Initial Intake Research Articles

DO PUBLIC HOME CARE CLIENTS “LOSE OUT ON SERVICES” BECAUSE THEY HAVE A FAMILY CAREGIVER?

Abstract The public home care (PHC) system in Canada is heavily reliant on family caregivers to enable clients to stay in the community. When caregivers are present, there are concerns formal home care aide (HCA) services are less available. Using data from the Resident Assessment Instrument for Home Care (RAI-HC), we examined caregiver and client characteristics in relation to HCA service amounts. Our cohorts were individuals aged 60+ receiving an initial RAI-HC assessment in 2011-2013, and one subsequent assessment in two provincial jurisdictions: the Winnipeg Regional Health Authority (n=5,251) and Nova Scotia Health (n=5291). We measured weekly HCA hours and constructed a predictive model for hours of care controlling for client need. To identify the most underserved client population, we calculated the ratio between predicted to actual received hours of care ascertaining the lowest client quintile. In both jurisdictions, the odds of being underserviced were higher when the client co-resided or had a spouse. Clients living alone at initial intake were least likely to be underserved. Caregiver characteristics increasing the risk of being underserved in Winnipeg included providing IADLs/ADLs support, caring more than 14 hours per week and being unable to continue. Rurality increased risk of underservice in Nova Scotia. These findings contribute to the debate: is PHC a supplement or substitution for family care? PHC as a supplement to family care was more pronounced in Winnipeg and in rural Nova Scotia. Implications for greater equity across regions is explored using an Equity, Diversity and Inclusion lens.

LEARNING FROM THE IMPLEMENTATION OF INTEGRATED COMMUNITY-BASED PROGRAMS FOR OLDER ADULTS WITH HIGHER NEEDS

Abstract Three demonstration projects of integrated community-based programs for older adults with higher needs were implemented in British Columbia over 2020 to 2023: 1) Social Prescribing (SP, n=19 programs), 2) Therapeutic Activation Programs for Seniors (TAPS, n=15 programs), and 3) Family and Friend Caregiver Groups (FFCG, n=16 programs). This presentation reports on findings on the programs’ design and implementation based on data collected via interviews and surveys of program staff. Since inception, the total number of unique participants programs have served is 1,078 for TAPS, 1,900 for FFCG, and 1,397 for SP. The majority of clients have been long-term clients receiving services for 3 or more months. Due to the COVID-19 pandemic, 80% of programs reported they had shifted their focus during their first year of operations in response to emergent pandemic needs, thus impacting their start-up and initial intake of clients. The flexibility provided to programs to pivot to offering needed supports during the height of the pandemic was considered an important success. Across all types of programs, client who were socially isolated or lacked social supports were perceived as one of the groups who benefited the most from the programs. Programs reported that their relationships with community-based organizations, primary care networks, and home and community care were strengthened and over three-quarters had formed at least three new partnerships. A variety of facilitating (e.g., leveraging pre-existing relationships) and limiting factors (e.g., awareness of programs and obtaining referrals) were identified that have affected the success of program implementation.

Screening and Follow-Up Care for Perinatal Mood and Anxiety Disorders at a Rural Obstetric Clinic

ObjectiveTo improve screening for perinatal mood and anxiety disorders (PMAD) and follow-up care while balancing team workload. DesignFour rapid plan–do–study–act cycles were implemented over 8 weeks. Setting/Local ProblemAt baseline, only 2% of patients with PMAD were identified at a rural obstetric clinic, and none (n = 0 of 50) received screening with a validated tool. Of the 12 patients who had a current or prior history of PMAD, 92% (n = 11) were not screened for self-harm, and 67% (n = 8) received no referral. The clinic had no standardized care for PMAD. ParticipantsPatients (n = 253) screened at initial pregnancy intake, early in the third trimester, and at the 6-week postpartum visit. Intervention/MeasurementsFollowing the screening, brief intervention, and referral to treatment model, patients were screened using the Edinburgh Postnatal Depression Scale, and brief intervention and referral to treatment were used with a point-of-care checklist. Data were collected three times weekly for run chart analysis, and team surveys measured workload. ResultsAt the end of 8 weeks, effective screening for PMAD and follow-up care were achieved for 98% of patients and included screening, education, shared decision-making for management, referral, and clinic and phone follow-up to support mental health care uptake. ConclusionsStandardizing screening and follow-up care can increase identification of PMAD and increase uptake of mental health care. For sustainability, a decision aid can streamline patient–provider communication and reduce visit length.

Burden and positive aspects of caregiving: cluster profiles of dementia caregiving experiences

Objectives Although caregiver burden is common in the context of dementia caregiving, the caregiving role is linked to beneficial outcomes too. Individuals reporting higher positive aspects of caregiving tend to exhibit lower burden relative to those reporting few. The goal of this retrospective review of outpatient memory clinic medical records was to demonstrate whether and how constructs of burden and positive aspects of caregiving coexist within individual caregivers, and to explore potential contributors to caregiver profiles created based upon these constructs. Method Cluster analyses were conducted on 1160 caregivers from an initial intake interview meeting criteria on primary measures of Positive Aspects of Caregiving and the Zarit Burden Interview and repeated with 225 caregivers meeting inclusion criteria on all measures. Samples were compared for similarity, and the smaller sample (n = 225) was deemed appropriately representative. Multinomial logistic regressions examined cluster predictors in sample with 225 caregivers. Results Results suggested a three-cluster solution: a High Burden group, a High Positive Experiences group, and a Low-Moderate Experiences group showing low burden and moderate positive experiences. Greater behavioral problems predicted belonging to the High Burden cluster. Greater care recipient dependence predicted belonging to the High Positive Experiences cluster while greater independence predicted the Low-Moderate Experiences cluster. Conclusion Findings suggest that burden and positive aspects of caregiving do not simultaneously present in caregivers at high levels. Supportive caregiver interventions might be tailored to profiles demonstrated here. Future research should investigate other potential contributors to experiences of burden and positive aspects of caregiving.

Closing the empathy gap in health care: Connection First – before “intake”

ABSTRACT In this article, a communication framework of Connection First is presented to help close the empathy gap in mainstream health care, including palliative and end-of-life care. Expanding beyond biomedicine, Connection First involves rethinking and restructuring business-as-usual in health care. It shifts the typical transactional process during the initial intake session into one that is transformational. Connection First is a structural intervention and skillset comprised of the following elements: disrupting diagnosis, humanizing history, and repairing ruptures. These elements combine to help close the empathy gap in health care during the initial clinical encounter, before intake, and improve outcomes.

Heart rate variability measures indicating sex differences in autonomic regulation during anxiety-like behavior in rats.

Mental health conditions remain a substantial and costly challenge to society, especially in women since they have nearly twice the prevalence of anxiety disorders. However, critical mechanisms underlying sex differences remain incompletely understood. Measures of cardiac function, including heart rate (HR) and HR variability (HRV), reflect balance between sympathetic (SNS) and parasympathetic (PNS) systems and are potential biomarkers for pathological states. To better understand sex differences in anxiety-related autonomic mechanisms, we examined HR/HRV telemetry in food-restricted adult rats during novelty suppression of feeding (NSF), with conflict between food under bright light in the arena center. To assess HRV, we calculated the SDNN (reflective of both SNS and PNS contribution) and rMSSD (reflective of PNS contribution) and compared these metrics to behaviors within the anxiety task. Females had greater HR and lower SNS indicators at baseline, as in humans. Further, females (but not males) with higher basal HR carried this state into NSF, delaying first approach to center. In contrast, males with lower SNS measures approached and spent more time in the brightly-lit center. Further, females with lower SNS indicators consumed significantly more food. In males, a high-SNS subpopulation consumed no food. Among consumers, males with greater SNS ate more food. Together, these are congruent with human findings suggesting women engage PNS more, and men SNS more. Our previous behavior-only work also observed female differences from males during initial movement and food intake. Thus, high basal SNS in females reduced behavior early in NSF, while subsequent reduced SNS allowed greater food intake. In males, lower SNS increased engagement with arena center, but greater SNS predicted higher consumption. Our findings show novel and likely clinically relevant sex differences in HRV-behavior relationships.

Dynamics of Growth in Purebred Pacu (Piaractus mesopotamicus) and Tambaqui (Colossoma macropomum), and Their Reciprocal Hybrids, under Varied Feeding Programs: Insights from Nonlinear Models.

We evaluated the growth performance of pacu and tambaqui and their reciprocal hybrids (tambacu and paqui) under different feeding programs. We raised 30 individuals from each species and their respective crosses, distributing them into three replicate cages with 10 individuals each. Throughout the 5-month experimental period, the fish were weighed six times while exposed to diverse feeding regimens involving three commercial diets with varying combinations of crude protein (CP) levels: 24%, 28%, and 32%. Growth curves were adjusted using nonlinear models. The evaluation period was insufficient for adjusting the logistic model for the tambaqui and paqui treatments with the highest initial protein intake. Pure pacu had a higher (p < 0.05) growth rate (k = 0.0185) than in the tambacu hybrid (k = 0.0134) and proved to have an early performance since animals from this group reached their weight at inflection faster. Despite growing more slowly, tambacu reached a higher (p < 0.05) final weight (A = 1137.12) than in the pacu (A = 889.12). Among the feeding programs, animals that received less CP showed greater growth potential; however, longer evaluation is important to verify if the initial CP intake has no significant positive effect on fish growth.

Effectiveness and feasibility of a motivational interviewing intake (MII) intervention for increasing client engagement in outpatient addiction treatment: an effectiveness-implementation hybrid design protocol

BackgroundClient discontinuation from outpatient addiction treatment programs is common, and the initial intake is the service delivery point with the highest attrition rate. Replacing the comprehensive intake assessment with a person-centered Motivational Interviewing (MI) intervention is a potential solution to address provider and client concerns about the disengaging, time-intensive nature of the typical initial intake. It remains unclear whether the use of an alternative to the standard intake at the initial visit can fit within typical organizational reporting requirements, whether it decreases attrition, and whether implementation of person-centered intake procedures within outpatient addiction treatment programs is feasible, acceptable, and can be sustained.PurposeTo describe the methods and design of an effectiveness-implementation hybrid type 1 trial of a Motivational Interviewing at Intake (MII) intervention using the Consolidated Framework for Implementation Research (CFIR).MethodsThe study will determine the effectiveness of two intake conditions: (1) standard comprehensive intake assessment (intake-as-usual [IAU]), and (2) MII consisting of a person-centered discussion between provider and client about the client’s desire and intent to enter treatment. Although both interventions are focused on understanding client presenting complaints and needs for treatment, the delivery differs as the IAU uses a semi-structured assessment guide, while MII applies the theory of MI to have a conversation about treatment engagement. Adults seeking outpatient addiction treatment services will be randomly assigned to the MII condition (n = 75) or the IAU condition (n = 75). Primary outcomes will be client engagement (i.e., treatment entry, attendance, and completion) obtained from the electronic medical record. Secondary outcomes (client motivation and therapeutic alliance) will be putative mechanisms of client engagement assessed immediately before and after the intake. The trial also will explore determinants of effective, sustainable implementation using assessments of organizational readiness and capacity to change, as well as interviews on MII implementation feasibility.ConclusionThis trial of an MII intervention will investigate the feasibility of a motivational intervention as an initial contact with substance use treatment-seeking clients as well as indicators of intervention effectiveness within the systems where it is employed.Trial registration Clinicaltrials.gov identifier: NCT05489068

Feeding signals inhibit fluid-satiation signals in the mouse lateral parabrachial nucleus to increase intake of highly palatable, caloric solutions.

Chemogenetic activation of oxytocin receptor-expressing neurons in the parabrachial nucleus (OxtrPBN neurons) acts as a satiation signal for water. In this research, we investigated the effect of activating OxtrPBN neurons on satiation for different types of fluids. Chemogenetic activation of OxtrPBN neurons in male and female transgenic OxtrCre mice robustly suppressed the rapid, initial (15-min) intake of several solutions after dehydration: water, sucrose, ethanol and saccharin, but only slightly decreased intake of Ensure®, a highly caloric solution (1 kcal/mL; containing 3.72 g protein, 3.27 g fat, 13.42 g carbohydrates, and 1.01 g dietary fibre per 100 mL). OxtrPBN neuron activation also suppressed cumulative, longer-term (2-h) intake of lower caloric, less palatable solutions, but not highly caloric, palatable solutions. These results suggest that OxtrPBN neurons predominantly control initial fluid-satiation responses after rehydration, but not longer-term intake of highly caloric, palatable solutions. The suppression of fluid intake was not because of anxiogenesis, but because OxtrPBN neuron activation decreased anxiety-like behaviour. To investigate the role of different PBN subdivisions on the intake of different solutions, we examined FOS as a proxy marker of PBN neuron activation. Different PBN subdivisions were activated by different solutions: the dorsolateral PBN similarly by all fluids; the external lateral PBN by caloric but not non-caloric solutions; and the central lateral PBN primarily by highly palatable solutions, suggesting PBN subdivisions regulate different aspects of fluid intake. To explore the possible mechanisms underlying the minimal suppression of Ensure® after OxtrPBN neuron activation, we demonstrated in invitro slice recordings that the feeding-associated agouti-related peptide (AgRP) inhibited OxtrPBN neuron firing in a concentration-related manner, suggesting possible inhibition by feeding-related neurocircuitry of fluid satiation neurocircuitry. Overall, this research suggests that although palatable beverages like sucrose- and ethanol-containing beverages activate fluid satiation signals encoded by OxtrPBN neurons, these neurons can be inhibited by hunger-related signals (agouti-related peptide, AgRP), which may explain why these fluids are often consumed in excess of what is required for fluid satiation.

Greenhouse Gas (GHG) Emission Estimation for Cattle: Assessing the Potential Role of Real-Time Feed Intake Monitoring

This study investigated the impact of feeding systems on the determination of enteric methane (CH4) emissions factor in cattle. Real-time feed intake data, a crucial CH4 conversion rate (Ym value) parameter, were obtained using a roughage intake control (RIC) unit within a smart farm system. Greenhouse gas (GHG) emissions, including CH4 and carbon dioxide (CO2), from Holstein steers were monitored using a GreenFeed (GF) 344 unit. The results revealed satisfactory body weight (383 ± 57.19 kg) and daily weight gain (2.00 ± 0.83 kg), which are crucial factors. CO2 production exhibited positive correlations with the initial body weight (r = 0.72, p = 0.027), feed intake (r = 0.71, p = 0.029), and feed conversion ratio (r = 0.69, p = 0.036). Five different emission factors (EFs), EFA (New Equation 10.21A) and Equation 10.21 (EFB, EFC, EFD, and EFE), were used for GHG calculations following the Intergovernmental Panel on Climate Change (IPCC) Tier 2 approach. The estimated CH4 EFs using these equations were 69.91, 69.91, 91.79, 67.26, and 42.60 kg CH4/head/year. These findings highlight the potential for further exploration and adoption of smart farming technology, which has the potential to enhance prediction accuracy and reduce the uncertainty in Ym values tailored to specific countries or regions.

Investigating Behavioral and Neuronal Changes in Adolescent Mice Following Prenatal Exposure to Electronic Cigarette (E-Cigarette) Vapor Containing Nicotine.

A substantial percentage of pregnant smokers stop using traditional cigarettes and switch to alternative nicotine-related products such as e-cigarettes. Prenatal exposure to tobacco increases the risk of psychiatric disorders in children. Adolescence is a complex phase in which higher cognitive and emotional processes undergo maturation and refinement. In this study, we examined the behavioral and molecular effects of first-trimester prenatal exposure to e-cigarettes. Adult female mice were divided into normal air, vehicle, and 2.5%-nicotine-exposed groups. Our analyses indicated that the adolescents in the 2.5%-nicotine-exposed group exhibited a significant lack of normal digging behavior, elevated initial sucrose intake, and reduced recognition memory. Importantly, we identified a substantial level of nicotine self-administration in the 2.5%-nicotine-exposed group. At a molecular level, the mRNAs of metabotropic glutamate receptors and transporters in the nucleus accumbens were not altered. This previously undescribed work indicates that prenatal exposure to e-cigarettes might increase the risk of nicotine addiction during adolescence, reduce cognitive capacity, and alter normal adolescent behavior. The outcome will aid in translating research and assist healthcare practitioners in tackling addiction and mental issues caused by toxicological exposure. Further, it will inform relevant policymaking, such as recommended taxation, labeling e-cigarette devices with more detailed neurotoxic effects, and preventing their sale to pregnant women and adolescents.

(RE-)AIMing for Rapid Uptake: Pilot Evaluation of a Modified Hub and Spoke Model of Medication for Opioid Use Disorder.

Medication for opioid use disorder (MOUD) is an effective, evidence-based treatment, but significant gaps in implementation remain. We evaluate one novel approach to address this gap: a Hub and Spoke model to increase buprenorphine access and management. This outcome evaluation was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework using secondary data analysis of clinical and administrative data to characterize program outcomes for program Reach, Effectiveness, Adoption, and Maintenance. Implementation was assessed through a chart review of provider progress notes and through key informant interviews with program staff to understand why this site was able to introduce a novel approach to MOUD. Nearly half of patients with opioid use disorder (45.48%, n=156) were reached by the program over 2 years. Of those, 91.67% had 1 or more program visits after an initial intake appointment, and 78.85% had a buprenorphine prescription. Patients in the program were 2.44 times more likely to have a buprenorphine prescription than those in comparator site that did not have a Hub and Spoke program (95% CI: 1.77-3.37; P <0.001). There was significantly greater program reach in year 1 than year 2, suggesting rapid initial uptake followed by modest program growth. Key informant interviews illustrated several themes regrading program implementation, including the importance of process champions, the beneficial impact of MOUD for patients, and addressing facility performance metrics. A supportive organizational culture and a receptive climate were also key factors for implementation. This program led to rapid improvement in MOUD uptake across the facility. Future efforts should focus on improving program maintenance, including supporting the exchange of patients from the hub to appropriate spokes.

Predictors of long-term decannulation in patients with disorders of consciousness.

The predictors of tracheostomy decannulation in patients with disorders of consciousness (DOC) are not comprehensively understood, making prognosis difficult. The primary objective of this study was to identify predictors of tracheostomy decannulation in patients with disorders of consciousness (DOC). The secondary aim was to evaluate the feasibility and safety of the modified Evans blue dye test (MEBDT) in tracheostomized DOC patients. This retrospective study included all patients with disorders of consciousness (DOC) who underwent tracheostomy and were admitted between January 2016 and September 2022. Age, sex, etiology, initial Glasgow coma scale (GCS), initial Coma Recovery Scale-Revised (CRS-R), diagnosis of unresponsive wakefulness syndrome (UWS) or minimal consciousness state (MCS), MEBDT, initial modified Rankin scale (mRS), and initial Functional Oral Intake Scale (FOIS) were collected upon study enrollment. The relationship between clinical characteristics and cannulation status was investigated through a Cox regression model. A total of 141 patients were included in the study. The average age of these patients was 52.5 ± 16.7 years, with 42 (29.8%) being women. During the study period, 86 subjects (61%) underwent successful decannulation. Univariate analysis revealed that decannulated patients exhibited a significantly better conscious state compared to those without decannulation (CRS-R: p < 0.001; GCS: p = 0.023; MCS vs. UWS: p < 0.001). Additionally, a negative modified Evans blue dye test (MEBDT) result was significantly associated with tracheostomy decannulation (p < 0.001). In the multivariate analysis, successful decannulation was associated with a higher level of consciousness (MCS vs. UWS, p < 0.001, HR = 6.694) and a negative MEBDT result (negative vs. positive, p = 0.006, HR = 1.873). The Kaplan-Meier analysis further demonstrated that MEBDT-negative patients and those in the MCS category had a higher probability of decannulation at 12 months (p < 0.001). The findings of this study indicate that a negative MEBDT result and a higher level of consciousness can serve as predictive factors for successful tracheostomy decannulation in DOC patients.

Growth Performance of Thai Native Chicken Fed Diet Supplemented with Mulato Grass

The objective of this study was to investigate the growth performance of Thai native chickens supplemented with different quantities of mulato grass (Brachiaria spp.). According to a completely randomized design, the 96 5-week-old Pradu hang-dum Thai native chickens were randomized into 4 treatment groups each of which has 3 replications with 8 chickens per replication. Each treatment group was supplemented with mulato grass at 0 (control), 5, 7.5 and 10 percentage, respectively. The results showed that initial weight and average daily feed intake of 4 treatment groups were not significantly different (P&gt;0.05). Final weight, weight gain and average daily gain of the chickens fed 5% mulato grass supplementation were better than those in other groups (P&lt;0.05). The chickens fed with 5% mulato grass supplementation had better feed conversion ratio than other groups (P&lt;0.05). This study showed that diet supplemented with 5% mulato grass affected growth performance in Thai native chickens.

Male and Female Laboratory Rats Equally Acquire Running‐Based Flavor‐Aversion Learning1

AbstractLaboratory rats can be conditioned to shy away from a flavored substance consumed immediately before running in activity wheels, suggesting flavor‐aversion learning. We examined whether the factor of sex impacted running‐based flavor‐aversion learning. A differential conditioning procedure was employed in Experiment 1: The measure of learning was the degree of differentiation in the intake of a target flavor solution paired with running and an unpaired non‐target flavor solution. Flavor‐aversion learning was observed as a gradual decrease in the intake of the target solution, which was absent in that of the non‐target solution. Although females ran more than twice as fast as males, the degree of differential conditioning was similar for males and females. This was the case not only for absolute intake but also for intake per body weight and change from the initial intake (percentage decrease). The null effect of sex was replicated in Experiment 2, which employed a simple conditioning procedure. These results suggest that rats’ running‐based flavor‐aversion learning is a robust phenomenon, despite the subjects being male or female.

Framing the work: A coparenting model for guiding infant mental health engagement with families.

When working with families of infants and toddlers, intentionally looking beyond dyadic child-parent relationship functioning to conceptualize the child's socioemotional adaptation within their broader family collective can enhance the likelihood that clinical gains will be supported and sustained. However, there has been little expert guidance regarding how best to frame infant-family mental health therapeutic encounters for the adults responsible for the child's care and upbringing in a manner that elevates their mindfulness about and their resolve to strengthen the impact of their coparenting collective. This article describes a new collaborative initiative organized by family-oriented infant mental health professionals across several different countries, all of whom bring expansive expertise assessing and working with coparenting and triangular family dynamics. The Collaborative's aims are to identify a means for framing initial infant mental health encounters and intakes with families with the goal of assessing and raising family consciousness about the relevance of coparenting. Initial points of convergence and growing points identified by the Collaborative for subsequent field study are addressed.

A Systematic Review to Manage Avoidant/Restrictive Food Intake Disorders in Pediatric Gastroenterological Practice.

Avoidant/Restrictive food intake disorder (ARFID) is a feeding disorder characterized by persistent difficulty eating, such as limited choices of preferred foods, avoidance or restriction of certain foods or food groups, and negative emotions related to eating or meals. Although ARFID mainly affects children, it can also occur in adolescents and adults. ARFID can have serious physical and mental health consequences, including stunted growth, nutritional deficiencies, anxiety, and other psychiatric comorbidities. Despite its increasing importance, ARFID is relatively underrecognized and undertreated in clinical practice. Treatment consists of a multidisciplinary approach involving pediatric gastroenterologists, nutritionists, neuropsychiatrists, and psychologists. However, there are several gaps in the therapeutic approach for this condition, mainly due to the lack of interventional trials and the methodological variability of existing studies. Few studies have explored the nutritional management of ARFID, and no standardized guidelines exist to date. We performed a systematic literature review to describe the different nutritional interventions for children and adolescents diagnosed with ARFID and to assess their efficacy and tolerability. We identified seven retrospective cohort studies where patients with various eating and feeding disorders, including ARFID, underwent nutritional rehabilitation in hospital settings. In all studies, similar outcomes emerged in terms of efficacy and tolerability. According to our findings, the oral route should be the preferred way to start the refeeding protocol, and the enteral route should be generally considered a last resort for non-compliant patients or in cases of clinical instability. The initial caloric intake may be adapted to the initial nutritional status, but more aggressive refeeding regimens appear to be well tolerated and not associated with an increased risk of clinical refeeding syndrome (RS). In severely malnourished patients, however, phosphorus or magnesium supplementation may be considered to prevent the risk of electrolyte imbalance, or RS.

Video-telecare collaborative pain management during COVID-19: a single-arm feasibility study

BackgroundChronic pain is among the most common conditions presenting to primary care and guideline-based care faces several challenges. A novel pain management program, Video-Telecare Collaborative Pain Management (VCPM), was established to support primary care providers and meet new challenges to care presented by the COVID-19 pandemic.MethodsThe present single-arm feasibility study aimed to evaluate the feasibility and acceptability of VCPM and its components among U.S. veterans on long-term opioid therapy for chronic pain at ≥ 50 mg morphine equivalent daily dose (MEDD). VCPM consists of evidence-based interventions, including opioid reassessment and tapering, rotation to buprenorphine and monitoring, and encouraging behavioral pain and opioid-use disorder self-management.ResultsOf the 133 patients outreached for VPCM, 44 completed an initial intake (33%) and 19 attended multiple VCPM appointments (14%). Patients were generally satisfied with VCPM, virtual modalities, and provider interactions. Nearly all patients who attended multiple appointments maintained a buprenorphine switch or tapered opioids (16/19; 84%), and buprenorphine switches were generally reported as acceptable by patients. Patients completing an initial intake with VCPM had reduced morphine equivalent daily dose after three months (means = 109 mg MEDD vs 78 mg), with greater reductions among those who attended multiple appointments compared to intake only (ΔMEDD = -58.1 vs. -8.40). Finally, 29 referrals were placed for evidence-based non-pharmacologic interventions.ConclusionPre-defined feasibility and acceptability targets for VCPM and its components were broadly met, and preliminary data are encouraging. Novel strategies to improve enrollment and engagement and future directions are discussed.

24 h Hydration profile of collegiate soccer players training once versus twice per day in the heat

This study examined 24-h hydration parameters among collegiate, male soccer players (n = 17) during twice (X2) and once (X1) per day practice schedules in the heat. Urine specific gravity (USG) and body mass were measured before morning practices, afternoon practice (X2)/team meeting (X1), and the next morning practices. Fluid intake, sweat losses, and urinary losses were assessed during each 24-h window. Pre-practice body mass or USG did not differ among the timepoints. Sweat losses differed among all practices (p < 0.05) and averaged approximately 2.181±0.693 (X2AM) 1.710±0.474 (X2PM), and 3.361±0.956 L (X1AM), but players averaged replacing >50% of sweat losses with fluid intake every practice. Fluid intake during and between practices from practice 1 to the afternoon practice for X2 resulted in a positive fluid balance for X2 (+0.446±0.916 L). However, higher sweat loss during the initial morning practice and lower relative fluid intake prior to the afternoon team meeting the following morning resulted in a negative fluid balance (-0.304±0.675 L; p < 0.05: Cohen's d = 0.94) over the same time period for X1. By the start of the next morning practice sessions, both X1 (+0.664±1.051 L) and X2 (+0.446±0.916 L) were in positive fluid balance, respectively. Ample fluid consumption opportunities, scaled down practice intensities during X2, and potentially intentional greater relative fluid intake during X2 training resulted in no difference in fluid shift versus an X1 schedule before the start of practices. The majority of players maintained fluid balance drinking ad libitum regardless of practice schedule.

Predictors of current suicidal ideation in a multi-diagnostic sample of individuals with eating disorders

BackgroundIndividuals with eating disorders (EDs) have high rates of suicidal ideation (SI) and attempts (SA). Fasting, body dissatisfaction, binge eating and purging have been associated with SI in non-clinical samples, individuals with anorexia nervosa or low-weight EDs, and a multi-diagnostic sample. However, few studies have examined how ED symptoms contribute to risk for SI in conjunction with other well-established risk factors, such as nonsuicidal self-injury (NSSI) and past SA. The aim of this study was to examine which ED symptoms contribute unique risk for current SI in a multi-diagnostic, clinical sample when statistically adjusting for gender, NSSI, past SA, and past SI.MethodsWe conducted a chart review of 166 individuals who presented for ED treatment at an outpatient facility and signed informed consent. Initial intake interviews were coded for the presence versus absence of fasting, fear of weight gain, binge eating, purging, excessive exercise, restriction, body checking, self-weighing, and body dissatisfaction, as well as NSSI, past SA, past SI, and current SI.ResultsA total of 26.5% of the sample endorsed current SI. In a logistic regression analysis, identifying as male (n = 17) or having a non-binary gender identity (n = 1), the presence of fasting, and past SI were all significantly associated with increased odds of current SI, whereas excessive exercise significantly decreased odds of current SI. Fasting was equally common across all diagnostic groups.ConclusionsFuture research should establish the temporal relationship between fasting and SI to better inform intervention.