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Objective: To describe the results of a technology-integrated intervention on sugar-sweetened beverage (SSB) and energy-dense snack intake with third graders experiencing low income., Design: A 2 × 2 quasi-randomized cluster-block, parallel-group experimental research design., Setting: Low-income schools in Rhode Island., Participants: Two-hundred seventeen intervention and 242 control third-grade students in low-income (89.6% and 88.2% free/reduced meals, respectively), ethnically and racially diverse (63% Hispanic/20% Black and 62% Hispanic/18% Black, respectively) schools., Intervention(s): A 13-week in-school program held once per week for 1 hour. The hands-on, technology-integrated program used a modified version of the Body Quest: Food of the Warrior curriculum., Main Outcome Measure(s): Intake of SSB and energy-dense snacks, both salty and sweet snacks, using baseline (week 1) and postassessment (week 13) previous day self-recall., Analysis: Generalized mixed modeling with nesting., Results: Intervention students significantly reduced their SSB intake by 38% (0.5 times/d; F[1, 540] = 4.26; P = 0.04) and salty snack intake by 58% (0.8 times/d; F[1, 534] = 6.58, P < 0.01) from baseline to postassessment as compared with the control students., Conclusions and Implications: Findings suggest a technology-integrated curriculum is effective in decreasing SSB and salty snacks in elementary-aged students of low-income, minoritized populations. Improved dietary habits can potentially influence other facets of students' lives., (Copyright © 2023 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Purpose: Faculty teaching workload has become a focus for many academic institutions given the increasing amount of faculty burnout and need for equitable distribution of effort. Many gaps exist in faculty workload guidance which contribute to decreased faculty productivity, lack of appropriate recognition, faculty burnout, and subsequently, retention of faculty. A task force was created to develop teaching workload guidance and to outline minimum teaching expectations at our school of pharmacy., Description: This manuscript highlights the need for clarity around the definition of roles of the contemporary educator and considerations when developing guidance around teaching workload expectations using the "What? So What? Now What?" reflection framework., Analysis/interpretation: Teaching workload guidance first starts with establishing a definition of the contemporary roles of the educator. Challenges, considerations, and eight next steps are outlined that are critical to address before equitable teaching workload guidance is established., Conclusions: Teaching workload guidance should include transparency, clarity, credit, norms, context, and accountability. Additionally, solutions created to address the gaps in workload policies should be data driven., Implications: The current traditional system of evaluating faculty workload has many gaps due to forces driving change in pharmacy education. Roles of the pharmacy educator should be valued and recognized across all mission centric learning programs., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023. Published by Elsevier Inc.)

Introduction: Faculty workload policy has gained increased attention recently given the growing amount of faculty burnout leading to decreased productivity, worsened faculty morale, and impaired retention. Faculty are one of the most valuable resources of an academic institution; thus, it is essential that a clear picture of the "jobs to be done" are defined and valued., Perspective: The approach of a task force charged with developing a teaching workload policy is described. Through this work, it was recognized that essential roles of the contemporary pharmacy educator have not been defined, resulting in workload policies that might only value and recognize "traditional" educator roles. This led the task force to evaluate the forces driving change in education and to identify the roles of faculty as educators. The stepwise approach used to define nine essential roles of contemporary pharmacy educators is described., Implications: Roles of the educator have become more complex, and traditional definitions of these roles do not recognize and value the multifaceted nature of the job to be done. Consideration of contemporary definitions of educator roles is a critical first step for developing workload policies. The new definition of educator roles will allow the academic institution to have more clarity around total teaching effort and recognize the value faculty provide the institution. We believe this is the essential first step for the Academy when developing teaching workload policies that are fair and equitable, while also understanding the overall faculty needs for executing their educational enterprise., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: We investigated whether patients with cryptococcal meningitis (CM) or fungaemia detected through South Africa's laboratory cryptococcal antigen (CrAg) screening programme had better outcomes than those presenting directly to the hospital., Methods: We compared 14-day in-hospital case-fatality ratios of HIV-seropositive individuals with CD4 counts below 100 cells/μL and laboratory-confirmed CM/fungaemia from 2017-2021, with or without evidence of a positive blood CrAg test within 14 days prior to diagnosis. We evaluated whether the impact of prior CrAg screening on mortality varied according to the study period (pre-COVID-19: before March 2020 vs. COVID-19: after March 2020)., Results: Overall, 24.5% (830/3390) of patients had a prior positive CrAg test within 14 days of diagnosis. CrAg-screened patients were less likely to have an altered mental status at baseline than non-CrAg-screened patients (38.1% [296/776] vs. 42.6% [1010/2372], p = 0.03), and had a lower crude 14-day case-fatality ratio (24.7% [205/830] vs. 28.3% [724/2560]; OR, 0.83 [95% CI, 0.69-0.99]; p = 0.045). Previous CrAg screening was associated with a greater reduction in the crude 14-day mortality during the COVID-19 period (OR, 0.64 [0.47-0.87]; p = 0.005) compared with before (OR, 0.95 [0.76-1.19]; p = 0.68). After adjustment, previous CrAg screening within 14 days was associated with increased survival only during the COVID-19 period (adjusted OR, 0.70 [0.51-0.96]; p = 0.03)., Discussion: Previous CrAg screening was associated with a survival benefit in patients hospitalized with CM/fungaemia during the COVID-19 period, with fewer patients having an altered mental status at baseline, suggesting that these patients may have been diagnosed with cryptococcosis earlier., (Copyright © 2023 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Background: The clinical value of using digital tools to assess adherence and lung function in uncontrolled asthma is not known. We aimed to compare treatment decisions guided by digitally acquired data on adherence, inhaler technique, and peak flow with existing methods., Methods: A 32-week prospective, multicentre, single-blinded, parallel, randomly controlled trial was done in ten severe asthma clinics across Ireland, Northern Ireland, and England. Participants were 18 years or older, had uncontrolled asthma, asthma control test (ACT) score of 19 or less, despite treatment with high-dose inhaled corticosteroids, and had at least one severe exacerbation in the past year despite high-dose inhaled corticosteroids. Patients were randomly assigned in a 1:1 ratio to the active group or the control group, by means of a computer-generated randomisation sequence of permuted blocks of varying sizes (2, 4, and 6) stratified by fractional exhaled nitric oxide (FeNO) concentration and recruitment site. In the control group, participants were masked to their adherence and errors in inhaler technique data. A statistician masked to study allocation did the statistical analysis. After a 1-week run-in period, both groups attended three nurse-led education visits over 8 weeks (day 7, week 4, and week 8) and three physician-led treatment adjustment visits at weeks 8, 20, and 32. In the active group, treatment adjustments during the physician visits were informed by digital data on inhaler adherence, twice daily digital peak expiratory flow (ePEF), patient-reported asthma control, and exacerbation history. Treatment was adjusted in the control group on the basis of pharmacy refill rates (a measure of adherence), asthma control by ACT questionnaire, and history of exacerbations and visual management of inhaler technique. Both groups used a digitally enabled Inhaler Compliance Assessment (INCA) and PEF. The primary outcomes were asthma medication burden measured as proportion of patients who required a net increase in treatment at the end of 32 weeks and adherence rate measured in the last 12 weeks by area under the curve in the intention-to-treat population. The safety analyses included all patients who consented for the trial. The trial is registered with ClinicalTrials.gov, NCT02307669 and is complete., Findings: Between Oct 25, 2015, and Jan 26, 2020, of 425 patients assessed for eligibility, 220 consented to participate in the study, 213 were randomly assigned (n=108 in the active group; n=105 in the control group) and 200 completed the study (n=102 in the active group; n=98 in the control group). In the intention-to-treat analysis at week 32, 14 (14%) active and 31 (32%) control patients had a net increase in treatment compared with baseline (odds ratio [OR] 0·31 [95% CI 0·15-0·64], p=0·0015) and 11 (11%) active and 21 (21%) controls required add-on biological therapy (0·42 [0·19-0·95], p=0·038) adjusted for study site, age, sex, and baseline FeNO. Three (16%) of 19 active and 11 (44%) of 25 control patients increased their medication from fluticasone propionate 500 μg daily to 1000 μg daily (500 μg twice a day; adjusted OR 0·23 [0·06-0·87], p=0·026). 26 (31%) of 83 active and 13 (18%) of 73 controls reduced their medication from fluticasone propionate 1000 μg once daily to 500 μg once daily (adjusted OR 2·43 [1·13-5·20], p=0·022. Week 20-32 actual mean adherence was 64·9% (SD 23·5) in the active group and 55·5% (26·8) in the control group (between-group difference 11·1% [95% CI 4·4-17·9], p=0·0012). A total of 29 serious adverse events were recorded (16 [55%] in the active group, and 13 [45%] in the control group), 11 of which were confirmed as respiratory. None of the adverse events reported were causally linked to the study intervention, to the use of salmeterol-fluticasone inhalers, or the use of the digital PEF or INCA., Interpretation: Evidence-based care informed by digital data led to a modest improvement in medication adherence and a significantly lower treatment burden., Funding: Health Research Board of Ireland, Medical Research Council, INTEREG Europe, and an investigator-initiated project grant from GlaxoSmithKline., Competing Interests: Declaration of interests DJJ reports grants from AstraZeneca and personal fees from Sanofi Regeneron, AstraZeneca, and GlaxoSmithKline. BDK report personal fees from AstraZeneca and GlaxoSmithKline. GG reports patents to quantify adherence and to predict exacerbations. CH reports fees from Alphabet, granted as part of employment by Google. DMM reports personal fees from AstraZeneca, Teva, GlaxoSmithKline, Sanofi, and Novartis. RBR reports a patent for the use of acoustics to assess inhaler adherence. JFMvB reports institutional grants from Aardex, AstraZeneca, Chiesi, European Commission COST Action 19132 ENABLE, Lung Alliance Netherlands, Novartis, Trudell Medical and personal fees from AstraZeneca, Chiesi, GlaxoSmithKline, Novartis, Teva, Trudell Medical, and Vertex. LGH was academic lead for the UK MRC Consortium for Stratified Medicine in Severe Asthma—Industrial Pharma partners Amgen, AstraZeneca, Medimmune, Janssen, Novartis, Roche–Genentech, GlaxoSmithKline, and Boehringer Ingelheim; grants or contracts from GlaxoSmithKline, Schering Plough, Synairgen, Novartis and Roche–Genentech MedImmune, Novartis UK, Roche–Genentech and GlaxoSmithKline; and lectures supported by AstraZeneca, Novartis, Roche–Genentech, Sanofi, Circassia, GlaxoSmithKline, Chiesi, and Teva. RWC reports institutional grants from GlaxoSmithKline, Aerogen, and Enterprise Ireland; personal fees from AstraZeneca, Teva, GlaxoSmithKline, PMD solutions, and Novartis; and a patent for the use of acoustics to assess inhaler adherence, to quantify adherence and to predict exacerbations. EM, CM, MCM, BC, IS, VB, PJK, MB, IC, JF, JH, MK, RC, LL, JW, SP, TAM, and AMNK declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Long-acting injectable antipsychotic (LAIA) medications offer an effective treatment option for patients with serious mental illness. Despite demonstrated clinical safety and efficacy as well as increased adherence and less frequent administration compared with daily oral regimens, LAIAs remain underutilized in clinical practice. With legislation allowing pharmacists to administer injectable medications in 48 U.S. states, community pharmacies are uniquely positioned to serve as an access point for patients with serious mental illnesses to receive LAIA injections., Objective: This study aimed to conduct a systematic review of the health and economic benefits and costs of community pharmacist administration of LAIA medications., Methods: A systematic search of the literature published from January 1996 to April 2022 was conducted across 3 databases (Embase, PubMed, and Scopus Plus). Publications describing pharmacist administration of LAIA medications in outpatient settings were included. Publications that examined the use of LAIAs but did not involve a pharmacist administering the medication were excluded., Results: Of 2261 publications reviewed, we identified 8 publications (4 articles and 4 abstracts) that met our inclusion criteria, of which only 7 included results. Four studies reported high medication adherence achieved by patients receiving pharmacist-administered LAIAs. Two publications surveyed patient satisfaction with pharmacist administration of LAIAs in community pharmacy settings. One study found pharmacists' mixed attitudes regarding LAIA administration and time and safety barriers to offering the service., Conclusion: We found very little evidence on the impact of pharmacist administration of LAIAs on patient outcomes. This review highlights the need to generate greater evidence on the health and economic benefits as well as financial models for pharmacists to administer LAIA medications in outpatient and community pharmacy settings. Such evidence could support more community pharmacists to offer LAIA medications and contribute to the shift toward value-based care., (Copyright © 2022 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Background: Response to the COVID-19 pandemic resulted in the temporary disruption of routine services in the UK National Health Service, including cancer screening. Following the reintroduction of services, we explored the impact on inequalities in uptake of the Bowel Screening Wales (BSW) programme to identify groups who might benefit from tailored intervention., Methods: BSW records were linked to electronic health record and administrative data within the Secured Anonymised Information Linkage (SAIL) Databank Trusted Research Environment. We examined uptake in the first 3 months (from August to October, 2020) of invitations following the reintroduction of the BSW programme compared with the same period in the preceding 3 years. We analysed inequalities in uptake by sex, age group, income deprivation quintile, urban and rural location, ethnic group, and uptake between different periods using logistic regression models., Findings: Overall uptake remained above the 60% Welsh standard during the COVID-19 pandemic period of 2020-21 but declined compared with the pre-pandemic period of 2019-20 (60·4% vs 62·7%; p<0·001). During the COVID-19 pandemic period of 2020-21, uptake declined for most demographic groups, except for older individuals (70-74 years) and those in the most deprived quintile. Variation by sex, age, income deprivation, and ethnic groups was observed in all periods studied. Among low-uptake groups, including males, younger individuals (60-64 years), those living in most deprived areas, and ethnic minorities, uptake remains below the 60% Welsh standard., Interpretation: Despite the disruption, uptake remained above the Welsh standard and inequalities did not worsen after the programme resumed activities. However, variations associated with sex, age, deprivation, and ethnicity remain. These findings need to be considered in targeting strategies to improve uptake and informed choice in colorectal cancer screening such as co-producing information products with low-uptake groups and upscaling the use of GP-endorsed invitations and reminder letters for bowel screening., Funding: Health Data Research UK, UK Medical Research Council, Administrative Data Research UK, and Health and Care Research Wales., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Non-invasive respiratory support (NRS) outside of the ICU has played an important role in the management of COVID-19 pneumonia. There is little data to guide selection of NRS modality. We present outcomes of NRS outside the ICU and discuss the effects of NRS on gas exchange with implications for management., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To refine and psychometrically validate the Revised Critical Nutrition Literacy Tool in a young adult sample., Methods: Young adults recruited from 3 universities completed the 11-item Critical Nutrition Literacy Tool claims scale. Exploratory factor analysis, confirmatory factor analysis (CFA), and item response theory were used to validate the Critical Nutrition Literacy Tool. Omega and Cronbach α assessed reliability., Results: A total of 1,718 participants completed the survey. Results from exploratory factor analysis and CFA analyses suggested that a 2-factor, 7-item instrument showed a reasonable fit to the data based on the comparative fit index and standardized root mean residual values, χ 2 (13) =161.64, P < .001, comparative fit index = 0.90, root mean square error of approximation = 0.11, standardized root mean residual = 0.07. All items loaded well onto the factors from the CFA and item response theory perspectives. The full measure and both factors showed questionable (>0.60) or acceptable (>0.70) internal consistency., Conclusions and Implications: A revised 2-factor instrument capturing (factor 1) critical appraisal of media and (factor 2) evidence-based sources of nutrition information demonstrated sound psychometric characteristics. Further item testing is necessary for different populations, and item development is warranted to capture Internet/social media sources and the relationship among critical nutrition literacy, dietary behaviors, and health outcomes., (Copyright © 2020 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Objective: To understand how the addition of an evidence-based framework to an online nutrition module influences college students' critical thinking decision making (CT-DM)., Design: Students were individually randomized into an intervention group or a control group. The nutrition modules focused on 2 topics related to different types of eating behavior. Students completed a CT-DM activity to generate a score., Participants: College students, between 18 and 24 years old, recruited from introductory nutrition and agriculture science courses at 2 universities., Intervention: Intervention and control received 2 nutrition modules. The intervention added a CT-DM framework that framed the topic as a problem, incorporated activities, and provided scaffolding., Main Outcome Measures: CT-DM was scored using a validated rubric to assess the use of critical thinking skills when making a food-related decision. Green eating and critical thinking disposition were measured., Analysis: Hierarchical linear regression and t tests were used to assess outcomes., Results: A total of 431 students participated (intervention = 203; control = 228). After controlling for university, the intervention group scored significantly higher on CT-DM (18.1 ± 7.6) compared with the control (15.4 ± 8.4); F (3,428) = 14.58, P < .001., Conclusions and Implications: The results show that an evidence-based framework using nutrition topics encourages CT-DM skills. Future higher-education nutrition interventions should use frameworks to enhance student learning., (Copyright © 2019 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Background: A recent Surgeon General's report encourages people to ask pharmacists about naloxone, but whether pharmacists are well-prepared to respond to these requests is unclear., Objectives: Determine factors that are associated with how often pharmacists offer and dispense naloxone., Methods: A convenience sample of 457 community pharmacists in North Carolina completed a 5-min online survey. Linear regressions were conducted to identify factors that are associated with how often pharmacists offer and dispense naloxone. Pharmacists' self-reported barriers to teaching naloxone administration were identified., Results: Most pharmacists (81.2%) worked in pharmacies that stocked naloxone, but many never offered (36.6%) or dispensed (19.4%) naloxone. Pharmacists offered (β = 0.15, p < 0.01) and dispensed (β = 0.15, p < 0.01) naloxone more often when their pharmacy stocked more naloxone formulations. Pharmacists who were more comfortable discussing naloxone offered it more often (β = 0.26, p = 0.001). Pharmacists who worked in regional/local/grocery chain pharmacies dispensed and offered naloxone less often than other pharmacy types. Barriers to teaching naloxone administration included: time constraints, inadequate training, and perceived lack of patient comprehension., Conclusions: Many community pharmacists do not offer or dispense naloxone. Pharmacists who are uncomfortable discussing naloxone or work at smaller chain pharmacies may benefit from targeted naloxone training., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To capture students' perceptions of participating in a nutrition education program., Design: Focus groups (n = 16)., Setting: Low-income schools in Rhode Island., Participants: A total of 64 low-income, ethnically and racially diverse third-grade students, 93.5% of whom were eligible for free or reduced-price meals, 62% of whom were Hispanic, and 16% of whom were black., Main Outcome Measure(s): Perceptions about the program's impact on food and beverage consumption, the value of the program, potential changes for improvement, and barriers to change., Analysis: Focus groups were recorded, transcribed, and coded using a hybrid approach of inductive and deductive thematic analysis. Interrater agreement was calculated., Results: Students perceived that the program positively influenced their attitudes toward making healthy choices and what they and their families were eating. Students reported increased empowerment, bravery to try new foods, and knowledge. Students enjoyed the program but suggested increasing the duration and frequency of lessons and including peer-to-peer education. Students felt that the tastiness of unhealthy food was a barrier to choosing healthier food., Conclusions and Implications: Findings suggest that the program may have improved students' knowledge, empowerment, and bravery, and that this had a positive influence on healthy food consumption for students and their families. Input from students will help inform future modifications to the curriculum., (Copyright © 2019 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Objective: To conduct a comprehensive process evaluation of a policy, systems, and environmental (PSE) change intervention., Design: Quasi-experimental, mixed methods., Setting: Low-income urban school district., Participants: Fifth-grade students in 4 schools assigned to 2 intervention and 2 comparison schools (intervention, n = 142; comparison, n = 170)., Intervention: Both groups received a nutrition curriculum delivered by classroom teachers. Intervention schools also received 10 PSE lessons taught by paraprofessional educators., Main Outcome Measures: Quantitative data were obtained from fidelity and observation checklists, grading rubrics and self-reported student surveys. Focus group and interviews provided qualitative data. Quantitative measures included assessments of PSE and fruit and vegetable knowledge, as well as assessment of times fruits and vegetables (FV) were consumed yesterday., Analyses: Qualitative data were analyzed using inductive content analysis. Quantitative data were analyzed using repeated measures analysis of variance and analysis of co-variance., Results: Fidelity, dose, reach, and acceptance of PSE intervention were high; students felt more empowered, although PSE lessons were considered lengthy and complicated. Intervention PSE and FV knowledge scores were significantly higher than comparison scores (F 37.56 , P < .001; and F 3.94 , P < .05, respectively). However, issues in communication were identified between school staff and researchers., Conclusions and Implications: Policy, systems, and environmental classroom interventions commented on the differences between quantitative and qualitative assessments, and this suggests the need for more sensitive quantitative assessments. Future research should look at long-term outcomes as this study only looked at short-term outcomes., (Copyright © 2018 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: This article describes the implementation of pyramid tests, an assessment strategy that utilizes individual and cooperative testing for formal examinations in an elective course for third year pharmacy students. This strategy provides individual accountability and uses group collaboration to extend students depth of thinking through essay responses. Pyramid tests have been suggested as a way to improve grading efficiency compared to traditional tests that use essay questions., Educational Activity and Setting: A two-credit hour pharmacy elective taught by synchronous video conferencing on two campuses of a large public university utilized pyramid tests for both the midterm and final examinations. Each examination had individual and group components and utilized a simple metacognitive question., Findings: The averages from the individual portions of the pyramid tests were similar to the prior year, while the combined group (2/3 weight) and individual (1/3 weight) pyramid test scores averages were slightly higher than the previous year's average (87% compared to 86%, respectively). Student feedback on this assessment technique was generally positive., Summary: This assessment strategy was an efficient way to test students' knowledge. Although it had a collaborative component, it also provided individual accountability. Time spent on course administration and grading was similar to previous years that employed fixed choice assessments without collaborative work., (Copyright © 2018 Elsevier Inc. All rights reserved.)

In multiple sclerosis (MS) and its animal model experimental autoimmune encephalomyelitis (EAE) autoaggressive CD4 + T cells cross the blood-brain barrier (BBB) and cause neuroinflammation. Therapeutic targeting of CD4 + T-cell trafficking into the CNS by blocking α4-integrins has proven beneficial for the treatment of MS but comes with associated risks, probably due to blocking CD8 + T cell mediated CNS immune surveillance. Our recent observations show that CD8 + T cells also rely on α4β1-integrins to cross the BBB. Besides vascular cell adhesion molecule-1 (VCAM-1), we identified junctional adhesion molecule-B (JAM-B) as a novel vascular α4β1-integrin ligand involved in CD8 + T-cell migration across the BBB. This prompted us to investigate, if JAM-B also mediates CD4 + T-cell migration across the BBB. We first ensured that encephalitogenic T cells can bind to JAM-B in vitro and next compared EAE pathogenesis in JAM-B -/- C57BL/6J mice and their wild-type littermates. Following immunization with MOG aa35-55 peptide, JAM-B -/- mice developed ameliorated EAE compared to their wild-type littermates. At the same time, we isolated higher numbers of CD45 + infiltrating immune cells from the CNS of JAM-B -/- C57BL/6J mice suffering from EAE. Immunofluorescence staining revealed that the majority of CD45 + inflammatory cells accumulated in the leptomeningeal and perivascular spaces of the CNS behind the BBB but do not gain access to the CNS parenchyma. Trapping of CNS inflammatory cells was not due to increased inflammatory cell proliferation. Neither a loss of BBB integrity or BBB polarity potentially affecting local chemokine gradients nor a lack of focal gelatinase activation required for CNS parenchymal immune cell entry across the glia limitans could be detected in JAM-B -/- mice. Lack of a role for JAM-B in the effector phase of EAE was supported by the observation that we did not detect any role for JAM-B in EAE pathogenesis, when EAE was elicited by in vitro activated MOG aa35-55- specific CD4 + effector T cells. On the other hand, we also failed to demonstrate any role of JAM-B in in vivo priming, proliferation or polarization of MOG aa35-55 -specific CD4 + T cells in peripheral immune organs. Finally, our study excludes expression of and thus a role for JAM-B on peripheral and CNS infiltrating myeloid cells. Taken together, although endothelial JAM-B is not required for immune cell trafficking across the BBB in EAE, in its absence accumulation of inflammatory cells mainly in CNS leptomeningeal spaces leads to amelioration of EAE., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: To determine the awareness, collaboration, and perceived values and barriers of enhanced pharmacy services from care managers and primary care practice responders., Methods: An electronic questionnaire was sent to 1648 primary care practices and 600 care managers that work in 76 North Carolina counties containing an enhanced-service community pharmacy. Questionnaires were distributed in January 2017 and responses collected for 7 weeks. The questionnaire collected data on the awareness and perceived value of enhanced pharmacy services, preferred method and level of communication for referral, and barriers to using enhanced services. Data were gathered with the use of Likert-type, rank-order, dichotomous, and multiple-choice questions. Data were analyzed with the use of descriptive statistics, and group mean responses were compared by means of t tests., Results: Data analysis was performed in March 2017. Response rates were 5.4% (n = 89) from practice responders and 45% (n = 270) from care managers. In the responses received, 35% of practice responders and 88% of care managers were familiar with enhanced services offered by community pharmacies. A majority of respondents thought that enhanced pharmacy services are valuable, with more than 85% of practice responders agreeing that partnering with an enhanced-service pharmacy can help to improve patient health outcomes. Lack of knowledge of enhanced-service pharmacies, services offered, and the referral process were identified as significant barriers for practice responders., Conclusion: Community-based pharmacies have an opportunity to collaborate with patient-centered medical home teams to provide enhanced pharmacy services, but provider outreach and education on enhanced services offered and the referral process are necessary to maximize this collaboration., (Copyright © 2018. Published by Elsevier Inc.)

The European regulatory system for the approval of pesticides includes a thorough evaluation of risks to the environment and is designed to be protective of ecosystems. However, a decision to ban an agrochemical could also potentially have a negative impact on the value of ecosystem services, if resulting changes in crop management are damaging to ecosystems or result in negative socio-economic impacts. To support regulatory decision-making, consideration of ecosystem services to identify best environmental management options could be a way forward. There is generally a growing trend for the consideration of ecosystem services in decision making. Ecosystems provide the conditions for growing food, regulate water and provide wildlife habitats; these, amongst others, are known as ecosystem services. The objectives of this case study were to bring a holistic approach to decision making by valuing the environmental, social and economic benefits derived from the use of chlorpyrifos in Valencian citrus production. Spanish growers harvest between 5 and 6 milliont of citrus annually, worth an estimated €5 to 7 billion in food markets throughout Europe. The approach highlighted the potential for unintended negative consequences of regulatory decisions if the full context is not considered. In this study, rather than a regulatory restriction, the best option was the continued use of chlorpyrifos together with vegetated conservation patches as refuges for non-target insects. The conservation patches offset potential insecticidal impacts to insects whilst maintaining citrus production, farm income and the amenity value of the citrus landscape of Valencia. This was an initial proof-of-concept study and illustrates the importance of a wider perspective; other cases may have different outcomes depending on policies, the pesticide, crop scenarios, farm economics and the region., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objective: This study examined associations between college students' self-report and measured height and weight., Methods: Participants (N = 1,686) were 77% white, 62% female, aged 18-24 years (mean ± SD, 19.1 ± 1.1 years), and enrolled at 8 US universities. Body mass index (BMI) was calculated for self-report (via online survey); trained researchers measured height and weight and categorized them as normal (18.5 to < 25), overweight (25 to < 30), obese (30 to < 35), and morbidly obese (≥ 35)., Results: Concordance of self-report vs objectively measured BMI groups using chi-square revealed that 93% were accurate, 4% were underestimated, and 2.7% were overestimated. Pearson correlations and adjusted linear regression revealed significant associations between self-report and measured BMI (r = .97; P < .001) and BMI adjusted for age, gender, and race/ethnicity (R² = .94). Concordance was also high between BMI categories (kappa = 0.77; P < .001)., Conclusions and Implications: Findings provide support for the utility of self-report height and weight for survey research in college students., (Copyright © 2015 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Background: The way in which different communities respond to similar threats to their health can vary, from outrage to indifference and public health agencies are often taken by surprise leading to potential loss of public confidence. The objective of this systematic literature review was to seek to better understand the community-level drivers that might explain the variability in response., Methods: A vigorous systematic cross-disciplinary literature review was undertaken searching thirteen bibliographic databases and a variety of grey sources were screened. The social amplification of risk framework and the risk perception management theoretical models were used to assess evidence and data were synthesised by Narrative review., Findings: Sixteen studies meeting the agreed inclusion criteria described eleven different threats ranging from: infectious disease outbreaks to environmental disasters to cancer clusters, affecting two or more communities were identified from medical, psychological, social science and environmental science literature. There was wide heterogeneity between the type and quality of the studies. There was a general absence of theoretical underpinning community responses. Most studies did not report sufficient data to allow an appropriate amount of validity. Very low response rates in particular were common. Potential explanatory drivers suggested included, prior experience and visibility of threat, sociodemographic characteristics, volume and type of media coverage, government reaction and availability of social support., Conclusions: This review confirmed that there are significant differences. Further work is needed to develop theoretical models that apply to the community level and do not assume that a community's response is simply the aggregate of individual level responses., (© 2013.)

Objective: To evaluate the motivational effect of the Project WebHealth study procedures and intervention components on weight-related health behavior changes in male and female college students., Design: Process evaluation., Setting: Eight universities in the United States., Participants: Project WebHealth participants (n = 653; 29% men)., Main Outcome Measures: Participants rated motivational effects of study procedures and intervention components. Participants were grouped into outcome-based health behavior categories based on achievement of desired targets for fruit and vegetable intake, physical activity, and/or body weight., Analysis: Differences in motivation from each procedure and component were analyzed by gender- and outcome-based health behavior category., Results: Women were generally more motivated than men. Compared to those who did not meet any target health behaviors, men with improved health outcomes (68%) were significantly more motivated by the skills to fuel the body lesson, goal setting, and research snippets. Their female counterparts (63%) were significantly more motivated by the lessons on body size and eating enjoyment, and by the suggested weekly activities., Conclusions and Implications: Specific study procedures and components of Project WebHealth motivated study participants to improve their weight-related health behaviors, and they differed by gender. Findings support the need for gender-tailored interventions in this population., (Copyright © 2013 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Objective: To develop and test the validity of the Behavior, Environment, and Changeability Survey (BECS) for identifying the importance and changeability of nutrition, exercise, and stress management behavior and related aspects of the environment., Design: A cross-sectional, online survey of the BECS and selected validated instruments., Setting: Ten state universities., Participants: A convenience sample of college students (n = 1,283), ages 18-24 years., Analysis: Principal component analysis was used to confirm a 6-component structure of the BECS in 2 independent samples for the purpose of cross-validation. Internal consistency was measured and construct and criterion-related analyses were conducted to test the reliability and validity of the BECS subscales., Results: Six components representing 34 BECS items were revealed from the original 69 items and explained 64% of the total variance. Six scales were retained, and internal consistency of each ranged from α = .82 to .93. BECS Nutrition Behavior and Nutrition Changeability scale scores were highest for participants in action/maintenance Stages of Change for fruit and vegetable intake., Conclusions and Implications: There is strong support for the use of the BECS when planning health programs to gain insight into behavior that young adults are willing to improve, specifically related to nutrition, exercise, and sleep., (Copyright © 2012 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Estrogen non-responsive estrogen receptor alpha (ERalpha) knock-in (ENERKI) mice have a mutation (glycine 525 to leucine, G525L) in the ligand-binding domain of ERalpha. The mutant ERalpha protein has a significantly lower affinity and response to endogenous estrogens, while not altering growth factor activated ligand-independent pathways. ENERKI females demonstrated signs of early follicle development as determined by a significant increase in antral follicle formation by 20 days of age. Adult ENERKI females were infertile, had hemorrhagic ovarian follicular cysts, and failed to develop corpora lutea in response to a superovulation regimen. These results illustrate the importance of ERalpha ligand-induced signaling for ovarian development and for estrogen feedback on the hypothalamus and pituitary. Although ERalpha ligand-induced signaling by endogenous estrogens is lost in ENERKI females, the ERalpha selective agonist propyl pyrazole triol (PPT), a synthetic nonsteroidal compound, is still able to activate G525L ERalphain vivo to increase uterine weight. To test whether PPT could restore ligand-dependent receptor activation, ENERKI females were treated with PPT and evaluated for spontaneous ovulation, ovarian hemorrhagic cysts, and LH serum levels. Daily PPT treatments beginning on day 4 of life prevented formation of ovarian hemorrhagic cysts in adult ENERKI animals. In accordance with this result, preputial gland weight and LH levels were also lowered in these animals, indicating PPT treatments most likely led to restoration of ERalpha negative feedback of the hypothalamic-pituitary axis.

Objective: Evaluate a theory-based, Internet-delivered nutrition education module., Design: Randomized, treatment-control design with pre-post intervention assessments., Setting and Participants: Convenience sample of 160 young adults (aged 18-24) recruited by community educators in 4 states. Study completers (n = 96) included a mix of racial/ethnic groups and family demographics, but were predominately white females without children., Intervention: A Transtheoretical Model (TTM)-based, stage-tailored Internet program, F&V (Fruit & Vegetable) Express Bites, was delivered to treatment group participants; controls received nontailored messages in a comparable format. MAIN OUTCOME MEASURES AND ANALYSIS: TTM constructs at baseline, immediately postviewing, and at 30-day follow-up were compared via chi-square, McNemar's test, and logistic regression. Qualitative use and acceptability indicators were collected postviewing (treatment only)., Results: Of baseline respondents, 86.5% completed the study. At follow-up, self-efficacy, decisional balance, and selected processes improved for both groups, with only marginal advantages for the theory-based version. Fruit and vegetable consumption changes were similar for both groups. Qualitative measures of knowledge, confidence, and motivation improved (not measured for controls). Favorable ratings of treatment program acceptability and personal relevance were reported., Conclusions and Implications: The Internet is a favorable option for reaching young adults with nutrition messages. This study did not identify strong advantages of theory-based tailoring, especially for fruit consumption, which had weaker barriers than vegetable consumption among this target audience.

Objective: To identify strengths and weaknesses of nutrition education via telephone calls as part of a larger stage-of-change tailored intervention with mailed materials., Design: Evaluative feedback was elicited from educators who placed the calls and respondents who received the calls., Setting: An internet and telephone survey of 10 states in the midwestern United States., Participants: 21 educators in 10 states reached via the internet and 50 young adults reached via telephone. VARIABLES MEASURED AND ANALYSIS: Rankings of intervention components, ratings of key aspects of educational calls, and cost data (as provided by a lead researcher in each state) were summarized via descriptive statistics. RESULTS, CONCLUSIONS, AND IMPLICATIONS: Educational calls used 6 to 17 minutes of preparation time, required 8 to 15 minutes of contact time, and had a mean estimated cost of $5.82 per call. Low-income young adults favored print materials over educational calls. However, the calls were reported to have positive effects on motivating participants to set goals. Educators who use educational telephone calls to reach young adults, a highly mobile target audience, may require a robust and flexible contact plan.

There are limited reports of human overdose with the animal tranquilizer, xylazine hydrochloride. The reported effects include hypotension, bradycardia, and respiratory depression. Ocular exposures to xylazine have not been previously reported. A 38-year-old man arrived in the Emergency Department, reporting the accidental irrigation of both eyes with approximately 8 mL of xylazine (100 mg/mL) 30 min before arrival. The patient was asymptomatic. The eyes were copiously irrigated with isotonic crystalloid. Two hours after the exposure, the patient developed sinus bradycardia (40-50 beats/min), hypotension (90/60 mm Hg), and a decreased level of consciousness. The patient was admitted for observation, during which the bradycardia and hypotension were noted to persist. He remained otherwise asymptomatic. The symptoms resolved without intervention, other than i.v. fluids, approximately 25 h after the exposure. The patient was discharged home. This case demonstrates that ocular exposure to xylazine can cause systemic central nervous system and cardiovascular effects.

Bupropion is an antidepressant that has recently seen increased usage in smoking cessation. This increased usage, along with its potential for causing seizures, has renewed interest among clinicians about the effects of this drug. The purpose of this study is to describe the clinical course of intentional bupropion overdoses in adults and adolescents. This study is a retrospective review of intentional bupropion overdoses reported to regional poison centers over a 2-year period. Our review included 385 cases. Women accounted for 63% of cases and ages ranged from 12 to 57 years. Significant clinical effects were noted in 26% of cases. Seizures were reported in 11% of patients. Seizures occurred within 6 h in most patients. Other prominent effects included tachycardia, agitation, and hallucinations. In conclusion, after a bupropion overdose, patients frequently display agitation, tachycardia, hallucinations and seizures. Seizures commonly occur within 6 h of the ingestion. However, seizures may occur beyond this time frame, particularly if persistent tachycardia, agitation, or hallucinations are noted.

This study determined whether psychosocial, weight satisfaction, and dietary pattern variables discriminate between the Stages of Change for fruit and vegetable intakes among young men and women. A random sample of 18 to 24 year-olds, from 10 states returned 1438 surveys. Discriminant analyses for fruit intake conveyed that between precontemplation and contemplation/preparation, pro-scores and self-efficacy predicted the men's but not women's stages. Between contemplation/preparation and action/maintenance, self-efficacy and breakfast consumption best predicted stage for women, whereas men were discriminated only by self-efficacy. Discriminant analyses for vegetable intake were similar by gender. Precontemplation and contemplation/preparation were discriminated by pro-score and staging into contemplation/preparation versus action/maintenance was best predicted by self-efficacy and weight satisfaction. Young men and women are at different places in the Stages of Change process and few are meeting the vegetable guidelines. Dietary interventions can be most effective if specifically tailored to food group, stage, and gender.

To identify candidate genes, chicken lines with the most divergent phenotypes are usually crossed to generate resource mapping populations, for example, either backcrossed or F2 populations. Linkage between the genetic marker and the phenotypic trait locus is then tested in the mapping population. As an initial step in the development of a mapping population from commercial broilers, the goal of the current research was to evaluate the phenotypic variation among three pure lines for antibody response to SRBC and in resistance to two economically important poultry diseases, Marek's disease (MD) and coccidiosis (Eimeria acervulina). Chicks from each line were received and separated into three experimental studies to evaluate each of their responses. In summary, broiler Line 3 had significantly lower antibody responses to SRBC immunizations compared to the other two lines, and nonvaccinated birds from Line 3 were also more susceptible to MD. With coccidiosis, the response was complex, and ranking of the lines was dependent on the age of infection, and whether it was a first or second challenge. With the first challenge, Line 1 was most susceptible at the younger age (Day 30), whereas Line 3 was susceptible at the older age (Day 58). Upon the second challenge, broiler Line 1 remained susceptible at the younger age, but Line 2 was more susceptible at the older age. Line 3 was completely resistant to the second challenge at the older age. Thus, although the broiler lines have been intensively selected for productivity and general livability, this study also demonstrates that the lines differ for immune response and disease resistance. Based on the phenotypic differences between Lines 1 and 3, they were chosen to establish a mapping population for identifying candidate genes that affect MD and coccidiosis in commercial broiler chickens.

Objective: To test the validity of staging methodology for dietary fat reduction by examining cognitive profiles of persons classified in these groups: precontemplation, lowerfat maintenance (< or = 30% of energy as fat), and higher-fat maintenance (> 30% of energy as fat)., Design: Cross-sectional survey of a random sample of 491 women residing in Guelph, Ontario, Canada, recruited by telephone., Setting/subjects: Mean age of subjects was 43.7 +/- 12.2 years. The majority (58%) lived with a spouse or partner and had completed high school (68%)., Statistical Analyses: Multivariate analysis of variance was used to compare the pros and cons of lower-fat eating, level of self-efficacy in avoiding high-fat foods, and use of 9 processes of change to support lower-fat eating habits in women assigned to the precontemplation, higher-fat, and lower-fat maintenance stages., Results: When compared with subjects classified in the precontemplation stage, the 2 groups of subjects in the maintenance stage had higher ratings of the pros (49.7 +/- 9.5 vs 43.7 +/- 7.2, P < .05), lower ratings of the cons (47.2 +/- 8.2 vs 51.9 +/- 11.8, P < .05), higher self-efficacy scores, and more frequent use of processes of change than subjects classified in the precontemplation stage. No differences between women in the 2 maintenance groups were observed in self-efficacy; however, those in the lower-fat maintenance group reported lower cons than those in the higher-fat maintenance group (46.2 +/- 7.2 vs 48.2 +/- 9.1, P < .05) and more frequent use of all processes of change., Conclusions/applications: Stage of change for dietary fat reduction is a cognitive variable that provides insights into attitudes about and motivations to consume lower-fat foods.

Objective: To describe the stages of change that take place over 18 months, using the criterion of fat intake < or = 30% of total energy to define effective action and to investigate the effect of a single dietary feedback report on dietary fat reduction., Design: Subjects were randomly assigned to experimental or control conditions and assessed at 0, 6, 12, and 18 months for fat intake and stage of change. Subjects in the experiment group received 1 feedback report at baseline; all subjects received a report at 12 months., Subjects: Potential subjects (n = 614) were recruited by mail from a random sample of nonsmoking adults (32% response rate). Subjects were excluded if consuming < or = 30% of energy from fat or if pregnant or lactating (n = 145). Although 83% of subjects (n = 389) completed the 18-month study, only 296 provided complete data for all time points. The study was restricted to these 296., Intervention: Dietary feedback reports plus brief educational materials were provided following the experiment design., Analyses: Repeated measures analysis of variance with fat intake (percent of energy from fat) as the dependent variable and baseline stage and condition as independent variables. In addition, t tests were used to compare groups at specific time points., Results: There was a main effect for time (F3,286 = 39, P < .0001) and baseline stage (F3,286 = 24, P < .0001), but no effect of feedback. There was a time-by-feedback interaction (F4,286 = 4.7, P < .01). There was a short-term effect of feedback over 6 months (t = 3.8, P < .001), but this effect was not significant at other time points. About 9% to 12% of subjects in the precontemplation or contemplation stages, 24% of subjects in the preparation stage, and 40% of unclassified subjects at baseline progressed to the action stage by 18 months. Between 12 and 18 months, subjects progressing at least 1 stage reduced their fat intake to a greater extent than subjects who failed to progress (t = 5.1, P < .0001)., Implications: Interventions targeted to stage of change have the potential for accelerating the rate of change for dietary fat reduction, but reaching the goal of fat intake < or = 30% of total energy may require more intensive interventions than a single dietary feedback report.

The purpose of this study was to determine whether the expression level of several metastasis-regulating genes correlates with the metastatic potential of human prostate cancer cells implanted into the prostate of nude mice. The steady-state mRNA expression levels for epidermal growth factor receptor (EGFR; growth), basic fibroblast growth factor (bFGF) and interleukin (IL)-8 (angiogenesis), 72-kd and 92-kd type IV collagenase (invasion), E-cadherin (adhesion), and multidrug resistance (mdr-1; drug resistance) were measured by Northern blot and colorimetric in situ hybridization techniques in human PC-3M cells and selected cell variants with different metastatic potentials. Highly metastatic cells growing in culture constitutively and uniformly expressed higher levels of bFGF, IL-8, type IV collagenase, and mdr-1 mRNA transcripts than parental PC-3M cells or low metastatic cells, which displayed a heterogeneous pattern of gene expression. Human prostate cancer cells implanted in nude mice at an ectopic site (subcutaneous) expressed lower levels of EGFR, mdr-1, bFGF, IL-8, and collagenase type IV than those implanted in an orthotopic site (prostate), indicating that the expression of these genes was dependent on the organ environment. Highly metastatic cells growing in the prostate expressed higher levels of EGFR, bFGF, type IV collagenase, and mdr-1 mRNA than low metastatic parental cells in the same site. These data demonstrate a direct correlation between the expression of several metastasis-related genes and the metastatic potential of human prostate cancer cells in nude mice and suggest that multiparametric in situ hybridization analyses can be used to identify the metastatic potential of individual patients' prostate cancers.

We examined the expression level of several genes that regulate different steps of metastasis in formalin-fixed, paraffin-embedded archival specimens of primary human colon carcinomas from patients with at least 5 years of follow-up. The expression of epidermal growth factor receptor, basic fibroblast growth factor, type IV collagenase, E-cadherin, and multidrug resistance (mdr-1) was examined by a colorimetric in situ mRNA hybridization technique concentrating on reactivity at the periphery of the neoplasms. The in situ hybridization technique revealed inter- and intratumor heterogeneity for expression of the metastasis-related genes. The expression of basic fibroblast growth factor, collagenase type IV, epidermal growth factor receptor, and mdr-1 mRNA was higher in Dukes's stage D than in Dukes' stage B tumors. Among the 22 Dukes' stage B neoplasms, 5 specimens exhibited a high expression level of epidermal growth factor receptor, basic fibroblast growth factor, and collagenase type IV. Clinical outcome data (5-year follow-up) revealed that all 5 patients with Dukes' stage B tumors developed distant metastasis (recurrent disease), whereas the other 17 patients with Dukes' stage B tumors expressing low levels of the metastasis-related genes were disease-free. Multivariate analysis identified high levels of expression of collagenase type IV and low levels of expression of E-cadherin as independent factors significantly associated with metastasis or recurrent disease. More specifically, metastatic or recurrent disease was associated with a high ratio (> 1.35) of expression of collagenase type IV to E-cadherin (specificity of 95%). Collectively, the data show that multiparametric in situ hybridization analysis for several metastasis-related genes may predict the metastatic potential, and hence the clinical outcome, of individual lymph-node-negative human colon cancers.

Pneumococcal meningitis is a common infection in adults for which penicillin has long been the drug of choice. Optimal treatment has recently become controversial, however, owing to an alarming increase in the number of penicillin-resistant isolates. The authors report a representative case of meningitis caused by such an organism, and provide a discussion of the history, mechanisms of resistance, laboratory evaluation, and treatment of these infections. Guidelines for prevention are also reviewed, including a renewed call for utilization of the 23-valent pneumococcal vaccine.

Objective: To develop an algorithm that defines a person's stage of change for fat intake < or = 30% of energy. The Stages of Change Model describes when and how people change problem behaviors; change is defined as a dynamic variable with five discrete stages., Design: A stage of change algorithm for determining dietary fat intake < or = 30% of energy was developed using one sample and was validated using a second sample., Subjects: Sample 1 was a random sample of 614 adults who responded to mailed questionnaires. Sample 2 was a convenience sample of 130 faculty, staff, and graduate students., Statistics: Subjects in sample 1 were initially classified in a stage of change using an algorithm based on their behavior related to avoiding high-fat foods. Dietary markers were selected for a Behavioral algorithm using logistic regression analyses. Sensitivity, specificity, and predictive value of the Behavioral algorithm were determined, then compared between samples using the Z test., Results: The following dietary markers predicted intake < or = 30% of fat (chi 2 = 131; P < .0001): low-fat cheese, breads without added fat, chicken without skin, low-calorie salad dressing, and vegetables for snacks. The specificity of the Behavioral algorithm was validated; the algorithm classified subjects consuming > 30% of energy from fat with 93% specificity in sample 1 and 87% in sample 2 (Z = 1.36; P > .05). Predictive value was also validated; 64% and 58% of subjects meeting the behavioral criteria had fat intakes < or = 30% of energy (Z = 1.1; P > .05). The algorithm was not sensitive, however; most subjects with fat intakes < or = 30% of energy from fat failed to meet the behavioral criteria. The sensitivity differed between samples 1 and 2 (44% and 27%, respectively; Z = 3.84; P < .0001)., Applications: The Behavioral algorithm determines stage of change for fat reduction to < or = 30% of energy in populations with high fat intakes. The algorithm could be used in dietary counseling to tailor interventions to a patient's stage of change.

Three hundred ninety-six employees of a large northeastern university participated in a blood cholesterol screening and provided follow-up data about their participation in a videotape cholesterol education program. Ten percent of these employees watched the videotape program; these individuals were significantly more likely to be at high risk for cardiovascular disease than were persons who chose not to watch the videotape. Persons participating in the cholesterol education program significantly increased their nutrition knowledge and significantly decreased their fat intake compared with nonparticipants. The most important reason given for watching the videotape was "concern about my cholesterol level." Reasons given for not watching the videotape were that it was "not well advertised" or that it was shown "at an inconvenient time." Although all 98 employees at high risk for cardiovascular disease were referred to their physicians for diagnostic evaluation, one third of these employees reported not seeing their physicians. These findings indicate that worksite cholesterol screening and education programs can improve nutrition knowledge and dietary behavior; however, these programs should develop strategies to increase participation and should follow up physician referrals.

A parent-child autotutorial dietary education program for 4- to 10-year-old, hypercholesterolemic children and their families was developed and pilot tested. The 10-lesson program, designed for weekly use at home, uses a "talking-book" approach (audiotapes with accompanying picture booklet) for the child. Parents are provided with information on ways to make recommended dietary changes, along with hands-on activities to do with the children. To help match the instructional approach to the wide developmental range within the children's age span, materials are divided into three program levels that use different story characters and concept presentations. During program development, evaluation by two children (and their parents) for each of the program levels guided the design and refinement of the lessons. A pilot test among 22 hypercholesterolemic children (whose treatment was limited to diet modification) revealed that children within the 4- to 10-year age range liked the "talking-book" approach and identified positively with the story characters. Parents indicated that their materials were clear and helpful. Between the baseline and 3-month follow-up visits, the children exhibited a significant increase in knowledge of heart healthy foods, a decrease in total fat consumption that approached significance, and a significant decrease in plasma low-density-lipoprotein cholesterol values.

A written case study--or patient management problem--was used to examine how the nutrition care planning process is influenced by increasing clinical experience. The sample consisted of 45 students in diet therapy courses, 46 dietetic interns, and 44 experienced clinical or generalist dietitians. The patient management problem tested data gathering, with sections containing information needed to assess nutritional status, and nutrition care planning, in which subjects identified and evaluated problems and selected short- and long-term goals. Performance was scored by comparing subjects' answers with those of five dietetic experts. Dietitians scored highest and students scored lowest on efficiency of data gathering. Dietitians and interns scored higher than students on proficiency of data gathering and nutrition care planning. Overall, dietitians and interns performed better than students. Only in tasks requiring the highest levels of information processing and/or confidence in clinical judgment were differences between dietitians and interns consistently found. These findings demonstrate that basic nutrition care planning skills are acquired during dietetic internships, but advanced skills are added with clinical experience.

We describe here a modification of the spot ELISA assay for the detection and enumeration of antibody-secreting cells. The modification increases sensitivity, convenience and simplicity while optimizing parameters of time, temperature and reagents. Laboratory reagents and 96 well microtiter plates commonly used for the standard ELISA assay are adapted for use in the spot ELISA assay. Special emphasis is placed on the detection of anti-hapten IgM or IgG production by splenocytes in response to stimulation by a range of doses of antigen. In addition, two procedures are described whereby the spot ELISA assay is altered to yield a measurable optical density: (1) the blue precipitate obtained in the spot ELISA assay is dissolved and the optical density of the resultant blue color is measured, and (2) a standard ELISA substrate is substituted for the spot ELISA substrate to yield a colored solution rather than a precipitate. Both of these are shown to correlate with spot numbers and can therefore supplement or substitute for the enumeration of spots (produced by antibody-secreting cells), thus speeding and mechanizing the assay.

Client perceptions of students enrolled in a nutrition counseling practicum were compared with client perceptions of those students' clinical instructors, who were registered dietitians. One hundred forty-two clients who had either a student (no. = 81) or a dietitian (no. = 61) as primary counselor completed a postcard evaluation or a telephone interview. Students were rated significantly more positively (p less than .01) than their instructors for the item "I would recommend the clinic to others" and (p less than .05) for the items "The counselor helped me with my problem" and "I learned at the clinic what I did not know before." Seventy-two of the 89 clients interviewed by telephone replied to the question "Did students enhance or detract from services provided?" Sixty-one percent replied that students enhanced, but 25% replied that students detracted in some way, primarily because of concerns about having an additional observer during counseling sessions. In general, clients receiving nutrition counseling evaluated student dietitians very positively.

Two monoclonal antibodies to the human progesterone receptor (PR), JZB39 and KD68, were used in determining the immunohistochemical distribution of PR in the human endometrium throughout the menstrual cycle and after menopause. These antibodies recognized PR, as demonstrated by a downfield shift in the radiolabeled progestin binding peak when KD68 or JZB39 was added to high salt sucrose density gradients. The specificity of both antibodies for PR was confirmed with Western immunoblots and competition studies performed with purified receptor. Progesterone receptor was identified with these antibodies and the peroxidase-antiperoxidase technique in the nuclei of epithelial cells, stromal cells, and myometrial smooth muscle cells. The receptor content of endometrial epithelium and stroma varied with the menstrual cycle. The variation was most marked in the epithelium, which demonstrated very strong PR immunostaining during the proliferative phase and postovulation Days 1-3 of the early secretory phase, but PR immunostaining decreased sharply at postovulation Day 4 and remained relatively weak or absent during the mid and late secretory phase. In contrast, stromal cell nuclei were moderately to strongly immunostained even during the secretory phase. Progesterone receptor was not localized in vascular smooth muscle cells or endothelial cells. Specific cytoplasmic staining for PR was not identified in any of these cases, even prior to ovulation, when circulating levels of progesterone are low, indicating that both the steroid-occupied and -unoccupied forms of human progesterone receptor, like rabbit and guinea pig PR, and estrogen receptor, is a nuclear protein.