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Background: Parkinson's disease (PD) is a progressive neurological disorder that involves a range of motor and non‐motor symptoms. About 66% of individuals with PD report sleep disturbance impacts their quality of life. Sleep disorders may precede the cardinal motor features in PD and can influence motor and non‐motor symptom severity, including cognition. Yet current evidence of this association with objective assessments remains limited. The goal of this pilot study was to evaluate the associations between cognition and overnight polysomnography results in early‐stage PD. Methods: Participants completed neuropsychological assessments and an overnight in‐clinic polysomnography. Associations between polysomnography results and cognitive performance were evaluated using partial correlations controlling for age and education. Results: Twenty participants (mean age 69±8; 25% female) without dementia and with a diagnosis of early‐stage PD (Hoehn and Yahr stage 1‐2) were enrolled (Table 1). Table 2 displays the associations between polysomnography results and cognitive assessments. Greater percentage time in stage N1 sleep and increased duration of wakefulness time after sleep onset (WASO) were associated with poorer phonemic fluency (r = ‐0.626, p =.005 and r = ‐0.512, p =.030, respectively); whereas increased time spent in stage N2 sleep and higher sleep efficiency index were correlated with better phonemic fluency (r = 0.829, p <.001 and r = 0.513, p =.029, respectively). Greater percentage in stage N2 was associated with better verbal learning (Hopkins Verbal Learning Test–Revised (HVLT‐R) Immediate Recall, r = 0.521, p =.027). Higher percent time in REM sleep was correlated with increased basic attention (Digit Span Forward, r = 0.483, p =.042). No associations were found between total sleep time and cognitive performance. Conclusion: While total sleep time was not associated with cognition, higher percent time spent in Stage N2, Stage N3, and REM sleep were associated with better cognitive performance. In contrast, higher percentage of Stage N1 sleep and increased duration of WASO were associated with poorer verbal fluency. The preliminary results highlight the importance of increased time in deeper stages of sleep for cognition in adults with early‐stage PD. Future longitudinal studies will be necessary to evaluate long‐term cognitive trajectories and transition to dementia in association with diminished sleep quality in Parkinson's disease. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) is a neurodegenerative disorder affecting 1% of the global population. While the core clinical symptoms of PD are bradykinesia, rigidity, and tremor, it is also often accompanied by non‐motor symptoms that reduce quality of life and increase health care costs. Of the non‐motor symptoms in PD, hyposmia is one of the most prevalent and often precedes clinical diagnosis by several years. In addition, hyposmia has been associated with accelerated disease progression. As individuals with PD are at elevated risk for dementia, the goal of this pilot study was to objectively evaluate the association between smell sensitivity and cognition in early‐stage PD. Method: Participants with a clinical diagnosis of PD completed cognitive assessments of verbal and visual learning and memory, processing speed, attention, and executive function. Smell sensitivity was assessed using the University of Pennsylvania Smell Identification Test (UPSIT). Associations between cognitive performance and smell sensitivity were evaluated using partial correlations adjusting for age and education. Result: Nineteen participants (mean age 69.4+7.9, 25% female) with early‐stage Parkinson's disease (Hoehn and Yahr stage 1‐2) and free of dementia completed the UPSIT and cognitive assessments (see table 1 for sample characteristics). The average UPSIT score was 5.84+2.12 points and ranged from 2 to 10. Diminished olfactory sensitivity, assessed by the total correct score on the UPSIT, was associated with poorer visual learning (Brief Visual Memory Test Revised (BVMT‐R) immediate recall: r = 0.564, p = 0.18, Figure 1) and memory (BVMT‐R delayed recall: r = 0.610, p = 0.009, Figure 2). Conclusion: In the early‐stages of PD, diminished smell sensitivity was associated with poorer visual learning and memory, domains preferentially affected by the disease. The findings suggest that olfactory dysfunction may be a biomarker of cognitive decline. Larger, longitudinal studies will be important for evaluating the utility of olfactory function as a predictor of dementia risk in PD. [ABSTRACT FROM AUTHOR]

Objective: To demonstrate the effectiveness of the Extension for Community Healthcare Outcomes (Project ECHO) in educating primary care clinicians (PCCs) to provide best practice rheumatic care to patients in under-resourced communities in New Mexico.Methods: Attendee data for weekly teleECHO sessions, lectures, grand rounds, and mini-residency trainings were evaluated from June 2006 to June 2014. Participant feedback was evaluated from January 2009 to December 2014, when the program was approved for continuing medical education (CME) credits. Retrospective review of diagnoses associated with case presentations was conducted from June 2006 to June 2014 to evaluate the types of cases presented. A focus group was conducted with a convenience sample of 8 New Mexico PCCs who participated in ECHO Rheumatology (ECHO Rheum) for 1 year or longer.Results: Over the course of 9 years, ECHO Rheum educated 2,230 clinicians, consisting primarily of physicians (53%) and nurse practitioners (22%). A total of 1,958 CME credits were awarded to those who participated. There were 1,173 cases presented; 85% of the cases reflected the 3 most common diagnoses: rheumatoid arthritis (n = 715), fibromyalgia (n = 241), and systemic lupus erythematosus (n = 54). In addition, ECHO Rheum conducted 15 two-day mini-residencies involving 30 PCCs; 21 of these clinicians subsequently completed the American College of Rheumatology online certification.Conclusion: Results from this study demonstrate that participation in ECHO Rheum provides clinicians in under-resourced areas access to best-practice knowledge and training in rheumatology. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate a new prenatal education program evaluation tool, the UpStart Parent Survey – Prenatal, in terms of: (a) reliability and validity; (b) sensitivity to change over time; (c) whether results differed for mothers versus fathers; and (d) whether results differed when using an electronic tablet‐computer versus a paper survey. Design and Sample: Psychometric study. Participants were 277 expectant mothers (n = 161) and fathers (n = 106) enrolled in Childbirth Essentials, a 6‐week prenatal education program. Measures: The UpStart Parent Survey – Prenatal is a retrospective pretest/posttest survey with three scales: Parenting Knowledge, Parenting Experience, and Program Satisfaction, and three open‐ended questions. Results: The UpStart Parent Survey – Prenatal is sensitive to change and demonstrated significant positive differences in parenting knowledge and parenting experience. There was no difference in results whether the survey was completed by mothers or fathers. Results were similar whether paper or electronic formats were used. The survey was easy to complete. Conclusion: The UpStart Parent Survey – Prenatal holds promise as a reliable and valid evaluation tool to capture outcomes of brief prenatal education programs that target the general population of expectant parents. [ABSTRACT FROM AUTHOR]

Type I interferon (IFN-α/β) plays a critical role in suppressing viral replication by driving the transcription of hundreds of interferon-sensitive genes (ISGs). While many ISGs are transcriptionally activated by the ISGF3 complex, the significance of other signaling intermediates in IFN-α/β-mediated gene regulation remains elusive, particularly in rare cases of gene silencing. In human Th2 cells, IFN-α/β signaling suppressed IL5 and IL13 mRNA expression during recall responses to T-cell receptor (TCR) activation. This suppression occurred through a rapid reduction in the rate of nascent transcription, independent of de novo expression of ISGs. Further, IFN-α/β-mediated STAT4 activation was required for repressing the human IL5 gene, and disrupting STAT4 dimerization reversed this effect. This is the first demonstration of STAT4 acting as a transcriptional repressor in response to IFN-α/β signaling and highlights the unique activity of this cytokine to acutely block the expression of an inflammatory cytokine in human T cells. [ABSTRACT FROM AUTHOR]

A case study of a 44 year old group woman, whose 32 weeks' gestation underwent emergent cesarean section delivery of a 1.57-kg singleton male infant due to chorioamnionitis and breech presentation, is presented.