Abstract
Background
Schizophrenia and related disorders are highly disabling and create substantial burdens for families, communities, and health care systems. Although pharmacological treatments can ...often lessen the psychotic symptoms that are a hallmark of schizophrenia, they do not lessen the social and cognitive deficits that create the greatest impediments to community engagement and functional recovery. This study builds on prior research on psychosocial rehabilitation by comparing the effectiveness of two treatments demonstrated as efficacious in improving social and community functioning, Cognitive Enhancement Therapy (CET) and a version of Social Skills Training (HOPES/SST).
Methods
The study uses a randomized cluster design in which a pair of clinicians at community- and hospital-based mental service centers deliver either CET or HOPES to at least one group of 6-8 eligible clients for 12 months. Clinicians are trained and then supervised weekly, with ongoing process measurement of treatment fidelity, attendance, satisfaction, and retention, and use of other services. Measures administered at baseline and at 6 and 12 months while in treatment, and then at 18 and 24 months after treatment include social adjustment, quality of life, social skills, positive and negative symptoms, and neuro- and social cognition. We hypothesize that CET will be associated with greater improvements than SST in both the primary outcome of community functioning and the secondary outcomes of neuro- and social cognition and social skills. Secondarily, we hypothesize that more cognitive impairment at baseline and younger age will predict more benefit from CET compared to HOPES.
Discussion
Resource shortages endemic in mental health services and exacerbated by the pandemic highlight the importance of identifying the most effective approach to improving social and community functioning. We aim to improve understanding of the impact of two efficacious psychosocial treatments and to improve clinicians’ ability to refer to both treatments the individuals who are most likely to benefit from them. We expect the result to be programmatic improvements that improve the magnitude and durability of gains in community functioning.
Trial registration
ClinicalTrial.gov
NCT04321759
, registered March 25, 2020.
Sexual and gender minority youth (SGMY) are at greater risk than their heterosexual and cisgender counterparts for suicidal thoughts and behaviors (STB) and nonsuicidal self-injury (NSSI). Unique ...stressors (i.e., minority stressors) specific to SGMY's stigmatized identities such as discrimination or concealment of one's identity are posited to explain these disparities. However, there is limited research examining the associations among minority stressors, affective mediating processes, and STB and NSSI in SGMY's daily lives. We conducted a 28-day daily diary study to test the mediating effects of daily negative and positive affect and emotion dysregulation between minority stressors and STB and NSSI among SGMY who were recruited from clinical and community settings. Participants were 92 SGMY, aged 12-19 years old (M = 16.45; SD = 1.81; 64% cisgender; 69% White). Results indicated that on days SGMY experienced external and internalized minority stressors, they reported greater intensity of suicidal and nonsuicidal self-injurious ideation and affective distress (i.e., greater negative affect, lower positive affect, and more emotion dysregulation). Greater affective reactivity processes were associated with greater suicidal and nonsuicidal self-injurious ideation intensity on the same day. Most of the within-person associations between external and internalized minority stressors and ideation intensity were mediated by heightened negative affect and emotion dysregulation but not lower positive affect. Our results provide the first evidence of these associations among SGMY, advance the minority stress model, and have implications for clinical interventions as we identified modifiable affective mechanisms.
General Scientific SummaryOn days sexual and gender minority youth experience greater than their usual minority stressors, such as discrimination, microaggressions, identity concealment, and internalized stigma, they report greater intensity of their thoughts of suicide and nonsuicidal self-injury (NSSI) and more emotional distress and dysregulation (i.e., greater negative affect, lower positive affect, and more emotion dysregulation). Emotional distress and dysregulation are also associated with greater intensity of thoughts of suicide and NSSI on the same day. The within-person associations between daily minority stressors and intensity of thoughts of suicide and NSSI were mostly accounted for by negative affect and emotion dysregulation but not positive affect.
This research explored the effectiveness of a manualized contemplative intervention among children receiving intensive residential psychiatric care. Ten children with severe psychiatric disabilities ...received 12 sessions (30–45 min) of “Mindful Life: Schools” (MLS) over the course of a month. Facility-reported data on the use of physical intervention (i.e., seclusions and restraints) were analyzed. Acceptability questionnaires and broad-band behavioral questionnaire data were also collected from children and their primary clinicians. Robust logistic regression analyses were conducted on person-period data for the 10 children to explore the timing of incidents resulting in the use of physical intervention. Incidents within each person-period were regressed on indicators of days of contemplative practice and days without contemplative practice. Results indicated that during the 24-h period following MLS class, relative to a comparison 24-h period, children had significantly reduced odds of receiving a physical intervention (OR = 0.3; 95 % CI 0.2, 0.5;
p
< 0.001). Behavioral questionnaires did not indicate significant contemplative intervention effects (
p
s >0.05), and MLS was found to be generally acceptable in this population and setting. These data indicate that contemplative practices acutely reduced the utilization of physical interventions. Clinicians seeking to implement preventative strategies to reduce the necessity of physical intervention in response to dangerous behavior should consider contemplative practices. Those wishing to empirically evaluate the effectiveness of contemplative practices should consider evaluating objective measures, such as utilization of physical intervention strategies, as oppose to subjective reports.
Objective
Bipolar disorder (BP) frequently co‐occurs with other psychiatric disorders. We examine whether course of anxiety disorders (ANX), attention deficit hyperactivity disorder (ADHD), ...disruptive behavior disorders (DBD), and substance use disorders (SUD) influence likelihood of recovery and recurrence of depression and mania in BP youth.
Method
Weekly ratings of psychiatric disorder intensity were obtained from 413 participants of the Course and Outcome of BP Youth project, followed for an average of 7.75 years. Multiple‐event Cox proportional hazards regression analyses examined worsening of comorbid disorders as predictors of mood episode recovery and recurrence.
Results
Increased severity in ANX and SUD predicted longer time to recovery and less time to next depressive episode, and less time to next manic episode. Multivariate models with ANX and SUD found that significant effects of ANX remained, but SUD only predicted longer time to depression recovery. Increased severity of ADHD and DBD predicted shorter time to recurrence for depressive and manic episodes.
Conclusion
There are significant time‐varying relationships between the course of comorbid disorders and episodicity of depression and mania in BP youth. Worsening of comorbid conditions may present as a precursor to mood episode recurrence or warn of mood episode protraction.
Sexual and gender minority youth (SGMY) are at greater risk than their heterosexual and cisgender counterparts for suicidal thoughts and behaviors (STB) and non-suicidal self-injury (NSSI). Unique ...stressors (i.e., minority stressors) specific to SGMY’s stigmatized identities such as discrimination or concealment of one’s identity are posited to explain these disparities. However, there is limited research examining the associations among minority stressors, affective mediating processes, and STB and NSSI in sexual and gender minority youth’s daily lives. We conducted a 28-day daily diary study to test the mediating effects of daily negative and positive affect and emotion dysregulation between minority stressors and STB and NSSI among SGMY who were recruited from clinical and community settings. Participants were 92 SGMY, ages 12 to 19 years old (
M
= 16.45;
SD
= 1.81; 64% cisgender; 69% White). Results indicated that on days SGMY experienced external and internalized minority stressors, they reported greater intensity of suicidal and non-suicidal self-injurious ideation and affective distress (i.e., greater negative affect, lower positive affect, and more emotion dysregulation). Greater affective reactivity processes were associated with greater suicidal and non-suicidal self-injurious ideation intensity on the same day. Most of the within-person associations between external and internalized minority stressors and ideation intensity were mediated by heightened negative affect and emotion dysregulation but not lower positive affect. Our results provide the first evidence of these associations among SGMY, advance the minority stress model, and have implications for clinical interventions as we identified modifiable affective mechanisms.
On days sexual and gender minority youth experience greater than their usual minority stressors, such as discrimination, microaggressions, identity concealment and internalized stigma, they report greater intensity of their thoughts of suicide and non-suicidal self-injury and more emotional distress and dysregulation (i.e., greater negative affect, lower positive affect, and more emotion dysregulation). Emotional distress and dysregulation are also associated with greater intensity of thoughts of suicide and non-suicidal self-injury on the same day. The within-person associations minority stressors and intensity of thoughts of suicide and non-suicidal self-injury were mostly accounted for by negative affect and emotion dysregulation but not positive affect.
Sclerochronology uses shell growth lines or bands for the construction of environmental time-series and the measurement of organism growth, but more study is needed to constrain the triggers of the ...dark cessation bands observed in many bivalve groups. We constructed a database of direct observations of modern growth seasonality across the class Bivalvia and compared the occurrence of seasonal growth bands to environmental data including latitude, temperature, and chlorophyll-a concentration. Bivalves with cold-season (winter) cessations are more common towards the poles, with logistic regression showing that temperature, followed by latitude of occurrence, displays the strongest relationship with occurrence of winter cessation. Remotely sensed and directly measured chlorophyll-a concentration show no significant relationship. Summer cessations are sparse and only weakly associated with environmental controls but are concentrated at the subtropical latitudes among temperate bivalves at their equatorial extremes. The rarity of summer cessations can be explained by the limited annual ranges of temperature in the tropics, combined with the exponential relationship of metabolic rate to temperature leading to a narrow window between normal functioning and mortality at high temperatures. This data suggests that, unless annual temperatures have low variability like in equatorial or polar regions, the season of growth cessation across bivalves is primarily a function of temperature tolerance through restriction of scope for growth. At most latitudes, growth bands can be interpreted as being primarily triggered by temperature stress, rather than seasonal starvation.
The health of reef-building corals has declined due to climate change and pollution. However, less is known about whether giant clams, reef-dwelling bivalves with a photosymbiotic partnership similar ...to that found in reef-building corals, are also threatened by environmental degradation. To compare giant clam health against a prehistoric baseline, we collected fossil and modern
shells from the Gulf of Aqaba, Northern Red Sea. After calibrating daily/twice-daily growth lines from the outer shell layer, we determined that modern individuals of all three species (
,
and
) grew faster than Holocene and Pleistocene specimens. Modern specimens also show median shell organic δ
N values 4.2‰ lower than fossil specimens, which we propose is most likely due to increased deposition of isotopically light nitrate aerosols in the modern era. Nitrate fertilization accelerates growth in cultured
, so nitrate aerosol deposition may contribute to faster growth in modern wild populations. Furthermore, colder winter temperatures and past summer monsoons may have depressed fossil giant clam growth. Giant clams can serve as sentinels of reef environmental change, both to determine their individual health and the health of the reefs they inhabit.
The Gulf of Aqaba is home to three giant clam species with differing ecological niches and levels of photosymbiotic activity. Giant clams grow a two‐layered shell where the outer layer is ...precipitated in close association with photosymbiont‐bearing siphonal mantle, and the inner layer is grown in association with the light‐starved inner mantle. We collected 39 shells of the three species (the cosmopolitan Tridacna maxima and T. squamosa, as well as the rare endemic T. squamosina) and measured carbon and oxygen isotope ratios from inner and outer shell layers, to test for differences among species and between the layers of their shells. T. squamosina records higher temperatures of shell formation as determined by oxygen isotope paleothermometry, consistent with its status as an obligately shallow‐dwelling species. However, the known negative fractionation imparted on tissue carbon isotopes by photosymbiotic algae did not produce measurable offsets in the carbonate δ13C values of the more symbiotic T. squamosina and T. maxima compared to the more heterotrophic T. squamosa. Across all species, outer shell layers recorded mean growth temperatures 1.8°C higher than corresponding inner layers, which we propose is a function of the high insolation, low albedo microenvironment of the outer mantle, and potentially the activity of the symbionts themselves. Population‐wide isotopic sampling of reef‐dwelling bivalve shells can help constrain the ecological niches of rare taxa and help reconstruct their internal physiology.
Plain Language Summary
Giant clams are large bivalves which live on reefs and, like corals, also contain algae living as symbionts within their tissue. These clams record temperature via the ratio of two isotopes of oxygen (the heavier 18O and lighter 16O) in their shell, and it has been proposed that their carbon isotope ratios are influenced by their symbionts. The three species of giant clam from around the Gulf of Aqaba (Northern Red Sea): Tridacna squamosina, T. squamosa, and T. maxima, are thought to live in different habitats and to have different amounts of photosynthesis. To test this, we collected several dozen shells to compare the oxygen and carbon isotopes of each species. We found that the rare T. squamosina records the highest average growth temperatures, which supports previous observations that it lives only in shallow water. Giant clams also have two layers in their shells, and we compared the isotopes of the layers. We found that the Sun‐drenched outer shell layer records higher temperatures than the inner one, which we propose is due to solar heating of the algae‐filled outermost tissue. Symbiosis does not appear to change the carbon isotope ratios between the layers or between species with different amounts of photosynthesis. More work is needed to investigate how ecology and physiology influence the isotopes between bivalve species and within their shells.
Key Points
The outer shell layer of Tridacna is depleted in 18O compared to the inner layer, corresponding to a 1.7°C higher reconstructed temperature
There is no significant difference in δ13C value between species, but δ18O is lower in the obligately shallow‐dwelling Tridacna squamosina
While carbon isotopes did not track different degrees of photosymbiosis, oxygen isotopes can be used to constrain ecological niche partitioning for rare species
Automated extraction of intelligence from wide-area motion imagery (WAMI) is a known challenge in the artificial intelligence and computer vision fields, with vehicle detection in particular ...providing wide-ranging applications to defense, environmental awareness, and economic monitoring. To properly trust automated WAMI image processing methods for remote sensing and situational awareness, a thorough investigation of where and why their performance deteriorates is critical. In this work, we explore boundary conditions of WAMI vehicle detection to identify situations where additional data can address existing performance degradation. Additionally, we propose a method of weakly-supervised detection to reduce reliance on fully labeled ground truth.
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