Search

Objective Methods Results Conclusion Syndrome of undifferentiated recurrent fevers (SURF) is characterized by recurrent fevers and autoinflammation without a confirmed molecular diagnosis of a hereditary recurrent fever syndrome, and not fulfilling criteria for periodic fever, adenitis, pharyngitis, aphthous stomatitis syndrome (PFAPA). The goal of this study was to characterize clinical features of patients with SURF compared to patients with PFAPA and to analyze their cytokine signature, genetic variations, and responses to treatment.We enrolled 46 patients observed at Cincinnati Children's Hospital Medical Center. Baseline data and inflammatory cytokines were collected at enrollment, and their clinical course was followed. Cytokine analysis was performed using a cytokine multiplex assay. Many patients had specific or whole exome genetic testing.The prevalence of rash and arthralgias were higher in patients with SURF compared to patients with PFAPA. Pharyngitis and adenopathy were less frequent. A subset of patients with SURF clustered together with elevated proinflammatory cytokines and more frequently required biologic therapy. Focused analysis of whole exome sequencing  data revealed that variants of unknown clinical significance (VUCS) were frequently identified in genes implicated in B cell development, immunodeficiencies, and inflammatory bowel disease risk. Treatments for patients with SURF commonly included on‐demand steroids, colchicine, and anti–interleukin‐1 therapy.Our findings suggest SURF is a heterogeneous group but has distinct clinical and immunologic features from disorders such as PFAPA. Patients have frequent VUCS, which may have relevance to disease pathogenesis. A subset of patients showed more inflammation and an increased need for biologic therapy. Further research is necessary to define whether there exist distinct SURF endotypes and to better predict treatment outcomes. [ABSTRACT FROM AUTHOR]

This commentary highlights a need for comprehensive measures of structural racism tailored to cancer health disparities, in particular Black–White disparities in multiple myeloma (MM). Recent political and social calls and advances in the ability to quantitate structural racism have led to rapidly growing research on the health consequences of structural racism. However, to date, most studies have used unidimensional measures of structural racism that do not capture cumulative influences or enable the identification of factors most responsible for driving disparities. Furthermore, measures may not reflect aspects of structural racism most relevant to underlying disease processes and risks. This study proposes a multifaceted approach to measuring structural racism relevant to MM that includes comprehensive, disease‐ and at‐risk population‐tailored social and environmental data and biomarkers of susceptibility and progression related to underlying biological changes associated with structural racism. Such novel measures of structural racism may improve the ability to assess the influence of structural racism on cancer health disparities, which may advance understanding of disease etiology and differences observed by racialized groups. This commentary highlights a need for comprehensive measures of structural racism tailored to cancer health disparities, in particular Black–White disparities in multiple myeloma. Novel, tailored measures of structural racism may advance understanding of disease etiology and differences observed by racialized groups. [ABSTRACT FROM AUTHOR]

Background: Older adults comprise the majority of patients with gastrointestinal (GI) cancer. Geriatric assessments (GAs) are recommended for older adults with cancer in part to detect aging‐related impairments (e.g., frailty) associated with early mortality. Social factors like social vulnerability may also influence aging‐related impairments. However, the association between social vulnerability and aging outcomes among older adults with cancer is understudied. Methods: The authors included 908 older adults aged 60 years and older who were recently diagnosed with GI cancer undergoing GA at their first prechemotherapy visit to the University of Alabama at Birmingham oncology clinic. The primary exposure of interest was the social vulnerability index (SVI). Outcomes were frailty (frail vs. robust/prefrail) and total number of GA impairments (range, 0–13). The authors examined the association between SVI and outcomes using Poisson regression with robust variance estimation and generalized estimating equations. Results: The median age at GA was 69 years (interquartile range, 64–75 years), 58.2% of patients were male, 22.6% were non‐Hispanic Black, 29.1% had colorectal cancer, 28.2% had pancreatic cancer, and 70.3% had stage III/IV disease. Adjusting for age, sex, cancer type, and disease stage, each decile increase in the SVI was associated with an 8% higher prevalence of frailty (prevalence ratio, 1.08; 95% confidence interval, 1.05–1.11) and a 4% higher average count of total GA impairments (risk ratio, 1.04; 95% confidence interval, 1.02–1.06). The results were attenuated after further adjustment for race and education. Conclusions: Greater social vulnerability was associated with a higher prevalence of frailty and an increasing average number of GA impairments among older adults with GI cancers before systemic treatment. Intervening on social vulnerability may be a target for improving the risk of frailty and GA impairments, but associations of race and education should be further evaluated. Higher social vulnerability at the census tract level is associated with higher prevalence of frailty and risk of additional geriatric assessment impairments among older adults with gastrointestinal malignancies before systemic treatment. These associations are attenuated with adjustment for individual‐level measures of social determinants of health, but multilevel interventions may be a target to prevent these important aging‐related outcomes in cancer. [ABSTRACT FROM AUTHOR]

Background: Food access is associated with higher gastrointestinal (GI) cancer mortality; however, its association with frailty, which is a predictor of premature mortality among older adults with cancer, is less understood. Methods: The authors included 880 adults aged 60 years and older who were recently diagnosed with GI cancers and were undergoing self‐reported geriatric assessment at their first prechemotherapy visit to the University of Alabama at Birmingham oncology clinic. Food access was measured using the 2019 US Department of Agriculture Economic Research Service designation low‐income, low‐access (LILA), classifying census tracts based on income and/or access to food stores at various distances. The primary outcome was frailty on the CARE (Cancer and Aging Resilience Evaluation) Frailty Index, a composite of the proportion of impaired geriatric assessment measures. The authors examined the LILA‐frailty association with modified Poisson regression accounting for census‐tract clustering. Results: The median patient age was 69 years, 58.1% were men, 22.5% were non‐Hispanic Black, 29.2% had colorectal cancer, 28.0% had pancreatic cancer, 70.1% presented with stage III/IV disease, and 34.9% were frail. A higher proportion in LILA areas were non‐Hispanic Black (44.1% vs. 10.8%; p <.001) and had less education (high school or less: 48.1% vs. 37.9%; p =.020). Adjusting for age, race and ethnicity, sex, cancer type and stage, and education, an LILA designation was associated with 58% greater odds of worsening frailty status (95% confidence interval, 1.18–2.12). An analysis of LILA subcategories revealed that associations were maintained across all LILA measures. Conclusions: Poor food access was associated with a greater risk of frailty among newly diagnosed older adults with GI cancers before they received systemic treatment. Intervening on local food access, particularly in LILA areas, may be a target for improving rates of frailty and promoting health equity in this population. Poor food access at the census‐tract level is associated with frailty among older adults with gastrointestinal malignancies before they receive systemic treatment. Improving local food access may be a target for improving rates of frailty, a common outcome among older adults who have cancer with many adverse consequences. [ABSTRACT FROM AUTHOR]

The increasing application of road deicing agents (e.g., NaCl) has caused widespread salinization of freshwater environments. Chronic exposure to toxic NaCl levels can impact freshwater biota at genome to ecosystem scales, yet the degree of harm caused by road salt pollution is likely to vary among habitats and populations. The background ion chemistry of freshwater environments may strongly impact NaCl toxicity, with greater harm occurring in ion‐poor, soft water conditions. In addition, populations exposed to salinization may evolve increased NaCl tolerance. Notably, if organisms are adapted to the water chemistry of their natal environment, toxicity responses may also vary among populations in a given test medium. We examined the potential for this evolutionary and environmental context to interact in shaping NaCl toxicity with a pair of laboratory reciprocal transplant toxicity experiments, using natural populations of the water flea Daphnia ambigua collected from three lakes that vary in ion availability and composition. We observed a strong effect of the lake water environment on NaCl toxicity in both trials. NaCl caused a much greater decline in reproduction and r in lake water from a low‐ion/calcium‐poor environment (20 μS/cm specific conductance; 1.7 mg/L Ca2+) compared with water from both a Ca2+‐rich lake (55 μS/cm; 7.2 mg/L Ca2+) and an ion‐rich coastal lake (420 μS/cm; 3.4 mg/L Ca2+). Daphnia from this coastal lake were most robust to the effects of NaCl on reproduction and r. A significant interaction between the population and lake water environment shaped survival in both trials, suggesting that local adaptation to the test waters used may have contributed to toxicity responses. Our findings that the lake water environment, adaptation to that environment, and adaptation to a contaminant of interest may shape toxicity demonstrate the importance of considering environmental and biological complexity in mitigating pollution impacts. [ABSTRACT FROM AUTHOR]

Objective: Systemic juvenile idiopathic arthritis–associated lung disease (SJIA‐LD) is a life‐threatening disease complication. Key questions remain regarding clinical course and optimal treatment approaches. The objectives of the study were to detail management strategies after SJIA‐LD detection, characterize overall disease courses, and measure long‐term outcomes. Methods: This was a prospective cohort study. Clinical data were abstracted from the electronic medical record, including current clinical status and changes since diagnosis. Serum biomarkers were determined and correlated with presence of LD. Results: We enrolled 41 patients with SJIA‐LD, 85% with at least one episode of macrophage activation syndrome and 41% with adverse reactions to a biologic. Although 93% of patients were alive at last follow‐up (median 2.9 years), 37% progressed to requiring chronic oxygen or other ventilator support, and 65% of patients had abnormal overnight oximetry studies, which changed over time. Eighty‐four percent of patients carried the HLA‐DRB1*15 haplotype, significantly more than patients without LD. Patients with SJIA‐LD also showed markedly elevated serum interleukin‐18 (IL‐18), variable C‐X‐C motif chemokine ligand 9 (CXCL9), and significantly elevated matrix metalloproteinase 7. Treatment strategies showed variable use of anti–IL‐1/6 biologics and addition of other immunomodulatory treatments and lung‐directed therapies. We found a broad range of current clinical status independent of time from diagnosis or continued biologic treatment. Multidomain measures of change showed imaging features were the least likely to improve with time. Conclusion: Patients with SJIA‐LD had highly varied courses, with lower mortality than previously reported but frequent hypoxia and requirement for respiratory support. Treatment strategies were highly varied, highlighting an urgent need for focused clinical trials. [ABSTRACT FROM AUTHOR]

Objective: Virtual care (VC) is an accepted modality of care delivery, and shared decision‐making (SDM) benefits patients with rheumatologic and chronic conditions (RCCs). Unfortunately, research suggests reduced quality of SDM during VC. This study explores the benefits and shortcomings of SDM regarding RCCs during VC with suggestions for optimally using VC during SDM. Methods: Following Stiggelbout's framework for SDM, we conducted focus groups of patients with RCCs and providers to understand their experiences with SDM during VC, probing for facilitating and challenging factors. We conducted content analysis of the transcripts, defining themes, and inductively reasoned to identify relationships among themes. We summarized the facilitators, barriers, and opportunities for improving SDM during VC that participants proposed. Results: Virtual SDM shares several similarities with in‐person practice, as both draw upon trusting patient‐provider relationships, following the same general steps, and relying on effective communication. VC presents solutions for known barriers to in‐person SDM, expanding time for making decisions and access to care. Technology and virtual health systems introduce new barriers to SDM, and participants list opportunities for overcoming these concerns. Conclusion: VC is a tool that can enhance and even support superior SDM compared with in‐person visits when implemented successfully, a condition requiring the development of nuanced skills to correctly identify when and how to best use VC for SDM as well as technology and health care structures that integrate SDM into VC. Therefore, patients, providers, insurance carriers, and policy makers all contribute to the success of SDM among RCCs during VC. [ABSTRACT FROM AUTHOR]

Ryanodine receptor type 1‐related disorder (RYR1‐RD) is the most common subgroup of congenital myopathies with a wide phenotypic spectrum ranging from mild hypotonia to lethal fetal akinesia. Genetic testing for myopathies is imperative as the diagnosis informs counseling regarding prognosis and recurrence risk, treatment options, monitoring, and clinical management. However, diagnostic challenges exist as current options are limited to clinical suspicion prompting testing including: single gene sequencing or familial variant testing, multi‐gene panels, exome, genome sequencing, and invasive testing including muscle biopsy. The timing of diagnosis is of great importance due to the association of RYR1‐RD with malignant hyperthermia (MH). MH is a hypermetabolic crisis that occurs secondary to excessive calcium release in muscles, leading to systemic effects that can progress to shock and death if unrecognized. Given the association of MH with pathogenic variants in RYR1, a diagnosis of RYR1‐RD necessitates an awareness of medical team to avoid potentially triggering agents. We describe a case of a unique fetal presentation with bilateral diaphragmatic eventrations who had respiratory failure, dysmorphic facial features, and profound global hypotonia in the neonatal period. The diagnosis was made at several months of age, had direct implications on her clinical care related to anticipated need to long‐term ventilator support, and ultimately death secondary an arrhythmia as a result of suspected MH. Our report reinforces the importance of having high suspicion for a genetic syndrome and pursuing early, rapid exome or genome sequencing as first line testing in critically ill neonatal intensive care unit patients and further evaluating the pathogenicity of a variant of uncertain significance in the setting of a myopathic phenotype. [ABSTRACT FROM AUTHOR]

Thirteen autistic teens, who were predominantly Latinx, completed the Program for the Education and Enrichment of Relational Skills (PEERS), a 16‐week social skills intervention. Time‐frequency decomposition was calculated using advanced electroencephalographic techniques to measure oscillatory brain activity during reward anticipation and processing before and after PEERS. Fourteen neurotypical teens participated but did not receive intervention. The perception of educational performance was also measured. The perception of educational performance did not differ between groups and did not change after participation in PEERS. Approach motivation increased after intervention in the autistic group. This suggests an enhancement of social motivation after learning social skills in a group composed of a majority of Latinx autistic teens. We investigated the change in perceived educational performance and brain activity of autistic teens, a majority of whom were Latinx, before and after a social skills intervention. Findings demonstrate that perceptions of educational performance remained unchanged after intervention. However, results provide brain‐based evidence of increased social motivation after learning social skills. Findings have implications for advanced techniques to measure changes in reward‐related brain activity before and after intervention with diverse samples. [ABSTRACT FROM AUTHOR]

Deletion of 17p13.3 has varying degrees of severity on brain development based on precise location and size of the deletion. The most severe phenotype is Miller–Dieker syndrome (MDS) which is characterized by lissencephaly, dysmorphic facial features, growth failure, developmental disability, and often early death. Haploinsufficiency of PAFAH1B1 is responsible for the characteristic lissencephaly in MDS. The precise role of YWHAE haploinsufficiency in MDS is unclear. Case reports are beginning to elucidate the phenotypes of individuals with 17p13.3 deletions that have deletion of YWHAE but do not include deletion of PAFAH1B1. Through our clinical genetics practice, we identified four individuals with 17p13.3 deletion that include YWHAE but not PAFAH1B1. These patients have a similar phenotype of dysmorphic facial features, developmental delay, and leukoencephalopathy. In a review of the literature, we identified 19 patients with 17p13.3 microdeletion sparing PAFAH1B1 but deleting YWHAE. Haploinsufficiency of YWHAE is associated with brain abnormalities including cystic changes. These individuals have high frequency of epilepsy, intellectual disability, and dysmorphic facial features including prominent forehead, epicanthal folds, and broad nasal root. We conclude that deletion of 17p13.3 excluding PAFAH1B1 but including YWHAE is associated with a consistent phenotype and should be considered a distinct condition from MDS. [ABSTRACT FROM AUTHOR]

Protein phosphatase 2A (PP2A) is a heterotrimeric serine/threonine phosphatase that regulates numerous biological processes. PPP2R1A encodes the scaffolding "Aα" subunit of PP2A. To date, nearly 40 patients have been previously reported with 19 different pathogenic PPP2R1A variants, with phenotypes including intellectual disability, developmental delay, epilepsy, infant agenesis/dysgenesis of the corpus callosum, and dysmorphic features. Apart from a single case, severe congenital heart defects (CHD) have not been described. We report four new unrelated individuals with pathogenic heterozygous PPP2R1A variants and CHD and model the crystal structure of several variants to investigate mechanisms of phenotype disparity. Individuals 1 and 2 have a previously described variant (c.548G>A, p.R183Q) and similar phenotypes with severe ventriculomegaly, agenesis/dysgenesis of the corpus callosum, and severe CHD. Individual 3 also has a recurrent variant (c.544C>T, p.R182W) and presented with agenesis of corpus callosum, ventriculomegaly, mild pulmonic stenosis, and small patent foramen ovale. Individual 4 has a novel variant (c.536C>A, p.P179H), ventriculomegaly, and atrial septal defect. To conclude, we propose expansion of the phenotype of PPP2R1A neurodevelopmental disorder to include CHD. Further, the R183Q variant has now been described in three individuals, all with severe neurologic abnormalities, severe CHD, and early death suggesting that this variant may be particularly deleterious. [ABSTRACT FROM AUTHOR]

Due to the coronavirus disease 2019 (COVID‐19) pandemic, the importance of telehealth has rapidly increased, in particular as many in‐person clinics have closed. Early intervention is crucial for improving outcomes in children with autism spectrum disorder (ASD). As such, the need for timely assessments and diagnoses remains despite COVID‐19‐related closures. This study offers preliminary data collected from 23 children assessed through a no‐cost autism clinic in Southern California using a novel telehealth model. This includes an overview of an adapted, telehealth version of in‐person observational assessment techniques for diagnosing autism. In addition, preliminary data on social validity assessed at two points are presented. Findings suggest that caregivers found the telehealth assessment procedures acceptable and convenient, and overall were satisfied with both the assessment and the written report/verbal feedback. Implications for future uses of telehealth are discussed, including how telehealth can assist with decision‐making around school‐based services and/or placement. KEY POINTS: Validation of telehealth assessments for autism spectrum disorders (ASD) is important to increase accessibility and timely diagnosis for families.Preliminary data on social validity suggests that caregivers found telehealth procedures to be helpful, convenient, and useful.A majority of caregivers planned to share the clinical report with their teacher or school. [ABSTRACT FROM AUTHOR]

College is a stressful time for students and social support can help students cope with stress. However, research investigating how college students' romantic relationships might serve as a daily source of support around academic stressors and academic outcomes is limited. This study investigated whether romantic partners are a source of daily academic support during times of academic stress (midterms), and whether satisfaction with academic support is associated with higher levels of student engagement. Students reported daily academic support seeking from their romantic partners during midterms, and satisfaction was positively associated with student engagement. Understanding how romantic partners can buffer against academic stress is crucial to supporting students' academic outcomes, mental, and physical health. While romantic partners serve as sources of support around academic stress and outcomes, low levels of academic support seeking suggest they may not be a main source. [ABSTRACT FROM AUTHOR]

Objective: The clinical variability of systemic lupus erythematosus (SLE) caused by the unpredictability of flares contributes to patients experiencing a diminished sense of social support. Digital health interventions (DHIs) have the potential to improve patients' social support but have yet to be studied extensively in SLE. Our objective was to assess general and SLE‐specific internet usage as well as specific suggestions for SLE‐related digital resources and tools among patients with SLE at the Washington University Lupus Clinic. Methods: Fifty‐six participants were recruited from the Washington University Lupus Clinic. Ten‐minute structured interviews consisting of multiple choice and open‐ended questions were conducted. A descriptive statistical analysis was conducted with the quantitative data, while the qualitative data were analyzed using an open coding approach. Results: Nearly all respondents indicated having access to the internet (98.2%). Eighty percent currently use the internet for their SLE. The qualitative data indicate that patients with SLE use the internet for understanding flares and changes in their symptoms and/or laboratory results, want an increased variety of SLE information online, have a desire to exchange personal experiences and knowledge of SLE with others, and desire increased diversity in the methods of delivering digital SLE information. Conclusion: Our findings support the continued use of DHIs for patients with SLE. We believe that these findings will aid the future development of DHIs tailored to patients with SLE. [ABSTRACT FROM AUTHOR]

The Engage for Equity (E2) study is an intervention trial for community–academic research partnerships that seeks to improve partnering practices and health equity outcomes by providing community and academic partners with tools to enhance and advance power sharing and health equity. Twenty‐five community/academic research teams completed a two‐day training intervention where they were introduced to the CBPR Conceptual Model and corresponding applied tools to their partnerships. We report on team interviews conducted immediately after the training, where teams discussed opportunities and challenges using the CBPR Model as an implementation framework as they considered their own contexts, their partnering processes/practices, actions, and their desired outcomes. We applied Diffusion of Innovation theory to guide data collection and analysis; augmented by intent to use and collective reflection. Results pointed to the flexibility of the CBPR model, concrete use of tools (e.g., planning/evaluation), and broader use in inspiring collective reflection to improve partnering practices and inform equity values. As an implementation framework, the CBPR model incorporates collaborative processes and strategies to mitigate power differentials into key phases of implementation studies, adding factors central to health equity work, not existing in previous implementation frameworks. Highlights: Community‐based participatory research can enhance implementation science.The CBPR framework facilitates collective empowerment in community/academic partnerships.Participants noted how the CBPR model and flexibility of tools can improve partnering practices. [ABSTRACT FROM AUTHOR]

Negotiating conflict in healthy ways is key to adolescents' social functioning. This paper examines interpersonal negotiation strategies (INS) (a developmental framework for navigating conflict) across three different contexts (friend, romantic, and parent) in a sample of 212 Canadian mid‐adolescents. Adolescents were asked how they would deal with a hypothetical conflict in each context. Adolescents were most advanced at negotiating conflict in the friend context, followed by parent and romantic contexts; negotiation skills were worst in the romantic context. Girls demonstrated a higher level of INS than boys, but only with friends. These results indicate the need for universal healthy relationship programs that support the development of conflict negotiation skills, especially within the new interpersonal context of romantic relationships. [ABSTRACT FROM AUTHOR]

Visual statistical learning (VSL) refers to the ability to extract associations and conditional probabilities within the visual environment. It may serve as a precursor to cognitive and social communication development. Quantifying VSL in infants at familial risk (FR) for Autism Spectrum Disorder (ASD) provides opportunities to understand how genetic predisposition can influence early learning processes which may, in turn, lay a foundation for cognitive and social communication delays. We examined electroencephalography (EEG) signatures of VSL in 3‐month‐old infants, examining whether EEG correlates of VSL differentiated FR from low‐risk (LR) infants. In an exploratory analysis, we then examined whether EEG correlates of VSL at 3 months relate to cognitive function and ASD symptoms at 18 months. Infants were exposed to a continuous stream of looming shape pairs with varying probability that the shapes would occur in sequence (high probability‐deterministic condition; low probability‐probabilistic condition). EEG was time‐locked to shapes based on their transitional probabilities. EEG analysis examined group‐level characteristics underlying specific components, including the late frontal positivity (LFP) and N700 responses. FR infants demonstrated increased LFP and N700 response to the probabilistic condition, whereas LR infants demonstrated increased LFP and N700 response to the deterministic condition. LFP at 3 months predicted 18‐month visual reception skills and not ASD symptoms. Our findings thus provide evidence for distinct VSL processes in FR and LR infants as early as 3 months. Atypical pattern learning in FR infants may lay a foundation for later delays in higher level, nonverbal cognitive skills, and predict ASD symptoms well before an ASD diagnosis is made. [ABSTRACT FROM AUTHOR]

Objective: To assess knowledge of the Zika virus (ZIKV), use of contraceptives, and sources of health information in rural communities in the Dominican Republic.Methods: Over 4 days in March 2017, a research team traveled to four rural communities in the Dominican Republic to provide healthcare services. Overall, 90 men and women consented to a voluntary verbal 12-question survey.Results: Of the participants, 55% were not certain whether ZIKV is transmitted sexually; 75% of participants were either not sure or thought ZIKV was not present in their community. Charlas (informal discussions led by community health workers) were cited as the most common source for public health information. Prevalence of contraceptive use was 26.6% hormonal and 1.1% long-acting reversible contraception (LARC); 30.0% cited no use of contraception.Conclusion: Significant deficits in ZIKV knowledge, underutilization of LARCs, and socioeconomic factors exist that constrain the application of WHO recommendations for preventing ZIKV infection. Additional and more robust surveys are needed to assess public health education and interventions, critical for disease prevention in communities facing current and future epidemics. [ABSTRACT FROM AUTHOR]

Objective: This study examines the relationship between wealth and obesity among adults entering midlife and whether this relationship varies by sex, race, and measure of wealth.Methods: The data were obtained from the National Longitudinal Survey of Youth 1979 (NLSY-79). Population-averaged models were used to examine the associations between multiple measures of wealth and obesity among 6,979 respondents while controlling for education, occupation, income, and relevant sociodemographic variables.Results: The analysis found a robust association between wealth and midlife obesity as well as heterogeneity in the wealth-obesity association across sex, race, and measure of wealth. With the exception of black men, net worth generally had a significant and inverse relationship with obesity. The net worth-obesity association was largest among women and was driven primarily by home value, in addition to savings and debt for black women. Although home value was significant for white men, the components of wealth were generally unrelated to obesity among men.Conclusions: The association between wealth and obesity was generally robust but also complex, depending on sex, race, and measure of wealth. Research that does not consider multiple components of wealth may overlook the importance of economic resources in shaping obesity rates in the US population. [ABSTRACT FROM AUTHOR]

Objective: The patient‐specific experience of living with systemic lupus erythematosus (SLE) is underreported, particularly when studying factors associated with health‐related quality of life (HRQOL). Recent work has suggested that biomedical interventions are only partially predictive of HRQOL measures. A qualitative analysis of patient‐specific experiences can uncover additional root causes of impaired HRQOL in populations with SLE beyond the scope of quantitative questionnaires. Methods: Consented adult patients with SLE classified by the American College of Rheumatology or Systemic Lupus International Collaborating Clinics were recruited. Ten semistructured interviews were conducted across six participants. Interviews were audio recorded, transcribed, and analyzed using an iterative process. Findings were presented to an interactive public forum with patients with SLE, family members and friends of patients, and health care professionals to assess accuracy. Results: Four themes emerged from the interviews: 1) ambiguity, inconsistency, and lack of symptom predictability due to SLE disease courses; 2) poor communication with family, friends, and/or partners and poor bidirectional communication between health care providers and patients (informational support); 3) lack of validation for patients' experiences (appraisal support); and 4) problematic aspects of social support, including negative support and patients' inability to reciprocate support because of role changes. Data also indicate a reciprocal association between appraisal and informational sources of support. Conclusion: Findings indicate that inadequate appraisal and informational support from informal and formal sources are salient factors influencing HRQOL among patients with SLE. Findings also point to the necessity of integrating community organizations, physicians, and friends and family of patients with SLE into capacity‐building interventions aimed at enhancing these sources of social support. [ABSTRACT FROM AUTHOR]

Copyright of Infant Mental Health Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Methamphetamine alters behavior and the stress response system. Relatively little research has examined the effects of methamphetamine in adolescents and compared these effects to those in adults. Housing in enriched environments has been explored as one way to protect against the effects of methamphetamine, but the findings are conflicting and no study has examined how enriched environment may alter the behavioral and corticosterone responses to methamphetamine in adolescent and adult rodents. We examined the long‐term effects of methamphetamine exposure on anxiety, social behavior, behavioral despair, and corticosterone levels in adolescent and adult mice housed in enriched or isolated environments. Enriched environment did not alter the behavioral or corticosterone response to methamphetamine. Methamphetamine exposure decreased anxiety and increased behavioral despair in adult mice, but methamphetamine did not alter behavior in adolescent mice. There was no effect of methamphetamine on social behavior or corticosterone levels. Our findings demonstrate that the specific environmental enrichment paradigm used in this study was not sufficient to mitigate the behavioral effects of methamphetamine and that adolescent mice are relatively resistant to the effects of methamphetamine compared to adult mice. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Schools are an important setting for improving behaviors associated with obesity, including physical activity. However, within schools there is often a tension between spending time on activities promoting academic achievement and those promoting physical activity. METHODS A community-based intervention provided administrators and teachers with a training on evidence-based public health and then collaborated with them to identify and implement environmental (walking track) and local school policy interventions (brain breaks). The evaluation included conducting in-depth interviews and SOPLAY observations to assess the facilitators and barriers and impact of the dissemination of environmental and policy changes. RESULTS Individual, organizational, intervention, and contextual factors influenced dissemination. Teachers reported that brain breaks increased student focus and engagement with classroom material and decreased student behavioral problems. Students decreased sedentary behavior and increased vigorous behavior. Of the 4 schools, 2 increased walking. CONCLUSIONS Active dissemination of environmental and policy interventions by engaging school administrators and teachers in planning and implementation shows potential for increasing physical activity in rural school settings. [ABSTRACT FROM AUTHOR]

Informed by sociocultural and systems theory tenets, this study used ethnographic research methods to examine the feasibility of using speech recognition ( SR) technology to support struggling readers in an early elementary classroom setting. Observations of eight first graders were conducted as they participated in a structured SR-supported writing center four days a week for five months. Participant observation, field notes, transcripts of audio and video recordings, and student artifacts (classroom worksheets, SR screenshots, and writing center compositions) were used to document students' use of SR as they wrote assigned compositions. Data analysis was recursive and ongoing. Constant comparison of in actu theoretical notes was used to form provisional patterns and develop and refine hypotheses. Triangulation of data sets, triangulation of informants, and negative case analyses were used to (dis)confirm hypotheses. Findings indicate that using SR was supportive of these struggling readers. Previous concepts of SR as an isolated entity and of the Language Experience Approach as cumbersome and reifying teacher hegemony are examined. Graphosemantic awareness, new literacies, and the possibilities for supporting struggling readers of all ages across expansive geographies are discussed. Finally, child safety, tensions between student independence and lost opportunities for teacher metacognitive modeling, questions about encoding as a viable or antiquated skill, and the need for additional research conducted in classroom settings to grasp sociocultural insights are discussed. [ABSTRACT FROM AUTHOR]

Objectives: Learning ultrasound‐guided regional anesthesia skills, especially needle/ beam alignment, can be especially difficulty for trainees, who can often become frustrated. We hypothesized that teaching novices to orient the transducer and needle perpendicular to their shoulders will improve performance on a standardized task, compared to holding the transducer and needle parallel to the shoulders. Methods: This study compared the effects of transducer orientation on trainees' ability to complete a standardized ultrasound‐guided nerve block simulation. The time to task completion and percentage of the attempt time without adequate needle visualization were measured. Participants were right‐handed healthy adults with no previous ultrasound experience and were randomly assigned to training in either transducer and needle alignment in a coronal plane, parallel to the shoulders (parallel group) or transducer and needle alignment in a sagittal plane, perpendicular to the shoulders (perpendicular group). Participants used ultrasound to direct a needle to 3 targets in a standardized gelatin phantom and repeated this task 3 times. Their efforts were timed and evaluated by an assessor, who was blinded to group assignment. Results: Data were analyzed on 28 participants. The perpendicular group was able to complete the task more quickly (P <.001) and with a smaller proportion of time lost to inadequate needle visualization (P <.001). Conclusions: Ultrasound‐guided regional anesthesia trainees complete a standardized task more quickly and efficiently when instructed to hold the transducer and needle in an orientation perpendicular to their shoulders. [ABSTRACT FROM AUTHOR]

ABSTRACT Product design is a topic that is regularly covered in introductory operations management courses. However, a pedagogical challenge exists related to the presentation of introductory-level product design in a way that promotes active learning. The hands-on exercise presented in this article provides instructors with an activity that gives students an open-ended opportunity to quickly develop a realistic product from conception to prototype. A unique material is used that allows students the flexibility to freely form a product prototype. A description of the exercise and an assessment of its efficacy in promoting student understanding of product design from an operations perspective are presented. Opportunities for future work are also identified. [ABSTRACT FROM AUTHOR]

Background: Delivering episodic memory tests on a mobile device can support increased accessibility across diverse health settings. This is particularly important for increasing access to memory screening tools for participants at risk of memory impairment including Alzheimer's and dementia. CANTAB PAL task is a short (8‐12 minutes) task of memory performance that is currently validated for delivery on a tablet, laptop or desktop device. Cambridge Cognition developed a prototype version of PAL that can be delivered on a smartphone (iPhone or Android). A key component of making the task available on smartphone is to understand the comparability to the original version of the task. For tasks delivered direct to patient, usability becomes even more important. This study was designed to evaluate the comparability and usability of PAL on smartphone device. Method: Participants (N = 98, mean age 55 ± 5.59 years, gender balanced (50% (49)) were recruited through the Prolific platform to remotely complete both smartphone and desktop versions of CANTAB PAL on two consecutive days followed by a usability questionnaire. A cross‐over design was used with 50:50 participants smartphone first: desktop first to counterbalance for exposure to the task. Participants used their own devices for assessment and the device operating system was captured. Result: Most participants used Android smartphones (74.1% (69)) and Windows desktops (90% (81)). Smartphone and desktop versions of PAL were shown to be highly correlated (r = 0.61, p < 0.05). Average performance was better on the desktop device; an upwards bias estimated as 3.52 (±1.96 SD 27 to ‐20) adjusted errors. The usability questionnaire found that 76.6% (59) participants strongly agreed they found the instructions clear and easy to follow and 42.9% (33) strongly agreed that they could see the symbols easily on their mobile phone. Most participants preferred using PAL on a desktop device in terms of ease of use (70.1% (54)) and enjoyment 66.2% (51). Conclusion: We have shown good correlation between iPhone and computer versions of the test, but with some important caveats. The usability data collected here will inform improvements to ensure suitability of PAL on a smartphone device for near patient assessments. [ABSTRACT FROM AUTHOR]

Statistical learning is characterized by detection of regularities in one's environment without an awareness or intention to learn, and it may play a critical role in language and social behavior. Accordingly, in this study we investigated the electrophysiological correlates of visual statistical learning in young children with autism spectrum disorder ( ASD) using an event-related potential shape learning paradigm, and we examined the relation between visual statistical learning and cognitive function. Compared to typically developing ( TD) controls, the ASD group as a whole showed reduced evidence of learning as defined by N1 (early visual discrimination) and P300 (attention to novelty) components. Upon further analysis, in the ASD group there was a positive correlation between N1 amplitude difference and non-verbal IQ, and a positive correlation between P300 amplitude difference and adaptive social function. Children with ASD and a high non-verbal IQ and high adaptive social function demonstrated a distinctive pattern of learning. This is the first study to identify electrophysiological markers of visual statistical learning in children with ASD. Through this work we have demonstrated heterogeneity in statistical learning in ASD that maps onto non-verbal cognition and adaptive social function. [ABSTRACT FROM AUTHOR]

The focus of this study was emotional engagement, or a strong emotional attachment to one's work (Kahn, 1990). The purpose of the study was to determine the relationship among five factors of personality (need for stability, extraversion, originality, accommodation, and consolidation); psychological conditions of engagement; person-work fit, and the emotional engagement of human resource senior leaders, managers, and generalists. Structural equation modeling was completed separately for each of the three job categories. The results supported significant direct relationships among personality factors and emotional engagement but suggested that meaningfulness, availability, and person-work fit also moderate these relationships. This study makes three main contributions to the literature on the topic. First, although previous research (May, Gilson, & Harter, 2004; Rothmann & Rothmann, 2010) investigated engagement in general, this study spotlighted emotional engagement. Second, this study drew a path leading from personality to emotional engagement, moderated by psychological engagement conditions. Third, this study focused on human resource professionals, who hitherto had received scant coverage in the literature. This study proposes an emotional engagement formula that accounts for a large portion of the variability in emotional engagement (58% for managers, 61% for generalists, and 62% for senior leaders). [ABSTRACT FROM AUTHOR]

Purpose: Rural residents are at greater risk of obesity than urban and suburban residents. Failure to meet physical activity and healthy eating recommendations play a role. Emerging evidence shows the effectiveness of environmental and policy interventions to promote physical activity and healthy eating. Yet most of the evidence comes from urban and suburban communities. The objectives of this study were to (1) identify types of environmental and policy interventions being implemented in rural communities to promote physical activity or healthy eating, (2) identify barriers to the implementation of environmental or policy interventions, and (3) identify strategies rural communities have employed to overcome these barriers. Methods: Key informant interviews with public health professionals working in rural areas in the United States were conducted in 2010. A purposive sample included 15 practitioners engaged in planning, implementing, or evaluating environmental or policy interventions to promote physical activity or healthy eating. Findings: Our findings reveal that barriers in rural communities include cultural differences, population size, limited human capital, and difficulty demonstrating the connection between social and economic policy and health outcomes. Key informants identified a number of strategies to overcome these barriers such as developing broad-based partnerships and building on the existing infrastructure. Conclusion: Recent evidence suggests that environmental and policy interventions have potential to promote physical activity and healthy eating at the population level. To realize positive outcomes, it is important to provide opportunities to implement these types of interventions and document their effectiveness in rural communities. [ABSTRACT FROM AUTHOR]

Background: While smoking rates in the United States have decreased, some population subgroups have smoking rates that exceed national and state averages. These higher rates often are associated with higher incidence rates of tobacco-associated cancers. Over time, a decrease in smoking rates leads to lower cancer incidence. Methods: Using spatial modelling techniques, we identified an underserved geographic locale in South Florida with higher than expected incidence rates of tobacco-associated cancers. We then used a community-based participatory research (CBPR) design to conduct focus groups in 2011 to elicit information about the acceptability of a smoking cessation intervention delivered by trained former smokers from within peer networks. Results: A variety of smoking cessation strategies was presented and discussed in separate, gender-stratified focus groups comprised of former and current smokers (n = 39). Focus group findings consistently indicated that support groups were the preferred cessation mechanism in this community. Based on this finding, we changed our initially proposed cessation approach to one which employed support groups as a quit method. Conclusions: Currently, we are collecting pilot data to test this intervention and to reach smokers who might not otherwise be directly targeted with cessation messaging from larger tobacco control initiatives. If successful, this strategy can be adapted to effect other important changes in health behaviours in at-risk populations. [ABSTRACT FROM PUBLISHER]

Effective methods and methodologies for building information systems (IS) remain crucial to building successful IS. This paper investigates the use of situational method engineering for IS development (ISD) projects in a professional bureaucracy. This specialist organization methodology (SOM) is built starting with the philosophy of ISD moving through to flexible, amethodical implementation methods, a proposed instance of situational method engineering that is targeted towards professional bureaucracies. An in-depth philosophical discussion of the ontological, epistemological, research methodological and ethical underpinnings of SOM are outlined, in addition to its limitations, to develop the building blocks of a methodology to implement within a professional bureaucracy organization ISD scenario. Amethodical ISD will be introduced as the appropriate way to implement this developed methodology to build a successful IS. The contribution of this paper is to detail how to develop a philosophically consistent methodology for a specific organizational environment (in this case, using the specific organizational example of a professional bureaucracy) that, when combined with developers and tools, can create a method to be applied to build an IS that has a greater possibility of successful organizational adoption than an IS built using a method devised using more common IS method engineering approaches. [ABSTRACT FROM AUTHOR]

Seventy-three samples of acute wound fluid were collected from 47 patients during the first 3 postoperative days (POD) following mastectomy for cancer ( n=47 on POD-1, n=19 on POD-2, and n=7 POD-3). Samples were analyzed by enzyme-linked immunosorbent assay for growth factor levels (epidermal [EGF], platelet-derived [PDGF], basic fibroblast [bFGF], transforming growth factor-β1 [TGF-β1], vascular endothelial [VEGF]), interleukin-6 (IL-6), matrix metalloproteinases (MMPs-2, -3, -9), and the tissue inhibitor of metalloproteinase 1 (TIMP-1). The levels of EGF, bFGF, PDGF, and interleukin-6 peaked on POD-1, with a significant decrease by POD-3, while total and active MMP-2, MMP-3, and tissue inhibitor of metalloproteinase 1 showed a progressive and significant increase from days 1 to 3. The wounds that later developed an infection (11%) were found to have a significantly lower PDGF and EGF on day 1 (PDGF, median 169 pg/mL [range, 86–2,595]) than the noninfected wounds (2,098 [17–66,506] p<0.05, Mann–Whitney U-test). Sixty-two percent patients developed a seroma and the levels of bFGF were significantly less in these patients (441 pg/mL [45–4,108]) than in those patients where there was no seroma (807 [245–3,133] p<0.05). The levels of certain growth factors in acute wound fluid may be important markers for wound outcomes. [ABSTRACT FROM AUTHOR]

Predicting an infant's risk of bronchopulmonary dysplasia (BPD) is challenging, particularly during the first weeks after birth. This retrospective cohort study assessed the BPD estimator's accuracy in predicting risk of severe BPD (sBPD) or death in infants admitted to two perinatal centres in Victoria, Australia. In this population, the BPD estimator accurately distinguishes infants who die before 36 weeks' PMA or have sBPD from those who do not, as evidenced by AUC of 0.81-0.84 at all postnatal time points (Figure S1). [Extracted from the article]

Inflammation is an essential component of normal wound healing. This study has correlated systemic (plasma) and local (wound fluid) concentrations of inflammatory cytokines (interleukin [IL]-6, tumor necrosis factor-α [TNF-α], and IL-1β) with wound healing and surgical outcome following elective colorectal surgery. Paired plasma and wound fluid samples were collected ( n=44) postoperatively (days 1, 3, 5, 7) and analyzed by enzyme-linked immunosorbent assay (pg/mL). Cytokine levels were significantly greater in drain fluid than plasma on each postoperative day (POD); e.g., POD 1 : IL-6; drain fluid, median, 77,050 pg/mL (range 9,928–456,408); plasma, 241 pg/mL (22–1,333). Daily profiles of IL-6 and TNF-α were similar in drain fluid and plasma; IL-6 levels peaked on POD 1 decreasing to POD 7, and TNF-α levels increased from PODs 1 to 7. However, IL-1β in plasma peaked on POD 1 and plateaued, whereas drain fluid showed two peaks (PODs 1 and 7). Only plasma levels of cytokines correlated to clinical parameters; IL-6 levels significantly correlated with postoperative complications; e.g., POD 5, complications 92(1–597) and no complications, 14(2–217). IL-6 also correlated with tumor pathology (Dukes stage, tumor depth, vascular invasion), and TNF-α levels correlated with the estimated blood loss during surgery. We conclude that local wound levels of cytokines correlated with the stage of wound healing, whereas systemic levels correlated with postoperative complications and tumor pathology. [ABSTRACT FROM AUTHOR]

Cytokines and growth factors are important at each stage of wound healing. This study aims to determine the changing profiles of these factors in intraperitoneal drainage, acute wound fluid, following colorectal surgery, and to correlate levels to wound healing and surgical outcomes. Acute wound fluid samples (n = 52 patients) were collected daily from postoperative day 1 until drain removal. Levels of cytokines (interleukins-6 and -1β and tumor necrosis factor-α) and epidermal growth factor, platelet-derived growth factor, vascular endothelial derived growth factor, basic fibroblast growth factor, and transforming growth factor-β1 were determined by enzyme-linked immunosorbent assay. A significant negative correlation emerged between the levels of interleukin-6, epidermal growth factor, platelet-derived growth factor, and basic fibroblast growth factor and the postoperative day, e.g., basic fibroblast growth factor : day 1, 695, median (29-2,806, range) pg/ml; day 2, 249 (1-1,784); day 3, 94 (0-722); day 7, 22 (0-326) (p < 0.05, Spearman's correlation). Levels appeared to relate to the stage of wound healing. Several factors, in particular interleukin-1β and tumor necrosis factor-α levels, correlated with surgical outcomes such as the need for a defunctioning stoma and/or postoperative complications. Cytokines and growth factors are involved in normal wound healing, and their levels in acute wound fluid may act as markers of wound healing and surgical outcome. [ABSTRACT FROM AUTHOR]

Matrix degradation and remodeling occurs during wound healing, thereby aiding tissue repair, angiogenesis, and cell migration. It is dependent on the balance between proteinases and their inhibitors, namely the matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs). Acute wound fluid samples (n = 58 patients) were collected daily from the intraperitoneal drain placed after colorectal surgery from the first postoperative day until drain removal. Three laboratory techniques were performed: enzyme linked immunosorbent assays (MMP-1, MMP-3, TIMP-1, TIMP-2), gelatinase activity assays (MMP-2, MMP-9), and quenched fluorescent substrate hydrolysis (total MMP activity). Levels were correlated with each postoperative day, wound healing, and surgical outcome (p < 0.05, Spearman's correlation). Significant negative (MMP-9, MMP-3, MMP-8, TIMP-2, total MMP activity) and positive (MMP-2, TIMP-1) correlations were observed with the postoperative day, e.g., total MMP-9: day 1, median, 121 (range, 12-189) ng/ml; day 3, 46 (8-179); day 5, 31 (0-155), day 7, 20 (6-58). Differences were also observed with the type of operation, estimated blood loss, and length of operation and with postoperative complications. MMPs and TIMPs are involved in wound healing after elective colorectal cancer surgery and their levels in drain fluid may act as markers of wound healing and surgical outcome. [ABSTRACT FROM AUTHOR]

Borrelia hermsii, a spirochaete responsible for relapsing fever in humans, grows to high density in the bloodstream and causes thrombocytopenia. We show here that B. hermsii binds to human platelets. Extended culture in bacteriological medium resulted in both diminished infectivity in vivo and diminished platelet binding in vitro. Platelet binding was promoted by the platelet integrin αIIbβ3: the bacterium bound to purified integrin αIIbβ3, and bacterial binding to platelets was diminished by αIIbβ3 antagonists or by a genetic defect in this integrin. Integrin αIIbβ3 undergoes a conformational change upon platelet activation, and bacteria bound more efficiently to activated rather than resting platelets. Nevertheless, B. hermsii bound at detectable levels to preparations of resting platelets. The bacterium did not recognize a point mutant of αIIbβ3 that cannot acquire an active conformation. Rather, B. hermsii was capable of triggering platelet and integrin αIIbβ3 activation, as indicated by the expression of the platelet activation marker P-selectin and integrin αIIbβ3 in its active conformation. The degree of platelet activation varied depending upon bacterial strain and growth conditions. Prostacyclin I2, an inhibitor of platelet activation, diminished bacterial attachment, indicating that activation enhanced bacterial binding. Thus, B. hermsii signals the host cell to activate a critical receptor for the bacterium, thereby promoting high-level bacterial attachment. [ABSTRACT FROM AUTHOR]

Wound healing is a complex process involving the interactions of many different cell types, matrix components and biological factors, including proteinases and cytokines. This study compared the levels of proteinases (matrix metalloproteinases and plasminogen activators), proteinase inhibitors (tissue inhibitors of metalloproteinases and plasminogen activator inhibitors), inflammatory cytokines and growth factors in acute wound fluid samples collected from the surgical drains of elective breast (n = 24) and colorectal (n = 26) patients on the first postoperative day. Gelatin zymography was used to determine matrix metalloproteinase-2 and -9 levels, quenched fluorescence substrate hydrolysis was applied for total MMP activity and enzyme-linked immunoassays were used to quantitate other factors. Colorectal wound fluid samples showed significantly (p < 0.05) greater levels of the matrix metalloproteinases (MMP-1, 2, 3, and 9), tissue inhibitor of metalloproteinases-1, urokinase plasminogen activator receptor and the inflammatory cytokines (interleukin-1β, -6, and tumor necrosis factor-α); e.g., matrix metalloproteinase-3 colon; median 275 (range 11–2.530) ng/ml; breast; 530–400. However, tissue plasminogen activator and growth factor levels (epidermal growth factor, platelet-derived growth factor, basic fibroblast growth factor, transforming growth factor-β1) were significantly greater in breast samples; e.g., epidermal growth factor breast 468 (103–1,444) pg/ml; colon 57(1–573). There was no difference in the levels of urokinase type plasminogen activator, plasminogen activator inhibitor-1 and -2, tissue inhibitor of metalloproteinases –2 or vascular endothelial growth factor. Acute wound fluid from different surgical wounds showed different profiles of proteinases, proteinase inhibitors, and cytokines. This may lead to differences in the rate of tissue remodeling and therefore healing in these two wounds in vivo. [ABSTRACT FROM AUTHOR]

The workplace has become the locus of many stress management and stress reduction interventions. However, little attention has focused on how worksite factors affect the implementation and impact of such interventions. In this paper, we investigate the effect of new versus traditional industrial relations practices on the impact of a worksite stress reduction program in a manufacturing setting. More specifically, a participatory action research (PAR) stress project is described and evaluated in two different labor- management relations contexts. One organization is characterized by the emerging 'new' industrial relations system where labor-management relations incorporate elements of joint problem-solving. The other organization has a more traditional approach where labor-management relations are formally adversarial. Results indicate that the labor- management relations context did influence the impact of the stress project. Involvement in the PAR stress project enhanced employee participation in decision-making in both contexts. However, involvement in the stress project enhanced employees' perceptions of the climate for participation only in the organization with more cooperative industrial relations. Increases in coworker support and decreases in depressive symptoms were associated with involvement in the PAR stress project in the organization with more adversarial industrial relations. [ABSTRACT FROM AUTHOR]