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Objectives: Implicit bias can affect clinical decisions that influence the care received by patients whose ancestors had been subjected to unfair medical and social practices. However, literature describing the effects of implicit bias training as part of continuing medical and nursing education is scarce. We conducted a longitudinal evaluation of a training for maternal health care clinical and nonclinical staff.Methods: A total of 80 staff members at 2 clinical sites in Cleveland, Ohio, participated in the training and evaluation in 2020 and 2021. We used a mixed-methods evaluation to capture changes in knowledge, awareness of bias, and application of strategies to reduce biased behavior by conducting pre- and posttraining surveys immediately after training and interviews at 3 and 6 months posttraining. We conducted univariate and bivariate analyses of the surveys and recorded, transcribed, and analyzed interviews for themes.Results: Using a threshold of answering 3 of 5 knowledge questions correctly, 50 of 80 (62.5%) trainees who engaged in the evaluation passed the pretraining knowledge questions and 67 (83.8%) passed the posttraining knowledge questions. Of the 80 participants, 75 (93.8%) were women. Interviewees (n = 11) said that low staff-to-patient ratios, lack of racial and ethnic diversity in leadership, inadequate training on implicit bias, and lack of institutional consequences for poor behavior exacerbated bias in maternity care. Interviewees reported having heightened awareness of bias and feeling more empowered after the training to advocate for themselves and patients to prevent and mitigate bias in the hospital.Conclusion: Additional study describing the effect of implicit bias training as part of continuing medical education should be conducted, and administrative and management changes should also be made to prevent bias and improve quality of care.

Objectives: People with disabilities, people experiencing homelessness, and people who have substance use disorders face unique health challenges. Gaps in public health surveillance data limit the identification of public health needs of these groups and data-driven action. This study aimed to identify current practices, challenges, and opportunities for collecting and reporting COVID-19 surveillance data for these populations.Methods: We used a rapid qualitative assessment to explore COVID-19 surveillance capacities. From July through October 2021, we virtually interviewed key informants from the Centers for Disease Control and Prevention, state and local health departments, and health care providers across the United States. We thematically analyzed and contextualized interview notes, peer-reviewed articles, and participant documents using a literature review.Results: We identified themes centered on foundational structural and systems issues that hinder actionable surveillance data for these and other populations that are disproportionately affected by multiple health conditions. Qualitative data analysis of 61 interviews elucidated 4 primary challenges: definitions and policies, resources, data systems, and articulation of the purpose of data collection to these groups. Participants noted the use of multisector partnerships, automated data collection and integration, and data scorecards to circumvent challenges.Conclusions: This study highlights the need for multisector, systematic improvements in surveillance data collection and reporting to advance health equity. Improvements must be buttressed with adequate investment in data infrastructure and promoted through clear communication of how data are used to protect health.

Objectives: State, local, and federal agencies have expanded efforts to address the root causes of overdoses, including health inequity and related social determinants of health. As an Overdose Data to Action (OD2A) technical assistance provider, the Association of State and Territorial Health Officials (ASTHO) conducted the first national needs assessment to understand capacity and technical assistance needs of OD2A jurisdictions in advancing health equity.Methods: ASTHO designed and disseminated the OD2A Recipient Health Equity Needs Assessment (RHENA) to 66 OD2A-funded jurisdictions from February to March 2022. OD2A principal investigators and staff were contacted via email and asked to complete the needs assessment within 6 weeks. One coder manually coded open-ended responses, conducted a thematic analysis on the qualitative data, and performed a simple frequency analysis on the quantitative data.Results: Fifty-two jurisdictions (78.8%) responded, including 36 states, 12 cities/counties, and 2 territories. Most jurisdictions (n = 46; 88.5%) reported having a formal or informal health equity lead in place. Common barriers included a lack of access to data sources (n = 37; 71.2%), lack of partnerships (n = 20; 38.5%), and lack of funding (n = 14; 26.9%). Respondents reported needing more information sharing among jurisdictions and partner organizations, coaching on best practices, and routine discussions such as peer-to-peer learning sessions.Conclusion: Findings suggest that gaps remain in programmatic policies and principles to address inequities in overdose prevention. Results are being used to identify additional technical assistance opportunities, jurisdictional capacity, and approaches to advance health equity.

Objectives: The Louisiana Department of Health identified a need for greater outreach in low-income Black communities that addressed environmental asthma triggers. We piloted an asthma virtual home visit (VHV) program and evaluated its reach and ability to promote asthma self-management strategies in communities with a high prevalence of poorly controlled asthma.Methods: Participants from Louisiana were continuously recruited into the VHV program starting in March 2021 and provided with asthma education materials. Participants reporting poorly controlled asthma and environmental triggers were also offered 3 VHVs with a respiratory therapist. All participants were asked to complete a preintervention and postintervention knowledge test, an Asthma Control Test (ACT) (maximum score = 25; scores ≤19 indicate poorly controlled asthma), and a final survey that assessed perceptions about asthma management and reduction of environmental triggers.Results: As of October 2022, 147 participants were enrolled in the program, and 52 had consented to and received ≥1 VHV. Forty VHV recipients (77%) were aged <18 years, 40 (77%) were Black people, and 46 (88%) were from families with extremely low or low incomes. Asthma symptoms improved across all participants, with a median increase of 2.4 points on the ACT. Knowledge tests revealed that 86% of participants learned about ≥1 new asthma trigger; a larger percentage of VHV recipients than nonrecipients (68% vs 36%) had an improved knowledge test score postintervention. Compared with preintervention, about three-quarters of participants reported feeling more empowered to self-manage their asthma and a significant improvement in their quality of life postintervention.Conclusions: The program provided virtual asthma education to communities with a high burden of asthma and improved asthma outcomes for participants. Similar virtual models can be used to promote health equity, especially in areas with limited access to health care.

On May 28, 1894, wealthy Boston businessman, mathematician, and astronomer Percival Lowell stepped off the train in Flagstaff, a hamlet of 800 people in the Arizona Territory, and headed up [...]

FLAGSTAFF, ARIZONA, WRAPS picturesquely around the base of the San Francisco Peaks, the state's highest mountain range. At an elevation of 7,000 feet (2,130 meters), the air is thin, and [...]

From 2009 to 2018, overall suicide rates in the United States increased by 20.3% and increased by 43.5% among non-Hispanic American Indian and Alaska Native (AI/AN) communities. Combining years 2009 through 2018, suicide rates per 100 000 population among non-Hispanic AI/AN adolescents and young adults aged 15 to 34 years were 2 to 4 times higher than those of adolescents and young adults of other races and ethnicities. An estimated 14% to 27% of non-Hispanic AI/AN adolescents attempted suicide during that time. The elevated rates of suicidal behavior among non-Hispanic AI/AN adolescents and young adults reflect inequities in the conditions that create health. In this topical review, we describe school-based educational efforts that are driven by local AI/AN communities, such as the American Indian Life Skills curriculum, that teach stress and coping skills and show promise in reducing suicidal ideation attempts and fatalities among AI/AN adolescents. Using a social-determinants-of-health lens, we review the availability and quality of employment as an important influencer of suicidal behavior, as well as the role of the workplace as an environment for suicide prevention in AI/AN communities. Working with tribal, state, local, and federal colleagues, the public health community can implement programs known to be effective and create additional comprehensive strategies to reduce inequities and ultimately reduce suicide rates.

Of course, most satellite operators want to maintain (or grow) their constellation, so a satellite's demise does not change the overall situation; one or more will take its place. SPACEX REJECTS gl HOW TO DIM A SATELLITE THERE ARE NUMEROUS STRATEGIES that can potentially reduce the impact of satellite trails on astronomy. FEATURES ON THE NIGHT OF MAY 25, 2019, astronomy educator Victoria Girgis was conducting a public stargazing session at Lowell Observatory in Flagstaff, Arizona. SpaceX has experimented with numerous strategies to reduce the amount of light Starlink reflects back to Earth, such as painting various components of satellites black. [Extracted from the article]

Corralling COVID-19's impact For the last several months, the COVID-19 pandemic has wreaked havoc on the American economy, which has made a difficult situation even harder for transitioning service members [...]

One of the pleasures of doing astronomy in northern Arizona is living in a land of wide horizons, brilliant sunshine, and spectacular topography. For two millennia, from about 1200 BC, [...]

Telehealth is the use of electronic information and telecommunication technologies to provide care when the patient and the provider are not in the same room at the same time. Telehealth accounted for less than 1% of all Medicare Fee-for-Service outpatient visits in the United States in 2019 but grew to account for 46% of all visits in April 2020. Changes in reimbursement and licensure policies during the COVID-19 pandemic appeared to greatly facilitate this increased use. Telehealth will continue to account for a substantial portion of care provided in the United States and globally. A better understanding of telehealth approaches and their evidence base by public health practitioners may help improve their ability to collaborate with health care organizations to improve population health. The article summarizes the Centers for Disease Control and Prevention's (CDC's) approach to understanding the evidence base for telehealth in public health practice, possible applications for telehealth in public health practice, and CDC's use of telehealth to improve population health.

Many of us, who care deeply about health equity, are struggling to re-attain our "balance." We continue to reel, as the acute, formidable challenges of the Coronavi-rus Disease 2019 (COVID-19) [...]

Weathering the storm In a relatively short period of time, our nation's economy and employment rates have been turned upside down as a result of the COVID-19 pandemic. For many [...]

This article reinforces the need for diversification of 401(k) plans to deal with economic fluctuations.

This paper proposes a Computerized Maintenance Management System (CMMS) based on the software package AutoCAD Release 12 as a solution to the maintenance challenge in a manufacturing firm. The system proposed here uses Release 12 in conjunction with the database program dBASE IV. The two programs are linked using the Structured Query Language (SQL) capabilities inherent in both programs. An example is provided in which a manufacturing cell in a plant is drawn in Release 12 and connected to its corresponding maintenance data in dBASE IV.

Four tips to help you stand out on LinkedIn Did you know that more than 100 million job applications are submitted through LinkedIn each month? While this makes the platform [...]

DAV recently released The Veteran Advantage: DAV Guide to Hiring and Retaining Veterans with Disabilities. The comprehensive guide is the result of more than four years of study regarding what [...]

This study explores whether chat negativity and the degree to which live chat rule sets encourage active (vs. passive) involvement influence participants' willingness to react to negative behavior within video game live streams. Using the Social Identity Model of Deindividuation Effects (SIDE) and an experimental design, this study examines chat participants' likelihood of calling out and reporting negative behaviors. A 2x3 experimental design manipulated type of negativity (i.e., clear/ambiguous) and framing of community-specific rules of users' role in responding to norm violations (i.e., active involvement/passive involvement/control). Results suggest clear negativity was associated with a higher likelihood of calling out/reporting. Active involvement interacted with degree of negativity: when live chat rule sets encouraged active (vs. passive) involvement, participants were more likely to call out clear negativity and less likely to call out ambiguous negativity. Furthermore, there was support for the hypothesis that social identification moderated the relationship between type of negativity and likelihood of response, whereby participants with higher social identification were more likely to respond to clear negativity and less likely to respond to ambiguous negativity. Finally, participants’ perceptions of group norms in the hypothetical communities were affected by prior experience and chat activeness, but not by type of negativity or active (vs. passive) involvement.

What is a power supply? A power supply is a source of energy used to 'energize' a piece of equipment. In the ever-growing world of portability, it is very important [...]

Making that first impression [ILLUSTRATION OMITTED] As we begin the third quarter of 2017, DAV has hosted more than 65 traditional and five virtual career fairs. Our career fairs are [...]

Timely process information is required to make effective fermentation decisions, but those data are rarely available. NIR spectroscopy can allow you--by incorporating rapid, nondestructive, multiconstituent analyses of fermentation broth directly [...]

Introduction:Federal Select Agent Program regulations require laboratories to document a validated procedure for inactivating select agents prior to movement outside registered space. Avian influenza viruses and virulent Newcastle disease virus (vNDV) are cultured in chicken amnio-allantoic fluid (AAF), but the efficacy of commercial lysis buffers to inactivate viruses in protein-rich media has not been documented.Objectives:We assesses the efficacy of MagMAX™ lysis buffer for inactivating highly pathogenic avian influenza virus (HPAIV) and vNDV in chicken AAF and confirm the inactivation of avian influenza in serum using heat.Methods:Low pathogenic avian influenza virus (LPAIV) and avian paramyxovirus subtype-1 (APMV-1) were incubated with lysis buffer and tested for viability. Known viable LPAIV and APMV-1 RNA was extracted from AAF using MagMAX™-96 AI/ND Viral RNA Isolation kit, and the eluate was tested for remaining infectious agent. Finally, inactivation of LPAIV in serum was examined over 3 combinations of temperature and incubation time.Results:MagMAX™ lysis buffer inactivated both LPAIV and APMV-1 in AAF when incubated for 30 minutes at room temperature. The full extraction process eliminated viable virus from the final RNA eluate. LPAIV in serum heated to 70°C for 30 minutes was rendered noninfectious.Conclusion:The ability of a diagnostic laboratory to move samples from one space to another is critical to maintaining biosecurity as well as efficient laboratory workflow. Our study demonstrates a method to ensure the inactivation of viable avian influenza and avian paramyxoviruses in AAF, RNA eluate, and viable avian influenza virus in sera.

This article explores the postqualitative notion of “ethics of becoming” through a critique of common understandings of ethical approaches to research. By applying Deleuze's reading of Spinoza, the ethics of becoming are discussed using empirical examples from field studies. Attention is given to how ethically challenging moments arise in the imminent space beyond humanism, in which commonly acknowledged handbooks insufficiently prepare the researcher for what is to (be)come. The analysis demonstrates that an ethic of becoming does not direct attention toward moments of stability, as universal ethics usually do, but toward the situation of becomings and of new relations that are created in the moments of research.

Although rarely available, timely process information about fermentation biomass, substrates, intermediates, and nutrients is required to make control decisions. NIR spectroscopy offers the opportunity to improve fermentation processes by incorporating [...]

Glycerol was conjugated to glass test tube surfaces in four configurations by employing two different silane spacers, covalent attachment to glycerol at either the 1- or the 2-position, and with a succinic acid spacer. The resulting surfaces were tested for their ability to inhibit the nucleation of tetrahydrofuran hydrate (THF hydrate) in comparison with polyvinylpyrrolidone (PVP), a known polymeric inhibitor of THF hydrate formation. Contact angle measurements were used as an indication of surface modification throughout the glass derivatization steps. Of the four final surfaces modified with glycerol, only the coating with (3-aminopropyl)triethoxysilane (APTES) and glycerol coupled at the 1-position (leaving a free 1,2-diol) showed significant inhibition of the formation of THF hydrate. The corresponding N-[3-(trimethoxysilyl)propyl]ethylenediamine (AEAPTMS) coating with glycerol coupled at the 1-position did not show a significant difference over the untreated test tubes. Attachment of glycerol at the 2-position yielded a coating with no benefit over the untreated test tubes regardless of the silane used, and a surface modified with APTES and succinic acid alone enhanced the formation of THF hydrate. The ability to inhibit THF hydrate formation using a polyol-modified surface is a first step in the development of a coating that, alone or in combination with known gas hydrate inhibitors, could be used to prevent gas hydrates from plugging pipelines in field applications.

The journey from injury to recovery is not complete until a veteran is able to find meaning in life. For those who are able, that means getting back to work [...]

18th Annual Restaurant Growth Index Will the foodservice industry continue to hold its place as one of the most vital segments of the American economy? What changes in how Americans [...]

17th Annual Restaurant Growth Index How will the restaurant industry grow in the second half of the 1980s? Growth will come--few observers doubt that. Economist Michael G. Van Dress states [...]

Abstract.This multistudy investigation examines how entrapment, which is the guilt, anxiety, or stress to respond and be available to others via mobile devices, shapes and is shaped by patterns of mobile use. Using structural equation modeling on cross-sectional survey responses, Study 1 (N= 300) tested relationships among offline social network size, voice and text frequency, entrapment, and well-being. Offline social network size was associated with text message frequency, and both were indirectly associated with lower subjective well-being via entrapment. Study 2 used experience sampling to confirm associations among entrapment, texting, and well-being. Participants (N= 112) reported on face-to-face, phone, and text interactions five times a day for 5 consecutive days (n= 1,879). Multilevel modeling results indicated that beginning-of-week entrapment was associated with more interactions with acquaintances and strangers, and with reporting lower affective well-being and relatedness when interacting via text. Well-being reported during text interactions and number of interactions with acquaintances and strangers during the week both predicted changes in entrapment by the week’s end. Change in entrapment was associated with lower subjective well-being at the week’s end. Results suggest that entrapment is associated with using texting to maintain larger networks of social relationships, potentially stressing individuals’ capacity to maintain less close relationships via mobile communication.

Michael Jackson's Thriller should have been included on your list of the 'Top 50 Albums of All Time' (November 2008). RON NOBLE / CLEVELAND, OH Nice work. As best-album lists [...]

Interest in ultrasound education in medical schools has increased dramatically in recent years as reflected in a marked increase in publications on the topic and growing attendance at international meetings on ultrasound education. In 2006, the University of South Carolina School of Medicine introduced an integrated ultrasound curriculum (iUSC) across all years of medical school. That curriculum has evolved significantly over the 9 years. A review of the curriculum is presented, including curricular content, methods of delivery of the content, student assessment, and program assessment. Lessons learned in implementing and expanding an integrated ultrasound curriculum are also presented as are thoughts on future directions of undergraduate ultrasound education. Ultrasound has proven to be a valuable active learning tool that can serve as a platform for integrating the medical student curriculum across many disciplines and clinical settings. It is also well-suited for a competency-based model of medical education. Students learn ultrasound well and have embraced it as an important component of their education and future practice of medicine. An international consensus conference on ultrasound education is recommended to help define the essential elements of ultrasound education globally to ensure ultrasound is taught and ultimately practiced to its full potential. Ultrasound has the potential to fundamentally change how we teach and practice medicine to the benefit of learners and patients across the globe.

The gnathostome (jawed vertebrates) classical pituitary glycoprotein hormones, FSH, LH, and TSH, consist of a common α-subunit (GpA1) and unique β-subunits (Gpβ1, -2, and -3), whereas a recently identified pituitary glycoprotein hormone, thyrostimulin, consists of GpA2 and GpB5. This paper reports the identification, expression, and function of an ancestral, nonclassical, pituitary heterodimeric glycoprotein hormone (GpH) consisting of the thyrostimulin A2 subunit with the classical β-subunit in the sea lamprey, Petromyzon marinus, a jawless basal vertebrate. Lamprey (l) GpA2, and lGpHβ were shown to form a heterodimer by coimmunoprecipitation of lGpA2 with FLAG-tagged lGpHβ after the overexpression in transiently transfected COS7 cells using a bipromoter vector. Dual-label fluorescent in situ hybridization and immunohistochemistry showed the coexpression of individual subunits in the proximal pars distalis of the pituitary. GnRH-III (1μΜ) significantly increased the expression of lGpHβ and lGpA2 in in vitro pituitary culture. Recombinant lamprey GpH was constructed by tethering the N terminal of lGpA2 to the C terminal of lGpHβ with a linker region composed of six histidine residues followed by three glycine-serine repeats. This recombinant lamprey GpH activated the lamprey glycoprotein hormone receptor I as measured by increased cAMP/luciferase activity. These data are the first to demonstrate a functional, unique glycoprotein heterodimer that is not found in any other vertebrate. These data suggest an intermediate stage of the structure-function of the gonadotropin/thyroid-stimulating hormone in a basal vertebrate, leading to the emergence of the highly specialized gonadotropin hormones and thyroid stimulating hormones in gnathostomes.

ABSTRACTVibrio parahaemolyticussequence type 36 (ST36) strains that are native to the Pacific Ocean have recently caused multistate outbreaks of gastroenteritis linked to shellfish harvested from the Atlantic Ocean. Whole-genome comparisons of 295 genomes of V. parahaemolyticus, including several traced to northeastern U.S. sources, were used to identify diagnostic loci, one putatively encoding an endonuclease (prp), and two others potentially conferring O-antigenic properties (cpsand flp). The combination of all three loci was present in only one clade of closely related strains of ST36, ST59, and one additional unknown sequence type. However, each locus was also identified outside this clade, with prpand flpoccurring in only two nonclade isolates and cpsin four. Based on the distribution of these loci in sequenced genomes, prpidentified clade strains with >99% accuracy, but the addition of one more locus increased accuracy to 100%. Oligonucleotide primers targeting prpand cpswere combined in a multiplex PCR method that defines species using the tlhlocus and determines the presence of both the tdhand trhhemolysin-encoding genes, which are also present in ST36. Application of the method in vitroto a collection of 94 clinical isolates collected over a 4-year period in three northeastern U.S. states and 87 environmental isolates revealed that the prpand cpsamplicons were detected only in clinical isolates identified as belonging to the ST36 clade and in no environmental isolates from the region. The assay should improve detection and surveillance, thereby reducing infections.

Cirrhosis of the liver results in complex hemostatic changes that place patients at risk for both bleeding and thrombotic events. This study evaluates the adverse effects of anticoagulation with unfractionated heparin among patients with cirrhosis and analyzes the discrepancy between anti-Xa and activated partial thromboplastin time (aPTT) values for heparin monitoring among cirrhotics.

This study uses co-orientation theory to examine the impact of mobile phone use on relational quality across three copresent contexts. It investigates the relationship between perceived similarity, actual similarity, and understanding of mobile phone usage on relationship outcomes, and uses a new measure of mobile relational interferenceto assess how commitment, satisfaction, and liking are affected by perceptions of relational partners’ mobile phone use. Contrary to popular belief, the results from this study of 69 dyads reveals that, at least within a sample of young Americans, failing to adhere to injunctive (i.e., societal) norms regarding mobile phone usage does not impact relational quality. Rather, results indicate that perceived adherence to participants’ own internal standards—by both the participant, and the participant’s relational partner—and perceived similarity between partners were more influential.

The present study applies the ideal standards model (ISM) to explore the role of ideal friendship standards on friendship satisfaction in a specific same-sex friendship and responses to unmet expectations in friendships in general. Participants (N=284) completed an online survey wherein they reported their expectations on six dimensions of friendship, their friendship satisfaction for a close same-sex friendship, and their response to unmet standards in friendship. The influence of participants’ self-evaluations and ideal standards on friendship satisfaction was mediated by the discrepancy between participants’ close friend and participants’ ideal standards. The flexibility of standards failed to explain variance in satisfaction and higher ideal standards were negatively associated with satisfaction. However, the flexibility of standards was negatively associated with direct communication, avoidance, and revenge in response to unmet expectations in friendships, and positively related to loyalty and acceptance. The present investigation clarifies how friendship ideals influence the evaluation of friendship and responses to unmet expectations.

Staphylococcus aureusis a formidable pathogen of both human and animal. Infection often gives rise to an economic loss resulting from the extended cost of treatment and hospitalization for humans, and loss of usable agriculture animal products from infected animals and treatment regiments. We describe here a protocol for the amplification and sequencing of predominant single nucleotide polymorphisms within the promoter region of hla(encoding α-toxin) that confers a hyper-producing α-toxin phenotype to S. aureusisolates associated with chronic and severe bovine mastitis infections. We validated our findings with a second round of analysis, confirming the SNPs as a valid genotypic marker for α-toxin hyper-producing bovine isolates. The identification of highly virulent isolates will allow for aggressive treatment of the infection and limit the disease and economic impact. With readily available reagents and facilities, this protocol can be completed in as little as 72 h once samples are isolated.

Background Surfactant-associated proteins (SP) A and D are both innate immunity mediators and produced in normal and diseased sinus mucosa. Cystic fibrosis (CF) is associated with Th1 adaptive inflammation whereas allergic fungal rhinosinusitis (AFRS) is associated with Th2 adaptive inflammation. The purpose of this study is to show and quantify the presence of SP A, SP D, tumor necrosis factor (TNF) alpha, (a Th1 marker), and eotaxin (a Th2 marker) in normal and diseased sinus mucosa.Methods Intraoperative sinus mucosal biopsy specimens from human volunteers were obtained during endoscopic sinus surgery for CF (n = 4), AFRS (n = 10), and normal controls (CTLs; n = 4). Specimens were evaluated for presence and quantity of SP A, SP D, and TNF-alpha using Western blot with semiquantitative immunoblot analysis. Eotaxin was quantified using ELISA immunoassay. Results were standardized and reported as picograms of mediator per microgram of total protein.Results SP A, SP D, and TNF-alpha levels in CF tissue extracts were 2–10 times higher than levels in AFRS tissue (with SP D and TNF-alpha reaching statistical significance) but CF tissue was not significantly higher than CTL tissue. SP A, SP D, and TNF-alpha were not significantly elevated in AFRS. Eotaxin showed elevated levels in CF and AFRS when compared with CTLs (p = 0.03 and 0.003, respectively).Conclusion SP D and TNF-alpha are significantly increased in CF compared with AFRS, suggesting activation of both innate immunity and Th1-mediated inflammation and potential correlation between SPs and downstream adaptive immune responses.