Search

Purpose: To arrive at a consensus of best practices currently employed by sports neuropsychologists regarding specific criteria for determining concussion recovery. Methods: A survey was sent to 120 sports neuropsychologists listed in a public membership directory of the Sports Neuropsychology Society. The survey included demographic, Likert-style, and multiple-choice questions regarding the importance of given criteria in determining concussion recovery for youth (up to age 18) or adult (18+ years). Results: A sample of 22 participants (95% White, 59% male, 68% working with youth and adults, 45% seeing ≥50 patients yearly, 86% ≥10 years of experience) was obtained. The two highest rated criteria for youth and adults were: 1) symptom-free with exercise, and 2) back to work/school without symptoms or accommodations. The two lowest rated criteria were: 1) physician exam without concerns, and 2) opinions from another healthcare professional. Of those who treat adults, 71% reported 1 week symptom free is sufficient. For youth, 63% rated ≥1 week, 31% rated 2–3 weeks, and 6% rated ≥1 month is preferred. Conclusions: Most respondents have worked with youth and adult athletes for at least 10 years. Responses were mostly consistent regarding importance of the various surveyed criteria. There may be a tendency to wait for longer symptom-free periods for youth. Interestingly, the opinions of another health care professional or physician were less important than all other criteria in the survey. The two most important criteria appear to be resolution of symptoms during physical exertion and return to functional activities without symptoms or accommodations.

Contains fulltext : 227229.pdf (Publisher’s version ) (Closed access) 1 p.

Despite a growing literature supporting the salutary effects of mindfulness meditation on emotion regulation, the underlying mechanisms linking neural and subjective changes occurring during the actual practice of meditation with emotion regulatory effects observed after meditation remains virtually unexplored. The current study sought to address this gap in knowledge by testing the hypothesis that adoption of internally-directed focused attention, indexed by increased alpha and theta spectral power, during brief open monitoring (OM) mindfulness meditation predicts reduced emotional reactivity, as measured by the late positive potential (LPP). Results revealed that the OM meditation did not produce demonstrable differences in alpha and theta power but did increase self-reported sleepiness relative to controls. Follow-up analyses showed that sleepiness uniquely moderated the effect of meditation on the LPP, such that less sleepiness during meditation, but not the control audio, corresponded to smaller LPPs to negative images. Change in theta, but not alpha power, between meditation and rest was positively correlated with the LPP even after controlling for sleepiness. Although the primary hypothesis was unsupported, the findings demonstrate that phenomenological and neural changes occurring during OM meditation may modulate its subsequent “off-the-cushion” effects on emotional reactivity.

INTRODUCTION: Previous studies have suggested that elevated neutrophils, monocytes, and neutrophil-to-lymphocyte ratio (NLR) may be associated with poor outcomes in intracerebral hemorrhage (ICH). We sought to determine if white blood cell (WBC) types were independently associated with poor outcome in ICH in a large cohort. METHODS: We performed a retrospective study of primary ICH at two academic centers. Cases were identified via ICD-9 code and verified via physician review. We included only those patients with WBC types obtained within 24 hours of ICH onset. RESULTS: We identified 593 patients with primary ICH and WBC differentials in the first 24 hours. Independent factors (OR, 95% CI) associated with 30-day case-fatality were age >80 (2.4 (1.4, 4.2)), p=0.0023; NIHSS greater than median (3.9 (2.4, 6.3)), p

Background Literature describing morbidity and mortality after truncus arteriosus repair is predominated by single-center reports. We created and analyzed a multicenter dataset to identify risk factors for late mortality and right ventricle-to-pulmonary artery (RV-PA) conduit reintervention for this patient population. Methods We retrospectively collected data on children who underwent repair of truncus arteriosus without concomitant arch obstruction at 15 centers between 2009 and 2016. Cox regression survival analysis was conducted to determine risk factors for late mortality, defined as death occurring after hospital discharge and greater than 30 days after operation. Probability of any RV-PA conduit reintervention was analyzed over time using Fine-Gray modeling. Results We reviewed 216 patients with median follow-up of 2.9 years (range, 0.1 to 8.8). Operative mortality occurred in 15 patients (7%). Of the 201 survivors there were 14 (7%) late deaths. DiGeorge syndrome (hazard ratio [HR], 5.4; 95% confidence interval [CI], 1.6 to 17.8) and need for postoperative tracheostomy (HR, 5.9; 95% CI, 1.8 to 19.4) were identified as independent risk factors for late mortality. At least one RV-PA conduit catheterization or surgical reintervention was performed in 109 patients (median time to reintervention, 23 months; range, 0.3 to 93). Risk factors for reintervention included use of pulmonary or aortic homografts versus Contegra (Medtronic, Inc, Minneapolis, MN) bovine jugular vein conduits (HR, 1.9; 95% CI, 1.2 to 3.1) and smaller conduit size (HR per mm/m2, 1.05; 95% CI, 1.03 to 1.08). Conclusions In a multicenter dataset DiGeorge syndrome and need for tracheostomy postoperatively were found to be independent risk factors for late mortality after repair of truncus arteriosus, whereas risk of conduit reintervention was independently influenced by both initial conduit type and size.

Mindfulness is frequently associated with improved attention. However, the nature of the relationship between mindfulness and executive attention, a core function of the attentional system, is surprisingly unclear. Studies employing behavioral measures of executive attention have been equivocal. Although neuroscientific studies have yielded more consistent findings, reporting functional and structural changes in executive attention brain regions, the observed changes in brain activity have not been linked to behavioral performance. The current study aimed to fill these gaps in the literature by examining the extent to which trait mindfulness related to behavioral and neurophysiological (indexed by the stimulus-locked P3) measures of executive attention. Results revealed that higher trait mindfulness was related to less flanker interference on accuracy and reaction time, consistent with enhanced executive attention. Critically, mediational analyses showed that the P3 accounted for the relationship between trait mindfulness and executive attention performance, elucidating a neural mechanism through which mindfulness enhances executive attention.

Mindset refers to a person’s beliefs about the nature of their abilities—whether they believe their ability in a given domain is malleable or fixed. We investigated whether a brief, online intervention could alter ability and non-ability traits, including mindset of intelligence, locus of control, challenge-approach motivation, grit, and performance on cognitive ability tests. Exploratory factor analysis indicated that measures of mindset, grit, and locus of control loaded onto a common self-determination factor, which was independent of a second factor reflecting fluid intelligence and crystallized intelligence. Multilevel modeling further revealed that participants who received a mindset intervention reported more growth mindset, internal locus of control, challenge-approach motivation, and self-determination. The mindset intervention did not alter cognitive ability scores or grittiness.

Background The relationship between obesity and risk of complications described during the 2009 influenza pandemic is poorly defined for seasonal influenza and other viral causes of influenza-like illness (ILI). Methods An observational cohort of hospitalized and outpatient participants with ILI was conducted in six hospitals in Mexico. Nasopharyngeal swabs were tested for influenza and other common respiratory pathogens. Results A total of 4778 participants were enrolled in this study and had complete data. A total of 2053 (43.0%) had severe ILI. Seven hundred and seventy-eight (16.3%) were positive for influenza, 2636 (55.2%) were positive for other viral respiratory pathogens, and 1364 (28.5%) had no respiratory virus isolated. Adults with influenza were more likely to be hospitalized if they were underweight (OR: 5.20), obese (OR: 3.18), or morbidly obese (OR: 18.40) compared to normal-weight adults. Obese adults with H1N1 had a sixfold increase in odds of hospitalization over H3N2 and B (obese OR: 8.96 vs 1.35, morbidly obese OR: 35.13 vs 5.58, respectively) compared to normal-weight adults. In adults with coronavirus, metapneumovirus, parainfluenza, and rhinovirus, participants that were underweight (OR: 4.07) and morbidly obese (OR: 2.78) were more likely to be hospitalized as compared to normal-weight adults. All-cause influenza-like illness had a similar but less pronounced association between underweight or morbidly obesity and hospitalization. Conclusions There is an increased risk of being hospitalized in adult participants that are underweight or morbidly obese, regardless of their viral pathogen status. Having influenza, however, significantly increases the odds of hospitalization in those who are underweight or morbidly obese.

We sought to validate the Vasoactive-Ventilation-Renal score, a novel disease severity index, as a predictor of outcome in a multicenter cohort of neonates who underwent cardiac surgery.Retrospective chart review.Seven tertiary-care referral centers.Neonates defined as age less than or equal to 30 days at the time of cardiac surgery.Ventilation index, Vasoactive-Inotrope Score, serum lactate, and Vasoactive-Ventilation-Renal score were recorded for three postoperative time points: ICU admission, 6 hours, and 12 hours. Peak values, defined as the highest of the three measurements, were also noted. Vasoactive-Ventilation-Renal was calculated as follows: ventilation index + Vasoactive-Inotrope Score + Δ creatinine (change in creatinine from baseline × 10). Primary outcome was prolonged duration of mechanical ventilation, defined as greater than 96 hours. Receiver operative characteristic curves were generated, and abilities of variables to correctly classify prolonged duration of mechanical ventilation were compared using area under the curve values. Multivariable logistic regression modeling was also performed.We reviewed 275 neonates. Median age at surgery was 7 days (25th-75th percentile, 5-12 d), 86 (31%) had single ventricle anatomy, and 183 (67%) were classified as Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Category 4 or 5. Prolonged duration of mechanical ventilation occurred in 89 patients (32%). At each postoperative time point, the area under the curve for prolonged duration of mechanical ventilation was significantly greater for the Vasoactive-Ventilation-Renal score as compared to the ventilation index, Vasoactive-Inotrope Score, and serum lactate, with an area under the curve for peak Vasoactive-Ventilation-Renal score of 0.82 (95% CI, 0.77-0.88). On multivariable analysis, peak Vasoactive-Ventilation-Renal score was independently associated with prolonged duration of mechanical ventilation, odds ratio (per 1 unit increase): 1.08 (95% CI, 1.04-1.12).In this multicenter cohort of neonates who underwent cardiac surgery, the Vasoactive-Ventilation-Renal score was a reliable predictor of postoperative outcome and outperformed more traditional measures of disease complexity and severity.

The feedback negativity (FN) and reward positivity (RewP) are event-related brain potentials (ERPs) that follow the presentation of negative and positive feedback information, respectively, and have become the focus of recent research on psychopathology because of their associations with symptom severity of and risk for depression. We advanced our understanding of these feedback-related ERPs by examining developmental differences, familial transmission, and associations with error-monitoring ERPs. Parents and their children completed parallel, developmentally-tailored guessing and go/no-go tasks while feedback- and error-related ERPs were measured. We found that the Δ FN and RewP amplitudes increased with age and were larger in males than females among the child participants. The RewP also demonstrated familial transmission between fathers and their children. Finally, the FN and RewP were associated with error-related ERPs in children and adults, albeit in different ways. The current findings demonstrate that the FN and RewP have promise as developmentally-sensitive neural markers of reward and action monitoring processes associated with risk for psychopathology.

The aim of the current review is to advance the hypothesis that change in self-referential processing is a key but under-examined mechanism through which mindfulness training confers its therapeutic benefits for individuals with internalizing disorders. Consequently, we integrated neuroscientific studies on aberrant self-referential processing in internalizing disorders with contemplative science scholarship examining the effects of mindfulness training on the self-referential system. Reviewing these literatures yielded four major conclusions: (1) internalizing disorders can be characterized by excessive self-referential processing and emotion dysregulation; (2) mindfulness training has moderate effects on reducing internalizing symptoms; (3) mindfulness training promotes the shifting from narrative self-focus to present-centered experiential awareness; (4) such mindfulness-induced changes in self-reference is accompanied by reduced activation in overactive self-referential brain regions that have been implicated in internalizing disorders. Clinical and research implications related to delineating the role of self-referential processing in producing the therapeutic effects of mindfulness training are discussed.

Objective To compare intraoperative and 1-hour postoperative outcomes in caudal vs dorsal penile nerve block (DPNB) patients undergoing penile surgeries. Materials and Methods We performed a retrospective cohort study of boys 3. Secondary outcomes were intraoperative-postanesthesia care unit (PACU) narcotics, preincision anesthesia time, adjusted operating room charges, and complications. We performed bivariate and multivariable analyses controlling for demographic and procedural characteristics and clustering by surgeon. Results Of 738 patients (mean age 2.1 years), 74.1% had a caudal block. DPNB patients were more likely to have a maximum pain score of >3 (19.5% vs 8.1%, P 3 (95% confidence interval 1.7-4.4, P Conclusion Caudal blocks may offer a small advantage in the immediate postoperative period, although cost-effectiveness is unproven.

OBJECTIVES To determine the validity of the Bedside Pediatric Early Warning Score system in the hematopoietic cell transplant population, and to determine if the addition of weight gain further strengthens the association with need for PICU admission. DESIGN Retrospective cohort study of pediatric allogeneic hematopoietic cell transplant patients from 2009 to 2016. Daily Pediatric Early Warning Score and weights were collected during hospitalization. Logistic regression was used to identify associations between maximum Pediatric Early Warning Score or Pediatric Early Warning Score plus weight gain and the need for PICU intervention. The primary outcome was need for PICU intervention; secondary outcomes included mortality and intubation. SETTING A large quaternary free-standing children's hospital. PATIENTS One-hundred two pediatric allogeneic hematopoietic cell transplant recipients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of the 102 hematopoietic cell transplant patients included in the study, 29 were admitted to the PICU. The median peak Pediatric Early Warning Score was 11 (interquartile range, 8-13) in the PICU admission cohort, compared with 4 (interquartile range, 3-5) in the cohort without a PICU admission (p < 0.0001). Pediatric Early Warning Score greater than or equal to 8 had a sensitivity of 76% and a specificity of 90%. The area under the receiver operating characteristics curve was 0.83. There was a high negative predictive value at this Pediatric Early Warning Score of 90%. When Pediatric Early Warning Score greater than or equal to 8 and weight gain greater than or equal to 7% were compared together, the area under the receiver operating characteristic curve increased to 0.88. CONCLUSIONS In this study, a Pediatric Early Warning Score greater than or equal to 8 was associated with PICU admission, having a moderately high sensitivity and high specificity. This study adds to literature supporting Pediatric Early Warning Score monitoring for hematopoietic cell transplant patients. Combining weight gain with Pediatric Early Warning Score improved the discriminative ability of the model to predict the need for critical care, suggesting that incorporation of weight gain into Pediatric Early Warning Score may be beneficial for monitoring of hematopoietic cell transplant patients.

PurposeDifferent lengths of collaboration with colleagues at work is a central feature of modern working life, and even more so in a work environment that is increasingly project focused and knowledge-intensive. Despite its practical importance, there is little research on how the perceived costs and benefits in an information-sharing dilemma might change depending on collaboration length. Based on a social dilemma framework, it is hypothesised that anticipated length of collaboration time will significantly influence the motivation to collaborate.Design/methodology/approachAn experimental scenario study (N= 87) compared the willingness to work collaboratively, share information and help the partner in a long-term (two academic terms) vs a short-term (one week) condition.FindingsAt first somewhat counter-intuitively, participants were more helpful in the short-term, and insisted more on equality and disengaged more from a defecting partner – but not the project – in the long-term condition. People appear to focus more on the immediate task in short-term collaborations – even at cost – because the outcome is more important than the relationship, and more on setting norms for equality and reciprocity in long-term collaborations to avoid future exploitation.Practical implicationsThe findings help understanding the motivation and the partner and task perception under different time conditions and support managing teams in an increasingly project-oriented work environment with changing partners and varying time frames.OriginalityTo the authors’ knowledge, this is the first paper investigating the influence of anticipated collaboration time in information-sharing dilemmas.

Background As adolescents gain autonomy, it remains important for parents to be involved with diabetes management to avoid deterioration in glycemic control. Technologies for self-monitoring of blood glucose (SMBG) allow for remote monitoring in real-time by parents. This research compared 3 strategies for improving SMBG and diabetes self-care in the short-term. These strategies were: (1) health information technology (HIT)-enhanced blood glucose meter that shared blood glucose data among patients, their parent, and care providers, and allowed for text messaging; (2) family-centered goal setting; and (3) a combination of (1) and (2). Methods One hundred twenty-eight participants enrolled; 97 adolescent-parent pairs attended clinic at 3-month intervals during the 6-month intervention. Differences between treatment groups were evaluated using analysis of variance (ANOVAs) for continuous variables and χ2 tests for frequencies. Within patient changes were evaluated using paired t tests. Results Participants in the HIT-enhanced SMBG group had no change in mean glycosylated hemoglobin (HbA1c). Participants assigned to family-centered goal setting had a non-significant decrease in HbA1c of −0.3% (P = .26) from baseline to 6 months. Participants in the combined approach had a significant decrease in HbA1c of −0.6% (P = .02) from baseline to 3 months, but the decrease of −0.4% at 6 months was non-significant (P = .51). The change in HbA1c from baseline to 3 months was greater for the combined approach than for the HIT-enhanced SMBG (P = .05) or family-centered goal setting (P = .01). Conclusions Our data suggest that utilizing the family-centered goal setting strategy when implementing HIT-enhanced diabetes technology deserves further study.

Background Mexican immigrants in the United States suffer from poor oral health. The objective of the current study was to explore the utility of applying theory-based factors associated with seeking preventive dental care in a sample of Mexican American adults. Methods Data were collected from a cross-sectional survey of a sample of 157 people of Mexican origin (64% female; age 34 ± 11 years) recruited primarily from church congregations and lay community organizations in Central Indiana. Using the Integrative Model of Behavioral Prediction as the guiding framework, structural equation modeling was used to test factors associated with intention to seek preventive dental care. Results Attitude towards seeking preventive dental care (estimate = 0.37; p

Commercial ships inadvertently transfer vast numbers of living organisms beyond their evolutionary ranges, sometimes resulting in invasions of distant marine habitats. Biofouling on ship hulls translocate organisms that cling to the undersides and interstices of ships that function as hard substrate habitat for biota. Because biofouling accumulates over space and time continually, it poses risk to all ports visited. To better understand the potential magnitude of the biofouling vector in the United States, we compiled information on ship-specific dimensions as well as actual arrival histories of the fleets of ships calling at U.S. ports (2011–2014) in an effort to calculate wetted surface area (WSA) flux to the U.S. The annual mean flux of WSA from overseas bioregions to the U.S. is 333 km2 year−1. An additional 177 km2 year−1 of WSA moves among the eight distinct biogeographic regions of the lower 48 United States. We confirm that over 90% of all global marine bioregions (120 of 132 identified by IUCN) are visited by commercial ships within five port calls of arriving to the U.S. Our analysis is the first ever to quantify the extent of WSA flux among global marine bioregions and underscores the urgent need for management approaches and technologies that will reduce associated invasion risks.

An important subgroup of people who inject drugs (PWID) receiving opioid agonist therapy (OAT) cannot be treated in the setting of a hepatology centre and would not regularly ingest their medication when handed to them for self-administration. Our hypothesis was that chronic hepatitis C in these patients could be ideally managed if modern, interferon-free regimens were administered together with OAT under direct observation of a physician or nurse at a low-threshold facility. In this open-label, noninterventional, proof-of-concept study (ClinicalTrials.gov number, NCT02638233), 40 PWID at risk of nonadherence to direct-acting antivirals (DAA) and previously untreated chronic hepatitis C virus genotype 1 infection without cirrhosis were treated with ledipasvir/sofosbuvir for 8 weeks. Patients received antiviral treatment together with OAT under direct observation of a physician or nurse at a low-threshold facility. By following the concept of directly observed therapy, excellent adherence to antiviral therapy was achieved as follows: only 0.16% (95% CI: 0.03-0.47) of scheduled dates for ingestion of the antiviral therapy in combination with OAT were missed by the 40 patients. The rate of sustained virological response 12 weeks after end of therapy was 100% (95% CI: 91.2-100.0). Between week 12 and week 24 of follow-up reinfections were recorded in 2 of 40 patients (5%). Directly observed therapy of chronic hepatitis C is highly effective in PWID at risk of nonadherence to DAA. By this new concept, a group of difficult-to-treat patients can be cured, who could not have been treated in settings of studies published so far.

INTRODUCTION: The effectiveness of high-frequency oscillatory ventilation (HFOV) in the pediatric hematopoietic cell transplant patient has not been established. We sought to identify current practice patterns of HFOV, investigate parameters during HFOV and their association with mortality, and compare the use of HFOV to conventional mechanical ventilation in severe pediatric ARDS. METHODS: This is a retrospective analysis of a multi-center database of pediatric and young adult allogeneic hematopoietic cell transplant subjects requiring invasive mechanical ventilation for critical illness from 2009 through 2014. Twelve United States pediatric centers contributed data. Continuous variables were compared using a Wilcoxon rank-sum test or a Kruskal-Wallis analysis. For categorical variables, univariate analysis with logistic regression was performed. RESULTS: The database contains 222 patients, of which 85 subjects were managed with HFOV. Of this HFOV cohort, the overall pediatric ICU survival was 23.5% (n = 20). HFOV survivors were transitioned to HFOV at a lower oxygenation index than nonsurvivors (25.6, interquartile range 21.1–36.8, vs 37.2, interquartile range 26.5–52.2, P = .046). Survivors were transitioned to HFOV earlier in the course of mechanical ventilation, (day 0 vs day 2, P = .002). No subject survived who was transitioned to HFOV after 1 week of invasive mechanical ventilation. We compared subjects with severe pediatric ARDS treated only with conventional mechanical ventilation versus early HFOV (within 2 d of invasive mechanical ventilation) versus late HFOV. There was a trend toward difference in survival (conventional mechanical ventilation 24%, early HFOV 30%, and late HFOV 9%, P = .08). CONCLUSIONS: In this large database of pediatric allogeneic hematopoietic cell transplant subjects who had acute respiratory failure requiring invasive mechanical ventilation for critical illness with severe pediatric ARDS, early use of HFOV was associated with improved survival compared to late implementation of HFOV, and the subjects had outcomes similar to those treated only with conventional mechanical ventilation.

PURPOSE OF REVIEW: I review the literature on the relationship between anxiety and the error-related negativity (ERN), a neurophysiological marker of performance monitoring, across development. I cover the development of the ERN, its functional significance, and its different relationship with anxiety in young children compared to adolescents and adults. RECENT FINDINGS: Contemporary research indicates that the ERN becomes larger with age and shows primary sources in cingulate, frontal, and motor cortices. Functional accounts of the ERN and its relationship with anxiety emphasize either cognitive control or affective mechanisms. Converging evidence across development suggests a reduced ERN characterizes anxious young children whereas an enlarged ERN characterizes older children, adolescents and adults. SUMMARY: The mechanisms involved in the developmental change in the relationship between the ERN and anxiety have important implications for better understanding interactions between cognitive control, anxiety, and motivation across the lifespan. Further research is needed to address extant methodological limitations and make stronger links to related neuroscience findings and theory on the development of anxiety and self-control.

Patients with a history of intravenous drug abuse included in an official opioid substitution program represent an important subgroup of patients with chronic hepatitis C. The objective of this study was to assess the efficacy of and adherence to treatment with peginterferon and ribavirin in Austrian patients on stable opioid substitution therapy (OST). This prospective, multicenter, observational, non-interventional trial (clinicaltrials.gov identifier, NCT01416610) included treatment-naive patients with chronic hepatitis C on OST. Treatment consisted of peginterferon alpha-2a (PEGASYS®, 180 µg/week) plus ribavirin (COPEGUS®, 1000/1200 mg/day in genotypes (GT) 1/4 and 800 mg/day in GT 2/3) for 24–72 weeks, according to GT and viral response. The intention-to-treat (ITT) population comprised 88 patients. Mean duration of therapy was 6.0 ± 2.8 months. Treatment was discontinued earlier than planned in 34 out of 88 patients (39%), mainly because of poor adherence or side effects of treatment. At the end of treatment 65/88 patients (74%) were PCR negative. During follow-up, 5 patients relapsed. Only 44/88 patients (50%) could be evaluated 24 weeks after the end of treatment. Sustained virologic response 24 weeks after end of therapy (SVR24) was documented in 39/88 patients (44%). If only patients were considered who finished treatment as planned and for whom results at follow-up week 24 were available, the SVR24 rate was 89% (32/36). Despite favorable prognostic factors, such as young age and a high proportion of GT3, SVR rates were low in this cohort of patients receiving OST, the main reason being poor adherence; however, in those patients completing treatment, the SVR rate was high.

Groups and organisations set cooperative goals for their members, yet in reality some team members contribute more than others to these goals. Experts, in particular, face a social dilemma: from the group s perspective they should share their knowledge, whereas individually they are better off not sharing, because acquiring knowledge is costly and they would give up a competitive advantage. Two experiments (N1596, N25192) tested the hypothesis, derived from indirect reciprocity theory, that experts contribute more if their status is being recognised. Expert status was manipulated under different performance feedback conditions and the impact on people s contributions in two different knowledge sharing tasks was analysed. In both studies, experts contributed more when feedback was individualised and public, ensuring both individual status rewards and public recognition. In contrast, novices contributed more when performance feedback was collective, regardless of whether it was public or private feedback. Novices did not have to fear negative performance evaluations under group feedback and could gain in social status as members of a successful group. Social value orientation moderated expert contributions in Study 2, with proself-oriented experts being particularly susceptible to reputation gains. The studies contribute to the neglected aspect of motivation in knowledge sharing dilemmas where collective and individual interests are not necessarily aligned. © 2017 International Association of Applied Psychology

We investigated the impact of emotions on learning vocabulary in an unfamiliar language to better understand affective influences in foreign language acquisition. Seventy native English speakers learned new vocabulary in either a negative or a neutral emotional state. Participants also completed two sets of working memory tasks to examine the potential mediating role of working memory. Results revealed that participants exposed to negative stimuli exhibited difficulty in retrieving and correctly pairing English words with Indonesian words, as reflected in a lower performance on the prompted recall tests and the free recall measure. Emotional induction did not change working memory scores from pre to post manipulation. This suggests working memory could not explain the reduced vocabulary learning in the negative group. We argue that negative mood can adversely affect language learning by suppressing aspects of native-language processing and impeding form-meaning mapping with second language words.

Does silently talking to yourself in the third-person constitute a relatively effortless form of self control? We hypothesized that it does under the premise that third-person self-talk leads people to think about the self similar to how they think about others, which provides them with the psychological distance needed to facilitate self control. We tested this prediction by asking participants to reflect on feelings elicited by viewing aversive images (Study 1) and recalling negative autobiographical memories (Study 2) using either “I” or their name while measuring neural activity via ERPs (Study 1) and fMRI (Study 2). Study 1 demonstrated that third-person self-talk reduced an ERP marker of selfreferential emotional reactivity (i.e., late positive potential) within the first second of viewing aversive images without enhancing an ERP marker of cognitive control (i.e., stimulus preceding negativity). Conceptually replicating these results, Study 2 demonstrated that third-person self-talk was linked with reduced levels of activation in an a priori defined fMRI marker of self-referential processing (i.e., medial prefrontal cortex) when participants reflected on negative memories without eliciting increased levels of activity in a priori defined fMRI markers of cognitive control. Together, these results suggest that third-person self-talk may constitute a relatively effortless form of self-control. This research was supported by funds provided by Michigan State University and the National Institutes of Health (HD065879) to JM and both funds provided by the University of Michigan and a grant provided by the John Templeton Foundation (#349798, #348747) to EK.

Beliefs about the malleability of global attributes like personality and intelligence – known as mindsets – are well-established predictors of resilience to challenges in educational contexts. Recent research further suggests that mindsets about anxiety may act in a similar fashion with mental health resilience. In this study we examined whether anxiety mindset would moderate relations between history of stressful life events and psychological distress and coping. Consistent with predictions, relations between number of stressful life events and posttraumatic stress symptoms, depression, substance use, and motivations for non-suicidal self-injury were weaker among those with more of a growth mindset relative to those with more of a fixed mindset. These initial results suggest that anxiety mindsets function in a similar way for mental health resilience as how mindsets of intelligence function for academic outcomes.

Zusammenfassung Hintergrund Die medizinische Versorgung in Pflegeheimen ist in manchen Bereichen unbefriedigend. Zur ärztlichen Koordination für multiprofessionelle Maßnahmen gibt es wenig klare Vorgaben. Es wurde eine systematische Literaturanalyse durchgeführt, inwiefern ärztliche Koordination im Pflegeheim die Lage verbessern kann. Methode In Datenbanken (CINAHL, Medline, PsycInfo, Psyndex) wurde von 2000 – 2014 mit folgenden Schlüsselwörtern gesucht: nursing homes AND nursing home physician OR nursing home doctor OR geriatrics OR gerontologic care OR primary health care AND cooperation OR coordination. Dasselbe wurde dort und in Verlagskatalogen in deutscher Sprache durchgeführt: Pflegeheim ODER Altenheim UND ärztliche Kooperation ODER ärztliche Koordination ODER ärztliche Versorgung. Ergebnisse Von den 537 ersten Treffern wurden in 3 Schritten schließlich 34 als ganze Arbeiten (Projektberichte, systematische Literaturanalysen und Originalarbeiten) analysiert. Die Definitionen und Zugänge zur ärztlichen Koordination sind recht inhomogen. Speziell in den Projektarbeiten zeigte sich, dass multiprofessionelle Arbeit zu besserer Versorgungsqualität, mehr Zufriedenheit im Betreuungsteam und schließlich zu einer Kostenreduktion führen kann. Schlussfolgerungen Unter Mitwirkung einer ärztlichen Koordination hat multiprofessionelle Zusammenarbeit eine positive Wirkung in den Pflegeheimen. Allerdings ist das Berufsbild des Arztes im Pflegeheim inhaltlich und strukturell wenig definiert.

Individuals who believe intelligence is malleable (a growth mindset) are better able to bounce back from failures than those who believe intelligence is immutable. Event-related potential (ERP) studies among adults suggest this resilience is related to increased attention allocation to errors. Whether this mechanism is present among young children remains unknown, however. We therefore evaluated error-monitoring ERPs among 123 school-aged children while they completed a child-friendly go/no-go task. As expected, higher attention allocation to errors (indexed by larger error positivity, Pe) predicted higher post-error accuracy. Moreover, replicating adult work, growth mindset was related to greater attention to mistakes (larger Pe) and higher post-error accuracy. Exploratory moderation analyses revealed that growth mindset increased post-error accuracy for children who did not attend to their errors. Together, these results demonstrate the combined role of growth mindset and neural mechanisms of attention allocation in bouncing back after failure among young children. Keywords: Mindset, Implicit theories of intelligence, Error monitoring, Error positivity, Event-related potential

IntroductionViolence at work is a major concern in healthcare services. Prevention programs have been implemented, albeit being scarce in Italy.Objectives or AimsThe Bolzano psychiatric department adopted a de-escalation model developed by the Institut-für-Professionelles-Deeskalations-Management (ProDeMa®). It includes evaluation, prevention, and practical training aimed at preventing/reducing patients’ aggressive behavior toward healthcare workers.MethodsIn 2015, health professionals were interviewed by using a ProDeMa® 11-item questionnaire that assessed the type and frequency of endured patients’ aggressive behavior, as well as the conditions capable of producing or preventing it. One-way ANOVA with Tukey post-hoc test was used for comparisons.ResultsA total of 165/211 (78%) surveyed workers (mean age ± DE = 44.9 ± 7.7; females = 64.6%) completed the questionnaire, of whom 21% employed at the inpatients unit (INP), 37% at the outpatients unit (OUTP), 42% at the rehabilitation facility (REHAB). The one-year number of verbal aggressions (VA) was 9766, with INP (mean ± SD = 15.2 ± 29.6) vs. OUTP (mean ± SD = 6.2 ± 30.6) vs. REHAB (mean ± SD = 8.4 ± 26.1). The one-year number of physical aggressions (PA) was 1502, with INP (mean ± SD = 3.3 ± 12.2) vs. OUTP (mean ± SD = 0.1 ± 0.5) vs. REHAB (mean ± SD = 0.1 ± 0.7). The one-year number of injuries (IN) was 200, with INP (mean ± SD = 0.5 ± 1.9) vs. OUTP (mean ± SD = 0.1 ± 0.5) vs. REHAB (mean ± SD = 0.1 ± 0.2). ANOVA showed significant differences in terms of mean verbal/physical aggression and injuries among the three workplaces (P-values = 0.000), with post-hoc Tukey test showing a significant difference of INP vs. REHAB and OUTP. The most frequent risk factors identified by the staff for precipitating aggression included rigid rules (15.1%) and inadequate communication (9.1%).ConclusionsThe three types of violence are common in all facilities of our Department.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Background Many CpGs become hyper or hypo-methylated with age. Multiple methods have been developed by Horvath et al. to estimate DNA methylation (DNAm) age including Pan-tissue, Skin & Blood, PhenoAge, and GrimAge. Pan-tissue and Skin & Blood try to estimate chronological age in the normal population whereas PhenoAge and GrimAge use surrogate markers associated with mortality to estimate biological age and its departure from chronological age. Here, we applied Horvath’s four methods to calculate and compare DNAm age in 499 subjects with type 1 diabetes (T1D) from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study using DNAm data measured by Illumina EPIC array in the whole blood. Association of the four DNAm ages with development of diabetic complications including cardiovascular diseases (CVD), nephropathy, retinopathy, and neuropathy, and their risk factors were investigated. Results Pan-tissue and GrimAge were higher whereas Skin & Blood and PhenoAge were lower than chronological age (p < 0.0001). DNAm age was not associated with the risk of CVD or retinopathy over 18–20 years after DNAm measurement. However, higher PhenoAge (β = 0.023, p = 0.007) and GrimAge (β = 0.029, p = 0.002) were associated with higher albumin excretion rate (AER), an indicator of diabetic renal disease, measured over time. GrimAge was also associated with development of both diabetic peripheral neuropathy (OR = 1.07, p = 9.24E−3) and cardiovascular autonomic neuropathy (OR = 1.06, p = 0.011). Both HbA1c (β = 0.38, p = 0.026) and T1D duration (β = 0.01, p = 0.043) were associated with higher PhenoAge. Employment (β = − 1.99, p = 0.045) and leisure time (β = − 0.81, p = 0.022) physical activity were associated with lower Pan-tissue and Skin & Blood, respectively. BMI (β = 0.09, p = 0.048) and current smoking (β = 7.13, p = 9.03E−50) were positively associated with Skin & Blood and GrimAge, respectively. Blood pressure, lipid levels, pulse rate, and alcohol consumption were not associated with DNAm age regardless of the method used. Conclusions Various methods of measuring DNAm age are sub-optimal in detecting people at higher risk of developing diabetic complications although some work better than the others.

There is no denying that the increasing use of the internet by end consumers has presented numerous challenges in the field of marketing research, and more specifically in the field of consumer behavior (Pomirleanu et al., 2013) as evidenced by a growing number of studies (Cummins et al., 2014). Understanding the psychology behind online consumer behavior is key to compete in today's markets which are characterized by ever increasing competition and globalization. In an online context, consumer responses are no longer dependent on the physical environment while at the same time entirely new factors come into play such as the device through which consumers interact, and the way products and services are sold and presented online which often differs significantly from traditional offline marketing strategies. It is for this reason that research into online consumer behavior has increasingly started looking to other disciplines, including psychological approaches and concepts. Several examples of cornerstone reviews highlight this trend. For example, Cummins et al. (2014) observed in their literature review how research on online consumer behavior often uses psychological and social networks theories. The authors found a much greater focus on aspects related to the relationships that consumers develop with companies over the internet and connected to that, the analysis of the attitudes, beliefs and feelings that consumers develop as part of their online experiences, thus moving the relationship from the physical into the virtual sphere. Similarly, Yadav and Pavlou (2014) did a review of marketing literature in computer-mediated environments (CME) and proposed a structured framework around four key interactions in CME to summarize their findings: consumer-firm interactions, firm-consumer interactions, consumer-consumer interactions, and firm-firm interactions. Both reviews support our suggestion that understanding consumer behavior in a digital world relates to important psychological aspects of behavior that are best understood by using psychological concepts and methods. Despite this evidence there are surprisingly still some important avenues of research that have received little attention. One area that we propose is central to understanding online consumer behavior concerns the impact of the different stages of internet evolution, the World Wide Web (WWW). This has received some attention in general management research and from practitioners but there is hardly any research in marketing and consumer behavior. The WWW is omnipresent in business today, and almost all work-related communications and interactions are at least partially supported by digital media (Moser and Axtell, 2013). It has transformed business operations and relations (Benito-Osorio et al., 2013; Kambil, 2008) and it is time to extend this to customer relations and marketing. It is the aim of this article to highlight the importance of studying the impact of the evolution of the WWW on consumer behavior. Especially in the most recent WWW developments, psychological aspects of consumer behavior have gained in importance, namely individual preferences, emotions, and sensory experiences. In order to analyse these transformations, it is important to briefly consider what each stage in the evolution of the WWW has brought about.

A nascent line of research aimed at elucidating the neurocognitive mechanisms of mindfulness has consistently identified a relationship between mindfulness and error monitoring. However, the exact nature of this relationship is unclear, with studies reporting divergent outcomes. The current study sought to clarify the ambiguity by addressing issues related to construct heterogeneity and technical variation in mindfulness training. Specifically, we examined the effects of a brief open monitoring (OM) meditation on neural (error-related negativity (ERN) and error positivity (Pe)) and behavioral indices of error monitoring in one of the largest novice non-meditating samples to date (N = 212). Results revealed that the OM meditation enhanced Pe amplitude relative to active controls but did not modulate the ERN or behavioral performance. Moreover, exploratory analyses yielded no relationships between trait mindfulness and the ERN or Pe across either group. Broadly, our findings suggest that technical variation in scope and object of awareness during mindfulness training may differentially modulate the ERN and Pe. Conceptual and methodological implications pertaining to the operationalization of mindfulness and its training are discussed.

Abstract. There has been an unprecedented increase in the number of research studies employing event-related potential (ERP) techniques to examine dynamic and rapidly occurring neural processes with children during the preschool and early childhood years. Despite this, there has been relatively little discussion of the methodological and procedural differences that exist for studies of young children versus older children and adults. That is, reviewers, editors, and consumers of this work often expect developmental studies to simply apply adult techniques and procedures to younger samples. Procedurally, this creates unrealistic expectations for research paradigms, data collection, and data reduction and analyses. Scientifically, this leads to inappropriate measures and methods that hinder drawing conclusions and advancing theory. Based on ERP work with preschoolers and young children from 10 laboratories across North America, we present a summary of the most common ERP components under study in the area of emotion and cognition in young children along with 13 realistic expectations for data collection and loss, laboratory procedures and paradigms, data processing, ERP averaging, and typical challenges for conducting this type of work. This work is intended to supplement previous guidelines for work with adults and offer insights to aid researchers, reviewers, and editors in the design and evaluation of developmental research using ERPs. Here we make recommendations for researchers who plan to conduct or who are conducting ERP studies in children between ages 2 and 12 years, focusing on studies of toddlers and preschoolers. Recommendations are based on both data and our cumulative experience and include guidelines for laboratory setup, equipment and recording settings, task design, and data processing.

Background Elevated pulmonary vascular resistance (PVR) is common following repair of truncus arteriosus. Inhaled nitric oxide (iNO) is an effective yet costly therapy that is frequently implemented postoperatively to manage elevated PVR. Objectives We aimed to describe practice patterns of iNO use in a multicenter cohort of patients who underwent repair of truncus arteriosus, a lesion in which recovery is often complicated by elevated PVR. We also sought to identify patient and center factors that were more commonly associated with the use of iNO in the postoperative period. Design Retrospective cohort study. Setting 15 tertiary care pediatric referral centers. Patients All infants who underwent definitive repair of truncus arteriosus without aortic arch obstruction between 2009 and 2016. Interventions Descriptive statistics were used to demonstrate practice patterns of iNO use. Bivariate comparisons of characteristics of patients who did and did not receive iNO were performed, followed by multivariable mixed logistic regression analysis using backward elimination to identify independent predictors of iNO use. Main results We reviewed 216 patients who met inclusion criteria, of which 102 (46%) received iNO in the postoperative period: 69 (68%) had iNO started in the operating room and 33 (32%) had iNO initiated in the ICU. Median duration of iNO use was 4 days (range: 1-21 days). In multivariable mixed logistic regression analysis, use of deep hypothermic circulatory arrest (odds ratio: 3.2; 95% confidence interval: 1.2, 8.4) and center (analyzed as a random effect, p = .02) were independently associated with iNO use. Conclusions In this contemporary multicenter study, nearly half of patients who underwent repair of truncus arteriosus received iNO postoperatively. Use of iNO was more dependent on individual center practice rather than patient characteristics. The study suggests a need for collaborative quality initiatives to determine optimal criteria for utilization of this important but expensive therapy.

Cognitive neuroscience research has traditionally overlooked half of the population. Arguing that variability in ovarian hormones confounds empirical findings, girls and women have been excluded from research for decades. But times are changing. This review summarizes historical trends that have led to a knowledge gap in the role of ovarian hormones in neuroscience, synthesizes recent findings on ovarian hormone contributions to cognitive brain structures and function, and highlights areas ripe for future work. This is accomplished by reviewing research that has leveraged natural experiments in humans across the life span that focus on puberty, the menstrual cycle, hormonal contraceptive use, menopause, and menopausal hormone therapy. Although findings must be considered in light of study designs (e.g., sample characteristics and group comparisons versus randomized crossover trials), across natural experiments there is consistent evidence for associations of estradiol with cortical thickness, especially in frontal regions, and hippocampal volumes, as well as with frontal regions during cognitive processing. There are also emerging investigations of resting state connectivity and progesterone along with exciting opportunities for future work, particularly concerning biopsychosocial moderators of and individual differences in effects in novel natural experiments. Thus, delineating complex ovarian hormone contributions to cognitive brain structures and function will advance neuroscience.

The fabrication of 3D ink-printed and sintered porous Si scaffolds as electrode material for lithium-ion batteries is explored. A hierarchically-porous architecture consisting of channels (~220 μm in diameter) between microporous Si struts is created to accommodate the large volume change from Si (de)lithiation during electrochemical (dis)charging. The influence of sintering parameters on Si strut porosity and the resulting mechanical and electrochemical properties of the scaffolds are studied experimentally and computationally. Varying sintering temperatures (1150–1300 °C) and sintering times (1–16 h) the open porosity within the Si filaments can be tailored between 46 and 60%. Pore size (3–6 μm) and wall thickness (3–8 μm) can be adjusted to tailor the surface-to-volume ratio. Computational results show that maximum capacity is expected at ~50% Si strut porosity, balancing short diffusion lengths and sufficient volume of active material. Stress concentrations are reduced at higher filament porosities albeit at the cost of energy density. For a filament porosity of 46%, hierarchically porous Si microlattice electrodes display gravimetric and volumetric capacities as high as 2,990 mA h g−1 and 2,860 mA h cm−3, respectively. The simple 3D printing + sintering approach provides further opportunities for optimization of Si electrodes by geometrical freedom.

Previous research indicates that worry is associated with poorer working memory performance. Moreover, prior work demonstrates that estradiol relates to both worry and working memory performance. In the present study, we sought to further examine interrelations between worry, estradiol and working memory by testing whether estradiol moderates the association between worry and working memory in females. We hypothesized that worry would be associated with poorer working memory performance at higher levels of estradiol. We also conducted exploratory analyses to examine the role of progesterone as a moderator of the association between worry and working memory. Participants were 97 naturally-cycling females who attended four lab sessions across their menstrual cycles. Consistent with predictions, higher average levels of worry were associated with lower working memory accuracy on particularly difficult trials when average levels of estradiol were also high. The same association between higher worry and lower working memory accuracy emerged when average levels of progesterone were high. Findings highlight the importance of considering ovarian hormones in future studies and current theories of anxiety and cognition.

Because self-regulation skills are in development through adolescence, social exclusion can pose significant challenges to the well-being of young people. Thus, an understanding of factors that may ease the self-regulation demands of social exclusion is particularly important. One such factor is aerobic fitness. Using a quasi-experimental within-subject design in a sample of girls (N = 47, 10.4 ± 1.2 years), we examined whether affective and working memory changes following social exclusion differ by level of aerobic fitness. Overall, findings suggest that more aerobically fit girls may better regulate the demands of social exclusion than less aerobically fit girls. Specifically, girls with higher aerobic fitness evidenced smaller decreases in pleasant affect and larger increases in working memory performance following social exclusion than girls with lower aerobic fitness. This research extends understanding of how aerobic fitness may benefit well-being in young people.

Niche areas of ships, such as lateral thruster tunnels, sea chests, and propellers, are often hot spots for the accumulation of biofouling organisms, a potential source of aquatic invasive species. Yet, the relative importance of different niche areas is poorly resolved, in terms of both total surface area and the associated biota (i.e., the species of organisms and their abundances). To address this information gap, a method was developed to estimate the extent of various niche areas in the global fleet of 120,252 commercial ships active between 1999 and 2013. The total niche area for these vessels was estimated to be 32,996 × 103 m2, representing approximately 10% of the total wetted surface area (WSA) available for colonization by biota. Considering the portion of niche areas relative to the total WSA, it was highest for passenger vessels (27%), followed by tugs (25%), and fishing vessels (21%), with niche areas representing a small portion of the WSA for bulk carriers and tankers (7–8%). Examining the different types of niche areas, thruster tunnels had the greatest total extent (10,189 × 103 m2), representing a disproportionately large contribution (>50%) of the total niche area for passenger vessels and tugs compared to other vessel types. This result, combined with the use and cleaning of thrusters, may render them “super-hot spots” of biofouling. The uneven distribution and extent of niche areas across vessels has implications for transfers of organisms and management strategies to reduce invasions associated with the surfaces of ships.

As the rapid assessment of mental health is a growing need, a quick and valid tool for the early detection of symptoms that can be flexibly deployed across a range of contexts may be especially beneficial. This is particularly true of anxiety problems, which when undetected contribute to health care costs and lost work productivity. Data from more than 10,000 respondents (primarily female undergraduates) were used to test whether a single item from the popular Penn State Worry Questionnaire could serve as a screening tool in settings where administration of the full scale is undesirable. Items were evaluated by examining item response theory models, screening capabilities, stability over time, convergence with other anxiety and depression measures, and a response time analysis that assessed how quickly participants responded to each item. Item 15 (“I worry all the time”) emerged as the strongest item: It was the most discriminating and reliable item, had sensitivity and specificity similar to the full scale, had the highest 1-month and 1-year retest coefficients, the highest convergent correlations with measures of anxiety and depression, and was responded to significantly faster than any other item. We suggest that in time-limited contexts, this item is suitable for screening.

Objective: To examine the effects of cola-flavored beverages and caffeine on growth and metabolism of Streptococcus mutans biofilm. This study was designed to determine if carbonated beverages or caffeine can increase S. mutans growth and biofilm formation and metabolic activity in vitro, potentially leading to increased S. mutans-associated cariogenicity in children that consume them. Study Design: Six different cola-flavored products, plus pure caffeine, and pure high fructose corn syrup (HFCS), at different concentrations similar to those in the beverages were tested. A 16-hour culture of S. mutans was treated with different dilutions in bacteriological media. To test for the effect on biofilm formation, the biofilm was stained with crystal violet. The absorbance was determined to evaluate biofilm growth. Biofilm metabolic activity was measured based on biofilm having the ability to reduce XTT to a water-soluble orange compound. Results: The inclusion of HFCS in the beverages, as well as pure HFCS, significantly enhanced bacterial biofilm formation and metabolic activity. Pure caffeine and the presence of caffeine in beverages did not significantly increase biofilm formation, but pure caffeine significantly increased metabolism, and Diet Coke had significantly greater metabolic activity than Caffeine-Free Diet Coke. Conclusions: HFCS increases both the biofilm formation and metabolism of S. mutans, and caffeine in some cases increases metabolism of S. mutans.

Anxiety is consistently associated with hyperactive neural responses to errors. The majority of existing research has focused on a single marker of error-elicited brain activity-the error-related negativity (ERN), an event-related brain potential (ERP) elicited 50-100ms following an erroneous response. The ERN has accumulated growing interest for its use in clinical contexts as a potential biomarker and/or endophenotype. However, it is unknown whether anxiety's effects are specific to brain activity following erroneous responses; anxiety may affect processes prior to error commission, suggesting that the ERN might reflect the output of abnormal processing that begins before an error. Here, we examined the error-preceding positivity (EPP) - an ERP time-locked to the correct response immediately before errors - that reflects a gradual disengagement of task-focused attention preceding errors. Results revealed that female worriers demonstrated significantly attenuated EPP amplitude, indicating reduced pre-error disengagement. Moreover, reduced EPP mediated the relationship between worry and the enhanced ERN following errors. These results suggest that the temporal dynamics of anxiety's impact on error processing are more nuanced than previously thought such that effects emerge prior to the actual occurrence of an erroneous response.

Objective:To characterize the pattern of urine drug screening in a cohort of intracerebral hemorrhage (ICH) patients at our academic centers.Methods:We identified cases of primary ICH occurring from 2009 to 2011 in our academic centers. Demographic data, imaging characteristics, processes of care, and short-term outcomes were ascertained. We performed logistic regression to identify predictors for screening and evaluated preguideline and postguideline reiteration screening patterns.Results:We identified 610 patients with primary ICH in 2009–2011; 379 (62.1%) were initially evaluated at an outside hospital. Overall, 142/610 (23.3%) patients were screened, with 21 positive for cocaine and 3 for amphetamine. Of patients p = 0.0009). In the best multivariable model, age group (p = 0.0001), black race (p = 0.4529), first Glasgow Coma Scale score (p = 0.0492), current smoking (p < 0.0001), and age group × black race (p = 0.0097) were associated with screening. Guideline reiteration in 2010 did not improve the proportion p = 0.01).Conclusions:We found disparities in drugs of abuse (DOA) screening and suboptimal guideline adherence. Systematic efforts to improve screening for DOA are warranted. Improved identification of sympathomimetic exposure may improve etiologic classification and influence decision-making and prognosis counseling.