Using synoptic weather types to predict visitor attendance at Atlanta and Indianapolis zoological parks.

Defining an ideal "tourism climate" has been an often-visited research topic where explanations have evolved from global- to location-specific indices tailored to tourists' recreational behavior. Unfortunately, as indices become increasingly specific, they are less translatable across geographies because they may only apply to specific activities, locales, climates, or populations. A key need in the future development of weather and climate indices for tourism has been a translatable, meteorologically based index capturing the generalized ambient atmospheric conditions yet considering local climatology. To address this need, this paper tests the applicability of the spatial synoptic classification (SSC) as a tool to predict visitor attendance response in the tourism, recreation, and leisure (TRL) sector across different climate regimes. Daily attendance data is paired with the prevailing synoptic weather condition at Atlanta and Indianapolis zoological parks from September 2001 to June 2011, to review potential impacts ambient atmospheric conditions may have on visitor attendances. Results indicate that "dry moderate" conditions are most associated with high levels of attendance and "moist polar" synoptic conditions are most associated with low levels of attendance at both zoological parks. Comparing visitor response at these zoo locations, visitors in Indianapolis showed lower levels of tolerance to synoptic conditions which were not "ideal." Visitors in Indianapolis also displayed more aversion to "polar" synoptic regimes while visitors in Atlanta displayed more tolerance to "moist tropical" synoptic regimes. Using a comprehensive atmospheric measure such as the SSC may be a key to broadening application when assessing tourism climates across diverse geographies.

Barriers and Facilitators to Treatment Engagement Among Clients in Inpatient Substance Abuse Treatment.

There is a call for drawing on client voice to provide a rich, nuanced understanding of factors influencing substance treatment engagement as to maximizing treatment benefits. We interviewed 60 clients in a short-term inpatient substance treatment program and examined facilitators and barriers to treatment engagement. Thematic analysis yielded four themes, including perceived treatment needs, trust and counselor rapport, peer inspiration, and organizational factors. Perceived treatment needs serve as both a facilitator and a barrier wherein the acknowledgment of needs led to greater treatment engagement whereas a lack of perceived needs hindered treatment engagement. The establishment of trust and counselor rapport and peer inspiration facilitated treatment engagement. Clients rated several organizational factors including a lack of treatment provision, gender-responsive treatment and infrastructure, and ineffective communication with nonclinical staff as barriers to treatment engagement. Clinical implications include enhancing treatment motivation and counselor rapport, establishing gender-responsive treatment programs, and providing trainings for staff.

Supporting sustainability initiatives through biometeorology education and training.

The International Society of Biometeorology (ISB) has covered significant breadth and depth addressing fundamental and applied societal and environmental challenges in the last 60 years. Biometeorology is an interdisciplinary science connecting living organisms to their environment, but there is very little understanding of the existence and placement of this discipline within formal educational systems and institutions. It is thus difficult to project the ability of members of the biometeorological community-especially the biometeorologists of the future-to help solve global challenges. In this paper, we ask: At present, how we are training people to understand and think about biometeorology? We also ask: What are the current tools and opportunities in which biometeorologists might address future challenges? Finally, we connect these two questions by asking: What type of new training and skill development is needed to better educate "biometeorologists of the future" to more effectively address the future challenges? To answer these questions, we provide quantitative and qualitative evidence from an educationally focused workshop attended by new professionals in biometeorology. We identify four common themes (thermal comfort and exposures, agricultural productivity, air quality, and urbanization) that biometeorologists are currently studying and that we expect to be important in the future based on their alignment with the United Nations Sustainable Development Goals. Review of recent literature within each of these thematic areas highlights a wide array of skill sets and perspectives that biometeorologists are already using. Current and new professionals within the ISB have noted highly varying and largely improvised educational pathways into the field. While variability and improvisation may be assets in promoting flexibility, adaptation, and interdisciplinarity, the lack of formal training in biometeorology raises concerns about the extent to which continuing generations of scholars will identify and engage with the community of scholarship that the ISB has developed over its 60-year history.

Physically equivalent temperature and mental and behavioural disorders in Germany in 2009-2011.

BACKGROUND: We aimed to understand the relationships of the weather as biometeorological and hospital admissions due to common mental and behavioural disorders in a national setting in recent years. METHODS: This is an ecological study. Ten percent of daily hospital admissions from the included hospitals (n = 1618) across Germany that were available between 1 January 2009 and 31 December 2011 (n = 5,235,600) were extracted from Statistisches Bundesamt, Germany. We identified F01-F51 mental ad behavioural disorders by International Classification of Diseases version 10 as the study outcomes. Daily weather data from 64 weather stations covering 13 German States including air temperature, humidity, wind speed, cloud cover, radiation flux and vapour pressure were obtained and generated into physiologically equivalent temperature (PET). We then plotted two-way fractional-polynomial regression. RESULTS: For the most subtypes, the highest admissions were recorded in spring. There were small peaks in autumn or late winter for a few subtypes as well. Admissions of delirium peaked when PET was at 0 °C. Admissions of personality disorders peaked at the coldest - when PET was at -10 °C. Admissions of schizophrenia and nonorganic sleep disorder peaked when PETs were between 0 and -10 °C while admissions of eating disorders dropped when PETs were above 10 °C. Admissions of depression and anxiety disorder did not vary much across PETs. Moreover, admissions of reaction to stress and dissociate disorder peaked when PETs were between 0 and 10 °C as well. CONCLUSIONS: More medical resources could have been needed for mental health on days when PETs were <10 °C than on other days.

Syncope and the Inability to Move: Was It the Magnesium?

Proton pump inhibitors (PPIs) were clinically introduced more than 30 years ago and have been a very safe and effective agent for the treatment of a variety of different acid-base disorders. PPIs work by inhibiting the final step in gastric acid synthesis production by covalently binding to the (H+,K+)-ATPase enzyme system at the level of the gastric parietal cells leading to the irreversible inhibition of gastric acid secretion until new enzymes are produced. This inhibition is useful in a wide variety of disorders, which include, but are not limited to, gastroesophageal reflux disease (GERD), peptic ulcer disease, erosive esophagitis, Helicobacter pylori infection, and pathological hypersecretory disorders. Despite PPIs' overall excellent safety profile, PPIs have raised concerns about both short- and long-term complications including multiple electrolyte derangements that can lead to life-threatening situations. We present a case of a 68-year-old male who presented to the emergency department after a syncopal episode with profound weakness and was found to have undetectable magnesium levels secondary to long-term omeprazole use. This case report highlights how important it is for clinicians to be aware of these electrolyte disturbances and the importance of monitoring electrolytes while being on these medications.

An object relations approach to cult membership.

Several pieces of literature suggest that most individuals who are successfully integrated into cults do not typically manifest symptoms of mental illness. However, the public is often taken aback by the lack of autonomy displayed by cult members and is bewildered by the ability of the cult leader and other cult members to transform fundamental personality functioning in an individual Within the framework of an object relations model of personality structure and functioning as delineated by Otto Kernberg and using existing data concerning the cult experience, the authors engage in a theoretical exploration of cult membership. The authors propose that some behaviors exhibited by cult members may be a function of an object relations-level regression, which is exemplified by the activation of primitive defensive operations that are usually relegated to those suffering with severe personality disorders.

Upper extremity Histoplasma capsulatum treatment with isavuconazole.

Extrapulmonary Histoplasma capsulatum infections in the immunocompetent population are rare and pose a diagnostic challenge. Upper extremity histoplasmosis without a primary lung infection is uncommon. It is possible to acquire it by inadvertent trauma with direct inoculation. Our case describes an immunocompetent patient with progressive swelling with minimal pain in the wrist associated with a small puncture wound on the left dorsal forearm. The initial workup failed to identify a specific etiology. For the following six weeks, the patient experienced progressive worsening of symptoms, warranting a referral to an orthopedic hand surgeon. Left lower extremity magnetic resonance imaging (MRI) findings were non-specific. The surgeon performed a surgical exploration and debridement with the excision of hypertrophic tissue. Initial stains showed a granulomatous tissue but did not reveal an organism; however, a month later, mold was identified on the growth medium. The patient was initiated in isavuconazole empiric therapy. Four weeks later, a matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) confirmed the diagnosis as Histoplasma capsulatum. The patient had clinical remission with isavuconazole used as the United States Food and Drug Administration (FDA) off label use.

Disseminated methicillin-susceptible Staphylococcus aureus infection.

INTRODUCTION: When clinicians think about Staphylococcus aureus bacteria, what comes to the mind of most is the dreaded methicillin-resistant form. However, clinicians should not forget the methicillin-susceptible type, which is just as virulent. CASE PRESENTATION: The authors present the case of a 20-year-old woman who was admitted with septic shock and multi-organ failure and was found to have disseminated methicillin-susceptible Staphylococcus aureus (MSSA) infection. The patient had persistent blood cultures positive for MSSA. A transesophageal echocardiogram showed a 1.1 cm vegetation in the mitral valve, and the patient had bilateral pleural effusions that grew MSSA. An MRI of the brain showed multiple areas consistent with infarctions thought to be secondary to septic emboli. The patient underwent a mitral valve replacement and was treated with a prolonged course of parenteral nafcillin. DISCUSSION: This case illustrates a severe clinical presentation and management of MSSA infections.

Contextual control by function and form of transfer of functions.

This study investigated conditions leading to contextual control by stimulus topography over transfer of functions. Three 4-member stimulus equivalence classes, each consisting of four (A, B, C, D) topographically distinct visual stimuli, were established for 5 college students. Across classes, designated A stimuli were open-ended linear figures, B stimuli were circular, C stimuli three-sided, and D stimuli four-sided. Three different computer tasks then were trained with the B stimuli. Differential reinforcement and punishment procedures were then used to establish control over function transfer by the topography of the class members. For Task 1, function transfer, responding to C and D stimuli as subjects had to B stimuli, was reinforced. For Task 2, function transfer was reinforced for C stimuli but punished for D stimuli. For Task 3, function transfer was punished for both C and D stimuli. New equivalence classes were then established and tests for generalized contextual control were presented. All 5 subjects showed generalized contextual control of transfer of functions by stimulus topography. Implications of contextual control over function transfer in natural settings are discussed.

Discovery and Optimization of Pyrrolopyrimidine Inhibitors of Interleukin-1 Receptor Associated Kinase 4 (IRAK4) for the Treatment of Mutant MYD88L265P Diffuse Large B-Cell Lymphoma.

Herein we report the optimization of a series of pyrrolopyrimidine inhibitors of interleukin-1 receptor associated kinase 4 (IRAK4) using X-ray crystal structures and structure based design to identify and optimize our scaffold. Compound 28 demonstrated a favorable physicochemical and kinase selectivity profile and was identified as a promising in vivo tool with which to explore the role of IRAK4 inhibition in the treatment of mutant MYD88L265P diffuse large B-cell lymphoma (DLBCL). Compound 28 was shown to be capable of demonstrating inhibition of NF-κB activation and growth of the ABC subtype of DLBCL cell lines in vitro at high concentrations but showed greater effects in combination with a BTK inhibitor at lower concentrations. In vivo, the combination of compound 28 and ibrutinib led to tumor regression in an ABC-DLBCL mouse model.

Relationships of physiologically equivalent temperature and hospital admissions due to I30-I51 other forms of heart disease in Germany in 2009-2011.

We aimed to understand relationships of the weather as biometeorological and hospital admissions due to other forms of heart disease by subtypes, which have been paid less attention, in a national setting in recent years. This is an ecological study. Ten percent of daily hospital admissions of the included hospitals (n = 1618) across Germany that were available between 1 January 2009 and 31 December 2011 (n = 5,235,600) were extracted from Statistisches Bundesamt, Germany. We identified I30-I51 other forms of heart disease by the International Classification of Diseases version 10 as the study outcomes. Daily weather data from 64 weather stations that have covered 13 German states, including air temperature, humidity, wind speed, cloud cover, radiation flux and vapour pressure, were obtained and generated into physiologically equivalent temperature (PET). Admissions due to other diseases of pericardium, nonrheumatic mitral valve disorders, nonrheumatic aortic valve disorders, cardiomyopathy, atrioventricular and left bundle-branch block, other conduction disorders, atrial fibrillation and flutter, and other cardiac arrhythmias peaked when PET was between 0 and 10 °C. Complications and ill-defined descriptions of heart disease admissions peaked at PET 0 °C. Cardiac arrest and heart failure admissions peaked when PET was between 0 and -10 °C while the rest did not vary significantly. A common drop of admissions was found when PET was above 10 °C. More medical resources could have been needed for heart health on days when PETs were <10 °C than on other days. Adaptation to such weather change for medical professionals and the general public would seem to be imperative.

Hospital admissions of hypertension, angina, myocardial infarction and ischemic heart disease peaked at physiologically equivalent temperature 0°C in Germany in 2009-2011.

We aimed to understand and to provide evidence on relationships of the weather as biometeorological and hospital admissions due to hypertension, angina, myocardial infarction and ischemic heart disease in a national setting in recent years that might help indicate when to expect more admissions for health professionals and the general public. This is an ecological study. Ten percent of daily hospital admissions from the included hospitals (n = 1618) across Germany that were available between 1 January 2009 and 31 December 2011 (n = 5,235,600) were extracted from Statistisches Bundesamt, Germany. We identified I11 hypertensive heart disease, I13 hypertensive heart and renal disease, I15 secondary hypertension, I20 angina pectoris, I21 acute myocardial infarction and I25 chronic ischemic heart disease by International Classification of Diseases version 10 as the study outcomes. Daily weather data from 64 weather stations that covered 13 German States including air temperature, humidity, wind speed, cloud cover, radiation flux and vapour pressure were obtained and generated into physiologically equivalent temperature (PET). Two-way fractional-polynomial prediction was plotted with 95% confidence intervals. Hospital admissions of hypertension, angina, myocardial infarction, heart disease peaked in winter and early spring when PETs were around 0°C. Admissions had an apparent drop when PETs reached 10°C. More medical resources could have been needed on days when PETs were around 0°C than on other days. While adaptation to such weather change for health professionals and the general public would seem to be imperative, future research with a longitudinal monitoring would still be needed.

Hospital admissions due to diseases of arteries and veins peaked at physiological equivalent temperature -10 to 10 °C in Germany in 2009-2011.

We aimed to understand relationships of the weather as biometeorological and hospital admissions due to diseases of arteries and veins by subtypes, which have been scarcely studied, in a national setting in recent years. This is an ecological study. Ten percent of daily hospital admissions from the included hospitals (n = 1,618) across Germany that were available between 1 January 2009 and 31 December 2011 (n = 5,235,600) were extracted from Statistisches Bundesamt, Germany. We identified I70-I79 Diseases of arteries, arterioles and capillaries and I80-I89 Diseases of veins, lymphatic vessels and lymph nodes by International Classification of Diseases version 10 as the study outcomes. Daily weather data from 64 weather stations that covered 13 German states including air temperature, humidity, wind speed, cloud cover, radiation flux and vapour pressure were obtained and generated into physiologically equivalent temperature (PET). Two-way fractional-polynomial prediction was plotted with 95 % confidence intervals. For most of the subtypes from diseases of arteries and veins, hospital admissions slightly peaked in spring and dropped when PET was at 10 °C. There were no other large differences across 12 months. Admissions of peripheral vascular diseases, arterial embolism and thrombosis, phlebitis and thrombophlebitis, oesophageal varices and nonspecific lymphadenitis peaked when PET was between 0 and -10 °C, while others peaked when PET was between 0 and 10 °C. More medical resources could have been needed on days when PETs were at -10 to 10 °C than on other days. Adaptation to such weather change for health professionals and the general public would seem to be imperative.

Inverted U-shape relationships of the weather as biometeorological and hospital admissions due to carcinoma in situ and benign neoplasm in Germany in 2009-2011.

We aimed to understand the relationships of the weather as biometeorological and hospital admissions due to carcinoma in situ and benign neoplasms, which have been less paid attention to, in a national setting in recent years. This is an ecological study. Ten percent of daily hospital admissions from the included hospitals (n = 1618) across Germany that were available between 1 January, 2009 and 31 December, 2011 (n = 5,235,600) were extracted from Statistisches Bundesamt, Germany. We identified D00-D48 in situ neoplasms, benign neoplasms and neoplasms of uncertain or unknown behaviour by International Classification of Diseases version 10 as the study outcomes. Daily weather data from 64 weather stations that covered 13 German states including air temperature, humidity, wind speed, cloud cover, radiation flux and vapour pressure were obtained and generated into physiologically equivalent temperature (PET). For most subtypes, peaks of admissions were observed in spring and late autumn. There could be four groups of phenomenon among these admissions. To be specific, D06, D16, D21, D24-25, D35 and D39 peaked when PET was at 0 °C. D46 peaked when PET was at 5-10 °C. D03, D04 and D33 had linear relationships. Other admissions peaked when PET was between 0 and 5 °C. All admissions were in common with a drop when PET reached 10 °C or higher. More medical resources could have been needed on days when PETs were at 0-10 °C than on other days. Adaptation to such weather change for medical professionals and the general public would seem to be imperative.

Contextual control of equivalence-based transformation of functions.

The transformation of functions refers to the untrained acquisition of stimulus functions among members of stimulus equivalence classes or relational frames. Although it is widely assumed that contextual control over the transformation of fuctions must exist, this has not yet been conclusively demonstrated in laboratory studies. Four experiments are reported in which (a) stimulus equivalence classes were established, (b) a conditional stimulus function was trained for one member of each of the classes, and (c) multiple-exemplar procedures were used to train and test for contextual control over the transformation of the stimulus function within the classes and to assess whether it generalized to new equivalence classes. Although a significant amount of training was required, the procedures ultimately resulted in the contextual control of function transformation for 9 of 10 participants and generalized contextual control for 4 of 5 participants.

Disregulated alcohol-related behavior among college drinkers: associations with protective behaviors, personality, and drinking motives.

OBJECTIVE: This study investigated the psychometric properties of the Disregulated Alcohol-Related Behaviors Inventory (DARBI), a measure of harmful alcohol-related behavior, and the relationship between protective behavior use and scores on the DARBI and several other measures. PARTICIPANTS: Participants were 281 undergraduate volunteers (60% female) enrolled in introductory psychology sections in Summer and Fall 2007. METHODS: Participants completed the DARBI along with paper-and-pencil self-report measures of broad personality domains, trait resilience, protective behavior use, and drinking motivations and consequences. RESULTS: The DARBI's internal consistency was good (alpha = .85). DARBI scores correlated negatively with conscientiousness scores but positively with neuroticism, the Michigan Alcohol Screening Test (MAST), Rutgers Alcohol Problem Index (RAPI), and positive-reinforcement motives scores. The self-reported use of protective behaviors related negatively to DARBI, MAST, RAPI, and enhancement motives scores. Protective behavior use was unrelated to broad personality domains. CONCLUSIONS: The DARBI may prove a useful tool in campus interventions. Further research should determine the dispositional and situational determinants of protective behavior use.