•Large sample of 30,071 students in grades 3–12.•Praise and rewards for good behavior and teaching social and emotional competencies related positively with school climate.•Punitive consequences ...related negatively associated with school climate.•Effects of teaching social and emotional competencies were nearly twice that of the use of praise and rewards.•At the student level, effects of teaching social and emotional competencies were nearly twice that of punitive consequences.
Deep sedation is associated with acute brain dysfunction and increased mortality. We had previously shown that early-assessed brainstem reflexes may predict outcome in deeply sedated patients. The ...primary objective was to determine whether patterns of brainstem reflexes might predict mortality in deeply sedated patients. The secondary objective was to generate a score predicting mortality in these patients.
Observational prospective multicenter cohort study of 148 non-brain injured deeply sedated patients, defined by a Richmond Assessment sedation Scale (RASS) <-3. Brainstem reflexes and Glasgow Coma Scale were assessed within 24 hours of sedation and categorized using latent class analysis. The Full Outline Of Unresponsiveness score (FOUR) was also assessed. Primary outcome measure was 28-day mortality. A "Brainstem Responses Assessment Sedation Score" (BRASS) was generated.
Two distinct sub-phenotypes referred as homogeneous and heterogeneous brainstem reactivity were identified (accounting for respectively 54.6% and 45.4% of patients). Homogeneous brainstem reactivity was characterized by preserved reactivity to nociceptive stimuli and a partial and topographically homogenous depression of brainstem reflexes. Heterogeneous brainstem reactivity was characterized by a loss of reactivity to nociceptive stimuli associated with heterogeneous brainstem reflexes depression. Heterogeneous sub-phenotype was a predictor of increased risk of 28-day mortality after adjustment to Simplified Acute Physiology Score-II (SAPS-II) and RASS (Odds Ratio 95% confidence interval = 6.44 2.63-15.8; p<0.0001) or Sequential Organ Failure Assessment (SOFA) and RASS (OR 95%CI = 5.02 2.01-12.5; p = 0.0005). The BRASS (and marginally the FOUR) predicted 28-day mortality (c-index 95%CI = 0.69 0.54-0.84 and 0.65 0.49-0.80 respectively).
In this prospective cohort study, around half of all deeply sedated critically ill patients displayed an early particular neurological sub-phenotype predicting 28-day mortality, which may reflect a dysfunction of the brainstem.
Abstract
We have combined X-ray observations from Chandra with Sunyaev–Zel’dovich effect data from Planck and Bolocam to measure intracluster medium pressure profiles from 0.03
R
500
≤
R
≤ 5
R
500
...for a sample of 21 low-
z
galaxy clusters with a median redshift of 〈
z
〉 = 0.08 and a median mass of 〈
M
500
〉 = 6.1 × 10
14
M
⊙
and a sample of 19 mid-
z
galaxy clusters with 〈
z
〉 = 0.50 and 〈
M
500
〉 = 10.6 × 10
14
M
⊙
. The mean scaled pressure in the low-
z
sample is lower at small radii and higher at large radii, a trend that is accurately reproduced in similarly selected samples from
The Three Hundred
simulations. This difference appears to be primarily due to dynamical state at small radii, evolution at intermediate radii, and a combination of evolution and mass dependence at large radii. Furthermore, the overall flattening of the mean scaled pressure profile in the low-
z
sample compared to the mid-
z
sample is consistent with expectations due to differences in the mass accretion rate and the fractional impact of feedback mechanisms. In agreement with previous studies, the fractional scatter about the mean scaled pressure profile reaches a minimum of ≃20% near 0.5
R
500
. This scatter is consistent between the low-
z
and mid-
z
samples at all radii, suggesting it is not strongly impacted by sample selection, and this general behavior is reproduced in
The Three Hundred
simulations. Finally, analytic functions that approximately describe the mass and redshift trends in mean pressure profile shape are provided.
Family factors, such as family accommodation and parent-child characteristics, are hypothesised as important maintaining factors in paediatric OCD. There is limited research assessing parent and ...child behaviour amongst young people with OCD during family interactions. Thus, the current study sought to further explore parent-child interaction variables in OCD, using an observational design with three groups.
23 young people with OCD, 30 young people with other anxiety disorders, and 23 young people with no clinical problems, along with their primary caregiver, completed a brief problem-solving discussion task designed to assess family interaction variables. Groups were compared on observer-rated and self-rated parent and child behaviours. It was expected that OCD families would differ from both anxious and nonclinical families on some behavioural dimensions, for example, rating lower on warmth, confidence, and positive problem solving.
Results showed that young people in the OCD group could be differentiated from young people in the clinical and nonclinical comparison groups based on observed behaviour. Young people in the OCD group showed less warmth during their interactions and less confidence in their ability to solve the problem. These children and adolescents also had higher levels of doubt and withdrawal during interactions with their parent. Interestingly, parent behaviour did not differ between the groups, suggesting that parent behaviours are a less reliable indicator of OCD symptomatology.
During family interactions, young people with OCD behave in a different way to young people with another anxiety disorder as well as young people with no diagnosis. These findings provide interesting and important exploratory information relating to observed parent and child behaviour across different clinical and nonclinical groups. Limitations of this study are addressed and directions for future research are discussed.
•Young people in the OCD group differed from those in the clinical and nonclinical comparison groups on observed behaviour.•Parent behaviour did not differ between the groups.•Effects were inconsistent across self and observer rated variables.•Maintenance models of OCD incorporating family interaction factors are important.
We have combined X-ray observations from Chandra with Sunyaev–Zel’dovich effect data from Planck and Bolocam to measure intracluster medium pressure profiles from 0.03 R500 ≤ R ≤ 5 R500 for a sample ...of 21 low-z galaxy clusters with a median redshift of 〈z〉 = 0.08 and a median mass of 〈M500〉 = 6.1 × 1014 M⊙ and a sample of 19 mid-z galaxy clusters with 〈z〉 = 0.50 and 〈M500〉 = 10.6 × 1014 M⊙. The mean scaled pressure in the low-z sample is lower at small radii and higher at large radii, a trend that is accurately reproduced in similarly selected samples from The Three Hundred simulations. This difference appears to be primarily due to dynamical state at small radii, evolution at intermediate radii, and a combination of evolution and mass dependence at large radii. Furthermore, the overall flattening of the mean scaled pressure profile in the low-z sample compared to the mid-z sample is consistent with expectations due to differences in the mass accretion rate and the fractional impact of feedback mechanisms. In agreement with previous studies, the fractional scatter about the mean scaled pressure profile reaches a minimum of ≃20% near 0.5 R500. This scatter is consistent between the low-z and mid-z samples at all radii, suggesting it is not strongly impacted by sample selection, and this general behavior is reproduced in The Three Hundred simulations. Finally, analytic functions that approximately describe the mass and redshift trends in mean pressure profile shape are provided.
In vitro perfusion studies are frequently used to determine the penetration of compounds through skin and mucosa. Porcine tissue has been shown to be an excellent model for human tissue in terms of ...structure, function, and reactivity. We describe the use of porcine tissue ex-vivo in a continuous flow perfusion system to study the behavior of superantigens in this model.
Stellar and black hole feedback heat and disperse surrounding cold gas clouds, launching gas flows off circumnuclear and galactic disks, producing a dynamic interstellar medium. On large scales ...bordering the cosmic web, feedback drives enriched gas out of galaxies and groups, seeding the intergalactic medium with heavy elements. In this way, feedback shapes galaxy evolution by shutting down star formation and ultimately curtailing the growth of structure after the peak at redshift 2–3. To understand the complex interplay between gravity and feedback, we must resolve both the key physics within galaxies and map the impact of these processes over large scales, out into the cosmic web. The Advanced X-ray Imaging Satellite (AXIS) is a proposed X-ray probe mission for the 2030s with arcsecond spatial resolution, large effective area, and low background. AXIS will untangle the interactions of winds, radiation, jets, and supernovae with the surrounding interstellar medium across the wide range of mass scales and large volumes driving galaxy evolution and trace the establishment of feedback back to the main event at cosmic noon. This white paper is part of a series commissioned for the AXIS Probe mission concept; additional AXIS white papers can be found at the AXIS website.
Urinary retention is a common postoperative complication associated with bladder overdistension and the risk of permanent detrusor damage. The goal of this study was to determine predictive factors ...of early postoperative urinary retention in the postanesthesia care unit (PACU). We prospectively collected, in 313 adult patients, variables including age, gender, previous history of urinary tract symptoms, type of surgery and anesthesia, intraoperative administration of anticholinergics, amount of intraoperative fluids, IV morphine titration, and bladder volume on entry to the PACU. For each patient, bladder volume was measured by ultrasound on entry and before discharge from the PACU. Urinary retention was defined as a bladder volume larger than 600 mL with an inability to void within 30 min. Predictive factors were identified by multivariate analysis. The incidence of urinary retention in the PACU was 16%. In the multivariate analysis only the amount of intraoperative fluids (≥750 mL; P = 0.02; odds ratio = 2.3), age (≥50 yr; P = 0.008; odds ratio = 2.4), and bladder volume on entry to PACU (≥270 mL; P = 0.0001; odds ratio = 4.8) were found to independently increase the risk of urinary retention. Considering the clinical impact of undiagnosed postoperative urinary retention, these results suggest systematic evaluation of bladder volume with a portable ultrasound device in the PACU, especially in patients with risk factors.
e17040 Background: Our aim was to evaluate two distinct clinical settings catering to US patients with metastatic castration-resistant prostate cancer (mCRPC): academic (A) and community (C) ...practice. We used data from a real-world non-interventional study (REASSURE; NCT02141438) examining the use of 223 Ra. Methods: Patients with mCRPC who received at least one dose of 223 Ra in the US were included. Enrolment occurred between 2014 and 2017; median follow-up was nearly 12 months. Our analysis included patient disease characteristics, treatment history, short- and long-term safety of 223 Ra, patient overall survival (OS), and patient-reported pain (Brief Pain Inventory – Short Form BPI–SF scores). A clinically meaningful pain response was a ≥2-point decrease from a baseline score of ≥2 in the BPI-SF worst pain item during treatment until last dose. Results: Analysis included 498 patients (A: 147; C: 351). Comparing A with C, the median ages were 70 and 76 years, respectively, and the majority of patients (74% and 84%) had bone-only metastases. A higher percentage of patients in A (69%) than in C (49%) had completed at least one life-prolonging therapy (LPT) prior to 223 Ra; these included abiraterone (A: 38%; C: 19%), enzalutamide (A: 32%; C:17%), docetaxel (A: 38%; C: 19%), and sipuleucel-T (A: 18%; C: 25%). Most patients received 5–6 223 Ra injections in both settings (A: 65%; C: 71%). 223 Ra was used concomitantly with LPTs in 48% of patients in A and 57% in C, predominantly with abiraterone (A: 25%; C: 25%) or enzalutamide (A: 25%; C: 36%); fewer patients in A (35%) received concomitant bone health agents than in C (52%). For safety outcomes, refer to the table. During treatment, 47% and 62% of patients with a baseline BPI-SF ≥2 had a clinically meaningful pain response in A and C, respectively. The median OS was 17.2 months (95% CI 14.0–19.4) in A and 18.4 months (14.8–21.0) in C. More patients in A (42%) than in C (26%) received a LPT after 223 Ra, most commonly docetaxel (A: 25%; C: 12%). Conclusions: Patients treated in A tended to be younger and more heavily treated, as evidenced by a higher number of patients receiving LPTs prior to and following 223Ra treatment. Bone health agents were more frequently used in C. Additionally, more patients in C had a clinically meaningful pain response and more drug-related AEs were reported in A. Despite the observed differences, overall survival was comparable for both practice settings. Clinical trial information: NCT02141438 . Table: see text
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