Five-Year Serial Brain MRI Analysis of Military Members Exposed to Chronic Sub-Concussive Overpressures.

BACKGROUND: The Canadian Special Operations Forces Command conducts explosives operations and training which exposes members to explosive charges at close proximity. This 5-year longitudinal trial was conducted in follow-up to our initial trial which examined military breachers with MRI and EEG pre and post blast exposure. PURPOSE: To examine brain MRI findings in military personnel exposed to multiple repeated blast exposures. STUDY TYPE: Five-year longitudinal prospective trial. POPULATION: Ninety-two males aged 23-42 with an average of 9.4 years of blast exposure. FIELD STRENGTH/SEQUENCE: 3 T brain MRI/T1-weighted 3D with reconstruction in three planes, T2-weighted, T2-weighted fluid attenuated inversion recovery (FLAIR) 3D with reconstruction in three planes, T2-weighted gradient spin echo (GRE), saturation weighted images, DWI and ADC maps, diffusion tensor imaging. ASSESSMENT: All MRI scans were interpreted by the two neuroradiologists and one neuroradiology Fellow in a blinded fashion using a customized neuroradiology reporting form. STATISTICAL TESTS: Matching parametric statistics represented the number of participants whose brain parameters improved or deteriorated over time. Odds ratio (OR) and 95% confidence intervals (CI) were computed using log regression modeling to determine volume loss, white matter lesions, hemosiderosis, gliosis, cystic changes and enlarged Virchow Robin (VR) spaces. A Kappa (κ) statistic with a 95% CI was calculated to determine rater variability between readers. RESULTS: A significant deterioration was observed in volume loss (OR = 1.083, 95% CI 0.678-1.731, permutation test), white matter changes (OR: 0.754, 95% CI 0.442-1.284, permutation test), and enlargement of VR spaces (OR: 0.775, 95% CI 0.513-1.171). Interrater reliability was low: κ = 0.283, 0.156, and 0.557 for volume loss, white matter changes, and enlargement of VR spaces, respectively. DATA CONCLUSION: There were significant changes in brain volume, white matter lesions, and enlargement of VR spaces. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.

Enhancing word signing in hearing students with reading disorders using computer-based learning trials.

Multiple-baseline-across-word-sets designs were used to determine whether a computer-based intervention would enhance accurate word signing with four participants. Each participant was a hearing college student with reading disorders. Learning trials included 3 s to observe printed words on the screen and a video model performing the sign twice (i.e., simultaneous prompting), 3 s to make the sign, 3 s to observe the same clip, and 3 s to make the sign again. For each participant and word set, no words were accurately signed during baseline. After the intervention, all four participants increased their accurate word signing across all three word sets, providing 12 demonstrations of experimental control. For each participant, accurate word signing was maintained. Application of efficient, technology-based, simultaneous prompting interventions for enhancing American Sign Language learning and future research designed to investigate causal mechanisms and optimize intervention effects are discussed.

Implementation of the Australian National Safety and Quality Digital Mental Health Standards.

OBJECTIVE: Following the release of the Australian National Safety and Quality Digital Mental Health (NSQDMH) Standards in November 2020, our objective was to ensure effective implementation of the Standards. This included the development of an accreditation scheme to allow digital mental health services to be formally assessed against the Standards and provide service users with an assurance of safe and high-quality services. METHOD: The accreditation scheme was adapted from the one used for the National Safety and Quality Health Service (NSQHS) Standards. As the digital mental health sector was largely unfamiliar with standards and accreditation, the scheme was pilot-tested with a range of service providers and further consultation took place to refine it. RESULTS: The accreditation scheme was launched in November 2022 with support resources published to aid implementation. CONCLUSIONS: The NSQDMH Standards accreditation scheme provides an assurance of safety and quality for digital mental health service users.

Disseminated Rasamsonia argillacea complex infection presenting as intraventricular brain hemorrhage in a German shepherd dog in Australia.

A German Shepherd Dog diagnosed with Rasamsonia argillacea based on fungal culture and DNA sequencing, is the first documented case in Australia, and the Southern Hemisphere. This species is part of R. argillacea complex, which is an emerging concern in immunocompromised human and veterinary patients. Intraventricular brain hemorrhage, noted on MRI, has not been reported previously in a dog with fungal encephalitis. The patient was euthanized due to progression of clinical signs before a final diagnosis was made, so no treatment was attempted in this case.

Evaluating and comparing three variations of cover, copy, and compare on multiplication fact fluency.

A longitudinal randomized design was used with a sample of 57 third-grade students to evaluate and compare the effectiveness of three variations of cover, copy, and compare (CCC; traditional CCC, CCC-answer only, and CCC-paired responding) on multiplication fluency in third-grade students. Traditional CCC requires students to write the problem and answer as a response, CCC-answer only requires students only to write the answer, and CCC-paired responding requires students to write the answer only, then verbally state the problem and answer twice. The interventions occurred for 4 min per day, 5 days per week, across 11 calendar weeks (minus 1 week during a school break). Digits correct per minute (DCPM) level and trend data were significantly higher for each of the CCC variations when compared to control probes, with a posttest unstandardized effect of 7.22 [5.39, 9.10] DCPM. However, there were no significant differences in learning across the three CCC variations. Overall, these results provide additional evidence that all three forms of CCC can enhance math fact fluency and suggest that educators could choose which version to apply based on idiosyncratic or contextual factors. The discussion focuses on future theoretical research designed to investigate these findings and the advantages of studies that evaluate multiple interventions and compare their effectiveness. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluating the effects of the color wheel system on a teacher's repeated directions.

Students are less likely to hear and understand teacher-delivered directions or instructions when they are attending to other activities (e.g., a classmate, a previously assigned task). A classroom management system known as the Color Wheel System includes rules and transition procedures designed to increase the probability that students stop their current activities and attend to teachers as they deliver directions or instructions for the next activity. A withdrawal design was used to evaluate the effects of the Color Wheel System on a teacher's repeated directions in a first-grade general-education classroom. Results showed large and immediate decreases in teacher repeated directions both times the Color Wheel System was applied and an immediate increase when it was withdrawn. Discussion focuses on limitations and directions for future longitudinal research evaluating the effects of the Color Wheel System on uninterrupted teaching and learning time, classroom climates, student-teacher relationships, and compliance. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

North Atlantic meltwater during Heinrich Stadial 1 drives wetter climate with more atmospheric rivers in western North America.

Atmospheric rivers (ARs) bring concentrated rainfall and flooding to the western United States (US) and are hypothesized to have supported sustained hydroclimatic changes in the past. However, their ephemeral nature makes it challenging to document ARs in climate models and estimate their contribution to hydroclimate changes recorded by time-averaged paleoclimate archives. We present new climate model simulations of Heinrich Stadial 1 (HS1; 16,000 years before the present), an interval characterized by widespread wetness in the western US, that demonstrate increased AR frequency and winter precipitation sourced from the southeastern North Pacific. These changes are amplified with freshwater fluxes into the North Atlantic, indicating that North Atlantic cooling associated with weakened Atlantic Meridional Overturning Circulation (AMOC) is a key driver of HS1 climate in this region. As recent observations suggest potential weakening of AMOC, our identified connection between North Atlantic climate and northeast Pacific AR activity has implications for future western US hydroclimate.

Usefulness of linked data for infectious disease events: a systematic review.

Surveillance is a key public health function to enable early detection of infectious disease events and inform public health action. Data linkage may improve the depth of data for response to infectious disease events. This study aimed to describe the uses of linked data for infectious disease events. A systematic review was conducted using Pubmed, CINAHL and Web of Science. Studies were included if they used data linkage for an acute infectious disease event (e.g. outbreak of disease). We summarised the event, study aims and designs; data sets; linkage methods; outcomes reported; and benefits and limitations. Fifty-four studies were included. Uses of linkage for infectious disease events included assessment of severity of disease and risk factors; improved case finding and contact tracing; and vaccine uptake, safety and effectiveness. The ability to conduct larger scale population level studies was identified as a benefit, in particular for rarer exposures, risk factors or outcomes. Limitations included timeliness, data quality and inability to collect additional variables. This review demonstrated multiple uses of data linkage for infectious disease events. As infectious disease events occur without warning, there is a need to establish pre-approved protocols and the infrastructure for data-linkage to enhance information available during an event.

Pandemic wave trends in COVID-19 cases, mobility reduction, and climate parameters in major metropolitan areas in the United States.

In this paper, we analyzed the association among trends in COVID-19 cases, climate, air quality, and mobility changes during the first and second waves of the pandemic in five major metropolitan counties in the United States: Maricopa in Arizona, Cook in Illinois, Los Angeles in California, Suffolk in Massachusetts, and New York County in New York. These areas represent a range of climate conditions, geographies, economies, and state-mandated social distancing restrictions. In the first wave of the pandemic, cases were correlated with humidity in Maricopa, and temperature in Maricopa and Los Angeles. In Suffolk and New York, cases were correlated with mobility changes in recreation, grocery, parks, and transit stations. Neither cases nor death counts were strongly correlated with air quality. Periodic fluctuations in mobility were observed for residential areas during weekends, resulting in stronger correlation coefficients when only weekday datasets were included in the analysis. We also analyzed case-mobility correlations when mobility days were lagged, and found that the strongest correlation in the first wave occurred between 12 and 14 lag days (optimal at 13 days). There was stronger but greater variability in correlation coefficients across metropolitan areas in the first pandemic wave than in the second wave, notably in recreation areas and parks. In the second wave, there was less variability in correlations over lagged time and geographic locations. Overall, we did not find conclusive evidence to support associations between lower cases and climate in all areas. Furthermore, the differences in cases-mobility correlation trends during the two pandemic waves are indicative of the effects of travel restrictions in the early phase of the pandemic and gradual return to travel routines in the later phase. This study highlights the utility of mobility data in understanding the dynamics of disease transmission. It also emphasizes the criticality of timeline and local context in interpreting transmission trends. Mobility data can capture community response to local travel restrictions at different phases of their implementation and provide insights on how these responses evolve over time alongside disease trends.

Northern Hemisphere vegetation change drives a Holocene thermal maximum.

The Holocene thermal maximum, a period of global warmth evident in early to mid-Holocene proxy reconstructions, is controversial. Most model simulations of the Holocene have not reproduced this warming, leading to a disagreement known as the Holocene Temperature Conundrum. Pollen records document the expansion of vegetation in the early and mid-Holocene African Sahara and Northern Hemisphere mid- and high latitudes, which has been overlooked in previous modeling studies. Here, we use time slice simulations of the Community Earth System Model to assess the impact of Northern Hemisphere vegetation change on Holocene annual mean temperatures. Our simulations indicate that expansion of Northern Hemisphere vegetation 9000 and 6000 years ago warms Earth's surface by ~0.8° and 0.7°C, respectively, producing a better match with proxy-based reconstructions. Our results suggest that vegetation change is critical for modeling Holocene temperature evolution and highlight its role in driving a mid-Holocene temperature maximum.

An Euler system for GU(2, 1).

We construct an Euler system associated to regular algebraic, essentially conjugate self-dual cuspidal automorphic representations of GL 3 over imaginary quadratic fields, using the cohomology of Shimura varieties for GU ( 2 , 1 ) .

Using a Tootling intervention to sequentially enhance and maintain at-risk elementary students' performance of multiple social skills.

The present study was designed to extend research on supplementing social skills training (SST) with a Tootling intervention to enhance student performance of social skills in authentic social contexts. The Tootling intervention included an interdependent group contingency with randomly selected criteria, which involved the after-school class receiving rewards contingent upon students reporting classmates' performance of prosocial behaviors as they participated in a typical school activity. First, reinforcement was delivered contingent upon peer reports of classmates' giving compliments. In subsequent phases, peer reports of classmates providing encouragement and saying thank you were added to the contingency, but each day students did not know which of these behaviors was selected as the criterion for reinforcement. Results from our multiple baseline across behaviors design provided three demonstrations of a treatment effect. When peer reports of each social skill were added to the contingency, the targeted social behavior increased. Discussion focuses on supplementing SST with Tootling interventions to enhance student performance of prosocial behaviors outside the SST context. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Health Outcomes and Healthcare Efficiencies Associated with the Use of Electronic Health Records in Hospital Emergency Departments: a Systematic Review.

Healthcare organisations and governments have invested heavily in electronic health records in anticipation that they will deliver improved health outcomes for consumers and efficiencies across emergency departments. Despite such investment, electronic health records designed to support emergency care have been poorly evaluated. Given the accelerated development and adoption of information technology across healthcare, it is timely that a systematic review of this evidence base is updated in order to drive improvements to design, interoperability and overall clinical utility of electronic health record systems implemented in emergency departments. To assess the impact of electronic health records on healthcare outcomes and efficiencies in the emergency department we carried out a systematic review of published studies on this topic. This is the first review to summarise the cost efficiencies associated with electronic health record use outside of just the United States of America. A systematic search was performed in three scientific databases (MEDLINE, EMcare and EMBASE), of literature published between January 2000 and September 2019. Studies were included in this review if they evaluated electronic health records or health information exchanges (and synonyms for these terms), reported patient outcome and/or healthcare efficiency benefits, were peer-reviewed and published in English. Out of 6635 articles, 23 studies met our inclusion criteria. Wide variation regarding electronic health record access in the emergency department was reported (1.46-56.6%), yet was most frequently reported as less than 20%. Seven different types of health outcomes and three different types of efficiency improvements associated with electronic health record use in the emergency department were identified. The most frequently reported findings were efficiencies, including reductions in diagnostic tests, imaging and costs. This review is the first to report moderate to significant increases in admission rates are associated with electronic health record use in the emergency department, contrasting the findings of previous reviews. Diversity in the methodology employed across the included studies emphasises the need for further research to examine the impact of electronic health record implementation and system design on the findings reported, in order to ensure return on investment for stakeholders and optimised consumer care.

Effects of unfamiliar diverse names on elementary students' passage comprehension.

Elementary school multicultural reading curricula include characters with diverse proper names, which are often unfamiliar and differ phonetically from students' native language. These names could impact reading outcomes by increasing students' cognitive load and/or creating cognitive disfluency. In Study 1, students in grades 1 through 2 read a standard passage including common names and a matched passage including unfamiliar names of Russian origin. A paired samples t test indicated unfamiliar diverse names in grade-level passages significantly reduced students' reading comprehension. Study 2 was designed to determine if preteaching diverse names would mitigate their adverse effects on reading comprehension. Results indicated second-grade students who received preteaching comprehended significantly more of the passage than those who did not receive preteaching. Discussion focuses on the need for research clarifying the relationship between multicultural learning materials and academic outcomes and validating efficient methods for familiarizing students with difficult, phonetically unfamiliar words. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Classroom Management in Self-Contained Classrooms for Children with Autism: Extending Research on the Color Wheel System.

The color wheel is an evidence-based classroom management system that has been used to decrease inappropriate behaviors and increase on-task behaviors in general education elementary classrooms but not in classrooms for students with autism spectrum disorder (ASD). A multiple-baseline design was used to evaluate the effects of the color wheel system (CWS) on disruptive behaviors (being out of seat for one classroom, inappropriate vocalizations for two classrooms) in three self-contained elementary classrooms for students with ASD. Partial-interval time sampling was used to record class-wide disruptive behaviors. Visual analysis of a time-series graph suggests that the CWS decreased disruptive behaviors across all three classrooms. Discussion focuses on limitations of the study and directions for researchers interested in modifying, applying, and evaluating the effects of the CWS in settings for children with ASD.

Amplification of heat extremes by plant CO2 physiological forcing.

Plants influence extreme heat events by regulating land-atmosphere water and energy exchanges. The contribution of plants to changes in future heat extremes will depend on the responses of vegetation growth and physiology to the direct and indirect effects of elevated CO2. Here we use a suite of earth system models to disentangle the radiative versus vegetation effects of elevated CO2 on heat wave characteristics. Vegetation responses to a quadrupling of CO2 increase summer heat wave occurrence by 20 days or more-30-50% of the radiative response alone-across tropical and mid-to-high latitude forests. These increases are caused by CO2 physiological forcing, which diminishes transpiration and its associated cooling effect, and reduces clouds and precipitation. In contrast to recent suggestions, our results indicate CO2-driven vegetation changes enhance future heat wave frequency and intensity in most vegetated regions despite transpiration-driven soil moisture savings and increases in aboveground biomass from CO2 fertilization.

Telephone follow-up calls for older patients after hospital discharge.

Population ageing poses many challenges. Recurrent readmission to hospital by frail older people places a strain on health systems and the individual. Registered nurses with experience in emergency department, ICU and aged care conducted telephone follow-up calls to patients or bereaved family members after an acute hospital admission. During follow-up calls, many patients reported feelings of loneliness and social isolation post-discharge. It was also found that patients may not be aware of support services available in the community. Telephone follow-up calls after discharge is a potentially cost-effective strategy to identify these patients and potentially provide comfort and timely referrals where needed.

Evaluating a computer flash-card sight-word recognition intervention with self-determined response intervals in elementary students with intellectual disability.

A concurrent multiple-baseline across-tasks design was used to evaluate the effectiveness of a computer flash-card sight-word recognition intervention with elementary-school students with intellectual disability. This intervention allowed the participants to self-determine each response interval and resulted in both participants acquiring previously unknown words across all word sets. Discussion focuses on the need to evaluate and compare computer flash-card sight-word recognition interventions with fixed and self-determined response intervals across students and dependent variables, including rates of inappropriate behavior and self-determination in students with intellectual disability. (PsycINFO Database Record

Cumulative Instructional Time and Relative Effectiveness Conclusions: Extending Research on Response Intervals, Learning, and Measurement Scale.

Adapted alternating treatments designs were used to evaluate three computer-based flashcard reading interventions (1-s, 3-s, or 5-s response intervals) across two students with disabilities. When learning was plotted with cumulative instructional sessions on the horizontal axis, the session-series graphs suggest that the interventions were similarly effective. When the same data were plotted as a function of cumulative instructional seconds, time-series graphs suggest that the 1-s intervention caused the most rapid learning for one student. Discussion focuses on applied implications of comparative effectiveness studies and why measures of cumulative instructional time are needed to identify the most effective intervention(s).Comparative effectiveness studies may not identify the intervention which causes the most rapid learning.Session-series repeated measures are not the same as time-series repeated measures.Measuring the time students spend in each intervention (i.e., cumulative instructional seconds) allows practitioners to identify interventions that enhance learning most rapidly.Student time spent working under interventions is critical for drawing applied conclusions.