The impact of educational rewards on the diagnosis of autism spectrum disorder

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that affects social interactions and communication. The prevalence of ASD has risen dramatically in recent years, but the underlying factors leading to this rise are not clear. In this paper, we test whether changes in state-level educational policy that impact school-level resources are associated with the rise in ASD diagnostic prevalence. Early identification of ASD can improve an array of outcomes for children, and school systems play an important role with identification of the condition. It is plausible that children attending schools with better resources from state governments are more likely to receive an ASD diagnosis and presumably appropriate services. We focus on one educational policy in particular, state-level rewards, which consist of a monetary transfer from state governments to school districts. To test the impact of educational rewards on ASD diagnosis, we rely on policy variation across states and time and estimate both two-way fixed effects (TWFE) models alongside recently advanced methods in the difference-in-differences (DiD) literature. Under a baseline TWFE specification we estimate that rewards policies are associated with a 18.46% increase in ASD diagnosis. Further, using DiD methods that account for bias in settings of differential policy timing, we find that the magnitude of the effect increases to 24.8%. We believe these findings to be suggestive evidence that educational rewards policies improved the likelihood of detection and diagnosis of ASD.

Trajectories of symptoms in digital interventions for depression and anxiety using Routine Outcome Monitoring data: A secondary analysis study (Preprint)

BACKGROUND

Research suggests there is heterogeneity in treatment response for internet-delivered cognitive behavioral therapy (iCBT) users, but few studies have investigated the trajectory of individual symptom change across iCBT treatment. Large patient data sets using routine outcome measures allows the investigation of treatment effects over time as well as the relationship between outcomes and platform use. Understanding trajectories of symptom change, as well as associated characteristics, may prove important for tailoring interventions or identifying patients who may not benefit from the intervention.

OBJECTIVE

We aimed to identify latent trajectories of symptom change during the iCBT treatment course for depression and anxiety and to investigate the patients' characteristics and platform use for each of these classes.

METHODS

This is a secondary analysis of data from a randomized controlled trial designed to examine the effectiveness of guided iCBT for anxiety and depression in the UK Improving Access to Psychological Therapies (IAPT) program. This study included patients from the intervention group (N=256) and followed a longitudinal retrospective design. As part of the IAPT's routine outcome monitoring system, patients were prompted to complete the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) after each supporter review during the treatment period. Latent class growth analysis was used to identify the underlying trajectories of symptom change across the treatment period for both depression and anxiety. Differences in patient characteristics were then evaluated between these trajectory classes, and the presence of a time-varying relationship between platform use and trajectory classes was investigated.

RESULTS

Five-class models were identified as optimal for both PHQ-9 and GAD-7. Around two-thirds (PHQ-9: 155/221, 70.1%; GAD-7: 156/221, 70.6%) of the sample formed various trajectories of improvement classes that differed in baseline score, the pace of symptom change, and final clinical outcome score. The remaining patients were in 2 smaller groups: one that saw minimal to no gains and another with consistently high scores across the treatment journey. Baseline severity, medication status, and program assigned were significantly associated (P<.001) with different trajectories. Although we did not find a time-varying relationship between use and trajectory classes, we found an overall effect of time on platform use, suggesting that all participants used the intervention significantly more in the first 4 weeks (P<.001).

CONCLUSIONS

Most patients benefit from treatment, and the various patterns of improvement have implications for how the iCBT intervention is delivered. Identifying predictors of nonresponse or early response might inform the level of support and monitoring required for different types of patients. Further work is necessary to explore the differences between these trajectories to understand what works best for whom and to identify early on those patients who are less likely to benefit from treatment.

School Administrators' Experiences in a 6-Month Health and Wellness Community of Practice

BACKGROUND

A statewide 6-month school administrator health and wellness program encouraged participants to use a fitness tracker to self-monitor their physical activity and sleep patterns. The purpose of this study was to examine participants' experience in a school administrator health and wellness program and their perceptions of the impact on health-related behaviors, including activity/movement, nutrition, and sleep.

METHODS

Each of the 45 participants completed a semi-structured interview at three points in the program. Questions were designed to discern school administrators' perceptions of their ideal health and wellness balance at home and work.

RESULTS

School administrators reported new insights into their own well-being, benefits of social supports in their personal wellness journey, an expanded understanding of their ideal health and wellness balance at home and work, and a stronger sense of serving as a role model who needs to take care of him/herself.

CONCLUSIONS

Although the program was helpful in establishing an ideal health and wellness balance at home and work for some school administrators, future programs should better emphasize nutrition and scaffold opportunities to maintain new habits following program completion.

The Relationship between Psychological Stress and Healthy Lifestyle Behaviors during COVID-19 among Students in a US Midwest University

The gripping coronavirus disease (COVID-19) has imposed dramatic changes to many areas of daily living in all sectors of society across the world. We examined the relationship between perceived stress and health behaviors among college students during the COVID-19 pandemic. An online survey with measures of psychological stress, physical activity and exercise, and sleep and social connectedness was distributed in June and July of 2020. The survey was completed by 550 college students (mean age: 21.3 ± 3.8 years, 74.2% female, 94.4% Caucasian). Being female and unemployed and having a lower annual income were significantly associated with higher levels of stress. In addition, regression analysis found that reduced exercise and sleep during the COVID-19 pandemic significantly predicted the levels of stress of participants after controlling for gender, employment status, and annual income. University officials should aim to implement health-promotion strategies directed at preventing reductions in exercise and sleep duration, especially in those at greater risk of increased perceived stress such as females and economically disadvantaged students.

Changes in fecal microbiota with CFTR modulator therapy: A pilot study

Studies have demonstrated that people with CF with pancreatic insufficiency (PI) have fecal dysbioses. Evidence suggests the causes of these dysbioses are multifactorial, and that important drivers include antibiotic exposure, dietary intake, and CF gastrointestinal tract dysfunction, including nutrient malabsorption. In this pilot study, we tested whether initiation of the CFTR modulator treatments ivacaftor (in a cohort of pancreatic sufficient (PS) people with CF and an R117H CFTR variant) or lumacaftor/ivacaftor (in a cohort of PI people with CF and an F508del variant) changed fecal measures of malabsorption or fecal microbiomes. While we identified no statistically significant fecal changes with either treatment, we detected trends in the PI cohort when initiating lumacaftor/ivacaftor towards decreased fecal fat content and towards fecal microbiomes that more closely resembled the fecal microbiota of people without PI. While these findings support a model in which nutrient malabsorption resulting from CF-induced PI drives fecal dysbiosis, they must be validated in future, larger studies of fecal microbiome and malabsorption outcomes with highly effective CFTR modulator therapies.

Author Correction: High-throughput single-cell activity-based screening and sequencing of antibodies using droplet microfluidics

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Can We Accurately Predict Cost Effectiveness Without Access to Overall Survival Data? The Case Study of Nivolumab in Combination with Ipilimumab for the Treatment of Patients with Advanced Melanoma in England

BACKGROUND

Nivolumab with ipilimumab (the Regimen) is the first immuno-oncology combination treatment to demonstrate long-term clinical benefit for advanced melanoma patients. We evaluated the cost effectiveness of the Regimen in this population, with and without the availability of overall survival (OS) data.

METHODS

A partitioned survival model and a Markov state-transition model were developed to estimate the lifetime costs and benefits of the Regimen versus ipilimumab. These models were built with and without the availability of OS data, as only progression-free survival data were available from the head-to-head, phase III trial against ipilimumab at the time of the National Institute for Health and Care Excellence (NICE) submission. Patient utilities and resource use data were sourced from trial data or the literature.

RESULTS

Incremental cost-effectiveness ratios (ICERs) and absolute costs were similar between the models with and without OS data, but the model with OS data generated more than 1 additional quality-adjusted life-year (QALY) across both treatment arms. In both models, based on list prices, the Regimen was the most cost-effective treatment.

CONCLUSIONS

The analyses show that the Regimen is a cost-effective treatment for advanced melanoma patients in England, and methods to overcome the lack of OS can give reasonable estimates of QALYs gained and ICERs.

Correction to: Can We Accurately Predict Cost Effectiveness Without Access to Overall Survival Data? The Case Study of Nivolumab in Combination with Ipilimumab for the Treatment of Patients with Advanced Melanoma in England

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Initial development and pilot testing of observer-reported outcomes (ObsROs) for children with cystic fibrosis ages 0-11years

PURPOSE

Patient-reported outcomes are important clinical trial endpoints. Young children may not be able to reliably report on how they feel or function, so observer-reported outcomes (ObsROs) may be more appropriate for them. The purpose of this study was to develop and pilot field test electronic parent-reported observational instruments for children with cystic fibrosis (CF) 0-6 and 7-11years of age.

METHODS

We performed concept elicitation interviews with parents of children with CF ≤11years of age to elicit the respiratory signs they could observe at baseline and during an acute respiratory illness. The resulting instruments were refined based on interviews with parents and clinicians. We conducted a pilot field test to evaluate test-retest reliability and the ability of items to distinguish well and sick periods.

RESULTS

The instruments consist of 17 items assessing respiratory signs and observable CF-related impacts. Test-retest reliability was acceptable for both age groups but discrimination was low for ages 7-11, likely reflecting less direct observation of older children by their parents.

CONCLUSIONS

An ObsRO for children with CF ages 0-6 appears promising, while self-report may be more appropriate for children >6years of age. Next steps for the 0-6year old instrument will be utilizing it as an exploratory endpoint in clinical trials to enable item reduction, scale development, and further reliability and validity testing. Ultimately, this ObsRO could be a promising endpoint for early intervention trials in young children with CF.

Evaluating Exercise as Evidence-Based Practice for Individuals with Autism Spectrum Disorder

Background

The purpose of this study was to conduct a systematic review of the literature to evaluate empirical support for the use of exercise as an evidence-based practice (EBP) for individuals with autism spectrum disorder (ASD), aged 1–21 years, using the Adapted Physical Activity Taxonomy (APAT) (1).

Method

A systematic review of research, published within the past 10 years and accessible in SPORTDiscus, ProQuest Nursing, Science Direct, ERIC, Ovid MEDLINE, and PsychINFO databases, was conducted following seven inclusion criteria. An initial 169 articles were identified of which 23 articles were found that met the inclusion criteria including implementation of an exercise intervention for participants diagnosed with ASD and utilization of an experimental/quasi experimental, correlational, single–subject, or qualitative research design. These 23 articles were evaluated using the APAT to determine the quality of the research and the strength of the recommendation in establishing exercise as an EBP.

Results

Of the 23 articles evaluated, 17 employed an experimental/quasi experimental design, 1 article employed a correlational design, and 5 articles employed a single-subject design. Only one article (2) was found to meet the minimum overall quality indicator of moderate (i.e., Level 2) when evaluated on the APAT. In total, 13 of the 23 articles (57%) had method sections evaluated as weak, and 17 of the 23 articles (74%) had results sections evaluated as weak.

Conclusion

From the findings of this systematic review, and in accordance with the Every Student Succeeds Act of 2015 (3) definition of an EBP, it appears that exercise can be considered an EBP for school-aged children with ASD. However, this recommendation is based solely on moderate evidence from one well-designed and well-implemented experimental study; therefore, generalization is still pending further similar findings. Recommendations for future research are offered.

Pregabalin Abuse amongst Opioid Substitution Treatment Patients

Pregabalin (Lyrica®) is used in treating epilepsy, nerve pain and anxiety. Pregabalin was initially thought to have a low misuse potential however there are emerging reports of Pregabalin being abused. A study was commenced at the National Drug Treatment Centre's (NDTC) Drug Analysis Laboratory to determine the level of usage of Pregabalin within the addiction services population in Ireland. A total of 498 urine samples representing samples from 440 individual opioid substitution patients, initially screened by immunoassay for drugs of abuse, were subjected to further analysis for Pregabalin by Liquid Chromatography/Mass Spectrometry (LC/MS). Of 440 patients tested, 39 tested positive for Pregabalin (9.2%). Only 10 patients from this group were prescribed this drug to our knowledge thus giving an estimated rate of misuse of 7.0%. Other drugs detected in the Pregabalin positive patients were Opiates (31.8%), Cocaine (11.4%), Benzodiazepines (79.5%) and Cannabis (77.8%). Our study confirms that Pregabalin abuse is taking place amongst the addiction services population. We believe that misuse of this prescription drug is a serious emerging issue which should be monitored carefully.

Resting-state connectivity deficits associated with impaired inhibitory control in non-treatment-seeking adolescents with psychotic symptoms

OBJECTIVE

Psychotic symptoms are common in the population and index risk for a range of severe psychopathological outcomes. We wished to investigate functional connectivity in a community sample of adolescents who reported psychotic symptoms (the extended psychosis phenotype).

METHOD

This study investigated intrinsic functional connectivity (iFC) during resting-state functional magnetic resonance imaging (fMRI; rs-fMRI). Following screening in schools, 11 non-treatment seeking, youth with psychotic symptoms (aged 11-13) and 14 community controls participated in the study. Seed regions of interest comprised brain regions previously shown to exhibit aberrant activation during inhibitory control in adolescents with psychotic symptoms.

RESULTS

Relative to controls, adolescents with psychotic symptoms exhibited reduced iFC between regions supporting inhibitory control. Specifically, they showed weaker iFC between the right inferior frontal gyrus (IFG) and the cingulate, IFG and the striatum, anterior cingulate and claustrum, and precuneus and supramarginal gyrus. Conversely, the psychotic symptoms group exhibited stronger iFC between the superior frontal gyrus and claustrum and IFG and lingual gyrus.

CONCLUSION

The present findings are the first to reveal aberrant functional connectivity in resting-state networks in a community sample of adolescents with psychotic symptoms and suggest that disruption in integration between distributed neural networks (particularly between prefrontal, cingulate and striatal brain regions) may be a key neurobiological feature of the extended psychosis phenotype.

Trends in classification, referral and treatment and the effect on outcome of patients with glioma: a 20 year cohort

This retrospective audit was conducted to examine the changes in patient characteristics, referral, treatment and outcome over a 20-year period in a large regional neuro-oncology centre, focusing on the impact of the changes in pathological classification of gliomas. Using the Edinburgh Cancer Centre (ECC) database all cases of glioma were identified and patient, tumour and treatment characteristics noted. Survival was calculated from date of surgery or, if no operation was performed, the date of referral. Comparison was made between four periods 1988-1992 (c1), 1993-1997(c2), 1998-2002(c3) and 2003-2007 (c4). During the 20 years, 1175 patients with a glioma were referred to ECC. The median age increased from 53 years to 57 years (p < 0.001) but the proportion without pathology remained unchanged (10%). The distribution of pathological grades changed over time Grade I-II: 24, 6, 6, and 6%, Grade III: 42, 27, 17, and 13% and Grade IV: 24, 61, 68, and 68% in c1, c2, c3 and c4, respectively (p < 0.001). Immediate RT was given to 68% (c1), 70% (c2), 78% (c3) and 79% (c4). Median interval from resection to RT reduced from 43 days (c1) to 36 days (c4) (p < 0.001). 5-year overall survival for patients with Grade III lesions increased: 21% (c1), 35% (c2), 37% (c3), 33% (c4) as did 1-year overall survival for Grade IV lesions: 18% (c1), 26% (c2), 29% (c3), 27% (c4)). This improvement probably reflects the change in pathological classification rather than a change in management. Proportional hazards analysis of grade IV 1993-2007 only (to reduce pathological variation) showed that younger age, frontal lesions, excision, higher RT dose had reduced hazard of death. Interval from surgery to RT had no impact on survival in this series.

Head shop compound abuse amongst attendees of the Drug Treatment Centre Board

The use of "Head Shop" compounds has received much media attention lately. There is very little research in the current literature with regard to the extent of the usage of these substances amongst the drug using population in Ireland. We conducted a study to examine the extent of the usage of Mephedrone, Methylone and BZP amongst attendees of Methadone maintenance programs at the DTCB. Two hundred and nine samples in total were tested. The results showed significant usage of these compounds amongst this cohort of drug users, with 29 (13.9%) of samples tested being positive for Mephedrone, 7 (3.3%) positive for Methylone and 1 (0.5%) positive for BZP.

Sediment transport in the saltation regime

We present a study of sediment transport in the creeping and saltation regimes. In our model, a bed of particles is simulated with the conventional event-driven method. The particles are considered as hard disks in a two-dimensional domain with periodic boundary conditions in the horizontal direction. The flow of the fluid over this bed of particles is modeled by imposing a force on each particle that depends on the velocity of the fluid at its height above the bed. We consider two velocity profiles for the fluid, parabolic and logarithmic. The first one models laminar flow and the second corresponds to turbulent flow. For each case we investigate the behavior of the saturated flux. We find that for the logarithmic profile, the saturated flux shows a quadratic increase with the strength of the flow, and for parabolic profile, a cubic increase. The velocity distribution functions are used to interpret the results.

Microscopic origin of granular ratcheting

Numerical simulations of assemblies of grains under cyclic loading exhibit "granular ratcheting:" a small net deformation occurs with each cycle, leading to a linear accumulation of deformation with cycle number. We show that this is due to a curious property of the most frequently used models of the particle-particle interaction: namely, that the potential energy stored in contacts is path dependent. There exist closed paths that change the stored energy, even if the particles remain in contact and do not slide. An alternative method for calculating the tangential force removes granular ratcheting.

Relationships among milk production, energy balance, plasma analytes, and reproduction in Holstein-Friesian cows

Associations were examined between components and indicators of early lactation energy balance (EB) and measures of fertility in Holstein cows. Milk production, dry matter intake (DMI), body condition score (BCS), and endocrine and metabolite data from 96 cows were analyzed using multivariate logistic regression and survival analysis. Fertility variables investigated were interval to commencement of luteal activity (C-LA), calving to conception interval (CCI), and conception rate to first service (CON1). Mean daily EB, milk protein content, and DMI during the first 28 d in milk were associated positively with CON1. Cows having poorer BCS (< or =2.25) at first service had a lower CON1. Positive associations were identified among EB, milk protein content, DMI, and the likelihood of a shorter interval to C-LA. Cows having greater DMI and a more positive EB had an increased likelihood of a shorter CCI, whereas a lower nadir BCS was associated with an increased likelihood of a longer CCI. Milk yield was not associated with any of the fertility variables investigated. A greater plasma concentration of insulin-like growth factor I (IGF-I) during the first 2 wk of lactation was associated with a greater CON1 and an increased likelihood of a shorter interval to C-LA. In conclusion, we identified DMI as the principal component of EB influencing subsequent fertility. Furthermore, results indicate that milk protein content and plasma IGF-I concentration in early lactation may be useful indicators of reproductive efficiency.

Shearing behavior of polydisperse media

We study the shearing of polydisperse and bidisperse media with a size ratio of 10. Simulations are performed with a two-dimensional shear cell using contact dynamics. With a truncated power law for the polydisperse media we find that they show a stronger dilatancy and greater resistance to shearing than bidisperse mixtures. To model additives used to control viscosity we introduce so-called "point-like particles". Even changing the kinematic behavior very little, the point-like particles reduce the force necessary to maintain a fixed shearing velocity.