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Silje Zink,1,2 Ingvild Kjeken,1,2 Marte Feiring1,2 1Diakonhjemmet Hospital, REMEDY Center for Treatment of Rheumatic and Musculoskeletal Diseases, Health Service Research and Innovation Unit, Oslo, Norway; 2Faculty of Health Sciences, Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, NorwayCorrespondence: Silje Zink, Diakonhjemmet Hospital, REMEDY Center for Treatment of Rheumatic and Musculoskeletal Diseases, Health Service Research and Innovation Unit, Postboks 23 Vinderen, Oslo, 0319, Norway, Email silje.zink@diakonsyk.noPurpose: The pressure on professionals within the healthcare workforce is increasing due to staffing shortages, economic demands and changing care models. Through boundary work theories, our study explores how task-shifting in hand osteoarthritis (OA) care impacts the professional boundaries and division of labor between rheumatologists and occupational therapists (OTs) in Norwegian specialist healthcare.Methodology: Seventeen semi-structured qualitative interviews were conducted at two hospitals in Norway. Participants included ten rheumatologists and five OTs. Data were analyzed using reflexive thematic analysis.Results: The analysis resulted in three themes (1) Forms of responsibility and task transfers, (2) Circumventing the rules to ensure efficient practices and appropriate patient care, (3) Broadening and specializing; movement of professional demarcations. Overall, we found that medical tasks in hand OA care are increasingly delegated to, and adopted by, OTs, blurring the rheumatologist-OT boundary. Some of the task delegations skirted Norwegian legal boundaries, in efforts to streamline clinic operations. OTs expanded their scope of practice by adopting new tasks, whereas rheumatologist increased their specialist status by shedding unwanted tasks.Conclusion: Task shifting between rheumatologists and OTs in hand OA care was characterized by boundary blurring activities. The results support a shift in hand OA management from rheumatologists to OTs.Keywords: professional boundaries, boundary work, interprofessional collaboration, hand osteoarthritis

Kenneth Sall,1 Gary N Foulks,2 Andrew D Pucker,1 Karen L Ice,1 Richard C Zink,1 George Magrath1 1Lexitas Pharma Services, Inc, Durham, NC, USA; 2University of Louisville (Retired), Louisville, KY, USACorrespondence: Kenneth Sall, Lexitas Pharma Services, Inc, 313 Foster St, Durham, NC, 27701, USA, Tel +1 919 205-0012, Email drsall@sallresearch.comPurpose: Validation of the novel Lexitas modified NEI scale for use in assessment of corneal fluorescein staining.Patients and Methods: A series of 18 illustrations and 14 clinical photographs depicting varying severity levels of corneal fluorescein staining were assessed by 3 independent examiners. Regions of the cornea were graded for staining severity based on 3 different grading scales: the original NEI staining scale (density-based scoring; 0– 3 scale), a structured version of the NEI scale (dot-count scoring; 0– 3 scale), and the Lexitas modified NEI staining scale (0– 4 scale with half-point increments). Kappa statistics (simple and weighted) were computed to determine intra-examiner image grading repeatability for each examiner over 2 separate assessments. Inter-examiner assessment reliability utilized the scores from the first read of each examiner, and pairs of examiners to compute kappa statistics.Results: Data was analyzed from the scores provided by the examiners from each gradable corneal region on 32 images (18 illustrations and 14 photographs) for a total of 154 corneal regions across the 3 grading scales for each validation run. The mean intra-examiner simple/weighted kappa values using the NEI density, NEI dot count, and the Lexitas modified NEI staining scales were 0.67/0.72, 0.91/0.94, 0.80/0.92 for the graded illustrations, and 0.83/0.88, 0.76/0.85, 0.77/0.88 for the graded photographs, respectively. The mean inter-examiner simple/weighted kappa values using the NEI density, NEI dot count, and the Lexitas modified NEI staining scales were 0.59/0.65, 0.86/0.90, and 0.78/0.91 for the graded illustrations, and 0.80/0.88, 0.84/0.89, 0.69/0.88 for the graded photographs, respectively.Conclusion: The expanded scale of the Lexitas modified NEI staining scale demonstrated a high degree of reliability and repeatability of grading assessments within and across individual examiners, comparing favorably with the original NEI staining scale. A future investigation into the in-office utility of the Lexitas modified NEI staining scale is warranted.Keywords: clinical trials, corneal sodium fluorescein staining, dry eye disease, repeatability, validation

School-based mental health professionals, including school psychologists, counselors, and social workers are critical to appropriate mental health services to youth in schools. However, the vast majority of states are chronically underserved by these professionals, despite policies that attempt to rectify the shortages. In this paper, we document variation in access to these professionals across the United States, assessing the school- and district-level factors associated with the presence and prevalence of these service providers using the Civil Rights Data Collection from 2017-2018. We analyze these results descriptively and with logistic regression and find evidence of varying degrees of inequity in all three positions with significant factors associated with the prevalence of these professionals. Implications for policy and future research are discussed.

Cristina Domenech,1,2 Adriana Pastore,3 A Carlo Altamura,4 Corrado Bernasconi,5 Ricardo Corral,6 Helio Elkis,7 Jonathan Evans,8 Ashok Malla,9 Francesco Margari,3 Marie-Odile Krebs,10 Anna-Lena Nordstroem,5 Mathias Zink,11 Josep Maria Haro1,2 1Universitat de Barcelona, Barcelona, Spain; 2Parc Sanitari Sant Joan de Déu, CIBERSAM, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; 3Department of Basic Medical Science, Neuroscience and Sense Organs, ‘Policlinico’ Hospital, University of Bari ‘Aldo Moro’, Bari, Italy; 4University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy; 5F. Hoffmann-La Roche Ltd, Basel, Switzerland; 6Fundación para el Estudio y Tratamiento de las Enfermedades Mentales (FETEM), Buenos Aires, Argentina; 7Departamento e Instituto de Psiquiatria – FMUSP, Sao Paulo, Brazil; 8Centre for Academic Mental Health, University of Bristol, Bristol, UK; 9Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada; 10Service Hospitalo Universitaire, Laboratoire de Physiopathologie des Maladies Psychiatriques, Inserm, Université Paris Descartes, Hôpital Sainte-Anne, Paris, France; 11Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany and Regional Clinical Centre, Ansbach, GermanyCorrespondence: Josep Maria HaroParc Sanitari Sant Joan de Déu - Antoni Pujadas, 42 - 08830 Sant Boi de Llobregat, Barcelona, SpainTel +34 93 600 26 85Email jmharo@pssjd.orgBackground: Generic health-related quality of life (HRQoL) scales are increasingly being used to assess the effects of new treatments in schizophrenia. The objective of this study is to better understand the usefulness of generic and condition specific HRQoL scales in schizophrenia by analyzing their correlates.Methods: Data formed part of the Pattern study, an international observational study among 1379 outpatients with schizophrenia. Patients were evaluated with the Mini International Neuropsychiatric Inventory, the Clinical Global Impression-Schizophrenia (CGI-SCH) Scale and the Positive and Negative Syndrome Scale (PANSS) and reported their HRQoL using the Schizophrenia Quality of Life Scale (SQLS), the Short Form-36 (SF-36), and the EuroQol-5 Dimension (EQ-5D). The two summary values of the SF-36 (the Mental Component Score and the Physical Component Score, SF-36 MCS and SF-36 PCS) were calculated.Results: Higher PANSS positive dimension ratings were associated with worse HRQoL for the SQLS, EQ-5D VAS, SF-36 MCS, and SF-36 PCS. Higher PANSS negative dimension ratings were associated with worse HRQoL for the EQ-5D VAS, SF-36 MCS, and SF-36 PCS, but not for the SQLS or the EQ-5D tariff. PANSS depression ratings were associated with lower HRQoL in all the scales. There was a high correlation between the HRQoL scales. However, in patients with more severe cognitive/disorganized PANSS symptoms, the SQLS score was relatively higher than the EQ-5D tariff and SF-36 PCS scores.Conclusion: This study has shown substantial agreement between three HRQoL scales, being either generic or condition specific. This supports the use of generic HRQoL measures in schizophrenia.Clinicaltrials.gov identifier: NCT01634542 (July 6, 2012, retrospectively registered).Keywords: schizophrenia, health-related quality of life, epidemiology, persistent symptoms

Real-world data are crucial to continuously improve the management of patients with rheumatic and musculoskeletal diseases (RMDs). The German RheumaDatenRhePort (RHADAR) registry encompasses a network of rheumatologists and researchers in Germany providing pseudonymized real-world patient data and allowing timely and continuous improvement in the care of RMD patients. The RHADAR modules allow automated anamnesis and adaptive coordination of appointments regarding individual urgency levels. Further modules focus on the collection and integration of electronic patient-reported outcomes in between consultations. The digital RHADAR modules ultimately allow a patient-centered adaptive approach to integrated medical care starting as early as possible in the disease course. Such a closed-loop system consisting of various modules along the whole patient pathway enables comprehensive and timely patient management in an unprecedented manner.

BackgroundInfectious conjunctivitis is contagious and may lead to an outbreak. Prevention systems can help to avoid an outbreak. ObjectiveWe aimed to evaluate if Google search data on conjunctivitis and associated terms can be used to estimate the incidence and if the data can provide an estimation for outbreaks. MethodsWe obtained Google search data over 4 years for the German term for conjunctivitis (“Bindehautentzündung”) and 714 associated terms in 12 selected German cities and Germany as a whole using the Google AdWords Keyword Planner. The search volume from Freiburg was correlated with clinical data from the Freiburg emergency practice (Eye Center University of Freiburg). ResultsThe search volume for the German term for conjunctivitis in Germany as a whole and in the 12 German cities showed a highly uniform seasonal pattern. Cross-correlation between the temporal search frequencies in Germany as a whole and the 12 selected cities was high without any lag. Cross-correlation of the search volume in Freiburg with the frequency of conjunctivitis (International Statistical Classification of Diseases and Related Health Problems [ICD] code group “H10.-”) from the centralized ophthalmologic emergency practice in Freiburg revealed a considerable temporal association, with the emergency practice lagging behind the frequency. Additionally, Pearson correlation between the count of patients per month and the count of searches per month in Freiburg was statistically significant (P=.04). ConclusionsWe observed a close correlation between the Google search volume for the signs and symptoms of conjunctivitis and the frequency of patients with a congruent diagnosis in the Freiburg region. Regional deviations from the nationwide average search volume may therefore indicate a regional outbreak of infectious conjunctivitis.

BackgroundBorreliosis is the most frequently transmitted tick-borne disease in Europe. It is difficult to estimate the incidence of tick bites and associated diseases in the German population due to the lack of an obligation to register across all 16 federal states of Germany. ObjectiveThe aim of this study is to show that Google data can be used to generate general trends of infectious diseases on the basis of borreliosis and tick bites. In addition, the possibility of using Google AdWord data to estimate incidences of infectious diseases, where there is inconsistency in the obligation to notify authorities, is investigated with the perspective to facilitate public health studies. MethodsGoogle AdWords Keyword Planner was used to identify search terms related to ticks and borreliosis in Germany from January 2015 to December 2018. The search volume data from the identified search terms was assessed using Excel version 15.23. In addition, SPSS version 24.0 was used to calculate the correlation between search volumes, registered cases, and temperature. ResultsA total of 1999 tick-related and 542 borreliosis-related search terms were identified, with a total of 209,679,640 Google searches in all 16 German federal states in the period under review. The analysis showed a high correlation between temperature and borreliosis (r=0.88), and temperature and tick bite (r=0.83), and a very high correlation between borreliosis and tick bite (r=0.94). Furthermore, a high to very high correlation between Google searches and registered cases in each federal state was observed (Brandenburg r=0.80, Mecklenburg-West Pomerania r= 0.77, Saxony r= 0.74, and Saxony-Anhalt r=0.90; all P

Anne Postler,1 Andres Luque Ramos,2 Jens Goronzy,1 Klaus-Peter Günther,1 Toni Lange,3 Jochen Schmitt,3 Angela Zink,4 Falk Hoffmann2 1University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany; 2Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Germany; 3Center for Evidence Based Healthcare, Medical Faculty, Technische Universität Dresden, Dresden, Germany; 4Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany Objective: Osteoarthritis (OA) is highly prevalent throughout the world, especially in the elderly population, and is strongly associated with patients’ frailty. However, little is known about the prevalence and treatment of OA in elderly patients in routine clinical care in Germany.Materials and methods: As a part of Linking Patient-Reported Outcomes with CLAIms Data for Health Services Research in Rheumatology (PROCLAIR), a cross-sectional study using claims data from a large Germany statutory health insurance (BARMER) was conducted. We included people aged 60 years or older and assessed the prevalence of OA of the hip or knee, defined as having outpatient diagnoses (ICD: M16 or M17) in at least two quarters of 2014. The use of conservative treatment, including analgesics and physical therapy, and total joint replacement was studied. Analyses were stratified by age, sex, comorbidities, and level of care dependency defined by social law.Results: A total of 595,754 patients (mean age: 74.9 years; 69.8% female) were diagnosed with OA (21.8%), with the highest prevalence in those between 80 and 89 years (31.0%) and in females compared to males (23.9% vs 18.3%). Prevalence decreased with increasing level of care dependency from 30.5% in patients with a low level (0/1) to 18.7% in the highest level of care dependency. A total of 63.4% of the patients with OA received analgesics, with higher use with increasing age. Physical therapy was prescribed to 43.1% of the patients, but use decreased with age. In all, 5.3% of the patients received total joint replacement in 2014.Conclusion: The lower frequency of coded OA with increasing level of care dependency may reflect underdiagnosis, and patients with many other medical problems seem to be at risk for inadequate recognition and treatment of their OA. Keywords: osteoarthritis, total joint replacement, health services research, aged, analgesics, frail elderly

Johanna Boretzki,1,2 Eva Wolf,3 Carmen Wiese,4 Sebastian Noe,4 Annamaria Balogh,3 Anja Meurer,5 Ivanka Krznaric,6 Alexander Zink,7 Christian Lersch,1 Christoph D Spinner1,2 1Department of Medicine II, University Hospital Klinikum rechts der Isar, Munich, 2German Center for Infection Research, Partner Site Munich, 3MUC Research, Munich, 4MVZ Karlsplatz, HIV Clinical Care Center, Munich, 5Center for Infectiology and Internal Medicine, Munich, 6Center for Infectiology Prenzlauer Berg, Berlin, 7Department of Dermatology and Allergology, University Hospital Klinikum rechts der Isar, Munich, Germany Background: Reasons for and frequency of nonadherence to antiretroviral therapy (ART) may have changed due to pharmacological improvements. In addition, the importance of known non-pharmacologic reasons for nonadherence is unclear.Methods: We performed a cross-sectional, noninterventional, multicenter study to identify current reasons for nonadherence. Patients were categorized by physicians into the following adherence groups: good, unstable, or poor adherence. Co-variables of interest included age, sex, time since HIV diagnosis, ART duration, current ART regimen, HIV transmission route, comorbidity, HIV-1 RNA viral load (VL), and CD4 cell count. Patients self-reported the number of missed doses and provided their specific reasons for nonadherent behavior. Statistical analyses were performed using Fisher’s extended exact test, Kruskal–Wallis test, and logistic regression models.Results: Our study assessed 215 participants with good (n=162), unstable (n=36), and poor adherence (n=17). Compared to patients with good adherence, patients with unstable and poor adherence reported more often to have missed at least one dose during the last week (good 11% vs unstable 47% vs poor 63%, p

Primary care is the backbone of many health care systems around the world. (1) With 15 years of experience in primary care, 6 of those as a family physician, and [...], Providing care for families under occupation has always been marked by scarce resources and too many patients. The current war in Gaza has dramatically worsened conditions in the Occupied Territories of Palestine (OTP). A family physician and her team in the southern West Bank describe their own challenges and give voice to the physicians in the OTP they interviewed to better understand the professional and personal challenges of living and working during the uncertainty of war.

As patients become increasingly involved in their medical care, physician-patient communication gains importance. A previous study showed that physician self-disclosure (SD) of personal information by primary care providers decreased patient rating of the provider communication skills. The objective of this study was to explore the incidence and impact of emergency department (ED) provider self-disclosure on patients’ rating of provider communication skills. A survey was administered to 520 adult patients or parents of pediatric patients in a large tertiary care ED during the summer of 2014. The instrument asked patients whether the provider self-disclosed and subsequently asked patients to rate providers’ communication skills. We compared patients’ ratings of communication measurements between encounters where self-disclosure occurred to those where it did not. Patients reported provider SD in 18.9% of interactions. Provider SD was associated with more positive patient perception of provider communication skills (p

Female faculty remain a minority in academic research and women are often perceived to lack the qualities needed to be successful scientists, which may contribute to discrimination and prejudice against female researchers. Research administrators play a pivotal role in the development of strategic, catalytic, and capacity-building activities designed to encourage faculty in attracting extramural research funding. The purpose of this investigation was to explore whether research administrators evaluate extramural grant applicants differently based on gender and different career ranks. Contrary to previous research examining faculty gender biases and stereotypes, our study showed that applicants were rated similarly in researcher competence across both male and female applicants by research administrators (Hypothesis 1). Our research also showed that female candidates were generally seen as more likeable (researcher collegiality) and were rated higher for mentoring potential than male candidates (Hypothesis 2). Furthermore, consistent with prior research, findings suggest that those in the senior career rank were more highly rated for research competence and skill (Hypothesis 3). Although we did not list a formal hypothesis, our findings did support the notion that senior career rank applicants are more highly rated for biosketch design and comprehension, most likely due to their perceived competence and advanced experience. These findings, while preliminary, suggest that traditional barriers related to perceived female researcher competence are not experienced as they interact with research administrators. The main implication of this study is that research administrators do not appear to significantly contribute to the previously reported discrimination and prejudice against the competence of female researchers.

Single-case design (SCD) is a quantitative experimental technique in which participants serve as their own control. The use of an effect size in SCD allows evaluation of outcomes as well as comparison of outcomes via meta-analyses. Characteristics of SCD research make the selection of an appropriate effect size complicated. Additionally, there are a number of factors that complicate the use of SCDs as a means to improve academic skills. The purpose of this study was to examine patterns by which SCD effect sizes are used to quantify outcomes from academic interventions. To do so, a descriptive analysis of an extant database of SCD studies was conducted. The authors created frequency tables for each effect size identified in the database as well as graphs to show the extent to which the use of effect sizes changed over time. The authors also determined whether the most frequently used effect sizes were appropriate for summarizing changes in academic outcomes. Although many effect sizes have been developed, only a small number are routinely used in SCD research for academic skills. The most frequently used effect sizes were those that come from standardized statistics, compared with those that utilized principles of regression or Bayesian analysis.

BackgroundTo address the limitations of the retrospective self-reports of activity, such as its susceptibility to recall bias, researchers have shifted toward collecting real-time activity data on mobile devices via ecological momentary assessment (EMA). Although EMA is becoming increasingly common, it is not known how EMA self-reports of physical activity and sedentary behaviors relate to the objective measures of activity or whether there are factors that may influence the strength of association between these two measures. Understanding the relationship between EMA and accelerometry can optimize future instrument selection in studies assessing activity and health outcomes. ObjectiveThe aim of this study was to examine the associations between EMA-reported sports or exercise using the accelerometer-measured moderate-to-vigorous physical activity (MVPA) and EMA-reported TV, videos, or video games with the accelerometer-measured sedentary time (ST) in children during matched 2-h windows and test potential moderators. MethodsChildren (N=192; mean age 9.6 years; 94/192, 49.0% male; 104/192, 54.2% Hispanic; and 73/192, 38.0% overweight or obese) wore an accelerometer and completed up to 7 EMA prompts per day for 8 days during nonschool time, reporting on past 2-h sports or exercise and TV, videos, or video games. Multilevel models were used to assess the relationship between the accelerometer-measured ST and EMA-reported TV, videos, or video games. Given the zero-inflated distribution of MVPA, 2-part models were used assess the relationship between the accelerometer-measured MVPA and EMA-reported sports or exercise. ResultsEMA-reported TV, videos, or video games were associated with a greater accelerometer-measured ST (beta=7.3, 95% CI 5.5 to 9.0, P

Background: Human-animal interactions in human services are on the rise, with an increased focus on the welfare of animals involved as well as on client safety. Based on scientifically based training methods, it has been proposed that horses involved in therapy settings could benefit from learning proactive strategies to reduce stress. One possible strategy is audible exhale communication (AEC). Inviting horses to actively use this strategy with humans could enhance the welfare of horses in equine-assisted therapy (EAT), thereby increasing client safety., Methods: A pilot project was conducted to test the feasibility of training 20 therapy horses to use AEC as a veto signal for an activity, while therapists responded to the signals. The number of audible exhales from the horses was compared between the initial and final training sessions. Furthermore, we tested whether age, years of training experience, and therapy experience served as moderating variables for the outcome. Additionally, qualitative observations were made by therapists working with the horses., Results: It has become apparent that training the horses to use AEC was successful. After 6 months of training, the horses showed a significantly higher number of audible exhales than in the initial training session, with a large effect size. Neither age nor years of training or therapy experience was found to be a moderating variable. The horses were eagerly engaged with newly acquired tools. These showed fewer indications of stress, greater sense of relaxation, and more positive emotions., Conclusion: Based on the findings of this pilot study, training horses to use AEC might be a feasible approach to reduce stress in horses working in therapeutic settings, increase client safety, enhance human-animal relationships, and open up new possibilities for improving the therapeutic process. This method is applicable to all horses, regardless of their age, training level, or experience in therapy. For future research, it would be interesting to replicate and extend the approach by addressing the aforementioned limitations and using a randomized controlled design to investigate the introduction and impact of AEC in a therapeutic setting and to gain more comprehensive insights.

Purpose: Individuals with proximal 16p11.2 copy number variants (CNVs), either deletions (16p11.2DS) or duplications (16p11.2Dup), are predisposed to neurodevelopmental difficulties and disorders, such as language disorders, intellectual disability, and autism spectrum disorder. The purpose of the current study was to characterize language profiles of school-age children with proximal 16p11.2 CNVs, in relation to the normative sample and unaffected siblings of children with 16p11.2DS. Method: Standardized language tests were conducted in 33 school-age children with BP4-BP5 16p11.2 CNVs and eight unaffected siblings of children with 16p11.2DS to evaluate language production and comprehension skills across various language domains. A standardized intelligence test was also administered, and parents completed a standardized questionnaire to assess autistic traits. Language profiles were compared across 16p11.2 CNVs and intrafamilial pairs. The influence of nonverbal intelligence and autistic traits on language outcomes was investigated. Results: No significant differences were found between children with 16p11.2DS and those with 16p11.2Dup, although both groups exhibited significantly poorer language skills compared to the normative sample and unaffected siblings of children with 16p11.2DS. Severe language deficits were identified in 70% of individuals with 16p11.2 CNVs across all language subdomains, with significantly better receptive vocabulary skills than overall receptive language abilities. In children with 16p11.2DS, expressive language deficits were more pronounced than receptive deficits. In contrast, only in children with 16p11.2Dup did nonverbal intelligence influence their language outcomes. Conclusions: The current study contributes to the deeper understanding of language profiles in 16p11.2 CNVs in a clinically ascertained cohort, indicating generalized deficits across multiple language domains, rather than a syndrome-specific pattern targeting specific subdomains. The findings underscore the importance of early diagnosis, targeted therapy, and monitoring of language skills in children with 16p11.2 CNVs.

Salik Hussain1,*, Faris Al-Nsour1,*, Annette B Rice1, Jamie Marshburn1, Zhaoxia Ji2, Jeffery I Zink2, Brenda Yingling1, Nigel J Walker3, Stavros Garantziotis11Clinical Research Unit, National Institute of Environmental Health Sciences/National Institute of Health, Research Triangle Park, NC, 2UC Center for Environmental Implications of Nanotechnology University of California, Los Angeles, CA, 3Division of National Toxicology Program, National Institute of Environmental Health Sciences/National Institute of Health, Research Triangle Park, NC, USA*Both are principal authorsBackground: Cerium dioxide (CeO2) nanoparticles have potential therapeutic applications and are widely used for industrial purposes. However, the effects of these nanoparticles on primary human cells are largely unknown. The ability of nanoparticles to exacerbate pre-existing inflammatory disorders is not well documented for engineered nanoparticles, and is certainly lacking for CeO2 nanoparticles. We investigated the inflammation-modulating effects of CeO2 nanoparticles at noncytotoxic concentrations in human peripheral blood monocytes.Methods: CD14+ cells were isolated from peripheral blood samples of human volunteers. Cells were exposed to either 0.5 or 1 µg/mL of CeO2 nanoparticles over a period of 24 or 48 hours with or without lipopolysaccharide (10 ng/mL) prestimulation. Modulation of the inflammatory response was studied by measuring secreted tumor necrosis factor-alpha, interleukin-1beta, macrophage chemotactic protein-1, interferon-gamma, and interferon gamma-induced protein 10.Results: CeO2 nanoparticle suspensions were thoroughly characterized using dynamic light scattering analysis (194 nm hydrodynamic diameter), zeta potential analysis (-14 mV), and transmission electron microscopy (irregular-shaped particles). Transmission electron microscopy of CD14+ cells exposed to CeO2 nanoparticles revealed that these nanoparticles were efficiently internalized by monocytes and were found either in vesicles or free in the cytoplasm. However, no significant differences in secreted cytokine profiles were observed between CeO2 nanoparticle-treated cells and control cells at noncytotoxic doses. No significant effects of CeO2 nanoparticle exposure subsequent to lipopolysaccharide priming was observed on cytokine secretion. Moreover, no significant difference in lipopolysaccharide-induced cytokine production was observed after exposure to CeO2 nanoparticles followed by lipopolysaccharide exposure.Conclusion: CeO2 nanoparticles at noncytotoxic concentrations neither modulate pre-existing inflammation nor prime for subsequent exposure to lipopolysaccharides in human monocytes from healthy subjects.Keywords: cerium dioxide, nanoparticle, nanomedicine, inflammation, human monocyte, lipopolysaccharides