Determinants of Exposure Therapy Implementation in Clinical Practice for the Treatment of Anxiety, OCD, and PTSD: A Systematic Review.

Exposure therapy (ET) forms a vital part of effective psychotherapy for anxiety-related presentations including anxiety disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), and is often underutilised in clinical practice. Using the Theoretical Domains Framework (TDF), this systematic review synthesised existing literature on the determinants of ET implementation for anxiety-related presentations and examined differences across presentations and developmental subgroups. Fifty-two eligible studies were assessed using the Mixed Methods Appraisal Tool, with 389 results (99%) mapped onto the TDF. Results suggested that clinicians' negative beliefs about the consequences of ET were commonly associated with reduced implementation. It also appeared that whilst broad unspecified ET training may be related to improved implementation for anxiety disorders; greater implementation for complex presentations (i.e., PTSD) likely requires more specialised training involving practical components. A subset of domains (e.g., social/professional role and identity) accounted for most results, whilst some remain unexplored (i.e., optimism; reinforcement; memory, attention, and decision processes) or underexplored (i.e., behavioural regulation). Likewise, specific presentations and developmental subgroups (i.e., PTSD and adults) represented a greater proportion of results in the literature than others (i.e., OCD and youth). Future research exploring ET implementation, across specific presentations and developmental subgroups, would benefit from integrating implementation science frameworks to guide the development of targeted, comprehensive strategies to close the research-practice gap of ET for the treatment of anxiety-related presentations.

The inclusion of companion forages in the diet alongside perennial ryegrass increased dry matter intake and organic matter digestibility in sheep.

The inclusion of companion forages in the diet of ruminant animals is gaining popularity in temperate regions due to observed improvements in animal performance. The aim of this study was to assess the effect of diet type on DM intake (DMI) and organic matter digestibility (OMD) in sheep. Furthermore, the effect of sward type on diet nutritive quality was investigated. Five dietary treatments were investigated using a 5 × 5 Latin square design experiment: Perennial ryegrass (Lolium perenne L.; PRG) only or PRG plus white clover (Trifolium repens L.;PRG + WC), red clover (Trifolium pratense L.; PRG + RC), chicory (Chicorium intybus L.; PRG + Chic) or plantain (Plantago lanceolata L.; PRG + Plan) at a ratio of 75% PRG and 25% of the respective companion forage and 100% PRG for the grass only treatment on a DM basis. Twenty Belclare castrated male (wether) sheep were housed in metabolism crates across five feeding periods. Individual DMI and faecal output were recorded daily and digestibility parameters were subsequently calculated. Results show that the inclusion of any companion forage increased DMI (kg/day DM) which ranged from 1.55 ± 0.038 (PRG) to 1.76 ± 0.038 (PRG + Chic) (P < 0.001). The PRG + WC (825 ± 1.1), PRG + RC (823 ± 1.1) and PRG + Chic (826 ± 1.1) diets had a greater in vitro OMD (g/kg DM) when compared to PRG (819 ± 1.1) or PRG + Plan (816 ± 1.1) (P < 0.001). Furthermore, the PRG + Chic (830 ± 2.9) diet had a greater in vivo OMD (g/kg DM) (P < 0.01) when compared to the PRG, PRG + RC, and PRG + Plan diets. Regression analysis showed that in vitro estimates moderately reflected in vivo measurements (r2 = 0.61). The inclusion of any companion forage increased dietary CP content and reduced the proportion of NDF in the diet. Crude protein concentration increased by an average of 16.5 g/kg DM and NDF content was reduced by 25.3 g/kg DM, on average, with companion forage inclusion (P < 0.001). Results suggest that binary sward mixtures benefit pasture-based sheep production systems, boosting sward quality, aiding increased DM intakes of a more digestible diet in the summer period.

Bio-economic modelling of sheep meat production systems with varying flock litter size using field data.

Sheep meat producers derive the majority of income from sales of weaned lambs, determined by flock conception rates, litter size, and lamb survival. Field data from commercial flocks can inform sensitivity analyses of the effect of litter size on flock productivity, feed demand, and gross margin. This study adapted an established bio-economic model of a flock of breeding ewes informed by statistical relationships (from linear models) between flock litter size (lambs born per ewe lambing) and production factors (such as flock barren rate, litter birth type and lamb birth weight) identified using 156 145 animal records from the Irish national sheep breeding database. Sensitivity analyses were undertaken to investigate the effects of flock litter size on flock production, feed demand, and gross margin. Results showed that as flock litter size increased, the proportion of lambs born as multiples increased, with 14 % of lambs born as singles when flock litter size was 2.2 lambs born per ewe lambing. Flock gross margin increased from €2 205 to €7 730 as litter size increased from 1.0 to 2.0 lambs born per ewe lambing. As litter size increased from 1.0 to 2.2 lambs born per ewe lambing, flock gross margin increased linearly by, on average, €52 per 0.01 increase in litter size. At a litter size of > 2.2 lambs born per ewe lambing, flock gross margin increased on average €12 per 0.01 increase in litter size. At a litter size of 2.2 lambs born per ewe lambing, flock efficiency (at 65.0 kg of lamb weaned per ewe presented for breeding), weaning rate (at 1.5 lambs weaned per ewe presented for breeding; not including excess lambs from large litters sold within a week after birth and thus not weaned on-farm), and gross margin (at €8 500) began to plateau. The results indicate lower marginal returns in gross margin at very high flock litter size, due to the lower value of additional lambs born as triplets and quadruplets compared with single- and twin-born lambs. However, the diminishing economic returns occurred at higher flock litter size than are currently biologically achieved in most flocks. Quantification from this analysis demonstrates how the value of increasing the number of lambs born changes at very high flock litter size, which can inform the priorities and performance benchmarking for international sheep meat production industries.

Revitalizing the drug pipeline: AntibioticDB, an open access database to aid antibacterial research and development.

The current state of antibiotic discovery, research and development is insufficient to respond to the need for new treatments for drug-resistant bacterial infections. The process has changed over the last decade, with most new agents that are in Phases 1-3, or recently approved, having been discovered in small- and medium-sized enterprises or academia. These agents have then been licensed or sold to large companies for further development with the goal of taking them to market. However, early drug discovery and development, including the possibility of developing previously discontinued agents, would benefit from a database of antibacterial compounds for scrutiny by the developers. This article describes the first free, open-access searchable database of antibacterial compounds, including discontinued agents, drugs under pre-clinical development and those in clinical trials: AntibioticDB (AntibioticDB.com). Data were obtained from publicly available sources. This article summarizes the compounds and drugs in AntibioticDB, including their drug class, mode of action, development status and propensity to select drug-resistant bacteria. AntibioticDB includes compounds currently in pre-clinical development and 834 that have been discontinued and that reached varying stages of development. These may serve as starting points for future research and development.

'Her cry is my cry': resettlement experiences of refugee women at risk recently resettled in Australia.

OBJECTIVES: Refugee women entering resettlement countries on woman-at-risk visas represent a particularly vulnerable population. While their specific gender-based resettlement will likely differ from the general refugee population, little is known about their experiences of early resettlement, with which to inform resettlement policy and practice. This research aimed to explore lived experiences of recently resettled refugee women at risk in Australia. STUDY DESIGN: Qualitative research used focus groups and a framework approach to identify and explicate common themes in participants' experience. METHODS: Two focus groups with a purposive sample of African and Afghan refugee women at risk (N = 10), aged 22-53 years, were conducted in South East Queensland, Australia (October 2016), recruited with the assistance of a local resettlement service. Discussions were audiotaped, transcribed, and themes explicated. RESULTS: Six superordinate themes emerged: (1) sentiment of gratitude; (2) sense of loneliness and disconnection; (3) feeling incapable; (4) experiencing distress and help-seeking; (5) experiencing financial hardship; and (6) anticipating the future. CONCLUSIONS: Findings indicate that resettlement policy, programs, and practice that explicitly target the needs of women-at-risk refugees are warranted, including a longer period of active service provision with specific attention to strategies that address the women's social connection, self-efficacy, emotional well-being, and financial hardships.

Alcohol and depression: Evidence from the 2014 health survey for England.

BACKGROUND: A relatively large body of literature examines the association between depression and alcohol consumption, with evidence suggesting a bidirectional causal relationship. However, the endogeneity arising from this reverse causation has not been addressed in the literature. METHODS: Using data on 5828 respondents from the Health Survey for England (HSE), this study revisits the relationship between alcohol and depression and addresses the endogenous nature of this relationship. We use information on self-assessed depression, and control for endogeneity using the Lewbel two-staged least square (2SLS) estimation technique. RESULTS: We find that drinking alcohol promotes depression, and this is consistent across several measures of drinking behaviour including the amount of alcohol consumed, consumption intensity, alcohol dependence and risk of dependence. CONCLUSION: While drinking may be generally accepted and in the case of England, part of the culture, this has costs in terms of both physical and mental health that ought not to be ignored. While public policy has predominantly focused on the physical aspects of excessive alcohol consumption it is possible that these policies will also have a direct positive spillover in terms of the mental health costs, through the impact of lower alcohol consumption on quality of life and wellbeing.

Evaluation of a pilot school-based physical activity challenge for primary students.

Issue addressed Physical inactivity and sedentary behaviour among children are growing public health concerns. The Culture Health Communities Activity Challenge (hereafter known as the Challenge) is a school-based pedometer program in which classes compete to achieve the highest class average daily steps in an 8-week period. The Challenge aims to encourage physical activity in primary school students, with a focus on engaging Aboriginal students. The program was piloted in 15 classes in New South Wales in 2014. Methods The evaluation aimed to explore students' and teachers' experiences of the Challenge, and assess its impact on the students' physical activity levels. Data sources were a pre- and post-intervention survey of students' physical activity levels and sedentary time (n=209), qualitative interviews with teachers (n=11) and discussions with 10 classes. Results Fifteen Year 5 and 6 classes comprising 318 students participated. Fifty percent of participants were girls, the average age was 11 years and the majority (57%) were Aboriginal students. Participation in the Challenge was associated with a slight but statistically significant increase in students' physical activity levels (P<0.05), and a significant decrease in weekend screen time (P<0.05). However, when stratified by Aboriginality these changes were not statistically significant for Aboriginal students. Qualitative feedback from teachers and students indicated high levels of engagement and satisfaction with the Challenge. Teachers and students reported positive impacts, including increased motivation to be physically active, and improved student attendance and engagement in class activities and teamwork. Conclusions Participation in the Challenge was associated with increased physical activity and decreased screen time for some students. Students and teachers also reported a range of positive social and educational outcomes. So what? The findings highlight the importance of primary schools as a setting for health promotion activities, and demonstrate that school-based physical activity programs can be engaging and appropriate for classes with high proportions of Aboriginal students.

Ancient texts to PubMed: a brief history of the peer-review process.

The formal evaluation of scientific literature by invited referees (peer reviewers) is a relatively recent phenomenon and now is considered a cornerstone of modern science. However, its roots can be traced back to antiquity. As the speed and complexity of scientific information and publishing increases in the digital age, peer review must continue to evolve. To understand the future direction of peer review, we must understand its past. Here, we briefly explore the history of scientific peer review. This may help us predict and design appropriate peer review for the new era. This work was originally presented at the Pediatric Academic Societies Annual Meeting in Baltimore, Maryland in the Spring of 2016.

Vitamin A provision for preterm infants: are we meeting current guidelines?

BACKGROUND: Preterm infants have reduced liver stores of vitamin A at birth compared to term born infants. Current guidelines recommend an intake of 700-1500 IU/kg/day vitamin A, and there is evidence to support higher doses for infants with significant lung disease. The importance of appropriate early nutrition for preterm infants is increasingly becoming apparent. OBJECTIVES: To examine whether preterm infants admitted to a UK neonatal unit received the currently recommended amounts of vitamin A during the first 4 weeks of life, and to identify the feeding patterns associated with optimal vitamin A intake. DESIGN: Retrospective case note review. SETTING: UK tertiary neonatal unit. POPULATION: 36 preterm infants with a median gestation of 30 weeks (range 26-33 weeks) and median birth weight of 1305 g (range 880-1800 g). MAIN OUTCOME MEASURE: Mean daily total intake of vitamin A in each of the first 4 weeks of life. RESULTS: Despite a policy of introducing intravenous lipid supplemented with fat soluble vitamins on day 2, only four infants (11%) consistently met the recommended daily intake of vitamin A during the first 2 weeks of life. Adequacy of vitamin A intake in the first 2 weeks of life was not predicted by gestation or pattern of feeding. CONCLUSION: Recommendations for intravenous vitamin A supplementation in parenterally fed preterm infants require revision. Intravenous lipid with added fat soluble vitamins should be started as soon as possible after birth, and consideration given to early oral vitamin A supplementation in those infants tolerant of enteral feeds.

Impaired episodic LH secretion in female mice with GFP in GnRH neurons.

The ability to assess the activity of gonadotropin-releasing hormone (GnRH) neurons has been greatly enhanced by transgenic animal models with targeted expression of green fluorescent protein (GFP). However, it has yet to be demonstrated that the GnRH system continues to exhibit a full range of normal physiological functions in the presence of such genetic manipulation. Accordingly, we have used repetitive blood sampling via indwelling venous catheters to define LH secretory patterns in normal and transgenic mice. Transgenic females proved to be reproductively competent as defined by fecundity, appropriate cyclic changes in vaginal cytology in intact adult females, and spontaneous LH surges as well as surges in response to steroid or mating stimuli. The expression of c-fos following such steroid treatment and mating in ovariectomized transgenics was similar to the expression previously reported in nontransgenic mice. Likewise, the percentage of retrogradely labeled GnRH neurons was similar to that reported in nontransgenic mice. However, episodic LH secretion, an index of GnRH pulse generator activity, was dramatically compromised in ovariectomized female transgenics compared with C57BL6 controls of both sexes and castrated transgenic males. Taken together, these findings suggest that the GnRH pulse generator is selectively impaired in ovariectomized females in which GnRH neurons express GFP.

Exploring opportunities for collaboration between the corporate sector and the dental education community.

The ultimate purpose of both dental industry and dental education is to improve the oral health of the public. This report provides background information on the different roles and objectives of the dental industry and dental education communities, the different operating environment of each sector and also areas of common interest where collaboration will be of mutual benefit. The report addresses five areas for potential collaboration between the dental industry and the dental education communities: 1. Contribution to joint activities. 2. Effectiveness and efficiency. 3. Workforce needs. 4. Middle- and low-income countries. 5. The future of International Federation of Dental Educators and Associations (IFDEA). The traditional areas of support and their limitations that have been provided by industry are outlined in the report and some new approaches for collaboration are considered. Industry-based research has been an important factor in developing new products and technologies and in promoting oral health. However there is a need to facilitate the introduction of these developments at an early stage in the education process. Industry has to operate in an efficient manner to remain competitive and maximise its returns and therefore survive. The academic sector operates in a different environment and under different governance structures; although some trends are noted towards adoption of greater efficiency and financial accountability similar to industry. Opportunities to jointly develop best business practices should be explored. Industry has responded well to the oral health needs of the public through the development of new products and technologies. The education community needs to respond in a similar way by examining different healthcare delivery models worldwide and developing programmes to train members of the dental team to cater for future needs and demands of communities in different regions of the world. The reputation of industry-based scientists and clinicians is high, and their role in contributing to the dental education process in practical ways needs to be explored and further developed. Closer relationships between industry scientists and faculty and students could assist industrys need and desire to develop new technologies for the broader dental care system. The corporate sector can play a key role in the future success of IFDEA by providing support and expertise in developing areas such as regional leadership institutes, a Global Faculty and Network and in collaborating in developing continuing education programmes as well as involvement in its governance. Thirteen recommendations are made in the report. These are considered to be important initial steps in developing the already strong relationship between the education and corporate sectors. Partnership and collaborating more effectively along the lines suggested should, almost certainly, generate mutually beneficial outcomes, whilst serving over the long term to elevate the publics oral health status on a global basis.

Association of maternal killer-cell immunoglobulin-like receptors and parental HLA-C genotypes with recurrent miscarriage.

BACKGROUND: The natural killer (NK) cells at the site of placentation express killer-cell immunoglobulin-like receptors (KIR) that can bind to human leukocyte antigen (HLA)-C molecules on trophoblast cells. Both these gene systems are polymorphic and an association of particular maternal KIR/fetal HLA-C genotypes has been shown in pre-eclampsia. Pre-eclampsia and recurrent miscarriage (RM) share the pathogenesis of defective placentation and therefore we have now genotyped couples with RM. METHODS AND RESULTS: DNA was obtained from the male (n = 67) and female (n = 95) partners of couples with three or more spontaneous miscarriages and genotyped for HLA-C groups and 11 KIR genes using the PCR-sequence-specific primer method (SSP). The frequency of the HLA-C2 group was increased in both parents (reaching significance only in the male partners, P = 0.018) compared with a parous control population. The KIR gene frequencies of the male partners were similar to controls, but the women had a high frequency of KIR AA haplotypes that lack activating KIR. In particular, the activating KIR for HLA-C2 groups (KIR2DS1) was significantly lower in these women (P = 0.00035, odds ratio 2.63, confidence interval 1.54-4.49). CONCLUSIONS: This is the first report to identify a genetic male factor that confers risk in RM. These findings support the idea that successful placentation depends on the correct balance of NK cell inhibition and activation in response to trophoblast.

Glutamate receptor abnormalities in the YAC128 transgenic mouse model of Huntington's disease.

A yeast artificial chromosome (YAC) mouse model of Huntington's disease (YAC128) develops motor abnormalities, age-dependent striatal atrophy and neuronal loss. Alteration of neurotransmitter receptors, particularly glutamate and dopamine receptors, is a pathological hallmark of Huntington's disease. We therefore analyzed neurotransmitter receptors in symptomatic YAC128 Huntington's disease mice. We found significant increases in N-methyl-d-aspartate, AMPA and metabotropic glutamate receptor binding, which were not due to increases in receptor subunit mRNA expression levels. Subcellular fractionation analysis revealed increased levels of glutamate receptor subunits in synaptic membrane fractions from YAC128 mice. We found no changes in dopamine, GABA or adenosine receptor binding, nor did we see alterations in dopamine D1, D2 or adenosine A2a receptor mRNA levels. The receptor abnormalities in YAC128 transgenic mice thus appear limited to glutamate receptors. We also found a significant decrease in preproenkephalin mRNA in the striatum of YAC128 mice, which contrasts with the lack of change in levels of mRNA encoding neurotransmitter receptors. Taken together, the abnormal and selective increases in glutamate receptor subunit expression and binding are not due to increases in receptor subunit expression and may exert detrimental effects. The decrease in preproenkephalin mRNA suggests a selective transcriptional deficit, as opposed to neuronal loss, and could additionally contribute to the abnormal motor symptoms in YAC128 mice.

Huntingtin inclusions do not down-regulate specific genes in the R6/2 Huntington's disease mouse.

Transcriptional dysregulation is a central pathogenic mechanism in Huntington's disease (HD); HD and transgenic mouse models of HD demonstrate down-regulation of specific genes at the level of mRNA expression. Furthermore, neuronal intranuclear inclusions (NIIs) have been identified in the brains of R6/2 mice and HD patients. One possibility is that NIIs contribute to transcriptional dysregulation by sequestering transcription factors. We therefore assessed the relationship between NIIs and transcriptional dysregulation in the R6/2 mouse, using double-label in situ hybridization combined with immunohistochemistry, and laser capture microdissection combined with quantitative real-time PCR. There was no difference in transcript levels of specific genes between NII-positive and NII-negative neurons. These results demonstrate that NIIs do not cause decreases in D2, PPE and PSS mRNA levels in R6/2 striatum and therefore are not involved in the down-regulation of these specific genes in this HD model. In addition, these observations argue against the notion that NIIs protect against transcriptional dysregulation in HD.

Injuries in women's professional soccer.

OBJECTIVE: The injury data from the first two seasons of the Women's United Soccer Association (WUSA) were analysed to determine the injury incidence, anatomic location of injuries, and relation of player position. METHODS: Injury data on 202 players from eight teams during the first two seasons of the WUSA were prospectively collected and analysed. RESULTS: A total of 173 injuries occurred in 110 players with an overall injury incidence rate of 1.93 injuries per 1000 player hours. The incidence of injury during practice and games was 1.17 and 12.63 per 1000 player hours, respectively. Of the injuries 82% were acute and 16% were chronic. Most of the injuries (60%) were located in the lower extremities. Strains (30.7%), sprains (19.1%), contusions (16.2%), and fractures (11.6%) were the most common diagnoses and the knee (31.8%) and head (10.9%) were the most common sites of injury. Anterior cruciate ligament (ACL) injuries accounted for 4.6% of all injuries and the incidence of ACL tears was 0.09 per 1000 player hours (practice 0.04, game 0.90). Midfielders suffered the most injuries (p<0.007). CONCLUSION: We conclude that the injury incidence in the WUSA is lower than the 6.2 injuries per 1000 player hours found in the corresponding male professional league (Major League Soccer); however, knee injuries predominate even in these elite female athletes.

Acromegaly secondary to growth hormone releasing hormone secretion.

BACKGROUND: Acromegaly secondary to growth hormone releasing hormone (GHRH) secretion is exceptionally rare. AIM: To report a case of acromegaly diagnosed in 1984 and assumed to be pituitary in origin. Sixteen years later, the cause was found to be a GHRH secreting neuroendocrine pancreatic tumour. METHOD: A case report. CONCLUSION: Although ectopic GHRH production is very rare, endocrinologists should be aware of this possibility in acromegaly patients if a pituitary tumour was not detected using pituitary imaging.

Opioids - Effects on Human Performance and Behavior.

The purpose of the monograph is to provide readers with a summary of the literature relating selected opioids to performance issues, specifically driving. This monograph provides a summary of information to aid expert witnesses in preparing for court testimony. Information for codeine, hydrocodone, hydromorphone, methadone, morphine, and oxycodone is provided. In addition to a review of performance studies, a summary of acute and chronic pharmacology, pharmacokinetics, and metabolism is included. Opioids appear to impair psychomotor functioning likely to be important to the performance of complex, divided attention tasks such as driving. This impairment is notably more prevalent in individuals with no history of opioid use; individuals with long-term opioid use do not demonstrate as extensive of an impairment. Other factors such as personality, environment, and pain control also sharply modulate opioid impairment.

Motor vehicle crashes in New York State: importance of accounting for emergency department deaths when assessing differences in in-hospital mortality by level of care.

BACKGROUND: Motor vehicle crashes (MVCs) are one of the leading causes of death in the nation and in New York State, particularly among younger adult males. It is important to study how to reduce mortality from MVCs. METHODS: Hospitalized victims of motor vehicle crashes in the 1994-1995 New York State Trauma Registry were identified for the study. A statistical model was used to calculate risk-adjusted mortality rates for groups of hospitals constituting each level of care (regional trauma center, area trauma center, noncenter). Levels of care were also compared with respect to the location of deaths in the hospital (emergency department, inpatient), and the time between emergency department admission and death for patients dying in the hospital. RESULTS: The risk-adjusted mortality rate for MVCs in patients in regional centers was higher, although not significantly higher (6.91%; 95% confidence interval [CI], 6.18%-7.70%) than for area centers (5.53%; 95% CI, 4.43%-6.82%) or for noncenters (5.83%; 95% CI, 4.70%-7.15%). However, regional centers admitted seriously injured trauma patients from the emergency department much more quickly than other levels of care. Whereas only 18% of all in-hospital deaths occurred in emergency departments of regional centers, the comparable percentages for area centers and noncenters were 39% and 46%, respectively. Also, 43% of all deaths in regional centers occurred within 24 hours of presentation to the emergency department, compared with 15% in area centers and 21% in noncenters. CONCLUSION: Risk-adjusted inpatient mortality rates for victims of MVCs may not yield a fair comparison of performance for different levels of care or for different hospitals because of differences in how quickly emergency department patients are admitted to the hospital. A more equitable way to assess hospital mortality rates may be to include emergency department deaths in addition to inpatient deaths.