Immunocontraceptive Efficacy of Native Porcine Zona Pellucida (pZP) Treatment of Nevada's Virginia Range Free-Roaming Horse Population.

In North America, range constraints due to burgeoning development increasingly encroach on wild horse habitat and necessitate effective but humane reproductive management. The largest free-roaming wild horse fertility control program by population (>3500) and territory size (≈300,000 acres) is located within Nevada's Virginia Range. Data from a field study investigated porcine zona pellucida (pZP) immunocontraception via remote dart delivery to mares in this population. Analyses aimed to measure efficacy by treatment effects on annual birth rates and population demographics and to evaluate treatment frequency and season against these variables. Analyses included mares' monthly data (January 2019-December 2022; 48 months), characterized by cumulative vaccination numbers subset into four classifications considering the vaccine as having no loss of efficacy or a loss within a 6-, 12-, and 18-month period post vaccination; from foaling data, the likelihood of being in foal and of conceiving in that month; and from age, as mature or immature (<1 years-old). A downward foaling rate and trend in the numbers of mature mares, descriptively presented at monthly intervals, showed markedly declining annual seasonal breeding peaks, with no observed change in foaling season or duration. Within four years, population coverage surpassed 70% and was associated with a 58% reduction in foaling, with only a 10% conception rate. Vaccinated mares increased proportionally: assuming a 12-month decay rate, the system reached stability at an average ≈1.0 vaccination/mare/year, providing a robust recommendation for treatment frequency contributing to best management practices.

Exploring the experience of service users following attendance at a student-led interprofessional neurodevelopmental clinic.

PURPOSE: The aim of the current study was to understand service users' experiences at a recently established student-led interprofessional neurodevelopmental clinic for children and adolescents with suspected or confirmed prenatal alcohol exposure. METHOD: Semi-structured interviews were completed at 3-months post-clinic attendance with 10 service users: eight parents/caregivers and two youth workers/case managers. Interview data were analysed thematically using NVivo12. RESULTS: Four main themes were developed: (1) clinic attendance seen as a positive event; (2) validation, clarification, and relief, but also challenges post-assessment; (3) need for further support and importance of advocacy; and (4) drawing on lived experiences for future service improvements. CONCLUSIONS: The current study demonstrated that service users reported benefits from tailored services delivered by student practitioners that were validating, supportive, and holistic. Findings from the current study can inform the development and implementation of future innovative service delivery models for individuals with suspected or confirmed prenatal alcohol exposure.

People with fetal alcohol spectrum disorder (FASD) can experience a range of neurocognitive impairments that impact their day-to-day living.Access to assessment, early diagnosis, and appropriate supports are important protective factors associated with improved outcomes for individuals with FASD.Results highlighted the benefits to rehabilitation professionals of listening to service users to understand the complexity of their lived experiences, including how this information can be used to improve service design and delivery.Results also highlighted the potential role of incorporating student-led clinics within models of healthcare and rehabilitation service delivery.Utilising student-led clinics can help to increase access to specialised services for underserved groups in our community, combat shortages in the health workforce, reduce burden on the public health system, and educate the future of rehabilitation professionals.

A single-center retrospective study of hospitalized COVID-19 patients: demographics, laboratory markers, neurological complications, ICU admission, and mortality.

The coronavirus disease 2019 (COVID-19) pandemic has unveiled a wide array of clinical biomarkers, and neurological manifestations in affected patients, necessitating further exploration. Methods: This single-center retrospective study evaluated clinical and neurological sequelae, demographics, as well as laboratory markers, in hospitalized COVID-19 patients from January to September 2020. Results: Among 1248 inpatients (median age: 68 years; 651 women), 387 (31%) were admitted to the ICU. Central nervous system (CNS) manifestations were present in 521 (41.74%) patients, while peripheral nervous system manifestations were observed in 84 (6.73%). COVID-19-related mortality occurred in 314 (25.16%) cases. ICU-admitted patients were predominantly male (P<0.0001), older (age≥60; P=0.037) and had more comorbidities such as diabetes (P=0.001), hyperlipidemia (P=0.043), and coronary artery disease (P=0.015). ICU patients exhibited more CNS manifestations (P=0.001), including impaired consciousness (P<0.0001) and acute cerebrovascular disease (P=0.023). Biomarkers linked to admission to the ICU included elevated white blood cell count, ferritin, lactate dehydrogenase, creatine kinase, blood urea nitrogen, creatinine, and acute phase reactants (e.g. erythrocyte sedimentation rate and C-reactive protein). ICU patients demonstrated lower lymphocyte and platelet counts compared to non-ICU patients. Those with CNS involvement in the ICU often exhibited elevated blood urea nitrogen, creatinine, and creatine kinase levels. Higher mortality from COVID-19 was observed in ICU patients (P<0.0001). Conclusions: Multiple serum biomarkers, comorbidities, and neurological manifestations in COVID-19 patients have been consistently documented and may be linked to increased morbidity, ICU admission, and mortality. Recognizing and addressing these clinical and laboratory markers is essential for effective COVID-19 management.

COVID-19 in the intensive care unit: Unmasking the critical factors impacting patient survival.

In the midst of the coronavirus disease 2019 (COVID-19) pandemic, intensive care units (ICUs) around the world have been pushed to their limits as they grapple with the effects of the severe acute respiratory syndrome coronavirus 2 virus. Identifying prognostic factors that influence mortality in COVID-19 patients admitted to the ICU could offer valuable insights for clinicians seeking to prevent disease progression. A retrospective analysis was conducted on COVID-19 patients admitted to the ICU between January and September 2020. The analysis considered patient demographics, comorbidities, neurological and non-neurological symptoms, as well as laboratory markers. The multivariate logistic regression analysis aims to uncover associations between these factors and patient outcomes. Of the 387 patients included in this study, nearly half (48.5%) of the ICU patients succumbed to COVID-19. Factors that contributed to increased mortality included being 60 years of age or older, impaired consciousness, lung disease, elevated international normalized ratio (INR), and elevated blood urea nitrogen (BUN) levels. Surprisingly, symptoms such as dizziness/lightheadedness, myalgia, and headache were associated with a higher likelihood of survival. In addition, elevated D-dimer and aspartate aminotransferase (AST) levels, as well as lymphopenia, were more commonly observed in deceased patients. The study concluded that those who died in the ICU tended to be older, white, and burdened with more comorbidities and impaired consciousness. With the intriguing link between specific symptoms and survival, further research is essential to uncover the underlying pathophysiological mechanisms that influence ICU patient outcomes in the context of COVID-19.

Lived experiences of the diagnostic assessment process for fetal alcohol spectrum disorder: A systematic review of qualitative evidence.

Early assessment and diagnosis of FASD are crucial in providing therapeutic interventions that aim to enhance meaningful participation and quality of life for individuals and their families, while reducing psychosocial difficulties that may arise during adolescence and adulthood. Individuals with lived experience of FASD have expertise based on their own lives and family needs. Their insights into the assessment and diagnostic process are valuable for improving service delivery and informing the provision of meaningful, person- and family-centered care. To date, reviews have focused broadly on the experiences of living with FASD. The aim of this systematic review is to synthesize qualitative evidence on the lived experiences of the diagnostic assessment process for FASD. Six electronic databases, including PubMed, the Cochrane Library, CINAH, EMBASE, PsycINFO, and Web of Science Core Collection were searched from inception until February 2021, and updated in December 2022. A manual search of reference lists of included studies identified additional studies for inclusion. The quality of included studies was assessed using the Critical Appraisal Skills Program Checklist for Qualitative Studies. Data from included studies were synthesized using a thematic analysis approach. GRADE-CERQual was used to assess confidence in the review findings. Ten studies met the selection criteria for inclusion in the review. Thematic analysis identified 10 first-level themes relating to four over-arching topics: (1) pre-assessment concerns and challenges, (2) the diagnostic assessment process, (3) receipt of the diagnosis, and (4) post-assessment adaptations and needs. GRADE-CERQual confidence ratings for each of the review themes were moderate to high. The findings from this review have implications for referral pathways, client-centered assessment processes, and post-diagnostic recommendations and support.

Integrating transformer and autoencoder techniques with spectral graph algorithms for the prediction of scarcely labeled molecular data.

In molecular and biological sciences, experiments are expensive, time-consuming, and often subject to ethical constraints. Consequently, one often faces the challenging task of predicting desirable properties from small data sets or scarcely-labeled data sets. Although transfer learning can be advantageous, it requires the existence of a related large data set. This work introduces three graph-based models incorporating Merriman-Bence-Osher (MBO) techniques to tackle this challenge. Specifically, graph-based modifications of the MBO scheme are integrated with state-of-the-art techniques, including a home-made transformer and an autoencoder, in order to deal with scarcely-labeled data sets. In addition, a consensus technique is detailed. The proposed models are validated using five benchmark data sets. We also provide a thorough comparison to other competing methods, such as support vector machines, random forests, and gradient boosting decision trees, which are known for their good performance on small data sets. The performances of various methods are analyzed using residue-similarity (R-S) scores and R-S indices. Extensive computational experiments and theoretical analysis show that the new models perform very well even when as little as 1% of the data set is used as labeled data.

Factors to be considered as part of a holistic assessment for fetal alcohol spectrum disorder: A scoping review.

We undertook a scoping review to identify the factors outside of current fetal alcohol spectrum disorder (FASD) diagnostic criteria to be considered as part of a holistic assessment process. This included physical, social, cultural, mental health and wellbeing factors to inform targeted recommendations and supports to improve outcomes for individuals with FASD. Evidence from this review will be used to inform the revision of the Australian Guide to the Diagnosis of FASD. Six electronic databases were searched. Studies were eligible if they included factors outside of the diagnostic criteria that cover dysmorphology, growth restriction, neurodevelopmental impairments. Data charting and content analysis were performed to synthesize the results. One hundred twenty-one studies were included that spanned 12 key areas These included physical health, sleep, adverse postnatal experiences, substance use/other risk-taking behaviors, contact with the criminal justice system, mental health, First Nations cultural considerations, transition to adult roles, involvement with the out-of-home care system, feeding and eating, strengths/interests/external resources and incontinence. Areas to be considered as part of a holistic assessment and diagnostic process spanned individual, family, and system level factors. Results provide guidance for clinicians on the wide range of factors that could influence long-term health, development, and wellbeing for individuals with prenatal alcohol exposure and FASD. In practice, this guidance can be used to inform an individualized assessment process to facilitate tailored recommendations and supports to best meet the complex needs of individuals living with FASD and their families.

Exploring resource implications and models of care for assessment and diagnosis of fetal alcohol spectrum disorder: A scoping review.

Previous reviews have examined annual mean costs of care for individuals with fetal alcohol spectrum disorder (FASD), costs of the health burden, costs to the justice system, productivity losses for caregivers, and both the monetary and nonmonetary costs of reduced quality of life. However, because there have been no published reviews focused on understanding the resource implications and specific service features for the assessment and diagnostic process for FASD, the current scoping review investigated the available evidence on these topics. Eligible studies were identified through a systematic search of six databases and included if they contained information on the potential costs or models of care associated with undertaking an assessment for FASD. Data were charted, underwent content analysis, and were reported according to the PRISMA extension for scoping reviews. Eleven studies were included in the final qualitative synthesis. The primary patient costs were attributed to the lengthy time required for diagnosis (up to 47 h). The primary service costs were attributed to costs of clinicians and support personnel and the involvement of multidisciplinary teams in the assessment process. Estimates of the specific dollar values of diagnostic costs were limited and varied between studies. Several models of care were explored, primarily in Canadian clinics, which aimed to capitalize on available services to improve accessibility and patient care and reduce service costs. This study provides important preliminary insights into the resource implications and models of care involved in the diagnostic assessment of FASD. However, the low number of available studies and variability in available data highlight the need for formal costing studies and detailed information gathering on available models of care to inform future clinical practice and policy development.

Altered bone and body composition in children and adolescents with confirmed prenatal alcohol exposure.

Prenatal alcohol exposure can contribute to long term adverse health outcomes. Development of the skeletal system begins at the early embryonic stage and continues into early adulthood but the effect of prenatal alcohol exposure on skeletal growth is relatively unexplored in a clinical population. Here, we performed dual X-ray absorptiometry to examine bone, fat, and muscle accrual in children and adolescents diagnosed with, or at risk of, fetal alcohol spectrum disorders (FASDs). Children (aged 4-9 years) with FASD or at risk of FASD (n = 10) had similar growth to age matched controls (n = 27). By adolescence (aged ≥10 years), those with FASDs (n = 13) were shorter and had lower areal bone mineral density and lean tissue mass than typically developing peers (n = 29). Overall, adolescents diagnosed with FASDs had greater odds of impairments to bone and body composition. These findings highlight the importance of early FASD diagnosis and appropriate post-diagnostic medical follow-up to enable timely, effective interventions to optimize bone and body composition during paediatric growth.

Key Stakeholder Priorities for the Review and Update of the Australian Guide to Diagnosis of Fetal Alcohol Spectrum Disorder: A Qualitative Descriptive Study.

Since the 2016 release of the Australian Guide to the Diagnosis of Fetal Alcohol Spectrum Disorder (FASD), considerable progress has been made in the identification and diagnosis of the disorder. As part of a larger process to review and update the Guide, the aim of this study was to identify review priorities from a broad range of stakeholders involved in the assessment and diagnosis of FASD. Sixty-two stakeholders, including healthcare practitioners, researchers, other specialists, individuals with cultural expertise, lived experience and consumer representatives completed an online survey asking them to describe up to five priorities for the review of the Australian Guide to the Diagnosis of FASD. A total of 267 priorities were described. Content analysis of responses revealed priority areas relating to diagnostic criteria (n = 82, 30.7%), guideline content (n = 91, 34.1%), guideline dissemination (n = 15, 5.6%) and guideline implementation (n = 63, 23.6%). Other considerations included prevention and screening of FASD (n = 16, 6%). Engaging stakeholders in setting priorities will ensure the revised Australian Guide can be as relevant and meaningful as possible for the primary end-users and that it meets the needs of individuals with lived experience who will be most affected by the diagnosis.

Contrasting constructs or continuum? Examining the dimensionality of body appreciation and body dissatisfaction.

Individuals experiencing body dissatisfaction have poorer health outcomes in part due to engaging in less physical activity. Body appreciation is protective of health behaviors and proposed to be conceptually different from body dissatisfaction. Two studies evaluated whether body appreciation and dissatisfaction represented two distinct dimensions, and whether body appreciation and dissatisfaction would interact in their effect on activity-related motivation and behavior. Study 1 (n = 313) was prospective and utilized a self-report measure of physical activity whereas Study 2 (n = 123) was prospective and used an objective measure. All hypotheses and analyses were pre-registered. A multiverse approach was taken to demonstrate the robustness of results. In exploratory factor analyses, body appreciation and dissatisfaction did not represent two distinct dimensions of body image as both loaded onto the same factor. This result was largely supported by latent profile analyses, which revealed that participants scored high, moderate, or low on both body satisfaction and appreciation. Additionally, body appreciation did not buffer the negative impact of body dissatisfaction on activity-related motivation and behavior. This study provides the first statistical evaluation of the theoretical proposition that body appreciation and dissatisfaction may be distinct constructs with distinct relationships to outcomes.

A brief clinician training program to manage sleep problems in ADHD: what works and what do clinicians and parents think?

OBJECTIVE/BACKGROUND: Brief behavioural sleep interventions have been shown to be effective in treating sleep problems in children with ADHD. Little research, however, has focused on the translational aspects of these programs from the consumer perspective. This study aimed to explore clinician and parent views of a brief training program in managing sleep problems in children with ADHD. PARTICIPANTS: Fifty-nine community-based clinicians (32 paediatricians, 27 psychologists) were trained to deliver a brief behavioural sleep intervention as part of the Sleeping Sound with ADHD translational trial; 183 families were allocated to receive the sleep intervention and 115 provided follow-up data. METHODS: Clinicians reported on competency, confidence and perceived barriers pre- and post-training. Parents reported on usefulness of the program and frequency of sleep strategy use at 3 months post-randomisation. Parent-report of severity of the child sleep problem was also measured at 3 and 6 months post-randomisation. RESULTS: Clinicians' feelings of competency and confidence in managing sleep difficulties increased from pre-to post-training, while perceptions of barriers decreased. Parent-reported usefulness of the program and frequency of sleep use varied by program domain and sleep strategy. Increased parent-reported use of sleep strategies was associated with improved sleep at 3 and 6 months post-randomisation. CONCLUSIONS: A brief sleep training program leads to improvements in clinician confidence and competence in managing sleep problems in children with ADHD and positive parent perspectives. The findings highlight the potential for the Sleeping Sound with ADHD program to be optimized to better help parents in their implementation of sleep strategies.

Understanding predictors of change in a day treatment setting for non-suicidal self-injury.

OBJECTIVES: To examine change in non-suicidal self-injury (NSSI) frequency, quality of life, and functional impairment from admission to discharge in patients enrolled in partial hospitalization and intensive outpatient programmes (PHP/IOP) designed to treat NSSI. Demographic, clinical, and treatment-related predictors of changes were also examined. DESIGN: Data were collected as part of routine clinical assessment procedures at admission and discharge from patients enrolled in a PHP/IOP programme designed to treat NSSI. The clinical assessment included measures examining quality of life, functional impairment, and NSSI behaviour. METHODS: Paired t-tests were used to examine change in NSSI frequency, quality of life, and functional impairment. Reliable clinical change analyses were used to identify clinically significant change in quality of life and functional impairment. Multilevel mixed-effects regression was used to examine predictors of change for quality of life and functional impairment. Negative binomial regression was used to examine predictors of change for NSSI frequency. RESULTS: From admission to discharge, NSSI frequency significantly decreased and quality of life and functional impairment evidenced clinically significant change. Age, race/ethnicity, and insurance type predicted change in functional impairment, while gender predicted change in quality of life. Urge to self-injure predicted change in NSSI frequency. Borderline symptoms predicted change across all outcome variables. CONCLUSIONS: Patients who completed a day treatment programme for NSSI evidenced significant change in NSSI frequency, functional impairment, and quality of life at discharge; however, several demographic and clinical variables were associated with change. PRACTITIONER POINTS: Patients who engage in NSSI show significant change from admission to discharge in a day treatment programme dedicated to the treatment of NSSI. Quality of life and functional impairment are important outcome variables to consider and evaluate in higher levels of care. It is important to consider demographic and clinical variables when creating a treatment plan for NSSI. Although BPD symptoms may be important to consider in day treatment for NSSI, interpersonal dysfunction, depressive symptoms, and mood lability may also affect change in symptoms.

Phosphatidylethanol Levels in Postpartum Women and Their Newborns in Uruguay and Brazil.

BACKGROUND: There is increasing interest in the development of newborn screening tests to identify children at risk of fetal alcohol spectrum disorder (FASD) in order to provide these children with early intervention. Phosphatidylethanol (PEth) has emerged as a potential universal newborn screening candidate. METHODS: The aim of this report was to present the results of a study designed to compare PEth levels in 1,140 postpartum women and their newborn infants in Montevideo, Uruguay, and Sao Paulo, Brazil. Self-report alcohol use during pregnancy data was collected, along with both maternal and newborn dried blood spot samples for PEth analysis. RESULTS: The average age and parity of the women in the sample were 26 years of age and 2.3 pregnancies. For the Uruguay sample (n = 611), 45.8% of postpartum women had PEth levels ≥ 8 ng/ml with a mean positive PEth of 43.6 ng/ml. In contrast, 86.8% of the newborns had PEth levels ≥ 8 ng/ml, with a mean positive PEth of 77.4 ng/ml. For the Brazil sample (n = 529), 33.2% of women had PEth levels ≥ 8 ng/ml with a mean positive PEth of 31 ng/ml. In contrast, 76.9% of the Brazil newborns had PEth levels ≥ 8 ng/ml and 43.9% with a mean positive PEth of 61.1 ng/ml. PEth levels were significantly higher in newborns compared with their postpartum mothers in both the Uruguay and Brazil samples. Self-reported third-trimester alcohol was 6% in the Uruguay sample and 9.1% in the Brazil sample compared with positive maternal PEth levels in 45.8% and 33.2%, respectively. CONCLUSIONS: Clinicians may want to consider newborn PEth screening in high-risk populations where prenatal alcohol use is common. The mechanism underlying significantly higher PEth levels in newborns compared with their mothers is not known.

Unabated Nitrogen Pollution Favors Growth of Toxic Cyanobacteria over Chlorophytes in Most Hypereutrophic Lakes.

Human release of reactive nitrogen (N) to the environment has increased 10-fold since 1860 and is expected to increase by a further ∼75% by 2050. Much of this N enters phosphorus (P)-rich, eutrophic lakes in agricultural and urbanized watersheds. While N pollution of eutrophic lakes can promote toxic cyanobacterial growth, some cases of extreme N loading have led to the dominance of chlorophytes (green algae). As N loads required to shift communities from cyanobacterial to chlorophyte dominance are unclear, we experimentally tested phytoplankton responses to a gradient of N loading in a P-rich lake. Low-to-moderate doses (1-3 mg N L-1 week-1) promoted toxic cyanobacterial dominance and elevated concentrations of the hepatotoxin microcystin. Conversely, loads characteristic of pure urban or agricultural effluents (up to 18 mg N L-1 week-1) led to the dominance of chlorophytes over cyanobacteria and lower microcystin content. This indicates that N loads needed to sustain chlorophyte dominance are uncommon, likely restricted to select shallow lakes directly exposed to urban or agricultural effluents. As most N pollution regimes in P-rich lakes will favor toxic cyanobacterial dominance, restricting future N pollution will help curb further cyanobacterial dominance in lakes both directly and by constraining the capacity for future P loading and climate warming to drive cyanobacterial growth.

Impact of a behavioral intervention, delivered by pediatricians or psychologists, on sleep problems in children with ADHD: a cluster-randomized, translational trial.

BACKGROUND: We have demonstrated the efficacy of a brief behavioral intervention for sleep in children with ADHD in a previous randomized controlled trial and now aim to examine whether this intervention is effective and cost-effective when delivered by pediatricians or psychologists in community settings. METHODS: Translational, cluster-randomized trial of a behavioral intervention versus usual care from 19th January, 2015 to 30th June, 2017. Participants (n = 361) were children aged 5-13 years with ADHD and parent report of a moderate/severe sleep problem who met criteria for American Academy of Sleep Medicine criteria for chronic insomnia disorder, delayed sleep-wake phase disorder, or were experiencing sleep-related anxiety. Participants were randomized at the level of the pediatrician (n = 61) to intervention (n = 183) or usual care (n = 178). Families in the intervention group received two consultations with a pediatrician or a psychologist covering sleep hygiene and tailored behavioral strategies. RESULTS: In an intention-to-treat analysis, at 3 and 6 months respectively, the proportion of children with moderate to severe sleep problems was lower in the intervention (28.0%, 35.8%) compared with usual care group (55.4%, 60.1%; 3 month: risk ratio (RR): 0.51, 95% CI 0.37, 0.70, p < .001; 6 month: RR: 0.58; 95% CI 0.45, 0.76, p < .001). Intervention children had improvements across multiple Children's Sleep Habits Questionnaire subscales at 3 and 6 months. No benefits of the intervention were observed in other domains. Cost-effectiveness of the intervention was AUD 13 per percentage point reduction in child sleep problem at 3 months. CONCLUSIONS: A low-cost brief behavioral sleep intervention is effective in improving sleep problems when delivered by community clinicians. Greater sample comorbidity, lower intervention dose or insufficient clinician supervisions may have contributed to the lack benefits seen in our previous trial.

Widespread nitrous oxide undersaturation in farm waterbodies creates an unexpected greenhouse gas sink.

Nitrogen pollution and global eutrophication are predicted to increase nitrous oxide (N2O) emissions from freshwater ecosystems. Surface waters within agricultural landscapes experience the full impact of these pressures and can contribute substantially to total landscape N2O emissions. However, N2O measurements to date have focused on flowing waters. Small artificial waterbodies remain greatly understudied in the context of agricultural N2O emissions. This study provides a regional analysis of N2O measurements in small (<0.01 km2) artificial reservoirs, of which an estimated 16 million exist globally. We show that 67% of reservoirs were N2O sinks (-12 to -2 µmol N2O⋅m-2⋅d-1) in Canada's largest agricultural area, despite their highly eutrophic status [99 ± 289 µg⋅L-1 chlorophyll-a (Chl-a)]. Generalized additive models indicated that in situ N2O concentrations were strongly and nonlinearly related to stratification strength and dissolved inorganic nitrogen content, with the lowest N2O levels under conditions of strong water column stability and high algal biomass. Predicted fluxes from previously published models based on lakes, reservoirs, and agricultural waters overestimated measured fluxes on average by 7- to 33-fold, challenging the widely held view that eutrophic N-enriched waters are sources of N2O.

Decoupled trophic responses to long-term recovery from acidification and associated browning in lakes.

Increases in the concentration of dissolved organic matter (DOM) have been documented in many inland waters in recent decades, a process known as "browning". Previous studies have often used space-for-time substitution to examine the direct consequences of increased DOM on lake ecosystems. However, browning often occurs concomitant with other ecologically important water chemistry changes that may interact with or overwhelm any potential ecological response to browning itself. Here we examine a long-term (~20 year) dataset of 28 lakes in the Adirondack Park, New York, USA, that have undergone strong browning in response to recovery from acidification. With these data, we explored how primary producer and zooplankton consumer populations changed during this time and what physical and chemical changes best predicted these long-term ecosystem changes. Our results indicate that changes in primary producers are likely driven by reduced water clarity due to browning, independent of changes in nutrients, counter to previously hypothesized primary producer response to browning. In contrast, declines in calcium concomitant with browning play an important role in driving long-term declines in zooplankton biomass. Our results indicate that responses to browning at different trophic levels are decoupled from one another. Concomitant chemical changes have important implications for our understanding of the response of aquatic ecosystems to browning.

Moderators of treatment outcomes in a partial hospitalization and intensive outpatient program for eating disorders.

Eating disorders cause a number of severely impairing symptoms that may require more intensive intervention that is available through outpatient therapy services. The PHP/IOP level of care may be an effective mode of treatment in these cases, but few studies have examined overall outcomes or treatment moderators for this level of care. Using a large sample from a PHP/IOP specifically designed for the treatment of eating disorders, the current study examines a variety of symptoms (eating disorder severity, quality of life, depression, etc.) from admission to discharge, as well as potential moderators of treatment, including demographic and clinical factors. Overall, the PHP/IOP level of care was found to improve treatment outcomes. Age, race, gender, and depression were found to moderate the change in quality of life and functional impairment. Additionally, patients diagnosed with anorexia nervosa had significantly lowered quality of life and greater eating disorder symptomatology than all other diagnoses. The results of this study can help to inform clinical practice and help guide in treatment decisions at the partial hospitalization level of care.