Profiles Of Recovery Research Articles

Exploring heterogeneity in recovery from substance use disorder following mindfulness-based relapse prevention: A latent profile analysis

IntroductionSubstance use disorder (SUD) recovery is heterogeneous. Yet, over the last 50 years, substance use treatment providers and researchers have often defined success as sustained abstinence from substance use. An often overlooked but equally valid pathway to recovery for persons with SUD is non-abstinent recovery. However, most of the literature on non-abstinent recovery exists for individuals with alcohol use disorder (AUD) with few studies of non-abstinent recovery for other types of SUD. Literature exploring the mechanisms that lead to non-abstinent recovery is also lacking. As such, the current study aimed to examine recovery profiles for individuals (N = 454) recruited in two randomized clinical trials comparing mindfulness-based relapse prevention with cognitive-behavioral relapse prevention and/or treatment as usual. MethodsLatent profile analysis empirically derived profiles of recovery following outpatient aftercare SUD treatment. Multinomial logistic regression examined associations between treatment assignment and recovery profile, including potential psychological mediators (e.g., mindfulness) and contextual moderators (e.g., annual household income). ResultsAnalyses supported four recovery profiles: (1) low-functioning frequent substance use; (2) low-functioning infrequent substance use; (3) high-functioning frequent substance use; (4) high-functioning infrequent substance use. There were no significant interaction effects of race or ethnicity by treatment type, or household income by treatment type, in predicting recovery profiles. Trait mindfulness, craving, and psychological flexibility failed to mediate the association between treatment assignment and recovery profile; however, there were statistically significant differences in trait mindfulness with individuals expected to be classified in the low-functioning infrequent substance use profile showing significantly lower levels of trait mindfulness compared to individuals in the two high-functioning profiles. ConclusionsFindings suggest that recovery from SUD is heterogeneous, and profiles of recovery based on dimensions of substance use and functioning can be identified across a variety of SUD, including among people with co-occurring SUD. Additionally, trait mindfulness appears to be a differentiating factor across recovery profiles. Further research is needed to explore how psychological and social factors may moderate and influence both abstinent and non-abstinent forms of recovery.

The metabolic fate of abalone: transport and recovery of Haliotis iris gills as a case study

ABSTRACT Abalone is a gourmet seafood with a high commercial value, particularly when obtained as a live product. During live transportation, abalone encounter stressors causing biochemical modifications to tolerate the changes. Using semi-targeted metabolomics, this study characterised the left and right gill metabolite profiles of Blackfoot abalone, Haliotis iris, following transportation (48 h) and recovery (48 h). This study reports the association between left and right gill metabolites, to enhance our physiological understanding of the interplay between gills. The left gill metabolites are mainly active following transportation, while both gills partake in the metabolite response following recovery. Transportation necessitated increased metabolites linked to the glycolysis pathway, the Krebs cycle, amino acid, and nucleotide metabolism, for energy production, achieved via aerobic and anaerobic pathways. The recovery phase supported the replenishing of glycogen, triglycerides, and protein stores, albeit metabolic homeostasis was not achieved following two-days of water immersion recovery. This study showcases the well-adapted metabolic mechanisms implemented by H. iris in response to transportation stress and show that metabolites are in the process of returning to the same concentrations as measured pre-transport stress. The findings herein can be applied to improve animal health during transport and subsequent survival, which in-effect supports profitability.

Characterizing burnout and resilience among nurses: A latent profile analysis of emotional exhaustion, emotional thriving and emotional recovery.

To identify subgroups of nurses with distinct profiles of burnout (emotional exhaustion) and resilience (emotional thriving and emotional recovery) and describe nurse characteristics associated with each profile. Cross-sectional, correlational design. Data were collected via electronic survey from 2018 to 2019. Latent profile analysis was used to identify subgroups of nurses with distinct profiles of emotional exhaustion, emotional thriving and emotional recovery, with each measured on a 0-100 scale. Bivariate statistics were used to determine profile differences in nurse sociodemographic, professional and psychological characteristics. Four distinct profile subgroups were identified: (1) "exhausted" (14% with very high emotional exhaustion, low emotional thriving and moderate emotional recovery), (2) "exhausted with thriving" (6% with high emotional exhaustion, moderate-high emotional thriving and low emotional recovery), (3) "exhausted with thriving and recovery" (52% with moderate-high emotional exhaustion, emotional thriving and emotional recovery), and (4) "thriving and recovery" (27% with low emotional exhaustion and very high emotional thriving and emotional recovery). Nurses in the "exhausted" and "exhausted with thriving" profiles reported greater depression and poorer work-life integration. Nurses in "exhausted" profile were more likely to work in an inpatient setting. Nurses in the "exhausted with thriving and recovery" and "thriving and recovery" profiles reported more positive emotions, more well-being behaviours, and better work-life integration, with the "thriving and recovery" subgroup having the highest levels of these characteristics, lower depression scores and greater racial minority representation. Approaches designed to improve nurse well-being should be tailored to the nurses' profile of emotional exhaustion, thriving and recovery to maximize effectiveness. Given the growing shortage of nurses in healthcare systems, it is critical that multilevel strategies be investigated to retain nursing staff that consider the intersectionality and complexity of the different aspects of burnout and resilience experienced by the nurse. The aim was to assess burnout and resilience among nurses.

Complete Classification of Gradient Blow-Up and Recovery of Boundary Condition for the Viscous Hamilton–Jacobi Equation

It is known that the Cauchy–Dirichlet problem for the superquadratic viscous Hamilton–Jacobi equation $$u_t-\Delta u=|\nabla u|^p$$ with $$p>2$$ , which has important applications in stochastic control theory, admits a unique, global viscosity solution. Solutions thus exist in the weak sense after the appearance of singularity in finite time, which occurs through gradient blow-up (GBU) on the boundary. The solutions eventually become classical again for large time, but in-between they may undergo losses and recoveries of boundary conditions at multiple times (as well as GBU at multiple times), hence forming a quite complex dynamics. In this paper, with the help of braid group theory combined with inner/outer region analysis, we give a complete classification of all viscosity solutions in one-dimensional case. Namely, we fully describe the (countably many, type II) rates and space–time profiles of gradient blow-up (GBU) or recovery of boundary condition (RBC), we characterize them at any time when such a phenomenon occurs, and we moreover determine whether the space–time profiles are stable or unstable. These results can be modified in radial domains in general dimensions. Even for type II blow-up in other PDEs, as far as we know, there has been no complete classification except Mizoguchi (Commun Pure Appl Math 75:1870–1886, 2022), in which the argument relies on features peculiar to chemotaxis system. Whereas there are many results on construction of special type II blow-up solutions of PDEs with investigation of stability/instability of bubble, determination of stability/instability of space–time profile for general solutions has not been done. A key in our proofs is to focus on braid group algebraic structure with respect to vanishing intersections with the singular steady state, as a GBU or RBC time is approached. In turn, the GBU and RBC rates and profiles, as well as their stability/instability, can be given a complete geometric characterization by the number of vanishing intersections. We construct special solutions in bounded and unbounded intervals in both GBU and RBC cases, based on methods from Herrero and Velázquez (Preprint, 1994), and then we apply braid group theory to get upper and lower estimates of the rates. After that, we rule out oscillation of the rates, which leads us to the complete space–time profile. In the process, careful construction of special solutions with specific behaviors in intermediate and outer regions, which is far from bubble and the RBC point, plays an essential role. The application of such techniques to viscosity solutions is completely new.

A Novel Method to Classify Cervical Incomplete Spinal Cord Injury Based on Potential for Recovery: A Group-Based Trajectory Analysis.

The outcomes of cervical incomplete spinal cord injury (SCI) are heterogeneous. This study sought to dissociate subgroups of cervical incomplete SCI patients with distinct longitudinal temporal profiles of recovery in upper limb motor function. Patients with cervical incomplete SCI (American Spinal Injury Association Impairment Scale [AIS] B-D; C1-C8) were identified from four prospective, multi-center SCI datasets. A group-based trajectory model was fit to longitudinal upper extremity motor scores out to 1 year. Multi-variable multinomial logistic regression was performed to identify features that characterize each trajectory group. A classification system for predicting trajectory group at baseline was developed by recursive partitioning. In total, 801 patients were eligible. Four distinct trajectory groups were identified: 1) "Poor outcome": Severe injury, very minimal recovery; 2) "Moderate recovery": Moderate-to-severe injury, moderate recovery; most recovery occurs by 6 months, with mild, gradual recovery continuing thereafter; 3) "Good recovery": Moderate injury, good recovery; most recovery occurs by 3 months, with mild, gradual recovery continuing thereafter; and 4) "Excellent outcome": Mild injury, recovery to normal/near-normal by 3 months. On adjusted analyses, older age was associated with lower likelihood of "excellent outcome" (p = 0.020). AIS C and D injuries were associated with "moderate recovery," "good recovery," and "excellent outcome" (p < 0.001). Mid-cervical injuries occurred more frequently in "moderate recovery," "good recovery," and "excellent outcome" (p < 0.001) groups. Early surgical decompression (< 24 h) was associated with increased propensity for "good recovery" (p = 0.039) and "excellent outcome" (p = 0.048). A classification model based on recursive partitioning could predict trajectory group using age, AIS grade, and neurological level with an area under the curve of 0.81. Patients with cervical incomplete SCI demonstrate distinct temporal profiles of recovery in upper limb motor function. The trajectory a patient is likely to follow may be predicted at baseline with fair accuracy.

The 5'-end motif of Senecavirus A cDNA clone is genetically modified in 36 different ways for uncovering profiles of virus recovery.

Senecavirus A (SVA) is an emerging picornavirus. Its genome is one positive-sense, single-stranded RNA. The viral protein (VPg) is covalently linked to the extreme 5′ end of the SVA genome. A complex hairpin-pseudoknot-hairpin (HPH) RNA structure was computationally predicted to form at the 5′ end of the SVA genome. A total of three extra “U” residues (UUU) served as a linker between the HPH structure and the VPg, causing putative UUU–HPH formation at the extreme 5′ end of the SVA genome. It is unclear how the UUU–HPH structure functions. One SVA cDNA clone (N0) was constructed previously in our laboratory. Here, the N0 was genetically tailored for reconstructing a set of 36 modified cDNA clones (N1 to N36) in an attempt to rescue replication-competent SVAs using reverse genetics. The results showed that a total of nine viruses were successfully recovered. Out of them, five were independently rescued from the N1 to N5, reconstructed by deleting the first five nucleotides (TTTGA) one by one from the extreme 5′ end of N0. Interestingly, these five viral progenies reverted to the wild-type or/and wild-type-like genotype, suggesting that SVA with an ability to repair nucleotide defects in its extreme 5′ end. The other four were independently rescued from the N26 to N29, containing different loop-modifying motifs in the first hairpin of the HPH structure. These four loop-modifying motifs were genetically stable after serial passages, implying the wild-type loop motif was not a high-fidelity element in the first hairpin during SVA replication. The other genetically modified sequences were demonstrated to be lethal elements in the HPH structure for SVA recovery, suggesting that the putative HPH formation was a crucial cis-acting replication element for SVA propagation.

Individual and Community Social Determinants of Health and Recovery from Alcohol Use Disorder Three Years following Treatment

ABSTRACT Prior research on recovery from alcohol use disorder (AUD) has often focused on individual-level factors that promote recovery. Given systemic health inequities, it is also important to study community-level social determinants of health (SDOH) that may promote recovery from AUD. This study extended prior work examining individual profiles of recovery from AUD to assess how individual and community SDOH at the time of treatment entry were associated with recovery from AUD three years after treatment. Data were utilized from the COMBINE study (n = 664), a multisite randomized clinical trial evaluating pharmacological and behavioral treatments for AUD. Public community data sources associated with participants’ study sites were used to measure community SDOH. Multilevel latent profile analyses with individual- and community-level variables as predictors of recovery profiles were estimated. Four profiles were identified based on participants’ alcohol consumption and functioning. Individual SDOH variables, such as fewer years of education and lower income, and community SDOH, including lower rates of health insurance, lower income, and greater income inequality, were each associated with lower functioning profiles. The findings highlight the importance of community SDOH in AUD recovery and the value of including both individual and community SDOH variables in research on long-term recovery.

A semi-analytical solution for shale gas production from compressible matrix including scaling of gas recovery

The aim of this work is to present semi-analytical solutions for shale gas production from a 1D porous medium, where constant pressure is assumed at one side and a no-flow boundary at the other. Adsorbed gas is modeled by a Langmuir isotherm, the gas and rock are compressible, porosity reduction reduces intrinsic permeability and apparent permeability further depends on the Knudsen number.The partial differential equation describing this system can be formulated as a nonlinear diffusion equation in terms bulk gas density M. This system is comparable to a form described for spontaneous imbibition with semi-analytical solutions regardless of the shape of the diffusion coefficient as function of the conserved property, in that case fluid saturation. Semi-analytical solutions are thus obtained that can give spatial profiles, at given times, of pressure, adsorption, porosity and apparent permeability, in addition to time profiles of gas recovery. These solutions are valid until the no-flow boundary is encountered (the critical time). Late time behavior is investigated using numerical solutions. The roles of system length, adsorption isotherm, rock compressibility, porosity-permeability relations and non-Darcy effects are examined.It is shown that gas recovery follows a square root of time profile before the critical time. Scaling yields full overlap of recovery curves until their critical time. The square root of time solution is valid for recoveries around 12–22%, but is a good approximation until obtainable recoveries of 35–50% for typical shale cases. Cases where the diffusion coefficient increases more steeply with M leave the square root profile at lower recovery values and obtain slower recovery with time systematically according to the steepness of the coefficient.

ANN-Kriging hybrid model for predicting carbon and inorganic phosphorus recovery in hydrothermal carbonization

Modeling of hydrothermal carbonization (HTC) of poultry litter to high-value materials was conducted in order to understand the process and predict the influence of process parameters on product properties. Reaction temperature and time were considered as inputs, whereas carbon and inorganic phosphorous recovery were considered as responses in the model. Artificial neural network (ANN) model was used in order to correlate the process parameters to the outputs. The model was trained and validated using the data collected from HTC experiments carried out at temperatures between 150 ≤ T ≤ 300 °C, and residence time between 30 ≤ t ≤ 480 min. In order to improve the predictability of ANN, more theoretical data points were generated using Kriging approach based on the available measured data. Kriging interpolation improved the ANN model dramatically in training and validation phases, where the carbon recovery model fitting was improved by 0.94% and 9.2% in training and validation respectively, and the inorganic phosphorous (IP) recovery model fitting was improved by a staggering 16.4% and 19.6% in training and validation respectively. This improvement is also reflecting on the derived profiles of carbon and IP recovery in terms of the process parameters. The validated model was then used to understand the effect of process parameters on the response. It was revealed that temperature has more significant effect on the carbon and phosphorous recovery, while the effect of reaction time is more important at low reaction temperatures. The derived profiles shows a monotonic increase in IP recovery and a monotonic decrease in Carbon recovery at higher temperatures and time, this is due to multiple mechanism occurring simultaneously in the HTC reactor at various temperatures and times.

Profiles of recovery from alcohol use disorder at three years following treatment: can the definition of recovery be extended to include high functioning heavy drinkers?

Recovery from alcohol use disorder (AUD) is often narrowly defined by abstinence from alcohol and improvements in functioning (e.g. mental health, social functioning, employment). This study used latent profile analysis to examine variability in recovery outcomes, defined by alcohol use, alcohol-related problems and psychosocial functioning at 3years following treatment. Secondary analysis investigated pre-treatment, post-treatment and 1- and 3-year post-treatment covariate predictors of the latent profiles. Secondary analysis of data from a randomized clinical trial. United States. We used data from the out-patient arm of Project MATCH (n=806; 29.7% female, 22.2% non-white). Recovery was defined by latent profile analyses including measures of psychosocial functioning and life satisfaction (Psychosocial Functioning Inventory), unemployment and mental health (Addiction Severity Index), alcohol and other drug use (Form 90) and alcohol-related consequences (Drinker Inventory of Consequences) 3 years following treatment. Mixture modeling was used to examine correlates of profiles. We identified four profiles at 3years following treatment: (1) poor functioning frequent heavy drinkers, (2) poor functioning infrequent heavy drinkers, (3) high functioning occasional heavy drinkers and (4) high-functioning infrequent non-heavy drinkers. There were relatively few differences on indicators of functioning and treatment-related variables between the high functioning infrequent non-heavy drinkers and the high-functioning occasional heavy drinkers, other than high-functioning occasional heavy drinkers having lower alcohol dependence severity [odds ratio (OR)=0.94, 95% confidence interval (CI)=0.90, 0.98], fewer post-treatment coping skills (OR=0.54, 95% CI=0.32, 0.90) and lower 3-year post-treatment abstinence self-efficacy (OR=0.37, 95% CI=0.28, 0.49) and Alcoholics Anonymous (AA) involvement (OR=0.87, 95% CI=0.85, 0.99). The two high-functioning profiles showed the greatest improvements in functioning from baseline through the 3-year follow-up, whereas the low-functioning profiles showed the least amount of improvement. High-functioning occasional heavy drinkers had higher purpose in life than the poor-functioning profiles. Some individuals who engage in heavy drinking following treatment for alcohol use disorder may function as well as those who are mostly abstinent with respect to psychosocial functioning, employment, life satisfaction and mental health.

Co-history Matching: A Way Forward for Estimating Representative Saturation Functions

Core-scale experiments and analyses would often lead to estimation of saturation functions (relative permeability and capillary pressure). However, despite previous attempts on developing analytical and numerical methods, the estimated flow functions may not be representative of coreflood experiments when it comes to predicting similar experiments due to non-uniqueness issues of inverse problems. In this work, a novel approach was developed for estimation of relative permeability and capillary pressure simultaneously using the results of “multiple” corefloods together, which is called “co-history matching.” To examine this methodology, a synthetic (numerical) model was considered using core properties obtained from pore network model. The outcome was satisfactorily similar to original saturation functions. Also, two real coreflood experiments were performed where water at high and low rates were injected under reservoir conditions (live fluid systems) using a carbonate reservoir core. The results indicated that the profiles of oil recovery and differential pressure (dP) would be significantly affected by injection rate scenarios in non-water wet systems. The outcome of co-history matching could indicate that, one set of relative permeability and capillary pressure curves can reproduce the experimental data for all corefloods.

Language and cognitive communication disorder during post-traumatic amnesia: Profiles of recovery after TBI from three cases

ABSTRACTBackground: There has been limited empirical speech–language pathology (SLP) study of language and cognitive communication during post-traumatic amnesia (PTA) and the early stages after TBI. The purpose of the current research was to explore the potential means and utility of assessing cognitive communication during PTA and the post-acute recovery period.Method: This research used a longitudinal mixed methods design to describe language and cognitive communication assessment and recovery profiles of three patients with TBI. Cognitive communication was assessed with repeated standardised and non-standardised methods during PTA (rated with Westmead PTA Scale) and at follow-up 3 months after PTA emergence.Results: All participants demonstrated a profile of language and cognitive communication strengths and weaknesses during PTA and the post-acute period, also evident at follow-up. Improvement occurred gradually throughout PTA, although with individual fluctuation across test occasions. There was no marked change in communication function immediately before and after PTA emergence, indicating that cognitive communication ability and those functions measured on the Westmead PTA Scale (memory and orientation) did not recover at the same rate.Conclusion: It was feasible to assess language and cognitive communication throughout PTA and the post-acute period, and early assessment results were relevant to the patient’s ongoing communicative function. It is suggested that early and repeated SLP assessment may contribute to the prediction of persisting cognitive communication issues.

Are we failing clinical trials? A case for strong aggregate outcomes.

Clinical trials in psychiatry inherit methods for design and statistical analysis from evidence-based medicine. However, trials in other clinical disciplines benefit from a more specific relationship between instruments that measure disease state (e.g. biomarkers, clinical signs), the underlying pathology and diagnosis such that primary outcomes can be readily defined. Trials in psychiatry use diagnosis (i.e. a categorical label for a syndrome) as a proxy for the underlying disorder, and outcomes are defined, for example, as a percentage change in a univariate total score on some clinical instrument. We label this approach to defining outcomes weak aggregation of disease state. Univariate measures are necessary, because statistical methodology is both tractable and well-developed for scalar outcomes, but we show that weak aggregate approaches do not capture disease state sufficiently, potentially leading to loss of information about response to intervention. We demonstrate how multivariate disease state can be captured using geometric concepts of spaces defined over routine clinical instruments, and show how clinically meaningful disease states (e.g. representing different profiles of symptoms, recovery or remission) can be defined as prototypes (geometric locations) in these spaces. Then, we show how to derive univariate (scalar) measures, which capture patient's relationships to these prototypes and argue these represent strong aggregates of disease state that may be a better basis for outcome measures. We demonstrate our proposal using a large publically available dataset. We conclude by discussing the impact of strong aggregates for analyses in traditional and novel trial designs.

Rehabilitation training in neural restitution.

Over the last decade, neural transplantation has emerged as one of the more promising, albeit highly experimental, potential therapeutics in neurodegenerative disease. Preclinical studies in rat lesion models of Huntington's disease (HD) and Parkinson's disease (PD) have shown that transplanted precursor neuronal tissue from a fetus into the lesioned striatum can survive, integrate, and reconnect circuitry. Importantly, specific training on behavioral tasks that target striatal function is required to encourage functional integration of the graft to the host tissue. Indeed, "learning to use the graft" is a concept recently adopted in preclinical studies to account for unpredicted profiles of recovery posttransplantation and is an emerging strategy for improving graft functionality. Clinical transplant studies in HD and PD have resulted in mixed outcomes. Small sample sizes and nonstandardized experimental procedures from trial to trial may explain some of this variability. However, it is becoming increasingly apparent that simply replacing the lost neurons may not be sufficient to ensure the optimal graft effects. The knowledge gained from preclinical grafting and training studies suggests that lifestyle factors, including physical activity and specific cognitive and/or motor training, may be required to drive the functional integration of grafted cells and to facilitate the development of compensatory neural networks. The clear implications of preclinical studies are that physical activity and cognitive training strategies are likely to be crucial components of clinical cell replacement therapies in the future. In this chapter, we evaluate the role of general activity in mediating the physical ability of cells to survive, sprout, and extend processes following transplantation in the adult mammalian brain, and we consider the impact of general and specific activity at the behavioral level on functional integration at the cellular and physiological level. We then highlight specific research questions related to timing, intensity, and specificity of training in preclinical models and synthesize the current state of knowledge in clinical populations to inform the development of a strategy for neural transplantation rehabilitation training.

Peripheral Inflammatory Markers and Antioxidant Response during the Post-Acute and Chronic Phase after Severe Traumatic Brain Injury.

Traumatic brain injury (TBI) is a mechanical insult to the brain caused by external forces and associated with inflammation and oxidative stress. The patients may show different profiles of neurological recovery and a combination of oxidative damage and inflammatory processes can affect their courses. It is known that an overexpression of cytokines can be seen in peripheral blood in the early hours/days after the injury, but little is known about the weeks and months encompassing the post-acute and chronic phases. In addition, no information is available about the antioxidant responses mediated by the major enzymes that regulate reactive oxygen species levels: superoxide dismutase, catalase, peroxidases, and GSH-related enzymes. This study investigates the 6-month trends of inflammatory markers and antioxidant responses in 22 severe TBI patients with prolonged disorders of consciousness, consecutively recruited in a dedicated neurorehabilitation facility. Patients with a high degree of neurological impairment often show an uncertain outcome. In addition, the profiles of plasma activities were related to the neurological recovery after 12 months. Venous peripheral blood samples were taken blindly as soon as clinical signs and laboratory markers confirmed the absence of infections, 3 and 6 months later. The clinical and neuropsychological assessment continued up to 12 months. Nineteen patients completed the follow-up. In the chronic phase, persistent high plasma levels of cytokines can interfere with cognitive functioning and higher post-acute levels of cytokines [interferon (IFN)-γ, tumor necrosis factor (TNF)-α, IL1b, IL6] are associated with poorer cognitive recoveries 12 months later. Moreover, higher IFN-γ, higher TNF-α, and lower glutathione peroxidase activity are associated with greater disability. The results add evidence of persistent inflammatory response, provide information about long-term imbalance of antioxidant activity, and suggest that the over-production of cytokines and the alteration of the redox homeostasis in the post-acute phase might adversely affect the neurological and functional recovery. Inflammatory and antioxidant activity markers might offer a feasible way to highlight some of the processes opposing recovery after a severe TBI.

Profiles of Recovery from Mood and Anxiety Disorders: A Person-Centered Exploration of People's Engagement in Self-Management.

Context: A shift toward person-centered care has been occurring in services provided to people with mood and anxiety disorders. Recovery is recognized as encompassing personal aspects in addition to clinical ones. Guidelines now recommend supporting people's engagement in self-management as a complementary recovery avenue. Yet the literature lacks evidence on how individualized combinations of self-management strategies used by people relate to their clinical and personal recovery indicators.Objectives: The aims of this study were to identify profiles underlying mental health recovery, describe the characteristics of participants corresponding to each profile, and examine the associations of profiles with criterion variables.Method: 149 people recovering from anxiety, depressive, or bipolar disorders completed questionnaires on self-management, clinical recovery (symptom severity), personal recovery (positive mental health), and criterion variables (personal goal appraisal, social participation, self-care abilities, coping).Results: Latent profile analysis (LPA) revealed three profiles. The Floundering profile included participants who rarely used self-management strategies and had moderately severe symptoms and the lowest positive mental health. The Flourishing profile was characterized by frequent use of self-empowerment strategies, the least severe symptoms, and the highest positive mental health. Participants in the Struggling profile engaged actively in several self-management strategies focused on symptom reduction and healthy lifestyle. They concomitantly reported high symptom severity and moderately high positive mental health. The study revealed that Floundering was associated with higher probabilities of being a man, being single, and having a low income. People in the Flourishing profile had the most favorable scores on criterion variables, supporting the profiles' construct validity.Discussion: The mixed portrait of Struggling participants on recovery indicators suggests the relationship between health engagement and recovery is more intricate than anticipated. Practitioners should strive for a holistic understanding of their clients' self-management strategies and recovery indicators to provide support personalized to their profile. While people presenting risk factors would benefit from person-centered support, societal efforts are needed in the long term to reduce global health inequalities. The integration of constructs from diverse fields (patient-centered care, chronic illness, positive psychology) and the use of person-oriented analysis yielded new insights into people's engagement in their health and well-being.

Identifying profiles of recovery from reward devaluation in rats

In humans and other mammals, the unexpected loss of a resource can lead to emotional conflict. Consummatory successive negative contrast (cSNC) is a laboratory model of reward devaluation meant to capture that conflict. In this paradigm, animals are exposed to a sharp reduction in the sucrose concentration of a solution after several days of access. This downshift in sucrose content leads to behavioral responses such as the suppression of consumption and physiologic responses including elevation of corticosterone levels. However, response heterogeneity in cSNC has yet to be explored and may be relevant for increasing the validity of this model, as humans demonstrate clinically meaningful heterogeneity in response to resource loss. The current analysis applied latent growth mixture modeling to test for and characterize heterogeneity in recovery from cSNC among rats (N=262). Although most animals exhibited recovery of consummatory behavior after a sharp drop in consumption in the first postshift trial (Recovery class; 83%), two additional classes were identified including animals that did not change their consumption levels after downshift (No Contrast class; 6%), and animals that exhibited an initial response similar to that of the Recovery class but did not recover to preshift consumption levels (No Recovery class; 11%). These results indicate heterogeneity in recovery from reward loss among rats, which may increase the translatability of this animal model to understand diverse responses to loss among humans.

Outcome of the upper limb in cervical spinal cord injury: Profiles of recovery and insights for clinical studies

BackgroundImproved appreciation of recovery profiles of sensory and motor function as well as complex motor functions (prehension) after cervical spinal cord injury (SCI) will be essential to inform clinical studies to consider primary and secondary outcome measures for interventions and the optimization of dosing and timing of therapies in acute and chronic SCI.Objectives(1) To define the sensory, motor, and prehension recovery profiles of the upper limb and hand in acute cervical SCI and (2) to confirm the impact of AIS severity and conversion on upper limb sensorimotor recovery.MethodsAn observational longitudinal cohort study consisting of serial testing of 53 patients with acute cervical SCI was conducted. International Standards of Neurological Classification of Spinal Cord Injury, Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP), Capabilities of Upper Extremity (CUE-Q) Questionnaire, and Spinal Cord Independence Measure III (SCIM-III) were administered at 0–10 days, 1, 3, 6, and 12 months.AnalysisChange over time was plotted using mean and standard deviation of the total and subgroups of the sample.ResultsIndividuals with traumatic tetraplegia show distinct patterns of recovery. Factors that distinguish homogeneous subgroups of the sample are: severity of injury (level of injury, completeness) at baseline and conversion from a complete to an incomplete injury.ConclusionsIn cervical SCI, clinical recovery can be assessed using standardized measures that distinguish levels of activity and impairment. Specific recovery profiles of the upper limb over the 1-year timecourse provide new insights and opportunity for combined analysis of recovery profiles for different clinical assessment tools of upper limb function which are meaningful to inform the design of study protocols.

Target organ profiles in toxicity studies supporting human dosing: An assessment of recovery and chronic dosing

We have previously reported the profile of toxic effects with respect to target organs (defined as organs showing histopathological changes) observed in rodent and non-rodent toxicity studies conducted prior to first time in man (FTIM) for 77 AstraZeneca candidate drugs (CDs) across a range of therapy areas. The main objectives of the current study were twofold; to determine which target organs observed in the FTIM studies recovered after a dose free recovery period and to determine which additional target organs were observed in subsequent chronic (⩾3month) studies required to support longer term clinical dosing. The analysis showed that ⩾86% of findings in studies supporting FTIM either fully or partially resolved at the end of the recovery period, with profiles of recovery that were similar whether the CD progressed into man or not and across different therapy areas. Compared to observations in FTIM studies, chronic studies identified toxicities in an additional 39% of target organs. Overall these data demonstrate that chronic studies in both rodents and non-rodents provide valuable information for the risk assessment for longer term dosing in humans. In addition, the high levels of recovery demonstrated in this analysis suggest that inclusion of recovery assessments on FTIM studies should be on a case-by-case basis driven by a positive indication of need. This is in line with ICH non-clinical guidance that states that reversibility of severe nonclinical toxicities of potential clinic relevance should be assessed ‘when appropriate’, but that the evaluation can be based on a study of reversibility or on a scientific assessment.

Wechsler Adult Intelligence Scale–Third Edition profiles and their relationship to self-reported outcome following traumatic brain injury

Neuropsychological assessments of outcome after traumatic brain injury (TBI) are often unrelated to self-reported problems after TBI. The current study cluster-analyzed the Wechsler Adult Intelligence Scale–Third Edition (WAIS–III) subtest scores from mild, moderate, and severe TBI (n = 220) and orthopedic injury control (n = 95) groups, to determine whether specific cognitive profiles are related to people’s perceived outcomes after TBI. A two-stage cluster analysis produced 4- and 6-cluster solutions, with the 6-cluster solution better capturing subtle variations in cognitive functioning. The 6 clusters differed in the levels and profiles of cognitive performance, self-reported recovery, and education and injury severity. The findings suggest that subtle cognitive impairments after TBI should be interpreted in conjunction with patient’s self-reported problems.