The origination of six nannoplankton species in the late Paleocene to middle Eocene involves significant change in the entire nannofossil assemblage. The change began at the first occurrence and ...accelerates at the increase in abundance of the new species. The changes in the environment generally reflect the preferred ecology of the originating species. The species that originated in the late Paleocene to early Eocene (outside of the Paleocene-Eocene thermal maximum (PETM)) are generally thought to be oligotrophic taxa adapted to warm water conditions. During this long interval, temperatures were generally increasing and nutrient availability was decreasing; conditions that would have been advantageous for the originating taxa. Conversely, the species that originated in the middle Eocene are generally thought to be mesotrophs adapted to colder water conditions. These taxa were selected for during a time of generally increasing nutrient availability and decreasing temperature. Orbital stratigraphy indicates that the first occurrences of three Paleocene taxa are time transgressive by up to 400kyr. The only event that appears to be synchronous is the abundance increase of Zygrhablithus bijugatus during the PETM. This species is thought to be mesotrophic and replaces the genus Fasciculithus at a time when nutrient availability was likely increasing rapidly.
Background Despite widespread dissatisfaction and low treatment persistence in moderate to severe psoriasis, patients' reasons behind treatment discontinuation remain poorly understood. Objectives We ...sought to characterize patient-reported reasons for discontinuing commonly used treatments for moderate to severe psoriasis in real-world clinical practice. Methods A total of 1095 patients with moderate to severe plaque psoriasis from 10 dermatology practices who received systemic treatments completed a structured interview. Eleven reasons for treatment discontinuation were assessed for all past treatments. Results A total of 2231 past treatments were reported. Median treatment duration varied by treatment, ranging from 6.0 to 20.5 months ( P < .001). The frequency of each cited discontinuation reasons differed by treatment (all P < .01). Patients who received etanercept (odds ratio OR 5.19; 95% confidence interval CI 3.23-8.33) and adalimumab (OR 2.10; 95% CI 1.20-3.67) were more likely to cite a loss of efficacy than those who received methotrexate. Patients who received etanercept (OR 0.34; 95% CI 0.23-0.49), adalimumab (OR 0.48; 95% CI 0.30-0.75), and ultraviolet B phototherapy (OR 0.21; 95% CI 0.14-0.31) were less likely to cite side effects than those who received methotrexate, whereas those who received acitretin (OR 1.56; 95% CI 1.08-2.25) were more likely to do so. Patients who underwent ultraviolet B phototherapy were more likely to cite an inability to afford treatment (OR 7.03; 95% CI 3.14-15.72). Limitations The study is limited by its reliance on patient recall. Conclusions Different patterns of treatment discontinuation reasons are important to consider when developing public policy and evidence-based treatment approaches to improve successful long-term psoriasis control.
Roughly 40% of those with intellectual/developmental disabilities (IDD) have mental health needs, twice the national average. Unfortunately, outpatient mental health services are often inaccessible, ...increasing reliance on hospital-based services. While telemental health services hold potential to address this gap, little is known about the effectiveness of telemental health for the diversity of persons with IDD, especially as it relates to crisis prevention and intervention services. Accordingly, the aims of this study are to: (1) compare telemental health versus in-person crisis prevention and intervention services among people with IDD; and (2) understand if outcomes vary across subpopulations, in order to identify potential disparities.
This study will take place within START (Systemic, Therapeutic, Assessment, Resources, and Treatment), a national evidence-based model of mental health crisis prevention and intervention for people with IDD. A total of 500 youth and adults, located across nine states, will be randomized 1:1 to telemental health vs. in-person. Participant inclusion criteria are ages 12-45 years, living in a family setting, and newly enrolled (within 90 days) to START. Outcomes will be assessed, using a non-inferiority design, for up to 1 year or until discharge. The intervention is comprised of four components: (1) outreach; (2) consultation/coping skills; (3) intake/assessment; and, (4) 24-hour crisis response. The in-person condition will deliver all components in-person. The telemental health condition will deliver components 1 & 2, via telephonic or other communication technology, and components 3 & 4 in-person. Outcomes include mental health crisis contacts, mental health symptoms, emergency psychiatric service use, perceived quality of mental healthcare, and time to discharge.
To our knowledge, this will be the first trial of a telemental health crisis program for the IDD population. The study will be executed by an interdisciplinary team of experts that includes persons with lived experience of disability. Understanding the benefits of specific telemental health methods has important implications to the design of interventions. This telemental health study offers promise to address disparities in access to mental health care for people with IDD across diverse racial, ethnic, linguistic, and cultural groups.
Clinicaltrials.gov ( #NCT05336955 ; Registration Date: 4/20/2022).
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Psoriasis is a chronic inflammatory disease associated with dyslipidemia, cardiovascular events, and mortality. We aimed to assess and compare the effect of treatment of moderate-to-severe psoriasis ...with adalimumab or phototherapy on vascular inflammation and cardiovascular biomarkers.
Randomized, double-blind, trial of adalimumab, phototherapy, and placebo (1:1:1) for 12 weeks, with crossover to adalimumab for 52 weeks total. Outcomes included vascular inflammation by
F-fluorodeoxyglucose positron emission tomography/computed tomography and biomarkers of inflammation, insulin resistance, and lipoproteins. Ninety-seven patients were randomized, 92 completed the randomized controlled trial portion; 81 entered the adalimumab extension with 61 completing 52 weeks of adalimumab. There was no difference in change in vascular inflammation at week 12 in the adalimumab group (change compared with placebo, 0.64%; 95% confidence interval, -5.84% to 7.12%) or the phototherapy group (-1.60%; 95% confidence interval, -6.78% to 3.59%) or after 52-week adalimumab treatment (0.02% compared with initiation; 95% confidence interval, -2.85% to 2.90%). Both adalimumab and phototherapy decreased inflammation by serum CRP, interleukin-6. Only adalimumab reduced tumor necrosis factor and glycoprotein acetylation at 12 and 52 weeks. Neither had an impact on metabolic markers (insulin, adiponectin, and leptin). Only phototherapy increased high-density lipoprotein-p at 12 weeks. At 52-week of adalimumab cholesterol efflux and high-density lipoprotein-p were reduced.
Adalimumab reduced key markers of inflammation including glycoprotein acetylation compared with phototherapy with no effect on glucose metabolism and vascular inflammation, and potential adverse effects on high-density lipoprotein. Glycoprotein acetylation improvement may partially explain the beneficial effects of adalimumab seen in observational studies. Larger studies with more detailed phenotyping of vascular disease should assess the comparative differences in the effects of adalimumab and phototherapy seen in our study.
URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01866592 and NCT01553058.
This study examined outcomes from the Systemic, Therapeutic, Assessment, Resources, and Treatment (START) program, a community-based tertiary care model for individuals with intellectual and ...developmental disabilities and mental health needs. The sample included 111 START service users and their family caregivers, who were receiving START Clinical Team services, located in the Northeast and Southwest regions of the United States. Results from the analyses found a significant 1-year pre-post improvement in caregiver service experiences and mental health symptoms of the service user. A significant decrease in psychiatric hospitalizations and emergency department visits was also found (all p < .01). These data suggest that START holds promise in improving outcomes, for both the caregiver and service user, while reducing dependence on costly and restrictive hospital-based services.
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•The liquid flow has a main effect on the hold-up while the gas flow is negligible.•Methanothermobacter strains better for methanation than Methanothermococcus strains.•Pure cultures ...and packings have to be well-matched to maximize methane quality.•Mtb. thermoautotrophicus IM5 + DuraTop® ideal for ORBIT-trickle-bed system.
The hydrogen gas-to-liquid mass transfer is the limiting factor in biological methanation. In trickle-bed reactors, mass transfer can be increased by high flow velocities in the liquid phase, by adding a packing material with high liquid hold-up or by using methanogenic archaea with a high methane productivity.
This study developed a polyphasic approach to address all methods at once. Various methanogenic strains and packings were investigated from a microbial and hydrodynamic perspective. Analyzing the ability to produce high-quality methane and to form biofilms, pure cultures of Methanothermobacter performed better than those of the genus Methanothermococcus. Liquid and static hold-up of a packing material and its capability to facilitate attachment was not attributable to a single property. Consequently, it is recommended to carefully match organism and packing for optimized performance of trickle-bed reactors. The ideal combination for the ORBIT-system was identified as Methanothermobacter thermoautotrophicus IM5 and DuraTop®.
Objective:Individuals with intellectual and developmental disabilities disproportionately use emergency psychiatric services compared with their neurotypical peers, suggesting that such individuals ...and their supports are at increased risk for crisis events. This prospective study examined the timing, outcomes, and predictors of mental health crises for this population.Methods:The data came from Systemic, Therapeutic, Assessment, Resources, and Treatment (START), a national model that provides mental health crisis services for those with intellectual and developmental disabilities in the United States. The study included 1,188 individuals from four U.S. regions enrolled between 2018 and 2019. The outcome was urgent crisis contacts with the START program. Baseline and clinical predictors were examined with multivariate regression analyses.Results:More than a quarter had at least one crisis contact, and 9% had three or more. Contacts increased within the initial 3 months of START enrollment, followed by a steep drop-off thereafter; few contacts happened after 1 year. Almost 45% of the contacts occurred after hours, and 30% involved police. Clinical factors predicted crisis contact most robustly, followed by lack of occupational supports. After START crisis intervention, 73% of individuals remained in their primary setting.Conclusions:For individuals with intellectual and developmental disabilities and mental health needs, crisis stabilization resources are needed, including after hours. Results clearly identify times and risk factors for mental health crisis contacts, including frequent involvement with emergency responders. Importantly, gainful employment conveyed benefits for community stabilization. Findings may be leveraged to develop effective mental health crisis intervention services and supports for this underserved group.
Healthcare students have expressed a need for more education on the aging adult population. Interprofessional education (IPE) is a well-known educational model intended to increase students' ...knowledge, skill, and abilities to use evidence-based practice for improved patient outcomes. At a Midwestern, urban-based university, we have implemented an interprofessional, student-led Geriatric Assessment Clinic in order to allow students in six health professions (including medicine, nutrition, occupational therapy, physical therapy, social work, and speech language pathology) to practically apply their skills in the aging adult population while learning to work with other healthcare professionals. This holistic clinic is free of cost to the aging adults who participate in it. The following article discusses the purpose, implementation, benefits, and limitations of such a clinic as it relates to both the patients who attend and the students who participate.
Strengths-based clinical practices are critical for supporting the wellbeing of individuals with intellectual and/or developmental disabilities. The VIA Inventory of Strengths ('VIA Survey') is an ...assessment grounded in positive psychology that may contribute to strengths-based practices. To identify how this assessment is used in clinical practice with individuals with intellectual and/or developmental disabilities, we conducted focus groups (n = 15) with clinicians who have used this survey with this population. We also asked individuals with intellectual and/or developmental disabilities (n = 36) to comment on the process of completing the VIA Survey. We found that clinicians utilize the VIA Survey with individuals with intellectual and/or developmental disability to foster self-esteem and self-understanding, provide a framework for understanding strengths, communicate across service systems and shape strengths-based interventions. Individuals with intellectual and/or developmental disabilities also endorsed use of the survey to increase their self-knowledge and self-esteem. Future research should address accessibility of the survey to foster greater uptake and propose standard protocols for independent survey completion.
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