The use of coaching in smartphone app-based cognitive behavioral therapy for body dysmorphic disorder.

Background: Body dysmorphic disorder (BDD) is severe and undertreated. Digital mental health could be key to expanding access to evidence-based treatments, such as cognitive behavioral therapy for BDD (CBT-BDD). Coach guidance is posited to be essential for effective uptake of digital interventions. However, little is known about how different patients may use coaching, what patterns correspond to meaningful outcomes, and how to match coaching to patient needs. Methods: Participants were 77 adults who received a 12-week guided smartphone CBT-BDD. Bachelor's-level coaches were available via asynchronous messaging. We analyzed the 400 messages sent by users to coaches during treatment. Message content was coded using the efficiency model of support (i.e., usability, engagement, fit, knowledge, and implementation). We aimed to clarify when and for what purposes patients with BDD used coaching, and if we can meaningfully classify patients by these patterns. We then assessed potential baseline predictors of coach usage, and whether distinct patterns relate to clinical outcomes. Results: Users on average sent 5.88 messages (SD = 4.51, range 1-20) and received 9.84 (SD = 5.74, range 2-30). Regarding frequency of sending messages, latent profile analysis revealed three profiles, characterized by: (1) peak mid-treatment (16.88 %), (2) bimodal/more communication early and late in treatment (10.39 %), and (3) consistent low/no communication (72.73 %). Regarding content, four profiles emerged, characterized by mostly (1) engagement (51.95 %), (2) fit (15.58 %), (3) knowledge (15.58 %), and (4) miscellaneous/no messages (16.88 %). There was a significant relationship between frequency profile and age, such that the early/late peak group was older than the low communication group, and frequency profile and adherence, driven by the mid-treatment peak group completing more modules than the low contact group. Regarding content, the engagement and knowledge groups began treatment with more severe baseline symptoms than the fit group. Content profile was associated with dropout, suggesting higher dropout rates in the miscellaneous/no contact group and reduced rates in the engagement group. There was no relationship between profile membership and other outcomes. Discussion: The majority of participants initiated little contact with their coach and the most common function of communications was to increase engagement. Results suggest that older individuals may prefer or require more support than younger counterparts early in treatment. Additionally, whereas individuals using coaching primarily for engagement may be at lower risk of dropping out, those who do not engage at all may be at elevated risk. Findings can support more personalized, data-driven coaching protocols and more efficient allocation of coaching resources.

Yarning about river safety: A qualitative study exploring water safety beliefs and practices for First Nations People.

ISSUE ADDRESSED: Water is vital to Australian First Nations Peoples' connection to country and culture. Despite this cultural significance, and epidemiological studies identifying elevated drowning risk among Australian First Nations Peoples, extremely limited qualitative research explores water safety beliefs and practices of First Nations Peoples. This study addressed this knowledge gap via qualitative research with Wiradjuri people living in Wagga Wagga, New South Wales. METHODS: Under Aboriginal Reference Group guidance, a local researcher recruited participants using purposive sampling for yarning circles across four groups: young people aged 18-30 years, parents of children under 5, parents of older children and adolescents and Elders. Yarning circles were audio recorded, transcribed and thematically coded using an inductive approach. RESULTS: In total, 10 First Nations individuals participated. Yarning led to rich insights and yielded five themes: families as first educators; importance of storytelling, lived experience and respect for knowledge holders; the river as a place of connection; historical influence on preference for river over pool and river is unpredictable and needs to be respected. CONCLUSIONS: This study demonstrates the importance of First Nations culture to water safety practices, particularly around the river. To reduce drowning risk among First Nations populations, knowledge holders need to be embedded in the design and delivery of community water safety education. SO WHAT?: Co-designing water safety initiatives with First Nations Peoples will have dual benefits; developing culturally appropriate and locally relevant water safety education, while also continuing First Nations culture across generations.

High-carbon wood ash biochar for mine tailings restoration: A field assessment of planted tree performance and metals uptake.

Unique properties of biochar render it appealing for revegetating and decontaminating historic, barren, and chemically complex mine tailings. Bottom ash from bioenergy facilities can contain high levels of charcoal residue, and thus qualify as a type of biochar; the wide availability of this material at low cost makes it of particular interest in the context of tailings remediation. Nevertheless, bottom ash is variable and often contains residual toxic metal/loids that could be phytoabsorbed into plant tissues. We implemented a replicated field trial on historic contaminated metal mine tailings in Northern Ontario (Canada) over a range of high­carbon wood ash biochar (HCWAB) dosages (0-30 t/ha) to evaluate tree and substrate responses. Sapling survivorship and aboveground biomass growth were quantified over a 4-year period; substrate chemical parameters were measured using acid-digestion and ICP-MS, as well as ion exchange resin probes. To assess elemental composition of sapling tissues, we used electron probe microanalysis combined with laser-ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) on intact samples across the range of dosages applied. Survival and growth of saplings peaked at mid-range ash dosages of 3-6 t/ha. Similarly, substrate ion availability of P, K, and Zn were stable at lower dosages, but increased above 6 t/ha. The trace amounts of toxic metal/loids of concern measured in wood ash (As, Cd, Cu, and Pb) did not result in significantly increased sapling tissue concentrations at low to moderate dosages, but in some cases tissue contaminant levels were elevated at the highest dosage examined (30 t/ha). Our findings highlight the potential for high­carbon wood ash biochar to be used for metal mine restoration at low to moderate dosages.

Prehospital and Emergency Management.

Burn care in the prehospital and emergency settings requires rapid assessment of airway, breathing, and circulation. Intubation (if indicated) and fluid resuscitation are most important in emergency burn care. Total body surface area burned and depth of burn are important early assessments that help guide resuscitation and disposition. Burn care in the emergency department further includes carbon monoxide and cyanide toxicity evaluation and management.

Antecedents and consequences of open and closed questions in intake sessions of psychodynamic psychotherapy.

To investigate whether there are different antecedents and consequences of different types of therapist questions as this has implications for conducting psychotherapy and for training therapists.We examined the antecedents and consequences of questions for 88 clients working with 33 doctoral student therapists in psychodynamic psychotherapy. Questions were coded into open questions for thoughts (OQT), open questions for feelings (OQF), closed questions for facts (CQF), and closed questions other (CQO). The antecedents and consequences were assessed in terms of self-referring pronouns (SRP), self-referring emotion words (SRE), and number of words.In terms of antecedents, when clients were using a high number of SRP, therapists were more likely to ask OQT and CQO than CQF. When clients were using a high number of SRE, therapists were more likely to ask OQF than CQF. In terms of consequences, clients spoke less after CQF than the other three skills, used fewer SRP after CQF than after CQO, and used more SRE after OQF than CQF.CQO were more similar in terms of antecedents and consequences to OQT and OQF than to CQF.

Credibility and expectancy of smartphone-based cognitive behavioral therapy among adults with body dysmorphic disorder.

BACKGROUND: Few patients receive cognitive behavioral therapy, the gold-standard for body dysmorphic disorder (CBT-BDD). Smartphones can make evidence-based interventions, like CBT-BDD, more accessible and scalable. A key question is: how do patients view it? Low credibility and expectancy would likely translate to low uptake and engagement outside of research settings, diminishing the impact. Thus, it is important to understand patients' beliefs about digital CBT-BDD. METHODS: We compared credibility and expectancy in a coach-guided app-based CBT-BDD trial (N=75) to a previous in-person CBT-BDD trial (N = 55). We further examined the relationship of perceptions of digital CBT-BDD to baseline clinical and demographic factors and dropout. RESULTS: Credibility did not differ between the in-person (M=19.3) and digital (M=18.3) trials, p=.24. Expectancy for improvement was moderately higher for in-person (M=58.4) than digital (M=48.3) treatment, p=.005. In the digital trial, no demographic variables were associated with credibility or expectancy. Better BDD-related insight and past non-CBT BDD therapy were associated with greater expectancy. Credibility was associated with lower likelihood of dropout. DISCUSSION: Digital CBT-BDD was regarded as similarly credible to in-person CBT-BDD but with lower expectancy. Tailored expectancy-enhancing strategies could strengthen this novel approach, particularly among those with poorer insight and without prior BDD treatment.

Mouse model of NASH that replicates key features of the human disease and progresses to fibrosis stage 3.

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in the United States and the world; with no Food and Drug Administration-approved pharmacological treatment available, it remains an area of unmet medical need. In nonalcoholic steatohepatitis (NASH), the most important predictor of clinical outcome is the fibrosis stage. Moreover, the Food and Drug Administration recommends that clinical trials for drugs to treat this disease include patients with fibrosis stage 2 or greater. Therefore, when using animal models for investigating the pathophysiology of NAFLD and for the preclinical evaluation of new drugs, it is important that the animals develop substantial fibrosis. The aim of this study was to develop a mouse model of NAFLD that replicated the disease in humans, including obesity and progressive liver fibrosis. Agouti yellow mutant mice, which have hyperphagia, were fed a Western diet and water containing high-fructose corn syrup for 16 weeks. Mice became obese and developed glucose intolerance. Their gut microbiota showed dysbiosis with changes that replicate some of the changes described in humans with NASH. They developed NASH with activity scores of 5-6 and fibrosis, which was stage 1 after 16 weeks, and stage 3 after 12 months. Changes in liver gene expression assessed by gene-set enrichment analysis showed 90% similarity with changes in human patients with NASH. Conclusion: Ay mice, when fed a Western diet similar to that consumed by humans, develop obesity and NASH with liver histology, including fibrosis, and gene expression changes that are highly similar to the disease in humans.

Purdue manual dexterity testing: A cohort study of community-dwelling elderly.

INTRODUCTION: The Purdue Pegboard Test is a manual dexterity test that requires the manipulation of pegs, washers, and collars. Our population for this research study focused on the geriatric community owing to the lack of recent available normative data. PURPOSE OF THE STUDY: The purpose of this study was to provide updated normative data for hand therapists to use in clinical practice to determine if seniors have dexterity deficits. STUDY DESIGN: This is a cohort study. METHODS: This study was completed through a convenience sample which included 128 participants. Participants were stratified into three age groups (60-69, 70-79, and 80+). Participants were asked to complete the Purdue Pegboard Test. Mean scores were analyzed using an independent-sample t-test and one-way analysis of variance to compare the mean scores of each designated age group. RESULTS: A one-way analysis of variance reported statistically significant differences between the 3 age groups (F = 15.03, P < .00). The results supported that those individuals who were younger (60-69) scored better on the assessment than those aged 80+ years. There was not a statistically significant difference between PPT mean scores of males and females. DISCUSSION: Mean scores for the PPT for community-dwelling seniors were established. CONCLUSION: The findings from this study support that dexterity may decline with age, which can affect occupational performance over time.

Zinc deficiency induces hypertension by promoting renal Na+ reabsorption.

Zn2+ deficiency (ZnD) is a common comorbidity of many chronic diseases. In these settings, ZnD exacerbates hypertension. Whether ZnD alone is sufficient to alter blood pressure (BP) is unknown. To explore the role of Zn2+ in BP regulation, adult mice were fed a Zn2+-adequate (ZnA) or a Zn2+-deficient (ZnD) diet. A subset of ZnD mice were either returned to the ZnA diet or treated with hydrochlorothiazide (HCTZ), a Na+-Cl- cotransporter (NCC) inhibitor. To reduce intracellular Zn2+ in vitro, mouse distal convoluted tubule cells were cultured in N,N,N',N'-tetrakis(2-pyridylmethyl)ethylenediamine (TPEN, a Zn2+ chelator)- or vehicle (DMSO)-containing medium. To replete intracellular Zn2+, TPEN-exposed cells were then cultured in Zn2+-supplemented medium. ZnD promoted a biphasic BP response, characterized by episodes of high BP. BP increases were accompanied by reduced renal Na+ excretion and NCC upregulation. These effects were reversed in Zn2+-replete mice. Likewise, HCTZ stimulated natriuresis and reversed BP increases. In vitro, Zn2+ depletion increased NCC expression. Furthermore, TPEN promoted NCC surface localization and Na+ uptake activity. Zn2+ repletion reversed TPEN effects on NCC. These data indicate that 1) Zn2+ contributes to BP regulation via modulation of renal Na+ transport, 2) renal NCC mediates ZnD-induced hypertension, and 3) NCC is a Zn2+-regulated transporter that is upregulated with ZnD. This study links dysregulated renal Na+ handling to ZnD-induced hypertension. Furthermore, NCC is identified as a novel mechanism by which Zn2+ regulates BP. Understanding the mechanisms of ZnD-induced BP dysregulation may have an important therapeutic impact on hypertension.

Discrimination and Depression among Urban Hispanics with Poorly Controlled Diabetes.

OBJECTIVES: We had three objectives for our study: 1) to describe the prevalence and burden of experiences of discrimination among Hispanics with poorly controlled diabetes; 2) to evaluate associations among discrimination experiences and their burden with comorbid depression among Hispanics with poorly controlled diabetes; and 3) to evaluate whether discrimination encountered in the health care context itself was associated with comorbid depression for Hispanic adults with diabetes. DESIGN: We conducted a cross-sectional analysis of baseline data of a randomized controlled trial (RCT). SETTING: We collected data in the context of an RCT in a clinical setting in New York City. PARTICIPANTS: Our sample comprised 221 urban-dwelling Hispanics, largely of Caribbean origin. MAIN OUTCOME MEASURES: The main outcome measure was major depression, measured by the Euro-D (score > 3). RESULTS: Of 221 participants, 58.8% reported at least one experience of everyday discrimination, and 42.5% reported at least one major experience of discrimination. Depression was associated significantly with counts of experiences of major discrimination (OR = 1.46, 95% CI = 1.09 - 1.94, P = .01), aggregate counts of everyday and major discrimination (OR = 1.13, 95% CI = 1.02 - 1.26, P = .02), and the experience of discrimination in getting care for physical health (OR = 6.30, 95% CI= 1.10-36.03). CONCLUSIONS: Discrimination may pose a barrier to getting health care and may be associated with depression among Hispanics with diabetes. Clinicians treating Caribbean-born Hispanics should be aware that disadvantage and discrimination likely complicate a presentation of diabetes.

A seven-year retrospective analysis of students entering medicine via a Rural Student Recruitment program in Western Australia.

OBJECTIVE: This research aimed to evaluate the effectiveness of the Rural Student Recruitment (RSR) program. This program was an initiative to address the low number of rural students enrolled in medicine at the University of Western Australia. RSR identifies students throughout rural and remote areas of Australia interested in pursuing a career in medicine. The program provides support to these students through the various stages of the selection process and subsequently through the course. SETTING: Medical School, the University of Western Australia. PARTICIPANTS: Rural students enrolled in medicine at the University of Western Australia. RESULTS: Of the 1591 participants in the RSR program, 11.6% have been successful in being offered a place. Participation was consistently higher for women, although men were proportionately more successful at gaining entry (14.5% versus 10.4%). It was found that the distribution of successful students in the RSR program generally reflects population density across rural Western Australia, with the majority of students coming from the South West, and the minority from the Pilbara and Kimberley. However, over the last three years (2006-2008) an increase in access from very remote regions was noted. This has been associated with a modification to the entry process that now includes a remoteness weighting for the secondary school attended. CONCLUSIONS: The conclusion from this analysis was that the RSR program in concert with refinements in entry criteria has been effective in increasing the number of medical students from a rural background.