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During February 7âSeptember 3, 2022, a total of 39 US states experienced outbreaks of highly pathogenic avian influenza A(H5N1) virus in birds from commercial poultry farms and backyard flocks. Among persons exposed to infected birds, highly pathogenic avian influenza A(H5) viral RNA was detected in 1 respiratory specimen from 1 person.
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Virus da Influenza A Subtipo H5N1 , Vírus da Influenza A , Influenza Aviária , Influenza Humana , Animais , Humanos , Estados Unidos/epidemiologia , Influenza Aviária/epidemiologia , Virus da Influenza A Subtipo H5N1/genética , Aves , Influenza Humana/epidemiologia , Aves Domésticas , Surtos de DoençasRESUMO
BACKGROUND: Managing hypertension in racial and ethnic minoritized groups (eg, African American/Black patients) in primary care is highly relevant. However, evidence on whether or how electronic health record (EHR)-driven approaches in primary care can help improve hypertension management for patients of racial and ethnic minoritized groups in the United States remains scarce. OBJECTIVE: This review aims to examine the role of the EHR in supporting interventions in primary care to strengthen the hypertension management of racial and ethnic minoritized groups in the United States. METHODS: A search strategy based on the PICO (Population, Intervention, Comparison, and Outcome) guidelines was utilized to query and identify peer-reviewed articles on the Web of Science and PubMed databases. The search strategy was based on terms related to racial and ethnic minoritized groups, hypertension, primary care, and EHR-driven interventions. Articles were excluded if the focus was not hypertension management in racial and ethnic minoritized groups or if there was no mention of health record data utilization. RESULTS: A total of 29 articles were included in this review. Regarding populations, Black/African American patients represented the largest population (26/29, 90%) followed by Hispanic/Latino (18/29, 62%), Asian American (7/29, 24%), and American Indian/Alaskan Native (2/29, 7%) patients. No study included patients who identified as Native Hawaiian/Pacific Islander. The EHR was used to identify patients (25/29, 86%), drive the intervention (21/29, 72%), and monitor results and outcomes (7/29, 59%). Most often, EHR-driven approaches were used for health coaching interventions, disease management programs, clinical decision support (CDS) systems, and best practice alerts (BPAs). Regarding outcomes, out of 8 EHR-driven health coaching interventions, only 3 (38%) reported significant results. In contrast, all the included studies related to CDS and BPA applications reported some significant results with respect to improving hypertension management. CONCLUSIONS: This review identified several use cases for the integration of the EHR in supporting primary care interventions to strengthen hypertension management in racial and ethnic minoritized patients in the United States. Some clinical-based interventions implementing CDS and BPA applications showed promising results. However, more research is needed on community-based interventions, particularly those focusing on patients who are Asian American, American Indian/Alaskan Native, and Native Hawaiian/Pacific Islander. The developed taxonomy comprising "identifying patients," "driving intervention," and "monitoring results" to classify EHR-driven approaches can be a helpful tool to facilitate this.
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Registros Eletrônicos de Saúde , Hipertensão , Grupos Minoritários , Atenção Primária à Saúde , Humanos , Etnicidade , Hipertensão/terapia , Grupos Raciais , Estados UnidosRESUMO
Sickle cell disease (SCD) is associated with increased risk of neurocognitive deficits. However, whether functioning changes following nonmyeloablative hematopoietic stem cell transplant (HSCT) remains unclear. This study aimed to examine changes in neuropsychological functioning pre- to post-transplant among patients with SCD and compare patients and siblings. Adults with SCD (n = 47; Mage = 31.8 ± 8.9) and their sibling stem cell donors (n = 22; Mage = 30.5± 9.2) enrolled on a nonmyeloablative HCST protocol completed cognitive and patient-reported outcome assessments at baseline and 12 months post-transplant. Path analyses were used to assess associations between pre-transplant variables and sibling/patient group status and post-transplant function. Mean patient cognitive scores were average at both timepoints. Patient processing speed and somatic complaints improved from baseline to follow-up. Baseline performance predicted follow-up performance across cognitive variables; patient/sibling status predicted follow-up performance on some processing speed measures. Results suggest that patients with SCD demonstrate slower processing speed than siblings. Processing speed increased pre- to post-HSCT among patients and siblings, and on some measures patients demonstrated greater improvement. Thus, HSCT may improve processing speed in patients, although further confirmation is needed. Findings provide promising evidence that neurocognitive functioning remains stable without detrimental effects from pre- to 12-months post nonmyeloablative HSCT in individuals with SCD.
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Mitochondrial permeability transition pore (mPTP) plays a central role in alterations of mitochondrial structure and function leading to neuronal injury relevant to aging and neurodegenerative diseases including Alzheimer's disease (AD). mPTP putatively consists of the voltage-dependent anion channel (VDAC), the adenine nucleotide translocator (ANT) and cyclophilin D (CypD). Reactive oxygen species (ROS) increase intra-cellular calcium and enhance the formation of mPTP that leads to neuronal cell death in AD. CypD-dependent mPTP can play a crucial role in ischemia/reperfusion injury. The interaction of amyloid beta peptide (Aß) with CypD potentiates mitochondrial and neuronal perturbation. This interaction triggers the formation of mPTP, resulting in decreased mitochondrial membrane potential, impaired mitochondrial respiration function, increased oxidative stress, release of cytochrome c, and impaired axonal mitochondrial transport. Thus, the CypD-dependent mPTP is directly linked to the cellular and synaptic perturbations observed in the pathogenesis of AD. Designing small molecules to block this interaction would lessen the effects of Aß neurotoxicity. This review summarizes the recent progress on mPTP and its potential therapeutic target for neurodegenerative diseases including AD.
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Proteínas de Transporte da Membrana Mitocondrial/antagonistas & inibidores , Terapia de Alvo Molecular , Degeneração Neural/tratamento farmacológico , Animais , Peptidil-Prolil Isomerase F , Ciclofilinas/antagonistas & inibidores , Ciclofilinas/metabolismo , Humanos , Isquemia/metabolismo , Isquemia/patologia , Proteínas de Transporte da Membrana Mitocondrial/metabolismo , Poro de Transição de Permeabilidade Mitocondrial , Modelos BiológicosRESUMO
BACKGROUND: 17ß-hydroxysteroid dehydrogenase type 10 (HSD10) has been shown to play a protective role in cells undergoing stress. Upregulation of HSD10 under nutrient-limiting conditions leads to recovery of a homeostatic state. Across disease states, increased HSD10 levels can have a profound and varied impact, such as beneficial in Parkinson's disease and harmful in Alzheimer's disease. Recently, HSD10 overexpression has been observed in some prostate and bone cancers, consistently correlating with poor patient prognosis. As the role of HSD10 in cancer remains underexplored, we propose that cancer cells utilize this enzyme to promote cancer cell survival under cell death conditions. METHODS: The proliferative effect of HSD10 was examined in transfected pheochromocytoma cells by growth curve analysis and a xenograft model. Fluctuations in mitochondrial bioenergetics were evaluated by electron transport chain complex enzyme activity assays and energy production. Additionally, the effect of HSD10 on pheochromocytoma resistance to cell death was investigated using TUNEL staining, MTT, and complex IV enzyme activity assays. RESULTS: In this study, we examined the tumor-promoting effect of HSD10 in pheochromocytoma cells. Overexpression of HSD10 increased pheochromocytoma cell growth in both in vitro cell culture and an in vivo xenograft mouse model. The increases in respiratory enzymes and energy generation observed in HSD10-overexpressing cells likely supported the accelerated growth rate observed. Furthermore, cells overexpressing HSD10 were more resistant to oxidative stress-induced perturbation. CONCLUSIONS: Our findings demonstrate that overexpression of HSD10 accelerates pheochromocytoma cell growth, enhances cell respiration, and increases cellular resistance to cell death induction. This suggests that blockade of HSD10 may halt and/or prevent cancer growth, thus providing a promising novel target for cancer patients as a screening or therapeutic option.
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3-Hidroxiacil-CoA Desidrogenases/genética , Expressão Gênica , Feocromocitoma/genética , 3-Hidroxiacil-CoA Desidrogenases/metabolismo , Animais , Morte Celular/genética , Linhagem Celular Tumoral , Proliferação de Células , Ciclofilinas/metabolismo , Modelos Animais de Doenças , Xenoenxertos , Humanos , Potencial da Membrana Mitocondrial/genética , Camundongos , Mitocôndrias/metabolismo , Biogênese de Organelas , Estresse Oxidativo/genética , Feocromocitoma/metabolismo , Feocromocitoma/patologia , Ligação Proteica , Ratos , TransfecçãoRESUMO
Ruthenium-catalyzed asymmetric [2 + 2] cycloadditions between chiral acyl camphorsultam-functionalized alkynes and bicyclic alkenes were examined, providing adducts with complete exo stereoselectivity in good overall yield and enantioselectivity (up to 99% and 166:1, respectively), as well as appreciable diastereoselectivity (up to 163:1). The diastereoselectivity showed dependence on the solvent and temperature, as well as on the substitution pattern of the reacting alkyne and bicyclic alkene components. In general, higher diastereoselectivities were observed for reactions conducted in ethereal solvents and at lower temperatures between N-propynoyl camphorsultams and bicyclic alkenes.
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Alcenos/química , Alcinos/química , Compostos Bicíclicos com Pontes/química , Compostos Heterocíclicos com 3 Anéis/química , Rutênio/química , Catálise , Reação de Cicloadição , Estrutura Molecular , EstereoisomerismoRESUMO
Transition metal-mediated N-O bond cleavage reactions of heterobicycloalkene-fused 3-methyl-2-isoxazolines were investigated. Optimal cleavage conditions were found with Raney nickel/AlCl3 mediation in aqueous methanol. The reaction provided a diverse collection of novel heterobicycle-fused ß-hydroxyketones with good to excellent yields (66-95%) and without the need for chromatographic purification.
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Prior studies of behavior therapy for trichotillomania (TTM) have shown that response is variable, and relapse after treatment discontinuation is common. Little information is available concerning prognostic factors capable of predicting individual differences in response or maintenance of improvement. The present study is a secondary analysis of a randomized controlled trial (N = 36) of the Comprehensive Behavioral (ComB) model of treatment for TTM (Carlson et al., 2021). We investigated age, disorder history, pre-treatment symptom severity, longest prior period of abstinence from pulling, and Emotion and Intention hair pulling styles as predictors of initial response. We studied age, disorder history, pre-treatment symptom severity, longest prior period of abstinence from pulling, and post-treatment symptom severity or hair-pulling abstinence as predictors of relapse following treatment. Older age significantly predicted lower TTM severity following treatment. Lower pre-treatment severity significantly predicted lower severity of TTM at the 3-month follow-up.
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Tricotilomania , Humanos , Tricotilomania/terapia , Emoções , Terapia Comportamental , RecidivaRESUMO
Hypertension disparities persist and remain high among racial and ethnic minority populations in the United States (US). Data-driven approaches based on electronic health records (EHRs) in primary care are seen as a strong opportunity to address this situation. This qualitative study evaluated the development, sustainability, and usability of an EHR-integrated hypertension disparities dashboard for health care professionals in primary care. Ten semi-structured interviews, exploring the approach and sustainability, as well as eight usability interviews, using the think aloud protocol were conducted with quality improvement managers, data analysts, program managers, evaluators, and primary care providers. For the results, dashboard development steps include having clear goals, defining a target audience, compiling data, and building multidisciplinary teams. For sustainability, the dashboard can enhance understanding of the social determinants of health or to inform QI projects. In terms of dashboard usability, positive aspects consisted of the inclusion of summary pages, patient's detail pages, and hover-over interface. Important design considerations were refining sorting functions, gender inclusivity, and increasing dashboard visibility. In sum, an EHR-driven dashboard can be a novel tool for addressing hypertension disparities in primary care. It offers a platform where clinicians can identify patients for culturally tailored interventions. Factors such as physician time constraints, data definitions, comprehensive patient demographic information, end-users, and future sustenance, should be considered before implementing a dashboard. Additional research is needed to identify practices for integrating a dashboard into clinical workflow for hypertension.
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Registros Eletrônicos de Saúde , Hipertensão , Atenção Primária à Saúde , Pesquisa Qualitativa , Humanos , Atenção Primária à Saúde/organização & administração , Hipertensão/terapia , Hipertensão/etnologia , Masculino , Feminino , Estados Unidos/epidemiologia , Melhoria de Qualidade , Disparidades em Assistência à Saúde , Pessoa de Meia-Idade , Adulto , Entrevistas como Assunto , EtnicidadeRESUMO
Plastics in aquatic ecosystems rapidly undergo biofouling, giving rise to a new ecosystem on their surface, the 'plastisphere.' Few studies quantify the impact of plastics and their associated community on ecosystem traits from biodiversity and functional traits to metabolic function. It has been suspected that impacts on ecosystems may depend on its state but comparative studies of ecosystem responses are rare in the published literature. We quantified algal biomass, bacterial and algal biodiversity (16S and 18S rRNA), and metabolic traits of the community growing on the surface of different plastic polymers incubated within rivers of the Lower Mekong Basin. The rivers selected have different ecological characteristics but are similar regarding their high degree of plastic pollution. We examined the effects of plastics colonized with biofilms on ecosystem production, community dark respiration, and the epiplastic community's capability to influence nitrogen, phosphorus, organic carbon, and oxygen in water. Finally, we present conceptual models to guide our understanding of plastic pollution within freshwaters. Our findings showed limited microalgal biomass and bacterial dominance, with potential pathogens present. The location significantly influenced community composition, highlighting the role of environmental conditions in shaping community development. When assessing the effects on ecosystem productivity, our experiments showed that biofouled plastics led to a significant drop in oxygen concentration within river water, leading to hypoxic/anoxic conditions with subsequent profound impacts on system metabolism and the capability of influencing biogeochemical cycles. Scaling our findings revealed that plastic pollution may exert a more substantial and ecosystem-altering impact than initially assumed, particularly in areas with poorly managed plastic waste. These results highlighted that the plastisphere functions as a habitat for biologically active organisms which play a pivotal role in essential ecosystem processes. This warrants dedicated attention and investigation, particularly in sensitive ecosystems like the Mekong River, which supports a rich biodiversity and the livelihoods of 65 million people.
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Ecossistema , Plásticos , Rios , Rios/microbiologia , Biodiversidade , Biomassa , Poluentes Químicos da ÁguaRESUMO
Mitochondria are well-known cellular organelles widely studied in relation to a variety of disease states, including Alzheimer's disease. With roles in several metabolic processes, numerous signal transduction pathways, and overall cell maintenance and survival, mitochondria are essential to understanding the inner workings of cells. As mitochondria are able to be utilized by diverse illnesses to increase the likelihood of disease progression, targeting specific processes in these organelles could provide beneficial therapeutic options.
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Body movement is a primary nonverbal communication channel in humans. Coordinated social behaviors, such as dancing together, encourage multifarious rhythmic and interpersonally coupled movements from which observers can extract socially and contextually relevant information. The investigation of relations between visual social perception and kinematic motor coupling is important for social cognition. Perceived coupling of dyads spontaneously dancing to pop music has been shown to be highly driven by the degree of frontal orientation between dancers. The perceptual salience of other aspects, including postural congruence, movement frequencies, time-delayed relations, and horizontal mirroring remains, however, uncertain. In a motion capture study, 90 participant dyads moved freely to 16 musical excerpts from eight musical genres, while their movements were recorded using optical motion capture. A total from 128 recordings from 8 dyads maximally facing each other were selected to generate silent 8-s animations. Three kinematic features describing simultaneous and sequential full body coupling were extracted from the dyads. In an online experiment, the animations were presented to 432 observers, who were asked to rate perceived similarity and interaction between dancers. We found dyadic kinematic coupling estimates to be higher than those obtained from surrogate estimates, providing evidence for a social dimension of entrainment in dance. Further, we observed links between perceived similarity and coupling of both slower simultaneous horizontal gestures and posture bounding volumes. Perceived interaction, on the other hand, was more related to coupling of faster simultaneous gestures and to sequential coupling. Also, dyads who were perceived as more coupled tended to mirror their pair's movements.
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Gestos , Música , Humanos , Comportamento Imitativo , Movimento , Postura , Percepção VisualRESUMO
Background: In recent decades, invasive quagga mussels have expanded to the Western United States from the Great Lakes region of North America. Most studies that evaluate the invasion potential of quagga mussels in western water bodies have utilized physiological and life history information from zebra mussels, a related taxon. Few studies have assessed the potential for invasion using specific information from quagga mussel life history or experiments that test for their survival in the fresh and saline waters of the western United States. Methods: We investigated quagga mussel survival, growth, and reproduction using semi-natural experiments under temperature and light controlled conditions across a gradient of water salinity (fresh to brackish) and pH (8.4-11). Water from Lake Mead was used as a positive control in our experiment, and water from Pyramid Lake and the Truckee River was used as brackish and freshwater treatments, respectively. The mussels used in the experiments were collected from Lake Mead. Results: After 12 h in brackish water (4 ppt, pH 9.3), we observed 100% mortality of adult mussels. The swelling and disintegration of body tissues and high mortality rates indicated that high potassium, sodium, and chloride concentrations were the likely causes of death in brackish water treatments. In contrast, mussels were able to survive, grow, and reach sexual maturity in freshwater (0.1 ppt) with a low calcium concentration (17 mg L-1) after 57 days. Mussels died after 2 days at pH 11 and after 12 days at pH 10; during the 14-day monitoring period, no mortality was detected at pH 9.0, 9.3, or 9.5 and mussels did not exhibit any visual indications of stress. Understanding quagga mussel physiological and environmental tolerances appears to be essential for assessing their invasion potential in aquatic habitats.
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Bivalves , Salinidade , Animais , Estados Unidos , Lagos , Reprodução , Concentração de Íons de HidrogênioRESUMO
Movement is a universal response to music, with dance often taking place in social settings. Although previous work has suggested that socially relevant information, such as personality and gender, are encoded in dance movement, the generalizability of previous work is limited. The current study aims to decode dancers' gender, personality traits, and music preference from music-induced movements. We propose a method that predicts such individual difference from free dance movements, and demonstrate the robustness of the proposed method by using two data sets collected using different musical stimuli. In addition, we introduce a novel measure to explore the relative importance of different joints in predicting individual differences. Results demonstrated near perfect classification of gender, and notably high prediction of personality and music preferences. Furthermore, learned models demonstrated generalizability across datasets highlighting the importance of certain joints in intrinsic movement patterns specific to individual differences. Results further support theories of embodied music cognition and the role of bodily movement in musical experiences by demonstrating the influence of gender, personality, and music preferences on embodied responses to heard music.
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This study provides the longest follow-up yet for comprehensive behavioral (ComB) treatment of trichotillomania (TTM) (M = 24.59 months after pre-treatment and 15.92 months after the last follow-up point in a recent clinical trial (Carlson et al., 2021), which had shown ComB to be significantly more efficacious than minimal attention at post-treatment). This study also examined changes in TTM severity from before to during the COVID-19 pandemic. Participants (N = 23) completed a survey assessing current TTM symptoms, the impact of the pandemic on their coping with TTM, and their experience with ComB treatment. Self-reported symptom severity at this follow-up evaluation fell between the scores obtained at the clinical trial's pre-treatment assessment and at its last follow-up before the pandemic and did not significantly differ from either time point. Most participants (73%) reported some change in their TTM management since onset of the pandemic, with changes to their environment/routine (61%) and in anxiety (32%) being the most common. Pandemic-related changes were associated with variable outcomes, improving symptoms and management for some while worsening them for others. Use of strategies from ComB had declined since the most recent follow-up, but more than half (55%) of participants reported that strategies from ComB remained useful.
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Youth on the autism spectrum often face challenges accessing services in rural communities compared to those who live in higher resource areas. There is a particular need for services that support skills that will help youth transition to adulthood and future employment. 4-H is a national youth development program that is well-positioned to address the needs of youth on the autism spectrum; however, minimal empirical evidence exists about the implementation and effectiveness of inclusive practices in 4-H programs. The goal of this study was to better understand barriers to enrollment and to identify gaps in support for youth on the autism spectrum participating in 4-H. Twenty Extension Educators in Indiana participated in two focus groups. Thematic analysis of focus group transcripts identified barriers to enrollment including awareness of 4-H as an inclusive program and difficulties navigating 4-H culture. Our analysis identified themes related to new training content and delivery including a resource portfolio, communication, individualized accommodations, and working within the existing leadership training structure. Findings support the benefits of 4-H as a program that can promote life skills and personal development for youth on the autism spectrum but also highlight a significant need for additional training opportunities and resources to increase uptake and improve the implementation of inclusive practices.
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Phosphorus (P)-limited plants produce higher amounts of root phosphatases, but research has mostly focused on phosphomonoesterases (PMEs). Because phosphate diesters can form a significant proportion of organic P in wetlands, we aimed to determine whether wetland plants produce both root PMEs and root phosphodiesterases (PDEs), and, if so, what factors influence activities of these enzymes. We measured the activities of root PMEs and PDEs colorimetrically in a wide range of macrophytes from natural and P-enriched wetlands. Hydrolyzable P in sediments was analyzed using commercially available PMEs and PDEs. In all species, both root PMEs and PDEs were always present, and their activities were closely correlated. Sedges and broadleaved emergents had the highest activity of both enzymes, while those of floating-leaved plants were the lowest. Redundancy analysis revealed close association between root enzymes and the proportion of monoesterase- and diesterase-hydrolyzable dissolved unreactive P. Both enzymes were positively correlated with root tissue N : P ratio. Both plant and sediment traits were important when explaining differences in enzyme activities. Although the activities are related to ambient P regime, the relationship was not close enough to use root enzymes as reliable predictors of dissolved unreactive P that is hydrolyzed by sediment phosphomono- and diesterases.
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Diester Fosfórico Hidrolases/metabolismo , Monoéster Fosfórico Hidrolases/metabolismo , Fósforo/metabolismo , Raízes de Plantas/enzimologia , Brotos de Planta/enzimologia , Belize , Nitrogênio/análise , Nitrogênio/metabolismo , Diester Fosfórico Hidrolases/análise , Monoéster Fosfórico Hidrolases/análise , Fósforo/análise , Raízes de Plantas/metabolismo , Brotos de Planta/metabolismo , Plantas/enzimologia , Plantas/metabolismo , Solo/química , Microbiologia do Solo , Áreas AlagadasRESUMO
Researchers often collect and analyze corbicular pollen from honey bees to identify the plant sources on which they forage for pollen or to estimate pesticide exposure of bees via pollen. Described herein is an effective pollen-trapping method for collecting corbicular pollen from honey bees returning to their hives. This collection method results in large quantities of corbicular pollen that can be used for research purposes. Honey bees collect pollen from many plant species, but typically visit one species during each collection trip. Therefore, each corbicular pollen pellet predominantly represents one plant species, and each pollen pellet can be described by color. This allows the sorting of samples of corbicular pollen by color to segregate plant sources. Researchers can further classify corbicular pollen by analyzing the morphology of acetolyzed pollen grains for taxonomic identification. These methods are commonly used in studies related to pollinators such as pollination efficiency, pollinator foraging dynamics, diet quality, and diversity. Detailed methodologies are presented for collecting corbicular pollen using pollen traps, sorting pollen by color, and acetolyzing pollen grains. Also presented are results pertaining to the frequency of pellet colors and taxa of corbicular pollen collected from honey bees in five different cropping systems.
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Abelhas/fisiologia , Pólen/fisiologia , Manejo de Espécimes/métodos , Ácido Acético/química , Animais , Polinização , Coloração e RotulagemRESUMO
Although music is known to be a part of everyday life and a resource for mood and emotion management, everyday life has changed significantly for many due to the global coronavirus pandemic, making the role of music in everyday life less certain. An online survey in which participants responded to Likert scale questions as well as providing free text responses was used to explore how participants were engaging with music during the first wave of the pandemic, whether and how they were using music for mood regulation, and how their engagement with music related to their experiences of worry and anxiety resulting from the pandemic. Results indicated that, for the majority of participants, while many felt their use of music had changed since the beginning of the pandemic, the amount of their music listening behaviors were either unaffected by the pandemic or increased. This was especially true of listening to self-selected music and watching live streamed concerts. Analysis revealed correlations between participants' use of mood for music regulation, their musical engagement, and their levels of anxiety and worry. A small number of participants described having negative emotional responses to music, the majority of whom also reported severe levels of anxiety.
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OBJECTIVE: This study is the first controlled trial of comprehensive behavioral (ComB) treatment of trichotillomania (TTM). ComB provides individualized treatment based on factors triggering and maintaining hair pulling. METHOD: Participants (Nâ¯=â¯36) were adults (Mâ¯=â¯34.08 years old, SDâ¯=â¯12.26) meeting DSM5 criteria for TTM. A majority were female (80%) and Caucasian (75%), whereas 17% were African American and 19% Hispanic/Latinx. In a parallel-group design, participants were randomly assigned to (a) Immediate ComB (12 sessions) or (b) Minimal Attention Control (MAC), followed by delayed ComB after week 12. Follow-up continued through week 38. Primary outcomes were self-report (Massachusetts General Hospital Hair pulling Scale; MGH-HPS) and interviewer-rated (NIMH-Trichotillomania Impact Scale and Trichotillomania Severity Scale; TIS/TSS) TTM symptom severity, as well as diagnosis (Trichotillomania Diagnostic Interview). RESULTS: Immediate efficacy of ComB (vs. MAC) was statistically significant (pâ¯=â¯.03) for self-reported symptoms, with an effect size dâ¯=â¯-.78, but not significant for interviewer-rated symptoms or diagnostic status. Immediate ComB was significantly more likely than MAC (27% vs. 0%) to lead to complete abstinence from hair pulling at week 12. Follow-ups showed good maintenance of effects. CONCLUSIONS: Efficacy of ComB was established for self-reported symptoms. Future research is needed to establish whether the lack of more widespread effects stems from limitations of the model or to a need for more extensive therapist training, as secondary analyses suggested stronger results among therapists with more TTM experience.