The effects of a multimedia intervention on help-seeking process with a Chinese college student sample

Little is known about encouraging help-seeking in non-English speaking settings and relatively little research has been directed to facilitate help-seeking among Chinese-speaking people. This study examined the effects of a multimedia intervention on barriers, attitudes, and intentions for seeking counseling in China. The multimedia intervention was informed by prior empirical research on models of help-seeking for counseling. A total of 200 participants were randomly assigned to one of the two conditions: (1) a help-seeking media-exposed intervention group and (2) a control group, who watched a hospital advertisement that was unrelated to mental health help-seeking. Results indicated that the intervention was effective at increasing both positive attitudes toward therapy and intentions to seek therapy. The intervention also improved participants' perceptions about treatment accessibility. This intervention is available and can be a resource for Chinese language populations (both within China and other countries), especially for immigrants, rural, and persons who might benefit from mental health treatments such as psychotherapy.

Integrating exploration and prediction in computational psychotherapy science: proof of concept

Introduction

Psychotherapy research has long preferred explanatory over predictive models. As a result, psychotherapy research is currently limited in the variability that can be accounted for in the process and outcome of treatment. The present study is a proof-of-concept approach to psychotherapy science that uses a datadriven approach to achieve robust predictions of the process and outcome of treatment.

Methods

A trial including 65 therapeutic dyads was designed to enable an adequate level of variability in therapist characteristics, overcoming the common problem of restricted range. A mixed-model, data-driven approach with cross-validation machine learning algorithms was used to predict treatment outcome and alliance (within- and between-clients; client- and therapist-rated alliance).

Results and discussion

Based on baseline predictors only, the models explained 52.8% of the variance for out-of-sample prediction in treatment outcome, and 24.1-52.8% in therapeutic alliance. The identified predictors were consistent with previous findings and point to directions for future investigation. Although limited by its sample size, this study serves as proof of the great potential of the presented approach to produce robust predictions regarding the process and outcome of treatment, offering a potential solution to problems such as p-hacking and lack of replicability. Findings should be replicated using larger samples and distinct populations and settings.

Trajectories of change in weekly and biweekly therapy

Higher therapy session frequency has been found to result in faster recovery, but few studies have considered that clients follow diverse trajectories of change in psychotherapy. It is unknown how session frequency may affect the sizes and shapes of change trajectories. The present study examined clients' change trajectories in weekly and biweekly therapy in a naturalistic setting, as well as predictors of these trajectories. Using a sample of 5,102 clients receiving 3-10 therapy sessions at a university counseling center, we identified 886 clients attending approximately weekly therapy and 1,753 clients attending approximately biweekly therapy. We examined the change trajectories of the weekly and biweekly samples using latent growth mixture modeling (LGMM). Three trajectories were identified in weekly therapy: slow change (78.33%), early improvement (17.61%), and worse before better (4.06%), and in biweekly therapy: slow change (80.38%), early improvement (13.52%), and worse before better (6.1%). The worse before better subgroup in weekly therapy experienced greater deterioration than those in biweekly therapy. The slow change and early improvement subgroups in weekly therapy showed treatment outcome comparable to those of their respective counterparts in biweekly therapy. Clients' intake symptoms, including eating concerns, frustration/anger, depression, and academic concerns, significantly predicted change trajectories. Compared to biweekly therapy, weekly therapy leads to higher chances of early improvement and shortens the duration of suffering but results in greater deterioration for individuals who deteriorate in therapy. The impact of session frequency on treatment outcome varies across clients, and session frequency should be adjusted individually. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Targeted temperature management and PbtO2 in traumatic brain injury

Introduction

Targeted Temperature Management (TTM) to normothermia is widely used in traumatic brain injury (TBI). We investigated the effects to of TTM to normothermia patients with TBI (GCS≤12) monitored with multimodality monitoring, to better understand the physiological consequences of this intervention.

Research question

In TBI patients cooled to normothermia and in which brain oxygenation deteriorates, are there changes in physiological parameters which are pertinent to brain oxygenation?

Material and method

102 TBI patients with continuous recordings of intracranial pressure (ICP) and brain oxygen tension (PbtO2) were studied retrospectively. Non-continuous arterial carbon dioxide (PaCO2) and oxygen (PaO2) tensions, and core body temperature (Tc) were added. PaO2 and PaCO2 were also corrected for Tc. Transitions from elevated Tc to normothermia were identified in 39 patients. The 8 h pre and post the transition to normothermia were compared. Data is given as median [IQR] or mean (SD).

Results

Overall, normothermia reduced ICP (12 [9-18] -11 [8-17] mmHg, p < 0.009) and Tcore (38.3 [0.3]-36.9 [0.4] oC, p < 0.001), but not PbtO2 (23.3 [16.6]-24.4 [17.2-28.7] mmHg, NS). Normothermia was associated with a fall in PbtO2 in 18 patients (24.5 [9.3] -20.8 [7.6] mmHg). Only in those with a fall in PbtO2 with cooling did ICP (15 [10.8-18.5] -12 [7.8-17.3] mmHg, p = 0.002), and temperature corrected PaCO2 (5.3 [0.5]- 4.9 [0.8] kPa, p = 0.001) decrease.

Discussion and conclusion

A reduction in PbtO2 was only present in the subgroup of patients with a fall in temperature corrected PaCO2 with cooling. This suggests that even modest temperature changes could result in occult hyperventilation in some patients. pH stat correction of ventilation may be an important factor to consider in future TTM protocols.

Observation of high-energy neutrinos from the Galactic plane

The origin of high-energy cosmic rays, atomic nuclei that continuously impact Earth's atmosphere, is unknown. Because of deflection by interstellar magnetic fields, cosmic rays produced within the Milky Way arrive at Earth from random directions. However, cosmic rays interact with matter near their sources and during propagation, which produces high-energy neutrinos. We searched for neutrino emission using machine learning techniques applied to 10 years of data from the IceCube Neutrino Observatory. By comparing diffuse emission models to a background-only hypothesis, we identified neutrino emission from the Galactic plane at the 4.5σ level of significance. The signal is consistent with diffuse emission of neutrinos from the Milky Way but could also arise from a population of unresolved point sources.

Helping skills training: Outcomes and trainer effects

We studied whether counseling self-efficacy increases after taking a helping skills course as well as whether trainer (instructor) effects are associated with postclass self-efficacy. We surveyed 551 undergraduate students and 27 trainers in helping skills courses across three semesters at one large mid-Atlantic U.S. public university. We found that students reported greater counseling self-efficacy after taking the course. In addition, trainers accounted for small but significant amount of the variance (7%) in changes in counseling self-efficacy. There was evidence that the instructors' authoritative teaching style but not their facilitative interpersonal skills were associated with increases in students' counseling self-efficacy. Implications for helping skills training are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Physician Perspectives on the Use of Beta Blockers in Heart Failure With Preserved Ejection Fraction

β-blockers are commonly used in heart failure with preserved ejection fraction (HFpEF), even in the absence of a compelling indication and despite the potential to cause harm. Identifying reasons for β-blocker prescription in HFpEF could permit the development of strategies to reduce unnecessary use and potentially improve medication prescribing patterns in this vulnerable population. We administered an online survey regarding β-blocker prescribing behavior to physicians trained in internal medicine or geriatrics (noncardiology physicians) and to cardiologists at 2 large academic medical centers. The survey assessed the reasons for β-blocker initiation, agreement regarding initiation and/or continuation of β-blockers by another clinician, and deprescribing behavior. The response rate was 28.2% (n = 231). Among respondents, 68.2% reported initiating β-blockers in patients with HFpEF. The most common reason for initiating a β-blocker was for treatment of an atrial arrhythmia. Notably, 23.7% of physicians reported initiating a β-blocker without an evidence-based indication. When a β-blocker was considered not necessary, 40.1% of physicians reported they were rarely or never willing to deprescribe. The most common reason for not deprescribing a β-blocker when the physician felt that a β-blocker was unnecessary was the concern about interfering with another physicians' treatment plan (76.6%). In conclusion, a significant proportion of noncardiology physicians and cardiologists report prescribing β-blockers to patients with HFpEF, even when evidence-based indications are absent, and rarely deprescribe β-blockers in these scenarios.

Early trajectories of symptom change and working alliance as predictors of treatment outcome

OBJECTIVE

We aim to examine how different trajectories of symptom change and working alliance in early psychotherapy predict treatment outcomes.

METHOD

We performed a growth mixture model (GMM) to examine trajectories of symptom change and working alliance in the first five therapy sessions in a sample of 272 outpatients and tested the association of early symptom trajectories and alliance patterns with treatment outcome.

RESULTS

We identified two symptom trajectories: high symptom/steady change (63.2%) and early improving (36.8%), and four alliance development patterns: undeveloped alliance (40.1%), strengthening moderate alliance (31.6%), optimal alliance (17.3%), and improved alliance (11%) in early psychotherapy. The symptom trajectories and alliance patterns both independently and interactively predicted treatment outcomes. The optimal alliance was generally associated with the best outcome. The effect of improved alliance on treatment outcome was moderated by symptom trajectories: for high symptom/steady change subgroup, the improved alliance was related to better treatment outcome, whereas for early improving subgroup, the improved alliance was associated with poorer outcome.

CONCLUSIONS

Patients fell into different trajectories regarding symptom reduction and alliance development in early psychotherapy that affected final treatment outcome. Combining early symptom trajectories and alliance trajectories simultaneously can facilitate routine outcome monitoring and contribute to the prediction of treatment outcome.

Assessing the quality of digital patient-therapist communication: the development and validation of a text-based facilitative interpersonal skills task

OBJECTIVE

Text-based communication is becoming an increasingly salient feature of the psychotherapeutic landscape. Yet little is known about the factors distinguishing high- and low-quality therapeutic conversations taking place over this modality. Prior research on therapist effects has outlined several common factors associated with better clinical outcomes. But these common factors can only be researched in the context of text-based communication if they can be measured. Accordingly, we developed and validated a new behavioral task and coding system: the Facilitative Interpersonal Skills Performance Task for Text (FIS-T) to measure therapists' messaging quality across eight dimensions of facilitative interpersonal skill.

METHODS

1150 survey-takers rated the interpersonal dynamics and response difficulty of the FIS-T Task's text-based stimuli. The FIS-T was then administered to 64 therapists.

RESULTS

The FIS-T stimuli displayed similar interpersonal dynamics to those elicited by the original FIS task, demonstrated a similar range of difficulties to those of the video-based stimuli of the original FIS Task, and showed high inter-rater reliability.

CONCLUSIONS

The text-based FIS-T Task demonstrates high reliability and convergent validity with the original FIS Task, making it appropriate for use in assessing the common factors in text-based therapy. Future directions in the quality assessment of internet-delivered psychotherapies are discussed.

Evidence for neutrino emission from the nearby active galaxy NGC 1068

A supermassive black hole, obscured by cosmic dust, powers the nearby active galaxy NGC 1068. Neutrinos, which rarely interact with matter, could provide information on the galaxy’s active core. We searched for neutrino emission from astrophysical objects using data recorded with the IceCube neutrino detector between 2011 and 2020. The positions of 110 known gamma-ray sources were individually searched for neutrino detections above atmospheric and cosmic backgrounds. We found that NGC 1068 has an excess of 79 − 20 + 22 neutrinos at tera–electron volt energies, with a global significance of 4.2σ, which we interpret as associated with the active galaxy. The flux of high-energy neutrinos that we measured from NGC 1068 is more than an order of magnitude higher than the upper limit on emissions of tera–electron volt gamma rays from this source.

Environmental exposure to metals and the development of tauopathies, synucleinopathies, and TDP-43 proteinopathies: A systematic evidence map protocol

BACKGROUND

Neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis are incurable and expected to increase in prevalence in the upcoming decades. Environmental exposure to metals has been suggested as a contributing factor to the development of neurodegenerative disease. This systematic evidence map will identify and characterize the epidemiological and experimental data available on the intersection of eighteen metals of environmental concern (i.e., aluminum, antimony, arsenic, barium, beryllium, cadmium, chromium, cobalt, copper, lead, manganese, mercury, nickel, palladium, radium, silver, vanadium, and zinc) and three neurodegenerative disease clusters (i.e., tauopathies, synucleinopathies, and TDP-43 proteinopathies). We aim to describe the type and amount of evidence available (or lack thereof) for each metal and neurodegenerative disease combination and highlight important knowledge gaps and knowledge clusters for future research.

METHODS

We will conduct a thorough search using two databases (MEDLINE and Web of Science Core Collection) and grey literature resources. Pre-defined criteria have been developed to identify studies which evaluate at least one of the selected metals and neurodegenerative disease-relevant outcomes (e.g., neuropathology, cognitive function, motor function, disease mortality). At each phase of review, studies will be evaluated by two reviewers. Studies determined to be relevant will be extracted for population, exposure, and outcome information. We will conduct a narrative review of the included studies, and the extracted data will be available in a database hosted on Tableau Public.

CONCLUSION

This protocol documents the decisions made a priori to data collection regarding these objectives.

Search for Unstable Sterile Neutrinos with the IceCube Neutrino Observatory

We present a search for an unstable sterile neutrino by looking for a resonant signal in eight years of atmospheric ν_{μ} data collected from 2011 to 2019 at the IceCube Neutrino Observatory. Both the (stable) three-neutrino and the 3+1 sterile neutrino models are disfavored relative to the unstable sterile neutrino model, though with p values of 2.8% and 0.81%, respectively, we do not observe evidence for 3+1 neutrinos with neutrino decay. The best-fit parameters for the sterile neutrino with decay model from this study are Δm_{41}^{2}=6.7_{-2.5}^{+3.9}  eV^{2}, sin^{2}2θ_{24}=0.33_{-0.17}^{+0.20}, and g^{2}=2.5π±1.5π, where g is the decay-mediating coupling. The preferred regions of the 3+1+decay model from short-baseline oscillation searches are excluded at 90% C.L.

Abstract P019: Clinical Impact Of A 3 Versus 5-minute Delay On Automated Office Blood Pressure Measurement

Background: Recent studies suggest that a reduced delay during automated office blood pressure (AOBP) measurement may be as accurate as a 5-minute delay. The clinical impact of this change compared to gold-standard assessments (i.e. 24-hour ambulatory BP monitoring, ABPM) has not been reported.

Objective: To compare the impact of a 3- vs 5-minute delay on AOBP and its relation with average awake-time ABPM.

Methods: Patients referred to a single hypertension (HTN) center had BP measurements with ABPM and one of two non-randomized, unattended AOBP protocols. Half of patients underwent AOBP with a 5-minute delay; the other half underwent AOBP with a 3-minute delay. All measurements were compared to the average awake-time ABPM. HTN was defined as SBP≥140 or DBP≥90 mmHg. We used linear regression adjusted for age, sex, and race to assess whether the 3-minute protocol was associated with a difference between mean AOBP and average awake-time ABPM.

Results: Among 100 participants (mean age 59.7±15.5 years, 58% women, 26% Black), the average awake-time BP was 132.6±14.8/77.4±11 for the 5-minute protocol and 134.4±17/78.2±11 for the 3-minute protocol. HTN misclassification between groups based on awake-ABPM was similar (14% for 5- versus 12% for 3-minute delay, p=0.51). Compared to 5-minute delay, 3-minute delay was not associated with a significant difference between mean AOBP and mean awake-time ABPM for SBP (2.3 mm Hg; 95% CI: -3.7, 8.2) or DBP (1.2 mm Hg; 95% CI: -2.5, 4.8).

Conclusion: Measuring AOBP with a 3-minute delay did not result in statistically different accuracy compared with average awake-time ABPM. However, this finding should be confirmed in a larger, clinic-based sample.

Abstract P015: Characteristics And Care Of Inpatients With Orthostatic Hypotension

Background: Orthostatic hypotension (OH) contributes to over 80,000 hospitalizations annually, yet most studies of OH are conducted in outpatient settings. We sought to better characterize the causes, care, and course of OH in hospitalized patients in a large academic center.

Methods: In this observational study, we reviewed 101 electronic medical records of adults with OH during admission to Beth Israel Deaconess Medical Center in Boston between January 1, 2017 and June 30, 2021, extracting details related to symptoms, etiology, interventions, blood pressure (BP), and post-hospital follow-up. OH was defined as a drop in systolic or diastolic BP of at least 20 or 10 mm Hg, respectively.

Results: Of these patients (39.6% female, 9.9% Black, mean length of stay of 6.8 days), 30.7% had evidence of OH on initial presentation (Table) . While dizziness (32.7%) and lightheadedness (29.7%) were common, 19.8% of patients were asymptomatic. Volume resuscitation (64.4%), medication changes (53.5%), and physical therapy (24.8%) were the most frequent interventions. Among medication changes, reductions in beta blockers (37.0%) and loop diuretics (27.8%) were most common. On average, orthostatic systolic and diastolic BP improved by 7.9 and 3.0 mm Hg, respectively, and OH improved or resolved in 64.3% of patients. Within six months of discharge, 24.8% of patients had a subsequent encounter for OH.

Conclusion: This study identifies important foci for further study of inpatient OH, including detection among asymptomatic patients, clinical practices focused on BP augmentation strategies (volume resuscitation, down-titration of beta blockers and loop diuretics), and high recurrence rates.

An apprenticeship model in the training of psychotherapy students. Study protocol for a randomized controlled trial and qualitative investigation

Background

One approach towards advancing the quality of mental health care is to improve psychotherapists’ skills through education and training. Recently, psychotherapy training has benefitted from adapting training methods from other professions (e.g., deliberate practice). The apprenticeship model has a long history in skill trades and medicine, but has yet to be adopted in training mental health professionals. This study aims to investigate the impact of apprenticeship training on clinical psychology students’ skills.

Methods

In a pragmatic mixed-methods trial, 120 first year students in a Master’s degree clinical psychology program will be randomized to either training-as-usual or training-as-usual plus psychotherapy apprenticeship. In the intervention group, students will participate, over a period of 10 weeks, in weekly treatment sessions together with licensed therapists at outpatient mental health and substance use treatment clinics. Outcomes are assessed post-intervention and at two-year follow-up. The main outcome measure is the Facilitative Interpersonal Skills (FIS) performance test. Additional self-report measures tap self-efficacy, self-compassion, worry, rumination, and stress. Weekly reflection log entries written by the students will be qualitatively analyzed in order to gain an in-depth understanding of the learning process. Students’ and therapists’ experiences with the intervention will be explored in focus group interviews.

Discussion

To the best of our knowledge, this is the first controlled study to investigate the impact of apprenticeship as an isolated training component in the education of clinical psychologists. The study is designed so as to yield a comprehensive understanding of an approach which could prove to be a valuable supplement to the existing educational methods in this field and ultimately, contribute to improve the quality of mental health care.

Strong Constraints on Neutrino Nonstandard Interactions from TeV-Scale ν_{μ} Disappearance at IceCube

We report a search for nonstandard neutrino interactions (NSI) using eight years of TeV-scale atmospheric muon neutrino data from the IceCube Neutrino Observatory. By reconstructing incident energies and zenith angles for atmospheric neutrino events, this analysis presents unified confidence intervals for the NSI parameter ε_{μτ}. The best-fit value is consistent with no NSI at a p value of 25.2%. With a 90% confidence interval of -0.0041≤ε_{μτ}≤0.0031 along the real axis and similar strength in the complex plane, this result is the strongest constraint on any NSI parameter from any oscillation channel to date.

Treating from Afar: Mental Health Providers' Challenges and Concerns During the COVID-19 Pandemic

The outbreak of COVID-19 has resulted in increasing needs for mental health treatments and yet simultaneously posed great challenges to the delivery of in-person psychological services. The standard clinical practice suddenly shifted to the use of telepsychology. This study aimed to identify how therapists have been responding to the public health crisis and the rapid transition to telepsychology. We distributed a survey to 502 mental health providers to investigate the challenges and concerns of the delivery of clinical work during the pandemic. Our study found that most therapists (75.9%) transitioned to telepsychology without suspension of services. Therapists reported varied concerns regarding telepsychology, clinical practice, and their personal lives. The most common concerns identified were the use of therapeutic techniques in telepsychology, provision of remote services, and the practitioner's own health. Our findings also indicated that therapists who are students, female, sexual minorities, unpartnered, and working in public settings experienced relatively greater concerns. It may imperative to allocate more resources to those subgroups of therapists to facilitate their clinical work in telepsychology. This study contributed to our understanding of how the pandemic has impacted clinical work and may inform practitioners in coping with the current and any future public crises.

Abstract 12: Oral Anticoagulant Prescribing For Older Adults Newly Diagnosed With Atrial Fibrillation During Hospitalization

Background: Oral anticoagulants are indicated in patients with atrial fibrillation (AF) at elevated thromboembolic risk. AF is often diagnosed during hospitalization, yet little is known about rates of anticoagulant initiation in this setting.

Methods: We examined a 20% national sample of Medicare fee-for-service beneficiaries enrolled in Part D, aged > 65 years, who were hospitalized in 2016, and who received a new diagnosis of AF. The primary outcome was anticoagulant claim within 7 days of discharge home. We used multivariable logistic regression and post-estimation predicted probabilities to identify predictors of discharge with an anticoagulant, hypothesizing that thromboembolic risk, bleeding risk, and frailty would independently influence anticoagulant initiation.

Results: Among 31,889 patients diagnosed with AF while hospitalized (mean age, 78; 52% female; 84% white; 95% CHA 2 DS 2 -VASc ≥2; 84% HAS-BLED ≥2; 37% frail), one-quarter initiated an anticoagulant following discharge. In multivariable models, rates of anticoagulant initiation varied by primary reason for hospitalization, with the highest predicted probability of initiation among those with a primary diagnosis of AF (46.3%; 95% CI 45.1-47.5), followed by cardiac surgery (42.8%; 39.6-46.0), other cardiovascular conditions (25.1%; 24.3-26.0), non-cardiac diagnoses (18.6%; 17.3-19.9), and bleeds (3.6%; 2.3-5.0). Higher CHA 2 DS 2 -VASc score was associated with a small increase in anticoagulant initiation (predicted probability 19.8% [15.4-24.2] for CHA 2 DS 2 -VASc <2 and 25.2% [24.7-25.7] for ≥4). Higher HAS-BLED score was associated with a small decrease (25.7% [24.6-26.8] for HAS-BLED <2 and 23.4% [22.7-24.1] for ≥3). Increased frailty was associated with decreased likelihood of anticoagulant initiation, with robust and moderately-severely frail patients having predicted probabilities of 25.0% (23.3-26.6) and 17.6% (15.9-19.2) respectively.

Discussion: Anticoagulant initiation is uncommon among older adults newly diagnosed with AF during hospitalization, even among those hospitalized primarily for AF and those with high thromboembolic risk. Providers should carefully weigh risks and benefits of anticoagulants with all inpatients found to have AF.

Search for Relativistic Magnetic Monopoles with Eight Years of IceCube Data

We present an all-sky 90% confidence level upper limit on the cosmic flux of relativistic magnetic monopoles using 2886 days of IceCube data. The analysis was optimized for monopole speeds between 0.750c and 0.995c, without any explicit restriction on the monopole mass. We constrain the flux of relativistic cosmic magnetic monopoles to a level below 2.0×10^{-19}  cm^{-2} s^{-1} sr^{-1} over the majority of the targeted speed range. This result constitutes the most strict upper limit to date for magnetic monopoles with β≳0.8 and up to β∼0.995 and fills the gap between existing limits on the cosmic flux of nonrelativistic and ultrarelativistic magnetic monopoles.

Zoom-in to zone-out: Therapists report less therapeutic skill in telepsychology versus face-to-face therapy during the COVID-19 pandemic

The coronavirus disease (COVID-19) pandemic has resulted in a rapid transition from in-person therapy to teletherapy. This study examined mental health providers' perceptions of the differences between in-person therapy and teletherapy in common therapeutic attributes and identified therapist characteristics that predicted differences. A sample of 440 therapists and trainees completed an online survey that assessed their provision of clinical services since the outbreak of COVID-19. Therapists provided ratings for having used 28 therapeutic attributes (e.g., empathy, emotional expression) and skills for in-person therapy and teletherapy. Those attributes were clustered into three factors via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA): common therapeutic skills (e.g., warmth), extra-therapeutic influence (e.g., providing resources), and perceived outcome (e.g., symptom reductions). Therapists perceived poorer common therapeutic skills, decreased outcomes, and reduced extra-therapeutic influence when conducting teletherapy compared to in-person therapy. Therapists who reported poorer common therapeutic skills in teletherapy tended to be male, younger, utilize experience-based and relational therapies, have smaller caseloads, and had little training and no prior experience in teletherapy. Additionally, being male, utilizing experience-based and relational therapies, and having no training in teletherapy were associated with therapists' perception of reduced outcome in teletherapy. More intensive training and support in these attributes/skills are needed to improve therapists' confidence and ability to use therapeutic skills during teletherapy and ultimately improve the quality of psychological services in the era of teletherapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Protracted Impairment of Maternal Metabolic Health in Mouse Dams Following Pregnancy Exposure to a Mixture of Low Dose Endocrine-Disrupting Chemicals, a Pilot Study

Pregnancy, a period of increased metabolic demands coordinated by fluctuating steroid hormones, is an understudied critical window of disease susceptibility for later-life maternal metabolic health. Epidemiological studies have identified associations between exposures to various endocrine-disrupting chemicals (EDCs) with an increased risk for metabolic syndrome, obesity, and diabetes. Whether such adverse outcomes would be heightened by concurrent exposures to multiple EDCs during pregnancy, consistent with the reality that human exposures are to EDC mixtures, was examined in the current pilot study. Mouse dams were orally exposed to relatively low doses of four EDCs: (atrazine (10 mg/kg), bisphenol-A (50 µg/kg), perfluorooctanoic acid (0.1 mg/kg), 2,3,7,8-tetrachlorodibenzo-p-dioxin (0.036 µg/kg)), or the combination (MIX), from gestational day 7 until birth or for an equivalent 12 days in non-pregnant females. Glucose intolerance, serum lipids, weight, and visceral adiposity were assessed six months later. MIX-exposed dams exhibited hyperglycemia with a persistent elevation in blood glucose two hours after glucose administration in a glucose tolerance test, whereas no such effects were observed in MIX-exposed non-pregnant females. Correspondingly, MIX dams showed elevated serum low-density lipoprotein (LDL). There were no statistically significant differences in weight or visceral adipose; MIX dams showed an average visceral adipose volume to body volume ratio of 0.09, while the vehicle dams had an average ratio of 0.07. Collectively, these findings provide biological plausibility for the epidemiological associations observed between EDC exposures during pregnancy and subsequent maternal metabolic dyshomeostasis, and proof of concept data that highlight the importance of considering complex EDC mixtures based of off common health outcomes, e.g., for increased risk for later-life maternal metabolic effects following pregnancy.

COVID-19 PANDEMIC INDUCED DISRUPTIONS IN TROPONIN AND LOW-DENSITY LIPOPROTEIN CHOLESTEROL LABORATORY TEST VOLUMES ACROSS ALBERTA

BACKGROUND

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality in Canada and worldwide. Laboratory tests, including troponin and low-density lipoprotein cholesterol (LDL-C), are important biomarkers of ASCVD risk. The objective of this study was to investigate patterns of testing for troponin and LDL-C test volumes among Alberta residents during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS AND RESULTS

A repeated cross-sectional study design captured population-level laboratory test volumes between March 15, 2019 and December 14, 2020. Three-month cross-sections were derived to report laboratory test volumes by different COVID-19 restriction periods during 2020-2021 and using 2019-2020 as a preceding control period. Percent change for troponin and LDL-C test volumes were calculated for both control and COVID-19 periods among adult (≥18 years of age) Alberta residents, and stratified by age (18-49, 50-65, 66-79, and ≥80 years), sex, and geographic zones (urban, rural). This preliminary data is part of an ongoing study for which further troponin and LDL-C test volumes will be available up until March 14, 2021 (representing one year of data throughout the COVID-19 pandemic). Among the Alberta population, 292,836 troponin and 794,789 LDL-C tests were captured between March 15, 2020 and December 14, 2020 (Figure 1). Testing patterns during the COVID-19 restriction period showed marked reduction in test volumes from the previous year. The initial cross-section of the COVID-19 period (March-June 2020) was characterized by the largest overall reduction with troponin test volumes decreasing 18% and LDL-C test volumes decreasing 63%, compared to the year prior. As restrictions eased in the summer months of 2020, testing volumes rebounded to near pre-pandemic volumes for both tests. However, in the fall of 2020, troponin tests decreased again (-15%). Within these drops in utilization, slightly larger relative declines were observed for troponin test volumes in women (-20%) and patients ≥80 years-old (-25%) and for LDL-C test volumes among urban residents (-64%), women (-67%) and patients aged 18-49 (-66%) and 50-65 (-65%) years (Table 1).

CONCLUSION

This study describes declines in troponin and LDL-C test volumes in the initial and second COVID-19 lockdown periods. Women had overall smaller total troponin and LDL-C test volumes and larger relative declines during the pandemic compared to men. The decrease in these ASCVD-related laboratory test volumes during the pandemic may have been accompanied by other important changes in indicators of healthcare utilization and associated clinical outcomes. Ongoing analyses will further explore the impact of the pandemic.

How safe are gloves and masks used for protection against Legionella longbeachae infection when gardening?

Legionella longbeachae has been frequently identified in composted plant material and can cause Legionnaires' disease (LD). We wanted to determine how frequently L. longbeachae DNA was present on gardeners' gloves, and how long L. longbeachae could persist on inoculated gloves and masks. Volunteers completed a survey of gardening practices and their gardening gloves were tested for L. longbeachae DNA by qPCR. The persistence of viable L. longbeachae was assessed by timed subcultures after inoculation of gardening gloves and masks. Gloves but not masks were used regularly. L. longbeachae was detected on 11 (14%; 95% CI 8-24%) gloves. Viable organisms were recovered from 25-50% of inoculated cotton, leather and PU coated gloves but not rubber gloves after 8 h incubation. There was a difference in dose-response curve slopes by glove material (P = 0·001) and time to 50% sterility (P = 0·036). There were differences in persistence of L. longbeachae between mask types from analysis of the slopes and 50% sterility on the decay curves (P = 0·042, P < 0·001 respectively). Gardening gloves and masks may act as a vector for transmission of L. longbeachae during gardening. Washing gardening gloves and prompt disposal of masks could reduce risk of LD.

Abstract MP59: Effects Of Sodium Reduction And Weight Loss On Lightheadedness And Falls In Older Adults: Results From TONE

Background: The Trial of Nonpharmacologic Interventions in the Elderly (TONE) demonstrated the efficacy of sodium reduction and weight loss to reduce hypertension medication use in older adults. However, adverse events related to lightheadedness and falls have not been reported.

Objective: To determine whether sodium reduction and weight loss are associated with greater risk of lightheadedness and falls among older adults.

Methods: TONE was a randomized trial of 60-80 year-old adults with systolic BP (SBP) and diastolic BP (DBP) below 145 and 85 mm Hg, respectively, while receiving treatment with a single antihypertensive medication. Participants were randomized to behavioral interventions focused on sodium reduction, weight loss, both, or neither (usual care); 3 months after randomization, the antihypertensive medication was withdrawn and only restored later during the study if needed for uncontrolled hypertension. Total follow-up was 36 months post-randomization. Two physicians independently adjudicated adverse event logs, masked to intervention assignment. The primary outcome was a composite of the first occurrence of adverse event related to falls (total N=95): 72 involved orthostatic symptoms (lightheadedness, dizziness, vertigo), while 23 involved hard events (fall or syncope). Hazard ratios were determined via Cox proportional hazards models.

Results: Among the 975 participants (mean age 66 yrs, 48% women, 24% black), mean SBP and DBP were 128 and 71 mm Hg. The cumulative incidence of adverse events at 30 months was 0.08, 0.13, 0.11, and 0.14 for usual care, reduced sodium, weight loss, or both, respectively ( Figure ). In adjusted multi-variable analyses, sodium reduction was associated with higher risk of an adverse event (HR 1.52; 95% CI: 1.02, 2.27), while weight loss was not associated with adverse events (HR 1.18; 0.77, 1.79).

Conclusions: In the context of antihypertensive medication withdrawal, sodium reduction was associated with a higher risk of fall-related adverse events, predominantly symptoms.

Outcome following surgery to treat septic peritonitis in 95 cats in the United Kingdom

OBJECTIVES

To review the cause, management and outcome in cats with septic peritonitis within the United Kingdom (2008 to 2018) and to identify if previously identified prognostic factors were associated with survival in this population.

MATERIALS AND METHODS

Clinical records from 10 referral hospitals in United Kingdom were reviewed. Data collected included signalment, clinicopathological data and management techniques. Serum albumin, glucose, lactate and ionised calcium concentration; presence of intraoperative hypotension and correct empirical antibiosis were analysed via logistic regression for association with survival.

RESULTS

Ninety-five cats were included. The overall survival rate was 66%. Lethargy (89%) and anorexia (75%) were the most common clinical signs, with abdominal pain and vomiting in 44% and 27% of cases, respectively. Gastro-intestinal leakage was the most common source of contamination. The presence of an abdominal mass on clinical examination was not strongly predictive of the presence of neoplasia on histology and did not confer a worse prognosis. Cats presenting with dehiscence of a previous enterotomy/enterectomy did not have a worse prognosis than those presenting with other aetologies. Intraoperative hypotension (adjusted odds ratio 0.173, 95% confidence intervals 0.034 to 0.866, P=0.033) was associated with non-survival. Cats that survived beyond 1 day postoperatively had an improved likelihood of survival (87.5%). All cats that survived beyond 6 days were successfully discharged.

CLINICAL SIGNIFICANCE

This study describes the largest group of cats with septic peritonitis with an overall survival rate of 66%. The presence of an abdominal mass on clinical examination or having dehiscence of a previous gastrointestinal surgery did not confer a worse prognosis.

Double trouble: Therapists with low facilitative interpersonal skills and without training have low in-session experiential processes

Objectives: This study examined the combined effect of therapist Facilitative Interpersonal Skills (FIS) and Training Status on experiential processes within therapy sessions. In this randomized trial of FIS and Training Status, we predicted that in-session experiential processes would be highest for the high FIS and trained therapist group and lowest for the low FIS and untrained therapists. Methods: Forty-five clients were selected from 2,713 undergraduates using a screening and clinical interview procedure. Twenty-three therapists were selected for their level of FIS (high vs. low) and Training (trainee vs. untrained) and each were assigned two clients for seven sessions each. Two different coder teams independently rated experiencing and narrative process from the third therapy session and computer analysis identified affect words from transcripts. Results: FIS×Training Status significantly interacted on the set of experiential process measures. Relative to all others, therapists who were in the low FIS / no training group had lower experiencing and reflexive content, but higher external content. Conclusions: The findings highlight the importance of therapist characteristics within therapy sessions. Therapists without training and with low interpersonal skills have sessions that are nearly devoid of content that focuses on client experiential processes and emotion.

Assessment of the status and trends in abundance of a coastal pinniped, the Australian sea lion Neophoca cinerea

Australian sea lions Neophoca cinerea are endemic to Australia, with their contemporary distribution restricted to South Australia (SA) and Western Australia (WA). Monitoring of the species has proved challenging due to prolonged breeding events that occur non-annually and asynchronously across their range. The most recent available data from 80 extant breeding sites (48 in SA, 32 in WA) enabled us to estimate the species-wide pup abundance to be 2739, with 82% (2246) in SA and 18% (493) in WA, mostly based on surveys conducted between 2014 and 2019. We evaluated 1776 individual site-surveys undertaken between 1970 and 2019 and identified admissible time-series data from 30 breeding sites, which revealed that pup abundance declined on average by 2.0% yr-1 (range 9.9% decline to 1.7% growth yr-1). The overall reduction in pup abundance over 3 generations (42.3 yr) was estimated to be 64%, with over 98% of Monte Carlo simulations producing a decline >50% over a 3-generation period, providing strong evidence that the species meets IUCN ‘Endangered’ criteria (decline ≥50% and ≤80%). The population is much smaller than previously estimated and is declining. There is a strong cline in regional abundances (increasing from west to east), with marked within-region heterogeneity in breeding site pup abundances and trends. Results from this study should improve consistency in the assessment of the species and create greater certainty among stakeholders about its conservation status. To facilitate species management and recovery, we prioritise key data gaps and identify factors to improve population monitoring.

Paraquat Inhalation, a Translationally Relevant Route of Exposure: Disposition to the Brain and Male-Specific Olfactory Impairment in Mice

Epidemiological and experimental studies have associated oral and systemic exposures to the herbicide paraquat (PQ) with Parkinson's disease. Despite recognition that airborne particles and solutes can be directly translocated to the brain via olfactory neurons, the potential for inhaled PQ to cause olfactory impairment has not been investigated. This study sought to determine if prolonged low-dose inhalation exposure to PQ would lead to disposition to the brain and olfactory impairment, a prodromal feature of Parkinson's disease. Adult male and female C57BL/6J mice were exposed to PQ aerosols in a whole-body inhalation chamber for 4 h/day, 5 days/week for 4 weeks. Subsets of mice were sacrificed during and after exposure and PQ concentrations in various brain regions (olfactory bulb, striatum, midbrain, and cerebellum) lung, and kidney were quantified via mass spectrometry. Alterations in olfaction were examined using an olfactory discrimination paradigm. PQ inhalation resulted in an appreciable burden in all examined brain regions, with the highest burden observed in the olfactory bulb, consistent with nasal olfactory uptake. PQ was also detected in the lung and kidney, yet PQ levels in all tissues returned to control values within 4 weeks post exposure. PQ inhalation caused persistent male-specific deficits in olfactory discrimination. No effects were observed in females. These data support the importance of route of exposure in determination of safety estimates for neurotoxic pesticides, such as PQ. Accurate estimation of the relationship between exposure and internal dose is critical for risk assessment and public health protection.

Consensus of All Solutions for Intractable Phylogenetic Tree Inference

Solving median tree problems is a classic approach for inferring species trees from a collection of discordant gene trees. Median tree problems are typically NP-hard and dealt with by local search heuristics. Unfortunately, such heuristics generally lack provable correctness and precision. Algorithmic advances addressing this uncertainty have led to exact dynamic programming formulations suitable to solve a well-studied group of median tree problems for smaller phylogenetic analyses. However, these formulations allow computing only very few optimal species trees out of possibly many such trees, and phylogenetic studies often require the analysis of all optimal solutions through their consensus tree. Here, we describe a significant algorithmic modification of the dynamic programming formulations that compute the cluster counts of all optimal species trees from which various types of consensus trees can be efficiently computed. Through experimental studies, we demonstrate that our parallel implementation of the modified dynamic programming formulation is more efficient than a previous implementation of the original formulation. Finally, we show that the parallel implementation can rapidly identify novel reassorted influenza A viruses potentially facilitating pandemic preparedness efforts.

eV-Scale Sterile Neutrino Search Using Eight Years of Atmospheric Muon Neutrino Data from the IceCube Neutrino Observatory

The results of a 3+1 sterile neutrino search using eight years of data from the IceCube Neutrino Observatory are presented. A total of 305 735 muon neutrino events are analyzed in reconstructed energy-zenith space to test for signatures of a matter-enhanced oscillation that would occur given a sterile neutrino state with a mass-squared differences between 0.01 and 100  eV^{2}. The best-fit point is found to be at sin^{2}(2θ_{24})=0.10 and Δm_{41}^{2}=4.5  eV^{2}, which is consistent with the no sterile neutrino hypothesis with a p value of 8.0%.

Characteristics of the Diffuse Astrophysical Electron and Tau Neutrino Flux with Six Years of IceCube High Energy Cascade Data

We report on the first measurement of the astrophysical neutrino flux using particle showers (cascades) in IceCube data from 2010-2015. Assuming standard oscillations, the astrophysical neutrinos in this dedicated cascade sample are dominated (∼90%) by electron and tau flavors. The flux, observed in the sensitive energy range from 16 TeV to 2.6 PeV, is consistent with a single power-law model as expected from Fermi-type acceleration of high energy particles at astrophysical sources. We find the flux spectral index to be γ=2.53±0.07 and a flux normalization for each neutrino flavor of ϕ_{astro}=1.66_{-0.27}^{+0.25} at E_{0}=100  TeV, in agreement with IceCube's complementary muon neutrino results and with all-neutrino flavor fit results. In the measured energy range we reject spectral indices γ≤2.28 at ≥3σ significance level. Because of high neutrino energy resolution and low atmospheric neutrino backgrounds, this analysis provides the most detailed characterization of the neutrino flux at energies below ∼100  TeV compared to previous IceCube results. Results from fits assuming more complex neutrino flux models suggest a flux softening at high energies and a flux hardening at low energies (p value ≥0.06). The sizable and smooth flux measured below ∼100  TeV remains a puzzle. In order to not violate the isotropic diffuse gamma-ray background as measured by the Fermi Large Area Telescope, it suggests the existence of astrophysical neutrino sources characterized by dense environments which are opaque to gamma rays.

Post-release survival of fallout Newell’s shearwater fledglings from a rescue and rehabilitation program on Kaua‘i, Hawai‘i

Light attraction impacts nocturnally active fledgling seabirds worldwide and is a particularly acute problem on Kaua‘i (the northern-most island in the main Hawaiian Island archipelago) for the Critically Endangered Newell’s shearwaterPuffinus newelli. The Save Our Shearwaters (SOS) program was created in 1979 to address this issue and to date has recovered and released to sea more than 30500 fledglings. Although the value of the program for animal welfare is clear, as birds cannot simply be left to die, no evaluation exists to inform post-release survival. We used satellite transmitters to track 38 fledglings released by SOS and compared their survival rates (assessed by tag transmission duration) to those of 12 chicks that fledged naturally from the mountains of Kaua‘i. Wild fledglings transmitted longer than SOS birds, and SOS birds with longer rehabilitation periods transmitted for a shorter duration than birds released immediately or rehabilitated for only 1 d. Although transmitter durations from grounded fledglings were shorter (indicating impacts to survivorship), some SOS birds did survive and dispersed out to sea. All surviving birds (wild and SOS) traveled more than 2000 km to the southwest of Kaua‘i, where they concentrated mostly in the North Pacific Equatorial Countercurrent Province, revealing a large-scale annual post-breeding aggregation zone for fledgling Newell’s shearwaters. While there was reduced survival among birds undergoing rehabilitation, SOS remains an important contribution toward the conservation of Newell’s shearwater because a proportion of released birds do indeed survive. However, light attraction, the root cause of fallout, remains a serious unresolved issue on Kaua’i.

Understanding the Ecological Validity of Relying Practice as a Basis for Risk Identification

Understanding the reliability of hazardous organizations and their protective systems is central to understanding the risk they produce. Work on "high reliability organization" has done much to illuminate the conditions in which social organization becomes reliable in highly demanding conditions. But risk depends just as much on how relying entities do their relying as it does on the reliability of the entities they rely on. Patterns of relying are often opaque in sociotechnical systems, and processes of relying and being relied on are mutually influencing in complex ways, so the relationship between relying and risk may not be at all obvious. This study was an attempt to study relying as a social practice, in particular analyzing how it had ecological validity in a social organization-how practice was responsive to the conditions in which it took place. This involved observational fieldwork and inductive, qualitative analysis on an offshore oil and gas production platform that was nearing the end of its design life and undergoing refurbishment. The analysis produced four main categories of ecological validity: responsiveness to formal organization, responsiveness to situational contingency, responsiveness to information asymmetry, and responsiveness to sociomateriality. This ecological validity of relying practice should be a primary focus of risk identification, assessing how relying can become mismatched to reliability in certain ways, both when relying practice is responsive to circumstances and when it is not.

A follow-up of undergraduate students five years after helping skills training

In a 5-year follow-up assessment, 33 students who had taken an undergraduate helping skills course indicated that they had continued to use the helping skills in both their professional lives and personal relationships. On average, there were no significant changes from pretraining to follow-up on empathy, natural helping ability, or facilitative interpersonal skills. Furthermore, although students had increased in self-efficacy for using the skills during training, on average they maintained their self-efficacy levels at the follow-up. The 15 participants who had further mental health education, however, scored higher at follow-up on empathy, natural helping ability, self-efficacy for using the skills, and facilitative interpersonal skills compared with the 18 participants who had no further mental health education (controlling for pretraining levels), suggesting that continued exposure to and practice using the skills helped them continue to improve their helping abilities. Qualitative data indicated that participants typically had positive experiences in the helping skills course. Implications for training and research are provided. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Can a computer detect interpersonal skills? Using machine learning to scale up the Facilitative Interpersonal Skills task

Objective: Therapist interpersonal skills are foundational to psychotherapy. However, assessment is labor intensive and infrequent. This study evaluated if machine learning (ML) tools can automatically assess therapist interpersonal skills. Method: Data were drawn from a previous study in which 164 undergraduate students (i.e., not clinical trainees) completed the Facilitative Interpersonal Skills (FIS) task. This task involves responding to video vignettes depicting interpersonally challenging moments in psychotherapy. Trained raters scored the responses. We used an elastic net model on top of a term frequency-inverse document frequency representation to predict FIS scores. Results: Models predicted FIS total and item-level scores above chance (rhos = .27-.53, ps < .001), achieving 31-60% of human reliability. Models explained 13-24% of the variance in FIS total and item-level scores on a held out set of data (R ²), with the exception of the two items most reliant on vocal cues (verbal fluency, emotional expression), for which models explained ≤1% of variance. Conclusion: ML may be a promising approach for automating assessment of constructs like interpersonal skill previously coded by humans. ML may perform best when the standardized stimuli limit the "space" of potential responses (vs. naturalistic psychotherapy) and when models have access to the same data available to raters (i.e., transcripts).

Diaphragmotomy to aid exposure during hepatobiliary surgery: a multi-centre retrospective review of 31 dogs

OBJECTIVES

To report surgical technique, intra- and post-operative complications, and short- and long-term outcome following canine hepatobiliary surgery in which exposure of intra-abdominal hepatobiliary lesions was aided by diaphragmotomy.

MATERIALS AND METHODS

Clinical records from four multi-disciplinary UK-based small animal referral hospitals were retrospectively reviewed for dogs in which diaphragmotomy was performed between January 2014 and May 2019. Signalment, diagnosis, surgery performed, diaphragmotomy technique, management of diaphragmotomy and pneumothorax, intra- and post-operative complications, short-term outcome and long-term outcome were recorded.

RESULTS

Thirty-one cases were identified. The most common hepatobiliary surgeries performed alongside diaphragmotomy were single hepatic lobectomy (14/31) and cholecystectomy (11/31). The most common diagnoses were hepatocellular carcinoma (10/31), gall bladder mucocoele (7/31) and hepatic nodular hyperplasia (4/31). Peri-operative mortality rate was 9.7% (3/31 cases) though none of these deaths were considered attributable to diaphragmotomy. Post-operative complications were encountered in 67.9% (19/28) cases that survived the peri-operative period, of which 25.0% (7/28) suffered complications that were considered attributable or likely attributable to diaphragmotomy. These seven complications resolved following non-surgical intervention. Follow-up was available for 26 of 28 patients that survived to discharge at a median of 4-months (range 10 days to 24 months) following surgery and revealed no evidence of complications related to diaphragmotomy.

CLINICAL SIGNIFICANCE

Diaphragmotomy appears safe and increases abdominal exposure of hepatobiliary lesions. The benefit of improved exposure must be carefully weighed up against the risks inherent in inducing pneumothorax.

The impact of alliance-focused and facilitative interpersonal relationship training on therapist skills: An RCT of brief training

Research on standard methods of therapist training has found mixed evidence to as to whether standard training methods are effective. This study investigated the impact of a novel, research-informed training protocol that integrated elements of alliance-focused training (AFT) and facilitative interpersonal skills (FIS). Beyond traditional training techniques of didactics and lecture, the AFT/FIS intervention incorporated empirically supported video simulations of therapy, which were reinforced by role plays and deliberate practice on key therapeutic interpersonal skills. Fifty-eight graduate-level therapy trainees and professional therapists from various helping fields were randomized to one of two brief trainings in a multi-site RCT: (i) the AFT/FIS workshop or (ii) a more traditional demonstration training (DT) workshop. Participants were assessed on critical, relational therapeutic skills before and after the training. After controlling for relevant covariates, participants in the AFT/FIS training saw a marginally higher post-intervention level of overall therapeutic skills. Subsequent exploratory analyses revealed AFT/FIS participants also had significantly higher levels of specifically targeted post-training therapist skills (i.e., empathy, alliance bond capacity, and alliance rupture-repair responsiveness) compared to participants in DT. Implications for future empirical investigations and training initiatives are discussed.