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Summary: Patients with cancer are at increased risk of death from COVID-19 and have reduced immune responses to SARS-CoV2 vaccines, necessitating regular boosters. We performed comprehensive chart reviews, surveys of patients attitudes, serology for SARS-CoV-2 antibodies and T cell receptor (TCR) β sequencing for cellular responses on a cohort of 982 cancer patients receiving active cancer therapy accrued between November-3-2020 and Mar-31-2023. We found that 92 · 3% of patients received the primer vaccine, 70 · 8% received one monovalent booster, but only 30 · 1% received a bivalent booster. Booster uptake was lower under age 50, and among African American or Hispanic patients. Nearly all patients seroconverted after 2+ booster vaccinations (>99%) and improved cellular responses, demonstrating that repeated boosters could overcome poor response to vaccination. Receipt of booster vaccinations was associated with a lower risk of all-cause mortality (HR = 0 · 61, p = 0 · 024). Booster uptake in high-risk cancer patients remains low and strategies to encourage booster uptake are needed.

Purpose: Spinal injuries resulting in neurological damage cause significant morbidity. Swift neurosurgical intervention can mitigate negative outcomes. However, variable mechanisms of injury may be associated with inappropriate transport (IAT), which may delay necessary surgical interventions. Patients with near shore spinal injuries (NSSI) presented with unique mechanisms, so we investigated factors associated with IAT in patients with NSSI. Methods: We performed a multicenter retrospective study of all adult patients transported from a beach resort to 3 hospitals for suspected NSSI between 2006 - 2017. We excluded patients transferred to other facilities, and those not injured in the water. Primary outcome was IAT, defined as patients with NSSI requiring transfer to another trauma center. To avoid heterogeneity in our analysis, we further excluded patients without NSSI who were inappropriately transported to a level I trauma center. We used multivariable logistic regression to assess association of independent variables (such as demographic, environmental, and clinical factors) with outcome. Results: We analyzed 278 patients with suspected NSSI, and found 14 (5.0%) had IAT. Compared to appropriately transported patients, diving was associated with higher percentages of IAT (28.6% vs. 3.9%, p = 0.014) and more were transported by air (50.0% vs. 20.6%, p = 0.01). In multivariable regression, patients’ oxygenation saturation (odds ratio [OR] = 0.8, 95% confidence intervals [CI]: 077–0.98) and diving (OR = 7.5, 95% CI: 1.2–46) were significantly associated with IAT. Conclusion: Rate of IAT for patients with NSSI was low. However, first responders and emergency medicine providers should be aware that diving is associated with a higher likelihood of IAT.

We believe these recommendations constitute "minimum requirements" for health care organizations to move toward greater health equity. As health systems, standards-setting organizations, national and private purchaser organizations, and thought leaders, we represent organizations in the health care ecosystem that can both advise on strategies for adopting the recommendations and have the power and leverage to cause their implementation. We commit individually and collectively to use our leverage to propel their implementation at our own institutions and across the county. We very much hope others will join us., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Co-author serves as editor-in-chief for the journal to which article is being submitted, Sachin Jain., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Wastewater-based epidemiology (WBE) has been deployed broadly as an early warning tool for emerging COVID-19 outbreaks. WBE can inform targeted interventions and identify communities with high transmission, enabling quick and effective responses. As the wastewater (WW) becomes an increasingly important indicator for COVID-19 transmission, more robust methods and metrics are needed to guide public health decision-making. This research aimed to develop and implement a mathematical framework to infer incident cases of COVID-19 from SARS-CoV-2 levels measured in WW. We propose a classification scheme to assess the adequacy of model training periods based on clinical testing rates and assess the sensitivity of model predictions to training periods. A testing period is classified as adequate when the rate of change in testing is greater than the rate of change in cases. We present a Bayesian deconvolution and linear regression model to estimate COVID-19 cases from WW data. The effective reproductive number is estimated from reconstructed cases using WW. The proposed modeling framework was applied to three Northern California communities served by distinct WW treatment plants. The results showed that training periods with adequate testing are essential to provide accurate projections of COVID-19 incidence., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background Aims: The targeting of solid cancers with chimeric antigen receptor (CAR) T cells faces many technological hurdles, including selection of optimal target antigens. Promising pre-clinical and clinical data of CAR T-cell activity have emerged from targeting surface antigens such as GD2 and B7H3 in childhood cancer neuroblastoma. Anaplastic lymphoma kinase (ALK) is expressed in a majority of neuroblastomas at low antigen density but is largely absent from healthy tissues., Methods: To explore an alternate target antigen for neuroblastoma CAR T-cell therapy, the authors generated and screened a single-chain variable fragment library targeting ALK extracellular domain to make a panel of new anti-ALK CAR T-cell constructs., Results: A lead novel CAR T-cell construct was capable of specific cytotoxicity against neuroblastoma cells expressing low levels of ALK, but with only weak cytokine and proliferative T-cell responses. To explore strategies for amplifying ALK CAR T cells, the authors generated a co-CAR approach in which T cells received signal 1 from a first-generation ALK construct and signal 2 from anti-B7H3 or GD2 chimeric co-stimulatory receptors. The co-CAR approach successfully demonstrated the ability to avoid targeting single-antigen-positive targets as a strategy for mitigating on-target off-tumor toxicity., Conclusions: These data provide further proof of concept for ALK as a neuroblastoma CAR T-cell target., Competing Interests: Declaration of Competing Interest The authors have no commercial, proprietary or financial interest in the products or companies described in this article., (Copyright © 2022 International Society for Cell & Gene Therapy. Published by Elsevier Inc. All rights reserved.)

A fundamental question in functional brain development is how the brain acquires specialised processing optimised for its individual environment. The current study is the first to demonstrate that distinct experience of eye gaze communication, due to the visual impairment of a parent, affects the specificity of brain responses to dynamic gaze shifts in infants. Event-related potentials (ERPs) from 6 to 10 months old sighted infants with blind parents (SIBP group) and control infants with sighted parents (CTRL group) were recorded while they observed a face with gaze shifting Toward or Away from them. Unlike the CTRL group, ERPs of the SIBP group did not differentiate between the two directions of gaze shift. Thus, selective brain responses to perceived gaze shifts in infants may depend on their eye gaze communication experience with the primary caregiver. This finding highlights the critical role of early communicative experience in the emerging functional specialisation of the human brain., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: In sub-Saharan Africa, there are no validated screening tools for delirium in older adults. This study assesses clinical utility of two instruments, the IDEA cognitive screen and the Confusion Assessment Method (CAM) for identification of delirium in older adults admitted to medical wards of a tertiary referral hospital in Tanzania., Method: The IDEA cognitive screen and CAM were administered to a consecutive cohort of older individuals on admission to Kilimanjaro Christian Medical Centre using a blinded protocol. Consensus diagnosis for delirium was established against DSM-5 criteria and dementia by DSM-IV criteria., Results: Of 507 admission assessments, 95 (18.7%) had DSM-5 delirium and 95 (18.7%) had DSM-IV dementia (33 (6.5%) delirium superimposed on dementia). The CAM and IDEA cognitive screen had very good diagnostic accuracy for delirium (AUROC curve 0.94 and 0.87 respectively). However, a number of participants (10.5% and 16.4% respectively) were unable to complete these screening assessments due to reduced consciousness, or other causes of reduced verbal response and were excluded from this analysis; many of whom met DSM-5 criteria for delirium. Secondary analysis suggests that selected cognitive and observational items from the CAM and IDEA cognitive screen may be as effective as the full screening tools in identifying delirium even in unresponsive patients., Conclusion: Both instruments appeared useful for delirium screening in this inpatient setting, but had significant limitations. The combination of assessment items identified may form the basis of a brief, simple delirium screening tool suitable for use by non-specialist clinicians. Further development work is needed., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Polymorphisms in the MUC5B promoter, TOLLIP, and nine additional genetic loci have been associated with idiopathic pulmonary fibrosis (IPF) within non-Hispanic white populations. It is unknown whether these variants account for risk of IPF in other racial/ethnic populations. We conducted a candidate single nucleotide polymorphism (SNP) association study in cohorts of Mexican and Korean patients with IPF., Methods: We chose 12 SNPs from 11 loci that are associated with IPF among non-Hispanic whites and genotyped these SNPs in cohorts of Mexican (83 patients, 111 control subjects) and Korean (239 patients, 87 control subjects) people. Each SNP was tested for association with IPF, after adjusting for age and sex., Results: The MUC5B promoter SNP rs35705950 was associated with IPF in the Mexican (OR = 7.36, P = .0001), but not the Korean (P = .99) cohort. The SNP in IVD (chromosome15, rs2034650) was significantly associated with pulmonary fibrosis in both the Mexican (OR = 0.40, P = .01) and Korean (OR = 0.13, P = .0008) cohorts. In the Korean cohort, there were no other variants associated with disease. In the Mexican cohort, SNPs on chromosomes 3, 4, and 11 were also associated with disease., Conclusions: The strongest identified genetic risk factor for IPF among the non-Hispanic white population, the MUC5B promoter polymorphism, is also a strong risk factor in a Mexican population, but is very rare in a Korean population. The majority of genetic variants that account for risk of IPF in groups other than non-Hispanic whites are unknown. Hispanic and Asian populations should be studied separately to identify genetic risk loci for IPF.

Objective: To measure the feasibility, safety, and efficacy of the cranial cup device in a sample of hospitalized infants at risk for deformational plagiocephaly (DP)., Design: A multisite, stratified, and randomized single-blinded study., Setting: Neonatal intensive care units (NICU) from three urban and one suburban hospital participated., Participants: Subjects included 62 infants with lengths of stay ≥ 14 days., Methods: Nurses caring for infants in study group 1 used the moldable positioner. In study group 2, nurses rotated the moldable positioner and cranial cup devices using the cranial cup for a target goal of 12 hours/day. Both study groups received routine position changes. Outcome measures included hours of device use (feasibility), cardiorespiratory and emesis events (safety), and cranial measurements obtained at discharge (efficacy) by one of four, licensed orthotists who were blinded to the study., Results: A total of 35 infants were randomized to study group 1 (moldable positioner) and 27 infants to study group 2 (moldable positioner and cranial cup). The median hours per day on the cranial cup was 10.7 (range 4.5-15.3). Emesis and cardiorespiratory events were equally distributed for the moldable positioner and cranial cup devices in study group 2. At discharge, more infants in study group 1 (46%, n = 16) exhibited abnormal cranial measurements than those in study group 2 (19%, n = 5) (p = .03)., Conclusion: Rotating the cranial cup with the moldable positioner provides a feasible, safe, and potentially efficacious therapy for prevention of DP., (© 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Improving immune status in neonates is crucial to health and production. Gut active carbohydrates (GAC) have been associated with increasing immunoglobin levels and immonucompetence development in mammals. The objective of the following studies was to evaluate whether GAC (mannan-oligosaccharides) applied orally to progeny immediately following parturition, improved blood plasma immunoglobulin (Ig) type G concentrations in piglets and calves. Three trials were conducted comparing control groups with those receiving GAC orally. The first two trials used piglets that were monitored for blood IgG at 2 days of age and for changes in body weight (BW), and the third trial monitored calf IgG from birth to 21 days of age. Piglets in the experimental group received 0.75 g GAC in 10 ml saline at birth and 24 h of age. The calf trial compared the control group against calves that received 22.5 g GAC mixed into 4.5 l of colostrum (to give 5 g/l) in the first 24 h after parturition. Blood serum samples were taken at 2 days post partum in piglets, and at several time points from 6 h to 21 days of age in calves, and were analysed for IgG levels by radial immunodiffusion. In the first piglet trial, significantly higher levels (32%) of IgG were observed for piglets fed GAC (P < 0.001), and in the second, IgG concentration was elevated by 23% (P < 0.01) and BW increased by 9% (P = 0.023) with GAC supplementation. Significant improvements for calves were recorded at all time points in those fed GAC (P < 0.05), with an increase in serum IgG observed after the first day, which was maintained throughout the sampling period, resulting in a difference of 39% at the end of the trial (21 d). These findings form a basis for further studies, which are required to investigate possible modes of action involved in enhancing blood immunoglobulin concentrations in young animals, and the longer-term effects this may have on the development of the immune response.

Background: Studies of infant siblings of children diagnosed with autism have allowed for a prospective approach to study the emergence of autism in infancy and revealed early behavioral characteristics of the broader autism phenotype. In view of previous findings of atypical eye gaze processing in children and adults with autism, the aim of this study was to examine the early autism phenotype in infant siblings of children diagnosed with autism spectrum disorder (sib-ASD), focusing on the neural correlates of direct compared with averted gaze., Methods: A group of 19 sib-ASD was compared with 17 control infants with no family history of ASD (mean age=10 months) on their response to direct versus averted gaze in static stimuli., Results: Relative to the control group, the sib-ASD group showed prolonged latency of the occipital P400 event-related potentials component in response to direct gaze, but they did not differ in earlier components. Similarly, time-frequency analysis of high-frequency oscillatory activity in the gamma band showed group differences in response to direct gaze, where induced gamma activity was late and less persistent over the right temporal region in the sib-ASD group., Conclusion: This study suggests that a broader autism phenotype, which includes an atypical response to direct gaze, is manifest early in infancy.

Using a sample of college-aged men, we evaluated the validity of a staging algorithm for dairy calcium intake that had been previously validated in a sample of college women. College-aged men enrolled at a private university in the United States were randomly selected to participate. The sample consisted of 180 male participants. Self-reported calcium intake was measured using a 26-item food frequency questionnaire. Stages of change classifications were based on a four-question algorithm for dairy calcium intake and a three-item self-efficacy questionnaire. Significant differences were found between dairy/calcium intake levels between pre-contemplation, contemplation/preparation, and action/maintenance groups. Results also showed that 46% of participants were in the action/maintenance stage. There was a significant difference in self-efficacy between members of the pre-action and action stages. The study suggests that this stage of change algorithm for dairy calcium intake is valid for use in a male college student population.

Objective: The purpose of this study was to evaluate the effectiveness of the Society of Pelvic Reconstructive Surgeons guidelines for the determination of the route of hysterectomy in a resident clinic population., Study Design: A total of 407 consecutive women from the resident clinic population at Wright State University between October 1, 1994, and December 31, 1999, were assigned prospectively to abdominal or vaginal hysterectomy groups according to Society of Pelvic Reconstructive Surgeons guidelines. The women's age, race, and preoperative and postoperative uterine weights, length of stay, laparoscopic scores, operative time, and complications were compared., Results: Vaginal hysterectomy was completed successfully in 91.8% of the women. As expected, vaginal hysterectomy required the shortest operative time and length of stay and was associated with fewer complications than the abdominal approach (P <.01). Laparoscopic assistance was necessary in 25.8% of patients to assess extrauterine disease., Conclusion: Resident physicians who followed the practice guidelines reduced the ratio of abdominal-to-vaginal hysterectomy from 3:1 to 1:11. The application of practice guidelines for the selection of the route of hysterectomy can increase the ratio of vaginal hysterectomies that are performed in residency programs and can help eradicate inconsistencies in health care delivery that exist currently.

Fecal samples were collected from 4,361 dairy cows on 91 dairy operations between 26 February and 8 July 1996. Fecal samples were cultured for Escherichia coli O157, and positive isolates were probed for verotoxin-producing genes. A total of 52 (1.2%) fecal samples on 22 (24.2%) operations were positive for verotoxin-producing E. coli O157. Herds in which samples were collected on or after 1 May 1996 were significantly more likely to test positive than herds sampled before that date (odds ratio = 7.7). Herds maintained on farms on which alleyways were flushed with water to remove manure were 8.0 times more likely to have samples test positive for verotoxin-producing E. coli O157 than were herds maintained on farms cleaned by use of other methods of manure removal.

Neural correlates of saccade planning in 6-month-old infants were investigated by high-density event-related potentials. Subjects made saccades to a target stimulus following a time gap from fixation stimulus offset (gap trials) or with the fixation stimulus still present (overlap trials). Like adults, infants were slower to make a saccade to the target when the fixation stimulus was still present. Strikingly, infants did not show clear evidence of the pre-saccadic components observed in adults which are thought to reflect cortical saccade planning processes. They did, however, show a left frontal positivity, which we suggest reflects cortical disinhibition of the colliculus initiated by fixation stimulus offset, and clear post-saccadic lambda waves. These results indicate that the frontal cortex already plays a role in action control by 6 months of age, while other aspects of cortical action planning may not yet be present in certain task situations.

Objective: To ascertain the association between diet composition and body fat percentage in 9- and 10-year-old children. Also, to examine the influence of gender, total energy intake, fitness, physical activity, and parental body mass on the relationship between diet composition and adiposity., Design: Diet composition was assessed using the National Cancer Institute food frequency questionnaire, and adiposity was measured using the average of results determined using two skinfold equations. Fitness levels and physical activity were ascertained using the 1-mile run/walk test and a self-report 15-item scale, respectively., Subjects: A sample of 262 children (162 boys and 100 girls, mean age = 9.8 +/- 0.5 years) participated., Statistical Analysis: Regression analysis was used to determine the extent to which diet composition contributed to adiposity without statistical control for any potentially confounding variables. Partial correlations were calculated to assess the relationship between macronutrient intake and adiposity after potential confounders (gender, total energy intake, physical fitness, and parental body mass) were controlled statistically., Results: Energy intake was positively related to adiposity. Fat intake, calculated as a percentage of total energy, was also positively related to adiposity, before and after control for potential confounding variables. Percentage of energy derived from carbohydrate was inversely related to adiposity, before and after controlling for potential confounders., Applications: These findings indicate that the macronutrient intake of children, particularly dietary fat and carbohydrate intake, may play a role in adiposity, independent of the influence of total energy intake, gender, physical fitness, and parental body mass index.

Objective: To assess whether usual diet (especially intake of dietary fat, carbohydrate, and fiber) was related to body fat percentage in healthy men., Design: A written questionnaire provided data on demographic and lifestyle characteristics. Dietary fat, carbohydrate, protein, and fiber intakes were analyzed using the National Cancer Institute food frequency questionnaire. Percentage of body fat was determined using three-site skinfold measurements, and a submaximal treadmill test was used to estimate aerobic fitness., Subjects: Subjects were 203 healthy men (14.0 +/- 5.3% mean body fat) aged 21 to 71 years. The subjects were chosen from randomly selected districts within Utah County and volunteered for free diet and fitness evaluations., Statistical Analysis: Multiple regression analysis determined the extent to which the individual diet components predicted body composition before and after controlling for energy intake, fitness level, body weight, and age. Multivariate analysis of variance was used to compare relative body fat groups in regard to dietary variables., Results: Reported intakes of carbohydrate (P = .0085, R2 = .022), complex carbohydrate (P = .0127, R2 = .024), and fiber (P = .002, R2 = .03) were inversely associated with body fat after controlling for age, energy intake, and fitness level. Energy intake was positively related to body fat after controlling for age, fitness level, and body weight. When subjects were separated into low-, moderate-, and high-body-fat groups, the fattest subjects reported eating significantly more dietary fat (P = .05) and less carbohydrate (P = .01), complex carbohydrate (P = .01), and fiber (P = .005) than the leanest subjects. No significant difference in reported energy intake was noted across body fat groups., Applications: Composition of the diet may play a role in obesity beyond energy intake in men over the long-term. Lifestyle changes for men should probably include modifications in diet composition, especially increased consumption of foods high in complex carbohydrate and fiber.

Cardiac surgery has many associated complications but the psychological problems that can occur are rarely discussed. This literature review focuses on both the physiological and psychological causes of post-pump delirium and suggests possible recommendations for nursing practice.

This study examined the association between diet composition, particularly dietary fat intake, and body-fat percentage in 205 adult females. Subjects completed a written questionnaire regarding lifestyle factors, such as exercise participation and smoking, demographic data, and the diet section of the National Cancer Institute's Health Habits and History Questionnaire by Block. Skinfold-thickness measures were used to ascertain the body-fat percentage of each subject. Results showed that intake of dietary fat was related significantly with adiposity, without (F = 13.65, R2 = 0.063, P = 0.0003) and with (F = 8.74, R2 = 0.033, P = 0.0035) control for multiple potential confounding factors: age, total energy intake, total exercise time per week, years of regular physical activity, consumption of other macronutrients, and smoking. Unlike dietary fat intake, protein consumption and carbohydrate intake were not significant individual predictors of body-fat percentage when the potential confounding variables were controlled. The findings suggest that dietary fat intake may play a role in obesity beyond dietary energy content.