A population health approach to workplace mental health: rationale, implementation and engagement.

Objectives: To describe a population health-based program to support employee and dependent mental health and learn from engagement trends. Methods: Retrospective analysis of a program utilizing an assessment of mental health risk. For scoring "at risk," a Care Concierge is offered to connect users with resources. Results: Participation was offered to 56,442 employees and dependents. Eight thousand seven hundred thirty-one completed the assessment (15%). Of those, 4,644 (53%) scored moderate or higher. A total of 418 (9%) engaged the Care Concierge. Factors that negatively influenced the decision to engage care included bodily pain, financial concerns. Positive influences were younger age, high stress, anxiety, PTSD and low social support. Conclusion: Proactive assessment plus access to a Care Concierge facilitates mental healthcare utilization. Several factors influence likelihood to engage in care. A better understanding of these factors may allow for more targeted outreach and improved engagement.

Neuroimaging Correlates of Post-Traumatic Stress Disorder in Traumatic Brain Injury: A Systematic Review of the Literature.

Neuroimaging is widely utilized in studying traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). The risk for PTSD is greater after TBI than after non-TBI trauma, and PTSD is associated with worse outcomes after TBI. Studying the neuroimaging correlates of TBI-related PTSD may provide insights into the etiology of both conditions and help identify those TBI patients most at risk of developing persistent symptoms. The objectives of this systematic review were to examine the current literature on neuroimaging in TBI-related PTSD, summarize key findings, and highlight strengths and limitations to guide future research. A Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) compliant literature search was conducted in PubMed (MEDLINE®), PsycINFO, Embase, and Scopus databases prior to January 2022. The database query yielded 4486 articles, which were narrowed based on specified inclusion criteria to a final cohort of 16 studies, composed of 854 participants with TBI. There was no consensus regarding neuroimaging correlates of TBI-related PTSD among the included articles. A small number of studies suggest that TBI-related PTSD is associated with white matter tract changes, particularly in frontotemporal regions, as well as changes in whole-brain networks of resting-state connectivity. Future studies hoping to identify reliable neuroimaging correlates of TBI-related PTSD would benefit from ensuring consistent case definition, preferably with clinician-diagnosed TBI and PTSD, selection of comparable control groups, and attention to imaging timing post-injury. Prospective studies are needed and should aim to further differentiate predisposing factors from sequelae of TBI-related PTSD.

Effects of an expert-modeled attentional focus cue structure on skilled jump rope performance and learning.

Instructions that direct attention externally have been shown to enhance motor performance. However, research on skilled performers and on learning effects has produced some distinct findings. Further, many studies have presented an overly simplistic view of attention and learning, such that all-internal focus protocols are contrasted with all-external focus protocols. Contrary to this approach, skilled performers have reported adopting combined focus strategies, revealing the need to test more realistic instructional protocols. The current study provided an experimental test of focus instructions that were modeled after the strategies of elite jump rope athletes. Four groups of skilled jump rope athletes practiced novel skills under various focus instructions. The internal focus (IF) and external focus (EF) groups were given traditional internal and external focus instructions, respectively. The expert modeled (EM) group was given a set of instructions that were based on experts' reported focus strategies. The expert modeled-autonomous (EM-A) group was allowed to choose how they used each of the expert-modeled instructions. All groups completed a baseline assessment, four practice sessions, and a learning assessment. Results of a chi-square test of independence revealed no relationship between group assignment and performance during baseline or practice. There was a significant relationship between group assignment and performance during the learning assessment (p < .05). Specifically, the IF group performed below expected values while the EM group performed better than expected. Findings support previous research showing learning detriments associated with internal focus instructions and also provide new insight into the advantages of using instructional approaches that are modeled after experts' strategies. Implications and suggestions for future research are discussed.

Elucidating the mechanism behind the infrared spectral features and dynamics observed in the carbonyl stretch region of organic carbonates interacting with lithium ions.

Ultrafast infrared spectroscopy has become a very important tool for studying the structure and ultrafast dynamics in solution. In particular, it has been recently applied to investigate the molecular interactions and motions of lithium salts in organic carbonates. However, there has been a discrepancy in the molecular interpretation of the spectral features and dynamics derived from these spectroscopies. Hence, the mechanism behind spectral features appearing in the carbonyl stretching region was further investigated using linear and nonlinear spectroscopic tools and the co-solvent dilution strategy. Lithium perchlorate in a binary mixture of dimethyl carbonate (DMC) and tetrahydrofuran was used as part of the dilution strategy to identify the changes of the spectral features with the number of carbonates in the first solvation shell since both solvents have similar interaction energetics with the lithium ion. Experiments showed that more than one carbonate is always participating in the lithium ion solvation structures, even at the low concentration of DMC. Moreover, temperature-dependent study revealed that the exchange of the solvent molecules coordinating the lithium ion is not thermally accessible at room temperature. Furthermore, time-resolved IR experiments confirmed the presence of vibrationally coupled carbonyl stretches among coordinated DMC molecules and demonstrated that this process is significantly altered by limiting the number of carbonate molecules in the lithium ion solvation shell. Overall, the presented experimental findings strongly support the vibrational energy transfer as the mechanism behind the off-diagonal features appearing on the 2DIR spectra of solutions of lithium salt in organic carbonates.

Baseline Prevalence of Polypharmacy in Older Hypertensive Study Subjects with Elevated Dementia Risk: Findings from the Risk Reduction for Alzheimer's Disease Study (rrAD).

BACKGROUND: Little is known about the prevalence of polypharmacy, the taking of five or more medications a day, in older adults with specific dementia risk factors. OBJECTIVE: To examine the prevalence of polypharmacy in participants at baseline in a vascular risk reduction focused Alzheimer's disease (rrAD) trial targeting older patients with hypertension and elevated dementia risk. METHODS: We conducted a detailed review of medications in a cross-sectional study of community-dwelling older adults with hypertension and elevated dementia risk. Medications were identified in a structured interview process with an onsite pharmacist or qualified designee. Polypharmacy was defined as use of five or more medications on a regular basis. Descriptive analyses were conducted on the sample as well as direct comparisons of subgroups of individuals with hypertension, diabetes, and hyperlipidemia. RESULTS: The 514 rrAD participants, mean age 68.8 (standard deviation [sd] 6), reported taking different combinations of 472 unique medications at their baseline visit. The median number of medications taken by participants was eight [Range 0-21], with 79.2% exhibiting polypharmacy (n = 407). Sites differed in their prevalence of polypharmacy, χ2(3) = 56.0, p < 0.001. A nearly identical percentage of the 2,077 prescribed (51.8%) and over the counter (48.2%) medications were present in the overall medication profile. The presence of diabetes (87.5%), hyperlipidemia (88.2%), or both (97.7%) was associated with a higher prevalence of polypharmacy than participants who exhibited hypertension in the absence of either of these conditions (63.2%), χ2(3) = 35.8, p < 0.001. CONCLUSION: Participants in a dementia risk study had high levels of polypharmacy, with the co-existence of diabetes or hyperlipidemia associated with a greater prevalence of polypharmacy as compared to having hypertension alone.

Medications for the treatment of obesity in adolescents.

While there are eight medications/combinations approved for the treatment of obesity in adults, the options for the treatment of obesity in adolescents remain limited. Evidence for obesity medication use in adolescents is limited due to the relatively small number of clinical trials that have been completed and the few adolescents that have been included in many of the trials. The goal of this review will be to present the current evidence for the medications approved for adolescents, medications not approved for adolescents but have adolescent data, and medications approved for adults with the prospect for use in adolescents. We will also discuss current limitations and next steps in the exploration of future treatment options.

Cognitive Loading During and After Continuous Task Execution Alters the Effects of Self-Controlled Knowledge of Results.

Previous research has repeatedly demonstrated that providing learners with self-control (SC) over their feedback schedules enhances motor skill learning. Increased information processing under SC conditions has been shown to contribute to these benefits. However, the timing of critical information processing for SC participants during the acquisition of continuous tasks is unknown. The present study was designed to enhance clarity related to this issue. Participants learned a continuous tracing task under SC or yoked (YK) conditions. Groups of participants also completed a secondary cognitive load task either during or after the execution of each primary task trial. Results showed enhanced learning for SC compared to YK participants who did not complete the cognitive load task. However, this benefit was eliminated for SC participants who completed the cognitive load task either during or after the primary task. These findings suggest that effective information processing both during and after continuous task execution is critical for reaping the benefits of self-controlled practice. Further interpretations and implications of these findings as well as suggestions for future research are discussed.

Naringenin Increases Insulin Sensitivity and Metabolic Rate: A Case Study.

Our studies in primary human adipocytes show that naringenin, a citrus flavonoid, increases oxygen consumption rate and gene expression of uncoupling protein 1 (UCP1), glucose transporter type 4, and carnitine palmitoyltransferase 1ß (CPT1ß). We investigated the safety of naringenin, its effects on metabolic rate, and blood glucose and insulin responses in a single female subject with diabetes. The subject ingested 150 mg naringenin from an extract of whole oranges standardized to 28% naringenin three times/day for 8 weeks, and maintained her usual food intake. Body weight, resting metabolic rate, respiratory quotient, and blood chemistry panel including glucose, insulin, and safety markers were measured at baseline and after 8 weeks. Adverse events were evaluated every 2 weeks. We also examined the involvement of peroxisome proliferator-activated receptor α (PPARα), peroxisome proliferator-activated receptor γ (PPARγ), protein kinase A (PKA), and protein kinase G (PKG) in the response of human adipocytes to naringenin treatment. Compared to baseline, the body weight decreased by 2.3 kg. The metabolic rate peaked at 3.5% above baseline at 1 h, but there was no change in the respiratory quotient. Compared to baseline, insulin decreased by 18%, but the change in glucose was not clinically significant. Other blood safety markers were within their reference ranges, and there were no adverse events. UCP1 and CPT1ß mRNA expression was reduced by inhibitors of PPARα and PPARγ, but there was no effect of PKA or PKG inhibition. We conclude that naringenin supplementation is safe in humans, reduces body weight and insulin resistance, and increases metabolic rate by PPARα and PPARγ activation. The effects of naringenin on energy expenditure and insulin sensitivity warrant investigation in a randomized controlled clinical trial.

Structure and Dynamics of the Lithium-Ion Solvation Shell in Ureas.

Lithium-ion batteries have become ubiquitous to modern life because of their use in the energy storage needs of our daily lives. In past several decades, much effort has been put into studying the molecular structure of electrolytes composed of organic carbonates. However, other solvents with similar properties but better thermal stabilities, such as tertiary amides, have not received the same level of scrutiny. In this work, solutions of lithium salts in ureas, tertiary amides with the structure RR'N-CO-NR″R‴, with different sizes and connectivity are studied. Ureas present an interesting case study because unlike organic carbonates, the amide bond is planar and has restricted conformational change. In addition, ureas cannot bind the lithium ion through their nitrogen atoms. By using steady-state and time-resolved infrared spectroscopies and ab-initio computational methods, detailed descriptions of the changes to the lithium-ion solvation structure as a result of the urea structure were derived for three ureas bearing a strong resemblance to commonly used organic carbonates. These results show that the solvation shell of ureas has a tetrahedral structure similar to that of other organic solvents. Although the structure of the amide bonds in these ureas is similar to that of carbonate molecules, the atomic connectivity differs. In addition, the dynamics of the cation solvation shell formed by ureas shows a picosecond motion, which is attributed to deformation of the tetrahedral structure. Our investigations also indicate that the deformation dynamics is controlled directly by the size of the urea because of the rigidity of the amide bond in these molecules. Overall, this work shows that ureas share similarity with their organic carbonate analogues, but the rigid urea structure provides an easier framework for interpreting the vibrational observations in terms of the solvent molecular structure.