, the STK is running extremely well since then. The STK in-orbit calibration and performance during its first more than 5 years of operation, including the noise behaviour and the thermal and mechanical stability, are presented in this contribution.

The current study systematically explored and described religious/spiritual (r/s) struggles – distress, tension, and conflict about certain aspects of r/s belief, practice, or experience – ...

BACKGROUND: Standard practice in assessing and diagnosing posttraumatic stress disorder (PTSD) entails identifying a single "worst" index event as the basis for symptom inquiry. Determining a single event can be challenging for clinicians and clients when multiple traumas are considered equally distressing. Additionally, it can be difficult to distinguish potential index events based on distress given the cumulative effect of repeated trauma exposure. This calls for the development of approaches that build on existing selection methods (e.g., worst event method). OBJECTIVE/CONCLUSIONS: In this article, we propose an innovative approach for identifying and measuring index events that utilizes the construct of event centrality to expand the parameters by which index events are selected. Event centrality assesses the degree to which traumatic events are perceived as integral to one's personal identity and worldviews. Given its role in the etiology and maintenance of PTSD symptoms, this construct also approximates the emotional impact of trauma. Incorporating validated measures of event centrality into PTSD assessments would provide an objective strategy for identifying index events in a way that may increase the reliability of diagnosis. Our proposed strategy may also have a positive impact on the therapeutic process and treatment outcomes.