Pretreatment Measures Research Articles

Assessing drywell designs for managed aquifer recharge via canals and repurposed wells

This study explores innovative drywell designs for managed aquifer recharge (MAR) in agricultural settings, focusing on smaller diameter and deeper drywells, including the repurposing of dried or abandoned wells. Numerical simulations assessed the impact of drywell diameter (5–120 cm), depth (15–55 m), screen height, and subsurface heterogeneity on infiltration (I) and recharge (R) volumes over a one-year period under constant head conditions. Results indicate that smaller diameter drywells can effectively infiltrate and recharge significant water volumes. A 5 cm diameter drywell exhibited only a 48% decrease in infiltration efficiency compared to a standard 120 cm drywell, while being easier to install and requiring less space. Deeper drywells substantially enhanced both I and R; a 20 cm diameter drywell at 55 m depth infiltrated 1.9 × 105 m3 and recharged 3.56 × 104 m3 within a year, with faster arrival times of recharge water. The study also proposes integrating drywells into existing irrigation canal networks. Simulations suggest that installing drywells every 70 m along canals could infiltrate 7.14 × 105 to 1.43 × 106 m3 of water per kilometer annually, significantly enhancing groundwater recharge in regions where traditional MAR methods are limited. Subsurface heterogeneity was found to increase I and R volumes compared to homogeneous conditions, emphasizing the importance of site-specific assessments. An economic analysis revealed that deeper, small-diameter drywells offer lower levelized costs, down to $0.46 per cubic meter of recharged water, making them economically viable alternatives. However, technical challenges such as clogging, water quality concerns, and regulatory requirements were identified. Pretreatment measures like sedimentation chambers and geotextile membranes are recommended to mitigate clogging, though their costs require further evaluation. Pilot-scale studies are recommended to validate simulation findings, assess technical and regulatory challenges, and refine designs for practical implementation.

Evaluating the performance and stability of microalgal-bacterial granular sludge in municipal wastewater treatment plants.

The microalgal-bacterial granular sludge (MBGS) process shows potential for carbon-neutral wastewater treatment, yet its application in wastewater treatment plants remains underexplored. This study attempted to use a continuous-flow raceway reactor to treat real municipal wastewater using the MBGS process. The results showed that the removal efficiencies of organics peaked on the fifth day, while declining trends were observed for nitrogen and phosphorus removal. Microbial community and functional gene analyses indicated that the removal of organics, nitrogen, and phosphorus might be heavily influenced by Proteobacteria, suggesting that fluctuations in their abundance significantly impacted the performance of MBGS. Bacteroidota and Actinobacteria played a vital role in cellulose decomposition via the cbhA gene. Moreover, energy shortages caused by light attenuation due to wastewater turbidity and environmental fluctuations disrupted the microbial balance, shifting metabolic activity towards carbon pathways. Key challenges for the broader application of the MBGS process include managing wastewater turbidity and ensuring process stability. These findings highlight the need for pretreatment measures and robust operational strategies to mitigate environmental fluctuations and maintain system performance.

Baseline-dependent improvement in CF studies, plausibility of bias

Background:It has been commonly reported that therapeutic treatments in cystic fibrosis (CF) have ceiling effects, such that their efficacy is diminished for persons with high pre-treatment health (Montgomery et al., 2012 and Newsome et al., 2019). Floor effects have also been reported where decline is of lower magnitude in those with below-average pre-treatment health (Harun et al., 2016; Konstan et al., 2012 and Szczesniak et al., 2017). When measurement error is present, the statistical literature has warned of exaggerated or spurious associations between pre-treatment measures and subsequent change (Chambless and Davis, 2003 and Yanez et al., 1998). Measurement error, equivalently described as day-to-day variation, has been described to occur in CF outcome measurements such as forced expiratory volume in 1 s taken by spirometry (FEV1pp) (Magaret et al., 2024; Stanojevic et al., 2020 and Thornton et al., 2023). Methods:We conducted a simulation study to assess the potential for spurious floor or ceiling effects in studies of CF therapeutics. We considered uncontrolled or single-arm studies, and evaluated estimated association between pre-treatment FEV1pp and treatment-induced change: post- versus pre-treatment. Results:When day-to-day variation was present in FEV1pp, at levels equivalent to those reported in large studies measuring spirometry both at home and in clinic, naive analytic approaches found spurious associations of change with baseline (Paynter et al., 2022 and Saiman et al., 2003). Type I error ranged from 31.9% to 98.3% for day-to-day variation as high as 3% to 15% relative to biological variation. Incorporating known day-to-day variation, the regression calibration approach corrected bias and controlled type I error (Chambless and Davis, 2003). Conclusion:Exaggerated ceiling effects are possible. Further studies could provide meaningful confirmation of ceiling effects in CF, perhaps reducing day-to-day variation by incorporating multiple pre- and post-treatment measurements.

Biological pretreatment and co-digestion strategies enhance the methane yield of waste wool

Anaerobic digestion (AD) is a sustainable way to dispose of waste wool (WW) and produce energy, but efficiency is low. In this study, the methanogenesis efficiency of co-digestion was improved by adjusting the mixture ratio of WW and corn straw (CS) and pretreatment measures. The results showed that anaerobic co-digestion could improve the synergistic effect of the substrate. When the proportion of WW was 50 % (CW55), the synergistic effect was the highest (46.78 %). Biological pretreatment increased methane yield (212.35 Nml/g VSadd ∼223.00 Nml/g VSadd) by 76.94 %–85.81 % compared with CW55. Microbial and PICRUSt2 analysis revealed that pretreatment increased organic acid content, by enriching hydrolytic acidifying bacteria and increasing the abundance of key transaminase. By increasing the abundance of Methanosarcina and MBA03, the symbiotic relationship between microorganisms was strengthened and the methane yield was increased. This study provides a sustainable management measure for WW, which accords with the concept of circular economy.

Platelet-rich plasma applications in the larynx: snake oil or stupendous?

To explore and summarize recent work examining the use of platelet-rich plasma (PRP) applications for vocal fold disorder. Intrachordal PRP injections have recently emerged as a treatment option for patients with damage to the lamina propria of the vocal fold (scar, atrophy, sulcus and inflammatory lesions). Studies support significant improvements in patient-reported and clinician-reported outcomes, and objective phonatory parameters. PRP demonstrates a good safety profile, absence of immune reactions, affordable cost model and improvement in mucosal wave features with resultant improved voice quality up to 12 months following treatment. PRP injection of the vocal folds is a novel repurposing of a previously validated technique, and emerging data shows consistent results across multiple centres, increasing confidence in use of this freely available material. Current published studies confirm improved voice outcomes compared with pretreatment measures and high patient satisfaction. Further research is required to properly assign the role of and ideal candidate for PRP applications, and to delineate durability of treatment.

Formulation determination and performance study of high-volume fly ash-based grouting fire extinguishing materials

Considering the continued advancement of China's industrial sector, a substantial quantity of circulating fluidized bed fly ash (CFBFA) and calcium carbide slag (CS) is generated throughout the production process. Considering the rich calcium content inherent in CFBFA (circulating fluidized bed fly ash) and the inherently alkaline nature of CS(carbide slag), the amalgamation of these two constituents leads to a multitude of hydration reactions, culminating in the synthesis of polymeric grouting materials. This study undertaked a comprehensive examination and regulation of three factors within the binary system: water-cement ratio, CS content, and CS particle size. Through the utilization of scanning electron microscopy (SEM), X-ray diffraction (XRD), and (TG) thermogravimetric analysis, the investigation aims to elucidate the influence mechanism of the composite gelling system comprising fly ash and calcium carbide slag on the compressive strength, setting time, and other pertinent indicators of grouting materials. The data reveals that when the water-cement ratio is set at 0.85, CS content at 30%, and CS ball milling time at 1 h, the resulting grouting material exhibits a fluidity of 279 mm, a water separation ratio of 3.13%, and achieves a strength of 15.6 MPa at 28 days. It boasts a stable and easily transportable slurry, which possesses a certain degree of cementitious performance, effectively sealing off any air leakage channels. Moreover, by subjecting CS to appropriate pre-treatment measures, a suitable quantity of active silicon and aluminum elements can be thoroughly dissolved within the CFBFA (circulating fluidized bed fly ash) slurry system, giving rise to a staggered distribution and dense hydration product structure. Considering the requirements for gangue mountain fire extinguishing slurry, a CFBFA-CS based grouting material formula has been carefully selected. Additionally, simulation grouting fire extinguishing experiments have demonstrated that the injection of the slurry is highly effective in reducing the temperature of the combustion test block, isolating oxygen, and lowering the temperature within the combustion zone. After 5 h, the temperature drops to below 100 °C, and no re-ignition phenomena are observed. The outcomes of this research can provide valuable scientific guidance for the development of high-performance fire extinguishing grouting materials utilizing fly ash and carbide slag.

Painful physical symptoms and antidepressant treatment outcome in depression: a systematic review and meta-analysis.

Painful physical symptoms (PPS) are highly prevalent in patients with major depressive disorder (MDD). Presence of PPS in depressed patients are potentially associated with poorer antidepressant treatment outcome. We aimed to evaluate the association of baseline pain levels and antidepressant treatment outcomes. We searched PubMed, Embase and Cochrane Library databases from inception through February 2023 based on a pre-registered protocol (PROSPERO: CRD42022381349). We included original studies that reported pretreatment pain measures in antidepressant treatment responder/remitter and non-responder/non-remitter among patients with MDD. Data extraction and quality assessment were performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses by two reviewers independently. The primary outcome was the difference of the pretreatment pain levels between antidepressant treatment responder/remitter and non-responder/non-remitter. Random-effects meta-analysis was used to calculate effect sizes (Hedge's g) and subgroup and meta-regression analyses were used to explore sources of heterogeneity. A total of 20 studies were included. Six studies reported significantly higher baseline pain severity levels in MDD treatment non-responders (Hedge's g = 0.32; 95% CI, 0.13-0.51; P = 0.0008). Six studies reported the presence of PPS (measured using a pain severity scale) was significantly associated with poor treatment response (OR = 1.46; 95% CI, 1.04-2.04; P = 0.028). Five studies reported significant higher baseline pain interference levels in non-responders (Hedge's g = 0.46; 95% CI, 0.32-0.61; P < 0.0001). Four studies found significantly higher baseline pain severity levels in non-remitters (Hedge's g = 0.27; 95% CI, 0.14-0.40; P < 0.0001). Eight studies reported the presence of PPS significantly associated with treatment non-remission (OR = 1.70; 95% CI, 1.24-2.32; P = 0.0009). This study suggests that PPS are negatively associated with the antidepressant treatment outcome in patients with MDD. It is possible that better management in pain conditions when treating depression can benefit the therapeutic effects of antidepressant medication in depressed patients.

Effects of Different Taping Techniques in Individuals with Myofascial Pain Syndrome with a Trigger Point in the Trapezius Muscle: A Sham-controlled Randomized Study.

This study aimed to compare the effects of three different kinesio taping (KT) techniques in individuals with myofascial pain syndrome (MPS) who have a trigger point in the trapezius muscle. The individuals included in our study were randomly divided into four groups: Group 1: Functional correlation technique, group 2: Fascia correlation technique, group 3: Star taping technique (STT), and group 4: Sham group. The visual analog scale was used to assess pain, cervical joint range of motion (ROM) with a universal goniometer, grip strength with a hand dynamometer, number of active trigger points by palpation, pressure-pain threshold with an algometer, quality of life with the Nottingham Health Profile and functional level with the Neck Disability index were evaluated before and after treatment. There was no difference between the groups in terms of demographic data and pre-treatment outcome measures (p>0.05). There was a significant difference in the pain score between the groups after treatment (p<0.05). A statistically significant difference was found in the cervical flexion ROM of all groups after treatment (p<0.05). In pairwise comparisons, these differences were found due to group 3 (p<0.05). The three KT techniques are effective in reducing pain, increasing ROM, reducing the number of active trigger points, and increasing grip strength. Among these techniques, STT was found to be more effective in reducing pain and increasing cervical flexion ROM. KT is a method that can be used in the clinic for patients with MPS.

Case of Marital Therapy Using I-ATTACH: An Indian Model of Marital Therapy Intervention

ABSTRACT The following case study demonstrates the potential of a culturally sensitive, integrated model of marital therapy intervention designed and developed using data from and research done in India. This integrated approach utilizes humanistic-existential approaches as the base frame of reference and techniques from the approaches falling within the theoretical frame of systemic and social constructionist approaches have been assimilated into it. The model is called the Indian model for Attunement To Tackle Active Conflict And Helplessness with married couples (I-ATTACH). This case demonstrates the application of the approach with a couple married for 2 years who saw an escalation of marital problems leading to talks of separation post the birth of their child 6 months ago. The couple completed both pre-treatment and post-treatment assessment measures that included a self-reported standardized questionnaire, a 5 point scaled questionnaire designed by the authors and a semi-structured questionnaire to assess for the couple’s assessment regarding the effectiveness of the intervention. After the pre-treatment assessment, the couple engaged in 16 joint and 2 individual intervention sessions of I-ATTACH. A description of the model and the stage-wise progress of the couple is discussed and the assessment data presented for both pre-treatment and post-treatment.

Factors Associated With Laboratory Test Negativity Following a Transition in Specimen Collection in Microbial Keratitis Cases

Purpose Negative laboratory results make targeting microbial keratitis treatment difficult. We investigated factors associated with laboratory negativity in patients with microbial keratitis in the context of a transition to a new specimen collection method. Methods Microbial keratitis patients with associated laboratory tests were identified in the electronic health record of a tertiary care facility from August 2012 to April 2022. Patient demographics and laboratory results were obtained. Random sampling of 50% of charts was performed to assess the impact of the ocular history and pretreatment measures. The relationship between probability of negative laboratory results with demographics, ocular history, pretreatment measures, and utilization of a new specimen collection method (i.e. ESwab) was evaluated by multivariable logistic regression. Results Of 3395 microbial keratitis patients identified, 31% (n = 1051) had laboratory tests. Laboratory testing increased over time (slope = 2.5% per year, p < 0.001; 19.6% in 2013 to 42.2% in 2021). Laboratory negative rate increased over time (slope = 2.2% per year, p = 0.022; 48.5% in 2013 to 62.3% in 2021). Almost one-third of patients (31.2%, n = 164) were pretreated with steroids. Over two-thirds of patients were pretreated with antibiotics (69.5%, n = 367). 56.5% (n = 297) of patients were outside referrals. In multivariable regression, patients with corticosteroid pretreatment had lower odds of negative laboratory results (odds ratio [OR] = 0.49, p = 0.001). There were higher odds of negative laboratory results for every additional antibiotic prescribed to a patient prior to presentation (OR = 1.30, p = 0.006) and for specimens collected using ESwabs (OR = 1.69, p = 0.005). Age, prior eye trauma, outside referrals, and contact lens wear were not significantly associated with negative laboratory results. Conclusion More microbial keratitis associated laboratory tests are being taken over time. Over 60% of tests were negative by 2022. Factors associated with negative laboratory test results included pretreatment with antibiotics and specimens collected with the new collection method.

Machine learning models predict PTSD severity and functional impairment: A personalized medicine approach for uncovering complex associations among heterogeneous symptom profiles.

Posttraumatic stress disorder (PTSD) is a debilitating psychiatric illness, experienced by approximately 10% of the population. Heterogeneous presentations that include heightened dissociation, comorbid anxiety and depression, and emotion dysregulation contribute to the severity of PTSD, in turn, creating barriers to recovery. There is an urgent need to use data-driven approaches to better characterize complex psychiatric presentations with the aim of improving treatment outcomes. We sought to determine if machine learning models could predict PTSD-related illness in a real-world treatment-seeking population using self-report clinical data. Secondary clinical data from 2017 to 2019 included pretreatment measures such as trauma-related symptoms, other mental health symptoms, functional impairment, and demographic information from adults admitted to an inpatient unit for PTSD in Canada (n = 393). We trained two nonlinear machine learning models (extremely randomized trees) to identify predictors of (a) PTSD symptom severity and (b) functional impairment. We assessed model performance based on predictions in novel subsets of patients. Approximately 43% of the variance in PTSD symptom severity (R²avg = .43, R²median = .44, p = .001) was predicted by symptoms of anxiety, dissociation, depression, negative trauma-related beliefs about others, and emotion dysregulation. In addition, 32% of the variance in functional impairment scores (R²avg = .32, R²median = .33, p = .001) was predicted by anxiety, PTSD symptom severity, cognitive dysfunction, dissociation, and depressive symptoms. Our results reinforce that dissociation, cooccurring anxiety and depressive symptoms, maladaptive trauma appraisals, cognitive dysfunction, and emotion dysregulation are critical targets for trauma-related interventions. Machine learning models can inform personalized medicine approaches to maximize trauma recovery in real-world inpatient populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

5 Cognitive Rehabilitation Using Teleneuropsychology. A Cohort Study in South America

Objective:The COVID-19 pandemic has affected the continuity of cognitive rehabilitation (CR) worldwide. However, the use of teleneuropsychology (TNP) to provide CR has contributed significantly to the continuity of treatment. The objective of this study was to measure the effects of CR via the TNP on cognition, neuropsychiatric symptoms, and memory strategies in a cohort of patients with Mild Cognitive Impairment (MCI).Participants and Methods:A sample of 60 patients (60% female; age: 72.4±6.96) with MCI according to Petersen criteria was randomly divided into two groups: 30 cases (treatment group) and 30 controls (waiting list group). Subjects were matched for age, sex, and MMSE or MoCA.The treatment group received ten weekly CR sessions of 45 minutes weekly. Pre-treatment (week 0) and post-treatment (week 10) measures were assessed for both groups. Different Linear Mixed Models were estimated to test treatment effect (CR vs. Controls) on each outcome of interest over Time (Pre/Post), controlling for Diagnosis, Age, Sex, and MMSE/MoCA performance.Results:A significant Group (Control/Treatment) x Time (pre/post) interaction revealed that the treatment group at 10 weeks had better scores in cognitive variables: memory (RAVLT learning trials p=0.030; RAVLT delayed recall p=0.029), phonological fluency(p=0.001), activities of daily living (FAQ p=0.001), satisfaction with memory performance (MMQ Satisfaction p=0.004) and use of memory strategies (MMQ Strategy p=0.00), and a significant reduction of affective symptomatology: depression (GDS p=0.00), neuropsychiatric symptoms (NPIQ p=0.045), Forgetfulness (EDO-10 p=0.00), Stress (DAS Stress p=0.00).Conclusions:This is the first study to test CR using teleNP in South America. Our results suggest that CR through teleNP is an effective intervention to improve performance on cognitive variables and reduce neuropsychiatric symptomatology compared to patients with MCI. These results have great significance in the context of the COVID-19 pandemic in South America, where teleNP is proving to be a valuable tool.

Chinese herbal medicine combined with cognitive–behavioural therapy for avoidant paruresis: a controlled trial

BackgroundAvoidant paruresis is a common clinical condition in urology and psychosomatic medicine. However, it has limited treatment options that are safe and effective with few side effects.AimsOur study aimed to...

Patterns of drinking behavior around a treatment episode for alcohol use disorder: Predictions from pre-treatment measures.

Alcohol use disorder (AUD) has been described as a chronic disease given the high rates that affected individuals have in returning to drinking after a change attempt. Many studies have characterized predictors of aggregated alcohol use (e.g., percent heavy drinking days) following treatment for AUD. However, to inform future research on predicting drinking as an AUD outcome measure, a better understanding is needed of the patterns of drinking that surround a treatment episode and which clinical measures predict patterns of drinking. We analyzed data from the Project MATCH and COMBINE studies (MATCH: n = 1726; 24.3% female, 20.0% non-White; COMBINE: n = 1383; 30.9% female, 23.2% non-White). Daily drinking was measured in the 90 days prior to treatment, 90 days (MATCH) and 120 days (COMBINE) during treatment, and 365 days following treatment. Gradient boosting machine learning methods were used to explore baseline predictors of drinking patterns. Drinking patterns during a prior time period were the most consistent predictors of future drinking patterns. Social network drinking, AUD severity, mental health symptoms, and constructs based on the addiction cycle (incentive salience, negative emotionality, and executive function) were associated with patterns of drinking prior to treatment. Addiction cycle constructs, AUD severity, purpose in life, social network, legal history, craving, and motivation were associated with drinking during the treatment period and following treatment. There is heterogeneity in drinking patterns around an AUD treatment episode. This study provides novel information about variables that may be important to measure to improve the prediction of drinking patterns during and following treatment. Future research should consider which patterns of drinking they aim to predict and which period of drinking is most important to predict. The current findings could guide the selection of predictor variables and generate hypotheses for those predictors.

Higher baseline emotion dysregulation predicts treatment dropout in outpatients with borderline personality disorder.

Treatment dropout is high among outpatients with borderline personality disorder (BPD) and is associated with myriad negative therapeutic and psychosocial outcomes. Identifying predictors of treatment dropout can inform treatment provision for this population. The present study investigated whether symptom profiles of static and dynamic factors could predict treatment dropout. Treatment-seeking outpatients with BPD (N = 102) completed pre-treatment measures of BPD symptom severity, emotion dysregulation, impulsivity, motivation, self-harm, and attachment style to determine their collective impact on dropout prior to 6 months of treatment. Discriminant function analysis was used to classify group membership (treatment dropout vs. nondropout) but did not produce a statistically significant function. Groups were distinguished by baseline levels of emotion dysregulation with higher dysregulation predicting premature treatment dropout. Clinicians working with outpatients with BPD might benefit from optimizing emotion regulation and distress tolerance strategies earlier in treatment to reduce premature dropout. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Dimensions of Warm Parenting Attributions Differentiate Conduct Problem Subtypes in Young Children

Understanding the developmental psychopathology of child conduct problems (CP) has been advanced by differentiating subtypes based on levels of internalizing problems (INT) and/or callous-unemotional (CU) traits (i.e., low empathy/guilt, poor motivation, shallow/deficient affect). The current study sought to elucidate prior inconsistencies in the role of warm/positive and harsh/negative parenting subcomponents in CP by differentiating subtypes on the basis of INT and CU traits. Parents of 135 young children (M age = 4.21 years, SD = 1.29) referred to specialty clinics for the treatment of CP completed pre-treatment measures of parenting and rated their child’s levels of CP, INT, and CU traits. Results of planned comparisons revealed that mothers of children classified as secondary CU variants (high CU/ high INT) reported fewer overall warm attributions toward their child, compared with CP-only (low CU) children. They also reported a more negative dyadic relationship characterized by feelings of anger/hostility, active avoidance and/or a desire to do harm to their child relative to primary CU variants (high CU/ low INT). Mothers of primary CU variants attributed fewer good and altruistic intentions towards others in their child, relative to CP-only children. Subtypes were undifferentiated on observed positive and negative parenting behaviors, indicative of a disconnect between parenting behaviors and cognitions for mothers of children high on CU traits. Findings are discussed in relation to their theoretical and practice implications, and in guiding future research.

Artificial Intelligence Ethics and Fairness: A study to address bias and fairness issues in AI systems, and the ethical implications of AI applications

Artificial intelligence (AI) has made incredible strides in several fields, revolutionising business and everyday life. Thoughts regarding the moral ramifications and fairness of AI systems have grown in prominence along with its fast development. This article explores the crucial issues of AI fairness and ethics, concentrating on ways to detect and reduce prejudice in AI systems while also discussing larger ethical implications. The paper emphasises the possible repercussions of biased decision-making while highlighting the many forms and sources of bias that might develop in AI models. There are several methods and strategies to deal with bias in AI systems, including data pretreatment, algorithmic changes, and transparency measures. In an effort to balance justice and efficacy, the trade-offs between fairness goals and overall model performance are examined. The article also emphasises how crucial it is for AI systems to be transparent and understandable in order to foster accountability. For the purpose of establishing ethical AI development and deployment practises, regulatory issues and ethical decision-making frameworks are also investigated. This study emphasises the need of ongoing research and development of moral AI systems to guarantee a just and equitable future for AI applications via in-depth analysis and case studies.

The sustained and generalized effects of multifaceted treatment on unsignalized pedestrian crossings

IntroductionOne method of improving pedestrian safety is through a multifaceted intervention program to enhance awareness and enforcement of pedestrian right-of-way laws, which has been shown to significantly improve driver behavior toward pedestrians at unsignalized crosswalks. An intervention using this approach was performed in Saint Paul, Minnesota in 2018. However, the sustainability of the intervention's positive effects on yielding, as well as the potential contributing role of police enforcement and infrastructure such as crosswalk markings, are not as well understood. MethodsThe present study provides a reassessment of driver yielding to pedestrians at unsignalized crosswalks in Saint Paul three years after the original intervention, as well as a comparison with unsignalized crosswalks in neighboring Minneapolis, the latter of which has not received any form of high visibility enforcement. The methodology employed the use of staged crossings and natural pedestrian observations at selected unsignalized crosswalk sites. ResultsAn analysis of driver yielding found that there was a sustained improvement in driver yielding in the reassessment period at generalized non-treated sites in Saint Paul in the final phase of the 2018 intervention, compared to the original baseline pre-treatment measures. Second, comparisons between Minneapolis baseline and original 2018 Saint Paul baseline showed significantly higher yielding averages for Saint Paul, which had prior iterations of high visibility enforcement. ConclusionsThe present research indicates long-term benefits to employing a multi-method intervention to improve pedestrian safety at unsignalized crosswalks and suggests there are moderate benefits to including high visibility enforcement as a component of these programs.

Who Benefits the Most From Different Psychological Chronic Pain Treatments? An Exploratory Analysis of Treatment Moderators

Different psychological chronic pain treatments benefit some individuals more than others. Understanding the factors that are associated with treatment response—especially when those factors differ between treatments—may inform more effective patient-treatment matching. This study aimed to identify variables that moderate treatment response to 4 psychological pain interventions in a sample of adults with low back pain or chronic pain associated with multiple sclerosis, spinal cord injury, acquired amputation, or muscular dystrophy (N = 173). The current study presents the results from secondary exploratory analyses using data from a randomized controlled clinical trial which compared the effects of 4 sessions of cognitive therapy (CT), hypnosis focused on pain reduction (HYP), hypnosis focused on changing pain-related cognitions and beliefs (HYP-CT), and a pain education control condition (ED). The analyses tested the effects of 7 potential treatment moderators. Measures of primary (pain intensity) and secondary (pain interference, depression severity) outcome domains were administered before and after the pain treatments, and potential moderators (catastrophizing, hypnotizability, and electroencephalogram (EEG)-assessed oscillation power across five bandwidths) were assessed at pre-treatment. Moderator effects were tested fitting regression analyses to pre- to post-treatment changes in the three outcome variables. The study findings, while preliminary, support the premise that pre-treatment measures of hypnotizability and EEG brain activity predict who is more (or less) likely to respond to different psychological pain treatments. If additional research replicates the findings, it may be possible to better match patients to their more individually suitable treatment, ultimately improving pain treatment outcomes. PerspectivePre-treatment measures of hypnotizability and EEG-assessed brain activity predicted who was more (or less) likely to respond to different psychological pain treatments. If these findings are replicated in future studies, they could inform the development of patient-treatment matching algorithms.

Dysphagia at 1 Year is Associated With Mean Dose to the Inferior Section of the Brain Stem

Dysphagia is a common toxicity after head and neck (HN) radiation therapy that negatively affects quality of life. We explored the relationship between radiation therapy dose to normal HN structures and dysphagia 1 year after treatment using image-based datamining (IBDM), a voxel-based analysis technique. We used data from 104 patients with oropharyngeal cancer treated with definitive (chemo)radiation therapy. Swallow function was assessed pretreatment and 1 year posttreatment using 3 validated measures: MD Anderson Dysphagia Inventory (MDADI), performance status scale for normalcy of diet (PSS-HN), and water swallowing test (WST). For IBDM, we spatially normalized all patients' planning dose matrices to 3 reference anatomies. Regions where the dose was associated with dysphagia measures at 1 year were found by performing voxel-wise statistics and permutation testing. Clinical factors, treatment variables, and pretreatment measures were used in multivariable analysis to predict each dysphagia measure at 1 year. Clinical baseline models were found using backward stepwise selection. Improvement in model discrimination after adding the mean dose to the identified region was quantified using the Akaike information criterion. We also compared the prediction performance of the identified region with a well-established association: mean doses to the pharyngeal constrictor muscles. IBDM revealed highly significant associations between dose to distinct regions and the 3 outcomes. These regions overlapped around the inferior section of the brain stem. All clinical models were significantly improved by including mean dose to the overlap region (P ≤ .006). Including pharyngeal dosimetry significantly improved WST (P=.04) but not PSS-HN or MDADI (P ≥ .06). In this hypothesis-generating study, we found that mean dose to the inferior section of the brain stem is strongly associated with dysphagia 1 year posttreatment. The identified region includes the swallowing centers in the medulla oblongata, providing a possible mechanistic explanation. Further work including validation in an independent cohort is required.